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  1. Article ; Online: Under-Diagnosis of Dementia with Lewy Bodies in Individuals Racialized as Black: Hypotheses Regarding Potential Contributors.

    Armstrong, Melissa J / Barnes, Lisa L

    Journal of Alzheimer's disease : JAD

    2024  Volume 97, Issue 4, Page(s) 1571–1580

    Abstract: Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias after Alzheimer's disease (AD) dementia. DLB is under-diagnosed across populations but may be particularly missed in older Black adults. The object of this review was to ... ...

    Abstract Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias after Alzheimer's disease (AD) dementia. DLB is under-diagnosed across populations but may be particularly missed in older Black adults. The object of this review was to examine key features of DLB and potential associations with race in order to hypothesize why DLB may be under-diagnosed in Black adults in the U.S. In terms of dementia, symptoms associated with high rates of co-pathology (e.g., AD, vascular disease) in older Black adults may obscure the clinical picture that might suggest Lewy body pathology. Research also suggests that clinicians may be predisposed to give AD dementia diagnoses to Black adults, potentially missing contributions of Lewy body pathology. Hallucinations in Black adults may be misattributed to AD or primary psychiatric disease rather than Lewy body pathology. Research on the prevalence of REM sleep behavior in diverse populations is lacking, but REM sleep behavior disorder could be under-diagnosed in Black adults due to sleep patterns or reporting by caregivers who are not bed partners. Recognition of parkinsonism could be reduced in Black adults due to clinician biases, cultural effects on self-report, and potentially underlying differences in the frequency of parkinsonism. These considerations are superimposed on structural and systemic contributions to health (e.g., socioeconomic status, education, structural racism) and individual-level social exposures (e.g., social interactions, discrimination). Improving DLB recognition in Black adults will require research to investigate reasons for diagnostic disparities and education to increase identification of core symptoms in this population.
    MeSH term(s) Humans ; Aged ; Lewy Body Disease/pathology ; Lewy Bodies/pathology ; Alzheimer Disease/psychology ; Parkinsonian Disorders/diagnosis ; REM Sleep Behavior Disorder/complications
    Language English
    Publishing date 2024-01-26
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1440127-7
    ISSN 1875-8908 ; 1387-2877
    ISSN (online) 1875-8908
    ISSN 1387-2877
    DOI 10.3233/JAD-231177
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  2. Article ; Online: Alzheimer disease in African American individuals: increased incidence or not enough data?

    Barnes, Lisa L

    Nature reviews. Neurology

    2021  Volume 18, Issue 1, Page(s) 56–62

    Abstract: Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous ... ...

    Abstract Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward.
    MeSH term(s) Black or African American/statistics & numerical data ; Aged ; Alzheimer Disease/epidemiology ; Data Collection ; Ethnicity ; Humans ; Incidence ; Middle Aged ; United States/epidemiology
    Language English
    Publishing date 2021-12-06
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2491514-2
    ISSN 1759-4766 ; 1759-4758
    ISSN (online) 1759-4766
    ISSN 1759-4758
    DOI 10.1038/s41582-021-00589-3
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  3. Article ; Online: Biomarkers for Alzheimer Dementia in Diverse Racial and Ethnic Minorities-A Public Health Priority.

    Barnes, Lisa L

    JAMA neurology

    2018  Volume 76, Issue 3, Page(s) 251–253

    MeSH term(s) Alzheimer Disease ; Biomarkers ; Ethnicity ; Health Priorities ; Humans ; Minority Groups
    Chemical Substances Biomarkers
    Language English
    Publishing date 2018-10-25
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2702023-X
    ISSN 2168-6157 ; 2168-6149
    ISSN (online) 2168-6157
    ISSN 2168-6149
    DOI 10.1001/jamaneurol.2018.3444
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  4. Article ; Online: The time course of motor and cognitive decline in older adults and their associations with brain pathologies: a multicohort study.

    Oveisgharan, Shahram / Wang, Tianhao / Barnes, Lisa L / Schneider, Julie A / Bennett, David A / Buchman, Aron S

    The lancet. Healthy longevity

    2024  

    Abstract: Background: Many studies have reported that impaired gait precedes cognitive impairment in older people. We aimed to characterise the time course of cognitive and motor decline in older individuals and the association of these declines with the ... ...

