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Social and health disparities associated with healthy brain ageing in Brazil and in other Latin American countries

LANCET GLOBAL HEALTH 2025年第2期13卷 e277-e284页

作者： Da Ros, Lucas U. Borelli, Wyllians Vendramini Aguzzoli, Cristiano Schaffer De Bastiani, Marco Antonio Schilling, Lucas Porcello Santamaria-Garcia, Hernando Pascoal, Tharick A. Rosa-Neto, Pedro Souza, Diogo O. da Costa, Jaderson Costa Ibanez, Agustin Suemoto, Claudia Kimie Zimmer, Eduardo R. Univ Fed Rio Grande do Sul Grad Program Biol Sci Biochem Porto Alegre Brazil Univ Fed Rio Grande do Sul Grad Program Biol Sci Biochem Porto Alegre Brazil Univ Fed Rio Grande do Sul Dept Pharmacol BR-90035003 Porto Alegre Brazil Hosp Moinhos Vento Memory Ctr Porto Alegre RS Brazil Pontifical Univ Rio Grande do Sul Brain Inst Rio Grande do Sul Porto Alegre Brazil Pontifical Univ Rio Grande do Sul Sch Med Dept Pediat Tokat Brazil Pontifical Univ Rio Grande do Sul Grad Program Biomed Gerontol Porto Alegre Brazil Univ Calif San Francisco Hosp Univ San Ignacio Ctr Brain & Cognit Intellectus PhD Program NeurosciPontificia Univ Javeriana San Francisco CA USA Univ Calif San Francisco Gobal Brain Hlth Inst Memory & Aging Ctr Francisco CA USA Univ Pittsburgh Dept Psychiat & Neurol Pittsburgh PA USA McGill Ctr Studies Aging Montreal PQ Canada McGill Univ Montreal Neurol Inst Dept Neurol & Neurosurg Montreal PQ Canada Douglas Hosp Res Ctr Montreal PQ Canada Univ Sao Paulo Med Sch Dept Internal Med Div Geriatr Sao Paulo Brazil Univ Adolfo Ibanez Latin Amer Brain Hlth Inst BrainLat Santiago Chile Trinity Coll Dublin Global Brain Hlth Inst Dublin Ireland Univ San Andres Cognit Neurosience Ctr Buenos Aires Argentina

Background Latin American countries present major health-related inequities due to historical, cultural, and social aspects. Recent evidence highlights that factors related to social and health disparities outweigh classic demographic factors in determining healthy brain aging in these populations. However, these analyses have not been conducted with the Brazilian population, the largest and most ethnically diverse population in Latin America. Methods Here, we evaluated demographic, social, and health factors for healthy brain ageing using a machine learning model in a Brazilian population-based cohort (n=9412) and in additional cohorts from other Latin American countries, including Colombia (n=23 694), Chile (n=1301), Ecuador (n=5235), and Uruguay (n=1450). Findings In the Brazilian population and other Latin American countries, social and health disparities were more influential than demographic factors for cognition and functional ability. Uniquely in Brazil, education emerged as the primary risk factor impacting cognitive outcomes, diverging from other Latin American countries where mental health symptoms played more prominent roles. In terms of functional ability, Brazil displayed a distinct pattern, with mental health symptoms identified as the primary contributing factor. Interpretation Our findings indicate that Brazil converges with other Latin American countries to show that heterogeneous factors impacted more than demographic factors, but also showed a unique set of health factors when compared with other Latin American countries. Therefore, our study emphasises that social and health disparity factors are relevant predictors of healthy brain ageing in Latin America, but population-specific analyses are necessary to identify the specific risk profiles of each country.

