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Article: Virtual mentalizing imagery therapy for Spanish language Latino family dementia caregivers: A feasibility and acceptability study.

Ramirez-Gomez, Liliana / Johnson, Julene K / Ritchie, Christine / Meyer, Ashley K / Tan, Emily / Madarasmi, Saira / Gutierrez-Ramirez, Paulina / Aldarondo-Hernández, Cecilianna / Mischoulon, David / Banerjee, Sreya / Jain, Felipe A

Frontiers in psychology

2023 Volume 14, Page(s) 961835

Abstract: Spanish speaking family caregivers of people living with dementia have limited supportive resources in Spanish. There are few validated, culturally acceptable virtual interventions for reducing these caregivers' psychological distress. We investigated ... ...

Abstract	Spanish speaking family caregivers of people living with dementia have limited supportive resources in Spanish. There are few validated, culturally acceptable virtual interventions for reducing these caregivers' psychological distress. We investigated the feasibility of a Spanish language adaptation of a virtual Mentalizing Imagery Therapy (MIT) program, which provides guided imagery and mindfulness training to reduce depression, increase mentalizing, and promote well-being. 12 Spanish-speaking family dementia caregivers received a 4-week virtual MIT program. Follow-up was obtained post group and at 4 months post baseline assessment. Feasibility, acceptability, and satisfaction with MIT were assessed. The primary psychological outcome was depressive symptoms; secondary outcomes included caregiver burden, dispositional mindfulness, perceived stress, well-being, interpersonal support, and neurological quality of life. Statistical analysis was performed with mixed linear models. Caregivers were 52 ± 8 (mean ± SD) years of age. 60% had a high school education or less. Participation in weekly group meetings was 100%. Home practice was performed on average 4 ± 1 times per week [range 2-5]. Satisfaction with MIT reached 19 ± 2 of a possible 20 points. Reduction in depression from baseline was observed by week three (
Language	English
Publishing date	2023-02-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2563826-9
ISSN	1664-1078
ISSN	1664-1078
DOI	10.3389/fpsyg.2023.961835
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Article ; Online: Vascular Contributions to Cognitive Impairment in Late Life.

Chui, Helena C / Ramirez Gomez, Liliana

Neurologic clinics

2017 Volume 35, Issue 2, Page(s) 295–323

Abstract: Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability ... ...

Abstract	Cerebrovascular disease (CVD) is the second leading cause of cognitive impairment in late life. Structural neuroimaging offers the most sensitive and specific biomarkers for hemorrhages and infarcts, but there are significant limitations in its ability to detect microvascular disease, microinfarcts, dynamic changes in the blood-brain barrier, and preclinical cerebrovascular disease. Autopsy studies disclose the common co-occurrence of vascular and neurodegenerative conditions, suggesting that in late life, a multifactorial approach to cognitive impairment may be more appropriate than traditional dichotomous classifications. Management of vascular risk factors remains a proven and practical approach to reducing acute and progressive cognitive impairment and dementia.
MeSH term(s)	Aging ; Cerebrovascular Disorders/complications ; Cognition Disorders/etiology ; Humans
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1013148-6
ISSN	1557-9875 ; 0733-8619
ISSN (online)	1557-9875
ISSN	0733-8619
DOI	10.1016/j.ncl.2017.01.007
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Article ; Online: Assessment of the Hispanic Cognitively Impaired Elderly Patient.

Ramirez Gomez, Liliana / Jain, Felipe A / D'Orazio, Lina M

Neurologic clinics

2017 Volume 35, Issue 2, Page(s) 207–229

Abstract: Hispanics are the largest minority group in the United States, approximately 7% of the population older than 65. They often encounter challenges related to health care access and quality of care. The prevalence of dementia among Hispanics is higher than ... ...

