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The perks of being bilingual: Autobiographical memory and aging among bilingual and monolingual Hispanic adults.
No full textOBJECTIVE: Significant gaps remain in our knowledge of cognitive aging in Hispanic adults, the largest and fastest-growing minority group in the United States (U.S.). Episodic autobiographical memory (EAM), which has well documented age-related differences, has not been directly examined in older U.S. Hispanic adults - a population that is commonly bilingual. This study aimed to examine the effects of Spanish-English bilingualism and aging on EAM among Hispanic adults.
METHODS: In the present study 100 young and middle-aged/older Hispanic adults (50 English-Spanish bilingual Hispanic participants and 50 monolingual English-speaking Hispanic participants) narrated EAMs in a structured interview. We assessed these narratives for episodic and non-episodic details using an established scoring protocol.
RESULTS: We replicated the commonly observed age-related decrease in episodic detail generation among Hispanic participants, with non-episodic detail not significantly differing between young and older Hispanic participants. Among young Hispanic participants, bilingualism was associated with higher episodic, but not non-episodic, detail generation. This bilingualism advantage for episodic detail, however, was not evident among older Hispanic participants.
CONCLUSIONS: These results underscore the complex interplay between bilingualism and age in autobiographical memory for events among Hispanic adults. Our study highlights the importance of including diverse racial/ethnic and linguistic samples in cognitive aging research to better understand how bilingualism and cultural factors influence memory across the lifespan
Long-Term Results of a Phase 2 Prospective Clinical Trial of Single-Fraction, High-Gradient Adjuvant Partial Breast Irradiation in Early-Stage, Hormone-Positive Breast Cancer.
No full textPURPOSE: This study evaluates the long-term outcomes of single-fraction, high-gradient partial breast irradiation (BreaStBRT) as a postoperative treatment in patients with early-stage, hormone-positive breast cancer. It aims to assess acute and late treatment-related toxicity, cosmesis, patient-reported quality of life (QoL), and oncologic outcomes.
METHODS AND MATERIALS: This single-institution, single-arm, phase 2 prospective trial included postmenopausal women ≥50 years with early-stage, hormone-positive breast cancer treated with breast-conserving therapy followed by BreaStBRT. Patients were treated in a single-fraction with a high-gradient by delivering a dose of 15 to 22 Gy to the surgical bed with a steep fall-off to a minimum of 5 Gy to a 1 cm isometric expansion from the surgical bed; most patients were treated with magnetic resonance imaging-guided radiation therapy. Primary endpoints included acute and late toxicity and 5-year ipsilateral breast tumor recurrence. Secondary endpoints included regional-nodal recurrence, distant metastasis, mastectomy-free survival, and overall survival, along with patient-reported cosmesis and QoL assessments.
RESULTS: Fifty patients were treated between 2015 and 2018. Median follow-up was 78 months. Acute and late radiation-related toxicities were observed in 44% and 68% of patients, respectively; no acute grade 3 or higher toxicities were reported, and one instance of late grade 3 fibrosis was observed. Five-year ipsilateral breast tumor recurrence, mastectomy-free survival, and overall survival were 4%, 98%, and 92%, respectively. Cosmesis was rated as good to excellent in over 90% of cases by both patients and physicians through a 5-year follow-up. QoL assessments showed stable global health, physical functioning, sexual functioning, and body image results through follow-up.
