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Singh's cultural evolutionary theory of shamanism provides a valuable framework for understanding shamanism. We argue, however, that a full understanding of shamanism should incorporate the psychological predilections and genetic predispositions commonly found in individual shamans. In other words, only a small subset of individuals in a culture is prone or attracted to shamanistic practices, regardless of the evolutionary value of those practices.

INTRODUCTION Poorer baseline functioning is associated with long‐term cognitive decline among Hispanic older adults, but little is known about associations of these factors with Alzheimer's disease (AD) neuroimaging biomarkers. METHODS A total of 461 Hispanic and White non‐Hispanic (NHW) older adults who are cognitively normal (n = 76), had impaired cognition without mild cognitive impairment (MCI) (n = 41), or carried a diagnosis of MCI (n = 253) or dementia (n = 91) completed neuropsychological and functional assessment, genetic testing, and brain magnetic resonance imaging (MRI). Structural equation modeling (SEM) was used to examine predictive associations between functional and cognitive measures of AD neuroimaging biomarkers. RESULTS MRI volumes significantly predicted functional limitations in both groups. Sex and amyloid load significantly predicted functional limitations among the Hispanic group only. Years of education and MRI regional volume were the strongest predictors of cognition among both groups. DISCUSSION Results indicate that functional performance is associated with early AD biomarkers among Hispanic older adults. Clinical implications are discussed. Highlights The current study addresses health disparities in Alzheimer's disease (AD) and related dementia assessment among Hispanics by identifying measures sensitive to early AD biomarkers. Associations of functional measures with AD genetic and neuroimaging biomarkers revealed that similarities in these associations exist between Hispanic and White non‐Hispanic individuals, but biological sex and amyloid load significantly predicted functional limitations among the Hispanic group only. These results have clinical implications for physicians who treat Hispanic AD patients and indicate that when compared to traditional diagnostic assessments, functional assessments may better aid in AD diagnostic precision among Hispanics.

Objective:Prior studies have presented demographic adjustment as beneficial because it helps equalize, across demographic groups, the percentage of participants (recruited from the general population without prior diagnosis) who fell beneath the test impairment cutoff (e.g., Smith, et al., 2008). This methodology ignores the possibility that group differences in those falling beneath an impairment cutoff could reflect cognitive impairment prevalence differences between demographic groups in the undiagnosed general population. Demographic group differences in cognitive test scores reflect a mixture of two categories of influences: measurement bias (item/test/examiner bias, language/cultural bias, stereotype threat, etc.) and factors which differentially increase the number of low scores in one group by increasing relative risk (RR) for cognitive impairment (biological aging processes, cognitive reserve, social determinants of health [SDoH], etc.). The current simulation study examined how the effect of demographic adjustment on the diagnostic accuracy of a hypothetical test (operationalized as the area under the curve [AUC] in an ROC analysis) varied as the mixture of influences which caused demographic differences in scores were varied.Participants and Methods:215,040 samples were randomly generated. Each sample consisted of two demographic groups, with Group 0 always representing the lower scoring group. Across samples, Group 1's baseline risk of impairment and Group 0's relative risk were varied, and these determined the prevalence of cognitive impairment in the groups. Three facets of measurement bias were varied in the simulation: how much lower Group 0's average score was than Group 1's, the degree of non-homogeneity of variance between groups, and how much less reliable the measure was for Group 0. Additional parameters were included and varied to ensure the robustness of findings across a variety of situations. Samples reflected all possible combinations of all varied parameters. For each sample, a baseline AUC was calculated when impairment was regressed on the unadjusted test score. Then, test scores were adjusted for demographic group and difference in adjusted and unadjusted AUC was calculated. This adjusted/unadjusted AUC difference was then regressed on the simulation parameters to quantify their relative influence.Results:The more Group 0's average score was reduced by measurement bias, the more improvement in AUC was seen after adjustment (ß = 1.76). Trivial but significant main effects of variance non-homogeneity (ß = .09), increased relative risk (ß = -.08), and reduced reliability (ß = .02) were also found, but more importantly, each of these predictors significantly interacted with Group 0 mean score reduction, such that higher relative risks (ß = -1.22), lower reliability (ß = .36), and higher variance (ß = -.15) in Group 0 compared to Group 1 each reduced the association between Group 0 mean score reduction and improvement in AUC.Conclusions:Demographic adjustment only improves AUC when the mean reduction in scores due to measurement bias is sufficiently high while risk for impairment, test reliability and test score variances are sufficiently equivalent among the demographic groups. When this is not the case, demographic adjustment can be counter-productive, reducing the AUC of the test. We conclude by proposing a novel method for adjusting test scores.

