Introduction:Alzheimer's disease and related dementias (AD/ADRD) pathology begin decades before diagnosis, yet scalable risk detection infrastructures for midlife adults remain limited. The Biomarker Evaluation of Young Onset Dementia from Diverse Populations (BEYONDD; R56AG075744) pilot study was designed to address this gap through a decentralized, community-engaged research (CER) model for neurodegenerative risk detection in midlife adults with subjective cognitive or behavioral complaints (sCBC). Methods:This cross-sectional pilot assessed the feasibility of CER-based digital recruitment and participant completion of remotely-acquired screening, cognitive, clinical, and phlebotomy assessments with support of Community Research Navigators (CRNs). Feasibility was evaluated using digital recruitment metrics, yield, retention, and geographic reach. Results:Our approach generated 1.8+ million advertisement impressions, 161,100 clicks, and 4,089 web-registrants. 2,117 individuals completed the online screener, exceeding the prespecified screening goal by 141%. We enrolled a multi-ethnic, midlife cohort of 579 participants (Mage =51.6[6.5]; 75% female; 44% Latinx, 31% non-Latinx Black-American, and 26% all other race/ethnicities), exceeding the enrollment goal by 290%, and 476 participants completed the remote protocol (82% retention). Participants were recruited from 49 U.S. states, Puerto Rico, Australia, and Canada. CRN engagement was concentrated during study stage transitions. Discussion:BEYONDD's decentralized, CER-based screening infrastructure demonstrated wide geographic reach, strong early-stage engagement, and efficient recruitment among diverse midlife adults. These findings support the feasibility of scalable CER-based digital recruitment for decentralized early detection initiatives and AD/ADRD trials.

BACKGROUND:A critical goal of ADNI4's Engagement Core is to promote engagement to ensure the generalizability of ADNI. To this end, ADNI4 Engagement Core employs a multi-pronged community-engaged research (CER) model. We highlight components of this model and provide enrollment updates to assess the preliminary efficacy of this approach. METHOD:Participants include persons from low education, rural, and other backgrounds. To promote engagement 1) our CER model prioritizes trust-building, co-learning, power-sharing, fostering sustainable community partnerships with community-based organizations (CBOs) and participants, across ADNI4's digital, blood biomarker, and in-clinic phases; 2) we partner with "Hub Sites" which receive support for participant engagement, including a funded, full-time Community Research Liaison (CRL). CRLs are our "boots on the ground." They work with CBOs (e.g., social services, faith groups) and community members to build partnerships, participate in events, share accurate information, assess community needs, and address beliefs to improve messaging; 3) we deploy Community Research Navigators (CRNs) who work remotely (e.g., phone, email, chat), to apply CER principles to support participants and study partners, address technology/logistical issues, answer inquiries, and nurturing relationships. RESULT:As of January 2025, there are 10 Hub Sites, 6 CRLs, and 6 CRNs. CRLs engaged 85 CBOs and participated in 101 community events (e.g., educational lectures, focus groups), reaching 7,994 people. CRNs have created 3,124 tickets (communications) responding to community members questions/concerns all over the U.S. Most communications have been via email (56%) or phone (42%). Leading topics include blood biomarkers, enrollment, and study questions/payments. Of the new in-clinic enrollees we reached our goal of greater generalizability. Our 10 Hub Sites (∼20% of ADNI sites), accounted for ∼50% of the improved generalizability. CONCLUSION:ADNI4 has scaled a comprehensive CER model to the national level. These preliminary findings suggest these methods are resulting in increased engagement and generalizability, exceeding our goal. These efforts require substantial support and resources and focus on building trust and long-term community partnerships. These strategies provide a replicable, scalable model for more generalizable data for AD/ADRD field.