Abstract	Hispanics are the largest minority group in the United States, approximately 7% of the population older than 65. They often encounter challenges related to health care access and quality of care. The prevalence of dementia among Hispanics is higher than that of non-Hispanic whites and they frequently present at a more advanced stage of illness. Cognitive evaluation should take into account sociodemographic information and cultural factors to avoid misdiagnosis and guide management. A provider who has knowledge of Hispanic culture should conduct the neuropsychological assessment, and tests used to measure cognitive functioning should be developed for Hispanics in the United States.
MeSH term(s)	Aged ; Aged, 80 and over ; Aging ; Cognition Disorders/diagnosis ; Cognition Disorders/epidemiology ; Cognition Disorders/ethnology ; Dementia/diagnosis ; Hispanic Americans ; Humans ; Neuropsychological Tests
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1013148-6
ISSN	1557-9875 ; 0733-8619
ISSN (online)	1557-9875
ISSN	0733-8619
DOI	10.1016/j.ncl.2017.01.003
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Article ; Online: Four-Week Mentalizing Imagery Therapy for Family Dementia Caregivers: A Randomized Controlled Trial with Neural Circuit Changes.

Jain, Felipe A / Chernyak, Sergey V / Nickerson, Lisa D / Morgan, Stefana / Schafer, Rhiana / Mischoulon, David / Bernard-Negron, Richard / Nyer, Maren / Cusin, Cristina / Ramirez Gomez, Liliana / Yeung, Albert

Psychotherapy and psychosomatics

2022 Volume 91, Issue 3, Page(s) 180–189

Abstract: Introduction: Family caregivers of patients with dementia suffer a high burden of depression and reduced positive emotions. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery skills training to improve balanced mentalizing and ... ...

Abstract	Introduction: Family caregivers of patients with dementia suffer a high burden of depression and reduced positive emotions. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery skills training to improve balanced mentalizing and emotion regulation. Objective: Our aims were to test the hypotheses that MIT for family caregivers would reduce depression symptoms and improve positive psychological traits more than a support group (SG), and would increase dorsolateral prefrontal cortex (DLPFC) connectivity and reduce subgenual anterior cingulate cortex (sgACC) connectivity. Methods: Forty-six caregivers participated in a randomized controlled trial comparing a 4-week MIT group (n = 24) versus an SG (n = 22). Resting state neuroimaging was obtained at baseline and post-group in 28 caregivers, and questionnaires completed by all participants. The primary outcome was change in depression; secondary measures included anxiety, mindfulness, self-compassion, and well-being. Brain networks with participation of DLPFC and sgACC were identified. Connectivity strengths of DLPFC and sgACC with respective networks were determined with dual regression. DLPFC connectivity was correlated with mindfulness and depression outcomes. Results: MIT significantly outperformed SG in improving depression, anxiety, mindfulness, self-compassion, and well-being, with moderate to large effect sizes. Relative to SG, participants in MIT showed significant increases in DLPFC connectivity - exactly replicating pilot study results - but no change in sgACC. DLPFC connectivity change correlated positively with mindfulness and negatively with depression change. Conclusions: In this trial, MIT was superior to SG for reducing depression and anxiety symptoms and improving positive psychological traits. Neuroimaging results suggested that strengthening DLPFC connectivity with an emotion regulation network might be mechanistically related to MIT effects.
MeSH term(s)	Caregivers ; Dementia ; Humans ; Imagery, Psychotherapy ; Magnetic Resonance Imaging ; Mentalization ; Mindfulness/methods ; Pilot Projects ; Prefrontal Cortex/diagnostic imaging
Language	English
Publishing date	2022-03-14
Publishing country	Switzerland
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	209490-3
ISSN	1423-0348 ; 0033-3190
ISSN (online)	1423-0348
ISSN	0033-3190
DOI	10.1159/000521950
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Article ; Online: Olfactory Function and Markers of Brain Pathology in Non-Demented Individuals with Autosomal Dominant Alzheimer's Disease.

Ramirez-Gomez, Liliana / Albers, Mark W / Baena, Ana / Vila-Castelar, Clara / Fox-Fuller, Joshua T / Sanchez, Justin / Jain, Felipe / Albers, Alefiya D / Lopera, Francisco / Quiroz, Yakeel T

Journal of Alzheimer's disease : JAD

2022 Volume 88, Issue 2, Page(s) 721–729

Abstract: Background: Olfactory dysfunction is one of the earliest signs of Alzheimer's disease (AD), highlighting its potential use as a biomarker for early detection. It has also been linked to progression from mild cognitive impairment (MCI) to dementia.: ... ...

