The relationship between healthy and positive aging and dementia and cognitive impairment has received limited attention in the field of aging. Affect impacts cognitive changes and processes, and ...cognitive impairment is associated with affective comorbidities. The purpose of the study was to examine (a) whether happiness, helplessness, and hopelessness are linked to cognitive health status, and (b) whether these associations differ by race.
Participants were enrollees in the Wisconsin Alzheimer's Disease Research Center's Clinical Core (ADRC). Average age at baseline was 60.85 (
= 8.65), 73.70 (
= 8.02), and 73.80 (
= 9.59) years for cognitively normal individuals, individuals with MCI, and individuals with dementia, respectively.
In the full sample, chi-square test results revealed associations between Cognitive Health Status (CHS) and (a) happiness, χ
(2) = 6.06,
< 0.05, (b) helplessness, χ
(2) = 6.44,
< 0.05, and (c) hopelessness, χ
(2) = 14.11,
< 0.01.
This study provides support for the association of both positive and negative affect with cognitive health status in middle- to older-aged adults.
Background
The NIH Toolbox was designed to provide brief, reliable, and valid measures of neurological and behavioral functions. Emotion assessment using the NIH Toolbox Emotion Battery has recently ...received significant attention given emerging evidence that emotional health is predictive of physical health and overall well‐being. The purpose of this study is to examine whether the modified emotion toolbox model is associated with cognition in sample of cognitively healthy adults.
Method
Participants were 529 enrollees in the Wisconsin ADRC who had normal cognition. The majority of participants were female (65.8%) and White (78.3%). Average age was 63.69 (SD = 8.37). NIH Toolbox Emotion Battery factors and a measure of executive function, Trail Making Test (TMT) Parts A & B were examined using SEM. To evaluate the overall goodness‐of‐fit, we used the following criteria: χ2 nonsignificant, χ2/df between1‐3, comparative fit index (CFI)>0.95, Tucker–Lewis index (TLI)>0.95, standardized root mean square residual (SRMR)<0.05, and the root mean square error of approximation (RMSEA)<0.08.
Result
The initial SEM results indicated a non‐acceptable fit for the data: χ2(51,N = 529) = 275.99, p<.01 (should be not significant), χ2/df = 5.41 (<3), CFI = 0.92(>.95), TLI = 0.90 (>.95), SRMR = 0.05, and RMSEA = 0.09 (<.08), 90% confidence interval (CI) = 0.08, 0.10 based on previously reported goodness‐of‐fit criteria. Based on modification indices, conceptually and statistically meaningful correlated error terms were added to the model (e,g., proximity between emotional support and friendship; emotional support and instrumental support; stress and sadness). After correlating some error terms based on theoretical background and modification indices, the modified SEM results indicated an acceptable fit for the data: χ2/df = 2.52 (<3), CFI = 0.98, TLI = 0.97, SRMR = 0.03 and RMSEA = 0.05, 90% confidence interval (CI) = 0.04,0.06.
Conclusion
Our modified model using the NIH Toolbox Emotion Battery had an acceptable fit for the data in a cognitively healthy cohort. Although we did not include all emotion toolbox variables, our modified model still had a great fit to the data. We specifically found that positive emotions including social satisfaction measures were correlated with cognition. We did not find any correlation between negative affect and cognition, which could be due to limited sample size. Measuring and identifying positive and negative emotions are important in clinical and research practice.
Background
Data suggest that establishing trust supports willingness to participate in research studies; yet there is a shortage of standardized systematic studies testing the effectiveness of ...various methods of building trust. The Building Bridges pilot study examined ways of establishing trust in communities of color comparing two different interventions.
Method
Using African American community leaders’ input, we conducted a mixed method study to investigate participants’ 1) preferred format for community‐based interventions, 2) comfort with discussing dementia with researchers/healthcare providers, and 3) attitudes of trust about research and researchers. African American subjects (age ≥ 45 years) without self‐reported cognitive impairment completed research attitudes (RAQ) and trust in medical researcher questionnaires, pre‐ and post‐intervention; individual medication reviews (n = 48) and/or public community talks (n = 49). Quantitatively, we compared pre‐ and post‐ intervention outcomes with paired Wilcoxon non‐parametric sign rank tests; all qualitative themes were analyzed using Nvivo QSR 12.
Result
Participants’ mean age was 64 (SD = 9.9). See Table 1 for demographics. Quantitatively, there was greater change in research attitudes and trust following a medication review intervention compared to experiencing a community talk (Figure 1); e.g., participants expressed “positive views about medical research in general” on questionnaires following medication reviews (p = 0.007). Qualitatively, we found a similar trend during our focus group discussions. Focus group members expressed more comfort with the medication review than the community talk resulting from “positive bedside manners, positive feedback, personal 1‐on‐1 interactions and race concordance.” Focus group participants noted a willingness to participate in future studies because of trust built from their Building Bridges team interactions. “Commonality, better connection, relatability, affinity and cultural similarities” all influenced trust and willingness to participate in future studies. Factors found to reduce trust included: “negative feedback, stereotypes, predominantly white practitioners in medicine and research, clinician unskillfulness, and not feeling seen as a “whole person” by providers” (Figure 2).
