The Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT) intervention: A personalized approach to dementia risk reduction.

Background: Addressing modifiable risk factors such as physical inactivity and social isolation could reduce risk of Alzheimer's disease and all-cause dementia, but little is known about which factors individuals are most willing to address or how they prefer to address them.

Objective: To examine and describe behavior change goals set by participants during the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT).

Methods: In SMARRT, older adults worked with a health coach and nurse over 2 years to set incremental, personalized goals to reduce dementia risk.

Racial and ethnic and sex differences in at-home estimates of sleep-disordered breathing parameters among Mexican American, Black, and Non-Hispanic White adults.

Background Racial and ethnic and sex differences in sleep may exist, but there are limited data directly comparing objective estimates of sleep-disordered breathing (SDB), particularly in rapid eye movement (REM) versus non-rapid eye movement (NREM) sleep, among Black, Mexican American (MA) and non-Hispanic White (NHW) men and women. Our goal is to investigate health disparities in SDB in a new, diverse cohort of older adults. Research Question Do SDB parameters during REM and NREM sleep differ by race and ethnicity or sex in community-dwelling older adults?.

Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial.

Importance: Modifiable risk factors are hypothesized to account for 30% to 40% of dementia; yet, few trials have demonstrated that risk-reduction interventions, especially multidomain, are efficacious.

Objective: To determine if a personalized, multidomain risk reduction intervention improves cognition and dementia risk profile among older adults.

Design, Setting, And Participants: The Systematic Multi-Domain Alzheimer Risk Reduction Trial was a randomized clinical trial with a 2-year personalized, risk-reduction intervention.

Intimate Partner Violence, Mental Health, and Aging-Related Health Among Men and Women Veterans Across the Lifespan.

Background: A growing body of evidence suggests adverse health outcomes related to intimate partner violence (IPV), including traumatic brain injury (TBI). However, most research in this area has focused on reproductive-aged women.

Objective: To examine relationships between IPV (with and without TBI), mental health, and aging-related health outcomes among men and women Veterans across the lifespan.

The Impact of Pandemic-Related Restrictions on Dementia Risk Factors in Older Adults.

Adults aged 65+ are at highest risk for severe COVID-19 outcomes, and prior to the distribution of vaccines in the U.S., were strongly advised to quarantine at home to reduce risk of infection.

Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans.

Background: Traumatic brain injury (TBI) is associated with significant morbidity, but the association of TBI with long-term stroke risk in diverse populations remains less clear. Our objective was to examine the long-term associations of TBI with stroke and to investigate potential differences by age, sex, race and ethnicity, and time since TBI diagnosis.

Methods: Retrospective cohort study of US military veterans aged 18+ years receiving healthcare in the Veterans Health Administration system between October 1, 2002 and September 30, 2019.

TBI and risk of death in military veterans over 14 years: Injury severity, timing, and cause of death.

The objective of this study was to determine the association of traumatic brain injury (TBI) with mortality in military veterans and whether this association differs as a function of TBI severity, timing, and cause of death. This national cohort study used U.S.

Traumatic brain injury, cardiovascular disease, and risk of dementia among older US Veterans.

Objective: Traumatic brain injury (TBI) is associated with elevated rates of cardiovascular disease (CVD), and both CVD and TBI are risk factors for dementia. We investigated whether CVD and its risk factors underlie the association between TBI and dementia.

Materials And Methods: Cox proportional hazards models among 195,416 Veterans Health Administration patients age 55+ with TBI and a non-TBI, age/sex/race-matched comparison sample.

Traumatic Brain Injury and Incidence Risk of Sleep Disorders in Nearly 200,000 US Veterans.

Objective: To test the hypothesis that veterans with traumatic brain injury (TBI) have an increased subsequent risk of sleep disorders, we studied the longitudinal association between TBI and incident sleep disorders in nearly 200,000 veterans.

Methods: We performed a cohort study of all patients diagnosed with a TBI in the Veterans Health Administration system from October 1, 2001, to September 30, 2015, who were age-matched 1:1 to veterans without TBI. Veterans with prevalent sleep disorders at baseline were excluded.

Agent Orange Exposure and Dementia Diagnosis in US Veterans of the Vietnam Era.

Importance: Agent Orange is a powerful herbicide that contains dioxin and was used during the Vietnam War. Although prior studies have found that Agent Orange exposure is associated with increased risk of a wide range of conditions, including neurologic disorders (eg, Parkinson disease), metabolic disorders (eg, type 2 diabetes), and systemic amyloidosis, the association between Agent Orange and dementia remains unclear.

Objective: To examine the association between Agent Orange exposure and incident dementia diagnosis in US veterans of the Vietnam era.

Sex, race, and risk of dementia diagnosis after traumatic brain injury among older veterans.

Objective: To investigate whether sex and race differences exist in dementia diagnosis risk associated with traumatic brain injury (TBI) among older veterans.

Methods: Using Fine-Gray regression models, we investigated incident dementia diagnosis risk with TBI exposure by sex and race.

Results: After the exclusion of baseline prevalent dementia, the final sample (all veterans ≥55 years of age diagnosed with TBI during the 2001-2015 study period and a random sample of all veterans receiving Veterans Health Administration care) included nearly 1 million veterans (4.

Blood biomarkers of traumatic brain injury and cognitive impairment in older veterans.

Objective: To determine whether blood-based biomarkers can differentiate older veterans with and without traumatic brain injury (TBI) and cognitive impairment (CogI).

