Susan Flowers Benton

Psychometric validation of the Clubhouse climate questionnaire as an autonomy support measure for people with severe mental illness

Abstract Background: Self-determination represents a paradigm shift from “shoulds” to “decisions and behaviors” as the best options for helping people with mental illness achieving recovery goals. Autonomy support plays an important role in self-determination. Aims: The purpose of this study was to validate the Clubhouse climate questionnaire (CCQ) as an autonomy support measure. Method: One hundred and twenty-four participants were recruited from eight Clubhouse programs in Hawaii. Measurement structure of the CCQ was evaluated using exploratory and confirmatory factor analysis. Findings: CCQ is a unidimensional scale with good reliability and acceptable levels of divergent and convergent validity. Conclusions: CCQ is a brief, reliable and valid instrument for assessing autonomy support and contributes to the use of self-determination as a paradigm for improving recovery outcomes in psychiatric rehabilitation.

Apathy in Preclinical Alzheimer’s Disease: Psychometric Validation of the Apathy Evaluation Scale

Objectives: The purpose of the present study was to validate the Apathy Evaluation Scale, self-rated version (AES-S), and assess the severity of apathy in a cognitively healthy middle-aged cohort at risk for Alzheimer’s disease (AD). Method: Three hundred and sixteen middle-aged adults were selected to represent a subset of the Wisconsin Alzheimer’s Disease Research Center Clinical Core: the Investigating Memory in People At-risk, Causes and Treatments cohort. Results: An exploratory factor analysis (EFA) with varimax rotation identified 3 subscales: apathy, disinterest, and social withdrawal factors. Confirmatory factor analysis confirmed the EFA findings. Results indicated acceptable convergent and discriminant validity. The AES-S is a reliable instrument to quantify apathy in cognitively healthy middle-aged individuals at risk for AD. Discussion: This study demonstrates the AES-S is a psychometrically sound measurement tool for assessing levels of apathy in a cognitively healthy middle-aged cohort at risk for AD.

THE LIVING WELL TOGETHER PROGRAM: A QUALITATIVE ANALYSIS OF A HEALTH SELF-MANAGEMENT PROGRAM FOR AGING AFRICAN AMERICANS WITH CHRONIC ILLNESS

easy 12 minute/day yoga meditation. The control group consisted of either music listening or memory enhancement training (MET). Memory, cognitive function and various biomarkers were measured at baseline, 3 and 6months. Results:Practicing KK 12minutes a day for 8 12 weeks improves cognitive function, increases cerebral blood flow, augments neurotransmitters and neuroanatomical plasticity in the anterior and posterior cingulate gyrus, hippocampus, & prefrontal cortex. Moreover, these studies show improved mental health, better sleep, reduced stress, increased telomerase and longer telomeres, reduced inflammatory markers, strengthened neuro-connectivity, increased plasma amyloid beta, and a rise in aspects of psycho-spiritual well-being such as selfacceptance and a sense of purpose in life. All of these benefits may help prevent or reverse cognitive decline. Gains were sustained or improved at 6 months. No side effects were reported. Conclusions:Kirtan Kriya is a simple and effective yoga meditation with striking results, including an improvement in cognitive function in SCD and MCI. KK has significant potential to be valuable in the fight against AD in women.

KEY ELEMENTS SUPPORTING RECRUITMENT AND RETENTION OF UNDERREPRESENTED GROUPS INTO RESEARCH: OUR EXPERIENCE IN THE AFRICAN AMERICAN COMMUNITY

care partner of a person with Alzheimer’s/another dementia); 2) multisensory enrichment group for person with dementia held in parallel with care partner support group; 3) early journey support group for persons with recently diagnosed mild cognitive impairment or early stage Alzheimer’s who attend with their primary family care partner (spouse and/or adult child); and 4) fronto-temporal dementia support group for care partners only. Groups lasts 90 minutes, are held weekly for 8-10 consecutive weeks, have 8-16 participants, and are led by licensed clinical social workers/counselors. Weekly sessions are guided by a unique handout that facilitates decompression (talking about experience of being a person with dementia or care partner), education (various topics addressing common cognitive, physical, and emotional challenges), problem solving (skills for addressing behavioral and psychological symptoms of dementia), and relationship building (strengthening relationships between person with dementia, care partner, and family members). After completing an 8-10-week support group, the person with dementia and their care partner have the opportunity for individual, couple, or family counseling. Care partners can also participate in a 90 minute monthly maintenance support group that focuses on decompression. The 8-10 week groups are offered three times a year and feed into the monthly group, resulting in a comprehensive and sustainable support group program for person with dementia and their care partners. Results: Over last 6 years, the usual attrition rate per group is 15-20%. Participants evaluate their support group experience when group ends. Over 90% rate the following as “5” on a Likert scale of 1 (not at all) to 5 (very much) for these measures: group met expectations, I felt safe and accepted, knowledge of dementia was increased, coping skills enhanced, and facilitators were knowledgeable/compassionate. Conclusions: A comprehensive, sustainable support group program for person with dementia and family care partners is feasible and beneficial. Challenges and future plans will be discussed.

INCIDENT DEMENTIA IN NON-HISPANIC AFRICAN AMERICANS AND WHITES WITH MILD COGNITIVE IMPAIRMENT: CAN WE MAKE RACIAL COMPARISONS USING ALZHEIMER’S DISEASE CENTER DATA?

