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Introduction We examined the ability of plasma hyperphosphorylated tau (p-tau)181 to detect cognitive impairment due to Alzheimer's disease (AD) independently and in combination with plasma total tau (t-tau) and neurofilament light (NfL). Methods Plasma samples were analyzed using the Simoa platform for 235 participants with normal cognition (NC), 181 with mild cognitive impairment due to AD (MCI), and 153 with AD dementia. Statistical approaches included multinomial regression and Gaussian graphical models (GGMs) to assess a network of plasma biomarkers, neuropsychological tests, and demographic variables. Results Plasma p-tau181 discriminated AD dementia from NC, but not MCI, and correlated with dementia severity and worse neuropsychological test performance. Plasma NfL similarly discriminated diagnostic groups. Unlike plasma NfL or t-tau, p-tau181 had a direct association with cognitive diagnosis in a bootstrapped GGM. Discussion These results support plasma p-tau181 for the detection of AD dementia and the use of blood-based biomarkers for optimal disease detection.

Clinical Alzheimer’s disease (AD) trials currently face a critical shortfall of thousands of eligible participants, which inflates the duration and cost of the clinical study as well as threatens the scientific merit of promising clinical interventions. This recruitment crisis is further compounded by the fact that underrepresented and marginalized populations—particularly those identifying as a racial or ethnic minority, those with low socioeconomic status, or living in rural areas—have been historically underrepresented in ongoing AD clinical trials despite overwhelming evidence that such populations are at increased risk for developing dementia. As a result of various recruitment barriers, current AD clinical studies frequently reflect a decreasingly representative segment of the US population, which threatens the overall generalizability of these findings. The current narrative review provides an updated examination and critique of common recruitment barriers and potential solutions, as well as a discussion of theoretical approaches that may address barriers disproportionately experienced by underrepresented communities. AD clinical researchers are encouraged to take purposive action aimed at increasing diversity of enrolled AD clinical trial cohorts by actively identifying and quantifying barriers to research participation—especially recruitment barriers and health disparities that disproportionately prevent underrepresented and marginalized populations from participating in research. Furthermore, researchers are encouraged to closely track which individuals who express interest in AD research ultimately enroll in research studies to examine whether AD research participation is appropriately representative of the intended population for whom these new and novel AD interventions are being designed.

Objectives To determine whether the measurement properties of the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted as 2 outcome measures in the Veterans Health Administration (VHA) National Polytrauma Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain injury (mTBI). Design Cross-sectional. Setting Outpatient rehabilitation. Participants Postdeployment veterans with blast-related mTBI (N=177). Intervention Not applicable. Main Outcome Measures Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and Community Integration Questionnaire (CIQ). Results The unidimensional factor structure of the MPAI-4 total and 3 index scores (abilities, adjustment, participation) were confirmed. Eight of the 30 items were removed for violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale was collapsed from 5 to 3 ratings because of structure issues. The remaining 22 MPAI-4 items demonstrated excellent item/person reliability (0.98/0.91) and separated person ability into 4 strata. Two of the MPAI-4 index scores (abilities and adjustment) had good measurement properties. The third index, M2PI, retained only 3 items that had adequate person reliability (0.75) but separated person ability into only 2 strata. A significant but fair association with the CIQ was demonstrated with the modified MPAI-4. Conclusions The MPAI-4 has been validated in moderate to severe traumatic brain injury but required modification when used in active military personnel with mTBI. We also identified the need for modification of the MPAI-4 to support adequate psychometrics when measuring outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans and active military personnel with mTBI, to determine whether the M2PI should continue to be used as an outcome measure in the VHA polytrauma rehabilitation systems.

