Journals
2025 EN
Mallon April · Lim Mei Ling · Jarrott Shan
+10 more
Abstract Background Recent evidence identifies that Positive Mental Health (PMH) factors such as purpose in life, life satisfaction, and emotional well‐being, may protect against cognitive decline and dementia. Interventions aiming to enhance PMH (“Positive Psychological Interventions”) have also been shown to improve engagement in behaviours protective for brain‐health such as good nutrition, smoking cessation, and adherence to hypertension treatment. These positive‐psychological interventions (PPIs) – often involving skills such as gratitude, mindfulness, and cognitive restructuring –may be a valuable addition to multi‐domain interventions for dementia prevention by bolstering effectiveness and promoting sustained change. However, while evidence suggests the benefits of PPIs for risk factor modification, it remains unclear whether this will improve cognitive outcomes. Therefore, GenWell‐BRAVE aims to (1) evaluate the feasibility of prescribing PPI within a multi‐domain intergenerational program and (2) estimate relative program efficacy for improving dementia risk profiles of older adults compared to an intergenerational program without PPI. Method GenWell‐BRAVE is a sub‐study of The INTEGRITY Trial (ACTRN12623000127606) and delivers multi‐domain intervention in an intergenerational environment. The pilot will recruit 40 community‐dwelling adults aged 65+, with no cognitive impairment, and 40 pre‐school children aged 3‐6. Four preschools will be cluster‐randomised into two arms. The intervention arm will receive the GenWell‐BRAVE program, involving physical, social, and cognitive activities whilst building PMH skills through PPI. Participants will receive the GenWell‐Brave program at the preschool for 20 weeks, for 2 hours each week. The active control arm will receive a comparable program without PPI. Pre‐post questionnaires (at baseline and end of program), qualitative interviews, and systematic behavioural observations will be used to evaluate the program. Result The primary outcome is comparison, between the trial arms, of change in cognitive score (NIH Toolbox Cognition Battery). Additional outcomes include change in PMH (MHC‐SF), dementia risk score (LIBRA‐2), and emotional regulation (DERS‐SF). Feasibility will be evaluated through measures of adherence, retention, implementation fidelity, and acceptability (TFA‐Q). Conclusion We anticipate GenWell‐BRAVE will show adequate feasibility. We expect to establish the value of PPI in multi‐domain intervention, through providing preliminary evidence that a program which co‐intervenes on PPI has superior effectiveness in maintaining cognition.
Journals
2025 EN
Manhester Margaret · Arias Jalayne J. · Helmly Victoria
+3 more
Abstract Background Quality of memory care varies across states and can affect health and quality of life outcomes for persons living with dementia (PLWD) within assisted living facilities (ALFs). This study evaluates regulations of memory care units in ALFs across six selected states as potential drivers of health and quality of life outcomes reported within the National Post‐acute and Long‐term Care Study (NPALS). Methods Empirical legal methods were used to map state regulations that guide training standards, staff ratios, and direct care staff time spent with residents. Comparative analysis was used to understand relationships between regulations and adverse events. Results Within the six‐state snapshot, significant variation of regulations may affect quality of care in memory care centers. Day‐shift direct care staff ratios varied significantly across states (e.g., California: 1:10, Virginia: 4:40; compared to Wisconsin requires only presence of 1 Direct Care Staff). Yet, in Wisconsin, residents must receive 3 hours of individual nursing care per week and average hours per day/resident is 6.1 hours ‐ highest of all six states. Comparatively, average hours per resident/day were lowest in New Mexico (4.7 hours) and falls below the national average (4.9). California also falls below the national average (3.9). States requirements in care and daily living activities were consistent with Alzheimer's Association Memory Care Recommendations, except for New Mexico. Although, states with training requirements that are consistent with the Alzheimer's Association recommendations may not follow all eight of the recommendations. For example, California state regulations meet 7 of 8 the Alzheimer's Association recommendations. The findings from this study indicate that inclusion of standardized memory care training and greater direct care time with residents in ALF policy may enhance care quality. Standardization and inclusion of memory care curriculum and greater direct care time with residents also may enhance care quality. Conclusion The results indicate that states with policy language that is more aligned with the Alzheimer's Association 2018 Dementia Care Recommendations may drive lower hospital visit rates, higher direct care staff time spent with residents, while staff ratio requirements may not. Aide and RN hours spent with residents may also influence the likelihood of resident ED visits.