CONCLUSIONS: BreaStBRT provides promising oncologic outcomes and favorable long-term cosmesis and QoL results with a low rate of treatment-related toxicity. This convenient regimen offers a viable alternative for carefully-selected early-stage, hormone-positive breast cancer patients. Further comparative trials are warranted to solidify the role of BreaStBRT in clinical practice
Quantitative analysis of thecal sac volume and morphology as a diagnostic tool in intracranial hypotension
No full textOBJECTIVES/BACKGROUND: This study was undertaken to determine whether thecal sac volume and morphometry can be used to differentiate patients with spontaneous intracranial hypotension (SIH). The mechanisms underlying SIH appear to be multifactorial. Association with connective tissue disorders is established, suggesting that increased thecal sac compliance and volume may contribute to SIH. METHODS: This study is an observational cross-sectional study that used magnetic resonance imaging (MRI) to compare thecal sac volume between patients with SIH and healthy controls. Patients with SIH and matched controls were prospectively recruited from December 1, 2020 to March 1, 2022. All participants underwent volumetric MRI of the entire spine. Semiautomated segmentation was used to extract three-dimensional volumetric models of the thecal sac. A single average thecal sac model was created for each group. Signed model to model distance function was used to compute and visualize the correspondent vectors that quantify the localized differences, including shape, between control and SIH thecal sacs. RESULTS: Twenty-eight patients with SIH (mean age = 45.9 years, mean body mass index = 27.7, 57% male) and 28 controls (mean age = 44.4 years, mean body mass index = 26.8, 57% male) were recruited. The thecal sac was significantly larger in patients with SIH (mean = 131.7 cm, 95% confidence interval [CI] = 108.1-155.3) than controls (mean = 116.5 cm, 95% CI = 105.1-127.9, p \u3c 0.001). Thecal sac volume demonstrated excellent discrimination for SIH (area under the curve = 0.91, 95% CI = 0.83-0.98, p \u3c 0.001). Volume \u3e 122 cm was 82% sensitive and 82% specific for SIH; volume \u3e 126 cm was 100% specific. Regional thoracic volume was slightly higher in patients with SIH (61.6 and 57.8 cm, respectively, p = 0.020), and lumbar volume was notably higher (46.6 and 33.0 cm, respectively, p \u3c 0.001). CONCLUSION: Patients with SIH have a significantly larger thecal sac than controls, which can be an effective tool to diagnose these patients
Ventral Spinal Cord Displacement: A Guide to Differentiating Spinal Cord Herniation From Dorsal Arachnoid Web With 2-Dimensional Operative Video Illustrations
No full textBACKGROUND AND OBJECTIVES: Spinal arachnoid webs (SAW) are abnormally thickened arachnoid membrane within the subarachnoid space that can tether and compress the cord and spinal cord herniation (SCH) results when there is displacement of the spinal cord through an opening of the dura or arachnoid mater. They have similar clinical presentations secondary to spinal cord compression, and both appear as focal anterior displacement of the spinal cord on MRI, making them difficult to differentiate from one another. However, operative technique for management differs significantly. The goal of this article was to review imaging characteristics of SAW and SCH with guidance on how to best differentiate the 2 during preoperative workup. We also aim to review nuances of operative technique for both pathologies. METHODS: We outline the presentation of SAW and SCH through 2 clinical cases, focusing on details of imaging characteristics and operative techniques using novel illustrations and animations in combination with 2D operative videos. We also reviewed existing literature comparing the radiographic differences between the 2 pathologies. RESULTS: We provide illustrative case presentations with narrated 2-dimensional operative videos to discuss in detail the nuanced imaging findings and intraoperative techniques required for management SAW and SCH to improve surgeon\u27s ability to differentiate between the 2 and effectively manage both pathologies. CONCLUSION: SAW and SCH can be difficult to differentiate and require very different strategies for operative management. These cases and operative videos provide a valuable resource for successfully managing both
Cognitive and Affective Performance of Brazilian Long COVID Patients: An In-Depth Analysis Before and After Psychoeducational Rehabilitation