Adults from underrepresented populations (URPs), including non-Latinx NLB (NLB) and Latinx adults, have higher Alzheimer’s disease and related dementia (ADRD) rates than non-Latinx Whites (NLWs). Young onset dementia is diagnosed when symptom onset occurs before age 65, and little is known about mild cognitive impairment (MCI) and dementia rates in younger URPs. We examined neurocognitive diagnoses, amyloid positivity, and psychiatric symptoms in adults from URPs under 65. A total of 1,562 participants under 65 ( Mage = 57.8, SD = 4.18; Meducation = 13.08, SD = 4.09; Ethnocultural Status: 28.9% NLB, 46.2% Latinx, 24.9% NLW; Gender: 65.5% Female) from the Health and Aging Brain Study-Health Disparities (HABS-HD) completed a neuropsychological (NP) battery and received Clinical Dementia Rating Scale (CDR) scores. Study partners completed the Physician’s Estimate of Duration for AD-related psychiatric symptoms (e.g., mood changes, anxiety/nervousness). Diagnoses (i.e., cognitively unimpaired (CU), MCI, dementia) were conferred using HABS-HD consensus diagnosis criteria. A subset of 756 participants ( M = 57.4, SD = 4.21; 57.7% NLB, 27.6% Latinx) underwent PET imaging with Florbetaben (FBB); amyloid positivity was defined by an SUVR of 1.08. Chi-square tests were computed to examine associations across ethnocultural groups (i.e., NLB, Latinx, and NLW) and neurocognitive diagnoses, amyloid positivity, and psychiatric symptoms. The NLB group had significantly higher rates of MCI and lower rates of CU based on consensus diagnoses ( n = 451; MCI = 30.6%, CU = 63.2%), compared to NLW ( n = 389; MCI = 14.1%; CU = 80.7%, X 2 = 41.20, p <.001) and Latinx groups ( n = 722; MCI = 18.6%; CU = 76.2%, X 2 = 40.09, p <.001). The NLB group also had higher rates of psychiatric symptoms, including mood changes ( X 2 = 17.70, p <.001), anxiety/nervousness ( X 2 = 13.05, p = .001), and aggression/irritability ( X 2 = 15.29, p <.001) compared to NLW and Latinx groups. In contrast, amyloid positivity and dementia rates did not significantly differ across groups (all ps >.05). Young NLB participants in HABS-HD had increased rates of MCI and psychiatric symptoms compared to NLW and Latinx participants. Also notable, there were no significant ethnocultural differences in amyloid positivity or dementia diagnosis. These patterns differ from those previously documented in primarily NLW samples, suggesting that psychosocial and possibly sociocultural factors may differentially affect cognitive health outcomes among middle-aged NLB adults. Future research, with deeper sociocultural phenotyping, may help elucidate the potential mechanisms driving these differences.

OBJECTIVE:Research indicates that demographic (e.g., age, education) and sociocultural (e.g., acculturation) factors can impact neuropsychological test performance among ethnoculturally diverse adults. Some studies suggest that greater acculturation to the United States (U.S.) is associated with better neurocognitive functioning, though no meta-analysis to date has examined this relationship. This review provides a comprehensive synthesis of the literature and determines the magnitude of the relationship between acculturation and neuropsychological test performance. METHOD:A literature search explored all published articles through January 1, 2024, using three databases (i.e., PubMED/MEDLINE, PsycInfo, PsycNET). Data to calculate study effect sizes (i.e., Fisher's z) were extracted from in-text results, tables, and figures. RESULTS:Findings (k = 18 included in quantitative analyses) revealed a small to medium (r = 0.29, partial r = 0.20, p < .01), statistically significant relationship between higher U.S. acculturation and better neuropsychological test performance. Moderation analyses indicated that language of testing emerged as a significant moderator, testing in English yielded larger effect sizes compared to testing in other languages (B = 0.29, p < .05). DISCUSSION:Neuropsychological test performance is significantly associated with U.S. acculturation, and results suggest that the magnitude may vary depending on study methodologies and samples (e.g., ethnocultural group, U.S. born vs. immigrant) examined. The current review also provides recommendations for incorporating acculturation assessment into clinical practice and highlights the need to examine the clinical utility of acculturation tools in conjunction with neuropsychological tests to assist in clinical decision-making with ethnoculturally diverse populations.

It is imperative to identify underrepresented populations (URPs) at risk for progression to Mild Cognitive Impairment (MCI) and dementia due to Alzheimer’s disease (AD), yet substantial heterogeneity exists in the presentation and risk of AD among URPs. Previous research with predominantly non-Latinx White participants indicates early functional decline is associated with increased risk and can be effectively evaluated by participants and study partners (SPs). This study aims to understand the association between subjective functional/cognitive decline and objectively-measured cognitive decline in URPs. Specifically, we hypothesize that SP-reported decline predicts diagnostic progression over time better than participant-reported decline in URPs. A sample of 283 Alzheimer’s Disease Neuroimaging Initiative (ADNI) participant-study partner dyads (M age 69.6 at baseline (±8.1), 62.1% female, 48.4% Black/African American, 29.0% Latinx, 15.5% Asian American, 0.4% Native Hawaiian/Pacific Islander, 1.4% American Indian/Alaska Native, and 8.8% of more than one race), completed the Everyday Cognition Questionnaire (ECog), which assesses real-world functioning related to specific neuropsychological domains, and received consensus neurocognitive diagnoses. An autoregressive, cross-lagged panel analysis examined whether ECog and diagnostic conversion from cognitively normal to MCI or MCI to AD were concurrently associated, whether participant-reported ECog predicted future diagnostic conversion, and whether SP-reported ECog predicted future diagnostic conversion across 3 time points (baseline, 12-months, and 24-months). All autoregressive paths of ECog and diagnostic progression were positive and significant ( p s < .05). Cross-lagged paths of SP-reported ECog more strongly predicted diagnostic progression than participant-reported ECog, and significantly predicted diagnostic progression from Time 2 ( n = 130) to Time 3 ( n = 92) ( b = 2.03, SE = 0.64, p = .002). Cross-lagged paths of participant-reported ECog were not a significant predictor of diagnostic progression across three time points ( p s > .05). Both models including SP-reported ECog were significantly stronger at predicting diagnostic progression. Early functional decline reported by SPs may be an independent predictor for cognitive decline in URPs. SPs also more accurately predicted cognitive decline cross-sectionally and longitudinally than their participant counterparts. Further characterization of the relationships between URP participants and their SPs and their involvement in AD research should be prioritized.

