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Now showing items 1 - 16 of 327

  • Intradialytic Cognitive and Exercise Training May Preserve Cognitive Function

    Mara A. McAdams-DeMarco   Jonathan Konel   Fatima Warsame   Hao Ying   Marlís González Fernández   Michelle C. Carlson   Derek M. Fine   Lawrence J. Appel   Dorry L. Segev  

    Introduction Cognitive decline is common and increases mortality risk in hemodialysis patients. Intradialytic interventions like cognitive training (CT) and exercise training (ET) may preserve cognitive function. Methods We conducted a pilot randomized controlled trial of 20 hemodialysis patients to study the impact of 3 months of intradialytic CT (tablet-based brain games) (n = 7), ET (foot peddlers) (n = 6), or standard of care (SC) (n = 7) on cognitive function. Global cognitive function was measured by the Modified Mini Mental Status Exam (3MS), psychomotor speed was measured by Trail Making Tests A and B (TMTA and TMTB), and executive function was assessed by subtracting (TMTB − TMTA). Lower 3MS scores and slower TMTA and TMTB times reflected worse cognitive function. P values for differences were generated using analysis of variance, and 95% confidence intervals (CIs) and P values were generated from linear regression. Results Patients with SC experienced a decrease in psychomotor speed and executive function by 3 months (TMTA: 15 seconds; P = 0.055; TMTB: 47.4 seconds; P = 0.006; TMTB − TMTA; 31.7 seconds; P = 0.052); this decline was not seen among those with CT or ET (all P > 0.05). Compared with SC, the difference in the mean change in 3MS score was −3.29 points (95% CI: −11.70 to 5.12; P = 0.42) for CT and 4.48 points (95% CI: −4.27 to 13.22; P = 0.30) for ET. Compared with SC, the difference in mean change for TMTA was −15.13 seconds (95% CI: −37.64 to 7.39; P = 0.17) for CT and −17.48 seconds (95% CI: −41.18 to 6.22; P = 0.14) for ET, for TMTB, the difference was −46.72 seconds (95% CI: −91.12 to −2.31; P = 0.04) for CT and −56.21 seconds (95% CI: −105.86 to −6.56; P = 0.03) for ET, and for TMTB – TMTA, the difference was −30.88 seconds (95% CI: −76.05 to 14.28; P = 0.16) for CT and −34.93 seconds (95% CI: −85.43 to 15.56; P = 0.16) for ET. Conclusion Preliminary findings of our pilot study suggested that cognitive decline in psychomotor speed and executive function is possibly prevented by intradialytic CT and ET. These preliminary pilot findings should be replicated.
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  • Impact of the Baltimore Experience Corps Trial on cortical and hippocampal volumes

    Michelle C. Carlson   Julie H. Kuo   Yi-Fang Chuang   Vijay R. Varma   Greg Harris   Marilyn S. Albert   Kirk I. Erickson   Arthur F. Kramer   Jeanine M. Parisi   Qian-Li Xue   Eriwn J. Tan   Elizabeth K. Tanner   Alden L. Gross   Teresa E. Seeman   Tara L. Gruenewald   Sylvia McGill   George W. Rebok   Linda P. Fried  

    Abstract Introduction There is a substantial interest in identifying interventions that can protect and buffer older adults from atrophy in the cortex and particularly, the hippocampus, a region important to memory. We report the 2-year effects of a randomized controlled trial of an intergenerational social health promotion program on older men's and women's brain volumes. Methods The Brain Health Study simultaneously enrolled, evaluated, and randomized 111 men and women (58 interventions; 53 controls) within the Baltimore Experience Corps Trial to evaluate the intervention impact on biomarkers of brain health at baseline and annual follow-ups during the 2-year trial exposure. Results Intention-to-treat analyses on cortical and hippocampal volumes for full and sex-stratified samples revealed program-specific increases in volumes that reached significance in men only ( P 's ≤ .04). Although men in the control arm exhibited age-related declines for 2 years, men in the Experience Corps arm showed a 0.7% to 1.6% increase in brain volumes. Women also exhibited modest intervention-specific gains of 0.3% to 0.54% by the second year of exposure that contrasted with declines of about 1% among women in the control group. Discussion These findings showed that purposeful activity embedded within a social health promotion program halted and, in men, reversed declines in brain volume in regions vulnerable to dementia. Clinical Trial Registration: NCT0038 .
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  • Midlife activity predicts risk of dementia in older male twin pairs