Abstract	Background: Olfactory dysfunction is one of the earliest signs of Alzheimer's disease (AD), highlighting its potential use as a biomarker for early detection. It has also been linked to progression from mild cognitive impairment (MCI) to dementia. Objective: To study olfactory function and its associations with markers of AD brain pathology in non-demented mutation carriers of an autosomal dominant AD (ADAD) mutation and non-carrier family members. Methods: We analyzed cross-sectional data from 16 non-demented carriers of the Presenilin1 E280A ADAD mutation (mean age [SD]: 40.1 [5.3], and 19 non-carrier family members (mean age [SD]: 36.0 [5.5]) from Colombia, who completed olfactory and cognitive testing and underwent amyloid and tau positron emission tomography (PET) imaging. Results: Worse olfactory identification performance was associated with greater age in mutation carriers (r = -0.52 p = 0.037). In carriers, worse olfactory identification performance was related to worse MMSE scores (r = 0.55, p = 0.024) and CERAD delayed recall (r = 0.63, p = 0.007) and greater cortical amyloid-β (r = -0.53, p = 0.042) and tau pathology burden (entorhinal: r = -0.59, p = 0.016; inferior temporal: r = -0.52, p = 0.038). Conclusion: Worse performance on olfactory identification tasks was associated with greater age, a proxy for disease progression in this genetically vulnerable ADAD cohort. In addition, this is the first study to report olfactory dysfunction in ADAD mutation carriers with diagnosis of MCI and its correlation with abnormal accumulation of tau pathology in the entorhinal region. Taken together, our findings suggest that olfactory dysfunction has promise as an early marker of brain pathology and future risk for dementia.
MeSH term(s)	Alzheimer Disease/diagnostic imaging ; Alzheimer Disease/genetics ; Amyloid beta-Peptides/metabolism ; Biomarkers ; Brain/pathology ; Cognitive Dysfunction/diagnostic imaging ; Cognitive Dysfunction/genetics ; Cognitive Dysfunction/pathology ; Cross-Sectional Studies ; Humans ; Magnetic Resonance Imaging/methods ; Olfaction Disorders/etiology ; Olfaction Disorders/genetics ; Positron-Emission Tomography/methods ; tau Proteins/genetics ; tau Proteins/metabolism
Chemical Substances	Amyloid beta-Peptides ; Biomarkers ; tau Proteins
Language	English
Publishing date	2022-06-30
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-220075
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Article: Clinical and imaging features of mixed Alzheimer and vascular pathologies.

Chui, Helena C / Ramirez-Gomez, Liliana

Alzheimer's research & therapy

2015 Volume 7, Issue 1, Page(s) 21

Abstract: The co-occurrence of both Alzheimer disease (AD) pathology and vascular brain injury (VBI) is very common, especially amongst the oldest of old. In neuropathologic studies, the prevalence of AD, VBI, and mixed AD/VBI lesions ranks ahead of Lewy bodies ... ...

Abstract	The co-occurrence of both Alzheimer disease (AD) pathology and vascular brain injury (VBI) is very common, especially amongst the oldest of old. In neuropathologic studies, the prevalence of AD, VBI, and mixed AD/VBI lesions ranks ahead of Lewy bodies and hippocampal sclerosis. In the modern era of structural magnetic resonance imaging (MRI) and amyloid positron emission tomography (PET) imaging, this review examines 1) the prevalence of mixed AD and VBI pathology, 2) the significance of these pathologies for cognitive impairment (AD and vascular cognitive impairment (VCI)), and 3) the diagnosis and treatment of mixed AD/VCI. Although epidemiologic studies report that vascular risk factors for arteriosclerosis increase the risk of incident AD, both autopsy and amyloid PET studies indicate that AD and VBI contribute additively, but independently, to the risk of dementia. The literature confirms the malignancy of AD and highlights the adverse effects of microinfarcts on cognitive function. For the clinical diagnosis of mixed AD/VCI, the presence of AD can be recognized by neuropsychological profile, structural imaging, cerebrospinal fluid biomarkers, and glucose PET and amyloid PET imaging. The diagnosis of VBI, however, still hinges predominantly on the structural MRI findings. Severe amnesia and atrophy of the hippocampus are characteristic of early AD, whereas the cognitive profile for VCI is highly variable and dependent on size and location of VBI. The cognitive profile of mixed AD/VBI is dominated by AD. With the notable exception of microinfarcts (which elude in vivo detection), infarcts, hemorrhages, and white matter hyperintensities on structural MRI currently represent the best markers for the presence VBI. Better markers that reflect the health and reactivity of intracerebral blood vessels are needed. For prevention and treatment, the type of underlying cerebrovascular disease (for example, arteriosclerosis or cerebral amyloid angiopathy) should be considered. It is likely that reduction of vascular risk factors for arteriosclerosis can significantly reduce vascular contributions to mixed dementia.
Language	English
Publishing date	2015
Publishing country	England
Document type	Journal Article
ZDB-ID	2506521-X
ISSN	1758-9193
ISSN	1758-9193
DOI	10.1186/s13195-015-0104-7
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Article ; Online: Mentalizing imagery therapy to augment skills training for dementia caregivers: Protocol for a randomized, controlled trial of a mobile application and digital phenotyping.