We investigated the imagination inflation effect in healthy older adults and older adults with mild cognitive impairment (MCI) to determine whether an intervention can reduce susceptibility to these distortions, with implications for daily functioning.Fifty-seven older adults aged 69-90 participated. In Session 1, participants either: listened to an action statement being read, performed the action, or imagined performing the action. Actions were eitherMemory was worse for functional compared to nonfunctional actions. For older adults with MCI, the intervention increased correct identifications of functional actions that were performed. For healthy older adults, the intervention increased source memory of functional actions that were imagined. The intervention did not impact the accuracy of nonfunctional actions or the rates of misremembering an action as having been performed.These initial findings supported the efficacy of a cue-utilization intervention to improve memory for functional actions in an imagination inflation effect paradigm in community-dwelling older adults. The use of such strategies represents an important first step in designing interventions that are applicable to daily life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In response to the needs of dementia caregivers during the COVID-19 pandemic, the NYU Langone Alzheimer's Disease and Related Disorders Family Support Program (FSP) quickly transitioned to providing most services online. To understand how dementia caregivers experienced FSP services after the switch to video telehealth, we conducted qualitative interviews of spouse or partner dementia caregivers.Ten participants were recruited from a convenience sample of dementia spouse or partner caregivers who used one or more online FSP services offered during the pandemic.Caregivers engaged in semi-structured interviews held via videoconference between May and June 2020. Qualitative analysis of interviews was conducted according to the principles of framework analysis.Caregivers reported high satisfaction with the FSP pre-pandemic and continued to feel supported when services were provided online. They transitioned to video telehealth services with little difficulty.While video telehealth is frequently cited as beneficial for those in rural communities, socioeconomically disadvantaged groups, or homebound individuals, our findings suggest that video telehealth is also advantageous for dementia caregivers, given their unique barriers, including lack of time due to caregiving responsibilities, lack of respite care for the person with dementia, and the additional burdens of travel time to access in-person services.

Dementia disrupts a number of brain chemicals, and medications may be helpful to restore the balance of these neurotransmitters. When considering a new medication, it is important to set clear, measurable goals; start with a low dose; and track the effects over time. Cholinesterase inhibitors help with memory, mood, behavioral problems, and hallucinations; memantine helps with attention, alertness, mood, and behavioral problems; selective serotonin reuptake inhibitors (SSRIs) help with mood, anxiety, and behavioral problems; dextromethorphan/quinidine helps with inappropriate laughing or crying as well as behavioral problems; melatonin and acetaminophen help with sleep; atypical neuroleptics help with agitation, aggression, delusions, hallucinations, and picking; carbidopa/levodopa helps with walking, movement, and parkinsonian tremors; and beta blockers help with essential tremor. Clinical trials of new medications being developed may be available for those who are looking for better treatments for their loved one and for the next generation.

Whether caused by dementia or an eye disease, problems with vision can disrupt your loved one’s function, create hallucinations, and even lead them to think you are an imposter. There are, however, many things you can do to help. Start with an eye examination to make sure their eyeglasses prescription is correct and to look for treatable diseases. Ensure adequate lighting in and around their home and increase visual cues in potentially hazardous areas, such as stairs. Adjust for difficulty seeing or paying attention on one side. Increase visual contrast and size of numbers and letters for their daily activities. Use navigation systems with audible directions. Reduce the impact of hallucinations. Lastly, manage difficulties when your loved one does not recognize you, thinks you are someone else, or believes that you have been replaced by an imposter.

It is important to address your loved one’s emotional problems. Learn to recognize the signs of depression and anxiety. Common symptoms of depression include feelings of sadness, worthlessness or guilt; fixating on past failures; being tearful; irritability or frustration, even over small matters; memory difficulties; trouble concentrating; sleep difficulties; daytime fatigue and lack of energy; changes in appetite; often wanting to stay home; physical slowing; physical aches or pains; loss of interest in activities; loss of interest in sex; loss of interest in living; hopelessness about the future; frequent thoughts of death. Help them to deal with the sadness and frustration that often come with declining abilities. Start by improving your loved one’s abilities and adjust tasks to make them easier. Treat depression and anxiety with aerobic exercise, meditation, relaxation, and talk therapy.

Dementia is the term used to describe progressive impairment of thinking and memory that interferes with daily function. Dementia is not a specific disorder; rather, it is a condition with many causes. Alzheimer’s disease is the most common cause of dementia. Other common causes of dementia include vascular dementia, dementia with Lewy bodies, primary progressive aphasia which comes in the logopenic, semantic, and nonfluent/agrammatic variants, behavioral variant frontotemporal dementia, and normal pressure hydrocephalus. Primary care providers are able to diagnose most straightforward cases of dementia, whereas specialists such as neuropsychologists, neurologists, psychiatrists, and geriatricians may be needed when the diagnosis is not straightforward.