A critical goal of ADNI4's Engagement Core is to promote engagement to ensure the generalizability of ADNI. To this end, ADNI4 Engagement Core employs a multi-pronged community-engaged research (CER) model. We highlight components of this model and provide enrollment updates to assess the preliminary efficacy of this approach. Participants include persons from low education, rural, and other backgrounds. To promote engagement 1) our CER model prioritizes trust-building, co-learning, power-sharing, fostering sustainable community partnerships with community-based organizations (CBOs) and participants, across ADNI4's digital, blood biomarker, and in-clinic phases; 2) we partner with “Hub Sites” which receive support for participant engagement, including a funded, full-time Community Research Liaison (CRL). CRLs are our “boots on the ground.” They work with CBOs (e.g., social services, faith groups) and community members to build partnerships, participate in events, share accurate information, assess community needs, and address beliefs to improve messaging; 3) we deploy Community Research Navigators (CRNs) who work remotely (e.g., phone, email, chat), to apply CER principles to support participants and study partners, address technology/logistical issues, answer inquiries, and nurturing relationships. As of January 2025, there are 10 Hub Sites, 6 CRLs, and 6 CRNs. CRLs engaged 85 CBOs and participated in 101 community events (e.g., educational lectures, focus groups), reaching 7,994 people. CRNs have created 3,124 tickets (communications) responding to community members questions/concerns all over the U.S. Most communications have been via email (56%) or phone (42%). Leading topics include blood biomarkers, enrollment, and study questions/payments. Of the new in-clinic enrollees we reached our goal of greater generalizability. Our 10 Hub Sites (∼20% of ADNI sites), accounted for ∼50% of the improved generalizability. ADNI4 has scaled a comprehensive CER model to the national level. These preliminary findings suggest these methods are resulting in increased engagement and generalizability, exceeding our goal. These efforts require substantial support and resources and focus on building trust and long-term community partnerships. These strategies provide a replicable, scalable model for more generalizable data for AD/ADRD field.

Acculturation is related to neurocognitive functioning in Latina/o/e PWH, however, little is known about the effects of stigma and nativity status. U.S.-born PWH (n = 44) and PWH born outside the U.S. (n = 22), M age = 45.33 (7.67), 71.2% male, M education = 12.33 (2.47) completed a neurocognitive battery, neuromedical evaluation, and sociodemographic questionnaires. Hierarchical regressions predicted neurocognitive T-scores from acculturation, perceived stigma, and nativity status. After accounting for acculturation, nativity status significantly predicted attention/working memory (p = .006), processing speed (p = .03), and executive function (p = .002), and the interaction between nativity status and stigma predicted English language verbal fluency (p = .001). Higher stigmatization was associated with higher English language fluency among those born outside the U.S. but lower English language fluency in U.S.-born participants. Nativity status should be considered when interpreting neurocognitive performance within Latina/o/e PWH.

Objective: Parental and other caregiving leave is important to postdoctoral fellows, yet there is no field-wide recommendation for leave policies among clinical neuropsychology postdoctoral training programs, which is of particular relevance given the two-year requirement for eligibility for board certification. The aims of this manuscript are to (a) discuss general guidelines and recommendations for leave policies, both informed by prior empirical evidence as well as relevant existing policy guidelines from various academic and healthcare organizations, and (b) use vignettes to provide possible solutions for potential leave scenarios. Method: A critical review of literature on family leave from public policy and political science, industrial-organizational psychology, academic medicine, and psychology was conducted and findings were synthesized. Results and Conclusions: Fellowship training programs are encouraged to adopt a competency-based model that permits flexibility in leave during training without necessarily requiring an extended end date. Programs should adopt clear policies and make this information readily available to trainees and think flexibly about training options that best meet the training needs and goals of each individual. We also encourage neuropsychologists at all levels to engage in advocacy for broader systemic supports of trainees seeking equitable family leave.

INTRODUCTION:The Health Equity Scholars Program (HESP) addresses the critical need for a diverse, culturally competent workforce to study and treat older adults from underrepresented populations (URPs) with Alzheimer's disease and related dementias (AD/ADRD). The HESP offers tailored mentored training in AD/ADRD research concepts, aiming to develop successful independent researchers. It recruits Scholars from underrepresented backgrounds as well as those passionate about AD/ADRD health equity research. METHODS:We (1) describe the fundamental elements of the HESP, and (2) present preliminary data from the HESP program evaluation results performed by an outside agency, pre-post participation surveys, and Scholar accomplishments. RESULTS:The HESP Scholars reported high rates of proficiency, satisfaction, and competency in nearly all evaluated areas, and have been successful in obtaining grants, promotions, and publications. DISCUSSION:These initial outcomes data suggest that the HESP is meeting its objective of diversifying the workforce in the field of AD/ADRD research and care. HIGHLIGHTS:The Health Equity Scholars Program aims to cultivate a diverse and culturally competent workforce, who are well-prepared to study and treat underrepresented older adults with Alzheimer's disease and related dementias (AD/ADRD). The program provides tailored mentored training in AD/ADRD research concepts, with the goal of nurturing successful independent researchers. Rigorous evaluation processes for applications ensure the selection of highly qualified Scholars. The program includes tailored training activities such as seminars and grant writing workshops, and tracks Scholar achievements while undergoing annual external evaluation to enhance its training program iteratively.

