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Background: Type 2 diabetes is a dementia risk factor, but its relation to Alzheimer’s disease (AD), the most common cause of dementia, is unclear. Objective: Our primary objective was to examine the association of pre-diabetes and type 2 diabetes with brain amyloid-β (Aβ), the putative main culprit of AD. Our secondary objective was to examine the association of pre-diabetes and type 2 diabetes with neurodegeneration, cerebrovascular disease (CVD), and memory performance. Methods: We conducted a cross-sectional study of 350 late middle-aged Hispanics without dementia in New York City. We classified diabetes status as normal glucose tolerance (NGT), pre-diabetes, and type 2 diabetes following American Diabetes Association criteria. Brain Aβ was ascertained as global Aβ standardized value uptake ratio using PET with 18F-Florbetaben. Neurodegeneration was operationalized as cortical thickness in regions affected by AD using MRI. CVD was operationalized as white matter hyperintensity volume (WMH) on MRI, and memory as performance with the selective reminding test (SRT). Results: Mean age was 64.15 ± 3.34 years, 72.00% were women, and 35.43% were APOE ε4 carriers. Pre-diabetes, but not type 2 diabetes, was associated with higher Aβ compared with NGT. Type 2 diabetes treatment was related to lower Aβ. Type 2 diabetes was related to lower cortical thickness, higher WMH, and lower SRT score. Conclusion: Pre-diabetes, but not type 2 diabetes, is associated with higher brain Aβ in late middle age, and this observation could be explained by the relation of diabetes treatment with lower brain Aβ. Whether type 2 diabetes treatment lowers brain Aβ requires further study.

Abstract Resident-to-resident aggression (RRA) includes negative and aggressive physical, sexual, or verbal interactions between long-term care residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient. Though not explored in detail, previous research has shown that ethnic stereotyping may contribute to RRA. Our goal was to examine, for the first time, acute precipitants and consequences of RRA involving racial and ethnic conflicts. The parent study included comprehensive quantitative and qualitative information of 2,011 residents in 10 randomly-selected New York State nursing homes. Our qualitative analyses used an events perspective, focusing on how aggressive situations unfolded. We identified 51 single or repeated incidents of racial and ethnic conflicts during the study observation period. At the facility level, racial and ethnic conflicts were most commonly triggered by congested living spaces. At the relational level, racial and ethnic conflicts were frequently preceded by negative reactions to residents with cognitive impairment. At the individual level, racial and ethnic conflicts were found to be preceded by residents’ unmet or unrecognized needs. Unresolved racial and ethnic conflict commonly resulted in aggression escalation and spillover. Our results indicated racial and ethnic conflicts occurred commonly and repeatedly. Such behavior appeared tolerated and normalized, with limited institutional response. As the long-term care population becomes increasingly diverse, recognizing and addressing potential racial and ethnic conflicts becomes more pressing. Targeting racial and ethnic conflicts in RRA for intervention may also improve interactions between residents and frontline workers.

Objectives Unexpected lucidity is a phenomenon of scientific, clinical, and psychological relevance to health professionals, to those who experience it, and their relatives. This paper describes qualitative methods used to develop an informant-based measure of lucidity episodes. Methods The approach was refinement of the operationalization of the construct; review of seminal items, modification, and purification; and confirmation of the feasibility of reporting methodology. Modified focus groups were conducted with 20 staff and 10 family members using a web-based survey. Themes included reaction when hearing the term; words that come to mind; description of and first reaction to referenced or observed ‘lucidity’ events. Semi-structured cognitive interviews were conducted with 10 health professionals working with older adults with cognitive impairment. Data were extracted from Qualtrics or Microsoft 365 Word® for analysis using NVivo. Results Conceptual issues, as well as issues regarding comprehension, interpretation, clarity, semantics, and standardization of definitions derived from an external advisory board, focus groups and cognitive interviews informed items’ modification, and resulted in the final lucidity measure. Conclusions An obstacle to understanding the mechanisms and estimating the prevalence of lucid events among individuals with dementia and other neurological conditions is the scarcity of reliable and valid measures. The substantive and varied data gathered from multiple methods including the collaborative work of an External Advisory Board, modified focus groups with staff and family caregivers, and structured cognitive interviews with health professionals were central in creating the revised version of the lucidity measure.