INTRODUCTION Commercially available plasma p‐tau217 biomarker tests are not well studied in ethnically diverse samples. METHODS We evaluated associations between ALZPath plasma p‐tau217 and amyloid‐beta positron emission tomography (Aβ‐PET) in Hispanic/Latino (88% of Cuban or South American ancestry) and non‐Hispanic/Latino older adults. One‐ and two‐cutoff ranges were derived and evaluated to assess agreement with Aβ‐PET. RESULTS A total of 239 participants underwent blood draw and Aβ‐PET (age 70.8 ± 7.8, 55.2% female, education 15.6 ± 3.4 years, 48.9% Hispanic/Latino, 94.9% white). Plasma p‐tau217 showed excellent discrimination of Aβ‐PET positive and negative participants (visual read: AUC = 0.91 [0.87–0.95], p < 0.001; Centiloids quantification: AUC = 0.90 [0.86–0.94]). There was a greater percent agreement between low p‐tau217 and negative Aβ‐PET (95.8%) than high p‐tau217 and positive Aβ‐PET (86.3%). Analyses within ethnicity‐specific subgroups suggested similar p‐tau217 performance. DISCUSSION Plasma p‐tau217 (ALZPath) relates to brain Aβ in Hispanic/Latino and non‐Hispanic/Latino older adults. Independent validation and replication are necessary to establish reference ranges and inform appropriate contexts of use across ethno‐racially diverse populations. HIGHLIGHTS Plasma p‐tau217 (ALZPath) and Aβ‐PET were measured in Hispanic/Latino and non‐Hispanic/Latino older adults. Plasma p‐tau217 accurately discriminated Aβ‐PET positive and negative participants. Applying a two‐cutoff “intermediate” plasma p‐tau217 approach could reduce need for more invasive and costly testing. Plasma p‐tau217 associations with Aβ‐PET were strong within both Hispanic/Latino and non‐Hispanic/Latino groups.

INTRODUCTION Factors underlying discordant visual and quantitative amyloid beta–positron emission tomography (Aβ‐PET) results and their clinical implications are not well understood. METHODS Participants from the 1Florida Alzheimer's Disease Research Center (1FLADRC) underwent Aβ‐PET, blood draw, brain magnetic resonance imaging (MRI), and neuropsychological testing. We evaluated differences in demographics, apolipoprotein E (APOE) status, biomarkers, and cognition among older adults with concordant and discordant visual‐quantitative Aβ‐PET. Discordance was defined as positive visual read (V) of Aβ‐PET with below‐threshold Centiloid quantification (Q; CL <25; V+/Q–) or negative visual read with CL ≥25 (V–/Q+). RESULTS We studied 386 participants (mean age ± SD: 70.7 ± 7.8, 55.2% female, 44.6% Hispanic White). Compared to V+/Q–, V–/Q+ had a higher frequency of APOE ε4 carriers (40%). Black/African American participants were overrepresented in V–/Q+ (40.9%). Both discordant groups had higher plasma phosphorylated tau 217 (p‐tau217) and glial fibrillary acidic protein (GFAP) than V–/Q– but lower than V+/Q+. Discordant groups had greater gray matter volume and better cognitive performance than V+/Q+. DISCUSSION Discordant Aβ‐PET findings likely hold clinical significance and may reflect early stages of neuropathological progression. Highlights Groups with concordant/discordant visual‐quantitative amyloid beta–positron emission tomography (Aβ‐PET) results were compared. Visual–/quant+ were more likely than visual+/quant– to be apolipoprotein E (APOE) ε4 carriers and Black/African American. Discordant groups had higher plasma phosphorylated tau 217 (p‐tau217) and glial fibrillary acidic protein (GFAP) than concordant negative. Discordant groups had less atrophy and better cognition than concordant positive. Centiloid quantification should supplement visual reads in clinical settings.