No full textBackgroundLong COVID patients report various cognitive and affective symptoms that are poorly understood.ObjectiveThis study analyzed cognitive and affective performance in 208 Long COVID patients pre and post psychoeducational rehabilitation using a standardized screening test of higher cerebral functions. Identifying persistent difficulties may help guide future rehabilitation efforts.MethodsThe sample was comprised by a subset of 208 who completed psychoeducational rehabilitation from 614 Long COVID patients seeking rehabilitation. Performance on specific items was analyzed and compared to a reference sample of 114 educationally matched normal functioning adults.ResultsDetailed item analyses in 208 patients revealed persistent difficulties in the efficiency of learning and memory, affective expression, and the ability to accurately predict verbal memory performance compared to a reference sample. Long COVID patients showed variable performance deficits on attention, visual-spatial problem solving and memory measures. Language and related functions were consistently at a level commensurate with normally functioning individuals.ConclusionsPersistent cognitive and affective impairments were identified in Long COVID patients post-rehabilitation. Future programs should aim on to improve the efficiency of learning and memory, enhance the range of affective expression, and improve self-awareness of functional capacities. Rehabilitation should consider the multifactorial causes of these neuropsychological symptoms
Correction to: Gender-based violence in the context of armed conflict in the Amhara Region, Northern Ethiopia
No full textMapping the Landscape of Diaschisis in Traumatic Brain Injury: A Scoping Review
No full textDiaschisis is a phenomenon in which damage to one brain region leads to dysfunction in remote, yet functionally connected, areas. Although it has been well characterized in stroke, the complex, multifocal nature of traumatic brain injury (TBI) suggests that similar network-level disruptions could occur, yet the presence and impact of diaschisis in TBI remain underexplored. This gap may stem from a historical focus on cerebrovascular events, underrecognition of diaschisis in TBI, and methodological challenges related to TBI\u27s heterogeneous nature. This review maps diaschisis in TBI by examining models, mechanisms, neuroimaging, clinical features, and therapeutic interventions. A PRISMA-ScR guided search of PubMed, Embase, and Cochrane included studies explicitly addressing diaschisis in TBI from inception up to January 2025. Two independent reviewers screened titles, abstracts, and full texts, with discrepancies resolved by consensus. Twenty-three studies were included, encompassing 110 human participants, 497 animals, and one in vitro model. Among these, 57% used neuroimaging, 39% assessed functional outcomes, and 22% examined potential interventions. The predominant experimental model was rodent-controlled cortical impact, typically simulating moderate TBI. Contrarily, human studies were fewer and focused on severe TBI cases. Crossed cerebellar diaschisis was the most common neuroimaging finding (36%), with MRI used most frequently, followed by PET and SPECT. Across both clinical studies and preclinical models, key mechanisms of diaschisis included deafferentation, reduced metabolism, altered glutamate signaling, hypoperfusion, and distant apoptotic cell death. Motor deficits were more common with better recovery than cognitive impairments. Interventions such as MK-801 and Ifenprodil showed potential to reverse diaschisis, but others had limited effects. This review underscores the limited but growing understanding of diaschisis in TBI. Targeted research on mild-to-moderate TBI, interventions, and imaging-validation trials is needed to improve diagnosis and treatment
Microbial production of short-chain fatty acids attenuates long-term neurologic impairment after traumatic brain injury
No full textBACKGROUND: Traumatic brain injury (TBI) triggers persistent gut microbiome dysbiosis characterized by depletion of short-chain fatty acid (SCFA)-producing bacteria. However, the link between SCFA depletion and long-term neurologic impairment (LTNI) after TBI remains unclear. Previously, we and others noted the involvement of metabolite-sensing receptors and SCFA ligands in mouse models of neurodegenerative diseases, including Alzheimer\u27s. Here, we further investigated SCFA-mediated neuroprotection in LTNI at both microbiome and single-cell resolution using the controlled cortical impact (CCI) model of TBI with a high-yielding SCFA diet to examine their mechanistic role in pathogenesis. METHODS: C57BL6/J mice were randomized to CCI (6 m/s, 2 mm) or sham surgery. Following surgery, mice were randomized to a study diet based on a balanced modification of the AIN93-G diet containing either 15% high amylose maize starch (HAMS) control diet or acetylated and butyrylated HAMS (HAMSAB) for 6 months to model increased SCFA production by bacterial fermentation in the gut. Morris water maze test and nesting assessment were performed at 1, 3, and 6 months after injury. The longitudinal gut microbiome changes were investigated by 16 S rRNA amplicon and metagenomic sequencing of fecal pellets at baseline, 1 month, and 6 months post-injury. At 6 months, pericontusional tissue was collected for single-cell RNA-sequencing following the 10X Genomics protocol or histologic analysis. RESULTS: Compared to the HAMS control diet, HAMSAB diet remodeled the CCI murine gut microbiome at an early phase, increased various SCFA-producing taxa, and attenuated neurologic deficits up to 6 months after CCI. In mice fed