Papers by Luis Dilan Medina Meza
Neuropsychology, 2021
OBJECTIVE Increasing evidence points to mild alterations in everyday functioning early in the cou... more OBJECTIVE Increasing evidence points to mild alterations in everyday functioning early in the course of Alzheimer's disease and related dementias (ADRD), despite prior research suggesting functional declines occur primarily in later stages. However, daily function assessment is typically accomplished with subjective self- or informant-report, which can be prone to error due to various factors. Performance-based functional assessments (PBFAs) allow for objective evaluation of daily function abilities, but little is known on their sensitivity to the earliest ADRD-related brain alterations. We aimed to determine the neural correlates of three different PBFAs in a pilot study. METHOD A total of 40 older participants (age = 70.9 ± 6.5 years; education = 17.0 ± 2.6 years; 51.5% female; 10.0% non-White; 67.5% cognitively normal) completed standardized PBFAs related to medication management (MM), finances (FIN), and communication abilities (COM). Participants underwent diffusion tensor imaging (DTI) scans, from which mean fractional anisotropy (FA) composite scores of late- (LMF) and early myelinated (EMF) fibers were calculated. Linear regression analyses controlling for age and global cognition were used to assess the relationship of PBFAs with FA. RESULTS Better performance on MM was associated with higher mean FA on LMF composite (t38 = 2.231, p = .032), while FIN and COM were not (ps > .05). PBFAs were not associated with EMF (p > .05). CONCLUSIONS Our preliminary findings demonstrate better performance on a PBFA of medication management is associated with higher FA in late-myelinated white matter tracts. Despite a small sample size, these results are consistent with growing evidence that performance-based functional assessments may be a useful tool in identifying early changes related to ADRD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Neurology, 2018
Objective: We examined the utility of the Spanish English Neuropsychological Assessment Scale (SE... more Objective: We examined the utility of the Spanish English Neuropsychological Assessment Scale (SENAS) in identifying and tracking Alzheimer’s disease (AD) in Latinos destined to develop autosomal dominant AD (ADAD) relative to a group of normal elderly Latinos. Background: Latinos are a growing population in the U.S. in which our ability to diagnose and track AD is limited by linguistic, educational, and cultural factors. Design/Methods: The SENAS was administered to Latinos in the population-based Los Angeles Latino Eye study (LALES) and to persons at-risk for inheriting pathogenic mutations causing ADAD. Pearson’s correlations of test scores with age (LALES) and with age adjusted for family-specific age of dementia diagnosis (ADAD) were performed. Using the Fisher r-to-z transformation, differences between the correlation coefficients in the two populations were examined. Results: 326 subjects in the LALES study and 20 ADAD mutation carriers were included. Age was negatively corre...
Puerto Rico health sciences journal, 2019
With the increasing geopolitical instability and environmental devastation occurring across the g... more With the increasing geopolitical instability and environmental devastation occurring across the globe, human migration is increasing. We report a case that illustrates a migration pattern seen a century ago that is currently in the process of repeating itself. Using information from a neuropathological examination, genetic analyses, and historical sources, we linked a patient with autosomal dominant Alzheimer's disease in Hawai'i with her ancestors in Puerto Rico. In this patient we identified the G206A PSEN1 mutation, previously identified as being linked to a founder effect from Puerto Rico. At the turn of the twentieth century, due to devastating hurricanes in Puerto Rico and the island's new status as a possession of the United States, over 5,000 Puerto Ricans, including the grandparents of our patient, migrated to Hawai'i. This short-term but historic migration has resulted in a significant population of Puerto Ricans in Hawai'i, today. As physicians we some...
OBJECTIVE The Internet serves an increasingly critical role in health behaviors for older adults ... more OBJECTIVE The Internet serves an increasingly critical role in health behaviors for older adults with chronic medical conditions. Guided by theories of health behaviors and literacy, this study examined whether the relationship between educational attainment and online pharmacy skills in older persons with HIV disease (PWH) is mediated by health literacy. Design: Participants included 98 PWH age 50 and older who completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate an experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). Participants also completed the Medication-Management Test-Revised (MMT-R). Results: Mediation analyses revealed a significant indirect effect of education on both online pharmacy accuracy and MMT-R, which was fully mediated by health literacy. In contrast, there was no direct or indirect effect of education on online pharmacy speed when health literacy was included as a ...
