Examining Demographic Factors, Psychosocial Wellbeing and Cardiovascular Health in Subjective Cognitive Decline in the Brain Health Registry Cohort.

BACKGROUND: Subjective cognitive decline (SCD) is defined as an individual's perception of sustained cognitive decline compared to their normal state while still performing within boundaries for normal functioning. Demographic, psychosocial and medical factors have been linked to age-related cognitive decline, and Alzheimer's dementia (AD). However, their relation to risk for SCD remains unclear. This study aims to identify demographic factors, psychosocial and cardiovascular health associated with SCD within the Brain Health Registry (BHR) online cohort. METHODS: Participants aged 55+ (N=27,596) in the BHR self-reported SCD measured using the Everyday Cognition Scale (ECog) and medical conditions, depressive symptoms, body mass index, quality of sleep, health, family history of AD, years of education, race, ethnicity and gender. Multivariable linear regression was used to examine whether SCD was associated with demographic, psychosocial, and medical conditions. RESULTS: We found that advanced age, depressive symptoms, poorer sleep quality and poorer quality of health were positively associated with more self-reported SCD in all models. No race or ethnicity differences were found in association with SCD. Males who reported alcohol and tobacco use or underweight BMI had higher ECog scores compared with females. CONCLUSION: In addition to well-established risk factors for cognitive decline, such as age, our study consistently and robustly identified a strong association between psychosocial factors and self-reported cognitive decline in an online cohort. These findings provide further evidence that psychosocial health plays a pivotal role in comprehending the risk of SCD and early-stage cognitive ageing. Our findings emphasise the significance of psychosocial factors within the broader context of cardiovascular and demographic risk factors.

Unsupervised Online Paired Associates Learning Task from the Cambridge Neuropsychological Test Automated Battery (CANTAB®) in the Brain Health Registry.

BACKGROUND: Unsupervised online cognitive assessments have demonstrated promise as an efficient and scalable approach for evaluating cognition in aging, and Alzheimer's disease and related dementias. OBJECTIVES: The aim of this study was to evaluate the feasibility, usability, and construct validity of the Paired Associates Learning task from the Cambridge Neuropsychological Test Automated Battery® in adults enrolled in the Brain Health Registry. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS: The Paired Associates Learning task was administered to Brain Health Registry participants in a remote, unsupervised, online setting. In this cross-sectional analysis, we 1) evaluated construct validity by analyzing associations between Paired Associates Learning performance and additional participant registry data, including demographics, self- and study partner-reported subjective cognitive change (Everyday Cognition scale), self-reported memory concern, and depressive symptom severity (Patient Health Questionnaire-9) using multivariable linear regression models; 2) determined the predictive value of Paired Associates Learning and other registry variables for identifying participants who self-report Mild Cognitive Impairment by employing multivariable binomial logistic regressions and calculating the area under the receiver operator curve; 3) investigated feasibility by looking at task completion rates and statistically comparing characteristics of task completers and non-completers; and 4) evaluated usability in terms of participant requests for support from BHR related to the assessment. RESULTS: In terms of construct validity, in participants who took the Paired Associates Learning for the first time (N=14,528), worse performance was associated with being older, being male, lower educational attainment, higher levels of self- and study partner-reported decline, more self-reported memory concerns, greater depressive symptom severity, and self-report of Mild Cognitive Impairment. Paired Associates Learning performance and Brain Health Registry variables together identified those with self-reported Mild Cognitive Impairment with moderate accuracy (areas under the curve: 0.66-0.68). In terms of feasibility, in a sub-sample of 29,176 participants who had the opportunity to complete Paired Associates Learning for the first time in the registry, 14,417 started the task. 11,647 (80.9% of those who started) completed the task. Compared to those who did not complete the task at their first opportunity, those who completed were older, had more years of education, more likely to self-identify as White, less likely to self-identify as Latino, less likely to have a subjective memory concern, and more likely to report a family history of Alzheimer's disease. In terms of usability, out of 8,395 received requests for support from BHR staff via email, 4.4% (n=374) were related to PAL. Of those, 82% were related to technical difficulties. CONCLUSIONS: Our findings support moderate feasibility, good usability, and construct validity of cross-sectional Paired Associates Learning in an unsupervised online registry, but also highlight the need to make the assessment more inclusive and accessible to individuals from ethnoculturally and socioeconomically diverse communities. A future, improved version could be a scalable, efficient method to assess cognition in many different settings, including clinical trials, observational studies, healthcare, and public health.

