Diversity in Cognitive Aging FINAL QUIZ

What are the 2 main parts of the NIHMHD Framework & what’s within them?

1. Domains of Influence

   1. Biological

   2. Behavioral

   3. Environmental

   4. Health Care System

2. Levels of Influence:

   1. Individual

   2. Community

   3. Interpersonal

   4. Societal

3. CELLS INSIDE:

   1. determinants (causes) for a health disparity

What does the socio-ecological theory suggest?

suggests that context plays an important role in the development of health problems; context also influences whether interventions will fail or succeed

1. It posits that individual health is nested between indivdual, interpersonal, and societal relationships

What are the 4 core principle of ho the socio-ecological theory can contribute to efforts in engaging communities?:

1. Health is influenced by multiple levels (individual, interpersonal, community, society)

2. The same environment may have different effects on an individual’s health depending on a variety of factors

3. Individuals and groups operate in multiple environments that ‘spill over’ & influence each other

4. There are personal & environmental intervention points that exert vital influences on health & well-being

What is the Life Course Theory?

theory that studies the physical or social exposures during different stages of life (gestation, childhood, adolescence, young adulthood, and late adult life) to determine health outcomes; the aim is to understand how these processes influence biology & development of diseases

What is a critical period?

1. a limited time window in which an exposure can have ADVERSE, irreversible effects on health outcomes; ex: drinking during pregnancy, not correcting vision in childhood, etc

What is a sensitive period?

1. time period in which an exposure has a STRONGER effect on disease risk than it would at other times, but it is NOT permanent; ex: lead exposure during childhood

What is within the Environmental Domain of Influence?

• personal environment

• household, school / work environment

• community environment & resources

• societal structure

How does our environment impact our cognitive & brain health?

• Since this is where individuals learn, live, work, & play, elements of our physical environment may be SOMEWHAT out of our control, but they are oftentimes KEY contributors to health outcomes

  • about 23% of globals deaths are linked to environment

What are some environmental factors of influence on health?

1. housing

2. walkability

3. green space

4. rural vs urban

5. food access

6. transportation

What are the 5 group of environmental toxins that affect our brain health along with examples?

1. Antimicrobials:

   1. parabens, triclosan,

2. Toxic Metals:

   1. arsenic, lead, aluminum

3. Pesticides & Insecticides:

   1. DDT,

4. Air Pollutants:

   1. Particulate matter (dust, soot, smoke, liquid droplets, *2.5*) Noxious gases (ozone, carbon monoxide, sulfur SMOG)

5. Industrial / Commercial Chemicals:

   1. BPA, phthalates

What are the 3 theoretical models of toxin exposure + their definitions?:

1. Immediate Effects: brief exposure to a toxin causes a damage / disease quite promptly

2. Sensitive / Critical Period: exposure during an especially sensitive time is extremely influential, and after the temporal window closes, the exposure is no longer relevant

3. Cumulative biological: each exposure period induces permanent physiologic harm and increases risk for disease

What is the Geographic Information Systems (GIS) tool?

1. a tool that facilitates understanding the relationship between geographic data & health; it takes spatial info (latitude, longitude, latitude) & allows researchers to relate the geographic characteristics of this space to other important metrics of interest such as pollution levels, fatality, etc

What is the Area Deprivation Index (ADI)?:

1. a measure of neighborhood disadvantage; based on census data; allows for rankings of neighborhoods by socioeconomic disadvantage in a region of interest

What are 2 toxin exposure methods and what do they employ?

1. Community-Level Sampling: allows for the level or spread of a contamination to be measured at the community or neighborhood level (good for exploring differences between community as opposed to within a community)

2. Personal-Level Sampling: personal monitoring is though to be the GOLD STANDARD in external exposure assessment; usually entails GPS, phone, or wearable sensor-based technology

What is Residential Segregation?:

1. the intentional separation and sorting of individuals into different social & geographic areas on the basis of race & class (redlining)

What’s the worst pollutant for AD risk?

