Biostatistics Commons^™

Rural–Urban Differences In Cognitive Outcomes Among Older Adults: The Roles Of Falls And Depressive Symptoms, Ayse Malatyali, Tom Cidav, Lisa A.K. Wiese, Jian Zou, Monique J. Brown Ph.D., Mph, Junfeng Ma, Breno S. Diniz, Ladda Thiamwong

Faculty Publications

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Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across …

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Rural–Urban Differences In Cognitive Outcomes Among Older Adults: The Roles Of Falls And Depressive Symptoms, Ayse Malatyali, Tom Cidav, Lisa A.K. Wiese, Jian Zou, Monique J. Brown Ph.D., Mph, Junfeng Ma, Breno S. Diniz, Ladda Thiamwong

Faculty Publications

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Background: Older adults with Alzheimer’s Disease and Related Dementias (ADRD) experience a higher risk of falls. However, research lacks evidence on the effect of fall exposure on cognitive impairment and dementia. We investigated the association of falls and depressive symptoms with cognitive impairment and dementia in a nationally representative sample. Methods: We analyzed data from 6221 participants (age ≥ 65) in the Health and Retirement Study (HRS) from the 2018–2020 waves, using Multinomial logistic regression models. Measures included the HRS health status questionnaire, HRS cognition scale, and the Center for Epidemiological Studies Depression scale. Results: Prevalence of fall exposure across …

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Home-Based Digital Technologies To Support Aging-In-Place For Rural African American People With Alzheimer Disease And Their Care Partners: Protocol For A Mixed Methods Feasibility Study, Otis Owens, Rahul Ghosal Ph.D., Zachary Beattie, Jeffrey Kaye, Jiajia Zhang Ph.D., Nora Mattek, Joel Steele, Thomas Riley, Nicole Sharma, Larry Frye, Leonardo Bonilha, Sue E. Levkoff Scd, Msw, Sm

Faculty Publications

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Background:

Rural, low-income African American people have the highest Alzheimer disease and related dementia (ADRD) incidence and prevalence rates but have the least access to formal dementia care. To support individuals living with ADRD, growing evidence suggests that remote monitoring technologies can augment existing care by facilitating the completion of activities of daily living (ADLs) and maintaining communication between individuals living with ADRD and their care partners. Despite the success of remote technologies, no studies have investigated the usability, acceptability, and feasibility of these technologies among rural, lower-income African American people living with ADRD and their care partners. Understanding the …

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Modifiable And Non-Modifiable Risk Factors For Dementia Among Non-Hispanic White And Black Populations Aged 50-64 In The United States, 2006-2016, Jingkai Wei, Matthew C. Lohman Ph.D., Monique J. Brown, James W. Hardin, Chih-Hsiang Yang, Anwar T. Nerchant, Daniela B. Friedman

Faculty Publications

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Background and Objectives

Non-Hispanic Black populations (NHB) have a significantly higher prevalence of dementia than non-Hispanic Whites in the U.S., and the underlying risk factors may play a role in this racial disparity. We aimed to calculate risk scores for dementia among non-Hispanic White (NHW) and non-Hispanic Black populations aged 50-64 years over a period of 10 years, and to estimate potential differences of scores between NHW and NHB.

Research Design and Methods

The Health and Retirement Study from 2006 to 2016 was used to calculate the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, a validated …

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Caregiving Burdens Of Task Time And Task Difficulty Among Paid And Unpaid Caregivers Of Persons Living With Dementia, Matthew Lee Smith, Jodi L. Southerland, Malinee Neelamegam, Gang Han, Shinduk Lee, Chung Lin Kew, Juanita Dawne R. Bacsu, Elyse Couch, Steffi M. Kim, Monique J. Brown Ph.D., Mph, Ayse Malatyali, Lucas Wilson, Zahra Rahemi, Jeremy Holloway, Marcia G. Ory

Faculty Publications

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Background: Demands of caregivers of persons living with dementia (PLWD) are often influenced by the context of their caregiving situation. This study examines common and unique factors associated with caregiving burden in terms of task time and task difficulty among paid and unpaid caregivers of PLWD. Methods: Cross-sectional baseline survey data were analyzed from 107 paid and unpaid caregivers of PLWD participating in a larger NIH-funded study assessing the feasibility of using a novel in-situ sensor system. Oberst Caregiving Burden Scale constructs of task time and task difficulty served as dependent variables. Two least squares regression models were fitted, controlling …

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Neighborhood Characteristics And Dementia Symptomology Among Community-Dwelling Older Adults With Alzheimer’S Disease, Dana M. Alhasan, Matthew C. Lohman Ph.D., Jana A. Hirsch, Margaret Chandlee Miller Ms, Ph.D., Bo Cai Ph.D., Chandra L. Jackson

Faculty Publications

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Background: Neuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer’s disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs.

