Reduction of Cognitive Decline in Patients with or at High Risk for Diabetes

Purpose of review—The incidence of Alzheimer’s disease and related disorders is expected to triple by 2050. People with type 2 diabetes and prediabetes have a higher risk of cognitive dysfunction, including Alzheimer’s disease and vascular dementia. Controversy remains about when and how to prevent and treat cognitive dysfunction in people with or at high risk of diabetes. Recent findings—In our review of ongoing clinical trials, we have found that there has been an increase in the number of studies assessing the efficacy of pharmacological and non-pharmacological approaches to prevent or slow down cognitive impairment among people with or at high risk of diabetes. Summary—Despite the considerable risk of cognitive impairment in people with diabetes and prediabetes, there is not enough evidence to support a specific treatment to prevent or slow mild cognitive impairment, or progression to Alzheimer’s disease or related disorders. Several ongoing trials are attempting to identify the usefulness of several compounds, as well as lifestyle changes including exercise and diet. Direct mechanisms linking diabetes to cognitive decline have not been elucidated

Assessing Dementia in Resource-Poor Regions

The numbers and proportions of elderly are increasing rapidly in developing countries, where prevalence of dementia is often high. Providing cost-effective services for dementia sufferers and their caregivers in these resourcepoor regions poses numerous challenges; developing resources for diagnosis must be the first step. Capacity building for diagnosis involves training and education of healthcare providers, as well as the general public, development of infrastructure, and resolution of economic and ethical issues. Recent progress in some low-to-middle-income countries (LMICs) provides evidence that partnerships between wealthy and resource-poor countries, and between developing countries, can improve diagnostic capabilities. Without the involvement of the mental health community of developed countries in such capacity-building programs, dementia in the developing world is a disaster waiting to happen

Wrap-around services to older adults with dementia: collaboration, education, and prevention as a model for integration of primary care and neurobehavioral health

Background: Medical care in the Rio Grande Valley (RGV) is fragmented and difficult to navigate, especially for older adults with cognitive decline and dementia. The communities are eager to have a new healthcare delivery system that integrate community-based aging services to provide integrated, team collaborative better health care in our communities. The University of Texas RGV School of Medicine, in collaboration with its affiliates in the regional healthcare systems, is a partner providing comprehensive care across the life-cycle bridging science, social services and patient care. Our interprofessional team collaborative emphasizes safe, appropriate, and effective neurobehavioral care, employing evidence-based medicine in collaboration with the patient’s preferences and culture. Methods: Different strategies are being deployed to create, enhance and target system-wide cross-organisational care pathways to support persons with dementia (PwD) and their caregivers. The initial focus of integration is the referral network management (inter-organizational care pathways). Additional mechanisms for care integration are the use of a mobile community health integrative care hub to improve access and prevention in the South Texas Colonias; a dedicated program for older adults care that may be triply diagnosed (general-neuro-behavioral); and, an innovative curriculum to achieve improvements in population health outcomes through AD-RCMAR programs emphasizing collaboration and prevention. Results: Small-scale testing has revealed that multidisciplinary teams, both within and across organizations, emerged as the most important single care coordination mechanism. Operationally this translates in identification of tasks and roles and in the agreement over one overall care plan per patient, not defined by each profession but patient-centered. Different barriers to integration include those related to IT infrastructure and limited access to services due to ‘gatekeeping’ rules that determine referral capabilities and geographical isolation. Conclusions: Wrap-around services to older adults with dementia are expected to have a direct impact on the care of the patients and families in the RGV and to be associated with better health outcomes and better satisfaction for all. A better understanding of factors determining integration is needed in order to develop more cost-effective pathways of care for PwD and their caregivers

Insights from a Study on Multimodal Experiences in a Plaza

By highlighting the neurobiological basis of people’s perception of urban spaces, this study provides a solid foundation for evidence-based design decisions. It presents a roadmap for crafting urban environments that not only accommodate the physical and social needs of people but also nurture their psychological well-being

Neuroarquitectura: percepción de cambios de la atmósfera

[Neuroarchitecture: perception of changes in the atmosphere

It is time to focus on an underestimated epidemic

Contemporary dementia research has spurred remarkable interest and endogenous efforts by clinical and research teams in Latin America and the Caribbean (LAC). The combination of unprecedented high burden of dementia, low resource settings, and wide acceptance of age-related cognitive changes has put thousands of individuals and families in a vulnerable situation that requires immediate attention. This issue of Dementia & Neuropsychologia is dedicated to cognitive impairment and dementia in LAC, and presents a timely series of fourteen reviews and original articles from Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, Peru, Trinidad and Tobago, and Venezuela. Many of the topics have been extensively examined by clinicians and scientists all over the world, but the focus on LAC is just emerging

Addressing Neurocognitive Disorders, Dementias, and Alzheimer’s Disease in Colonias of the Lower Rio Grande Valley: Establishing a Research Foundation Using Promotores

Several Texas communities along the Mexican border, including the Lower Rio Grande Valley (LRGV), are home to low-income Hispanic populations, many of whom live in underserved communities known as colonias. These areas have high incidences of neurocognitive disorders, dementia, and Alzheimer’s disease (AD); health care strategies that are culturally and linguistically appropriate for the area are needed. We aim to build capacity to reduce risk, facilitate treatment, and provide caregiver support for affected individuals. However, gaining trust of communities and presenting information about research studies in a way that is culturally appropriate is critical for engagement of underserved communities. This brief report examines our work with local community health workers (CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the LGRV. Lessons from the successful experience of training promotores in autism spectrum disorder in the LRGV highlight the importance of specifically addressing outreach in health fairs, clinic vists and referral as well as adequate selection, training, management, and support of the promotores as critical aspects. To initiate and sustain recruitment of older adults and care partners in research studies of AD and other dementias in the RGV, we have incorporated these aspects as components of the promotores training and engagement model, which has been developed and implemented by researchers and their colleagues at the School of Medicine at the University of Texas Rio Grande Valley