INTRODUCTION:The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) Engagement Core was launched to advance Alzheimer's disease (AD) and AD-related dementia (ADRD) health equity research in underrepresented populations (URPs). We describe our evidence-based, scalable culturally informed, community-engaged research (CI-CER) model and demonstrate its preliminary success in increasing URP enrollment. METHODS:URPs include ethnoculturally minoritized, lower education (≤ 12 years), and rural populations. The CI-CER model includes: (1) culturally informed methodology (e.g., less restrictive inclusion/exclusion criteria, sociocultural measures, financial compensation, results disclosure, Spanish Language Capacity Workgroup) and (2) inclusive engagement methods (e.g., the Engagement Core team; Hub Sites; Community-Science Partnership Board). RESULTS:As of April 2024, 60% of ADNI-4 new in-clinic enrollees were from ethnoculturally or educationally URPs. This exceeds ADNI-4's ≥ 50% URP representation goal for new enrollees but may not represent final enrollment. DISCUSSION:Findings show a CI-CER model increases URP enrollment in AD/ADRD clinical research and has important implications for clinical trials to advance health equity. HIGHLIGHTS:The Alzheimer's Disease Neuroimaging Initiative-4 (ADNI-4) uses a culturally informed, community-engaged research (CI-CER) approach. The CI-CER approach is scalable and sustainable for broad, multisite implementation. ADNI-4 is currently exceeding its inclusion goals for underrepresented populations.

Older adults may experience decreased social support, which has been linked to cognitive decline and increased risk of dementia. Immigrants may also experience more social isolation due to discrimination and fear of deportation. This study examined social networks, nativity status, and neurocognitive functioning(NC) in an ethnoculturally diverse sample of middle/older adults. Participants included 26 immigrants ( M age = 64.12, SD = 5.64) and 109 U.S.-born adults ( M age = 65.37, SD = 7.10). Participants completed a comprehensive NC battery and the Berkman-Syne Social Network Index(SNI; a well-validated self-reported questionnaire assessing close social support, where higher scores represent more social support). Demographically-adjusted norms were used to compute average global NC and domain T-scores. A series of hierarchical multiple regressions were computed to predict global and domain NC T-scores. SNI and age were entered at Step-One, the interaction term(age*SNI) was entered at Step-Two, and nativity status was entered at Step-Three. Results revealed that the omnibus model was significantly associated with Attention/Working Memory(A/WM) (R² = .13; p s = .009) and Processing Speed(PS) (R² = .20; p s = .002). Notably Step-Three of the model significantly contributed to the association of AWM ( R² Δ = .11; ps <.05) and PS ( R² Δ = .09; ps <.05) beyond Step-One and Step-Two. For A/WM, the interaction term, and nativity status (𝛽s = .04-6.96, respectively; ps <.05) were significantly associated with A/WM. For PS, SNI, the interaction term, and nativity status (𝛽s = -3.91-8.17; ps <.05) were significantly associated with PS. Such that, there is a main effect of nativity status with immigrants scoring lower on measures of A/WM by 6.96 and PS by 8.17 units. Overall, there is a negative association between age and A/WM and PS but as SNI increases the relation between age and NC becomes positive. Only nativity status (𝛽s = 5.99-8.23; ps <.05) significantly predicted Memory, Verbal Fluency, and Global NC functioning scores. Findings show that among middle/older adults, both SNI and nativity status are associated with A/WM and PS, suggesting that a larger SNI can serve as a protective factor against the effects of aging on NC functioning. Importantly, even when SNI and age were not significantly related to NC T-scores, nativity status was. Nativity status likely serves as a proxy for other risk factors (e.g., healthcare access), which should be explored in future studies.