Journals
2025 EN
Wang Yufei · Morgado Lillian · Scipion Catherine E. A.
+1 more
Abstract Background Evidence indicates education is a protective factor on cognitive function. The mechanisms through which education is protective are unknown. Prior research has indicated that lifestyle may play a factor in mitigation role education has in protecting against the risk of Alzheimer's Disease and cognitive impairment. Yet, evidence is scarce. This study aims to explore the potential mediating role of lifestyle factors on the education‐cognition relationship. Method Data were derived from Waves 8–13 of the Health and Retirement Study, including 1,752 Americans aged ≥50. Based on Wave 8 data, participants' education levels were categorized as “High school or less” or “College degree or above.” Cognitive function at Wave 13 was assessed using the Telephone Interview of Cognitive Status. Ten years of lifestyle behavior data, including smoking, alcohol consumption, BMI, and physical activity, were collected from Waves 8–13. We used mediation analyses to explore the direct and indirect effects of education on cognitive function in R Version 4.3.1. Result Moderate physical activity had the highest mediation effect [4.86%, 95%CI:(2.68%, 8.60%)], followed by light physical activity [2.88%, 95%CI: (1.16%, 6.11%)] and vigorous physical activity [1.97%, 95%CI: (0.67%, 4.20%). Other lifestyle variables had no significant mediation effect on the relationship between education and cognitive function. Conclusion Physical activity potentially mediates the education‐cognition relationship. In cognitive function research or intervention projects, the lifestyle of people having low education levels warrants further attention.
Journals
2025 EN
Khakali Linda Norah · Onchari Everline N · Ondire Maureen N
+3 more
Abstract Background The global elderly population is increasing and expected to double in the next decade. Aging increases the likelihood of adversities, with resilience becoming an important aspect of healthy aging. Understanding how individuals conceptualize resilience offers an opportunity to create contextually relevant interventions for promoting healthy aging. This study aimed to explore adults’ perspectives on factors influencing resilience in Kenya. Method Using qualitative methods, 36 adults aged 35 years and above were purposively recruited from various communities in Nairobi County to participate in interviews. We asked questions about their understanding of aging, adversity and resiliency. We also provided them with case scenarios of two individuals responding differently to the same adversity and asked them to discuss what influenced one to respond better when compared to the other. Interviews were audio‐recorded, transcribed verbatim and thematically analyzed. Result Participants understood resilience as the ability to bounce back after adversity. They highlighted that adversities could accelerate physical and cognitive aging, manifesting as signs of faster aging, increased risk of illnesses, cognitive decline, and other comorbidities of unhealthy aging. Reflecting on the cases, they narrated that resilience was promoted by internal factors (inner strength, mindset, routine practices, and attitude) and external factors such as social support from family and friends; psychological support including professional interventions and positive reinforcement from loved ones and medical interventions. Physical well‐being was also linked to health awareness and proactive activities. Internal factors were seen as adaptable and shaped by the individual's environment and experiences. Conclusion We argue that resilience, key to healthy aging, is shaped by both internal factors and external factors. These factors should be considered when designing interventions aimed to promote healthy aging in resource constrained settings.
