Browsing by Author "Hammers, Dustin"

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    Developments in understanding early onset Alzheimer’s disease
    (Wiley, 2023) Griffin, Percy; Apostolova, Liana; Dickerson, Bradford C.; Rabinovici, Gil; Salloway, Stephen; Raghuram, Srilath; Brandt, Katie; Hall, Stephen; Masdeu, Joseph; Carrillo, Maria C.; Hammers, Dustin; Neurology, School of Medicine
    On September 25 and 26, 2021, the Alzheimer's Association hosted the first meeting focused on people with early-onset Alzheimer's disease (EOAD)-sometimes referred to as younger onset Alzheimer's disease (AD). Though a diagnosis of AD can be devastating at any age, those with a younger onset-defined as symptoms developing prior to 65 years of age-face unique challenges. EOAD occurs when people are in the prime of their lives, often with multiple responsibilities including careers, community activities, and raising children and caring for older family members. These challenges warrant special consideration and study, yet people with EOAD are often excluded from AD research because of their atypical age of onset. To help fill this gap, we designed and launched the Longitudinal Early-Onset Alzheimer's Disease Study (LEADS) to enroll and follow 500 people with EOAD from > 15 sites in the United States, which the National Institute on Aging funded in 2018. The September 2021 meeting was designed to inform people with EOAD and their family members and caregivers about the latest research on the biology of EOAD, treatments in the pipeline, practical considerations about legal and financial arrangements for families, and the support networks available to them. More than 217 registrants attended.
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    Exploring Factors Contributing to Caregiver Burden in Family Caregivers of Congolese Adults with Suspected Dementia
    (Wiley, 2023) Ikanga, Jean; Reyes, Anny; Zhao, Liping; Hill-Jarrett, Tanisha G.; Hammers, Dustin; Epenge, Emmanuel; Esambo, Herve; Kavugho, Immaculée; Esselakoy, Christian; Gikelekele, Guy; Tshengele, Nathan; Alonso, Alvaro; Robinson-Lane, Sheria G.; Neurology, School of Medicine
    Introduction: Predicting caregiver burden in individuals with suspected dementia - is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub-Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC). Methods: Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient-caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI). Results: Average caregiver burden on the ZBI was 36.1 (SD = 14.6; range = 12-58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden. Conclusion: Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden.
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    Feasibility and Acceptability of Using Plasma Biomarkers for Diagnosing Alzheimer’s Disease in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Blood-based biomarkers (Aβ, P-tau, neurofilament light) are clinically available to aid in the diagnosis of Alzheimer’s disease and related dementias (ADRD). However, no research has examined the use of blood biomarkers to aid in the diagnosis of ADRD in primary care (PC). Our study will test feasibility and acceptability of implementing blood-based biomarkers for ADRD in PC. Participants include: all PC patients ≥65 years presenting to one of six PC clinics between 6/1/22 and 5/31/23 who score cognitively impaired on the Linus Health Digital Clock and Recall (DCR™), and PC providers (PCPs) of these patients. Patients will view a decision guide about biomarkers and complete the Concerns about Alzheimer’s Disease Dementia Scale, and the Future Time Perspective Scale and the Impact of Events Scale. These measures and the PHQ-9 and GAD-7 will be repeated within 2 weeks of results disclosure. PCPs will receive training on biomarker disclosure techniques and best practices. To date 9 PCPs have consented to provide the biomarker results disclosure and 11 have declined. Following completion of PCP consent (n=100), a total of 200 patients who failed the DCR are eligible to be approached for consent. By November 2023, we anticipate that 150 patients will have completed biomarker testing, and we will have examined the biomarker results in the context of patient neuropsychological and clinical data, comorbidities, and sociodemographic information. This study will provide information regarding feasibility and utility of ADRD biomarkers in PC and a preliminary analysis of biomarker results compared with the patients’ clinical profiles.
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    Implementation of a Digital Cognitive Screening Program for Dementia in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Mullavey, Judy; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Early identification of Alzheimer’s disease and related dementias (ADRD) has become paramount given the emergence of disease modifying therapies. Integration of rapid, scalable tools to identify early cognitive impairment in primary care is essential because most at-risk individuals have limited access to specialty care. Yet, competing demands on primary care practices can make integration challenging. This demonstration project is being conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Patients ≥65 years presenting to one of six primary care sites between 06/01/2022 and 06/30/2023 are asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive screening. Data regarding number of screening attempts that were refused, incomplete, or completed was collected. Results of the first completed screening-results were analyzed using descriptive statistics. As of 2/15/23, there are 3,920 screening attempts. DCR™ screenings were completed 40.8% of the time, refused 57.4%, and attempted but incomplete 1.8%. Thirteen-percent of attempts were positive for cognitive impairment, 37% were borderline, 44% were unimpaired, and 6% were unanalyzable. Average patient age is 73.2±6.0 years, 58% female, and 6% report less than high school education. Patients with positive screenings are older, slightly more female, and reported less education. Cognitive screening via DCR™ is ongoing and has been completed in nearly half of those approached, with half scoring cognitively impaired or borderline. This approach appears to have utility in early detection of cognitive impairment in primary care. By November 2023 we will have follow-up data for patients who screened positive.
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    Predicting daily functioning with the modified Telephone Interview for Cognitive Status
    (Springer Nature, 2022) Dixon, Ava; Porter, Sariah; Suhrie, Kayla; Hammers, Dustin; Duff, Kevin; Neurology, School of Medicine
    Background: The modified Telephone Interview for Cognitive Status (mTICS) is a frequently used telephone-based cognitive screening measure that can distinguish between normal aging, mild cognitive impairment (MCI), and dementia. Although it has been used to predict current and future cognitive function in older adults, no studies have examined if the mTICS can predict daily functioning. Aims: The current study sought to examine the relationship between the mTICS and a performance-based measure of daily functioning. Methods: The mTICS and demographic information (age, sex, education) were collected during a telephone screening visit for 149 older adults (65-91 years in age) with amnestic MCI. Three subscales of the Independent Living Scales (ILS; Managing Money, Managing Home and Transportation, Health and Safety) were collected during a baseline visit and during a 16 month follow-up visit in a subsample of 93 individuals. Results: Using simple hierarchical regression, baseline mTICS total score combined with demographic variables significantly predicted 19-22% of baseline ILS subscale scores. Similarly, in a subsample of 93 participants with 16 month follow-up data, baseline mTICS and demographic information predicted 9-31% of ILS subscale scores at follow-up. Conclusions: The mTICS appears able to predict daily functioning in older individuals with MCI. Remote tracking of cognition and daily functioning in this at-risk group seems particularly beneficial to geriatricians and other providers, especially during COVID-19.