Browsing by Author "Padron, Dilianna"

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    Associations Between Clinical Functioning and Ad Biomarkers Among Hispanic and White Non-Hispanic Older Adults
    (Oxford University Press, 2023-12-21) Rodriguez, Miriam; Mendoza, Lisandra; Garcia, Patricia; Duart, Andres; Padron, Dilianna; Marsiske, Michael; Fiala, Jacob; Duara, Ranjan; Neurology, School of Medicine
    Objectives: Hispanics are 1.5x more likely to develop Alzheimer’s disease (AD) when compared to White non-Hispanics (WNHs). There is also evidence to support that cognitive performance disproportionately reflects neuropathology among Hispanics and that functional decline is concurrent with the accumulation of AD biomarkers. The current study aimed to examine relationships between AD biomarkers and a functional measure among Hispanic and WNH older adults. It was hypothesized that the functional measure would be strongly related to AD biomarkers among Hispanics. Methods: The modified clinical dementia rating scale (mCDR) was administered in the participants primary language (English or Spanish) to WNH (n=203) and Hispanic (n=258) older adults who were cognitive normal or diagnosed with Mild Cognitive Impairment (MCI) or dementia. Invariance SEM models were used to compare the pattern of relationships between the mCDR and neurocognitive test performance, MRI volumes, and amyloid load adjusting for age, education, ApoE4 status, and intracranial volume. Results: Model fit was good and not significantly worsened by imposing strict structural invariance. Nested model comparisons indicated that regression weights and correlations among measures differed by group, suggestive of moderation by Hispanic status. Among Hispanic participants, sex (♌=-0.17, p<.05) and Amyloid load (♌=0.25, p<.001) significantly predicted mCDR scores. MRI volumes significantly predicted MCDR scores among both Hispanic (♌=-0.51, p<.001) and WNH participants (♌= -0.42, p<.001). Conclusions: Functional measures like the mCDR may better correlate with Amyloid load among Hispanic older adults than among WNHs, while the correlation with MRI volumes may be comparable in both groups.
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    Functional measures and AD biomarkers among Hispanic and White non-Hispanic older adults
    (Wiley, 2024-08-10) Rodriguez, Miriam J.; Mendoza, Lisandra; Garcia, Patricia; Duarte, Andres; Padron, Dilianna; Marsiske, Michael; Fiala, Jacob; Gonzalez, Joanna; Duara, Ranjan; Neurology, School of Medicine
    Introduction: Poorer baseline functioning is associated with long-term cognitive decline among Hispanic older adults, but little is known about associations of these factors with Alzheimer's disease (AD) neuroimaging biomarkers. Methods: A total of 461 Hispanic and White non-Hispanic (NHW) older adults who are cognitively normal (n = 76), had impaired cognition without mild cognitive impairment (MCI) (n = 41), or carried a diagnosis of MCI (n = 253) or dementia (n = 91) completed neuropsychological and functional assessment, genetic testing, and brain magnetic resonance imaging (MRI). Structural equation modeling (SEM) was used to examine predictive associations between functional and cognitive measures of AD neuroimaging biomarkers. Results: MRI volumes significantly predicted functional limitations in both groups. Sex and amyloid load significantly predicted functional limitations among the Hispanic group only. Years of education and MRI regional volume were the strongest predictors of cognition among both groups. Discussion: Results indicate that functional performance is associated with early AD biomarkers among Hispanic older adults. Clinical implications are discussed. Highlights: The current study addresses health disparities in Alzheimer's disease (AD) and related dementia assessment among Hispanics by identifying measures sensitive to early AD biomarkers.Associations of functional measures with AD genetic and neuroimaging biomarkers revealed that similarities in these associations exist between Hispanic and White non-Hispanic individuals, but biological sex and amyloid load significantly predicted functional limitations among the Hispanic group only.These results have clinical implications for physicians who treat Hispanic AD patients and indicate that when compared to traditional diagnostic assessments, functional assessments may better aid in AD diagnostic precision among Hispanics.
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    Reliability and Validity of the Mcdr for Hispanic Older Adults
    (Oxford University Press, 2023-12-21) Mendoza, Lisandra; Garcia, Patricia; Padron, Dilianna; Duarte, Andres; Marsiske, Michael; Fiala, Jacob; Duara, Ranjan; Rodriguez, Miriam; Neurology, School of Medicine
    Objective: Effective functional measures can be used among Hispanics to diagnose and evaluate functional dementia progression, especially in the prodromal stages when treatment can be most effective. The current study examined the reliability and validity of the modified version of the modified Clinical Dementia Rating Scale (mCDR) compared to the Alzheimer’s Disease Cooperative Study (ADCS)-MCI-ADL. These are quantitative severity measures of functional impairment in dementing conditions. The mCDR uses an itemized informant-based structured interview with multiple-choice responses and does not include cognitive testing (Duara et al., 2010). Methods: Functional measures were administered to 101 White non-Hispanic Cognitively Normal (CN, n=20) and MCI (n=81) and 159 Hispanic CN (n=32) and MCI (n=127) participants in the patient’s primary language (English or Spanish). Inter-rater reliability and convergent validity for these instruments were examined. Multiple regression analyses were conducted to determine if the administration’s language (English vs. Spanish) moderated the raters’ scores relationships. Results: The results revealed moderate-to-good mCDR inter-rater reliability [β =.73, F (40,40) = 6.24, p < .001], even when controlling for language (β = .72, p < .001; main effect and interaction were not significant). ADCS-MCI-ADL showed moderate-to-good inter-rater reliability [β = .71, F (40,36.6) = 6.34, p < .001] also, when controlling for language (β = .72, p < .001; main effect and interaction were not significant). The mCDR and the ADCS-MCI-ADL were correlated at -.75, suggesting a high convergent validity (56%). Conclusions: The m-CDR is a valid and reliable quantitative functional measure among Hispanic individuals.