Model 1 .125 31.13** MFE-Total informants -.359 -5.58** -.53, -.25 Model 2 .134 17.31** MFE-Total informants -.341 -5.26** -.51, -.23 GDS -.115 -1.78 -.98, .05 Model 3 .399 47.63** MFE-Total informants -.227 -4.10** -.36, -.13 GDS -.10 -1.89 -.84, .02 Age -.528 -9.65** -.63, -.42 Model 4 .582 74.58** MFE-Total informants -.186 -4.02** -.3, -.10 GDS -.033 -.73 -.50, .23 Age -.324 -6.43** -.42, -.22 Years of schooling .487 9.62** .64, .98

PSYCHOSOCIAL PREDICTORS OF HIPPOCAMPAL VOLUME AND COGNITION AMONG AFRICAN AMERICAN AND WHITE OLDER ADULTS AT RISK FOR ALZHEIMER’S DISEASE

Frontal 6.87 1.37 (.16) 1.28 (.07) .01 .10 4.92 1.36 (.14) 1.28 (.11) .03 .07 Lateral temporal 5.54 1.32 (.14) 1.24 (.08) .02 .08 7.05 1.33 (.13) 1.24 (.10) .01 .11 Hippocampal 2.65 0.96 (.08) .93 (.05) .11 .03 5.66 .97 (.07) .92 (.06) .02 .09 Posterior cingulate 3.50 1.63 (.17) 1.56 (.09) .07 .05 9.62 1.65 (.15) 1.54 (.11) .003 .15 Precuneus 7.18 1.50 (.15) 1.41 (-08) .01 .11 8.30 1.51 (.12) 1.41 (.11) .006 .13 Supramarginal gyrus 6.83 1.31 (-15) 1.22(-09) .01 .10 4.90 1.31 (.15) 1.23 (11) .03 .07 Angular gyrus 10.01 1.42 (.15) 1.31 (.08) .003 .15 4.42 1.41 (.14) 1.33 (.12) .04 .06

TOBACCO EXPOSURE AND CESSATION IS ASSOCIATED WITH INCIDENT DEMENTIA AND NURSING HOME PLACEMENT

Background:It has been suggested that illiteracy and low level of education are risk factors for developing dementia, but also that bilingualism could function as a protective factor. In Peru, both conditions are very frequent. We observed a dementia prevalence of 6.85% in schooled subjects and 15.2% for illiterates; but there is still no data on how bilingualism modulates cognitive response in healthy illiterates, especially in executive function. Therefore, our objectivewas to compare performance of bilingual andmonolingual healthy elder illiterates in executive control tasks, controlling the influence of age and the type of work. Methods:We evaluated 56 healthy illiterate elderlies, 40 bilinguals (M 1⁄4 71.20, SD 1⁄4 5.94) and 16monolinguals (M1⁄4 75.25, SD1⁄4 10.28) with inhibitory control tasks (modified Stroop, see figure 1), response suppression (Go / No Go), cognitive flexibility (Hanoi tower) and working memory (forward and backward digits, WAIS III). Non-parametric contrast statistics (U Mann Whitney) and covariance analysis were used, where the fixed factors were bilingualism and type of work (elementary or instrumental) and age as a covariate. Results: We observed significant differences between number and symbol (Z 1⁄4 -3.38, p <.001) and interference (Z1⁄4 -2.61, p <.009) of the Stroop tasks; in both cases bilinguals score better than monolinguals (see figure 2). The analysis of covariance also showed a greater effect of bilingualism on the measures of inhibitory control (Numbers and symbols, F 1⁄4 8.085, p <.006 and interference, F 1⁄4 9.604, p <.003) than age and type of work. No significant differences were observed in the other components of executive control. Conclusions: a bilingual advantage is observed in inhibitory control tasks in healthy illiterate older adults, which is not associated with age or type of work. This advantage seems to be associated with the activation of executive control mechanisms formore complex tasks. These data show that bilingualism modulates the cognitive response and functions as a cognitive reserve factor; hence the importance of its promotion and empowerment. We recommend conducting epidemiological and follow-up studies in this population.

RACIAL DIFFERENCES POTENTIALLY INFLUENCING SELF-IDENTIFICATION OF MILD COGNITIVE IMPAIRMENT

per se, particularly oily fish rich in omega 3 fatty acids, further limits the potential protective effect on dementia(3-4). Given the role of diet modification in dementia prevention, understanding the link between diet and dementia in Lebanon can be an important dementia prevention intervention for Lebanon and for the Middle East.Methods: 510 participants 65 years old residing in Beirut and Mount Lebanon governorates were included in a cross-sectional survey. Data collection by trained interviewers took place in randomly selected clusters from the capital Beirut andMount Lebanon area. The 10/66 Dementia Research Group diagnostic assessment for dementia and risk factor questionnaires were administered to the participants and their caregivers. Results: Preliminary analysis was carried on 303 participants, 174 females (57.4%) and 129 males (42.6%). The mean age was 72.28 years (SD 7.03). 24 participants were diagnosed with dementia (8%). There was a high prevalence of overweight (54.4%) and obesity (27.7%) among the study population. Neither fish nor meat consumption in this sample was related to dementia prevalence (OR: 0.83; 95%CI: 0.30, 2.33; and OR: 1.48; CI: 0.33,6.56, respectively). Conclusions: Preliminary findings do not support the protective effect of fish consumption, but more definitive conclusions can be made once the entire sample of 510 randomly selected individuals are analyzed. Still, the trends of a lower odds of dementia among older people who consumed fish, and a higher odds of dementia amongmeat consumers is consistent with the results of the large 10/66 study carried out in five LMIC. The latter finding, combined with the nutritional transitions observed in Lebanon and the Arab region and the mounting evidence of the role of diet on dementia, warrants further investigation on a larger national and regional scale.