Older adults and ethnoracially diverse groups (e.g., non-Latinx Black (NLB), Latinx) are at higher risk of poor sleep quality. Poor sleep is linked to neurocognitive (NC) decline in middle/older adults, but much of the sleep literature has relied on global NC screening measures. This study examined the effects of age and sleep quality on NC functioning within a multi-ethnic sample of middle/older adults utilizing a multi-domain NC battery. This cross-sectional study included 119 middle/older adults ( M age = 65.3, SD age = 6.9; 46% NLB, 31% Latinx, and 23% non-Latinx White (NLW); 63% female) who completed demographic questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and a comprehensive NC battery. PSQI global and component scores (e.g., Daytime Dysfunction; PSQI-DD) measured subjective reporting of sleep quality. Demographically-adjusted NC T-scores were used to compute 8 NC-domain and global average T-scores. Pearson’s correlations, ANOVA, and multiple regressions were used to test hypotheses. Global NC was not related to any PSQI components, and the PSQI components did not differ across ethnoracial groups (all p ’s<.05). However, within-group correlations revealed that the relationship between PSQI components and NC domains significantly differed across ethnoracial groups. For example, frequency of sleep medication usage was significantly negatively correlated with executive functioning in the NLB group (r = -.39, p = .02), but not NLW or Latinx groups. Multiple regressions, including age and the interactions between race/ethnicity and PSQI component scores, significantly predicted 21-39% of the variance in all NC domains ( p ’s<.05), except attention/working memory ( p = .60). The interaction between PSQI-DD and ethnoracial status significantly predicted memory ( p ’s<.05); this relationship was positive in the NLW group ( B = 20.20), yet negative in the NLB ( B = -1.16) and Latinx ( B = -0.56) groups ( ps <.05). Disordered sleep may have a greater impact on NC functioning, namely memory, among middle/older adults from diverse ethnoracial groups, who are already at heightened risk for NC decline. Importantly, global cognitive screening may be insufficient in examining the effects of sleep quality on NC in middle/older adults. Given the ethnoracial differences in sleep quality, future research should consider culturally-tailored sleep interventions. Using objective sleep quality measures (e.g., actigraphy) may better quantify sleep components.

COVID-19 pandemic stress differentially affects older adults and persons from minoritized, underrepresented populations (URPs; e.g., Black, Latinx), yet potential protective factors are not well understood. This study aimed to evaluate whether pandemic-related social and emotional stressors negatively affect functional capacity, mental health, and cognitive outcomes in an ethnoculturally diverse sample of middle-aged and older adults. Cross-sectional data were obtained from adults (55± years) participating in SALUD, an ongoing study examining risk and resilience factors for dementia in diverse populations. Participants completed a well-validated, comprehensive battery of questionnaires and cognitive assessments. Aggregate scores of social and emotional pandemic stressors (e.g., more anxiety, loneliness) from Item 3 of the Pandemic Stress Index (PSI-3) were examined in association with demographics, Patients Assessment of Own Functioning Inventory (PAOFI; self-reported functional status measure), and Patient Health Questionnaire-2 (PHQ-2; self-report depressive symptomatology measure). Demographically-adjusted norms were used to compute Global Neurocognition (NC) and eight domain-specific NC average T-scores (e.g., learning, memory). Spearman’s correlations, Kruskal-Wallis, Mann-Whitney U -tests were used for non-normal variables. The sample included 110 adults (37.3% Non-Latinx Black [NLB], 33.6% Latinx, and 29.1%, non-Latinx White [NLW]; 63% female; M age = 65.27 [ SD = 7.11]; M ed = 13.89 [ SD = 3.07]). Age was negatively correlated with the PSI-3 ( r s = -.25, p <.01), but education ( r s = -.05, p = .59) and gender (U<.01, p = .99) were not. PSI-3 differed across ethnocultural groups (H = 8.00, p = .02), such that Latinx participants had the highest PSI-3 scores. However, this relationship became non-significant after accounting for age (p = .11). PAOFI impairment scores ( r s = .37, p = .01) and PHQ-2 scores ( r s = .29, p = .01) were positively related to the PSI-3, but Global NC and domain-specific NC average T-scores were not significant ( r s = -.08 - .10, p s> .05). In this ethnoculturally diverse sample, findings suggest older adults may be more resilient to pandemic-related stress. Older age was associated with lower social and emotional pandemic stress, while greater functional impairment and depression were moderately associated with higher pandemic-related stress. As pandemic-related increases in psychosocial stressors (e.g., worry and depression) continue to affect middle-aged and older adults, longitudinal research should investigate the risk and resilience factors that may buffer against developing these negative outcomes.

