Rush University Medical Center

Hand grip strength (HGS) is a predictor of cognitive decline in aging. To understand the direct and indirect mechanisms underlying this association, we performed integrative analyses of genetic, cognitive, and autopsy data. A polygenic risk score for HGS (PRSHGS) was calculated in two independent studies of aging (total n = 25,227). Cross-sectional and longitudinal modeling, including mediation with physical activity, assessed the effects of PRSHGS on cognitive performance and postmortem neuropathology. In both cohorts, higher PRSHGS predicted better global cognitive performance (p = 7.77 × 10-4 and p = 0.025) and improved the predictive performance of an Alzheimer's disease PRS (likelihood ratio test p = 2.5 × 10-5 and p = 0.007). PRSHGS was not associated with levels of any postmortem neuropathology. PRSHGS effects on cognition were only partially and inconsistently mediated by physical activity. Genetic predisposition for greater HGS predicts better cognitive performance in late life, independent from Alzheimer's disease-related neuropathology.

To investigate longitudinal trends in the American Board of Emergency Medicine (ABEM) Qualifying Examination (QE) performance, identify statistically significant inflection points in pass rates, and determine factors associated with the recent decline observed in 2022. This was a retrospective, observational study conducted in 2 phases. Phase 1 analyzed all QE attempts from 1980 to 2024 (n = 83,254) to identify changepoints using segmented regression and Bayes factor comparisons. Phase 2 focused on QE attempts surrounding the most recent changepoint from 2016 to 2024 (n = 23,784) and used multilevel nonlinear piecewise growth models to examine the association between physician characteristics and QE pass rates before and after the 2022 changepoint. Three statistically significant changepoints were identified: 1988, 2003, and 2022. Although increases in pass rates were noted in 1988 and 2003, 2022 was marked by a decline in pass rates with a steeper drop post-2022 (slope from 2016 to 2022 = -0.17 vs slope 2022 to 2024 = -0.67). From 2016 to 2022, MD graduates had a lesser decline in performance compared with non-MD peers. After 2022, those trained during the COVID pandemic also experienced a lesser decline. ABEM QE pass rates experienced 3 major inflection points since 1980, with the most recent occurring in 2022 and representing a meaningful decline. Physician-level characteristics, particularly medical school degree type and COVID-era training, were significantly associated with this trend.

ABSTRACTBACKGROUNDRecent studies consisting primarily of white participants have found lowered plasmalogen levels to be associated with lower cognitive function. We explore the association of blood plasmalogen levels with global cognition and brain imaging metrics in older African Americans.METHODSIncluded in these cross-sectional analyses were participants in the Minority Aging Research Study (MARS) and the Rush Clinical Core without dementia, available serum lipid levels, and a concurrent cognitive function assessment. A plasmalogen biosynthesis value (PBV) was calculated for each participant utilizing five ratios of four key glycerophospholipids. A linear regression model of global cognition was constructed with PBV, adjusted for sex, age, education, total cholesterol, and body mass index. In participants with 3T MRI brain imaging, the association between PBV and white matter hyperintensities (WMH) was explored.RESULTSOf the 298 participants, the mean age was 74.6 years, mean education was 15.6 years, and 84% were women. The median PBV was 0.42 (interquartile range: 0.22 to 1.14). A unit higher in PBV was suggestively associated with a 0.17 β-unit higher cognitive z-score (SE =0.09, p = 0.06). In 254 participants with MRI data, an increase in log10SD of PBV suggested the less white matter hyperintensities (estimate = –0.20, SE = 0.12, p = 0.08).DISCUSSIONIn older African Americans, higher PBV was associated with higher level of global cognition, and potentially lower levels of brain white matter hyperintensities. Larger studies are needed in additional cohorts to determine if PBV is associated with annual rate of change in cognitive function.KEY POINTSWhat was known before this study?Recent studies, in primarily older, white participants have found increased plasmalogen levels to be associated with better cognition. Given the prevalence of lipid related chronic conditions and disproportionate burden of cognitive impairment in African Americans, we explored whether plasmalogen ratios may be associated with brain function and structure in this population.What did we learn in this analysis?Utilizing data from 298 participants recruited from the Minority Aging Research Study (MARS) and Rush Clinical Core, we tested whether higher blood plasmalogen levels were associated with (1) lowered cognitive scores, and (2) increased white matter hyperintensities (WMH) on brain imaging. We found that higher PBV values showed a trend towards better global cognition. We found that PBV was associated with WMH.What do we still have to learn?Future studies may need to investigate these novel biomarkers and their neuroprotective capabilities in persons with cognitive impairment or in later stages of cognitive decline in addition to their longitudinal fluctuations to better gauge their role in dementia and AD.

Hip arthroscopy has shown satisfactory outcomes for the treatment of intra-articular pathology and femoroacetabular impingement syndrome (FAIS) in the setting of acetabular dysplasia at short- and mid-term follow-up. However, the long-term outcomes remain less understood. To systematically review the literature to determine patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, reoperation rates, and predictors of failure in patients with acetabular dysplasia undergoing hip arthroscopy at long-term follow-up. Systematic review; Level of evidence, 4. Three databases were searched around the following terms: hip arthroscopy, dysplasia, and long-term follow-up. Articles available in English, presenting original data, and reporting on a mean follow-up of ≥10 years after primary hip arthroscopy using either PROs, CSOs, or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using Methodological Index for Non-Randomized Studies (MINORS) assessment. Five studies (555 hips) were included in the systematic review: patients had a mean age of 30 to 41 years, 13% to 88% of patients were female, and follow-up ranged from 9.6 to 12 years. MINORS assessment ranged from 11 to 21. All studies included PROs and reported statistically significant improvement for most PROs. The most frequent PRO was the Modified Harris Hip Score (mHHS) (n = 5). All studies reported CSO achievement, with mHHS and Hip Outcome Score-Sport Specific (HOS-SS) being the most common (n = 4). Revision surgery and conversion to THA ranged from 2.6% to 15.2% and from 2.6% to 23.7%, respectively across dysplasia cohorts. The most common definition of failure was conversion to THA, and Tönnis angle was the most common predictor of failure. Four studies made comparisons to a nondysplasia group, with 1 study finding inferior HOS-SS and inferior achievement of Patient Acceptable Symptom State across multiple PROs in the dysplasia group. All 4 comparative studies found no differences in rates of revision surgery or conversion to THA between groups. Hip arthroscopy can reliably provide durable and clinically meaningful improvements for the treatment of intra-articular pathology and FAIS in patients with acetabular dysplasia at long-term follow-up, with comparable rates of revision surgery and conversion to THA to nondysplastic cohorts, although select dysplastic populations may demonstrate inferior patient-reported outcomes.