1. PM2.5 is particularly detrimental & associated with increased risk

What are some of the biological mechanisms in which environmental factors like pollution can enter and affect brain health?

1. pollutants inhaled, enter brain via olfactory pathway

2. enter indirectly through circulatory system after they penetrate lung tissue

3. both of those modes of entering cause inflammation within local tissues

4. this systematic inflammation can cause neuroinflammation & cerebrovascular damage

5. Pollutants can activate the HPA axis— activation of the stress response increase cortisol levels in the blood

6. prolonged activation of inflammatory cytokines & cortisol can alter the brain

What is precision medicine?

• personalized medicine; an innovative approach to tailoring disease prevention & intervention; it acknowledges that there are individual differences in genes, environments, & lifestyle factors; these factors play an important role in disease risk, manifestation, & treatment outcomes

What does the Personalized Medicine Model posit for AD?

1. that people with high amyloid, or inflammation should receive TARGETED treatments; treatments should be tailored to the person’s pathology. The treatments should then yield positive effects for everyone regardless of their differences in pathology due to the fact that their treatment was personalized

What are the benefits of personalized medicine?:

1. Delivering better treatments for patients—improve efficacy, overall survival, reduced adverse effects

2. Delivering benefits to healthcare systems & society—prevention & prediction of disease, delay more expensive costs, improve patient management of disease, reduce hospitalization

3. More efficient development of novel medicines—more effective clinical trials, efficient clinical trials & reduction costs, more ethical clinical trials

What are the 3 type of in-vivo biomarkers of AD as used by NIA-AD

1. Amyloid

2. Tau

3. Neurodegeneration

   1. (ATN)

What is vertical transmission of cultural identity?

the transfer of cultural elements from parents

What is oblique transmission of cultural identity?

the transfer of cultural elements from non-parental adults (could be other members of parent’s generation)

What is horizontal transmission of cultural identiy?

the transfer of cultural elements from peers

Under most conditions, which type of transmission of cultural identity is the most predominant one ?

vertical transmission; for younger children especially, BUT, social learning from teachers, friends, and other members of society becomes more salient as children grow

What are the three processes by which cultural transmission within the same culture occurs through?

1. Enculturation

2. Socialization

3. Aculturation

What are the 3 ways in which cultural identity is formed?

1. Vertical transmission

2. Oblique transmission

3. Horizontal transmission

What is enculturation?

a form of cultural transmission that occurs through PASSIVE & social learning & the developing individual gradually acquires the values, language, & core elements of the immediate culture

What is socialization?

a form of cultural transmission in through which formal instruction or the deliberate shaping of the child’s behaviors & beliefs is employed. It ensures members of the cultural group learn those attributes deemed by broader society to be an essential way of life.

What is acculturation?

a form of cultural transmission; the bidirectional process of change & accumulation that occur when 2 or more cultural groups come into direct contact; the exchange of cultural elements between members of different cultures

What is special about acculturation?

there is a continuum of assimilation, integration, marginalization, & separation that individual’s may face through acculturation from varying levels of rejection of one’s culture to having a preference for their own culture

What is assimilation, integration, marginalization, & separation?

These are acculturation strategies:

1. Assimilation — the accepting of other cultures & rejecting one’s own

2. Integration — the bicultural adoption of receiving culture & relative retention of heritage culture

3. Marginalization — rejects both cultures

4. Separation — rejects receiving culture, accept’s ones on

How is acculturation & acculturation strategies linked with health outcomes?

1. strategies are linked to mortality & chronic disease burden

   1. marginalization is generally linked to higher levels of stress & chronic disease; although there is incredible variability

What are factors that explain the variability of health outcomes in Latinos of Mexican, Puerto rican, Cuban & other cultural heritage groups in relation to heritage groups?:

1. socioeconomic status

2. educational level

3. language fluency

4. immigration status

5. the # of generations that have lived in the US

What do scales of acculturation measure?

