Associations between life‐course cognitive reserve and cognitive domains over 8 years in a large cohort of middle‐aged and older adults: The Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil)

Abstract INTRODUCTION Cognitive reserve (CR) arises from cognitively enriching experiences over time and may buffer against cognitive decline. However, the mechanisms underlying CR in low‐ and middle‐income countries (LMICs) remain underexplored. This study investigated the latent structure of CR using socioeconomic and occupational indicators, and evaluated whether CR categories are associated with cognitive trajectories over 8 years. METHODS In the ELSA‐Brasil study, we derived a CR construct via principal component analysis from five indicators: education, occupational social class, occupational nature, technological stratum of work, and leisure‐time physical activity. Memory, verbal fluency, and executive functioning were assessed at three waves; longitudinal trajectories were analyzed using mixed‐models. RESULTS Participants with higher CR exhibited significantly slower age‐related cognitive decline across multiple domains, after controlling for demographic and health covariates. DISCUSSION In a middle‐income country with strong socioeconomic inequalities, early‐life socioeconomic conditions were key determinants of CR development, contributing to disparities in late‐life cognitive aging.

Classifying cognitive status with TabCAT Match and UDS executive function tests

Abstract INTRODUCTION Tablet‐based Cognitive Assessment Tool (TabCAT) Match, a digital neuropsychological test, was compared to measures of executive function from the National Alzheimer's Coordinating Center's Uniform Dataset (UDS). METHODS TabCAT Match data were available for 1792 clinically diverse older adults. Receiver operating characteristic curves and analyses of covariance examined classification of Clinical Dementia Rating Scale (CDR) stages based on Match and UDS executive function scores. Sensitivity analyses were conducted across education level and testing language groups. RESULTS All measures had utility in differentiating CDR stages, with Match displaying the highest classification accuracy (AUC = 0.862) for cognitively unimpaired (CDR 0, clinically normal) versus cognitively impaired (CDR ≥ 0.5, mild cognitive impairment/dementia). The advantages of Match were especially apparent in non‐English tested groups relative to UDS tests. DISCUSSION The identification of efficient neuropsychological measures, such as TabCAT Match, that are easily administered, sensitive to impairment, and appropriate across demographic groups is critical for optimizing diagnosis and clinical monitoring.

Harnessing the Neurobiology of Empathy and Compassion to Alleviate Burnout in Neurology

Neurologists regularly care for patients with complex, chronic, and often incurable conditions. These circumstances impose profound emotional burdens on the patient and physician. Whereas empathy is central to therapeutic effectiveness in clinical practice, sustained empathic engagement can contribute to emotional exhaustion and physician burnout, a condition now endemic in neurology. This review synthesizes insights from neuroscience, psychology, and clinical education to propose “skillful empathy” as a trainable capacity that integrates affective resonance with cognitive perspective‐taking. We describe how emotional contagion harms clinician well‐being and advocate for the integration of empathy training into medical education to support sustainable, compassionate neurological care. ANN NEUROL 2026;99:35–48

Additive Effects of White Matter Hyperintensity and APOE ε4 Status on Risk of Incident Dementia in Two Large Longitudinal Cohorts