There are many way to help manage your loved one’s memory problems. If their dementia is fairly mild, memory strategies and aids can often help. Using a pillbox or another method to ensure that medications are being taken correctly is critical. Pictures are more easily learned than words. Don’t tell a person with dementia what not to do; tell them what they should do. Habits and routines are generally preserved in dementia, and new ones can be learned. Use methods to make sure the stove is not left on and the water is not left running. Work to eliminate wandering and write a plan in case it occurs. Take advantage of technological solutions to memory problems. Use reminders of the past to make your loved one feel more at home. Don’t fight false memories. Lastly, reminding your loved one that they have memory problems is rarely helpful.

Alzheimer’s is a disease in which amyloid plaques build up in the brain. The plaques damage brain cells, the cells develop tangles, and the tangles destroy the cells. Alzheimer’s disease begins silently and progresses through very mild, mild, moderate, and severe stages. Age, being a woman, and family history are risk factors for the disease. Tests using a lumbar puncture or PET scan can help to confirm the diagnosis of Alzheimer’s disease, but they are only used in special circumstances. Lastly, you can reduce your risk of developing Alzheimer’s disease by eating a Mediterranean-style diet, engaging in aerobic exercise, and staying socially active.

No one person can manage the demands of dementia alone. Building a strong care team early following a diagnosis is critical to your wellbeing and to providing your loved one with the best care. By reaching out to family, friends, neighbors, and professional caregivers, you can limit your burden, reduce your feelings of isolation, and create a healthier environment for you and your loved one. Your loved one’s doctor should be a source of help as well. Support groups can provide you with information and important skills in addition to emotional support. Whether as a day program or overnight stay, respite care may be an invaluable resource for you. National organizations dedicated to Alzheimer’s disease and dementia can also be an invaluable resource.

Caregivers experience higher rates of emotional and physical illness. They are often so focused on taking good care of others that they put themselves last. This is particularly true for the sandwich generation caring for aging parents and growing children. Remember, you can’t pour from an empty cup. In order to care for others, you must take care of yourself. This means scheduling time for your physical and emotional health. Exercise regularly. Sleep well. Eat a healthy diet. Limit alcohol intake. Get medical care. Maintain your social connections. Take time for yourself. Learn relaxation techniques. Seek professional help when needed. Look for the joys of caregiving.

Although discussing the death of your loved one may be uncomfortable, we believe it is best to be prepared. Have conversations with your loved one about the end of their life. Consider hospice and palliative care, the death itself, the ceremony, and what should be done with their body and brain. Think about whether you wish to be present at the death. Managing grief and preparing for your future after your loved one has died are important. Find the resources you need to cope with the many emotions you may feel during the grieving process. Build a life for yourself after caregiving.

As your loved one begins to experience more problems with thinking and memory, they will need help managing their health care, finances, and other aspects of daily living. They may need to leave their home in order to receive the amount or type of care they require. Preparing legal documents such as a will, power of attorney, and health care proxy is an important step in planning for the future. Having conversations with your loved one early after a diagnosis ensures that they can participate in future planning as much as possible, easing your burden as increased care is required. Even if they don’t want to participate, you can still explore options so you will be ready when a crisis occurs.

When you get a good night’s rest, you’re better able to tackle the most challenging dementia issues. On the other hand, when your sleep is poor, even small difficulties can cause you to feel frustrated and irritable. And if that’s true for you with a healthy brain, think about how important sleep is for your loved one with dementia. Poor sleep can cause many problems in those with dementia—not to mention often disrupting your own sleep! Although sleep problems are common in dementia, most of them can be managed without medications. Start by using a sleep log. Work to improve your loved one’s sleep habits and modify their daily routines to improve sleep. Be alert for disorders such as sleep apnea and abnormal sleep movements; let your loved one’s doctor know if you suspect them.