Neuropsychological research has been limited in representation of cultural diversity due to vario... more Neuropsychological research has been limited in representation of cultural diversity due to various issues. These limitations raise questions regarding applicability of current findings to diverse populations. Nonetheless, culture-dependent differences in fundamental psychological processes have been demonstrated in several domains. One of the most basic of these, self-construal, is central to how many other differences are interpreted. Self-construals, described as individualistic or collectivistic (IC), may have possible consequences on social interactions, emotions, motivation, and cognition. Despite research demonstrating cultural differences, frontal-lobe-dependent cognitive processes are not well understood in the context of self-construal. This dissertation explored this relationship. A total of 201 adults (101 young, 100 older) were recruited. The young adults (YA) were recruited from undergraduate psychology students between ages 18 and 26. The older adults (OA) were commun...
Neuropsychology, 2021
OBJECTIVE Neuropsychological instruments are often developed in English and translated to other l... more OBJECTIVE Neuropsychological instruments are often developed in English and translated to other languages to facilitate the clinical evaluation of diverse populations or to utilize in research environments. However, the psychometric equivalence of these assessments across language must be demonstrated before populations can validly be compared. METHOD To test this equivalence, we applied measurement invariance procedures to a subsample (N = 1,708) of the Hispanic Community Health Survey/Study of Latinos (HCHS/SOL) across English and Spanish versions of a neurocognitive battery. Using cardinality matching, 854 English-speaking and 854 Spanish-speaking subsamples were matched on age, education, sex, immigration status (U.S. born, including territories, or foreign-born), and Hispanic/Latino heritage background. Neurocognitive measures included the Six-Item Screener (SIS), Brief-Spanish English Verbal Learning Test (B-SEVLT), Word Fluency (WF), and Digit Symbol Substitution (DSS). Confirmatory factor analysis was utilized to test item-level invariance of the SIS, B-SEVLT, and WF, as well as factor-level invariance of a higher-order neurocognitive functioning latent variable. RESULTS One item of both the SIS and WF were more difficult in Spanish than English, as was the DSS test. After accounting for partial invariance, Spanish-speakers performed worse on each of the subtests and the second-order neurocognitive functioning latent variable. CONCLUSIONS We found some evidence of bias at both item and factor levels, contributing to the poorer neurocognitive performance of Spanish test-takers. While these results explain the underperformance of Spanish-speakers to some extent, more work is needed to determine whether such bias is reflective of true cognitive differences or additional variables unaccounted for in this study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
EClinicalMedicine, 2021
Background: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high... more Background: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. Methods: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. Findings: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, h p 2 = 0.031); while Blacks reported experiencing discrimination more often (p < .001, h p 2 = 0.050). Blacks and Latinos reported more positive coping (p < .001, h p 2 = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. Interpretation: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact.
Alzheimer Disease & Associated Disorders, 2021
BACKGROUND Cognitive behavioral therapy (CBT) is a goal-oriented intervention that aims to improv... more BACKGROUND Cognitive behavioral therapy (CBT) is a goal-oriented intervention that aims to improve detrimental emotional or behavioral distress by modifying individuals' thought processes. This review evaluates the efficacy and specific adaptations of CBT in persons with mild cognitive impairment and dementia. METHODS A literature search of PubMed, Embase, and PsycINFO was conducted up to March 2020. Study quality was assessed using the Cochrane risk of bias criteria. RESULTS Twelve publications were identified. Seven of the studies demonstrated CBT efficacy to improve depression, anxiety, and/or quality of life. One study's positive postintervention outcome became insignificant with longer term follow up. Two of the studies improved sleep outcomes. Four studies integrated caregivers into intervention delivery. Three studies utilized content, memory, and adherence adaptations aimed to improve intervention efficacy. Two studies included adaptations to address caregiver burden and depression. CONCLUSION There is strong evidence to suggest that CBT is associated with improvements in anxiety, depression, and quality of life in persons with mild cognitive impairment and dementia. CBT showed a reduction in insomnia and improvements in sleep quality. However, there is insufficient evidence to draw conclusions on the effects of CBT on insomnia. These results suggest that further investigation into insomnia outcomes is needed.