HAMSAB diet, single-cell transcriptomics and pathway analysis identified the promotion of neurogenesis, including increased doublecortin-positive immature neurons. In myeloid cells, HAMSAB induced an anti-inflammatory phenotype, inhibiting pro-inflammatory signaling interaction such as midkine signaling, and promoted differentiation to disease-associated microglia (DAM). Simultaneously, SCFAs reduced neurodegenerative pathway activity in neurons and glial cells and reduced phosphorylated tau deposition in pericontusional cortex. CONCLUSIONS: Diet-facilitated microbial production of acetate and butyrate attenuates behavioral deficits of LTNI after TBI and produces enduring benefits at the single-cell level on the neuro-inflammatory and neuro-progenitor responses. This therapeutic approach could have a broader potential to prevent neurodegenerative disease
Nonamyloid-beta active immunization for the treatment of Alzheimer\u27s disease
No full textINTRODUCTION: Alzheimer\u27s disease (AD) is characterized by the formation of senile plaques composed of amyloid-beta (Aβ) peptides and the intraneuronal accumulation of neurofibrillary tangles composed of abnormal, hyperphosphorylated tau proteins. These act in concert to drive cognitive decline, but it is widely held that tau spread correlates better with cognitive decline than does amyloid burden. Control of AD neuropathologies with active immunizations is studied as a potential therapeutic avenue because it could build innate immunity. Although most active immunization studies have focused on Aβ targets, tau and other targets continue to be explored. AREAS COVERED: This study aimed to identify and describe non-Aβ active immunization trials for AD treatment. A narrative review was conducted to analyze the current status of non-Aβ active immunization for AD using PubMed as the research database. EXPERT OPINION: The potential of active immunization beyond Aβ was explored as a therapeutic strategy for AD with a focus that targets tau and provides insights into its effectiveness, associated challenges, and limitations. Results from preclinical and clinical studies were examined, highlighting the progress and the hurdles that exist. Active immunization against non-Aβ targets, such as tau, for the treatment of AD remains a promising and expanding field
Physical and Cognitive Activities and Trajectories of AD Neuroimaging Biomarkers: Longitudinal Analysis in the Mayo Clinic Study of Aging
No full textBACKGROUND AND OBJECTIVES: Engagement in physical and cognitive activities is associated with a decreased risk of mild cognitive impairment (MCI) and dementia, but the association with Alzheimer disease (AD) neuroimaging biomarkers is less clear. We thus examined associations of physical and cognitive activities with longitudinal trajectories of AD neuroimaging biomarkers among older adults free of dementia. METHODS: We conducted a longitudinal study within the population-based Mayo Clinic Study of Aging (mean follow-up durations 1.3-3.4 years). Participants were aged 50 years or older and were cognitively unimpaired or had MCI at baseline. Engagement in physical and cognitive activities during 12 months before baseline was assessed through questionnaires. Participants underwent AD neuroimaging biomarker assessments at 1 or more time points. We ran linear mixed-effect models to examine associations between physical and cognitive activity composite scores and trajectories of individual yearly change in amyloid deposition (Pittsburgh compound B [PiB]-PET centiloid), tau burden (tau-PET standardized uptake value ratio [SUVR]), and regional glucose hypometabolism (fluorodeoxyglucose [FDG]-PET SUVR), adjusted for age, sex, APOE ɛ4 carrier status, and medical comorbidity. RESULTS: We included 1,176 participants (47% female; mean [SD] age, 68.7 [9.6] years) for PiB-PET trajectories, 399 participants (49% female; mean [SD] age, 71.9 [11.0] years) for tau-PET trajectories, and 983 participants (46% female; mean [SD] age, 67.9 [9.2] years) for FDG-PET trajectories. PiB-PET and tau-PET measures increased during follow-up (3.4 [SD 4.0] and 1.3 [SD 2.1] years, respectively), whereas FDG-PET values decreased over 2.9 (SD 3.5) years of follow-up. Participants with higher total physical activity (interaction estimate 0.0017; 95% CI 0.0003-0.0031; p = 0.021) and higher moderate-to-vigorous physical activity (interaction estimate 0.0015; 95% CI 0.0001-0.0029; p = 0.040) had a less pronounced decrease in FDG-PET over time. Participants with higher cognitive activity experienced a less pronounced increase in PiB-PET (interaction estimate -0.2253; 95% CI -0.4437 to -0.0070; p = 0.043) and a smaller decrease in FDG-PET (interaction estimate 0.0015; 95% CI 0.0001-0.0028; p = 0.038) over time. DISCUSSION: Physical activity was associated with less synaptic dysfunction and cognitive activity with less synaptic dysfunction and lower amyloid burden over time, albeit effect sizes were small. Further research is needed to validate findings and clarify causal inference between physical and cognitive activities and AD neuroimaging biomarkers