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The interplay between age at menopause and synaptic integrity on Alzheimer's disease risk in women

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SCIENCE ADVANCES 2025年第10期11卷 eadt0757页

作者： Wood Alexander, Madeline Honer, William G. Saloner, Rowan Galea, Liisa A. M. Bennett, David A. Rabin, Jennifer S. Casaletto, Kaitlin B. Sunnybrook Res Inst Hurvitz Brain Sci Program Toronto ON Canada Univ Toronto Rehabil Sci Inst Temerty Fac Med Toronto ON Canada Univ British Columbia Dept Psychiat Vancouver BC Canada Univ Calif San Francisco Weill Inst Neurosci Memory & Aging Ctr Dept Neurol San Francisco CA USA Univ Toronto Dept Pharmacol & Toxicol Toronto ON Canada Campbell Family Mental Hlth Res Inst Ctr Addit & Mental Hlth Toronto ON Canada Univ Toronto Temerty Fac Med Dept Psychiat Toronto ON Canada Rush Univ Med Ctr Chicago IL 60612 USA Sunnybrook Res Inst Ctr Brain Resilience & Recovery Hurvitz Brain Sci Program Toronto ON Canada Univ Toronto Temerty Fac Med Sunnybrook Hlth Sci Ctr Div Neurol Toronto ON Canada Univ Toronto Harquail Ctr Neuromodulat Sunnybrook Hlth Sci Ctr Toronto ON Canada

Menopause is a major biological transition that may influence women's late-life brain health. Earlier estrogen depletion-via earlier menopause-has been associated with increased risk for Alzheimer's disease (AD). Synaptic dysfunction also incites and exacerbates AD progression. We investigated whether age at menopause and synaptic health together influence AD neuropathology and cognitive trajectories using clinical and autopsy data from 268 female decedents in the Rush memory and aging Project. We observed significant interactions between age at menopause and synaptic integrity on cognitive decline and tau tangles, such that earlier menopause strengthened the associations of reduced synaptic integrity with faster cognitive decline and elevated tau. Exploratory analyses showed that these relationships were attenuated in women who took menopausal hormone therapy. These findings suggest that midlife endocrine processes or their sequalae may influence synaptic vulnerability to AD. Interventions addressing both hormonal factors and synaptic health could enhance resilience to dementia in women.

关键词： Neurodegenerative diseases

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Behavioral variant frontotemporal dementia in a 23-year-old man

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NEUROCASE 2023年第1期29卷 6-13页

作者： Ghazarian, Tania C. Hall, Matthew G. H. Horton, Leslie A. Miller, Bruce L. Rubin, Robert T. Western Univ Hlth Sci Coll Osteopath Med Pacific Pomona CA USA Loma Linda Univ Sch Med Dept Psychiat Loma Linda CA USA Univ Calif San Francisco Weill Inst Neurosci Memory & Aging Ctr Dept Neurol San Francisco CA USA Community Mem Healthcare Psychiat Residency Program Ventura CA 93003 USA Ventura Cty Med Ctr Dept Psychiat Ventura CA USA David Geffen Sch Med UCLA Dept Psychiat & Biobehav Sci Los Angeles CA USA

A 23-year-old man presented with behavioral disinhibition, stereotypies, motor apathy, flattened affect, and inappropriate laughter. CT demonstrated generalized cerebral atrophy. He was admitted with a diagnosis of unspecified psychosis and discharged on antipsychotic medication. He was readmitted 3 months later, was diagnosed with schizophrenia, and antipsychotic medication was continued. Owing to symptom progression and aggressive behavior, he was readmitted 2 months later. CT again demonstrated moderate central and cortical cerebral atrophy. MRI showed severe, stable atrophy with frontotemporal predominance, and he was diagnosed with probable behavioral variant frontotemporal dementia (bvFTD). Over the next year he rapidly deteriorated, with loss of cognitive abilities. Genetic testing revealed several variants, none of which are clearly disease-causing.

关键词： Frontotemporal dementia behavioral variant dementia psychosis early dementia

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Does transcranial direct current stimulation enhance cognitive performance in Parkinson's disease mild cognitive impairment? An event-related potentials and neuropsychological assessment study

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NEUROLOGICAL SCIENCES 2022年第6期43卷 4029-4044页