Jain, Felipe A / Okereke, Olivia / Gitlin, Laura / Pedrelli, Paola / Onnela, Jukka-Pekka / Nyer, Maren / Ramirez Gomez, Liliana A / Pittman, Michael / Sikder, Abu / Ursal, D J / Mischoulon, David

Contemporary clinical trials

2022 Volume 116, Page(s) 106737

Abstract: More than 50 million people worldwide live with a dementia, and most are cared for by family members. Family caregivers often experience chronic stress and insomnia, resulting in decreased mental and physical health. Accessibility of in-person stress ... ...

Abstract	More than 50 million people worldwide live with a dementia, and most are cared for by family members. Family caregivers often experience chronic stress and insomnia, resulting in decreased mental and physical health. Accessibility of in-person stress reduction therapy is limited due to caregiver time constraints and distance from therapy sites. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery tools to reduce stress, promote self and other understanding, and increase feelings of interconnectedness. Combining MIT with caregiver skills training might enable caregivers to both reduce stress and better utilize newly learned caregiving skills, but this has never been studied. Delivering MIT through a smartphone application (App) has the potential to overcome difficulties with scalability and dissemination and offers caregivers an easy-to-use format. Harnessing passive smartphone data provides an important opportunity to study behavioral changes continuously and with higher granularity than routine clinical assessments. This protocol describes a randomized, controlled, superiority trial in which 120 family dementia caregivers, aged 60 years or older, will be assigned to smartphone App delivery of caregiver skills with MIT (experimental condition) or without MIT (control condition). The primary objectives of the trial are to assess whether the experimental condition is superior to control on reducing family caregiver stress, insomnia and related outcomes and to demonstrate the feasibility of developing behavioral markers from passive smartphone data that predict health outcomes in older adults. Trial outcomes may inform the suitability of our intervention for caregivers and provide new methods for assessment of older adults.
MeSH term(s)	Aged ; Caregivers/education ; Dementia/therapy ; Humans ; Imagery, Psychotherapy ; Mentalization ; Mobile Applications ; Quality of Life ; Randomized Controlled Trials as Topic ; Sleep Initiation and Maintenance Disorders/therapy
Language	English
Publishing date	2022-03-21
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2022.106737
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Article ; Online: Associations Among Loneliness, Purpose in Life and Subjective Cognitive Decline in Ethnoracially Diverse Older Adults Living in the United States.

Pluim, Celina F / Anzai, Juliana A U / Martinez, Jairo E / Munera, Diana / Garza-Naveda, Ana Paola / Vila-Castelar, Clara / Guzmán-Vélez, Edmarie / Ramirez-Gomez, Liliana / Bustin, Julian / Serrano, Cecilia M / Babulal, Ganesh M / Okada de Oliveira, Maira / Quiroz, Yakeel T

Journal of applied gerontology : the official journal of the Southern Gerontological Society

2022 Volume 42, Issue 3, Page(s) 376–386

Abstract: Subjective cognitive decline (SCD), which precedes Mild Cognitive Impairment and dementia, may be affected by purpose in life (PiL) and loneliness in older adults. We investigated associations among PiL, loneliness, and SCD in US Latino ( ...

