ABSTRACT
OBJECTIVE: Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer's disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants' personal devices in their everyday environments. METHODS: We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65-97 years) and 22 individuals with very mild dementia (ages 61-88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies. RESULTS: First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures (r = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants. CONCLUSIONS: Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.
ABSTRACT
Objective We explain evolving policy choices made by all 50 states in response to the coronavirus (COVID-19) pandemic in the United States against the background of each state's political and public health landscape. Method We create an index of eight state preventative measures and explain variation in that index by infection and death rates, vaccination rates, support for President Trump in 2020, and the political party of the governor. We control for population density and the health vulnerability of each state. Results State response was largely driven by three factors: the death rate from COVID-19, Trump votes in 2020 and Republican control of the governorship. Conclusion Understanding state response to the pandemic requires going beyond a partisan lens and considering the shifting onus of responsibility for taking action to protect against the virus from states to individual citizens in an increasingly politicized sphere of pandemic response.
ABSTRACT
The COVID-19 pandemic has increased adoption of remote assessments in clinical research. However, longstanding stereotypes persist regarding older adults' technology familiarity and their willingness to participate in technology-enabled remote studies. We examined the validity of these stereotypes using a novel technology familiarity assessment (n = 342) and with a critical evaluation of participation factors from an intensive smartphone study of cognition in older adults (n = 445). The technology assessment revealed that older age was strongly associated with less technology familiarity, less frequent engagement with technology, and higher difficulty ratings. Despite this, the majority (86.5%) of older adults elected to participate in the smartphone study and showed exceptional adherence (85.7%). Furthermore, among those enrolled, neither technology familiarity, knowledge, perceived difficulty, nor gender, race, or education were associated with adherence. These results suggest that while older adults remain significantly less familiar with technology than younger generations, with thoughtful study planning that emphasizes participant support and user-centered design, they are willing and capable participants in technology-enabled studies. And once enrolled, they are remarkably adherent.
ABSTRACT
Background As the world grapples with the COVID-19 pandemic, there have been widespread disruptions to everyday life due to social distancing. Older adults with Alzheimer disease (AD) are at increased risk of morbidity and mortality from COVID-19. It is unknown how COVID-19 affects the mobility patterns of older adults with preclinical AD. Since before the pandemic, we have been monitoring the driving behaviors of older adults, enabling us to evaluate the impact of the pandemic on individuals with and without preclinical AD. Method We used in-vehicle Global Positioning System (GPS) devices to study driving behaviors of 115 older adults enrolled in the DRIVES study (aged 65+) from 1/1/2019 to 31/12/2020. The cohort included 62 individuals with preclinical AD (PreAD) and 53 without preclinical AD (CTL), as determined by cerebrospinal fluid biomarkers. All participants completed an online survey about their overall experiences during the pandemic. Using the GPS data, we determined the average monthly distance travelled, and the number of visitations to destinations categorized as food shopping, place of worship, restaurant, leisure, or health. All measures were computed monthly. Result oth groups experienced an approximate 40% decline in average monthly distance travelled overall after the start of the pandemic (PreAD: 1287.92 to 783.38 km vs. CTL: 1751.26 to 1053.29 km). Visits to places of worship, restaurants, leisure and health places declined by 70%, 46%, 23%, and 23% for the PreAD group, and by 48%, 31%, 48%, and 22% for the CTL group, respectively. However, the pandemic did not result in a significant decline in Food Shopping among either of the groups. Overall, compared to the CTL group, the PreAD group experienced a higher level of stress in response to the recommendations for socially distancing (p<0.01), more uncertainty about their risk of COVID-19 (p<0.05), more decline in trips for worship (p<0.05) and less decline in trips for leisure (p<0.01). Conclusion Our findings indicate decreased mobility in all older adults during the pandemic, with the preclinical AD group exhibiting more decline in trips to places of worship, less decline in leisure activities, and increased stress and uncertainty in response to COVID-19.
ABSTRACT
The federal government's response the novel coronavirus (COVID-19) pandemic has been marked by a series of apparently disjointed, chaotic, and confusing statements and actions on the part of both the White House and federal agencies charged with coordinating the federal response. These actions have left many state governors (and citizens) in a position to address the effects of the pandemic in a haphazard and atomistic manner. In this essay, we contend that the actions of the Trump administration, and its relationships with states and local governments, can best be understood through a lens of what we refer to as "transactional federalism," in which federalism relationships are governed by a set of exchanges between the president and states, and between states. We conclude by discussing the ramifications of this form of federalism. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
ABSTRACT
The COVID-19 pandemic has presented many challenges to governments around the world. The federal structure within the United States has further complicated effective responses to mitigate the personal and economic effects of COVID. Here, we argue that the Trump administration?s approach to federalism?highlighted by the pandemic?is incapable of efficiently and effectively addressing state needs and those needs are only going to grow as a result, further exacerbating the problem. This form of federalism, which we dub ?transactional federalism,? is likely to have deleterious effects on state infrastructure, much of which is already in need. The long-term effects of transactional federalism are likely to weaken state efforts to address critical infrastructure needs.
ABSTRACT
The federal government?s response the novel coronavirus (COVID-19) pandemic has been marked by a series of apparently disjointed, chaotic, and confusing statements and actions on the part of both the White House and federal agencies charged with coordinating the federal response. These actions have left many state governors (and citizens) in a position to address the effects of the pandemic in a haphazard and atomistic manner. In this essay, we contend that the actions of the Trump administration, and its relationships with states and local governments, can best be understood through a lens of what we refer to as ?transactional federalism,? in which federalism relationships are governed by a set of exchanges between the president and states, and between states. We conclude by discussing the ramifications of this form of federalism.