Associations between Participant Characteristics and Participant Feedback about an Unsupervised Online Cognitive Assessment in a Research Registry.

BACKGROUND: This study aims to understand whether and how participant characteristics (age, gender, education, ethnocultural identity) are related to their feedback about taking a remote, unsupervised, online cognitive assessment. METHODS: The Brain Health Registry is a public online registry which includes cognitive assessments. Multivariable ordinal regressions assessed associations between participant characteristics and feedback responses of older (55+) participants (N=11,553) regarding their Cogstate Brief Battery assessment experience. RESULTS: Higher age, secondary education or less, Latino identity, and female gender were associated with a poorer assessment experience; higher age and a non-White identity were associated with experiencing the assessment instructions as less clear; and higher age, non-White identity, and secondary education or less were associated with rating additional human support with the assessment as more useful. DISCUSSION: Our findings highlight the importance of improving the design and instructions of unsupervised, remote, online cognitive assessments to better suit the needs of diverse communities.

A photothrombotic model of small early ischemic infarcts in the rat brain with histologic and MRI correlation.

Over the last two decades several studies have suggested the role of photothrombotic occlusion of cerebral microvessels using rose bengal, resulting in small strokes in rodents that resemble those in humans. This paper describes such a photothrombotic method of acute small stroke induction in rats with histopathologic and in vivo magnetic resonance imaging (MRI) observations from 3 to 6 h after irradiation, which is homologous to a human autopsy specimen. Utilizing 30 min of irradiation with minimal beam intensity (0.1 W/cm(2)) cold white light in conjunction with 20 mg of intravenous (iv) rose bengal as a rapid infusion, small infarcts were induced photochemically in the frontal lobes of six rats. The infarcts showed a consistent pattern on histologic and in vivo MR sections when examined within 7 h or less of irradiation. Both MRI and histologic sections were comprised of (a) a superior zone of infarcted neurons, (b) a middle curvilinear transition zone of edema on MRI and histologically vacuolated neuropil, and (c) an inferior zone of normal neurons. Shorter duration water-sensitive (T2)- and postgadolinium longer duration (T1)-weighted signal decay images both showed a curvilinear hyperintense transition zone of edema. The mean infarct and transition zone areas measured from the histologic sections were comparable to those measured on the MRI. The infarct model described above allows in vivo observations using MRI with the potential for use in testing putative neuroprotective agents. As demonstrated by a comparison with the histologic features of such infarcts in surgical and autopsy brain specimens, the model is relevant to acute human ischemic infarcts.

Distribution of lead and transthyretin in human eyes.

BACKGROUND: The retinal pigment epithelium serves as a defensive barrier to the retina in the same way that the choroid plexus functions in the brain. Previous studies have shown that lead sequestration in the choroid plexus reduces the production and secretion of transthyretin by the choroid plexus. The purpose of this study was to investigate the distribution of lead and transthyretin in human eyes and to explore the potential effect of lead on transthyretin in human eyes. METHODS: Eight pairs of human eyes were obtained from the New York City Eyebank within 24 hours of postmortem. The eyes were dissected to obtain the aqueous, vitreous, retina, and choroid. Lead and transthyretin concentrations in ocular tissues and liquids were determined by atomic absorption spectrophotometry for lead and radioimmunoassay for transthyretin. Lead accumulated in the retina at concentrations that were 166, 739, and 5 times higher than those in the aqueous, vitreous, and choroid, respectively (p < 0.05 for all comparisons). Lead concentrations in ocular tissues or intraocular liquids did not change as a function of age or gender. The concentration of transthyretin in the vitreous (14.4 +/- 5.1 SE microg/mL) was twice as much as in the aqueous (7.0 +/- 1.1SE microg/mL) and was significantly correlated to that in the retina (r = 0.93, p < 0.005). CONCLUSIONS: This study indicates that lead accumulates in human ocular tissues, particularly in the retina. The markedly elevated retina lead level and its relationship to ocular transthyretin and other macromolecules bear further investigation.