Objective To evaluate whether white matter hyperintensities (WMH) and apolipoprotein E ( APOE) ε4 status have an additive or multiplicative effect on the risk of incident all‐cause dementia. Methods We conducted a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study and confirmed findings in the UK Biobank (UKB). The exposures were APOE ε4 status (0 vs. ≥1 allele) and WMH on magnetic resonance imaging (MRI). The primary outcome was incident all‐cause dementia. After confirming an additive interaction, we created combined exposure groups: WMH−/ε4−, WMH+/ε4−, WMH−/ε4+, and WMH+/ε4+. Cox proportional hazards models were adjusted for age, sex, race, education, cognition (ARIC only), hypertension, diabetes, and prior stroke. Results In ARIC (n = 1,736, mean age 63, 58.8% female, 48.7% non‐Hispanic White individuals, median follow‐up 18.6 years), the dementia incidence rate was 10.4 (95% CI, 9.2–11.6) per 1,000 person‐years. Compared to WMH−/ε4–, adjusted hazard ratios (HRs) for dementia were: WMH− / ε4+, 1.5 (95% CI, 1.1–2.1); WMH+/ε4–, 2.0 (95% CI, 1.4–2.7); and WMH+ / ε4 + , 3.2 (95% CI, 2.2–4.6). In UKB (n = 40,307, mean age 55, 52.7% female, 97.1% non‐Hispanic White individuals, median follow‐up 3.2 years), the dementia incidence rate was 0.42 (95% CI, 0.32–0.55) per 1,000 person‐years. Adjusted HRs were: WMH− / ε4+, 2.3 (95% CI, 1.2–4.5); WMH+/ε4–, 2.1 (95% CI, 1.0–4.6); and WMH+ / ε4 + , 6.7 (95% CI, 3.2–13.9). Interpretation WMH burden and APOE ε4 status additively increase dementia risk. These findings support the potential benefit of vascular risk management to reduce WMH and delay dementia onset, even among genetically at‐risk individuals. ANN NEUROL 2026;99:656–667

Not Trauma Alone: Story, Justice and the Ethics of Naming

ABSTRACT This paper explores the ethical and political implications of trauma becoming the dominant frame in professional and cultural discourse. Although the term trauma has gained widespread use in clinical practice, education and public life, we argue that it risks flattening lived experience, relocating harm inside individuals and obscuring acts of violence, responsibility and resistance. Through a dialogical form, we examine what is lost when trauma replaces more specific words, such as rape, racism or violence and consider what alternative frames—story‐informed, justice‐informed and solidarity‐based—might make possible. Drawing on the work of Michael White, Kathie Crocket, David Newman, Angel Yuen, Vikki Reynolds, Alan Jenkins, Alan Wade, Jenny Snowdon, Loretta Pederson and others, we weave Jacques Derrida's concept of deconstruction with narrative practices, such as double listening, response‐based enquiry and documenting small pieces of justice. We argue that words are never neutral: they perform, they shape how responsibility is named and what accountability may come to require, and they influence who is seen or silenced. Our purpose was not to offer closure, but to open commitments and questions. We invite practitioners to resist the reduction of lives into trauma, to centre people's responses, values and acts of living, and to come alongside those whose stories call for clarity, dignity and justice.

Identifying Top Research Priorities in Perioperative Nursing: An eDelphi Study of AORN Guideline Gaps

ABSTRACT AORN published an extensive list of research priorities (2023–2028), spanning 34 guidelines and more than 400 subtopics, posing a challenge for focused research. To address this “choice overload” and guide future efforts, we followed Guidance on Conducting and Reporting Delphi Studies reporting guidelines and conducted an eDelphi study with a panel of perioperative nurse experts. Through five iterative rounds, including surveys and a concluding virtual focus group, panelists achieved consensus on the most essential research needs. The study successfully identified the top five AORN guideline research gaps: unintentionally retained surgical items, positioning, sterile technique, safe patient handling, and hypothermia. These priorities, often linked to sentinel events and evolving technology, provide a crucial, focused roadmap for perioperative nursing practice, research, and education. This eDelphi method offers a replicable framework for translating broad research needs into actionable, impactful priorities, ultimately enhancing patient safety and quality of care.

Integrating a Dedicated Neuroprotector Role Through Interprofessional Education to Support Extremely Preterm and Extremely Low Birth Weight Infants During Golden Hour

ABSTRACT Extremely preterm and extremely low birth weight infants are vulnerable to brain injury due to physiological immaturity and environmental stressors during the critical first hour after birth, known as the “Golden Hour.” A multiphase, interprofessional education and in situ simulation program was designed to introduce a dedicated neuroprotector role to mitigate noxious stimuli and prioritize neuroprotective strategies during resuscitation and stabilization of vulnerable infants. Grounded in adult learning theory, this educational program prepared existing staff members for this role through presimulation education and in situ simulation in perioperative settings. Outcomes after the education program included improved interprofessional team collaboration and prioritized integration of the neuroprotector role. Through education and simulation, implementation of role‐specific interventions closed a key care gap and advanced alignment with evidence‐based practices, enhancing both immediate and long‐term neurodevelopmental outcomes for extremely preterm and extremely low birth weight infants.