Journals
2025 EN
Lim Mei Ling · Sparks Amy · Ee Nicole
+20 more
Abstract Background Programs which facilitate purposeful intergenerational interactions are promising risk‐reduction tools. They can combine strong social engagement alongside cognitive and physical activities targeting executive function, memory and processing speed, moderate intensity movement and balance, themed around key areas e.g. healthy diet to target risk‐reduction for dementia and frailty. However, implementing risk‐reduction opportunities can be challenging, and sustained benefit likely requires long‐term lifestyle change. Intergenerational‐practice represents a unique opportunity to deliver a community‐embedded social and multidomain approach with additional potential benefits for children. However, there is a lack of clinical trial data on effectiveness, particularly outside the United States Method The INTEGRITY trial is an on‐going cluster‐randomised wait‐list controlled trial in Sydney, Australia, measuring the impact of multidomain intergenerational‐practice sessions on reducing frailty in older adults. Secondary endpoints include cognition. The intervention consists of weekly 2‐hour sessions conducted in community‐based preschools and involving ∼10 older adults and ∼10 preschool children per site over a 20‐week program. The unit of randomization is the preschool. Outcome assessments for older adults include cognitive and physical ability, mood, quality of life, social connections, loneliness, sleep and the frailty index. Children are engaged from the local preschool and receive assessments on language and empathy. Process evaluation data to assess feasibility and engagement is also collected. The control group receive the same sessions after a 20‐week waitlist period has elapsed Result Recruitment and sessions are underway. Over 550 older adults have expressed interest with 317 progressing to screening. Screen success rates are 81.1%. A total of 237 older adults have been allocated to sites and 9 sites (out of a planned 44) have completed their sessions. Adult withdrawal rates are 25% overall and 13.7% for those who start attending sessions, primarily due to ill health (their own/their family). Child recruitment has been similarly successful. Anecdotal feedback from older adults, parents and preschool educators is highly positive, with several preschools requesting repeat sessions. Conclusion Preliminary findings suggest intergenerational‐practice is well received and a feasible way to deliver community‐based interventions. Further data will give insight into the potential cognitive, physical and social benefits for older adults and developmental benefits for children.
Journals
2025 EN
UdehMomoh Chinedu T · Shah Jasmit · Musili Litha
+14 more
Abstract Background Cardiometabolic risk factors (CMRFs), such as hypertension and diabetes, are modifiable contributors to dementia risk. However, these conditions are often underdiagnosed or undertreated, particularly in African populations. This study aimed to examine discrepancies between self‐reported and objectively measured CMRFs across multiple indigenous African and African diaspora cohorts, investigate sex‐specific patterns of underdiagnosis, and explore their implications for dementia risk and brain health equity. Methods Data were analyzed from three cohorts: (1) the African American (AA) and rural Nigerian Indianapolis‐Ibadan Dementia Study cohort ( n = 4,353; mean age 74 years; 66% female), (2) the East African (EA) AD‐Detect Kenya project ( n = 51; mean age 55 years; 51% female), and (3) the EA Brain Resilience Kenya (BRK) study ( n = 61; mean age 61 years; 61% female). Underdiagnosis was operationalized as self‐reported absence of hypertension or diabetes despite borderline‐to‐abnormal clinical biomarker status, using systolic blood pressure (SBP) and fasting blood glucose (FBG) levels. Sex‐specific and demographic‐related associations were assessed using logistic regression models. Results Underdiagnosis of key dementia‐related CMRFs (hypertension and diabetes) was widespread across all cohorts , indicating systemic challenges in early detection and management. Hypertension underdiagnosis was more prevalent in urban men from the East African (EA) and African American (AA) cohorts (OR: 2.74 [0.95–7.90] and 1.65 [1.39–1.95], respectively). Conversely, rural women from the Ibadan cohort had a higher likelihood of underdiagnosed hypertension. Diabetes underdiagnosis was more frequent among African American men (OR: 1.28 [0.98–1.69]), with similar trends observed in indigenous African men . Notable demographic and contextual variability were observed, with underdiagnosis patterns differing by sex, marital status, socio‐economic disparities and cognitive diagnosis . Conclusion The systematic underdiagnosis of CMRFs in African populations underscore critical disparities in dementia risk identification . These findings highlight the urgent need for culturally and contextually adapted, gender‐sensitive, and geographically tailored prevention strategies to improve early diagnosis and management of CMRFs. Addressing these gaps is essential for promoting global brain health equity , particularly for individuals of African ancestry. Future research to be presented will explore longitudinal associations between underdiagnosed CMRFs and cognitive decline as well as incident dementia, informing targeted interventions for dementia prevention.