Conclusion
Findings continue to support our hypothesis that more personalized community engagement approaches have a greater influence on participants’ research attitudes and build interest in research. Additional studies of person‐centered recruitment strategies are essential to understanding how to improve trust and positive research attitudes among communities of color.
Background
Several studies have shown the importance of establishing trust in supporting an individual’s willingness to participate in research; yet evidence is limited regarding systematic studies ...testing the effectiveness of various methods used to build trust. Our pilot study examined two methods of building trust in communities of color by measuring willingness to participate in research pre‐ and post‐intervention. We hypothesized that a more personalized intervention would be more effective than a non‐personalized one in changing attitudes about research participation.
Methods
97 non‐randomized African American participants, without self‐reported cognitive impairment, completed the research attitudes questionnaire (RAQ) before and after participating in two different community engagement (CE) activities: 1) personalized medication review (MR), n = 48; and/or 2) a less personalized public community talk (Talk), n = 49. Numeric comparisons were conducted using student t‐tests. We used chi‐square and Fisher’s exact test for categorical comparisons. Pre‐ and post‐Talk and MR outcomes were tested for significant changes using the paired Wilcoxon non‐parametric sign rank test.
Results
In this predominantly female sample (80% female), mean age was 64 (standard deviation = 9.9). Study participant characteristics provided in Table 1. There were no significant differences in RAQ or trust questions in the pre‐ and post‐Talk session. However, during the MR session, significant changes were seen on the question “I have a positive view about medical research in general” (P = 0.007). During the pre‐MR, 16.7% strongly agreed with this statement, while 39.6% strongly agreed at the post‐MR. Similarly, agreement with the statements “Medical researchers treat people from my racial group as guinea pigs” (p = 0.004) and “Medical researchers work hard to keep participants’ information private and secure” (P = 0.01) were also significantly different following the intervention (see Figure 5).
Conclusions
These findings support our hypothesis that a more personalized community engagement approach would have a greater influence on participant’s research attitudes. Compared to individuals with ≤ 1 co‐morbidities at baseline, those with ≥2 co‐morbidities had positive responses prior to an intervention and felt less responsibility to volunteer post med review. Additional studies are needed to further investigate these findings and the role of trust in association with research attitudes.
Abstract
Background
Mild cognitive impairment (MCI) and dementia are among the most disabling conditions. Patients with MCI and dementia may experience difficulties in executing instrumental ...activities of daily living (IADL), resulting in distress for patients and families. Measuring and understanding abilities to execute IADL is important to understand how MCI and dementia impacts patients’ functioning. We explored the factor structure of the Functional Activities Questionnaire as a measure of functional disability in a sample with MCI and dementia.
Methods
Participants were 198 enrollees in the Wisconsin ADRC who had MCI, and dementia. Not applicable responses were counted as missing data, resulting in 98 participants in main analyses. The majority of participants were male (61.1%) and Caucasian (88.4%). Average age at baseline was 73.76 (
SD
=8.90). We conducted the following analysis: exploratory factor analysis (EFA), reliability analysis, correlation analysis, and Mann‐Whitney U test.
Results
The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was .89, and the Barlett’s test of sphericity was significant,
χ
2
(45,
N
=98)=717.24,
p
<.001, indicating suitability for factor analysis. Kaiser–Guttman’s criterion and Cattell’s scree test both indicated a single‐factor measurement structure, accounting for 64% of the total variance. The Cronbach’s alpha was found to be .94 for the FAQ. Functional disability was positively correlated with neuropsychiatric symptoms (r=.43,
p
<.001), CDR global score (r=.79,
p
<.001), and lack of independence (r=.66,
p
<.001). A Mann‐Whitney U test showed that individuals with dementia had significantly higher levels of functional disability than those with MCI (U=214.00,
p
<.001).
Conclusion
The FAQ was found to be a unidimensional, reliable, and valid measure of functional disability. Participants with higher scores on the FAQ endorsed greater levels of neuropsychiatric symptoms, symptoms of cognitive impairment, and dependence to others. As expected, those with dementia had higher levels of functional disability/limitations. Future research may examine whether functional disability/limitations predicts incident MCI or dementia in cognitively normal individuals.
Abstract
Background
Cognitive impairments are linked to changes in positive and negative affect. However, it remains unclear whether some dimensions of positive and negative affect are associated ...with cognitive health status (CHS) and the relationships between pillars of positive and negative affects and CHS function similarly across racial groups. In this study, we tested whether (a) happiness, helplessness, and hopelessness are linked to CHS and (b) if these relationships are similar among blacks and whites.
Methods
Participants were 755 enrollees in the Wisconsin ADRC who had normal cognition, MCI, and dementia at baseline. The majority of participants were female (59.2%) and Caucasian (81.5%). The average age at baseline was 64.23 (
SD
=10.40).CHS was categorized as cognitively normal, mild cognitive impairment, and dementia. Happiness, helplessness, and hopelessness were measures with three items from the 15‐item
Geriatric Depression Scale
. For question (a), all races were included in the analyses. For question (b), blacks and whites are subgrouped and all other races were excluded. Chi‐square or Fisher’s Exact tests were conducted to test our research hypotheses.