Objective:To measure caregivers’ and clinicians’ perception of false memories in the lives of patients with memory loss due to Alzheimer’s disease (AD) and mild cognitive impairment (MCI) using a novel false memories questionnaire. Our hypotheses were that false memories are occurring as often as forgetting according to clinicians and family members.Method:This prospective, questionnaire-based study consisting of 20 false memory questions paired with 20 forgetting questions had two forms: one for clinicians and the other for family members of older subjects. In total, 226 clinicians and 150 family members of 49 patients with AD, 44 patients with MCI, and 57 healthy older controls (OCs) completed the questionnaire.Results:False memories occurred nearly as often as forgetting according to clinicians and family members of patients with MCI and AD. Family members of OCs and patients with MCI reported fewer false memories compared to those of the AD group. As Mini-Mental State Examination scores decreased, the mean score increased for both forgetting and false memories. Among clinicians, correlations were observed between the dementia severity of patients seen with both forgetting and false memories questionnaire scores as well as with the impact of forgetting and false memories on daily life.Conclusion:Patients with AD experience false memories almost as frequently as they do forgetting. Given how common false memories are in AD patients, additional work is needed to understand the clinical implications of these false memories on patients’ daily lives. The novel false memories questionnaire developed may be a valuable tool.

Objectives:To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.Design:Cross-sectional survey.Setting:13 geographically dispersed Alzheimer’s Disease Centers across the United States.Participants:431 racially diverse caregivers of persons with dementia.Measurements:Survey on “Care Planning for Individuals with Dementia.”Results:The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.Conclusions:Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.

INTRODUCTION: We examined the ability of plasma hyperphosphorylated tau (p-tau)(181) to detect cognitive impairment due to Alzheimer’s disease (AD) independently and in combination with plasma total tau (t-tau) and neurofilament light (NfL). METHODS: Plasma samples were analyzed using the Simoa platform for 235 participants with normal cognition (NC), 181 with mild cognitive impairment due to AD (MCI), and 153 with AD dementia. Statistical approaches included multinomial regression and Gaussian graphical models (GGMs) to assess a network of plasma biomarkers, neuropsychological tests, and demographic variables. RESULTS: Plasma p-tau(181) discriminated AD dementia from NC, but not MCI, and correlated with dementia severity and worse neuropsychological test performance. Plasma NfL similarly discriminated diagnostic groups. Unlike plasma NfL or t-tau, p-tau(181) had a direct association with cognitive diagnosis in a bootstrapped GGM. DISCUSSION: These results support plasma p-tau(181) for the detection of AD dementia and the use of blood-based biomarkers for optimal disease detection.

Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families explains everything that a family member or other caregiver needs to care for their loved one with Alzheimer’s disease or another dementia, all the way from the mild stage through death—and beyond. It begins by explaining Alzheimer’s and dementia, and how to manage problems with memory, language, vision, emotion, behavior, sleep, and bodily functions. Next discussed are which medications help—and which make things worse. Caring for yourself and building a care team are then covered, as well as how to sustain your relationship. Final chapters discuss the progression of dementia, the eventual death, and how to plan for life afterward. It is written in an easy-to-read style, featuring clinical vignettes and character-based stories that provide real-life examples of how to successfully manage Alzheimer’s disease and dementia.

Behavioral problems are among the most difficult ones you may face caring for your loved one with dementia. The good news is that there are many approaches you can use to reduce unwanted behaviors and encourage positive ones. Conquer apathy with routines. Sidestep willfulness with small steps. Use the ABCs of Behavior Change, 4Rs, and Three Time Principles to manage agitation, aggression, combativeness, and inappropriate/disinhibited behavior. Stay safe by giving away or securing guns, power tools, and knives. Remember to call for help or leave a dangerous situation when you need to. Know how to stay safe in the car when you’re driving, and stop your loved one from driving when necessary. Deal with sundowning and challenging interactions outside of the home. Manage jealousy and paranoia. Finally, consider helping your loved one to feel more comfortable with soothing and familiar music, pleasing scents, stuffed animals, and real or robotic pets.

Although language may become impaired by dementia, communication with your loved one is still possible. Speak clearly and slowly in a quiet environment. Help them obtain hearing aids, if needed. Reading and writing may be beneficial for those who have hearing or speech problems and mild dementia. Speech therapy may also benefit those with mild dementia and trouble talking. Pictures can often compensate for a variety of comprehension and communication problems. Gestures, body language, facial expression, tone of voice, and other nonlinguistic and nonverbal communication can be useful, both in person and over a video phone. Lastly, remember that emotional communication is often preserved in dementia.