作者： Aksu, Serkan Uslu, Atilla Iscen, Pinar Tulay, Emine Elif Barham, Huzeyfe Soyata, Ahmet Zihni Demirtas-Tatlidede, Asli Yildiz, Gulsen Babacan Bilgic, Basar Hanagasi, Hasmet Woods, Adam J. Karamursel, Sacit Uyar, Fatma Aytul Istanbul Univ Grad Sch Hlth Sci Dept Physiol Istanbul Turkey Istanbul Univ Istanbul Fac Med Dept Physiol Istanbul Turkey Mugla Sitki Kocman Univ Fac Med Dept Physiol Mugla Turkey Istanbul Univ Istanbul Fac Med Dept Neurol Istanbul Turkey Mugla Sitki Kocman Univ Fac Engn Dept Software Engn Mugla Turkey Kirklareli Res & Training Hosp Dept Psychiat Kirklareli Turkey Ergani State Hosp Dept Psychiat Diyarbakir Turkey Bahcesehir Univ Sch Med Dept Neurol Istanbul Turkey Univ Florida Ctr Cognit Aging & Memory Cognit Aging & Memory Clin Translat Res Program Dept Clin & Hlth PsycholMcKnight Brain Inst Gainesville FL USA Koc Univ Sch Med Dept Physiol Istanbul Turkey

Background Parkinson's disease-mild cognitive impairment (PD-MCI) is garnering attention as a key interventional period for cognitive impairment. Currently, there are no approved treatments for PD-MCI and encouraging results of transcranial direct current stimulation (tDCS) combined with other interventions have been proposed, though the efficacy and neural mechanisms of tDCS alone have not been studied in PD-MCI yet. Objectives The present double-blind, randomized, sham-controlled study assessed the effects of tDCS over the dorsolateral prefrontal cortex on cognitive functions via neuropsychological and electrophysiological evaluations in individuals with PD-MCI for the first time. Method Twenty-six individuals with PD-MCI were administered 10 sessions of active (n = 13) or sham (n = 13) prefrontal tDCS twice a day, for 5 days. Changes were tested through a comprehensive neuropsychological battery and event-related potential recordings, which were performed before, immediately, and 1 month after the administrations. Results Neuropsychological assessment showed an improvement in delayed recall and executive functions in the active group. N1 amplitudes in response to targets in the oddball test-likely indexing attention and discriminability and NoGo N2 amplitudes in the continuous performance test-likely indexing cognitive control and conflict monitoring increased in the active group. Active stimulation elicited higher benefits 1 month after the administrations. Conclusion The present findings substantiate the efficacy of tDCS on cognitive control and episodic memory, along with the neural underpinnings of cognitive control, highlighting its potential for therapeutic utility in PD-MCI.

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Expansion of highly interferon-responsive T cells in early-onset Alzheimer's disease

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ALZHEIMERS & DEMENTIA 2024年第7期20卷 5062-5070页

作者： Sirkis, Daniel W. Warly Solsberg, Caroline Johnson, Taylor P. Bonham, Luke W. Oddi, Alexis P. Geier, Ethan G. Miller, Bruce L. Rabinovici, Gil D. Yokoyama, Jennifer S. Univ Calif San Francisco Weill Inst Neurosci Memory & Aging Ctr Dept Neurol 165 14th St San Francisco CA 94158 USA Univ Calif San Francisco Pharmaceut Sci & Pharmacogen Grad Program San Francisco CA USA NIH Ctr Alzheimers Dis & Related Dementias Bethesda MD USA DataTecnica LLC Washington DC USA Univ Calif San Francisco Dept Radiol & Biomed Imaging San Francisco CA USA Transposon Therapeut Inc San Diego CA USA Univ Calif San Francisco Global Brain Hlth Inst San Francisco CA USA

INTRODUCTION: Altered immune signatures are emerging as a central theme in neurodegenerative disease, yet little is known about immune responses in early-onset Alzheimer's disease (EOAD). METHODS: We examined single-cell RNA-sequencing (scRNA-seq) data from peripheral blood mononuclear cells (PBMCs) and droplet digital polymerase chain reaction (ddPCR) data from CD4 T cells from participants with EOAD and clinically normal controls. RESULTS: We analyzed PBMCs from 16 individuals by scRNA-seq and discovered increased interferon signaling-associated gene (ISAG) expression and striking expansion of antiviral-like ISAG(hi) T cells in EOAD. Isolating CD4 T cells from 19 individuals, including four cases analyzed by scRNA-seq, we confirmed increased expression of ISAG(hi) marker genes. Publicly available cerebrospinal fluid leukocyte scRNA-seq data from late-onset mild cognitive impairment and AD also revealed increased expression of interferon-response genes. DISCUSSION: Antiviral-like ISAG(hi) T cells are expanded in EOAD. Additional research into these cells and the role of heightened peripheral IFN signaling in neurodegeneration is warranted.