Results
Chi‐square test results revealed that (a) an association between happiness and CHS,
χ
2
(2)=6.06,
p
<.05, (b) an association between helplessness and CHS,
χ
2
(2)=6.44,
p
<.05, and (c) an association between hopelessness and CHS,
χ
2
(2)=14.11,
p
<.01. The association of happiness with CHS remained significant in blacks (Fisher’s exact=.03), but not in whites,
χ
2
(2)=1.04,
p
=.59. The association of helplessness with CHS was not significant for blacks (Fisher’s exact = 1.00), but was significant for whites,
χ
2
(2)=8.47,
p
< .05. Finally, the relationship between hopelessness and CHS was not associated in blacks (Fisher’s exact=.19), but was in whites,
χ
2
(2)=16.31,
p
<.01.
Conclusion
Race differences in the association of CHS and happiness, helplessness, and hopelessness were found. For blacks, only happiness was significantly associated with CHS, whereas, for whites, CHS was associated with helplessness and hopelessness, but not with happiness. These findings can inform the development of culturally‐tailored interventions to prevent cognitive decline for specific races.
Background
Mild cognitive impairment (MCI) and dementia are among the most disabling conditions. Patients with MCI and dementia may experience difficulties in executing instrumental activities of ...daily living (IADL), resulting in distress for patients and families. Measuring and understanding abilities to execute IADL is important to understand how MCI and dementia impacts patients’ functioning. We explored the factor structure of the Functional Activities Questionnaire as a measure of functional disability in a sample with MCI and dementia.
Methods
Participants were 198 enrollees in the Wisconsin ADRC who had MCI, and dementia. Not applicable responses were counted as missing data, resulting in 98 participants in main analyses. The majority of participants were male (61.1%) and Caucasian (88.4%). Average age at baseline was 73.76 (SD=8.90). We conducted the following analysis: exploratory factor analysis (EFA), reliability analysis, correlation analysis, and Mann‐Whitney U test.
Results
The Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was .89, and the Barlett’s test of sphericity was significant, χ
2(45,N=98)=717.24, p<.001, indicating suitability for factor analysis. Kaiser–Guttman’s criterion and Cattell’s scree test both indicated a single‐factor measurement structure, accounting for 64% of the total variance. The Cronbach’s alpha was found to be .94 for the FAQ. Functional disability was positively correlated with neuropsychiatric symptoms (r=.43, p<.001), CDR global score (r=.79, p<.001), and lack of independence (r=.66, p<.001). A Mann‐Whitney U test showed that individuals with dementia had significantly higher levels of functional disability than those with MCI (U=214.00, p<.001).
Conclusion
The FAQ was found to be a unidimensional, reliable, and valid measure of functional disability. Participants with higher scores on the FAQ endorsed greater levels of neuropsychiatric symptoms, symptoms of cognitive impairment, and dependence to others. As expected, those with dementia had higher levels of functional disability/limitations. Future research may examine whether functional disability/limitations predicts incident MCI or dementia in cognitively normal individuals.
Background
Cognitive impairments are linked to changes in positive and negative affect. However, it remains unclear whether some dimensions of positive and negative affect are associated with ...cognitive health status (CHS) and the relationships between pillars of positive and negative affects and CHS function similarly across racial groups. In this study, we tested whether (a) happiness, helplessness, and hopelessness are linked to CHS and (b) if these relationships are similar among blacks and whites.
Methods
Participants were 755 enrollees in the Wisconsin ADRC who had normal cognition, MCI, and dementia at baseline. The majority of participants were female (59.2%) and Caucasian (81.5%). The average age at baseline was 64.23 (SD=10.40).CHS was categorized as cognitively normal, mild cognitive impairment, and dementia. Happiness, helplessness, and hopelessness were measures with three items from the 15‐item Geriatric Depression Scale. For question (a), all races were included in the analyses. For question (b), blacks and whites are subgrouped and all other races were excluded. Chi‐square or Fisher’s Exact tests were conducted to test our research hypotheses.
Results
Chi‐square test results revealed that (a) an association between happiness and CHS, χ
2(2)=6.06, p<.05, (b) an association between helplessness and CHS, χ
2(2)=6.44, p<.05, and (c) an association between hopelessness and CHS, χ
2(2)=14.11,p<.01. The association of happiness with CHS remained significant in blacks (Fisher’s exact=.03), but not in whites, χ
2(2)=1.04, p=.59. The association of helplessness with CHS was not significant for blacks (Fisher’s exact = 1.00), but was significant for whites, χ
2(2)=8.47,p< .05. Finally, the relationship between hopelessness and CHS was not associated in blacks (Fisher’s exact=.19), but was in whites, χ
2(2)=16.31,p<.01.
Conclusion
Race differences in the association of CHS and happiness, helplessness, and hopelessness were found. For blacks, only happiness was significantly associated with CHS, whereas, for whites, CHS was associated with helplessness and hopelessness, but not with happiness. These findings can inform the development of culturally‐tailored interventions to prevent cognitive decline for specific races.
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