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      American Geriatrics Society and National Institute on Aging Bench-to-Bedside Conference: Sensory Impairment and Cognitive Decline in Older Adults : Sensory Impairment and Cognitive Decline in Older Adults

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          Abstract

          <p class="first" id="P3">This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench-to-Bedside research conference, “Sensory Impairment and Cognitive Decline,” on October 2–3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench-to-bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population. J Am Geriatr Soc 66:2052–2058, 2018. </p>

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          Most cited references28

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          Stress and cognition.

          Stress can affect cognition in many ways, with the outcome (i.e., facilitating or impairing) depending on a combination of factors related to both stress and the cognitive function under study. Among the factors identified as particularly relevant to define the cognitive effects of stress are the intensity or magnitude of stress, its origin (i.e., whether triggered by the task or externally), and its duration (i.e., whether acute or chronically delivered). At the cognitive end, the specific cognitive operation (e.g., implicit or explicit memory, long-term or working memory, goal-directed or habit learning) and information processing phases (e.g., learning, consolidation, and retrieval) are essential as well to define stress effects. The emerging view is that mild stress tends to facilitate cognitive function, particularly in implicit memory or simple declarative tasks or when the cognitive load is not excessive. Exposure to high or very high stress acutely (whether elicited by the cognitive task or experienced before being trained or tested in the task) or chronically impairs the formation of explicit memories and, more generally, of those that require complex, flexible reasoning (as typically observed for hippocampus- and prefrontal cortex-related functions) while improving performance of implicit memory and well-rehearsed tasks (as reported for amygdala-dependent conditioning tasks and for striatum-related processes). In addition to these general principles, there are important individual differences in the cognitive impact of stress, with gender and age being particularly influencing factors. WIREs Cogn Sci 2013, 4:245-261. doi: 10.1002/wcs.1222 For further resources related to this article, please visit the WIREs website.
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            Chronic psychosocial stress causes apical dendritic atrophy of hippocampal CA3 pyramidal neurons in subordinate tree shrews.

            We have shown previously that repeated laboratory restraint stress or daily corticosterone administration affects the structure of CA3 hippocampal neurons in rats. In the present study, we investigated the effect of repeated daily psychosocial stress on the structure of hippocampal CA3 pyramidal neurons in male tree shrews (Tupaia belangeri). Male tree shrews develop social hierarchies in which subordinates show characteristic changes in physiological and behavioral parameters when confronted with a dominant. In the present experiments, subordinate animals lost body weight soon after starting the daily social conflict, and urinary excretion of cortisol was elevated throughout the experiment as compared with the control period. Golgi-impregnated brain tissue from subordinates exposed to 28 d (1 hr/d) of social confrontations was compared with that from control nonstressed animals. The apical dendrites of the CA3 pyramidal cells from subordinates had a decreased number of branch points and total dendritic length as compared with controls. No differences were observed in apical dendritic spine density or in the basal dendritic tree morphology. The stress-induced CA3 apical dendritic atrophy in subordinates was prevented by administering daily oral doses of the antiepileptic drug phenytoin (Dilantin, Sigma, St. Louis, MO) (200 mg/kg), which interferes with excitatory amino acid (EAA) action. These results suggest that the naturalistic stressor psychosocial stress induces specific structural changes in hippocampal neurons of subordinate male tree shrews. These changes, like those in the rat after glucocorticoid treatment or restraint stress, probably are mediated by activation of the hypothalamo-pituitary-adrenal-axis acting in concert with endogenous EAAs from mossy fiber input.
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              Validation of the Patient Health Questionnaire-9 for depression screening among Chinese Americans.

              The objective of this study was to validate the Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9) for screening for depression among Chinese Americans in primary care. Chinese-American patients attending a primary care clinic were screened for major depressive disorder (MDD) using the CB-PHQ-9. All patients who scored 15 or higher on the CB-PHQ-9 were interviewed using the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version. Eight percent of patients who scored less than 15 on the CB-PHQ-9 were randomly selected and interviewed with the depression module of the Chinese-bilingual Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, patient version. During the study, 1940 unduplicated patients completed the CB-PHQ-9. The CB-PHQ-9 had high internal consistency (alpha = 0.91), and the scores of each of its 9 items had moderate to moderately high correlations (0.52-0.85) with the total scores. The sensitivity and specificity of the CB-PHQ-9 for recognizing MDD were found to be 81% and 98%, respectively, and the area under the receiver operating characteristic curve was estimated to be 0.97 (SE, 0.01). The CB-PHQ-9 is a valid and useful instrument for screening for MDD among Chinese Americans in primary care.

                Author and article information

                Journal
                Journal of the American Geriatrics Society
                J Am Geriatr Soc
                Wiley
                00028614
                November 2018
                November 2018
                September 24 2018
                : 66
                : 11
                : 2052-2058
                Affiliations
                [1 ]School of Medicine, Duke University; Durham North Carolina
                [2 ]Geriatrics Research, Education, and Clinical Center; Durham Veterans Affairs; Durham North Carolina
                [3 ]Boston University; Boston Massachusetts
                [4 ]School of Medicine and Public Health, University of Wisconsin; Madison Wisconsin
                [5 ]Case Western Reserve University; Cleveland Ohio
                [6 ]University of Alabama at Birmingham; Birmingham Alabama
                [7 ]Washington University in St. Louis; St. Louis Missouri
                [8 ]University of California, Davis; Davis California
                [9 ]University of Colorado at Boulder; Boulder Colorado
                [10 ]Johns Hopkins University; Baltimore Maryland
                [11 ]University of California, San Francisco; San Francisco California
                Article
                10.1111/jgs.15506
                6410371
                30248173
                df51e8f6-3aad-4c32-ac3f-0a6d9b41bf2e
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

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