The prevalence of eye disease in nursing home and non-nursing home geriatric populations.

The objective of this study was to determine whether rates of eye disease among the elderly are higher for residents of nursing homes than for persons who reside elsewhere. Articles reporting the prevalence of eye disease in geriatric populations (classified as nursing home or non-nursing home) were identified through a Medline search and a search of articles' bibliographies. Identified articles were reviewed, and the relevant data compared with prevalence rates obtained from 738 residents of two nursing homes in New York City. Each of the nursing home residents received an ocular examination upon admission that determined the presence or absence of four varieties of eye disease-i.e. cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. Demographic data were obtained through chart review. Results indicate that prevalence rates of eye disease found in geriatric nursing home populations are generally higher than those found in other geriatric populations. With the exception of the rates for diabetic retinopathy, the rates found in the combined nursing home population sampled in this study were much higher than those reported in any previous study. It is concluded that eye disease is a more serious problem for elderly residents of nursing homes than for the elderly who reside in the community. Possible reasons for this are discussed.

Acute red eye. Differentiating viral conjunctivitis from other, less common causes.

Adenoviral conjuctivitis is one of the most common causes of acute red eye. Other diagnostic considerations include herpes virus conjunctivitis, chlamydial conjunctivitis, allergic conjunctivitis, and various other less common infections. Careful history taking can help in identifying a viral cause. The presentation may range from a minor conjunctivitis resulting from an upper respiratory tract infection to a serious, debilitating epidemic keratoconjunctivitis. Local care and interventions to minimize transmission are the cornerstones of management. Infection is usually self-limiting. Warm soaks and artificial tear lubricants may relieve itching and burning. Patients should be instructed to avoid touching their eyes, wash hands often, use disposable towels, and avoid group activities for as long as an ocular discharge is present. Use of topical corticosteroids or antibacterial preparations can lead to complications, and injudicious use of topical corticosteroids may mask serious conditions that require other interventions.

Iridoschisis: high frequency ultrasound imaging. Evidence for a genetic defect?

AIMS: To elucidate changes in the anatomy of the anterior chamber associated with iridoschisis, a rare form of iris atrophy, and their potential contribution to angle closure glaucoma. METHODS: Both eyes of a 71-year-old woman with bilateral iridoschisis and fibrous dysplasia and her asymptomatic 50-year-old daughter were scanned with a very high frequency (50 MHz) ultrasound system. RESULTS: The symptomatic patient exhibited diffuse changes in the iris stoma with an intact posterior iris pigmented layer in both eyes. These changes were clinically compatible with the lack of iris transillumination defects. Additionally, iris bowing with a resultant narrowing of the angle occurred. The asymptomatic daughter showed discrete, but less severe iris stromal changes. CONCLUSION: This is the first detailed study of high frequency ultrasonic imaging of the iris in iridoschisis. The observed structural changes suggest angle narrowing by forward bowing of the anterior iris stroma may be a mechanism of IOP elevation in this condition. The ultrasonic detection of iris changes in the asymptomatic daughter of the symptomatic patient and the association of iridoschisis with fibrous dysplasia suggest a possible genetic component in the pathogenesis of this condition.

Vitamins for cataracts and macular degeneration.