1. engaging in culturally specific behaviors

2. proficiency & preferences for the spanish or english language

3. knowledge of culture-specific history & current events

4. a sense of cultural identity

5. Adoption & belief in culture-specific views

What have measures of acculturation in US latinos shown?

1. acculturation (assimilation) has been shown to have positive, negative, or no effect on certain health outcomes

   1. more assimilated latinos have been shown to have increased drug use, higher ETOH consumption, less nutritious diets; HOWEVER, positive effects include that more assimilated Latinos have higher rates of insurance coverage & access to healthcare

What is the difference bewteen unidimensional and bidimensional measures of acculturation?

1. unidimensional scales capture assimilation, bidimensional scales capture integration, separation, or marginalization

What is true of minority groups and AD?

they have less access to care, less awareness or knowledge of medication options, higher levels of familial responsibility & caregiving

How are test & norms a complicating factor to diagnosis & treatment of AD?

1. many tests are culturally biased or better at measuring impairment in the homogeneous populations they were developed in

2. Many norms used to interpret test scores are also normed in homogeneous population

3. cultural factors or values may impact the tests we use to make diagnostic decisions about dementia

What is true of bilingual speakers and test taking?

bilingual speakers tend to have an advantage in processing speed & executive functioning, but perform more poorly on verbal fluency tests relative to monolingual speakers

What does ECLECTIC mean & stand for?

1. Factors that impact test taking approach, performance, and clinician interpretation

   1. E — education level, quality & literacy

   2. C — culture & acculturation

   3. L — language

   4. E — economic issues

   5. C — communication style

   6. T — testing situation

   7. I — intelligence

   8. C — contexts of immigration

What physiological changes does Acute Stress Response cause?

1. Heightened senses

2. Increased respiration

3. Increased blood pressure

4. Suppressed immune system & pain response

5. Increased glucose levels

6. Suppressed growth system

7. Increases blood clotting activity

8. Interferes with the onset & sustainability of the sleep

What is the HPA axis?

the Hypothalamic-pituitary-adrenal (HPA) axis that’s responsible for:

• regulating bodily functions that include increasing glucose levels for energy

• suppressing immune response

• promoting fight or flight responses

What occurs during the

physiological during acute stress? (stress response activation)

• the amygdala (part of brain that contributes to emotional processing) sends distress signals to the hypothalamus

• the hypothalamus secretes corticotropin (CRH), which activates the pituitary gland

• the pituitary gland releases adrenocorticotropic hormone (ACTH) into the blood stream. This travels down to the adrenal glands of the kidneys

• the adrenal glands release cortisol, which helps the body to cope with stress; increasing access to glucose energy stores

What affects the stress response activation?

• threat type & duration are major factors of this activation

• the magnitude of the stress response alarm is directly proportional to the degree of perceived threat

• the magnitude of stress response will determine the length of recovery after the threat has ended

• chronic or repeated activation of this system can have profound effects on health

What are the 4 biological bodily systems are affected by stress (stress response)?

1. Neural — hyperactivation of amygdala; increased attention & memory; anxious mood state

2. Cardiovascular — increased heart rate & blood pressure

3. Immune — immune system suppression

4. Metabolic — increased glucose levels & adiposity deposits

What is the temporal course of the stress response?

1. an initial rapid increase in physiological response followed by a recovery

2. The degree of the physiological response is directly proportional to the perceived threat

What is homeostasis?

1. the ideal set of parameters at which the body is functioning; it is a steady, internal, physiological state of OPTIMAL functioning

2. characterized by normal levels of hormones, heart rate, blood pressure, glucose levels, respiration rate, etc.

What is allostasis?

1. an adaptive change in physiological functioning to respond to a threat; for example, elevated heart rate or cortisol may be needed in short-term to help the body adapt

2. During allostasis, the system is functioning outside of the IDEAL ranges, but does so temporarily for surviva;

What are the consequences of chronic stress response?

1. negative health consequences; if it is very chronic, it can lead to long-term maladaptive changes in allostasis

What are the differing effects of short-term and long-term allostasis?