Journal of Alzheimer's Disease, 2020
Background: Various factors, such as age, cardiovascular concerns, and lifestyle patterns, are as... more Background: Various factors, such as age, cardiovascular concerns, and lifestyle patterns, are associated with risk for cognitive decline and Alzheimer's disease (AD). Risk scores model predictive risk of developing a disease (e.g., dementia, stroke). Many of these scores have been primarily developed in largely non-Hispanic/Latino (non-H/L) White samples and little is known about their applicability in ethno-racially diverse populations. Objective: The primary aim was to examine the relationship between three established risk scores and cognitive performance. These relationships were compared across ethnic groups. Methods: We conducted a cross-sectional study with a multi-ethnic, rural-dwelling group of participants (M age = 61.6 ± 12.6 years, range: 40-96 years; 373F:168M; 39.7% H/L). The Cardiovascular Risk Factors, Aging and Dementia (CAIDE), Framingham Risk Score (FRS), and Washington Heights-Inwood Columbia Aging Project (WHICAP) score were calculated for each participant.
Aging, Neuropsychology, and Cognition, 2020
ABSTRACT Older adults commonly experience difficulties efficiently searching the Internet, which ... more ABSTRACT Older adults commonly experience difficulties efficiently searching the Internet, which can adversely affect daily functioning. This study specifically examined the neuropsychological aspects of online transit planning in 50 younger (M = 22 years) and 40 older (M = 64 years) community-dwelling adults. All participants completed a neuropsychological battery, questionnaires, and measures of Internet use and skills. Participants used a live transit planning website to complete three inter-related tasks (e.g., map a route from an airport to a specific hotel at a particular time). On a fourth Internet transit task, participants were randomized into either a support condition in which they received brief goal management training or into a control condition. Results showed that older adults were both slower and less accurate than their younger counterparts in completing the first three Internet transit tasks. Within the older adults, Internet transit accuracy showed a medium association with verbal memory, executive functions, and auditory attention, but not visuomotor speed, which was the only domain associated with Internet transit task speed in both groups. The goal management training was beneficial for plan development in younger, but not older adults. The planning supports did not impact actual Internet transit task performance in either group. Findings indicate that older adults experience difficulties quickly and accurately using a transit website to plan transportation routes, which is associated with poorer higher-order neurocognitive functions (e.g., memory). Future work might examine the benefits of established memory strategies (e.g., spaced retrieval practice) for online transit planning.
Alzheimer's & Dementia, 2020
We examined whether educational attainment differentially contributes to cognitive reserve (CR) a... more We examined whether educational attainment differentially contributes to cognitive reserve (CR) across race/ethnicity.
Scientific reports, Jan 2, 2018
Evidence from small-scale studies indicates that impairments in postural stability are an early a... more Evidence from small-scale studies indicates that impairments in postural stability are an early and disabling feature of Huntington's disease (HD) and may be a useful clinical endpoint for disease modifying trials. Larger studies are needed to confirm these preliminary findings and the suitability of postural stability outcomes as clinical endpoints. Static and dynamic postural stability were evaluated in 54 premanifest HD, 36 manifest HD and 45 healthy individuals using the Sensory Organization Test (SOT) and Limits of Stability (LOS) test. Manifest HD displayed significantly lower scores on all SOT conditions and on the SOT composite score and had more falls than healthy and premanifest HD (p < 0.05). Premanifest and manifest HD demonstrated significantly lower endpoint excursion (p < 0.001), maximum excursion (p ≤ 0.001), and directional control (p ≤ 0.004) values than healthy individuals on the LOS test. Deficits in LOS were found to manifest on the left side of preman...