Many medications may cause memory impairment, drowsiness, and confusion. Make sure that you know and keep track of all the medications your loved one is taking, including prescriptions, over-the-counter medications, vitamins, herbs, and supplements. Review these medications with their doctor. When possible, stop or lower the dose of medications that are causing problems. There are a variety of medications that can produce impairments in thinking and memory, including anticholinergic medications; antidepressants; antihistamines; antipsychotics; anxiety medications (benzodiazepines); dizziness and vertigo medications; incontinence medications (antispasmodics); migraine medications; muscle relaxants; narcotics (opioids); nausea, stomach, and bowel medications; seizure medications (anticonvulsants); sleeping medications; tremor medications; and herbal remedies. Consider anesthesia and cancer treatments carefully. Lastly, note that cholesterol-lowering medications do not cause memory problems.

Despite the challenges of dementia, it is important to continue to have fun with your loved one and nurture your relationship. Engaging in pleasant activities is a great way to remain connected. These activities can also help to reduce behavioral problems, boost mood, and even improve functioning in your loved one. Engaging in activities with your loved one can also help reduce burden and stress on you. Although your loved one may have trouble doing some of the things they enjoyed before their dementia, there are a variety of activities that they can still participate in. Some activities may be variations on things they used to enjoy and others may be entirely new. We encourage you to take time to engage in pleasant activities with your loved one on a regular basis.

Although dementia can disrupt many bodily functions, there are ways you can help your loved one and yourself. Determine the cause of any falls and work proactively to prevent future ones. If their walking is impaired, work with a physical therapist to improve it. To reduce incontinence, use a toileting schedule, decrease fluid intake before bed, and plan ahead when you go on outings. Make meals more enticing by increasing the flavor and spice of food. Use heavy silverware and mugs to dampen tremors. Improve swallowing and reduce choking by altering the consistency of solid foods and liquids and consider a swallowing evaluation. Reduce the difficulties inherent in activities requiring skilled or complicated movements to the extent possible. Lessen scratching and picking by treating medical problems and dry skin; cover the arms if needed.

There are many activities that you can enjoy with your loved one. Visiting museums, attending the theater, watching movies, and listening to music are just a few. You may both enjoy having a massage, strolling on a nature walk, or filling in an adult coloring book—even if you never pursued such pastimes before. Exercise is good for everyone and is a wonderful way to spend time with your loved one. Most people enjoy the touch and warmth of human contact and, for couples, sexual intimacy can be an important aspect of your relationship. Lastly, participating in meaningful activities—including research, advocacy, and providing support to others—can provide an important sense of purpose in life for you and your loved one.

Dementia is the term used to describe progressive impairment of thinking and memory that interferes with daily function. Dementia is not a specific disorder; rather, it is a condition with many causes. Alzheimer’s disease is the most common cause of dementia. Other common causes of dementia include vascular dementia, dementia with Lewy bodies, primary progressive aphasia which comes in the logopenic, semantic, and nonfluent/agrammatic variants, behavioral variant frontotemporal dementia, and normal pressure hydrocephalus. Primary care providers are able to diagnose most straightforward cases of dementia, whereas specialists such as neuropsychologists, neurologists, psychiatrists, and geriatricians may be needed when the diagnosis is not straightforward.

In addition to Alzheimer’s disease, other brain disorders of aging that affect thinking and memory include vascular dementia, dementia with Lewy bodies, Parkinson’s disease dementia, behavioral variant frontotemporal dementia, primary progressive aphasia that has logpenic, semantic, and non-fluent agrammatic variants, and normal pressure hydrocephalus. Each produces characteristic changes in thinking, memory, language, behavior, and/or movement that allow you and the doctor to know when to consider them as possible causes of your loved one’s dementia. Note that the dementia of every individual is unique, so the symptoms and signs that they will manifest are all different. However, when dementias reach the moderate to severe stage, most dementias looks similar, despite having different causes.

Objective: Telehealth offers the opportunity to address a growing need to improve access to specialty services, such as neuropsychology, particularly for older adults and those in rural areas. Init...