This pilot study aims to explore the psychometric properties of the Cognitive Function Instrument (CFI) as a measure of subjective cognitive complaints (SCC) and its performance in distinguishing mild cognitive impairment (MCI) from normal control (NC) compared to an objective cognitive screen (Montreal Cognitive Assessment [MoCA]). One hundred ninety-four community-dwelling non-demented older adults with racial/ethnic diversity were included. Unidimensionality and internal consistency of the CFI were examined using factor analysis, Cronbach's alpha, and McDonald's omega. Logistic regression models and receiver operating characteristic (ROC) analysis were used to examine the performance of CFI. The CFI demonstrated adequate internal consistency; however, the fit for a unidimensional model was suboptimal. The CFI distinguished MCI from NC alone or in combination with MoCA. ROC analysis showed comparable performance of the CFI and the MoCA. Our findings support the use of CFI as a brief and easy-to-use screen to detect MCI in culturally/linguistically diverse older adults. What is the key scientific question or problem of central interest of the paper? Subjective cognitive complaints (SCCs) are considered the earliest sign of dementia in older adults. However, it is unclear if SCC are equivalent in different cultures. The Cognitive Function Instrument (CFI) is a 14-item measure of SCC. This study provides pilot data suggesting that CFI is sensitive for detecting mild cognitive impairment in a cohort of older adults with racial/ethnic diversity. Comparing performance, CFI demonstrates comparable sensitivity to the Montreal Cognitive Assessment, an objective cognitive screening test. Overall, SCC may provide a non-invasive, easy-to-use method to flag possible cognitive impairment in both research and clinical settings.

L'Arlsienne de l'tat d'IsralS T C e qui fascine, avant tout, dans la question des territoires , c'est le mur idologique et terminologique qui les entoure, les dsigne et, en mme temps, les occulte dans la conscience collective.Car voici 450 000 citoyens israliens qui s'y sont installs et y rsident, tout en tant pousss hors de l'ensemble de la communaut nationale ; voici des territoires inextricablement lis par la gographie aux territoires de l'Isral de 1967 tout en en tant spars et dissocis dans la structure administrative.C'est jusqu' la terminologie mme qui est concerne, tout d'abord avec la distinction tonnante -qu'on ne saisit qu'en parlant l'hbreu -entre mityashvim (ceux qui s'installent , soit les Israliens d'avant 1967) et mitnakhalim (soit les Israliens qui se sont installs en Jude Samarie, aprs 1967), ceux que la Gauche isralienne et aprs elle les Occidentaux, identifient des colons . LA MANIPULATION TERMINOLOGIQUECela mrite une petite histoire, car le terme de mityashvim dsigne depuis toujours les crateurs des kibboutzim les pionniers du sionisme.La hityashvut dsigna l'action de peuplement de la Terre d'Isral et notamment travers la cration de kiboutz sous l'gide du mouvement travailliste.En somme les mityashvim seraient les reprsentants du sionisme authentique et normatif, que trahiraient les mithnakhalim , sionistes religieux (sans oublier qu'il y a eu aussi des laques (des mityashvim ?) qui se sont installs dans ces territoires juste aprs 1967).Les uns seraient des pionniers, les autres, des colons Le paralllisme des termes est frappant pour qui entend l'hbreu.

BackgroundResident-to-resident elder mistreatment (R-REM) is defined as negative and aggressive physical, sexual, or verbal interactions between (long-term care) residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological harm and distress. R-REM has been established as a serious problem that has a negative impact on the safety, physical well-being, and quality-of-life of residents living in nursing homes. Although there are no in-depth studies, there is evidence that it is prevalent in assisted living residences and associated with a variety of person, environmental, and facility characteristics. The authors conducted the first systematic, prospective study of resident-to-resident elder mistreatment in nursing homes and developed an intervention for direct care staff to enhance knowledge of R-REM and increase reporting and resident safety by reducing falls and associated injuries. The study aim was to examine the effects of this intervention in assisted living residences. The primary distal outcome is falls and injuries, and the key process outcomes are staff knowledge and reporting.MethodsTwelve larger licensed assisted living residences with special care dementia units in two New York State regions will be enrolled on a rolling basis and randomized to intervention or usual care. Data derived from five sources, (1) resident interviews, (2) staff informants, (3) observational data, (4) chart, and (5) incident/accident report data, will be collected at baseline and 6 and 12 months with respect to 1050 residents (750 “downstate” and 300 “upstate”). The intervention is three training modules delivered on-site after baseline data collection for front line staff on all shifts in facilities randomized to the intervention. Modules relate to recognition, management, and reporting of resident-to-resident elder mistreatment.DiscussionGiven the movement toward alternative congregate living arrangements for older individuals with significant comorbidities, including cognitive impairment; it is critical to enhance resident safety measured by falls, accidents, and injuries and staff knowledge related to recognition, reporting, and treatment of resident-to-resident aggressive and related negative interactions in such settings. This project is important in developing approaches for ameliorating and preventing R-REM in assisted living residences and enhancing resident safety and quality of life.Trial registrationClinicalTrials.gov NCT03383289. Registered on 26 December 2017