Movement disorders : official journal of the Movement Disorder Society, Jan 10, 2018
Outcome measures that capture functional abilities related to cognition offer the potential to de... more Outcome measures that capture functional abilities related to cognition offer the potential to demonstrate real-world effectiveness of cognitive-enhancing treatments. However, distinguishing functional disability related to cognition from that attributed to motor symptoms can be difficult in PD. A performance-based functional assessment allows for direct observation of activity of daily living skills and separation of cognitive from motoric disabilities. Validate the University of California San Diego Performance-Based Skills Assessment in PD. One hundred PD participants, ranging from normal cognition to dementia, completed the University of California San Diego Performance-Based Skills Assessment, a performance-based measure of cognitively demanding activities of daily living, as well as a neuropsychological battery and motor examination. Cognitive classification was determined by consensus conference, blinded to University of California San Diego Performance-Based Skills Assessmen...
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, Jan 18, 2018
Fibromyalgia (FM) is a chronic pain syndrome of unknown etiology that can include subjective cogn... more Fibromyalgia (FM) is a chronic pain syndrome of unknown etiology that can include subjective cognitive symptoms and variable evidence of cognitive dysfunction. Rates of occurrence and severity of cognitive impairment remain unclear. Additionally, comparison of this group with other pain conditions has been limited. The current cross-sectional study sought to identify rates of clinically significant cognitive impairment in FM and rheumatoid arthritis (RA) using an automated clinical rating approach. A total of 62 females (32 with FM, 29 with RA) completed a comprehensive neuropsychological (NP) battery and an assessment of personality and psychological distress. All study measures were completed in one visit and all participants were recruited over the span of 3 years. Demographically corrected NP scores were used to compare participants with normative expectations and a summary score was calculated to compare groups on NP impairment. Compared to normative expectations using a 1 stan...
Neurobiology of aging, May 8, 2018
Fast, inexpensive, and noninvasive identification of Alzheimer's disease (AD) before clinical... more Fast, inexpensive, and noninvasive identification of Alzheimer's disease (AD) before clinical symptoms emerge would augment our ability to intervene early in the disease. Individuals with fully penetrant genetic mutations causing autosomal dominant Alzheimer's disease (ADAD) are essentially certain to develop the disease, providing a unique opportunity to examine biomarkers during the preclinical stage. Using a generalization task that has previously shown to be sensitive to medial temporal lobe pathology, we compared preclinical individuals carrying ADAD mutations to noncarrying kin to determine whether generalization (the ability to transfer previous learning to novel but familiar recombinations) is vulnerable early, before overt cognitive decline. As predicted, results revealed that preclinical ADAD mutation carriers made significantly more errors during generalization than noncarrying kin, despite no differences between groups during learning or retention. This impairmen...
