Acc ccult lturatio ion, C , Cognit itio ion, a , and B Brain in I Imagin ing C Corr rrela lates in a a Diverse C Coh ohort ort Rosie E. Curiel Cid, PsyD Assistant Professor Center for Cognitive Neuroscience and Aging Department of Psychiatry and Behavioral Sciences MCI Symposium January 18, 2018
Disclos osures es None.
Population o of Hi Hispan anic E Elders i in the U U.S. w will double…
South F Flor orida’ a’s E Ethno-raci cial “PAR ARAD ADISE” University of Miami Hospital Community Health Needs Assessment, 2016
An Urgen ent C t Call f for or No Novel el Asses essmen ent P t Paradigms • AD-specific c cog ognitive vulnerabilities • Cross-cu cultu turally ap applicable
Can we identify a sensitive and specific cognitive marker of preclinical AD??
Sa Salient C t Cog ognitiv ive Mark rkers of Earl rly AD AD • Seman antic I Interference • Proactive Semantic Interference (PSI) • Retroactive Semantic Interference(RSI) • Failure to Recover from Proactive Semantic Interference (frPSI) • Sem emantic tic I Intr trusio ion E Errors ( (SI)
LASSI ASSI-L C Cog ognitiv tive St Stress T Test • 15 words, each belonging to one of three categories (fruits, musical instruments, clothing) • Semantic c cues a at acqui quisition; n; 2 trials • Controlled l d learni rning ng - promotes optimal encoding of to-be-remembered targets, minimizes individual differences in learning strategies • A second list of 15 semantically related targets is presented twice with 2 cued re reca call trials. • Produces measures of: A. PSI (B1Cued Recall) B. Recov over ery f from P PSI ( (frPSI PSI) w which i h is unique que to the L LAS ASSI-L ( (B2 Cued ed R Recall ll) C. RSI (short-delayed recall for List A items). D. Semantic Intrusions
frPSI is related to Amyloid Load in Cognitively Normal Elders SUVR Anterior Posterior Precuneus Frontal Total Cingulate Cingulate LASSI-L Cued 1 ( PSI) rs=-.42* rs=-.42* rs=-.41* rs=-.40 rs=-.31 LASSI-L Cued 2 rs=-.60** rs=-.48** rs=-.50** rs=-.62** rs=-.43* (frPSI) LASSI-L A2 rs=-.26 rs=-.31 rs=-.19 rs=-.32 rs=-.20 (Maximum Storage) FOME Total Recall rs=-.16 rs=-.17 rs=-.10 rs=-.16 rs=-.16 NACC Story rs=-.29 rs=-.35* rs=-.08 rs=-.17 rs=-.36* Delayed Recall Note *p<.05; **p<.01, survived FDR Loewenstein, D. A., Curiel, R. E., et al. (2016). The American Journal of Geriatric Psychiatry .
Semantic I Intrusions s Assoc ociated ed wi with Am Amyloid + + in M n MCI CI due due to AD AD MCI-AD (n=34) ◦ Amyloid Positive, Clinical Features of AD, HPC Atrophy+ MCI-SNAP (n=29) ◦ Amyloid Negative, Clinical features of AD, HPC Atrophy+ MCI- Other Etiologies (n=25) • Amyloid Negative, cerebrovascular disease, DLBD, FTD, CTE, Mass Effect of Angioma, Depression, Other Psychiatric Conditions and NOS) Loewenstein, D. A., Curiel, R. E., et al. (2018). Neurology .
MCI-AD MCI-SNAP MCI-No Non- F-Te Test o or F-test Adjus usting ng f for X 2 Te (Amyloid id+) (Amyloid id-) Alzhei eimer er’s Test Age, M MMSE a and nd (n=34) 34) (HPC PC+) (Amyloid id-) Lang ngua uage (n=29) 29) (n=25) 25) 75.44 a 76.42 a 70.53 b Age ge 3.49 NA (SD=8.0) (SD=7.5) (SD=5.9) (p=.036) HVLT LT-R To Total 16.77 18.00 17.88 .44 .09 (SD=5.0) (SD=3.6) (SD=7.3) (.643) (p=.917) Categ egory F Fluen ency 35.97 35.58 34.31 .18 1.01 (SD=9.0) (SD=8.6) (SD=9.7) (p=.84) (p=.371) Trails ls B B Tim ime 157.63 172.75 130.00 1.48 .35 (SD=72.8) (SD=83.9) (SD=75.4) (.236) (p=.707) 50 b 00 a 41 a LASSI-L B L B1 6. 6.50 3.00 3. 3.41 3. 14.52 14. 52 12. 12.33 33 Sem emantic (SD=3. 3.2) 2) (SD=2. 2.2) 2) (SD=1. 1.8) 8) (p<.001) 01) (p<.001) 01) Intrus usions ns 78 b 63 a 29 a LASSI-L B L B2 4. 4.78 2. 2.63 2.29 2. 9.13 9. 13 6.28 6. 28 Sem emantic (SD=2. 2.5) 5) (SD=2. 2.2) 2) (SD=1. 1.9) 9) (p<.001) 01) (p<.001) 01) Intrusions
As Asso sociations B Between en D Differ erent S SI Mea easu sures a s and nd L Left Hem Hemisp spher ere AD AD- prone regions f for Amy+ a + aMCI I LASSI ASSI-L B L B1 LASSI ASSI-L B L B2 HVLT-R T HVL Tot otal al Semantic ic I Intrusion ions Seman mantic Intrusions Hippocampus r=-.31 r=-.34 r=.41 Entorhin inal C l Cor ortex r= r=-.51* 51** r= r=-.55* 55** r=.43 Prec ecuneu eus r=-.35 r=.-31 r=.48* 48** Superior ior T Tempor oral al r=-.47* r= 47** r= r=-.49* 49** r=.26 Pos osterior ior C Cingula late r=-.27 r=-.25 r=.43 Supram amar argin inal al r= = -.62*** *** r= r=-.48* 48** r=.30
Cross Cross-Cultu tural App pplicati tions i s in the U e U.S. Do Hispanics differ from Non-Hispanics with regards to semantic intrusion errors? To what extent does acculturation impact LASSI -L performance in normal and cognitively impaired groups?
