scholarly journals HETEROGENEITY IN PROGRESSION OF COGNITIVE IMPAIRMENT AND VARIATIONS IN HEALTH EXPENDITURES AND HEALTH SERVICES USE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S126-S126
Author(s):  
Wassim Tarraf ◽  
Hector M González
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Cognitive Aging ◽  
Linear Models ◽  
Health Issues ◽  
Health Services Use ◽  
The Us ◽  
Inpatient Hospitalizations ◽  
Baseline Probability ◽  
Using Data

Abstract Cognitive aging and disease (e.g. dementia) are leading public health issues as longevity increases and the US population ages. We fit generalized linear models using data from the longitudinal Health and Retirement Study (2008-2014) on (Unweighted N=1,884) participants 70-years and older who met criteria for cognitive impairment not dementia (CIND), based on Aging, Demographics, and Memory Study specification, at baseline (2008) to test how impairment reversion, stability, and transition to dementia over 8-years affect change in biennial hospitalizations, nursing-home use, and out-of-pocket expenditures (OOP). Over 8-years, 13% reverted to normal cognition, 20% remained as CIND, 21% transitioned to dementia, and 46% died. In these groups, average OOP spending at baseline was $2311 (SE=$225), $2722 (SE=$278), $2180 (SE=$228), and $3653 (SE=$322), respectively. Average OOP spending increased to $3,095, $4,720, and $11,548 by the 8th year for those that reverted, stayed stable, and transitioned, respectively. Average OOP spending at the wave preceding death was $11,600. We observed substantial increases in nursing home use that were particularly pronounced among those that transitioned to dementia (Baseline Probability=0.04 increasing to 0.37 over 8-years) or died (0.09 increasing to 0.35 over 6-years), and similar but less pronounced differences in patterns of inpatient hospitalizations. Estimates were only slightly modified through adjustments to sociodemographic characteristics and comorbid conditions. We discuss how healthcare policy and clinical interventions focusing on early identification of impairment can potentially lead to improved and more efficient healthcare if better understanding of heterogeneities in impairment and cognitive disease progression is achieved.

Design Equations for Bod Removal in Facultative Ponds

1987 ◽  
Vol 19 (12) ◽  
pp. 187-193 ◽  
Author(s):  
E. Joe Middlebrooks
Keyword(s):  
Environmental Protection Agency ◽  
Linear Models ◽  
Plug Flow ◽  
Empirical Models ◽  
The Us ◽  
Non Linear ◽  
The Usa ◽  
Using Data ◽  
Removal Model ◽  
Best Fit

Facultative pond performance data collected for the US Environmental Protection Agency (USEPA) at four locations throughout the USA and data collected by others were used to evaluate the most frequently used design equations and to develop non-linear design equations. Empirical models were evaluated as well as the classical plug flow and complete mix models. The first order plug flow model gave the best fit of all the rational models. The empirical non-linear models did not fit the data, nor did the other empirical models with the exception being the areal loading and removal model. Attempts to verify the models developed with the USEPA data using data collected by others were not successful with the exception of the areal loading and removal model.

scholarly journals Vision and Cognition: Findings from the Longitudinal Aging Study in India—Diagnostic Assessment of Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 660-660
Author(s):  
Joshua Ehrlich ◽  
Sandy Chien ◽  
Jinkook Lee
Keyword(s):  
Cognitive Decline ◽  
Cognitive Aging ◽  
Linear Models ◽  
Diagnostic Assessment ◽  
Cognitive Measures ◽  
Poor Vision ◽  
Cognitive Domains ◽  
Aging Study ◽  
Longitudinal Aging Study ◽  
Using Data

Abstract Vision impairment (VI) is associated with cognitive decline and dementia, however little research has been conducted in India. Using data from LASI-DAD, linear models tested the association of VI (better-seeing eye <20/60) with cognitive domains including orientation, learning/memory, language, attention, and total cognition. Models were adjusted for age, sex, geographic, and socioeconomic characteristics. VI was significantly associated with lower orientation (β=-0.47, p<.01), learning/memory (β=-4.6, p<.01), attention (β=-1.6, p<.01), and total cognition (β=-8.4, p<.01), but not language (β=-0.14, p<.1) scores. The association of VI with cognitive measures did not vary by sex. For each measure, VI was equivalent to 5-13 years of cognitive aging. In summary, VI is associated with poorer performance in most cognitive domains among older Indian adults. Longitudinal data are needed to determine directionality and causality. Since >80% of VI in India is treatable, poor vision may represent a modifiable risk factor for cognitive decline and dementia.

scholarly journals Birth Cohort Differences in Multimorbidity Burden Among Aging U.S. Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 257-257
Author(s):  
Nicholas Bishop ◽  
Steven Haas ◽  
Ana Quiñones
Keyword(s):  
Cognitive Impairment ◽  
Birth Cohort ◽  
Repeated Measures ◽  
Chronic Conditions ◽  
Linear Models ◽  
Birth Cohorts ◽  
Older Americans ◽  
Cohort Differences ◽  
Increased Risk ◽  
The Us