We examined baseline and longitudinal associations between plasma neurofilament light (NfL) and total tau (t-tau), and the clinical presentation of Alzheimer's disease (AD). A total of 579 participants (238, normal cognition [NC]; 185, mild cognitive impairment [MCI]; 156, AD dementia) had baseline blood draws; 82% had follow-up evaluations. Plasma samples were analyzed for NfL and t-tau using Simoa technology. Baseline plasma NfL was higher in AD dementia than MCI (standardized mean difference = 0.55, 95% CI: 0.37–0.73) and NC (standardized mean difference = 0.68, 95% CI: 0.49–0.88), corresponded to Clinical Dementia Rating scores (OR = 1.94, 95% CI: 1.35–2.79]), and correlated with all neuropsychological tests (r's = 0.13–0.42). Longitudinally, NfL did not predict diagnostic conversion but predicted decline on 3/10 neuropsychological tests. Baseline plasma t-tau was higher in AD dementia than NC with a small effect (standardized mean difference = 0.33, 95% CI: 0.10–0.57) but not MCI. t-tau did not statistically significant predict any longitudinal outcomes. Plasma NfL may be useful for the detection of AD dementia and monitoring of disease progression. In contrast, there was minimal evidence in support of plasma t-tau.

The purpose of this simulation study was to investigate the effect of several different item exposure control procedures in computerized adaptive testing (CAT) with variable-length stopping rules using the partial credit model. Previous simulation studies on CAT exposure control methods with polytomous items rarely considered variable-length tests. The four exposure control techniques examined were the randomesque with a group of three items, randomesque with a group of six items, progressive-restricted standard error (PR-SE), and no exposure control. The two variable-length stopping rules included were the SE and predicted standard error reduction (PSER), along with three item pools of varied sizes (43, 86, and 172 items). Descriptive statistics on number of nonconvergent cases, measurement precision, testing burden, item overlap, item exposure, and pool utilization were calculated. Results revealed that the PSER stopping rule administered fewer items on average while maintaining measurement precision similar to the SE stopping rule across the different item pool sizes and exposure controls. The PR-SE exposure control procedure surpassed the randomesque methods by further reducing test overlap, maintaining maximum exposure rates at the target rate or lower, and utilizing all items from the pool with a minimal increase in number of items administered and nonconvergent cases.

Background and objectives: To understand the perceptions, knowledge, and understanding of memory, cognition, and aging among older veterans. Research design and methods: Twelve male, Caucasian, community-dwelling veterans from a suburban New England demographic area, aged 62 to 83 years, participated in qualitative interviews. The interviews were audio recorded, transcribed verbatim, and subsequently coded by three independent reviewers. The responses were calculated and analyzed for major themes. Results: Veterans equated healthy aging to be both of a physical and cognitive nature, although a significant subset viewed especially intact cognitive faculties to be a sign of successful aging despite physical limitations. Two of the most widely cited concerns about aging were loss of functional independence and the progression of cognitive decline into dementia, although most of the participants were unable to accurately describe dementia or Alzheimer’s disease. Military service was associated with both positive (e.g., social support) and negative (e.g., trauma) associations with aging. Most of the participants noted the importance of a healthy diet and exercise in aging but were unable to accurately describe a healthy diet or exercise regimen or the effect of these activities on the brain. Discussion and implications: Aging veterans represent a unique population among older adults, and more information is required to understand their specific needs. Older male veterans are less likely to engage in healthcare; for some, education alone may be enough to improve engagement, whereas for others an estimate of current cognitive function would provide the extra motivation required.

Supporting returning veterans' job-seeking, hiring, and retention issues has become an essential goal for effective community reintegration. Given both the particular strengths and challenges associated with veterans transitioning from military to civilian life, multiple models for supported employment have become integrated into Veterans Affairs health care facilities across the nation. In this article, we review the state of vocational rehabilitation for veterans, with a particular focus on individual placement and support-supported employment (IPS-SE), the current vocational services model that is considered the gold standard of vocational rehabilitation. Various modifications to the IPS-SE model are presented, including additions such as cognitive rehabilitation, contingency management, motivational interviewing, supported self-employment, and transitional work. Finally, recommendations are made about future directions and strategies to expand access to IPS-SE-based programs and to effectively meet the needs of returning veterans for employment in jobs of their choice. (PsycINFO Database Record