    Michelle C. Carlson   Michael J. Helms   David C. Steffens   James R. Burke   Guy G. Potter   Brenda L. Plassman  

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  • Experience Corps: A dual trial to promote the health of older adults and children's academic success

    Linda P. Fried   Michelle C. Carlson   Sylvia McGill   Teresa Seeman   Qian-Li Xue   Kevin Frick   Erwin Tan   Elizabeth K. Tanner   Jeremy Barron   Constantine Frangakis   Rachel Piferi   Iveris Martinez   Tara Gruenewald   Barbara K. Martin   Laprisha Berry-Vaughn   John Stewart   Kay Dickersin   Paul R. Willging   George W. Rebok  

    Background As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact children's academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers. Methods Dual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio. Outcomes For older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults. Summary This trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.
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  • Marketing Public Health Through Older Adult Volunteering: Experience Corps as a Social Marketing Intervention

    Erwin J. Tan   Elizabeth K. Tanner   Teresa E. Seeman   Qian-Li Xue   George W. Rebok   Kevin D. Frick   Michelle C. Carlson   Tao Wang   Rachel L. Piferi   Sylvia McGill   Keith E. Whitfield   Linda P. Fried  

    Objectives We present a social marketing conceptual framework for Experience Corps Baltimore City (EC) in which the desired health outcome is not the promoted product or behavior. We also demonstrate the feasibility of a social marketing–based recruitment campaign for the first year of the Baltimore Experience Corps Trial (BECT), a randomized, controlled trial of the health benefits of EC participation for older adults. Methods We recruited older adults from the Baltimore, MD, area. Participants randomized to the intervention were placed in public schools in volunteer roles designed to increase healthy behaviors. We examined the effectiveness of a recruitment message that appealed to generativity (i.e., to make a difference for the next generation), rather than potential health benefits. Results Among the 155 participants recruited in the first year of the BECT, the average age was 69 years; 87% were women and 85% were African American. Participants reported primarily generative motives as their reason for interest in the BECT. Conclusions Public health interventions embedded in civic engagement have the potential to engage older adults who might not respond to a direct appeal to improve their health.
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  • Higher baseline serum uric acid is associated with poorer cognition but not rates of cognitive decline in women

    Tracy D. Vannorsdall   Alexandra M. Kueider   Michelle C. Carlson   David J. Schretlen  

    Abstract Serum uric acid is a powerful antioxidant that may have neuroprotective properties. While some studies have found that greater serum uric acid is associated with better cognition in older adults, it is also associated with numerous vascular risk factors that increase risk for dementia. Women may also be particularly vulnerable to the vascular effects of elevated uric acid. We previously found that mildly elevated serum uric acid is a biomarker of cognitive dysfunction in older adults, and that this likely is mediated by cerebral ischemic burden. Here we examine both cross-sectional and longitudinal associations between serum uric acid and declines in cognition and functioning in 423 cognitively healthy community-dwelling older women in the Women's Health and Aging Study (WHAS II). We hypothesized that higher serum uric acid would be associated with poorer concurrent functioning and greater declines over 9 years. In linear regression analyses, higher baseline serum uric acid was associated with poorer working memory, with a trend toward slower manual speed and dexterity before and after adjusting for baseline serum uric acid, demographic and health/cardiovascular variables. However, there were no associations for global cognitive functioning, learning/memory, sequencing, verbal fluency, or visuoconstruction. Mixed effects models also revealed no association with subsequent cognitive declines. Future research should examine changes in serum uric acid at earlier periods in the lifespan and their relationships with later cognitive declines. Highlights • Serum uric acid has conflicting associations with late-life cognitive functioning. • It is associated with cerebral ischemia and poorer cognition cross-sectionally. • Women may be especially vulnerable to the vascular effects of elevated uric acid. • We explored longitudinal associations with cognition in WHAS II participants. • Uric acid correlated inversely with cognition at baseline but not longitudinally.
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  • Cardiovascular risk factors and risk of incident depression throughout adulthood among men: The Johns Hopkins Precursors Study