Demographic C Characteristi tics Non-Hispanic Hispanic Non-Hispanic Hispanic F-Value p-Value Normals Normals aMCI aMCI or X 2 (n=62) (n=51) (n=71) (n=63) Value 73.89 ab 70.74 a 75.18 b 74.00 ab Age 3.31 .02 (Range 60-98) (SD=8.3) (SD=6.2 (SD=8.5) (SD=7.4) 15.83 b 13.22 a 15.78 ab 13.76 a 12.21 <.001 Education (Range 4-21) (SD=2.6) (SD=3.6) (SD=2.9) (SD=3.4) 29.03 b 28.59 b 27.39 a 26.97 a MMSE 20.2 <.001 (Range 23-30) (SD=1.2) (SD=1.5) (SD=2.1) (SD=1.8)
Neurop opsychol ologi gical Performan ance i in Normal C Cognition No Non-Hi Hisp Hispa pani nic F-Va Value p-Value lue No Normals No Normals Adjus usted f for (n=62) 62) (n=51) 51) Age, S Sex x & & Ed. d. LASSI-L C Cue ued B d B1 Semantic ic 3. 27 3.12 3.48 .065 Intrusions ( (PSI) (SD=2.8) (SD=2.5) LASSI-L C Cue ued B d B2 Semantic ic 1.83 1.92 .13 .717 Intrusions ( (frPSI) (SD=1.7) (SD=1.6) HVLT LT –R To Total 25. 37 23.04 3. 3.90 90 .05 05 (SD=4.1) (SD= 4.2) HVLT LT-R Delay ay 9.10 7.94 4. 4.81 81 .031 031 (SD=2.3) (SD=2.3) Categ egory F Fluen ency 48. 70 39.70 16. 16.47 47 <.001 001 (SD=9.1) (SD=9.6)
Neuropsychological al P Performan ance in Mild C Cognitive Impai airment No Non-Hi Hisp MCI Hispa pani nic MCI CI F-Va Value p-Value lue (n=62) 62) (n=51) 51) Adjus usted f for Age, S Sex x & & Ed. d. LASSI-L C Cue ued B d B1 Semantic ic 4.37 4.75 .12 .725 Intrusions ( (PSI) (SD=3.0) (SD=3.0) LASSI-L C Cue ued B d B2 Semantic ic 3.40 3.51 .14 .712 Intrusions ( (frPSI) (SD=2.8) (SD=2.3) HVLT LT –R To Total 17.82 18. 56 2.50 .116 (SD=5.1) (SD= 4.4) HVLT LT-R Delay ay 2.92 2.49 .70 .403 (SD=3.1) (SD=2.7) Categ egory F Fluen ency 38.24 36.22 .06 .812 (SD=10.2) (SD=8.2)
Does Degree of Acculturation Impact Semantic Intrusion Errors on the LASSI-L?
Bi-dimensional Acculturation Scale for Hispanics (BAS), Marin and Gamba (1996) 1. Language Use 2. Linguistic Proficiency 3. Electronic Media High versus low acculturation was not related to differences in semantic intrusion errors the LASSI-L among Hispanic individuals. Acculturation level did not affect performance on other LASSI -L indices.
Semantic c Intr trusio ions a and Relationship wi with Co Cortical Thick ckness Non-Hispanics Hispanics PSI Intrusions frPSI PSI frPSI Intrusions Intrusions Intrusions (n=71) (n=71) (n=62) (n=62) Left ERC r=-.09 r=-.34 ** r=.28* r=.22 Left Parahippocampal r=-. 01 r=-.35 ** r=-.15 r=-.16 Left Precuneus r=-.06 r= -.22 r=-.29* r=-.16 Inferior Temporal r=-.03 r= =.14 r=-.32* r=-.22 Superior Temporal r=-08 r= -. 31* r=.25 r=-.04
Summary • The LASSI-L distinguishes between cognitively normal elders from those on the preclinical AD continuum. • Among Hispanics in the U.S., LASSI-L discriminates aMCI from cognitively normal elders • The measurement of semantic intrusion errors is a useful measure of risk in Hispanic individuals. • Low acculturation to mainstream culture was not associated with poorer performance. • Expanding upon previous research about the association of the LASSI-L with multiple biomarkers of early AD pathology, Semantic intrusion errors was also associated with cortical thickness in several AD ROIs among Non-Hispanic and Hispanic persons. • Cognitive Stress Tests such as the LASSI-L are worthy of further research, particularly among diverse cultural groups.
Acknowledgments FUNDING: UM Department of Computer Sciences 1RO1AG055638-01A1, Curiel, PI UM Department of Neurology 7AZ14, Curiel, PI UM Department of Radiology & Nuclear Medicine 8AZ21, Curiel, PI UM Department of Anesthesiology 8AZ23, Loewenstein PI Graduate Students: 7AZ18, Loewenstein, PI John Skicki R01AG047649-01, Loewenstein, PI Lubna Jahjah P50AG047266-OA1, Golde, PI Livia Perez Lloyd Beaufils Odileibys Garcia Valerie Zaldivar
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