Public Communication of Science: The Experience of the Rio Grande Valley Alzheimer’s Disease Resource Center for Minority Aging Research

Introduction: There are multiple models of public communication of science. Some models focus on communication within the science community, while others involve public participation. At the Rio Grande Valley AD-RCMAR, we hope to implement a public outreach program to aid in the dissemination of accurate information regarding Alzheimer’s disease and related dementias. Objective: The purpose of this project was to identify behavioral change models that will allow the RGV AD-RCMAR to increase awareness and engagement of brain aging, including Alzheimer’s disease, within the Rio Grande Valley. Methods: A literature review was conducted to identify models of behavioral change that will assist the center in the dissemination of science. Public communication models were narrowed down to models that aligned with the goals of the center. Results: We identified four models and found that the Precaution Adoption Process Model (PAPM) and the Tailored Health Communication (THC) model were grounded in behavioral change and would best fit the needs of the AD-RCMAR. We integrated these models by building profiles to highlight Latinx researchers and a database of neuroscience seminars that will aid in the increased awareness and recruitment of individuals on topics that are tailored to their interests. Discussion: In order to make an impact, we must consider human behavior. By integrating the PAPM and THC models, individuals will have access to topics that are tailored to what they are searching for, which will result in raised awareness. Conclusion: These models will allow us to raise engagement and awareness in the RGV and support the recruitment of participants in research. There are some factors to consider prior to implementing these models including Hispanic values and their effect on involvement and communication of scientific information. Then, we will begin to question the changes in the levels of engagement and action

Critical reflection in practice: Generating Knowledge from the Interactions with Promotores for Engagement in Neurocognitive Disorders

Background: Colonias are underserved areas along the Texas-Mexico border, with high incidences of neurocognitive disorders, dementia, and Alzheimer\u27s disease (AD). Our goal is to build capacity to reduce risk, facilitate treatment for affected individuals, and provide caregiver support. Our aim was to construct an approach that was reflective and would reveal the rich and diverse ways in which people make meaning of their experiences and interactions with scientists, faculty, staff and students. Methods: We examined our work with local community health workers. (CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the Lower Rio Grande Valley (LRGV). Qualitative research methods were the principal way to approach this aim, including critical reflection. Results: We now have 347 certified promotores in LRGV: 174 in Cameron County, 169 in Hidalgo County, 3 in Starr County, and 1 in Willacy County. Most of the promotores in LRGV are female, Spanish-speakers (98%) although half of them are also fluent in English and more than half of the promotores have five years or more as a state-certified CHW. Assumptions about knowledge, power and reflexivity surfaced in the interactions with members of the academic world interacting with Colonia’s residents. Conclusions: Aspects of critical reflection, including deconstructing assumptions about knowledge, power and reflexivity, are useful to guide actions that facilitate capacity building in the Colonias, as well as action research methodology. The LRGV population’s characteristics make early detection of AD and dementia and support for patients and caregivers’ high priorities and clearly understanding the role of promotores as mediators is important

Using Cartesian Coordinate Systems to Create, Classify, and Retrieve Biomedical Time-Series: Applications to 24-hour Ambulatory Blood Pressure Monitoring

Background: Ambulatory Blood Pressure Measurement (ABPM) allows physicians to monitor blood pressure variability under everyday living conditions and predicts clinical outcomes better than conventional blood-pressure measurement. ABPM can demonstrate mean arterial pressure (MAP) behavior over 24 hours relevant to clinical practice, such as nocturnal hypertension or increased blood pressure variability. We hypothesized that individuals with the same cardiovascular health status would have the same MAP signal (MAPs) waveform. Methods: This study reutilizes a data subset from the IDACO Consortium to create 24-hour MAPs. We assigned all the MAPs to data matrix X, performed principal components analysis (PCA) to X, and calculated the percentage of the total variance explained by each of the 82 principal components (PC). The first three PC explained 85.03%, 9.47%, and 5.50% of the total variance. We used every MAP signal\u27s first three PC scores as their three-dimensional Euclidean Space (x, y, z) coordinates and assigned them to matrix C. Then, we calculated hierarchical clusters of the rows of C with Ward\u27s linkage minimum variance algorithm and a Euclidian metric and encoded this information on the agglomerative hierarchical cluster tree Z. We determined the gap statistic in Z to obtain the optimal number of clusters. We created seven agglomerative clusters from the linkages stored in Z, using Ward’s distance as the criterion for defining the clusters. Finally, we plotted and colored the mapped MAPs by their assigned cluster number at the locations specified by their (x, y, z) coordinates. Results: The MAPs cartesian representations show that MAPs with similar waveforms cluster in the same three-dimensional Euclidean subspace. These patterns identified individuals with dipping and non-dipping blood pressure behavior, which is relevant to clinical management. Conclusions: Mapping a set of physiological signals into a Euclidian space creates a mathematical formalism that provides a statistical framework to classify physiological signals by their waveform. By applying our method to existing electrophysiological and physiological databases, we can cluster any biomedical time-series (blood pressure, ECG, EEG, EMG, patch-clamp, single-unit recordings, etc.) by physiologic or pathological waveform, so further epidemiological and genetic studies can be conducted on the subjects or tissue samples sharing similar patterns