Associations of Sex, Race, and Apolipoprotein E Alleles With Multiple Domains of Cognition Among Older Adults
IMPORTANCE/UNASSIGNED:Sex differences are established in associations between apolipoprotein E (APOE) ε4 and cognitive impairment in Alzheimer disease (AD). However, it is unclear whether sex-specific cognitive consequences of APOE are consistent across races and extend to the APOE ε2 allele. OBJECTIVE/UNASSIGNED:To investigate whether sex and race modify APOE ε4 and ε2 associations with cognition. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This genetic association study included longitudinal cognitive data from 4 AD and cognitive aging cohorts. Participants were older than 60 years and self-identified as non-Hispanic White or non-Hispanic Black (hereafter, White and Black). Data were previously collected across multiple US locations from 1994 to 2018. Secondary analyses began December 2021 and ended September 2022. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Harmonized composite scores for memory, executive function, and language were generated using psychometric approaches. Linear regression assessed interactions between APOE ε4 or APOE ε2 and sex on baseline cognitive scores, while linear mixed-effect models assessed interactions on cognitive trajectories. The intersectional effect of race was modeled using an APOE × sex × race interaction term, assessing whether APOE × sex interactions differed by race. Models were adjusted for age at baseline and corrected for multiple comparisons. RESULTS/UNASSIGNED:Of 32 427 participants who met inclusion criteria, there were 19 007 females (59%), 4453 Black individuals (14%), and 27 974 White individuals (86%); the mean (SD) age at baseline was 74 years (7.9). At baseline, 6048 individuals (19%) had AD, 4398 (14%) were APOE ε2 carriers, and 12 538 (38%) were APOE ε4 carriers. Participants missing APOE status were excluded (n = 9266). For APOE ε4, a robust sex interaction was observed on baseline memory (β = -0.071, SE = 0.014; P = 9.6 × 10-7), whereby the APOE ε4 negative effect was stronger in females compared with males and did not significantly differ among races. Contrastingly, despite the large sample size, no APOE ε2 × sex interactions on cognition were observed among all participants. When testing for intersectional effects of sex, APOE ε2, and race, an interaction was revealed on baseline executive function among individuals who were cognitively unimpaired (β = -0.165, SE = 0.066; P = .01), whereby the APOE ε2 protective effect was female-specific among White individuals but male-specific among Black individuals. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this study, while race did not modify sex differences in APOE ε4, the APOE ε2 protective effect could vary by race and sex. Although female sex enhanced ε4-associated risk, there was no comparable sex difference in ε2, suggesting biological pathways underlying ε4-associated risk are distinct from ε2 and likely intersect with age-related changes in sex biology.
State Public Health Communications and Public Compliance during the Pre-election SARS-CoV-2 Pandemic: Interpreting the Effectiveness of Messaging Guidelines Utilizing Moral Foundations Theory
Background: State-level public health messaging during the pre-election coronavirus pandemic was very inconsistent. Moral motivational content of the messages, as characterized by moral foundations theory, may have contributed to the degree of compliance in particular states. More attention to this content might result in greater compliance and a lessening of the pandemic's severity. Methods: A comprehensive review of official state messaging in six U.S. states (California, Florida, Massachusetts, Mississippi, New York, and Texas) was reviewed for the number and distribution of moral foundations as described by moral foundations theory. A search was done for state-level data concerning compliance with mask-wearing and social distancing, the primary public precautionary measures during the pandemic. Rates of compliance by the state were compared with messaging content and analyzed for associations and correlations with the known partisan leanings of the states. Examples of messages with balanced moral foundations, which might be prospectively employed for greater acceptance, were presented. All data were gathered prior to the introduction of the first available vaccine. Results: Message review and compliance data suggested that the quantity and proportion of coronavirus-related official messages and the utilization of a balanced combination of moral foundations were associated with higher levels of compliance with the recommended public health measures and lower infection rates. The political orientations of states did not align with the use of known conservative/liberal preferred moral foundations as previously established by Moral Foundations Theory. Conclusion: Adjusting messaging with attention to the balanced employment of moral foundations can lead to wider acceptance of and compliance with preventive public health measures.
Acute Rheumatic Fever
Acute rheumatic fever (ARF) is an immune-mediated nonsuppurative complication of group A streptococcal (GAS) pharyngitis. Approximately 470,000 new cases of ARF occur annually, with a more significant disease burden in developing countries with higher rates of untreated or inadequately treated GAS infections. Globally, over 275,000 deaths yearly are attributed to rheumatic heart disease (RHD). The most significant contributors to the spread of GAS pharyngitis are household overcrowding, poor sanitation, and inadequate access to healthcare. The pathophysiology of ARF is characterized by an aberrant immune response to GAS infection triggered by molecular mimicry between GAS antigens and self-antigens. This immune response typically manifests 2 to 4 weeks after the initial GAS infection and may lead to the development of carditis, valvulitis, Sydenham chorea, subcutaneous nodules, erythema marginatum, and polyarthritis that is usually migratory. The severity and distribution of these manifestations vary significantly between individuals making the diagnosis of ARF challenging. Early recognition of ARF using the modified Jones criteria is essential in treating acute infection and preventing complications. A major long-term consequence is RHD, which carries significant morbidity and mortality.
Gait dysfunction in Alzheimer disease
Alzheimer's disease (AD) is the most common cause of age-associated dementia and will exponentially rise in prevalence in the coming decades, supporting the parallel development of the early stage detection and disease-modifying strategies. While primarily considered as a cognitive disorder, AD also features motor symptoms, primarily gait dysfunction. Such gait abnormalities can be phenotyped across classic clinical syndromes as well as by quantitative kinematic assessments to address subtle dysfunction at preclinical and prodromal stages. As such, certain measures of gait can predict the future cognitive and functional decline. Moreover, cross-sectional and longitudinal studies have associated gait abnormalities with imaging, biofluid, and genetic markers of AD across all stages. This suggests that gait assessment is an important tool in the clinical assessment of patients across the AD spectrum, especially to help identify at-risk individuals.