Abstract Multimorbidity is the co-occurrence of two or more chronic health conditions and affects more than half of the US population aged 65 and older. Recent trends suggest increased risk of poor self-reported health, physical disability, cognitive impairment, and mortality among later born birth cohorts, yet we are unaware of work examining cohort trends in multimorbidity among aging US adults. Observations were drawn from the Health and Retirement Study (2000–2018) and included adults aged 51 and older across 7 birth cohorts (1923 and earlier, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, and 1960–1965). Multimorbidity was measured as a count of 9 chronic conditions including heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer (excluding skin cancer), depression, and cognitive impairment. General linear models adjusting for repeated measures and covariates including age, sex, race/ethnicity, and education were used to identify whether trends in multimorbidity varied across birth cohort. 31,923 adults contributed 153,940 total observations, grand mean age was 68.0 (SD=10.09), and mean multimorbidity was 2.19 (SD=1.49). In analyses adjusted for age and other covariates, adults born 1948–1953 reported .34 more chronic conditions (SE=.03, p<.001), adults born 1954–1959 reported .42 more chronic conditions (SE=.03, p<.001), and adults born 1960–1965 reported .55 more chronic conditions (SE=.03, p<.001), than those born 1931–1941, respectively. Our preliminary results confirm increasing multimorbidity among later birth cohorts of older Americans and should help guide policy to manage impending health declines among older Americans.

scholarly journals Dog visits in nursing homes – increase complexity or keep it simple? A randomised controlled study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251571
Author(s):  
Karen Thodberg ◽  
Poul B. Videbech ◽  
Tia G. B. Hansen ◽  
Anne Bak Pedersen ◽  
Janne W. Christensen
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Linear Models ◽  
Controlled Trial ◽  
Nursing Home Residents ◽  
Controlled Study ◽  
Period 2 ◽  
Parametric Statistics ◽  
Randomised Controlled ◽  
The Impact

Objective To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability. Methods In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics). Results Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F1,90 = 4.60, P < 0.05; period 3: F1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F1,89 = 7.89, P < 0.01; period 2: F1,97 = 6.76, P = 0.01; period 3: F1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F1,89 = 13.78, P <0.001; period 2: F1,88 = 3.27, P = 0.07; period 3: F1,86 = 3.88, P = 0.05). Conclusion Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.

Physical activity and cognitive function in older persons

2016 ◽  
Vol 64 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Executive Functions ◽  
Cognitive Aging ◽  
Clinical Studies ◽  
Older Persons ◽  
Positive Effects ◽  
Critical Challenge

Strategies to improve cognitive aging are highly needed. Among those, promotion of exercise and physical activity appears as one of the most attractive and beneficial intervention. Indeed, results from basic and clinical studies suggest that exercise and physical activity have positive effects on cognition in older persons without cognitive impairment, as well as in those with dementia. Despite inconsistent results, aerobic exercise appears to have the strongest potential to enhance cognition. However, even limited periods of walking (45 minutes, three times a week, over a 6-month period) have also been shown to enhance cognition, particularly executive functions. Changing long-term lifestyle habits in these older persons remains a critical challenge and attractive programs susceptible to gain adherence are needed to succeed in achieving improved cognitive aging.

scholarly journals EEG Measures of Value-Directed Strategic Processing in Older Adults With and Without Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 292-293
Author(s):  
Lydia Nguyen ◽  
Shraddha Shende ◽  
Daniel Llano ◽  
Raksha Mudar
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Aging ◽  
Spectral Power ◽  
Group Differences ◽  
Cognitive Resources ◽  
Alpha Power ◽  
Strategic Processing ◽  
Unique Word

Abstract Value-directed strategic processing is important for daily functioning. It allows selective processing of important information and inhibition of irrelevant information. This ability is relatively preserved in normal cognitive aging, but it is unclear if mild cognitive impairment (MCI) affects strategic processing and its underlying neurophysiological mechanisms. The current study examined behavioral and EEG spectral power differences between 16 cognitively normal older adults (CNOA; mean age: 74.5 ± 4.0 years) and 16 individuals with MCI (mean age: 77.1 ± 4.3 years) linked to a value-directed strategic processing task. The task used five unique word lists where words were assigned high- or low-value based on letter case and were presented sequentially while EEG was recorded. Participants were instructed to recall as many words as possible after each list to maximize their score. Results revealed no group differences in recall of low-value words, but individuals with MCI recalled significantly fewer high-value words and total number of words relative to CNOA. Group differences were observed in theta and alpha bands for low-value words, with greater synchronized theta power for CNOA than MCI and greater desynchronized alpha power for MCI than CNOA. Collectively, these findings demonstrate that more effortful neural processing of low-value words in the MCI group, relative to the CNOA group, allowed them to match their behavioral performance to the CNOA group. Individuals with MCI appear to utilize more cognitive resources to inhibit low-value information and might show memory-related benefits if taught strategies to focus on high-value information processing.