Methods: Using 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer’s Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood …

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Analysis Of Genes (Tmem106b, Grn, Abcc9, Kcnmb2, And Apoe) Implicated In Risk For Late-Nc And Hippocampal Sclerosis Provides Pathogenetic Insights: A Retrospective Genetic Association Study, Adam J. Dugan, Peter T. Nelson, Yuriko Katsumata, Lincoln M. P. Shade, Kevin L. Boehme, Merilee A. Teylan, Matthew D. Cykowski, Shubhabrata Mukherjee, John S. K. Kauwe, Timothy J. Hohman, Julie A. Schneider, Alzheimer’S Disease Genetics Consortium, David W. Fardo

Biostatistics Faculty Publications

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Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is the most prevalent subtype of TDP-43 proteinopathy, affecting up to 1/3rd of aged persons. LATE-NC often co-occurs with hippocampal sclerosis (HS) pathology. It is currently unknown why some individuals with LATE-NC develop HS while others do not, but genetics may play a role. Previous studies found associations between LATE-NC phenotypes and specific genes: TMEM106B, GRN, ABCC9, KCNMB2, and APOE. Data from research participants with genomic and autopsy measures from the National Alzheimer’s Coordinating Center (NACC; n = 631 subjects included) and the Religious Orders Study and Memory …

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Neighborhood Characteristics And The Mental Health Of Caregivers Cohabiting With Care Recipients Diagnosed With Alzheimer’S Disease, Dana M. Alhasan, Jana A. Hirsch, Chandra L. Jackson, Margaret Chandlee Miller, Bo Cai Ph.D., Matthew C. Lohman Ph.D.

Faculty Publications

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While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional associations between neighborhood characteristics and mental health among caregivers cohabiting with Alzheimer’s disease care recipients that were experiencing severe or non-severe neuropsychiatric symptoms (NPSs) (e.g., aggression/anxiety). We obtained data collected in 2010 on caregivers and care recipients (n

While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional …

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Time-Varying Insomnia Symptoms And Incidence Of Cognitive Impairment And Dementia Among Older Us Adults, Nicholas V. Resciniti, Valerie Yelverton, Bezawit Eyob Kase, Jiajia Zhang, Matthew C. Lohman

Faculty Publications

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There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive …

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Dietary Inflammatory Index And Sleep Quality In Southern Italian Adults, Justyna Godos, Raffaele Ferri, Filippo Caraci, Filomena I. I. Cosentino, Sabrina Castellano, Nitin Shivappa, James R. Hébert, Fabio Galvano, Giuseppe Grosso

Faculty Publications

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Background: Current evidence supports the central role of a subclinical, low-grade inflammation in a number of chronic illnesses and mental disorders; however, studies on sleep quality are scarce. The aim of this study was to test the association between the inflammatory potential of the diet and sleep quality in a cohort of Italian adults. Methods: A cross-sectional analysis of baseline data of the Mediterranean healthy Eating, Aging, and Lifestyle (MEAL) study was conducted on 1936 individuals recruited in the urban area of Catania during 2014-2015 through random sampling. A food frequency questionnaire and other validated instruments were used to calculate …

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Tdp-43 Proteinopathy In Aging: Associations With Risk-Associated Gene Variants And With Brain Parenchymal Thyroid Hormone Levels, Peter T. Nelson, Zsombor Gal, Wang-Xia Wang, Dana M. Niedowicz, Sergey C. Artiushin, Samuel Wycoff, Angela Wei, Gregory A. Jicha, David W. Fardo

Pathology and Laboratory Medicine Faculty Publications

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TDP-43 proteinopathy is very prevalent among the elderly (affecting at least 25% of individuals over 85 years of age) and is associated with substantial cognitive impairment. Risk factors implicated in age-related TDP-43 proteinopathy include commonly inherited gene variants, comorbid Alzheimer's disease pathology, and thyroid hormone dysfunction. To test parameters that are associated with aging-related TDP-43 pathology, we performed exploratory analyses of pathologic, genetic, and biochemical data derived from research volunteers in the University of Kentucky Alzheimer's Disease Center autopsy cohort (n = 136 subjects). Digital pathologic methods were used to discriminate and quantify both neuritic and intracytoplasmic TDP-43 pathology …

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Tobacco Smoking And Dementia In A Kentucky Cohort: A Competing Risk Analysis, Erin L. Abner, Peter T. Nelson, Gregory A. Jicha, Gregory E. Cooper, David W. Fardo, Frederick A. Schmitt, Richard J. Kryscio

Epidemiology and Environmental Health Faculty Publications

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Tobacco smoking was examined as a risk for dementia and neuropathological burden in 531 initially cognitively normal older adults followed longitudinally at the University of Kentucky’s Alzheimer’s Disease Center. The cohort was followed for an average of 11.5 years; 111 (20.9%) participants were diagnosed with dementia, while 242 (45.6%) died without dementia. At baseline, 49 (9.2%) participants reported current smoking (median pack-years = 47.3) and 231 (43.5%) former smoking (median pack-years = 24.5). The hazard ratio (HR) for dementia for former smokers versus never smokers based on the Cox model was 1.64 (95% CI: 1.09, 2.46), while the HR for …

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Evaluating Trajectories Of Episodic Memory In Normal Cognition And Mild Cognitive Impairment: Results From Adni, Xiuhua Ding, Richard J. Charnigo, Frederick A. Schmitt, Richard J. Kryscio, Erin L. Abner, Alzheimer’S Disease Neuroimaging Initiative

Statistics Faculty Publications

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BACKGROUND: Memory assessment is a key factor for the diagnosis of cognitive impairment. However, memory performance over time may be quite heterogeneous within diagnostic groups.