关键词： Alzheimer's disease CD4 T cells cerebrospinal fluid droplet digital PCR early-onset Alzheimer's disease interferon interferon signaling-associated gene peripheral blood mononuclear cells single-cell RNA-sequencing T cells tauopathy

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Discharge Disposition in Veterans with Heart Failure: Impact of Dementia and Severe Mental Illness

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JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION 2025年第5期26卷 105533-105533页

作者： Howe, Matthew D. Jiang, Lan Browne, Julia W. Bayer, Thomas A. Kunicki, Zachary J. De Vito, Alyssa N. Mcgeary, John E. Wu, Wen-Chih Lind, Jason D. Kelso, Catherine M. Rudolph, James L. VA Providence Healthcare Syst Ctr Innovat Transformat Hlth Syst Res Improve Vet Providence RI USA Brown Univ Dept Psychiat & Human Behav Alpert Med Sch Providence RI USA Brown Univ Alpert Med Sch Div Geriatr & Palliat Med Providence RI USA Butler Hosp Memory & Aging Program Providence RI USA Providence VA Med Ctr VA RR&D Ctr Neurorestorat & Neurotechnol Providence RI USA Vet Hlth Adm Off Patient Care Serv Geriatr & Extended Care Washington DC USA Brown Univ Dept Hlth Serv Policy & Practice Providence RI USA

Objectives: Post-acute heart failure (HF) care presents significant management challenges, particularly among veterans with cognitive and behavioral impairments due to Alzheimer disease and related dementias (AD/ADRD) or severe mental illness (SMI). We hypothesized that comorbid AD/ADRD and SMI would reduce the likelihood of discharge home following HF hospitalization. In addition, we explored how AD/ADRD and SMI influence discharge to Veterans Affairs (VA) Community Living Centers (CLCs) compared with Medicare Skilled Nursing Facilities (SNFs). Design: Retrospective cohort study spanning January 1, 2011, to September 30, 2019. Setting and Participants: Veterans hospitalized with acute HF at VA hospitals (n = 291,117). Methods: We examined VA administrative data from HF hospitalizations to assess how AD/ADRD and SMI impact post-hospital discharge location. Using diagnostic codes from the prior year, we stratified participants by the presence of AD/ADRD and/or SMI, then employed logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for discharge location, adjusted for demographics, comorbidities, and health care utilization. Results: Participants were predominantly older (mean age: 78.1 f 11.1 years), male (97.5%), and selfidentified as white (72.7%). Those with AD/ADRD alone (n = 16,212) or SMI alone (n = 33,194) outnumbered those with both conditions (n = 3612). Compared with neither condition, the presence of AD/ ADRD alone [adjusted OR (aOR), 0.523;95% CI, 0.505-0.542], SMI alone (aOR, 0.869;95% CI, 0.843 -0.896), and both conditions (aOR, 0.505;95% CI, 0.47-0.542) all reduced likelihood of discharge home. Participants with AD/ADRD and SMI were more likely to be discharged to a CLC than a SNF (aOR, 1.225;95% CI, 1.064-1.411). Conclusions and Implications: Our findings indicate that AD/ADRD and SMI are major barriers to discharge home for patients with HF, suggesting a need for enhanced supervision during health care trans

关键词： Alzheimer disease heart failure hospitalization mental disorders patient discharge skilled nursing facilities

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Reversibility of cognitive worsening observed with BACE inhibitor umibecestat in the Alzheimer's Prevention Initiative (API) Generation Studies

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ALZHEIMERS & DEMENTIA 2024年第11期20卷 7745-7761页