Journals
2025 EN
Punyamurthula Sanjana · Stovall Mary Catherine · Stone Addison
+2 more
Abstract Background The MeDi emphasizes the consumption of foods high in fiber, nuts, and healthy fats such as olive oil. Its neuroprotective benefits are often attributed to its high antioxidant and polyphenol content. However, it remains unclear whether these components are solely responsible for the health benefits, or if other factors, such as practices and nutrient profiles present in diets beyond the Mediterranean region, also contribute. As the MeDi is one of the most physician‐recommended diets, it is crucial that these recommendations are mindful of cultural dietary patterns to encourage better adherence. Objective There is a growing body of evidence supporting the link between brain health and nutrition, suggesting that dietary interventions can help reduce the risk of Alzheimer's disease. However, nutritional recommendations must be accessible and adaptable to diverse populations. This literature review examines the origins of the MeDi and its cultural accessibility. We explore how MeDi‐based recommendations have been adapted for individuals with varying dietary patterns and the challenges associated with these adaptations. Method A literature review was conducted from October 2023 – September 2024 using the databases CINAHL, PubMed, and Web of Science. Examples of terms searched include “Mediterranean diet” AND (“cultural adaptation” OR “cultural sensitivity” OR “cultural diversity”), “Mediterranean diet” AND “patient education” OR “communication”. Results Current MeDi scoring tools emphasize foods common in Spain, Italy, and Greece, from where the diet originates, making them less applicable to the culinary traditions of the 19 remaining countries in the Mediterranean region. Including regional foods improves dietary assessment accuracy. Interventions that incorporate traditional recipes into dietary plans enhance satisfaction and compliance, further supporting the importance of culturally inclusive dietary approaches. When adapting the MeDi, recommendations should remain evidence‐based, particularly the inclusion of extra virgin olive oil and nuts. Conclusion We suggest using a more accurate term for the MeDi, as the nomenclature may inadvertently exclude regions within the Mediterranean not part of its original framework. These exclusions can create barriers to adherence. A broader framework is needed to account for a diverse population, ensuring that the neuroprotective benefits of the MeDi are accessible to individuals from all backgrounds.
Journals
2025 EN
Chiao Catherine · Mashinchi Genna M · Cieri Filippo
+1 more
Abstract Background Healthy lifestyle is linked with better brain health outcomes in aging and may reduce dementia risk. The Dynamic Neurocognitive Adaptation Scale (dNA) assesses level of lifespan engagement in physical, cognitive, creative, and social activity. This analysis examined relationship of lifetime activity with current memory scores in midlife women with a family history of Alzheimer's disease. We predicted that higher dNA scores would relate to better memory performance. Method Data were assessed for 47 women (mean age=51) who completed dNA and baseline cognitive testing. Bivariate Spearman correlation analyses examined the relationship between dNA scores (total, and sum for each domain and time window) and Rey Auditory Verbal Learning Test (RAVLT) delayed recall and Face Name Associative Memory Exam Test (FNAME) total recall scores. Exploratory analysis examined dNA relationships with Trails B, Boston Naming Test, Mini‐Mental State Examination and verbal fluency (FAS and Animals). Result DNA subdomains were intercorrelated (rs =.51‐73, ps< .001). Highest total mean activity (M = 51.27), as well as in domains of cognitive (M = 12.16), physical (M = 10.37), and creative activities (M = 18.49) was observed in adolescence, while social activity peaked in youth (M = 10.33). Greater total dNA social domain activity was correlated with poorer RAVLT delayed recall ( r = ‐.37, p = .01). There were no other significant correlations between memory scores and dNA total, domain, or time window scores. In exploratory analyses, better verbal fluency was correlated with higher total dNA ( r = .34, p = .02), and higher creative ( r = .36, p = .01), and physical domains ( r = .32, p = .03). Conclusion Findings demonstrate that in women at risk for Alzheimer's, engagement levels peak in adolescence and youth, and that domains of activity engagement are intercorrelated. Exploratory analysis showed positive correlations between dNA and verbal fluency, suggesting a link between cognitive flexibility and higher lifespan activity engagement. Moreover, reduced engagement in adulthood suggests women may be in need of lifestyle intervention at midlife. However, the single, negative correlation of dNA with delayed recall memory was unexpected. Lack of findings may be due to low power or may reflect our younger sample of cognitively healthy women.