METHOD: To identify latent trajectories in memory performance and their associated risk factors, we analyzed data from Alzheimer's Disease Neuroimaging Initiative (ADNI) participants who were classified either as cognitively normal or as Mild Cognitive Impairment (MCI) at baseline and were administered the Rey Auditory Verbal Learning test (RAVLT) for up to 9 years. Group-based trajectory modeling on the 30-minute RAVLT delayed recall score was applied separately to the two baseline diagnostic groups.

RESULTS: There were …

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Evaluating The Impacts Of Antidepressant Use On The Risk Of Dementia, Ran Duan

Theses and Dissertations--Epidemiology and Biostatistics

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Dementia is a clinical syndrome caused by neurodegeneration or cerebrovascular injury. Patients with dementia suffer from deterioration in memory, thinking, behavior and the ability to perform everyday activities. Since there are no cures or disease-modifying therapies for dementia, there is much interest in identifying modifiable risk factors that may help prevent or slow the progression of cognitive decline. Medications are a common focus of this type of research.

Importantly, according to a report from the Centers for Disease Control and Prevention (CDC), 19.1% of the population aged 60 and over report taking antidepressants during 2011-2014, and this number tends to …

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Outcomes After Diagnosis Of Mild Cognitive Impairment In A Large Autopsy Series, Erin L. Abner, Richard J. Kryscio, Frederick A. Schmitt, David W. Fardo, Daniela C. Moga, Eseosa T. Ighodaro, Gregory A. Jicha, Lei Yu, Hiroko H. Dodge, Chengjie Xiong, Randall L. Woltjer, Julie A. Schneider, Nigel J. Cairns, David A. Bennett, Peter T. Nelson

Epidemiology and Environmental Health Faculty Publications

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OBJECTIVE: To determine clinical and neuropathological outcomes following a clinical diagnosis of mild cognitive impairment (MCI).

METHODS: Data were drawn from a large autopsy series (N = 1,337) of individuals followed longitudinally from normal or MCI status to death, derived from 4 Alzheimer Disease (AD) Centers in the United States.

RESULTS: Mean follow‐up was 7.9 years. Of the 874 individuals ever diagnosed with MCI, final clinical diagnoses were varied: 39.2% died with an MCI diagnosis, 46.8% with a dementia diagnosis, and 13.9% with a diagnosis of intact cognition. The latter group had pathological features resembling those with a final clinical …

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Self-Reported Sleep Apnea And Dementia Risk: Findings From The Prevention Of Alzheimer's Disease With Vitamin E And Selenium Trial, Xiuhua Ding, Richard J. Kryscio, Joshua Turner, Gregory A. Jicha, Gregory E. Cooper, Allison M. Caban-Holt, Frederick A. Schmitt, Erin L. Abner

Sanders-Brown Center on Aging Faculty Publications

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OBJECTIVES: To investigate the association between baseline sleep apnea and risk of incident dementia in the Prevention of Alzheimer's Disease with Vitamin E and Selenium (PREADViSE) study and to explore whether the association depends on apolipoprotein E (APOE) ɛ4 allele status.

DESIGN: Secondary analysis based on data collected during PREADViSE.

SETTING: Participants were assessed at 128 local clinical study sites during the clinical trial phase and later were followed by telephone from a centralized location.

PARTICIPANTS: Men enrolled in PREADViSE (without dementia or other active neurological conditions that affect cognition such as major psychiatric disorders, including depression; N = …

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Hidden Markov Chain Analysis: Impact Of Misclassification On Effect Of Covariates In Disease Progression And Regression, Haritha Polisetti

USF Tampa Graduate Theses and Dissertations

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Most of the chronic diseases have a well-known natural staging system through which the disease progression is interpreted. It is well established that the transition rates from one stage of disease to other stage can be modeled by multi state Markov models. But, it is also well known that the screening systems used to diagnose disease states may subject to error some times. In this study, a simulation study is conducted to illustrate the importance of addressing for misclassification in multi-state Markov models by evaluating and comparing the estimates for the disease progression Markov model with misclassification opposed to disease …

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A Markov Transition Model To Dementia With Death As A Competing Event, Liou Xu

University of Kentucky Doctoral Dissertations

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The research on multi-state Markov transition model is motivated by the nature of the longitudinal data from the Nun Study (Snowdon, 1997), and similar information on the BRAiNS cohort (Salazar, 2004). Our goal is to develop a flexible methodology for handling the categorical longitudinal responses and competing risks time-to-event that characterizes the features of the data for research on dementia. To do so, we treat the survival from death as a continuous variable rather than defining death as a competing absorbing state to dementia. We assume that within each subject the survival component and the Markov process are linked by …

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