Objective:In the United States, Black individuals have suffered from 300 years of racism, bias, segregation and have been systematically and intentionally denied opportunities to accrue wealth. These disadvantages have resulted in disparities in health outcomes. Over the last decade there has been a growing interest in examining social determinants of health as upstream factors that lead to downstream health disparities. It is of vital importance to quantify the contribution of SDH factors to racial disparities in order to inform policy and social justice initiatives. This demonstration project uses years of education and white matter hyperintensities (WMH) to illustrate two methods of quantifying the role of a SDH in producing health disparities.Participants and Methods:The current study is a secondary data analysis of baseline data from a subset of the National Alzheimer's Coordinating Center database with neuroimaging data collected from 2002-2019. Participants were 997 cognitively diverse, Black and White (10.4% Black) individuals, aged 60-94 (mean=73.86, 56.5% female), mean education of 15.18 years (range= 0-23, SD=3.55). First, mediation, was conducted in the SEM framework using the R package lavaan. Black/White race was the independent variable, education was the mediator, WMH volume was the dependent variable, and age/sex were the covariates. Bootstrapped standard errors were calculated using 1000 iterations. The indirect effect was then divided by the total effect to determine the proportion of the total effect attributable to education. Second, a population attributable fraction (PAF) or the expected reduction in WMH if we eliminated low education and structural racism for which Black serves as a proxy was calculated. Two logistic regressions with dichotomous (median split) WMH as the dependent variable, first with low (less than high school) versus high education, and second with Black/White race added as predictors. Age/sex were covariates. PAF of education, and then of Black/White race controlling for education were obtained. Subsequently, a combined PAF was calculated.Results:In the lavaan model, the total effect of Black/White race on WMH was not significant (B=.040, se=.113, p=.246); however, Black/White race significantly predicted education (B= -.108, se=.390, p=.001) and education significantly predicted WMH burden (B=-.084, se=.008, p=.002). This resulted in a significant indirect effect (effect=.009, se=.014, p=.032). 22.6 % of the relationship between Black/White race and WMH was mediated by education. In the logistic models, the PAF of education was 5.3% and the additional PAF of Black/White race was 2.7%. The combined PAF of Black race and low education was 7.8%.Conclusions:From our mediation we can conclude that 22.6% of the relationship between Black/White race and WMH volume is explained by education. Our PAF analysis suggests that we could reduce 7.8% of the cases with high WMH burden if we eliminated low education and the structural racism for which Black serves as a proxy. This is an under estimation of the role that education and structural racism play in WMH burden due to our positively selected sample and crude measure of education. However, these methods can help researchers quantify the contribution of SDH to disparities in older adulthood and provide targets for policy change.