1. short-term can help to overcome acute challenges & ensure survival by forcing systems to function outside their normal ranges (temporary adaptive change)

2. long-term it’s maladaptive because prolonged changes in physiological functioning are taxing on the body

What is maladaptive of allostasis?

1. repeated exposure to the same stressor can lead to a failure to habituate or adapt

What is allostatic load?

1. term used to account for the long-term cost of repeated stress & wear & tear on the body & brain

2. it is a measure of the strain on the body produced by repeated ‘ups & downs’ of physiological systems under challenge

3. these repeated changes impact a number of organs & tissues & predispose an individual to disease

4. when the elevation of cortisol & inflammatory cytokines occur chronically, it leads to hypertension, depression, arthritis, & metabolic syndrome

What has a study of allostatic load shown for the brain?

• it is associated with MORE widespread reductions in brain volume in older adults relative to other health conditions

What is structural violence?

• a way of understanding the inequities and explains how the organization of society has put individuals and populations in harm’s way

  • arrangements are structural because they are embedded in the political & economic organization of our social world; they are violent because they cause injury to people

What was the conclusion of the Tuskegee Syphilis Study?:

• during the study, penicillin was approved for treating syphilis yet researchers withheld this information from their black participants

  • led to the 1979 Belmont Report & federal laws & regulations requiring institutional review boards for the protection of human subjects in research studies

What are 3 examples of historical injustices?:

1. Sloan-Kettering Cancer Studies

2. San Antonio Contraception Study

3. Jewish chronic disease hospital

How is medical mistrust defined?

• an absence of trust that health care providers & organizations genuinely care for patients’ interest, are honest, practice confidentiality, and have the competence to produce the best possible results

What are documented consequences of medical mistrust?:

1. less likely to get care & care is delayed

2. less likely to follow medical advice

3. may miss out on critical advances in care

4. more likely to be in report of being in poor health

What are the 3 Belmont Principles + an extra?

1. Respect for persons: participants should be treated as autonomous individuals, and those with less autonomy should be afforded special protection

   1. Informed Consent: procedure by which participants learn about the study & decide whether or not they would like to participate

2. Beneficence: researchers must take protections to minimize harm to their participants & ensure their well being

3. Justice: there must be a fair balance between the kinds of people who participate in the research and the kinds of people who benefit from it

What is the difference between an anonymous study & a confidential study?

1. Anonymous — no identifying information collection

2. Confidential — identifying information is collected but carefully protected and not disclosed to others

What is the Institutional Review Board (IRB)?

1. committee responsible for interpreting ethical principles and ensuring that university researchers are abiding by these principles in their studies

What is biological determinism?

1. theory that an individual’s physical & mental characteristics are solely determined by biology (genes)

What are eugenics?

1. coined by Sir Francis Galton; denoting the scientific attempt to genetically improve the human species through selective parenthood

   1. it became a "‘science’ of white supremacy which promoted selective breeding for the purpose of ‘improving the human race’

Who was Binet & what did he do?

• he was an anti-hereditarian who denied biological determinisim

• he developed the first intelligence test for identifying children who could not learn by the ordinary methods

What where Binet’s 3 cardinal principles?

1. The scores are practical devices & they do NOT define anything innate or permanent

2. The scale is a rough empirical guide for identifying mildly retarded and learning-disabled children who need special help

3. Whatever the cause of the difficulty in children identified for help, emphasis shall be placed on improvement through special training

Who abused Binet’s test & how?

1. Henry Goddard; he wanted to use IQ tests to sort people into intellectual categories; introduced the term moron & emphasized the correlation between mental deficiency & criminality

What were the 3 types of tests given to army recruits developed by Robert Yerkes (eugenicist)

1. Army Alpha — given to literature recruits

2. Army Beta — pictorial test given to illiterates & men who failed the alpha

3. Individual Examination — given to beta failures, some version of the Binet scales

What did eugenics practices lead to in the US?