Journal of Behavior, Health & Social Issues, 2012
How to cite Complete issue More information about this article Journal's homepage in redalyc.org ... more How to cite Complete issue More information about this article Journal's homepage in redalyc.org Scientific Information System Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Non-profit academic project, developed under the open access initiative
OBJECTIVE: To determine if generalization of memory pairings is affected in preclinical FAD. BACK... more OBJECTIVE: To determine if generalization of memory pairings is affected in preclinical FAD. BACKGROUND: Generalization of arbitrary memory pairings is impaired in persons with medial temporal lobe damage. We hypothesized that this skill would be impaired early in the course of FAD due to fully-penetrant mutations. DESIGN/METHODS: 31 persons at-risk for inheriting FAD mutations underwent comprehensive evaluations including a lap-top based acquired equivalence task. During a training phase, subjects were implicitly trained on pairings between types of persons (e.g. male vs. female, child vs. adult) and fish of a specific color. Subjects learned the ways in which persons were associated with fish (e.g. females with blue fish, males with green fish) and were then trained on an examplar of a new pairing (a female child with a red fish as opposed to a purple fish). This was followed by a testing phase in which subjects were shown novel combinations (e.g. a female adult and red and purple fish) and were asked to choose the correct pairing (e.g. adult female and red fish). The number of errors was recorded and compared between mutation carriers (MCs) and non-carriers (NCs) using mixed ANOVAs. RESULTS: 22 subjects were FAD MCs and 9 were NCs. They did not differ with regard to age, gender, or MMSE score (mean score of MCs 29.2, range 25-30). 9 MCs had CDR scores of 0.5, suggesting mild impairment, and the rest were asymptomatic. MCs made significantly more errors on generalization trials during the testing phase than NCs (F(1,29) = 9.3, p = 0.005) though the interaction between group and type of trial was only marginally significant (F(1,29)= 2.9, p = 0.099). CONCLUSIONS: Generalization of arbitrary memory pairings tested using this acquired equivalence paradigm is impaired in medial temporal lobe damage, including in preclinical FAD mutation carriers. Supported by: Easton Consortium for Alzheimer9s Disease Drug Discovery and Biomarker Development, NIA K08 AG-22228, the Dominantly Inherited Alzheimer Network (DIAN, U01 AG032438), the UCLA Alzheimer9s Disease Research Center Grant (P50 AG16570), and the UCLA Clinical Translational Research Institute 1UL1-RR033176. Disclosure: Dr. Myers has nothing to disclose. Dr. Simon has nothing to disclose. Dr. Wharton has nothing to disclose. Dr. Medina has nothing to disclose. Dr. Alvarez-Retuerto has nothing to disclose. Dr. Coppola has nothing to disclose. Dr. Gluck has nothing to disclose. Dr. Ringman has received personal compensation for activities with Takeda Pharmaceuticals and StemCells, Inc. as an advisory board member. Dr. Ringman has received research support from Janssen, Pfizer Inc, Accera, Bristol-Myers Squibb, Inc., and Wyeth Pharmaceuticals.
Neurobiology of Aging, 2012
Although many Alzheimer's disease (AD) patients have a family history of the disease, it is rarel... more Although many Alzheimer's disease (AD) patients have a family history of the disease, it is rarely inherited in a predictable way. Functional magnetic resonance imaging (fMRI) studies of nondemented adults carrying familial AD mutations provide an opportunity to prospectively identify brain differences associated with early AD-related changes. We compared fMRI activity of 18 non-demented autosomal dominant AD mutation carriers with fMRI activity in 8 of their noncarrier relatives as they performed a novelty encoding task in which they viewed novel and repeated images. Because age of disease onset is relatively consistent within families, we also correlated fMRI activity with subjects' distance from the median age of diagnosis for their family. Mutation carriers did not show significantly different voxelwise fMRI activity from non-carriers as a group. However, as they approached their family age of disease diagnosis, only mutation carriers showed increased fMRI activity in the fusiform and middle temporal gyri. This suggests that during novelty encoding, increased fMRI activity in the temporal lobe may relate to incipient AD processes.
Neuroscience Letters, 2011
Background-Familial Alzheimer's disease (AD) due to PSEN1 mutations provides an opportunity to ex... more Background-Familial Alzheimer's disease (AD) due to PSEN1 mutations provides an opportunity to examine AD biomarkers in persons in whom the diagnosis is certain. Methods-We describe a 55 year-old woman with clinically probable AD and a novel PSEN1 mutation who underwent genetic, clinical, biochemical and magnetic resonance and nuclear imaging assessments. We also describe neuropathological findings in her similarly affected brother. Results-Neuropsychological testing confirmed deficits in memory, visuospatial and language function. CSF t-tau and p-tau 181 were markedly elevated and Aβ 42 levels reduced. FDG-PET revealed hypometabolism in the left parietotemporal cortex. FDDNP-PET showed increased binding of tracer in medial temporal and parietal lobes and in the head of the caudate and anterior putamen bilaterally. Neuropathological examination of her brother showed the typical findings of
Neuroscience Letters, 2011
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Papers by Luis Dilan Medina Meza