Background Hispanic/Latina(o) persons in the United States (U.S.) are at a unique intersection of cultural, social, and systemic experiences affecting health. While acculturation, the degree to which a person integrates aspects of their host country's culture, has been explored in cognitive outcomes, findings are inconclusive. Importantly, acculturation's effect on cognition is rarely explored in social and structural contexts. This study evaluated the association between acculturation and cognitive outcomes and examined whether social and structural factors affect this relationship. Method A cross‐sectional analysis of Hispanic/Latina(o) participants (68% Female; Meducation = 10.01 ±  4.54; Mage = 64 ± 7.99) enrolled in the Health and Aging Brain Study‐Health Disparities (HABS‐HD; N =  1,095) was conducted. Participants completed an acculturation measure, a social support scale, and a comprehensive neuropsychological workup. State‐level neighborhood disadvantage was calculated using the Area Deprivation Index (ADI). Analysis of variance (ANOVA) and multivariate ANOVA compared performance across seven cognitive domains based on acculturation level (low, moderate, high) and assessed whether cognitive performance differed by social support and State‐level ADI. K‐cluster analysis determined whether socio‐structural phenotypes captured cognitive outcomes. Result Persons in the high acculturation tertile outperformed other groups in general cognition, processing speed, language, memory, and executive function (all p < .01). Social support was positively associated with general cognition, processing speed, language, memory, and executive function (all p < .01). ADI was inversely associated with general cognition, processing speed, memory, and executive function (all p < .01). An interaction between social support and ADI for language was found (p < .05). Three clusters were identified: (1) High Acculturation/Low Social Support/Moderate ADI, (2) Moderate Social Support/Lowest Acculturation/Highest ADI, and (3) High Social Support/Moderate Acculturation/Low ADI. Cluster 3 performed significantly better in general cognition (F(2, 725) = 15.43, p < .001, partial η2 = .025) and reading level (F(2, 725) = 143.14, p < .001, partial η2 = .19). Conclusion The association between acculturation and cognition varied based on social and structural determinants of health. These findings underscore the importance of examining the contribution of these variables when assessing cognitive outcomes. Future studies are needed to determine whether interventions targeting social support and stressors in the built environment may promote cognitive health, particularly in the context of acculturation.

Objective:Approximately 10-15% of patients with mild traumatic brain injury (mTBI) report persistent, chronic symptoms more than one month later. Coping behaviors after mTBI can range from fear avoidance (FA), or a reluctance to return to activity because of the fear of symptom exaggeration, to endurance (END), or an overly aggressive return to activity. We evaluated how coping strategy relates to self-reported symptoms in patients with prolonged recovery from mTBI.Participants and Methods:Participants were 72 individuals (age 37.8 + 18.4, 65% female) who sustained a mTBI at least one month prior to assessment (median (IQR) = 5.5 (2.0-11.3) months). Participants completed the Brain Injury Recovery Disposition Scale (BIRDS) to assess FA and END behaviors, and Sport Concussion Assessment Tool (SCAT5) Symptom Inventory. A BIRDS spectrum score was calculated as the difference between FA and END scores to determine individual coping behavior on a spectrum from extreme FA (more negative) to extreme END (more positive). SCAT5 symptoms were separated into four domain scores: somatic, cognitive, sleep, and emotion. Regressions were performed for each outcome examining their potential linear and quadratic associations to coping behavior (i.e., BIRDS spectrum score). Follow-up regressions were performed covarying for age and sex to explore the potential influence of these variables on each outcome.Results:The linear and quadratic components of the BIRDS spectrum score were not significantly related to total number of persisting concussive symptoms. For overall total symptom severity, the quadratic component of the relationship was significant (B = .24, p = 0.04). Visualization of the overall trend line suggested that symptom severity was highest on the extreme FA side of the BIRDS spectrum (highly negative BIRDS spectrum score), decreased as coping behavior become more balanced (BIRDS spectrum score surrounding “0\"), plateaued, then increased abruptly on the extreme END side (highly positive BIRDS spectrum score). For cognitive symptoms, the linear component of the BIRDS spectrum score was significant (B = -.28, p = 0.02) and the quadratic component was marginally significant (B = .22, p = 0.06). The quadratic (but not linear) component was significantly related to both the severity of sleep (B = .31, p = 0.01) and emotion symptoms (B = .25, p = 0.03). Finally, neither the linear nor quadratic components were significantly related to the somatic symptom severity. After covarying for age and sex, the quadratic component remained significant for total symptom severity (p = 0.05) as well as the linear component for cognitive severity (p = 0.02).Conclusions:Both extreme “fear avoidance” and “endurance” coping styles may be related to more severe chronic mTBI symptoms, especially in domains of sleep and emotion symptoms. Patients with balance of both fear avoidance and endurance behaviors may be more likely to experience less severe symptoms even among mTBI patients with persistent complaints. Identifying coping behavior styles early after mTBI could improve prognostication and help with developing personalized treatment plans to improve patient recovery. Future research with larger sample sizes should further examine the influence of age and sex on the relationship between coping behavior and symptom severity.

