San Francisco VA Medical Center

Microstructures of sleep electroencephalography (EEG) are closely related to cognition and undergo age-dependent changes. However, their multidimensional nature makes them challenging to interpret using conventional approaches. The machine learning-based EEG brain age index (BAI) measures the deviation between sleep EEG-based brain age and chronological age. To determine the association between sleep BAI and incident dementia in community-dwelling populations. For this individual participant data (IPD) meta-analysis, sleep study data from 5 community-based longitudinal cohorts were pooled. These cohorts included the Multi-Ethnic Study of Atherosclerosis (MESA; 2010-2013), the Atherosclerosis Risk in Communities (ARIC) study (1987-1989), the Framingham Heart Study-Offspring Study (FHS-OS; 1995-1998), the Osteoporotic Fractures in Men Study (MrOS; 2003-2005), and the Study of Osteoporotic Fractures (SOF; 2002-2004). Adults (aged ≥18 years) without dementia at the time of polysomnography were included. The BAI was computed using interpretable machine learning, incorporating sleep EEG features extracted from central channels in overnight, home-based polysomnography. Fine-Gray models were used to assess the association between BAI and incident dementia within each cohort, accounting for death as a competing risk. Cohort-specific estimates were then pooled using random-effects meta-analysis. Analyses were performed between March 2024 and September 2025. Incident dementia or probable dementia was determined in each cohort, with death as a competing risk. This meta-analysis included 7105 participants from the MESA (n = 1802; mean [SD] age, 69.3 [9.0] years; 956 females [53.1%]), ARIC (n = 1796; 62.5 [5.7] years; 918 females [51.1%]), FHS-OS (n = 617; 59.5 [8.9] years; 318 females [51.5%]), MrOS (n = 2639 males [100%]; 76.0 [5.3] years), and SOF (n = 251 females [100%]; 82.7 [2.9] years) cohorts. The median (IQR) time to dementia was 4.8 (4.2-5.6) years in the MESA cohort (n = 119 [6.6%]), 16.9 (14.9-19.8) years in the ARIC cohort (n = 354 [19.7%]), 13.1 (8.5-16.2) years in the FHS-OS cohort (n = 59 [9.6%]), 3.6 (1.3-7.1) years in the MrOS cohort (n = 470 [17.8%]), and 4.6 (4.2-5.2) years in the SOF cohort (n = 86 [34.3%]). Across the cohorts, each 10-year increase in BAI was associated with a 39% higher risk of incident dementia (hazard ratio [HR], 1.39 [95% CI, 1.21-1.59]; P < .001) after adjustment for covariates. These associations remained after additional adjustment for comorbidities and apnea-hypopnea index scores (HR, 1.31 [95% CI, 1.14-1.50]; P < .001) and apolipoprotein E ε4 (HR, 1.22 [95% CI, 1.02-1.45]; P = .03), and they were consistent across sex and age groups. In this IPD meta-analysis, a higher sleep EEG-based BAI was associated with a higher risk of incident dementia. These findings highlight the need to evaluate the predictive value of the BAI as a noninvasive digital marker for early detection of dementia in community settings.

Standard brief alcohol and drug use interventions focus on motivating reductions in use and associated harms and have shown reliable reductions in these outcomes. However, effect sizes are small, and dissemination is limited by low rates of help seeking. Incorporating intervention elements focused on enhancing wellness, mood, and goal pursuit might enhance efficacy and appeal. The substance-free activity session (SFAS) integrates behavioral economic and motivational interviewing elements to enhance goal-directed and mood-enhancing activity patterns that might provide alternatives to alcohol- and drug-related reward. We conducted a narrative review of 15 empirical studies that investigated the efficacy of the SFAS and evaluated mechanisms of behavior change. We then provide an overview of how to conduct the SFAS, including a session vignette. There is support for the efficacy of the SFAS when integrated with standard brief alcohol interventions for college students. There is also evidence that the SFAS reduces negative affective symptoms and increases self-regulation and proportionate reinforcement from substance-free activities. Evidence for cannabis use reductions is less robust. The SFAS has been successfully implemented as an adjunct to intensive alcohol and drug treatment for adults, but not in the context of adequately powered efficacy trials. The clinical vignette and intervention manual provides a model for how to motivate an individual to pursue reductions in substance use supported by increased engagement in goal-directed and enjoyable substance-free activities. The SFAS shows promise as a brief intervention that supports substance use reductions via motivating patterns of substance-free activities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Greater sodium avidity in acute heart failure (AHF) is associated with worse outcomes, but whether kidney tubule injury is associated with sodium avidity and impaired diuretic responsiveness remains underexplored. We evaluated 339 participants from the ROSE-AHF trial, which enrolled patients hospitalized for AHF with kidney dysfunction and randomized them to the dopamine, nesiritide, or placebo group. Urinary kidney injury molecule-1 (KIM-1), N-acetyl-β-D-glucosaminidase (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) were measured at enrolment. Associations between these biomarkers and urinary sodium (uNa) concentration at baseline, fractional excretion of sodium (FeNa), as well as total uNa output and urine output over 72-h were assessed using multivariable regression models. Higher KIM-1 and NAG values at baseline were associated with lower uNa concentration at baseline [-6.1% (-8.5%, -3.7%), P < 0.001 and -5.9% (-9.2%, -2.6%), P & .001, respectively, per two-fold increase in each biomarker]. Higher baseline KIM-1 and NAG were also associated with lower FeNa [-6.1% (-8.5%, -3.6%), P < .001 and -5.2% (-8.6%, -3.6%), P = 0 .001, respectively, per two-fold increase in each biomarker]. Higher baseline KIM-1 was associated with lower total uNa excretion over 72-h [-3.6% (-6.8%, -0.2%), P = 0.037 per two-fold increase]. None of the biomarkers were associated with urine output over 72-h. Kidney tubular injury, as assessed by urine KIM-1 and NAG, is associated with greater sodium avidity and higher KIM-1 is associated with impaired diuretic responsiveness in AHF.

SGLT2i users prior to hospitalization for sepsis had reduced risk of 90-day mortality and AKI, suggesting chronic organ protection decreases the risk of organ failure when sepsis develops.