BACKGROUND:Older adults may experience decreased social support, which has been linked to cognitive decline and increased risk of dementia. Immigrants may also experience more social isolation due to discrimination and fear of deportation. This study examined social networks, nativity status, and neurocognitive functioning(NC) in an ethnoculturally diverse sample of middle/older adults. METHOD:Participants included 26 immigrants (Mage= 64.12, SD = 5.64) and 109 U.S.-born adults (Mage= 65.37, SD = 7.10). Participants completed a comprehensive NC battery and the Berkman-Syne Social Network Index(SNI; a well-validated self-reported questionnaire assessing close social support, where higher scores represent more social support). Demographically-adjusted norms were used to compute average global NC and domain T-scores. A series of hierarchical multiple regressions were computed to predict global and domain NC T-scores. SNI and age were entered at Step-One, the interaction term(age*SNI) was entered at Step-Two, and nativity status was entered at Step-Three. RESULT:Results revealed that the omnibus model was significantly associated with Attention/Working Memory(A/WM) (R² = .13; ps = .009) and Processing Speed(PS) (R² = .20; ps = .002). Notably Step-Three of the model significantly contributed to the association of AWM (R²Δ= .11; ps<.05) and PS (R²Δ= .09; ps<.05) beyond Step-One and Step-Two. For A/WM, the interaction term, and nativity status (𝛽s = .04-6.96, respectively; ps<.05) were significantly associated with A/WM. For PS, SNI, the interaction term, and nativity status (𝛽s = -3.91-8.17; ps<.05) were significantly associated with PS. Such that, there is a main effect of nativity status with immigrants scoring lower on measures of A/WM by 6.96 and PS by 8.17 units. Overall, there is a negative association between age and A/WM and PS but as SNI increases the relation between age and NC becomes positive. Only nativity status (𝛽s = 5.99-8.23; ps<.05) significantly predicted Memory, Verbal Fluency, and Global NC functioning scores. CONCLUSION:Findings show that among middle/older adults, both SNI and nativity status are associated with A/WM and PS, suggesting that a larger SNI can serve as a protective factor against the effects of aging on NC functioning. Importantly, even when SNI and age were not significantly related to NC T-scores, nativity status was. Nativity status likely serves as a proxy for other risk factors (e.g., healthcare access), which should be explored in future studies.

Among Latinx people living with HIV (PLWH), neurocognitive (NC) function, culture, and mental health impact medication adherence. Similarly, health beliefs and attitudes play a role in health care barriers and health behaviors. Research has not examined the effect that compromised neurocognition, sociocultural factors, and mental health have on health beliefs and attitudes. This is especially relevant for Latinx PLWH who are disproportionately impacted by HIV, given that sociocultural factors may uniquely impact HIV-related NC and psychological sequelae. This study investigated the associations between neurocognition, sociocultural factors, mental health, health beliefs, and health attitudes among Latinx HIV-seropositive adults. Within a sample of 100 Latinx PLWH, better verbal learning and executive functioning abilities were associated with more positive attitudes about the benefits of medications and memory for medications. In terms of sociocultural factors, higher English language competence was related to better self-reported memory for medications, and overall, higher US acculturation was associated with more positive attitudes toward health professionals. Depressive symptomatology was negatively associated with attitudes toward medications and health professionals, as well as with self-reported memory for medications. These findings highlight the important interplay between NC, sociocultural, psychological factors, and health beliefs among Latinx PLWH. Adherence intervention strategies and suggestions for dispensing medical information are presented for clinicians and health care practitioners.

Alzheimer’s Disease (AD) and dementia inequities highlight the need to eliminate barriers and promote motivators for study engagement of underrepresented populations (URPs; e.g., non-Latinx Black, Latinx, sexual/gender minoritized populations). Lower educational attainment and URP status are associated with lower research engagement rates. This study examined whether engagement in this community-engaged research (CER) study of middle/older-age adults differs according to ethnoracial identity, gender identity, income, age, education, acculturation, sexual orientation, cardiovascular risk, healthcare access, ethnic discrimination, stress, and loneliness. SALUD is an ongoing, longitudinal study in NYC whose aim is to examine genetic, cerebrovascular, sociocultural risk and resilience factors for dementia. CER strategies (i.e., sustained participation in community events/organizations, Community Science Partnership Board) were employed. The Perceived Stress Scale, UCLA Loneliness Scale, Perceived Ethnic Discrimination Questionnaire, Abbreviated Multidimensional Acculturation Scale, Healthcare Task Difficulty Questionnaire, and Northern Manhattan Study Neuromedical Evaluation were administered. Participants’ progress was coded as retained or dropped out of the study (DOS) for each visit in the study. Cross-sectional analyses ( t -tests, chi-square and Mann-Whitney U -tests) compared demographic, health, and psychosocial variables between those who completed the in-person neuropsychological visit (i.e., ∼5 hour comprehensive neuropsychological battery, blood draw, saliva sample, neuromedical interview and questionnaires in a hospital; INP-V) and MRI visit (i.e., ∼1 hour closed MRI scan; MRI-V) with those who DOS. The sample ( N = 145) was 53.8% female, older, and well-educated ( M age = 65.25, SD age = 6.55, M education = 13.59, SD education = 3.23). URP study engagement was high: 31.7% non-Latinx Black, 34.5% Latinx, and 33.8% non-Latinx White. There were no significant differences in independent variables (e.g., ethnoracial, gender, discrimination) between the INP-V and DOS groups (all p ’s>.09). However, analyses revealed that the MRI-V group ( M = 13.42, SD = 3.07) had significantly fewer years of education than the DOS group ( M = 14.15, SD = 3.71) ( t (143) = 2.69, p <.01, 95% CI [0.39, 2.58]) other differences were observed ( ps >.05). This study’s CER-based approach yielded a high level of URP study engagement. Contrary to previous findings, people with less education were more likely to complete the MRI visit suggesting a willingness to undergo more invasive procedures after establishing trust. CER-based AD studies may help URP participants overcome participation barriers through collaboration with the community.