    Abstract Background: Many studies have reported that impaired gait precedes cognitive impairment in older people. We aimed to characterise the time course of cognitive and motor decline in older individuals and the association of these declines with the pathologies of Alzheimer's disease and related dementias.
    Methods: This multicohort study used data from three community-based cohort studies (Religious Orders Study, Rush Memory and Aging Project, and Minority Aging Research Study, all in the USA). The inclusion criteria for all three cohorts were no clinical dementia at the time of enrolment and consent to annual clinical assessments. Eligible participants consented to post-mortem brain donation and had post-mortem pathological assessments and three or more repeated annual measures of cognition and motor functions. Clinical and post-mortem data were analysed using functional mixed-effects models. Global cognition was based on 19 neuropsychological tests, a hand strength score was based on grip and pinch strength, and a gait score was based on the number of steps and time to walk 8 feet and turn 360°. Brain pathologies of Alzheimer's disease and related dementias were assessed at autopsy.
    Findings: From 1994 to 2022, there were 1570 eligible cohort participants aged 65 years or older, 1303 of whom had cognitive and motor measurements and were included in the analysis. Mean age at death was 90·3 years (SD 6·3), 905 (69%) participants were female, and 398 (31%) were male. Median follow-up time was 9 years (IQR 5-11). On average, cognition was stable from 25 to 15 years before death, when cognition began to decline. By contrast, gait function and hand strength declined during the entire study. The combinations of pathologies of Alzheimer's disease and related dementias associated with cognitive and motor decline and their onsets of associations varied; only tau tangles, Parkinson's disease pathology, and macroinfarcts were associated with decline of all three phenotypes. Tau tangles were significantly associated with cognitive decline, gait function decline, and hand function decline (p<0·0001 for each); however, the association with cognitive decline persisted for more than 11 years before death, but the association with hand strength only began 3·57 years before death and the association with gait began 3·49 years before death. By contrast, the association of macroinfarcts with declining gait function began 9·25 years before death (p<0·0001) compared with 6·65 years before death (p=0·0005) for cognitive decline and 2·66 years before death (p=0·024) for decline in hand strength.
    Interpretation: Our findings suggest that average motor decline in older adults precedes cognitive decline. Macroinfarcts but not tau tangles are associated with declining gait function that precedes cognitive decline. This suggests the need for further studies to test if gait impairment is a clinical proxy for preclinical vascular cognitive impairment.
    Funding: National Institutes of Health.
    Language English
    Publishing date 2024-04-03
    Publishing country England
    Document type Journal Article
    ISSN 2666-7568
    ISSN (online) 2666-7568
    DOI 10.1016/S2666-7568(24)00033-3
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  5. Article ; Online: Racial/ethnic disparities in initiation and persistent use of anti-dementia medications.

    Zhu, Carolyn W / Neugroschl, Judith / Barnes, Lisa L / Sano, Mary

    Alzheimer's & dementia : the journal of the Alzheimer's Association

    2022  Volume 18, Issue 12, Page(s) 2582–2592

    Abstract: Background: Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear.: Methods: The study included initially untreated participants followed in National Alzheimer's Coordinating Center ... ...

    Abstract Background: Racial/ethnic disparities in anti-dementia medications use in longitudinally followed research participants are unclear.
    Methods: The study included initially untreated participants followed in National Alzheimer's Coordinating Center Uniform Data Set who were ≥65 at baseline with Alzheimer's disease dementia.
    Outcomes: Outcomes for acetylcholinesterase inhibitor (AChEI) treatment included (1) any new AChEI treatment during follow-up, and (2) persistence of treatment during follow-up categorized into: intermittent treatment (< 50% follow-ups reporting treatment), persistent (≥50% follow-ups), and always treated. Outcomes for memantine treatment were similarly constructed.
    Results: Controlling for participant characteristics, Black and Hispanic participants remained less likely than White participants to report any new AChEI or memantine treatment during follow-up. Among those who reported new treatment during follow-up, both Black and Hispanic participants were less likely than White participants to be persistently treated with AChEI and memantine.
    Discussion: Substantial racial/ethnic treatment disparities remain in controlled settings of longitudinal research in which participants have access to dementia experts, suggesting wider disparities in the larger community.
    MeSH term(s) Humans ; Memantine/therapeutic use ; Acetylcholinesterase/therapeutic use ; Racial Groups ; Alzheimer Disease/drug therapy ; Cholinesterase Inhibitors/therapeutic use ; Healthcare Disparities
    Chemical Substances Memantine (W8O17SJF3T) ; Acetylcholinesterase (EC 3.1.1.7) ; Cholinesterase Inhibitors
    Language English
    Publishing date 2022-02-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2211627-8
    ISSN 1552-5279 ; 1552-5260
    ISSN (online) 1552-5279
    ISSN 1552-5260
    DOI 10.1002/alz.12623
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  6. Article ; Online: Whitest City in America: A Smaller Black Community's Experience of Gentrification, Displacement, and Aging in Place.

    Croff, Raina / Hedmann, Monique / Barnes, Lisa L

    The Gerontologist

    2021  Volume 61, Issue 8, Page(s) 1254–1265

    Abstract: Background and objectives: The influx of people with higher socioeconomic status into large Black communities is well documented; less is known regarding smaller, aging Black communities. Older Black adults in Portland, Oregon, among America's fastest ... ...