Abstract	Subjective cognitive decline (SCD), which precedes Mild Cognitive Impairment and dementia, may be affected by purpose in life (PiL) and loneliness in older adults. We investigated associations among PiL, loneliness, and SCD in US Latino (
MeSH term(s)	Aged ; Humans ; Cognitive Dysfunction/epidemiology ; Cognitive Dysfunction/psychology ; Dementia/epidemiology ; Loneliness/psychology ; United States/epidemiology
Language	English
Publishing date	2022-11-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	155897-3
ISSN	1552-4523 ; 0733-4648
ISSN (online)	1552-4523
ISSN	0733-4648
DOI	10.1177/07334648221139479
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Article ; Online: Waning locus coeruleus integrity precedes cortical tau accrual in preclinical autosomal dominant Alzheimer's disease.

Jacobs, Heidi I L / Becker, John Alex / Kwong, Kenneth / Munera, Diana / Ramirez-Gomez, Liliana / Engels-Domínguez, Nina / Sanchez, Justin S / Vila-Castelar, Clara / Baena, Ana / Sperling, Reisa A / Johnson, Keith A / Lopera, Francisco / Quiroz, Yakeel T

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

2022 Volume 19, Issue 1, Page(s) 169–180

Abstract: Introduction: Autopsy studies recognize the locus coeruleus (LC) as one of the first sites accumulating tau in Alzheimer's disease (AD). Recent AD work related in vivo LC magnetic resonance imaging (MRI) integrity to tau and cognitive decline; however, ... ...

Abstract	Introduction: Autopsy studies recognize the locus coeruleus (LC) as one of the first sites accumulating tau in Alzheimer's disease (AD). Recent AD work related in vivo LC magnetic resonance imaging (MRI) integrity to tau and cognitive decline; however, relationships of LC integrity to age, tau, and cognition in autosomal dominant AD (ADAD) remain unexplored. Methods: We associated LC integrity (3T-MRI) with estimated years of onset, cortical amyloid beta, regional tau (positron emission tomography [PET]) and memory (Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word-List-Learning) among 27 carriers and 27 non-carriers of the presenilin-1 (PSEN1) E280A mutation. Longitudinal changes between LC integrity and tau were evaluated in 10 carriers. Results: LC integrity started to decline at age 32 in carriers, 12 years before clinical onset, and 20 years earlier than in sporadic AD. LC integrity was negatively associated with cortical tau, independent of amyloid beta, and predicted precuneus tau increases. LC integrity was positively associated with memory. Discussion: These findings support LC integrity as marker of disease progression in preclinical ADAD.
MeSH term(s)	Adult ; Humans ; Alzheimer Disease/diagnostic imaging ; Alzheimer Disease/genetics ; Amyloid beta-Peptides/metabolism ; Cognitive Dysfunction ; Locus Coeruleus ; Mutation/genetics ; Positron-Emission Tomography/methods ; Presenilin-1/genetics ; tau Proteins/genetics ; tau Proteins/metabolism
Chemical Substances	Amyloid beta-Peptides ; Presenilin-1 ; tau Proteins
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2211627-8
ISSN	1552-5279 ; 1552-5260
ISSN (online)	1552-5279
ISSN	1552-5260
DOI	10.1002/alz.12656
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Article ; Online: Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group.

Tanev, Kaloyan S / Camprodon, Joan A / Caplan, David N / Dickerson, Bradford C / Chemali, Zeina / Eldaief, Mark C / Kim, David Dongkyung / Josephy-Hernandez, Sylvia E / Kritzer, Michael D / Moo, Lauren R / Newhouse, Amy / Perez, David L / Ramirez Gomez, Liliana A / Razafsha, Mahdi / Rivas-Grajales, Ana Maria / Scharf, Jeremiah M / Schmahmann, Jeremy D / Sherman, Janet C

The Journal of neuropsychiatry and clinical neurosciences

2023 Volume 36, Issue 2, Page(s) 87–100

Abstract: Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & ...

Abstract	Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.
MeSH term(s)	Humans ; COVID-19 ; Neuropsychiatry ; Hospitals, General ; Pandemics ; Activities of Daily Living ; Telemedicine ; Neurology ; Massachusetts ; Cognition
Language	English
Publishing date	2023-12-19
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1036340-3
ISSN	1545-7222 ; 0895-0172
ISSN (online)	1545-7222
ISSN	0895-0172
DOI	10.1176/appi.neuropsych.20220154
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