作者： Tariot, Pierre N. Riviere, Marie-Emmanuelle Salloway, Stephen Burns, Jeffrey M. Snaedal, Jon G. Borowsky, Beth Lopez, Cristina Lopez Liu, Fonda Rouzade-Dominguez, Marie-Laure Cazorla, Pilar Mousseau, Marie-Catherine Arkuszewski, Michal Ricart, Javier Viglietta, Vissia Sui, Yihan Caputo, Angelika Langbaum, Jessica B. Reiman, Eric M. Graf, Ana Banner Alzheimers Inst Phoenix AZ 85006 USA Univ Arizona Coll Med Dept Psychiat Phoenix AZ USA Arizona Alzheimers Consortium Phoenix AZ USA Novartis Pharm AG Clin Dev Neurosci Basel Switzerland Butler Hosp Neurol & Memory & Aging Program Providence RI USA Univ Kansas Alzheimers Dis Res Ctr Dept Neurol Mission KS USA Landspitali Univ Hosp Memory Clin Reykjavik Iceland Novartis Pharmaceut Clin Dev Neurosci E Hanover NJ USA Novartis Ireland Ltd Global Business Solut Neurosci Dublin Ireland Novartis Farmaceut SA Clin Dev Neurosci Barcelona Spain Amgen Inc Cambridge MA USA Univ Arizona Coll Med Dept Neurol Phoenix AZ USA Arizona State Univ ASU Banner Neurodegenerat Res Ctr Phoenix AZ USA Translat Genom Res Inst Neurogenom Div Phoenix AZ USA

INTRODUCTION: The Alzheimer's Prevention Initiative (API) Generation Studies evaluated the BACE inhibitor umibecestat for Alzheimer's disease (AD) prevention. The studies were terminated early, and the reversibility of umibecestat's side effects was assessed. METHODS: Cognitively unimpaired 60- to 75-year-old apolipoprotein E (APOE) epsilon 4 homozygotes and heterozygotes (the latter with elevated brain amyloid deposition) (n = 1556) received umibecestat (50 or 15 mg daily) or placebo for 7 months on average and were followed for a median (interquartile range) of 4 (3 to 6) months after washout. RESULTS: Compared to placebo, umibecestat-treated participants had small, non-progressive, but statistically significant decline in performance on certain cognitive batteries including Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and API Preclinical Composite Cognitive test, but not Clinical Dementia Rating-Sum of Boxes. RBANS differences were no longer significant at the end of follow-up. DISCUSSION: In people at genetic risk for AD, high-dose beta-site amyloid precursor protein cleaving enzyme (BACE) inhibition was associated with early mild cognitive worsening, which reversed shortly after washout, suggesting a symptomatic side effect not associated with neurodegeneration. Fully anonymized data, images, and samples are available upon request for further research on BACE inhibition.

关键词： Alzheimer's disease (AD) prevention amyloid beta lowering APOE BACE inhibitors biomarkers imaging

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Phenotypic Screening Using High-Content Imaging to Identify Lysosomal pH Modulators in a Neuronal Cell Model

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ACS CHEMICAL NEUROSCIENCE 2022年第10期13卷 1505-1516页

作者： Chin, Marcus Y. Ang, Kean-Hooi Davies, Julia Alquezar, Carolina Garda, Virginia G. Rooney, Brendan Leng, Kun Kampmann, Martin Arkin, Michelle R. Kao, Aimee W. Univ Calif San Francisco Memory & Aging Ctr Dept Neurol San Francisco CA 94158 USA Univ Calif San Francisco Small Mol Discovery Ctr Dept Pharmaceut Chem San Francisco CA 94143 USA Univ Calif San Francisco Inst Neurodegenerat Dis Dept Biochem & Biophys San Francisco CA 94158 USA Univ Calif San Francisco Biomed Sci Grad Program San Francisco CA 94158 USA Univ Calif San Francisco Med Scientist Training Program San Francisco CA 94158 USA