    Abstract Background and objectives: The influx of people with higher socioeconomic status into large Black communities is well documented; less is known regarding smaller, aging Black communities. Older Black adults in Portland, Oregon, among America's fastest gentrifying cities with the smallest metropolitan Black population, discussed barriers to healthy aging. Perspectives centered on the experience of gentrification, displacement, and its impact on social microsystems, place security, and aging in place.
    Research design and methods: One-time focus groups engaged 41 Black adults aged at least 45. A demographic survey included residence area/duration. Discussions were thematically coded. Ecological Systems Theory guided interpretation.
    Results: The majority of participants resided within gentrifying historically Black neighborhoods (89.2%), were aged at least 65 (54.6%), and lived in their neighborhood for at least 21 years (24.3%). Emergent discussion themes were rise and fall of Black ownership, displacement, race-related stress, and financial burden. Gentrification contributed to the dismantling of Black property ownership curated over generations, increased financial burden, and threatened place security. Physical displacement strained social networks, diminishing intergenerational neighborhood ties that supported aging in place. Cultural and physical displacement weakened the sense of social cohesion and belonging and induced race-related stressful interactions with new residents within original and relocation neighborhoods.
    Discussion and implications: Gentrification in the Pacific Northwest echoes national trends, uprooting critical close-proximity social networks and deteriorating motivation to engage in neighborhood-based social activity. Smaller, aging Black communities may be particularly vulnerable to these effects, which critically affect aging in place. Data inform researchers and policymakers to better understand how gentrification affects smaller, aging Black communities.
    MeSH term(s) Aged ; Cities ; Housing ; Humans ; Independent Living ; Residence Characteristics ; Social Cohesion
    Language English
    Publishing date 2021-03-26
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 216760-8
    ISSN 1758-5341 ; 0016-9013
    ISSN (online) 1758-5341
    ISSN 0016-9013
    DOI 10.1093/geront/gnab041
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  7. Article ; Online: Chronic traumatic encephalopathy and aging-related tau astrogliopathy in community-dwelling older persons with and without moderate-to-severe traumatic brain injury.

    Agrawal, Sonal / Leurgans, Sue E / Barnes, Lisa L / Dams-O'Connor, Kristen / Mez, Jesse / Bennett, David A / Schneider, Julie A

    Journal of neuropathology and experimental neurology

    2024  Volume 83, Issue 3, Page(s) 181–193

    Abstract: This study examined the frequency of chronic traumatic encephalopathy-neuropathologic change (CTE-NC) and aging-related tau astrogliopathy (ARTAG) in community-dwelling older adults and tested the hypothesis that these tau pathologies are associated with ...

    Abstract This study examined the frequency of chronic traumatic encephalopathy-neuropathologic change (CTE-NC) and aging-related tau astrogliopathy (ARTAG) in community-dwelling older adults and tested the hypothesis that these tau pathologies are associated with a history of moderate-to-severe traumatic brain injury (msTBI), defined as a TBI with loss of consciousness >30 minutes. We evaluated CTE-NC, ARTAG, and Alzheimer disease pathologies in 94 participants with msTBI and 94 participants without TBI matched by age, sex, education, and dementia status TBI from the Rush community-based cohorts. Six (3%) of brains showed the pathognomonic lesion of CTE-NC; only 3 of these had a history of msTBI. In contrast, ARTAG was common in older brains (gray matter ARTAG = 77%; white matter ARTAG = 54%; subpial ARTAG = 51%); there were no differences in severity, type, or distribution of ARTAG pathology with respect to history of msTBI. Furthermore, those with msTBI did not have higher levels of PHF-tau tangles density but had higher levels of amyloid-β load (Estimate = 0.339, SE = 0.164, p = 0.040). These findings suggest that CTE-NC is infrequent while ARTAG is common in the community and that both pathologies are unrelated to msTBI. The association of msTBI with amyloid-β, rather than with tauopathies suggests differential mechanisms of neurodegeneration in msTBI.
    MeSH term(s) Humans ; Aged ; Aged, 80 and over ; Chronic Traumatic Encephalopathy/pathology ; Independent Living ; Astrocytes/pathology ; tau Proteins/metabolism ; Aging/pathology ; Brain/pathology ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/pathology ; Alzheimer Disease/pathology ; Amyloid beta-Peptides
    Chemical Substances tau Proteins ; Amyloid beta-Peptides
    Language English
    Publishing date 2024-02-01
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 3088-0
    ISSN 1554-6578 ; 0022-3069
    ISSN (online) 1554-6578
    ISSN 0022-3069
    DOI 10.1093/jnen/nlae007
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  8. Article ; Online: Everyday Discrimination Is Associated With Higher Odds of Hospitalizations Among Older African Americans.