Objective: Rates of HIV are disproportionately high among Black individuals in the United States (CDC, 2020). Black individuals are at increased risk for neurocognitive impairment due to HIV (Marquine et al., 2016) and experience health disparities including increased morbidity and mortality (Asari, 2018; Manly et al., 1998). We sought to examine the relationship between perceived quality of healthcare and neuropsychological functioning among people living with HIV (PLWH) who identify as Black compared to those who are non-Black. Participants and Methods: 151 PLWH in the Los Angeles area (52% Black, age = 49.85 ± 10.54, education = 13.23 ± 2.11; 87% cisgender men, 8% cisgender women, 1% transgender men, 3% transgender women) completed comprehensive neuropsychological (NP) assessments (from which demographically-corrected domain and global T-scores were derived), psychiatric and sociodemographic interviews, and self-report questionnaires, including a measure of perceived healthcare quality (i.e., QUOTE-HIV). Statistical analyses included chi-square, t-test, ANOVA, and stepwise linear regression. Results: Only 14% of Black PLWH had private healthcare insurance (versus Medicare/Medicaid) compared to 33% of nonBlack PLWH (x2=11.33, p<.01). Black participants were significantly older than nonBlack participants (p<.01), but did not differ on gender, education, income, CD4 count, or HIV viral load. Younger Black participants (based on a median split for age; n = 23) reported the lowest perceived quality of healthcare (i.e., QUOTE-HIV total performance score), while older Black participants (n = 56) reported the highest perceived care (F = 3.80, p = .01), but the same relationship was not observed in nonBlack participants. In a stepwise multivariate regression model, including demographic and virological factors as well as healthcare quality, only household income and overall perceived healthcare quality (i.e., QUOTE-HIV total performance score) were significantly associated with Global NP T-scores among Black PLWH (R2=.12, F(1, 66)=4.46, p=.02). Conclusions: When assessing healthcare quality and healthcare experiences among people living with HIV, race and age are important to consider. Private healthcare coverage may be less accessible to people of color, and in a multivariate model, only income and healthcare quality significantly predicted neuropsychological functioning in Black PLWH. When examining HIV and health outcomes, the complex relationships among quality of healthcare and health disparities, neuropsychological functioning, and structural racism warrant further investigation.

Ethnoculturally diverse (e.g., non-Latinx Black (NLB), Latinx) older adults are up to twice as likely as non-Latinx White (NLW) older adults to experience depressive symptoms. While the relationship between neurocognition (NC) and functional status (e.g., everyday functioning) in older adults is well-established, the impact of depression remains unclear in diverse populations. We assessed the influence of depression on the relationship between NC and functional status in a sample of Latinx, NLB, and NLW middle-aged/older adults. This cross-sectional study included 50 NLB, 45 Latinx, and 38 NLW ( N = 133) adults (59% female; 39% with HIV; M age = 65.3, SD = 6.69; M ed = 13.9, SD = 3.22) who completed the Beck Depression Inventory-II (BDI-II), Activities of Daily Living (ADL) scale, and a comprehensive NC battery. Demographically-corrected T-scores were used to compute global NC and domain average T-scores (global cognition, executive function, learning, memory, verbal fluency). The BDI-II Total Score (BDI-tot), Cognitive-Affective Subscale (BDI-cog), Functional-Somatic Subscale (BDI-som), current functional status (ADL-tot), and decline over time (ADL-dec) were computed. A series of hierarchical linear regressions (HLRs; Step 1: BDI-tot; Step 2: NC global/domain NP T-scores) were computed to predict ADL-dec in each ethnocultural group. To assess age effects in this relationship, additional HLRs (Step 1: BDI-tot, age, BDI-tot×age and Step 2: NC global T-score) were computed. BDI-tot, BDI-cog, and BDI-som were significantly correlated with ADL-dec ( r s = .58-.64, p s<.01) in NLW adults. However, in NLB adults, only BDI-cog was correlated with ADL-dec ( r = .51, p <.01), while in Latinx adults, both BDI-tot and BDI-som were significantly related to ADL-dec ( r s = .38, p s <.05). Within NLB adults, BDI-tot accounted for 15-16% of the variance in ADL-dec ( p s<.05), but NC scores did not uniquely contribute to the model/s (Δ R 2 = 0-.11, p s>.05). Across ethnocultural groups, BDI-tot×age did not significantly predict ADL-dec. However, in the NLW group BDI-tot×age was a significant predictor of ADL-tot (Δ R 2 = .53, p <.05). Depressive symptoms are associated with functional decline, particularly in NLB middle/older adults. Cognitive-affective symptoms may better predict functional status in middle/older NLB adults, while somatic-functional symptoms are associated with functional decline in Latinx middle/older adults. Future studies should examine the longitudinal impact of depression on functional status/NC within ethnoculturally diverse older adults.