Methods: We enrolled 155 veterans from 2 veterans' retirement homes: 90 without TBI and 65 with TBI history. Participants were further separated into CogI groups: controls (no TBI, no CogI), n = 60; no TBI with CogI, n = 30; TBI without CogI, n = 30; and TBI with CogI, n = 35.

Traumatic brain injury increases plasma astrocyte-derived exosome levels of neurotoxic complement proteins.

Possible involvement of complement (C) systems in the pathogenesis of traumatic brain injury (TBI) was investigated by quantifying Cproteins in plasma astrocyte-derived exosomes (ADEs) of subjects with sports-related TBI (sTBI) and TBI in military veterans (mtTBI) without cognitive impairment. All sTBI subjects (n = 24) had mild injuries, whereas eight of the mtTBI subjects had moderate, and 17 had mild injuries. Plasma levels of ADEs were decreased after acute sTBI and returned to normal within months.

Military Sexual Trauma in Older Women Veterans: Prevalence and Comorbidities.

Background: Recent attention has highlighted the common occurrence and health consequences of military sexual trauma (MST) in younger women veterans. However, almost nothing is known about MST in older veterans.

Objective: To describe MST among older women veterans, including prevalence and common comorbidities.

Neuron-Derived Plasma Exosome Proteins after Remote Traumatic Brain Injury.

To identify long-term effects of traumatic brain injury (TBI) on levels of plasma neuron-derived exosome (NDE) protein biomarkers of cognitive impairment (CI), plasmas were obtained from four groups of older veterans, who were matched for age and sex: no TBI or CI ( = 42), no TBI with CI ( = 19), TBI without CI ( = 21), and TBI with CI ( = 26). The TBI was sustained 12 to 74 years before the study in 75%. The NDEs were enriched by sequential precipitation and anti-L1CAM antibody immunoabsorption, and extracted protein biomarkers were quantified by enzyme-linked immunosorbent assays.

Ten-Year Prevalence of Cognitive Impairment Diagnoses and Associated Medical and Psychiatric Conditions in a National Cohort of Older Female Veterans.

Objective: Veterans are at risk for dementia because of elevated general risk factors and exposure to military risk factors; however, few studies have focused on female veterans despite their growing numbers. We sought to characterize the 10-year prevalence of cognitive impairment (i.e.

Military-related risk factors in female veterans and risk of dementia.

Objective: To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans.

Methods: This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes.

Systematic Multi-Domain Alzheimer's Risk Reduction Trial (SMARRT): Study Protocol.

This article describes the protocol for the Systematic Multi-domain Alzheimer's Risk Reduction Trial (SMARRT), a single-blind randomized pilot trial to test a personalized, pragmatic, multi-domain Alzheimer's disease (AD) risk reduction intervention in a US integrated healthcare delivery system. Study participants will be 200 higher-risk older adults (age 70-89 years with subjective cognitive complaints, low normal performance on cognitive screen, and ≥ two modifiable risk factors targeted by our intervention) who will be recruited from selected primary care clinics of Kaiser Permanente Washington, oversampling people with non-white race or Hispanic ethnicity. Study participants will be randomly assigned to a two-year Alzheimer's risk reduction intervention (SMARRT) or a Health Education (HE) control.

CNS disease-related protein variants as blood-based biomarkers in traumatic brain injury.

Objective: To utilize a panel of 11 single chain variable fragments (scFvs) that selectively bind disease-related variants of TAR DNA-binding protein (TDP)-43, β-amyloid, tau, and α-synuclein to assess damage following traumatic brain injury (TBI), and determine if the presence of protein variants could account for the increased risk of various neurodegenerative diseases following TBI.

Methods: We utilized the panel of 11 scFvs in a sensitive ELISA format to analyze sera from 43 older veterans, 25 who had experienced at least 1 TBI incident during their lifetime (∼29.4 years after TBI), and 18 controls who did not incur TBI, in a cross-sectional study.

Remote Traumatic Brain Injury Is Associated with Motor Dysfunction in Older Military Veterans.

Background: Traumatic brain injury (TBI) has been identified as a risk factor for Parkinson's disease (PD). Motor dysfunction among TBI-exposed elders without PD has not been well characterized. We sought to determine whether remote TBI is a risk factor for motor dysfunction on exam and functionally relevant motor dysfunction in day-to-day life among independently living elders without PD.

Neuropsychological Profile of Lifetime Traumatic Brain Injury in Older Veterans.

Objectives: The aim of this study was to characterize the neuropsychological profile of lifetime traumatic brain injury (TBI) in older Veterans.

Methods: Participants were 169 older Veterans [mean age=79.1 years (range, 51-97 years), 89% male, 92% Caucasian], 88 with lifetime TBI and 81 without TBI, living in Veterans' retirement homes in independent residence.

Neurobehavioral Characteristics of Older Veterans With Remote Traumatic Brain Injury.

Objective: While traumatic brain injury (TBI) is common across the life span, the detailed neurobehavioral characteristics of older adults with prior TBI remain unclear. Our goal was to compare the clinical profile of older independently living veterans with and without prior TBI.

Setting: Two veterans' retirement communities.

Long-term Cognitive Trajectories and Mortality in Older Women.

Background: Few studies have examined whether change in cognition is linked to mortality. This study examined the relationship between cognitive trajectories in older age and risk of death.

Methods: We studied community-dwelling, nondemented women aged 65+ (mean age = 71) enrolled in a prospective study of aging and followed up to 25 years.