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    Sensitivity and Specificity of the Mcdr for Mci Diagnosis among Hispanic and White Non-Hispanic Older Adults
    (Oxford University Press, 2023-12-21) Garcia, Patricia; Mendoza, Lisandra; Duarte, Andres; Padron, Dilianna; Marsiske, Michael; Fiala, Jacob; Duara, Ranjan; Rodriguez, Miriam; Neurology, School of Medicine
    Objective: Greater functional impairment has been associated with higher rates of progression to dementia. Identifying sensitive functional measures that can detect early ADRD have immediate implications for prognosis, especially among ethnically diverse groups who are disproportionately affected. The modified Clinical Dementia Rating scale (mCDR) is a multiple-choice format assessment that assesses the five domains of the Clinical Dementia Rating scale. The current study aimed to compare sensitivity and specificity of the mCDR between White non-Hispanic (WNH) and Hispanic participants. Methods: The mCDR was administered in the patient’s primary language (English or Spanish) to 101 WNH Cognitively Normal (CN, n=20) and with MCI (n=81) and 159 Hispanic CN (n=32) and MCI (n=127) participants. Sensitivity to MCI diagnosis and Specificity to CN, using the mCDR “mean of means” total score, was quantified via Area under the Curve (AUC) calculated from a Receiver Operating Characteristic analysis. Results: Among WNH participants, the mCDR score demonstrated 78% Sensitivity and 90% Specificity (AUC = .88; CI95%= .81, .94). Among Hispanics, the mCDR showed 61% Sensitivity and 78% specificity (AUC = .73; CI95%= .64, .83). AUC was significantly worse for Hispanic participants. Conclusion: The mCDR is a tool that can be used by a trained psychometrist to facilitate focused answers and reduce administration time when assessing clinical functioning among dementia populations. It demonstrated excellent discrimination between CN and MCI among WNHs and acceptable discrimination among Hispanic individuals. Future research should further examine the utility of this tool for Hispanic older adults in early diagnosis of ADRD.
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    Sex significantly predicts medial temporal volume when controlling for the influence of ApoE4 biomarker and demographic variables: A cross-ethnic comparison
    (Cambridge University Press, 2024) Garcia, Patricia; Mendoza, Lisandra; Padron, Dilianna; Duarte, Andres; Duara, Ranjan; Loewenstein, David; Greig-Custo, Maria; Barker, Warren; Curiel, Rosie; Rosselli, Monica; Rodriguez, Miriam; Neurology, School of Medicine
    Objective: To explore the relationship between age, education, sex, and ApoE4 (+) status to brain volume among a cohort with amnestic mild cognitive impairment (aMCI). Method: One hundred and twenty-three participants were stratified into Hispanic (n = 75) and White non-Hispanic (WNH, N = 48). Multiple linear regression analyses were conducted with age, education, sex, and ApoE4 status as predictor variables and left and right combined MRI volumes of the hippocampus, parahippocampus, and entorhinal cortex as dependent variables. Variations in head sizes were corrected by normalization with a total intracranial volume measurement. Results: Bonferroni-corrected results indicated that when controlling for ApoE4 status, education, and age, sex was a significant predictor of hippocampal volume among the Hispanic group (β = .000464, R2 = .196, p < .01) and the WNH group (β = .000455, R2 = .195, p < .05). Education (β = .000028, R2 = .168, p < .01) and sex (β = .000261, R2 = .168, p < .01) were significant predictors of parahippocampal volume among the Hispanic MCI group when controlling for the effects of ApoE4 status and age. One-way ANCOVAs comparing hippocampal and parahippocampal volume between males and females within groups revealed that females had significantly larger hippocampal volumes (p < .05). Hispanic females had significantly larger hippocampal (p < .001) and parahippocampal (p < .05) volume compared to males. No sex differences in parahippocampal volume were noted among WNHs. Conclusions: Biological sex, rather than ApoE4 status, was a greater predictor of hippocampal volume among Hispanic and WNH females. These findings add to the mixed literature on sex differences in dementia research and highlight continued emphasis on ethnic populations to elucidate on neurodegenerative disparities.