1. In some instances, the lay and scientific community already have concluded that antioxidants confer protection against cataracts and macular degeneration, and have been using them toward that end for some years. 2. Because vitamins are not considered drugs, their prescription and dosage are not subject to the regulation of the Food and Drug Administration. While some studies support their use, others do not. 3. Until sound randomized, controlled clinical trials have been completed in the use of antioxidant supplements and the development of cataracts and macular degeneration, the exact therapeutic role and dosage of antioxidants will remain less than clear. As is the case with any drug, short- and long-term side effects, as well as potential toxicity, have to be carefully weighed against the protective benefits in each individual case.

Computers and eyestrain.

Computer video display terminals have revolutionized the home and office work habits of millions of people. Although no verifiable organic ocular diseases have been shown to derive from computer monitors, symptoms related to eyestrain are very common. Some 10% to 15% of patients presenting for routine eye exams complain of computer-related headache and eyestrain. Comprehensive ocular examination including distance, intermediate and near refraction, as well as uncovering evidence of ergonomic and lighting inadequacy, often is clinically quite helpful. A careful eye exam with particular attention to middle and near range refraction, oculomotor balance, the workstation, lighting, and seating comfort will assist measurably in alleviating eyestrain.

Nodular granulomatous episclerokeratitis in dogs: 19 cases (1973-1985).

We examined the age and breed prevalence and the response to treatment of 19 dogs with nodular granulomatous episclerokeratitis. Biopsy specimens were evaluated to determine the histologic characteristics of the lesions. In these dogs, this disorder was an idiopathic, bilateral disease characterized histologically by the presence of chronic granulomatous inflammation and reticulin fiber formation. The onset of clinical signs developed predominantly in young to middle-aged Collies, with a slow progression and benign clinical course. With treatment, the condition rarely threatened vision and was controlled easily with azathioprine (2 mg/kg) and/or corticosteroid. The dose of immunosuppressive drug was tapered to allow for minimal systemic effects and continued remission of clinical signs. The response to treatment was highly variable.

Immunohistochemical staining patterns of canine eyes affected with chronic superficial keratitis.

Fourteen limbal biopsy specimens from 11 dogs with chronic superficial keratitis (CSK) were examined histologically and immunohistochemically. Ten of the 14 specimens had corneal epithelial hyperplasia and/or atrophy. Eleven of the 14 specimens had thickened epithelial basement membranes. Each specimen had cellular infiltration and lamellar disruption of the stroma. An avidin-biotin immunoperoxidase complex stain was used to detect immunoglobulin (Ig) deposition. Twelve of the 14 specimens stained positive for Ig. The staining pattern was consistent and characterized by diffuse deposition of stain in the superficial conjunctival stroma near the limbus. Four of the 12 Ig-positive specimens also stained positive in the superficial corneal stroma with 1 of these 4 also staining positive along the epithelial cell basement membrane. The diffuse pattern of stain deposition and the absence of staining of specific epithelial structures indicated that CSK is not a classical autoimmune disease similar to any disease in the pemphigus group or similar to systemic lupus erythematosus. Although the results may implicate CSK as an immune-mediated disease, nonspecific factors could not be ruled out.

Extended-wear aphakic soft contact lenses and corneal ulcers.

A review of 100 aphakic extended-wear soft contact lenses is presented for the period July 1980 to August 1981. Four previously successfully fitted patients with either American Optical Company's Sofcon or Cooper Laboratories' Permalens for extended wear developed corneal ulcers either directly under the lenses or shortly after removal. Three of the female patients were well controlled diabetics without retinopathy, one of whom sustained severe visual loss and neovascular glaucoma after a pseudomonas ulcer. Another patient, who had developed a Seratia marcescens ulcer 3 months later, developed metastatic carcinoma of the bowel. Special attention to diabetic aphakic patients being fitted with extended-wear soft contact lenses is suggested.