Interprofessional Simulations and Drills: Powerful Approaches to Education and Training

Associations of Specific Pesticides and Incident Rheumatoid Arthritis Among Female Spouses in the Agricultural Health Study

Objectives Growing evidence suggests farming and agricultural pesticide use may be associated with rheumatoid arthritis (RA), but few studies have examined specific pesticides and RA among women living on farms, who may personally use pesticides or may be indirectly exposed. We investigated pesticide use and RA risk among female spouses of licensed pesticide applicators in the Agricultural Health Study. Methods Participants were enrolled in 1993 to 1997 in North Carolina and Iowa (N = 32,126). Incident RA cases were identified in follow‐up questionnaires (1999–2021) and confirmed by medical records, relevant medication use, or Medicare claims data (1999–2016) or identified from Medicare claims if lacking questionnaire data on RA. Noncases reported no RA and had no RA Medicare claims. Among those with complete covariate data (N = 410 cases and 21,850 noncases), we examined associations with pesticide classes and 32 specific pesticides (personal lifetime use reported at enrollment, updated in 1999–2003). We calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, state, education, smoking pack‐years smoking, body mass index, and correlated pesticides (ρ > 0.35). Results Incident RA was associated with use of organochlorine (DDT: OR 1.89, 95% CI 1.30–2.75; lindane: OR 1.97, 95% CI 1.12–3.47) and organophosphate insecticides (coumaphos: OR 2.32, 95% CI 1.29–4.19; malathion: OR 1.21, 95% CI 0.91–1.62), the carbamate insecticide carbofuran (OR 1.87, 95% CI 0.97–3.63), and permethrin and pyrethroid insecticides on crops (OR 1.56, 95% CI 0.92–2.64) and livestock (OR 1.69, 95% CI 1.07–2.68). RA was not associated with using herbicides, except for metribuzin (OR 1.88, 95% CI 0.94–3.79). The fungicides captan (OR 1.78, 95% CI 1.13–2.83) and metalaxyl (OR 2.49, 95% CI 1.41–4.40) were also associated with RA. Conclusion These findings indicate that persistent organochlorine insecticides and some pesticides also used in public health or residential settings may increase RA risk in women.

Medical students' initial experiences of the dissection room and interaction with body donors: A qualitative study of professional identity formation, educational benefits, and the experience of Pasifika students

Abstract The first experience of medical students in the dissecting room (DR) likely influences professional identity formation (PIF). Sparse data exist exploring how exposure to the DR and body donors without undertaking dissection influences PIF, or how culture may influence this experience. This qualitative study explored students' first, non‐dissection DR experience to determine how this contributes to PIF, including the impact of culture through a Pasifika‐student lens. It also explored student perspectives on what learning opportunities are unique to this experience. Medical students with no prior DR experience were recruited and then interviewed after initial engagement with the DR and body donors. Questions included participant experiences, cultural perspectives, and how the DR differed from other teaching experiences. Interviews were recorded, transcribed, and analyzed thematically. Twenty students were interviewed (mean age 22 years, 12 females; 8 Pasifika) resulting in 520 min of audio recording (mean 26 min). Four primary themes were identified: professional identity formation, educational elements, death and spirituality, and cultural perspectives. Three subthemes including student experiences, behaviors, and environment were developed within each theme. Findings indicate development of PIF likely occurs from a single engagement with body donors without undertaking dissection, including recognition of professional role. Culture can play an important role for students, with several Pasifika students viewing the DR as a “cultural purgatory”. Unique learning experiences are identified, such as cultural awareness around behaviors with the dead. The experience is an educational “threshold concept” where students likely undergo substantial developments in PIF, and educational initiatives to support students are outlined.