    Lange-Maia, Brittney S / James, Bryan D / Capuano, Ana W / Grodstein, Francine / Chen, Yi / Barnes, Lisa L

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2024  Volume 79, Issue 5

    Abstract: Background: Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with ... ...

    Abstract Background: Everyday discrimination-experiences of being treated unfairly based on background characteristics like race-is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher odds of being hospitalized in older African Americans has not been explored.
    Methods: Community-dwelling participants from 3 longitudinal cohort studies (N = 446, age 65+ years) with discrimination scores and ≥12 months of linked Medicare claims were included. Hospitalizations were identified using Medicare fee-for-service claims, available for an average of 6.2 (SD: 3.7) years of follow-up after baseline.
    Results: In mixed-effects ordinal logistic regression models (outcomes of 0, 1, or 2+ hospitalizations per year) adjusted for age, sex, education, and income, higher discrimination was associated with higher odds of total annual hospitalizations (odds ratio [OR] per point higher = 1.09, 95% confidence intervals [95% CI]: 1.02-1.17). Results were similar when accounting for depressive symptoms.
    Conclusions: Higher exposure to everyday discrimination is associated with higher odds of hospitalization among older African Americans. Mechanisms underlying associations should be explored further to understand how hospitalizations may be reduced in older African Americans.
    MeSH term(s) Humans ; Male ; Hospitalization/statistics & numerical data ; Female ; Aged ; Black or African American/statistics & numerical data ; United States/epidemiology ; Longitudinal Studies ; Medicare/statistics & numerical data ; Aged, 80 and over ; Racism/statistics & numerical data ; Racism/psychology
    Language English
    Publishing date 2024-03-10
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glae089
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  9. Article ; Online: Changes in Body Mass Index and Incident Mild Cognitive Impairment Among African American Older Adults.

    Aiken-Morgan, Adrienne T / Capuano, Ana W / Wilson, Robert S / Barnes, Lisa L

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2023  Volume 79, Issue 3

    Abstract: Background: Previous research suggests a decline in body mass index (BMI) among older adults is associated with negative health outcomes, including mild cognitive impairment (MCI) and incident dementia. However, no studies have examined the effects of ... ...

    Abstract Background: Previous research suggests a decline in body mass index (BMI) among older adults is associated with negative health outcomes, including mild cognitive impairment (MCI) and incident dementia. However, no studies have examined the effects of education or developing MCI on BMI trajectories over time. The purpose of this investigation was to characterize trajectories of change in BMI among older adults who develop MCI.
    Methods: Participants were from the Minority Aging Research Study (MARS), a longitudinal cohort study of cognitive decline and Alzheimer's disease in older African Americans living in the greater Chicago, Illinois, area. The study included annual clinical evaluations of cognitive status, as well as measurements of height and weight for BMI calculation. Older African American participants without cognitive impairment at baseline were included in the present analysis (N = 436, 78% women, mean baseline age = 72 [SD = 5.7], mean education = 15 [SD = 3.5]).
    Results: In piecewise linear mixed-effects models that included a random intercept and 2 random slopes, BMI declined over time (B = -0.20, SE = 0.02, p < .001), with a faster decline after MCI diagnosis (additional decline, B = -0.15, SE = 0.06, p = .019). Older age was associated with lower baseline BMI (B = -0.19, SE = 0.05, p < .001), as was higher education (B = -0.34, SE = 0.09, p < .001). Further, higher education was associated with a slower decline in BMI before MCI (B = 0.02, SE = 0.006, p = .001), but a faster decline after MCI (B = -0.06, SE = 0.022, p = .003).
    Conclusions: These results suggest an accelerated decline in BMI following an MCI diagnosis, with higher education related to an even faster BMI decline.
    MeSH term(s) Humans ; Female ; Aged ; Male ; Body Mass Index ; Black or African American ; Longitudinal Studies ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/psychology ; Alzheimer Disease
    Language English
    Publishing date 2023-11-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glad263
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  10. Article ; Online: The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline.

    Mitchell, Uchechi A / Shaw, Benjamin A / Torres, Jacqueline M / Brown, Lauren L / Barnes, Lisa L

    The journals of gerontology. Series B, Psychological sciences and social sciences

    2023  Volume 78, Issue 12, Page(s) 2147–2155

    Abstract: Objectives: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute ... ...

    Abstract Objectives: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.
    Methods: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.
    Results: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.
    Discussion: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.
    MeSH term(s) Humans ; Middle Aged ; Black or African American ; Cognition ; Cognitive Dysfunction ; White ; Stress, Psychological
    Language English
    Publishing date 2023-10-03
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 1223664-0
    ISSN 1758-5368 ; 1079-5014
    ISSN (online) 1758-5368
    ISSN 1079-5014
    DOI 10.1093/geronb/gbad143
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