1. Forced sterilization (Buck v Bell)

What is the Flynn Effect?

• the observed rise over time in standardized intelligence test scores

• it affects the normative reference dat we use to interpret test scores

• States should correct for the Flynn affect so as to not misdiagnose due to using old norms

What is phase 1 of a clinical trial?

• tests if a new treatment is SAFE and looks for the BEST way to administer the treatment + side effects

• small group of people (20-80)

• (70& success rate)

What is phase 2 of a clinical trial?

• studies the efficacy of the drug & further study of safety

• larger group of people (100 - 300)

• 33% success

What is phase 3 of a clinical trial

• confirms its effectiveness, monitors its side effects, compares it with standard or similar treatments + dosing

• 1,000 - 3,000 participants

• (25-30% success)

What is phase 4 of the clinical trial?

1. monitors long term effectiveness + cost effectiveness, + optimal use

2. (70 - 90% success)

What was the first approved drug used to clear amyloid accumulation in brain?

1. Aduhelm

Which two clinical trial arms were involved in the Adulhelm studies?

1. ENGAGE (low dose)

2. EMERGE (high dose)

What were the primary outcomes of interest in the Aduhelm clinical trials?

1. amyloid reduction

2. cognitive decline

What was the conclusion found from the futility analyses of the Aduhelm trials?

1. the drug trial was unlikely to show positive therapeutic effects & the trial was halted in 2019

What was reported about the impact of Aduhelm on cognitive endpoints?

1. the drug had an impact on amyloid pathology but did not show a clinically significant impact on cogntion

Why was Aduhelm’s approval considered controversial by the scientific community?

1. the advisory board did NOT recommend approval, yet the FDA granted it via the accelerated pathway

What was one of the main side effects of Aduhelm was experienced by participants?

• 40% experienced brain swelling (ARIA — Amyloid-related imaging abnormalities) + headaches & falls

What were the findings from Biogen’s investor report regarding EMERGE & ENGAGE trials?

• in EMERGE, high-dose aducanumab reduced clinical decline as measured by primary & secondary endpoints, while in ENGAGE it did NOT reduce clinical decline

What is Community-Based Participatory Research (CBPR):

1. a research approach that is grounded in the needs & issues of communities, directly engages community knowledge, and enhances strategic actions leading to community transformation & social change

What are the key elements of CBPR & why should we use it?:

1. community members are involved throughout the research process, from establishing research questions to analyzing data & disseminating findings

2. this approach is rooted in equity & social justice; allowing for more collaboration especially in marginalized communities

What characterizes traditional research practices?:

1. these practices treat the community as passive subjects, follow a linear design created by academic researchers, and do NOT prioritize sustainability or community involvement

What are the levels of community engagement in research?

1. Outreach

2. Consult

3. Involve

4. Collaborate

5. Shared leadership

What are some of the cons of CBPR?

1. costly & time-consuming

2. issues with integration of the academic community with local communities

3. historical context of harm that creates hesitancy in partnerships

In the A4 clinical trial, what was the targeted participant demographic, as well as the goal of the trial? What ended up happening?

1. adults aged 65+ who were cognitively normal but amyloid positive

2. wanted at least 20% of participants to be from minoritized & ethnic groups

3. in the end, 88% of eligible participants were non-hispanic whites

What are some common recruitment sources for clinical trials?

1. Internal source (investigator practices)

2. Outside physician referrals

3. organization referrals (like Alzhemer’s association)

4. Paid advertisements

5. Earned Media

What is Sci-comm?

• refers to the practice of informing, educating, and raising awareness about science-related topics, particularly to non-specialists

What is the ADNI study and how did it’s recruitment sites differ in diversity?

1. study aimed at understanding AD progression using neuroimaging

2. despite the study being located in racially diverse cities, onlyy ONE site succeeded in effectively recruiting diverse participants through community-based outreach

What is the role of the HPA axis in the stress response?

• it regulates bodily functions like increasing glucose levels for energy, suppressing the immune response, and promoting the fight or flight response