    Nicole M. Armstrong   Lucy A. Meoni   Michelle C. Carlson   Qian-Li Xue   Karen Bandeen-Roche   Joseph J. Gallo   Alden L. Gross  

    Abstract Background Modifiable cardiovascular risk factors elevate risk of subsequent depression in older adults, but the effect of their onset before or after age 65 on incident depression is unclear. Methods Participants were 1190 male medical students without a diagnosis of depression, who matriculated in 1948–1964 and followed through 2011. Cox proportional hazards models were used to assess associations of vascular risk-factor burden, diabetes, hypertension, hyperlipidemia, smoking status, and overweight/obese status with onset of incident depression. Adjustment covariates were race, enrollment wave, baseline age, physical activity, and heavy alcohol use. Results The analysis included 44,175 person-years of follow-up. Among participants depression-free until age 65, vascular risk-factor burden after age 65 (Hazard Ratio, [HR]: 2.13, 95% Confidence Interval, [CI]: 1.17, 3.90) was associated with incident depression risk after age 65. The magnitude of vascular risk-factor burden after age 65 on depression risk after age 65 is comparable to the effect of 8.2 additional years of age. Diabetes (HR: 2.79, 95% CI: 1.25, 6.26), hypertension (HR: 2.72, 95% CI: 1.52, 4.88), and hyperlipidemia (HR: 1.88, 95% CI: 1.05, 3.35) before age 65 were associated with incident depression risk after age 65. Men diagnosed with diabetes after age 65 had 2.87 times the risk of incident depression after age 65 (95% CI: 1.24, 6.62). Limitations Our findings are restricted to male former medical students, which may affect study generalizability. Conclusions Results support the vascular depression hypothesis. Depression screening in older adults with vascular risk-factor burden may provide an avenue for prevention of late-onset depression. Highlights • The vascular burden – depression association is comparable to 8.2 years of aging. • Results are consistent with the vascular depression hypothesis. • Diabetes, hypertension, and hyperlipidemia
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  • Education is associated with sub-regions of the hippocampus and the amygdala vulnerable to neuropathologies of Alzheimer’s disease

    Xiaoying Tang   Vijay R. Varma   Michael I. Miller   Michelle C. Carlson  

    We evaluated the correlation of educational attainment with structural volume and shape morphometry of the bilateral hippocampi and amygdalae in a sample of 110 non-demented, older adults at elevated sociodemographic risk for cognitive and functional declines. In both men and women, no significant education-volume correlation was detected for either structure. However, when performing shape analysis, we observed regionally specific associations with education after adjusting for age, intracranial volume, and race. By sub-dividing the hippocampus and the amygdala into compatible subregions, we found that education was positively associated with size variations in the CA1 and subiculum subregions of the hippocampus and the basolateral subregion of the amygdala (p<0.05). In addition, we detected a greater left versus right asymmetric pattern in the shape-education correlation for the hippocampus but not the amygdala. This asymmetric association was largely observed in men versus women. These findings suggest that education in youth may exert direct and indirect influences on brain reserve in regions that are most vulnerable to the neuropathologies of aging, dementia, and specifically, Alzheimer disease.
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  • The Law of Refugee Status by James C. Hathaway & Michelle Foster

    Macklin Audrey  

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  • James C. Hathaway and Michelle Foster. The Law of Refugee Status

    Byrne, Rosemary  

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  • James C. Hathaway and Michelle Foster. The Law of Refugee Status

    Byrne   Rosemary  

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  • The Text of Galatians and its History. By Stephen C. Carlson.

    Gurry, Peter J.  

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  • The Law of Refugee Status, second edition. By James C. Hathaway and Michelle Foster

    Barsky   Robert F  

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  • The Text of Galatians and its History.\r By Stephen C. Carlson.

    Gurry   Peter J.  

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  • Linda C. Giudice, M.D., Ph.D., and Allison S. Carlson

    Carr   Bruce  

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  • Linda C. Giudice, M.D., Ph.D., and Allison S. Carlson

    Carr, Bruce  

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