BACKGROUND:Alzheimer's Disease (AD) and dementia inequities highlight the need to eliminate barriers and promote motivators for study engagement of underrepresented populations (URPs; e.g., non-Latinx Black, Latinx, sexual/gender minoritized populations). Lower educational attainment and URP status are associated with lower research engagement rates. This study examined whether engagement in this community-engaged research (CER) study of middle/older-age adults differs according to ethnoracial identity, gender identity, income, age, education, acculturation, sexual orientation, cardiovascular risk, healthcare access, ethnic discrimination, stress, and loneliness. METHOD:SALUD is an ongoing, longitudinal study in NYC whose aim is to examine genetic, cerebrovascular, sociocultural risk and resilience factors for dementia. CER strategies (i.e., sustained participation in community events/organizations, Community Science Partnership Board) were employed. The Perceived Stress Scale, UCLA Loneliness Scale, Perceived Ethnic Discrimination Questionnaire, Abbreviated Multidimensional Acculturation Scale, Healthcare Task Difficulty Questionnaire, and Northern Manhattan Study Neuromedical Evaluation were administered. Participants' progress was coded as retained or dropped out of the study (DOS) for each visit in the study. Cross-sectional analyses (t-tests, chi-square and Mann-Whitney U-tests) compared demographic, health, and psychosocial variables between those who completed the in-person neuropsychological visit (i.e., ∼5 hour comprehensive neuropsychological battery, blood draw, saliva sample, neuromedical interview and questionnaires in a hospital; INP-V) and MRI visit (i.e., ∼1 hour closed MRI scan; MRI-V) with those who DOS. RESULT:The sample (N = 145) was 53.8% female, older, and well-educated (M age = 65.25, SDage= 6.55, Meducation = 13.59, SDeducation= 3.23). URP study engagement was high: 31.7% non-Latinx Black, 34.5% Latinx, and 33.8% non-Latinx White. There were no significant differences in independent variables (e.g., ethnoracial, gender, discrimination) between the INP-V and DOS groups (all p's>.09). However, analyses revealed that the MRI-V group (M = 13.42, SD = 3.07) had significantly fewer years of education than the DOS group (M = 14.15, SD = 3.71) (t(143) = 2.69, p<.01, 95%CI [0.39, 2.58]) other differences were observed (ps>.05). CONCLUSION:This study's CER-based approach yielded a high level of URP study engagement. Contrary to previous findings, people with less education were more likely to complete the MRI visit suggesting a willingness to undergo more invasive procedures after establishing trust. CER-based AD studies may help URP participants overcome participation barriers through collaboration with the community.

BACKGROUND:COVID-19 pandemic stress differentially affects older adults and persons from minoritized, underrepresented populations (URPs; e.g., Black, Latinx), yet potential protective factors are not well understood. This study aimed to evaluate whether pandemic-related social and emotional stressors negatively affect functional capacity, mental health, and cognitive outcomes in an ethnoculturally diverse sample of middle-aged and older adults. METHOD:Cross-sectional data were obtained from adults (55± years) participating in SALUD, an ongoing study examining risk and resilience factors for dementia in diverse populations. Participants completed a well-validated, comprehensive battery of questionnaires and cognitive assessments. Aggregate scores of social and emotional pandemic stressors (e.g., more anxiety, loneliness) from Item 3 of the Pandemic Stress Index (PSI-3) were examined in association with demographics, Patients Assessment of Own Functioning Inventory (PAOFI; self-reported functional status measure), and Patient Health Questionnaire-2 (PHQ-2; self-report depressive symptomatology measure). Demographically-adjusted norms were used to compute Global Neurocognition (NC) and eight domain-specific NC average T-scores (e.g., learning, memory). Spearman's correlations, Kruskal-Wallis, Mann-Whitney U-tests were used for non-normal variables. RESULT:The sample included 110 adults (37.3% Non-Latinx Black [NLB], 33.6% Latinx, and 29.1%, non-Latinx White [NLW]; 63% female; M age = 65.27 [SD = 7.11]; M ed = 13.89 [SD = 3.07]). Age was negatively correlated with the PSI-3 (rs = -.25, p<.01), but education (rs= -.05, p = .59) and gender (U<.01, p = .99) were not. PSI-3 differed across ethnocultural groups (H = 8.00, p = .02), such that Latinx participants had the highest PSI-3 scores. However, this relationship became non-significant after accounting for age (p = .11). PAOFI impairment scores (rs = .37, p = .01) and PHQ-2 scores (rs = .29, p = .01) were positively related to the PSI-3, but Global NC and domain-specific NC average T-scores were not significant (rs = -.08 - .10, ps> .05). CONCLUSION:In this ethnoculturally diverse sample, findings suggest older adults may be more resilient to pandemic-related stress. Older age was associated with lower social and emotional pandemic stress, while greater functional impairment and depression were moderately associated with higher pandemic-related stress. As pandemic-related increases in psychosocial stressors (e.g., worry and depression) continue to affect middle-aged and older adults, longitudinal research should investigate the risk and resilience factors that may buffer against developing these negative outcomes.