Journals
2025 EN
LefèvreArbogast Sophie · Scala Pierre · Zorilla Aurore
+5 more
Abstract Background Persistent Organic Pollutants (POP), including polychlorinated biphenyls (PCB) and organochlorine pesticides (OCP), are established neurotoxicants, especially during developmental periods. Mechanisms of actions include disruption in neurotransmitter systems, calcium dyshomeostasis, oxidative stress and certain OCPs also promote amyloidogenesis in experimental models. Yet, it remains uncertain whether low‐grade environmental exposures in the general population increase the risk to develop brain aging pathologies. We assessed the prospective associations of plasma POP concentrations with three dementia‐related outcomes in a population‐based cohort of older adults. Method We included 515 participants from the French Three‐City Study, free of dementia at baseline at the time of blood measurements (1999‐2000, mean age 72.5; 19% APOE‐ɛ4 carriers), who underwent up to 8 repeated assessments of cognitive function and dementia over 17 years and 3 neuroimaging examinations over 10 years. Plasma concentrations of 12 OCPs and 15 PCBs were measured by GC/MS/MS, and a POP score summarizing overall exposure was derived via factorial analysis. Associations with dementia risk, and longitudinal changes in cognitive function (composite measure of four tests) and volume of the medial temporal lobe (MTL) were analyzed using Cox and linear mixed models, adjusted for baseline age, sex, education, APOE genotype, body mass index and total lipid concentrations. Result Median plasma concentrations were in accordance with expected values in the population age range. In multivariable‐adjusted models, neither individual POPs nor the POP factorial score were significantly associated with any dementia‐related outcome. Significant interactions were observed between APOE genotype and highly‐chlorinated PCBs (congeners 180, 194, and 196‐203) across all outcomes ( p for interaction ≤0.05): adverse associations were seen in carriers of the APOE‐ɛ4 allele (e.g. for each SD increase in PCB 194, HR [95% CI] for dementia = 1.51 [1.03‐2.21]; β coefficient [95% CI] for cognitive decline and MTL atrophy = ‐0.15 [‐0.34; 0.04] and ‐0.42 [‐0.74; ‐0.10] SD per decade, respectively), whereas opposing trends were observed in non‐carriers. Conclusion Overall, this prospective study does not provide robust evidence to support an adverse association between low‐grade environmental exposure to POPs in the general population and the risk of all‐cause dementia, cognitive decline, or brain atrophy in older adults.
Journals
2025 EN
Pietrowski MarieAnne · Crivello Fabrice · Burrel Sonia
+3 more
Abstract Background While previous studies have suggested the involvement of herpes simplex virus 1 (HSV‐1) in the pathophysiology of Alzheimer's disease (AD), neuroimaging studies in this area are scarce. We aimed to determine the association of HSV‐1 infection with neuroimaging markers of AD and to assess the impact of susceptibility factors that could modulate the deleterious effects of HSV‐1. Method Within a subsample of the UK Biobank with both serological and MRI data, we analyzed the associations between HSV‐1 seropositivity and grey matter (GM) volumes in four brain areas affected early in AD (hippocampus, amygdala, parahippocampal and entorhinal cortex), using linear regressions adjusted on potential cofounders (age, sex, APOE4 allele, education, income, smoking and alcohol intake, diabetes, hypertension, body mass index and total intracranial volume). To assess the impact of susceptibility factors, interactions of HSV‐1 with cytomegalovirus (CMV), APOE4 and age were tested and stratifications on these factors were performed. CMV infection and co‐infection with HSV‐1 were further investigated to identify the separate and cumulative effects of each virus. Result Among 901 participants (mean age 64.1 (SD = 7.7) at MRI; 55.6% of women), when considering only HSV‐1 we found no significant difference in GM volume in the four brain regions studied between HSV‐1‐infected and uninfected participants. Nevertheless, considering interaction with CMV, HSV‐1 infection was associated with a lower parahippocampal volume in CMV non‐infected participants only (β = ‐105 mm 3 , p = 0.03). Further investigation of interactions with CMV and other susceptibility factors showed that, among APOE4 carriers ≥ 65y, i.e. the most at‐risk people for AD: i) those infected only by CMV had lower amygdala volume (β = ‐197 mm 3 , p = 0.04); and ii) those infected by CMV (alone or in combination with HSV‐1) tended to have smaller GM volumes in three other brain regions studied ( p < 0.20). Conclusion Our study highlighted the complexity of the interactions involved when assessing associations between viral infections and radiological biomarkers of AD and the importance of considering susceptibility factors such as viral co‐infection, age and APOE4 genotype to decipher the role of infections in AD.