Hispanic/Latina(o) persons in the United States (U.S.) are at a unique intersection of cultural, social, and systemic experiences affecting health. While acculturation, the degree to which a person integrates aspects of their host country's culture, has been explored in cognitive outcomes, findings are inconclusive. Importantly, acculturation's effect on cognition is rarely explored in social and structural contexts. This study evaluated the association between acculturation and cognitive outcomes and examined whether social and structural factors affect this relationship. A cross-sectional analysis of Hispanic/Latina(o) participants (68% Female; M  = 10.01 ±  4.54; M  = 64 ± 7.99) enrolled in the Health and Aging Brain Study-Health Disparities (HABS-HD; N =  1,095) was conducted. Participants completed an acculturation measure, a social support scale, and a comprehensive neuropsychological workup. State-level neighborhood disadvantage was calculated using the Area Deprivation Index (ADI). Analysis of variance (ANOVA) and multivariate ANOVA compared performance across seven cognitive domains based on acculturation level (low, moderate, high) and assessed whether cognitive performance differed by social support and State-level ADI. K-cluster analysis determined whether socio-structural phenotypes captured cognitive outcomes. Persons in the high acculturation tertile outperformed other groups in general cognition, processing speed, language, memory, and executive function (all p < .01). Social support was positively associated with general cognition, processing speed, language, memory, and executive function (all p < .01). ADI was inversely associated with general cognition, processing speed, memory, and executive function (all p < .01). An interaction between social support and ADI for language was found (p < .05). Three clusters were identified: (1) High Acculturation/Low Social Support/Moderate ADI, (2) Moderate Social Support/Lowest Acculturation/Highest ADI, and (3) High Social Support/Moderate Acculturation/Low ADI. Cluster 3 performed significantly better in general cognition (F(2, 725) = 15.43, p < .001, partial η  = .025) and reading level (F(2, 725) = 143.14, p < .001, partial η  = .19). The association between acculturation and cognition varied based on social and structural determinants of health. These findings underscore the importance of examining the contribution of these variables when assessing cognitive outcomes. Future studies are needed to determine whether interventions targeting social support and stressors in the built environment may promote cognitive health, particularly in the context of acculturation.

This study examines the relationship between depression and clinical functioning among cognitively normal (CN) and mildly cognitively impaired (MCI) older adults, with a specific focus on cross-ethnic comparisons between Hispanic and White non-Hispanic (WNH) populations. Despite a significant body of research linking depression to cognitive decline, limited studies have explored how this relationship differs across ethnic groups. Using data from the 1Florida Alzheimer's Disease Research Center (1Florida ADRC), multiple ordinal logistic regression models were applied separately for Hispanic and WNH samples to assess the impact of cognitive status, depression severity, and age on clinical functioning, as measured by the modified Clinical Dementia Rating (mCDR) scale. Results indicated that among Hispanics, higher depression levels were significantly associated with greater clinical impairment, whereas this association was not significant among WNHs. Given the cross-sectional nature of this study, future longitudinal research should examine whether clinical impairment leads to increased depressive symptoms over time. These findings underscore the need for culturally informed interventions targeting depression in aging Hispanic populations.