scholarly journals Temporal trajectory of biofluid markers in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Seok Baek ◽  
Myung Jun Lee ◽  
Han-Kyeol Kim ◽  
Chul Hyoung Lyoo
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Amyloid Β ◽  
Rapid Progression ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Using Data ◽  
Negative Exponential ◽  
T Tau

AbstractFull dynamics of biofluid biomarkers have been unknown in patients with Parkinson’s disease (PD). Using data from 396 PD patients and 182 controls in the Parkinson's Progression Markers Initiative (PPMI) database, we estimated long-term temporal trajectories of CSF α-synuclein (α-syn), amyloid-β (Aβ), total tau (t-tau), phosphorylated tau (p-tau) and serum neurofilament light chain (NfL) by integrating function between the baseline levels and annual changes. At baseline, PD patients showed lower CSF α-syn, Aβ, t-tau and p-tau levels than those of the controls. In all PD patients, CSF α-syn and Aβ decreased in a negative exponential pattern before the onset of motor symptoms, whereas CSF t-tau and p-tau, and serum NfL increased. Patients with cognitive impairment exhibited faster decline of Aβ and α-syn and faster rise of t-tau, p-tau and NfL, when compared to those without. Similarly, low Aβ group showed earlier decline of α-syn, faster rise of t-tau, p-tau and NfL, and faster decline of cognitive performances, when compared to high Aβ group. Our results suggest that longitudinal changes in biomarkers can be influenced by cognitive impairment and Aβ burden at baseline. PD patients with Aβ pathology may be associated with early appearance of α-synuclein pathology, rapid progression of axonal degeneration and neurodegeneration, and consequently greater cognitive decline.

EXPRESS: Commercial Success through Commercials? Advertising and Pay TV Operators

2021 ◽  
pp. 002224372110281
Author(s):  
Joonhyuk Yang ◽  
Jung Youn Lee ◽  
Pradeep K. Chintagunta
Keyword(s):  
Television Advertising ◽  
Service Market ◽  
Unit Costs ◽  
Cost Efficiencies ◽  
Pay Television ◽  
National Advertising ◽  
The Us ◽  
Television Service ◽  
Asymmetric Cost ◽  
Using Data

The US pay television service market had been dominated by cable operators until the nationwide entry of satellite operators in the early 1990s. The latter have been consistently growing their footprints since. This study documents the role of television advertising to explain the success. Using data on US households’ subscription choices and operators’ advertising decisions, the authors document both demand- and supply-side conditions conducive to the growth of the satellite operators. First, the authors find consumers in this market were sensitive to advertising, and especially so to that of the satellite operators (ad-elasticities of about .05-.06 for satellite operators vs. .02 for cable operators). The authors employ a border strategy to demonstrate advertising-elastic demand and discuss its robustness to potential threats to identification. Second, the authors provide suggestive evidence that a form of asymmetric cost efficiencies in television advertising benefited the entrants more than the incumbents. Specifically, the unit costs of local advertising tend to be higher than of national advertising, which likely allowed the satellite operators to better leverage their national presence with (cheaper) national advertising. Overall, this study highlights the interaction between advertising efficiencies and the scale of entry in explaining the competition between market incumbents and entrants.

scholarly journals Preliminary Results of MyCog, a Brief Assessment for the Detection of Cognitive Impairment in Primary Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 259-260
Author(s):  
Laura Curtis ◽  
Lauren Opsasnick ◽  
Julia Yoshino Benavente ◽  
Cindy Nowinski ◽  
Rachel O’Conor ◽  
...  
Keyword(s):  
Primary Care ◽  
Cognitive Impairment ◽  
Cognitive Aging ◽  
False Positive ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Self Report ◽  
Card Sorting ◽  
Primary Care Settings

Abstract Early detection of Cognitive impairment (CI) is imperative to identify potentially treatable underlying conditions or provide supportive services when due to progressive conditions such as Alzheimer’s Disease. While primary care settings are ideal for identifying CI, it frequently goes undetected. We developed ‘MyCog’, a brief technology-enabled, 2-step assessment to detect CI and dementia in primary care settings. We piloted MyCog in 80 participants 65 and older recruited from an ongoing cognitive aging study. Cases were identified either by a documented diagnosis of dementia or mild cognitive impairment (MCI) or based on a comprehensive cognitive battery. Administered via an iPad, Step 1 consists of a single self-report item indicating concern about memory or other thinking problems and Step 2 includes two cognitive assessments from the NIH Toolbox: Picture Sequence Memory (PSM) and Dimensional Change Card Sorting (DCCS). 39%(31/80) participants were considered cognitively impaired. Those who expressed concern in Step 1 (n=52, 66%) resulted in a 37% false positive and 3% false negative rate. With the addition of the PSM and DCCS assessments in Step 2, the paradigm demonstrated 91% sensitivity, 75% specificity and an area under the ROC curve (AUC)=0.82. Steps 1 and 2 had an average administration time of &lt;7 minutes. We continue to optimize MyCog by 1) examining additional items for Step 1 to reduce the false positive rate and 2) creating a self-administered version to optimize use in clinical settings. With further validation, MyCog offers a practical, scalable paradigm for the routine detection of cognitive impairment and dementia.

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