Understanding Health Beliefs and Health Behaviors in Older Adults at Risk for Alzheimer's Disease.

Background: There are significant public health benefits to delaying the onset of Alzheimer's disease (AD) in individuals at risk. However, adherence to brain healthy behaviors is low. The Health Belief Model proposes that specific beliefs are mediators of behavior change. Objective: To characterize health belief measures from the Science of Behavior Change Research Network (SBCRN) in an older adult population and associations between health beliefs, AD risk, and current health behaviors. Methods: A total of 172 individuals from the Rhode Island AD Prevention Registry participated. SBCRN health belief measures included assessments of future time perspective, self-efficacy, deferment of gratification, and consideration of future consequences. Outcome measures included individual AD risk index score, dementia risk awareness, and lifestyle behaviors including physical, cognitive, and social activity. Results: Participants who were older had higher scores for AD risk, lower future time perspective, and lower generalized self-efficacy (all at p < 0.001). Higher generalized self-efficacy was related to increased physical activity (p < 0.010). Higher future time perspective (p < 0.001) and generalized self-efficacy (p = 0.48) were associated with lower AD risk score. Subjective cognitive decline (SCD) was associated with lower self-efficacy, ability to delay gratification, and a less expansive future time perspective. Conclusions: Greater self-efficacy and perceived future time remaining were associated with lower AD risk and greater engagement in physical activity. SCD was associated with health beliefs that may negatively affect engagement in positive brain health behaviors. Assessment of and psychoeducation about these intrapersonal health belief constructs may be important targets for behavioral interventions to reduce AD risk.

Association between neuropsychological assessment and amyloid status in a clinical setting.

OBJECTIVE: Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases. METHOD: Participants (N = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status. RESULTS: AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile). CONCLUSIONS: Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of aging on externally cued and internally driven uncertainty representations.

OBJECTIVE: The Hick-Hyman law states that response time (RT) increases linearly with increasing information uncertainty. The effects of aging on uncertainty representations in choice RT paradigms remain unclear, including whether aging differentially affects processes mediating externally cued versus internally driven uncertainty. This study sought to characterize age-related differences in uncertainty representations using a card-sorting task. METHOD: The task separately manipulated internally driven uncertainty (i.e., probability of each stimulus type with fixed number of response piles) and externally cued uncertainty (i.e., number of response piles with fixed probability of each stimulus type). RESULTS: Older adults (OA) showed greater RT slowing than younger adults in response to uncertainty load, an effect that was stronger in the externally cued than internally driven condition. While both age groups showed lower accuracy and greater RTs in response to unexpected (surprising) stimuli in the internally driven condition at low uncertainty loads, OA were unable to distinguish between expected and nonexpected stimuli at higher uncertainty loads when the probability of each stimulus type was close to equal. Among OA, better performance on the internally driven, but not externally cued, condition was associated with better global cognitive performance and verbal fluency. CONCLUSIONS: Collectively, these findings provide behavioral evidence of age-related disruptions to bottom-up (externally cued) and top-down (supporting internally driven mental representations) resources to process uncertainty and coordinate task-relevant action. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pre-treatment frontal beta events are associated with executive dysfunction improvement after repetitive transcranial magnetic stimulation for depression: A preliminary report.

Repetitive transcranial magnetic stimulation (rTMS) is an established clinical treatment for major depressive disorder (MDD) that has also been found to improve aspects of executive functioning. The objective of this study was to examine whether oscillatory burst-like events within the beta band (15-29 Hz) prior to treatment could predict subsequent change in self-reported executive dysfunction (EDF) across a clinical course of rTMS for MDD. Twenty-eight adults (64% female) with MDD completed the self-report Frontal Systems Behavior Scale (FrSBe) and provided eyes-closed resting-state electroencephalography (EEG) before and after a clinical course of rTMS therapy for primary MDD. The rate, power, duration, and frequency span of transient EEG measured oscillatory beta events were calculated. Events within delta/theta and alpha bands were examined to assess for beta specificity. After controlling for improvement in primary depressive symptoms, a lower rate of beta events at F3, Fz, F4, and Cz prior to rTMS treatment was associated with a larger improvement in EDF after rTMS treatment. In addition, a decrease in beta event rate at Fz pre-to-post treatment was associated with a larger improvement in EDF after treatment. Results were largely specific to the beta band. In this study, the rate of frontrocentral beta events prior to treatment significantly predicted the likelihood of subsequent improvement in EDF symptoms following a clinical course of rTMS for MDD. These preliminary findings suggest the potential utility of EEG measured beta events and rTMS for targeting EDF across an array of neuropsychiatric disorders.

The effects of short interventions of focused-attention vs. self-compassion mindfulness meditation on undergraduate students: Evidence from self-report, classroom performance, and ERPs.

Mindfulness-based stress reduction (MBSR) training has been shown to improve cognitive processing, wellbeing, and academic performance. However, mindfulness interventions that are integrated into non-mindfulness related courses have not been well-investigated. Further, the unique effects of different aspects of MBSR training are not as well understood. This paper examines the effects that are uniquely associated with focused-attention versus self-compassion mindfulness practices utilizing a multi-method approach. Event-related potentials (ERPs) were recorded during an Emotional Flanker task, and self-report measures of wellbeing and measures of classroom performance were collected before and after training. Participants were students in two sections of the same undergraduate course and either completed 10 weeks of focused-attention practice or self-compassion practice that was built into their class sessions. Students in the focused-attention group (mean age = 22.08) had reduced interference effects on their reaction times following the training. Students in the self-compassion group (mean age = 23.91) showed altered processing of conflict on negative trials via the N2 and P3 ERP amplitudes after the training. This group also reported significant improvements in wellbeing and performed significantly better on more class tests compared to the focused-attention group. These data support the effectiveness of incorporating brief, simplified mindfulness practices in any classroom as an intervention to improve attention, wellbeing and classroom performance.