Latinos in the United States (U.S.) experience greater prevalence and worse course for certain health conditions associated with dementia when compared to the general population. Close scrutiny of these discrepancies is crucial in order to improve the early and accurate detection of neurodegenerative processes, as well as intervene in potentially treatable causes of cognitive decline. Such scrutiny involves the examination of biological and sociocultural contributors of medical comorbidities among different Latino subgroups, with the largest U.S.-residing populations being Mexican Americans and Caribbean Latinos. This chapter will review the medical comorbidities most often associated with dementia and cognitive decline as they pertain to Latinos in the U.S., including type 2 diabetes mellitus (T2DM), thyroid disease, infectious diseases (i.e., HIV, hepatitis C), obstructive sleep apnea (OSA), depression, alcohol abuse, and nutritional deficiencies (i.e., vitamin B12, folate). Following this section, the four major dementias are reviewed with an emphasis on the prevalence, genetics, pathology, and clinical presentation for Latino populations: Alzheimer’s disease (AD), vascular dementia (VaD), frontotemporal lobar degeneration (FTLD), and Lewy body dementias (LBD), including dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD).

Veterans with blast-related mild traumatic brain injury (mTBI) report difficulty engaging in life roles, also referred to as participation. Current measures are either global or lack comprehensive coverage of life roles and have not been validated in Veterans with mTBI. The Community Reintegration of Service-members instrument (CRIS) is a promising measure that was specifically developed for Veterans using a well-formulated conceptual framework and Rasch analysis. However, the CRIS has not been validated in Veterans with mTBI. Two data sets were combined for 191 Veterans with blast-related mTBI to conduct a confirmatory factor analysis of the CRIS. High residual and low loading items (33) were removed to improve the model fit. The remaining items demonstrated high correlation (0.87-0.89) between subscales and high test re-test (0.85 to 0.95). Mean scores were better for Veterans without Post Traumatic Stress Disorder (PTSD) or depression compared to Veterans with PTSD or depression. The refined CRIS offers a valid comprehensive measure of participation for Veterans with blast-related mTBI. Future directions include examining aspects of participation that may not be covered by the CRIS for Veterans with mTBI..

Work plays a significant role in how people identify themselves, and successful return to work is associated with significant psychological and rehabilitative benefits. Unfortunately, despite the many benefits of employment, Veterans who experience mild traumatic brain injury and have mental health issues often have significant difficulty getting their vocational needs met. Considering that a consistent relationship between cognitive dysfunction and difficulties with employability has been firmly established, cognitive rehabilitation may enhance engagement in vocational rehabilitation and return to work outcomes. In this pilot study, we evaluated a 12 wk cognitive rehabilitation intervention embedded within vocational rehabilitation services. Eighteen Veterans were randomly assigned to receive either the embedded cognitive rehabilitation intervention (n = 10) or a control condition offering supportive client-centered therapy that did not focus on employment or cognitive rehabilitation (n = 8); all Veterans (intervention and control groups) received vocational rehabilitation services. This pilot feasibility study demonstrated efficient implementation of an embedded cognitive rehabilitation intervention within vocational rehabilitation. The current pilot data revealed small to moderate effect sizes on employment outcomes. Given these preliminary findings, a larger outcome study is warranted.

We conducted a randomized controlled trial of the Aging Well through Interaction and Scientific Education (AgeWISE) program, a 12-week manualized cognitive rehabilitation program designed to provide psychoeducation to older adults about the aging brain, lifestyle factors associated with successful brain aging, and strategies to compensate for age related cognitive decline.Forty-nine cognitively intact participants ≥ 60 years old were randomly assigned to the AgeWISE program (n = 25) or a no-treatment control group (n = 24). Questionnaire data were collected prior to group assignment and post intervention. Two-factor repeated-measures analyses of covariance (ANCOVAs) were used to compare group outcomes.Upon completion, participants in the AgeWISE program reported increases in memory contentment and their sense of control in improving memory; no significant changes were observed in the control group. Surprisingly, participation in the group was not associated with significant changes in knowledge of memory aging, perception of memory ability, or greater use of strategies.The AgeWISE program was successfully implemented and increased participants' memory contentment and their sense of control in improving memory in advancing age.This study supports the use of AgeWISE to improve perspectives on healthy cognitive aging.