Lysosomes are intracellular organelles responsible for the degradation of diverse macromolecules in a cell. A highly acidic pH is required for the optimal functioning of lysosomal enzymes. Loss of lysosomal intralumenal acidity can disrupt cellular protein homeostasis and is linked to age-related diseases such as neurodegeneration. Using a new robust lysosomal pH biosensor (FIRE-pHLy), we developed a cell-based fluorescence assay for high-throughput screening (HTS) and applied it to differentiated SH-SY5Y neuroblastoma cells. The goal of this study was twofold: (1) to screen for small molecules that acidify lysosomal pH and (2) to identify molecular targets and pathways that regulate lysosomal pH. We conducted a screen of 1835 bioactive compounds with annotated target information to identify lysosomal pH modulators (both acidifiers and alkalinizers). Forty-five compounds passed the initial hit selection criteria, using a combined analysis approach of population-based and object-based data. Twenty-three compounds were retested in dose-response assays and two compounds, OSI-027 and PP242, were identified as top acidifying hits. Overall, data from this phenotypic HTS screen may be used to explore novel regulatory pathways of lysosomal pH regulation. Additionally, OSI-027 and PP242 may serve as useful tool compounds to enable mechanistic studies of autophagy activation and lysosomal acidification as potential therapeutic pathways for neurodegenerative diseases.

关键词： lysosomes lysosomal pH pH biosensor high-content analysis neurons phenotypic screening

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Outcomes in heart failure patients discharged to skilled nursing facilities with delirium

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ESC HEART FAILURE 2022年第3期9卷 1891-1900页

作者： Lafo, Jacob Singh, Mriganka Jiang, Lan Correia, Stephen Madrigal, Caroline Clements, Rachel Wen-Chih Wu Erqou, Sebhat Rudolph, James L. Providence VA Med Ctr Ctr Innovat Long Term Serv & Supports 830 Chalkstone Ave Providence RI 02908 USA Brown Univ Dept Psychiat & Human Behav Providence RI 02912 USA Brown Univ Warren Alpert Med Sch Dept Med Providence RI 02912 USA Butler Hosp Memory & Aging Program Providence RI 02906 USA Brown Univ Sch Publ Hlth Ctr Gerontol Providence RI 02912 USA

Aim Heart failure (HF) outcomes are disproportionately worse in patients discharged to skilled nursing facilities (SNF) as opposed to home. We hypothesized that dementia and delirium were key factors influencing these differences. Our aim was to explore the associations of dementia and delirium with risk of hospital readmission and mortality in HF patients discharged to SNF. Methods and results The study population included Veterans hospitalized for a primary diagnosis of HF and discharged to SNFs between 2010 and 2015. Pre-existing dementia was identified based on International Classification of Diseases-9 codes. Delirium was determined using the Minimum Data Set 3.0 Confusion Assessment Method algorithm. Proportional hazard regression analyses were used to model outcomes and were adjusted for covariates of interest. Patients (n = 21 655) were older (77.0 +/- 10.5 years) and predominantly male (96.9%). Four groups were created according to presence (+) or absence (-) of dementia and delirium. Relative to the dementia-/delirium- group, the dementia-/delirium+ group was associated with increased 30 day mortality [adjusted hazard ratio (HR) = 2.2, 95% confidence interval (CI) = 1.7, 3.0] and 365 day mortality (adjusted HR = 1.5, 95% CI = 1.3, 1.7). Readmission was highest in the dementia-/delirium+ group after 30 days (HR = 1.2, 95% CI = 1.0, 1.5). In the group with dementia (delirium-/dementia+), 30 day mortality (12.8%;HR = 0.7, 95% CI = 0.7, 0.8) and readmissions (5.3%;HR = 1.0, 95% CI = 0.8, 1.1) were not different relative to the reference group. Conclusions Delirium, independent of pre-existing dementia, confers increased risk of hospital readmission and mortality in HF patients discharged to SNFs. Managing HF after hospitalization is a complex cognitive task and an increased focus on mental status in the acute care setting prior to discharge is needed to improve HF management and transitional care, mitigate adverse outcomes, and reduce healthcare costs.

关键词： Heart failure Rehabilitation Delirium Dementia Mortality Skilled nursing facilities

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Understanding the Perspectives and Needs of Latinx Caregivers of Persons with Alzheimer's Disease in the Appalachians: An Interpretive Phenomenological Approach

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JOURNAL OF ALZHEIMERS DISEASE REPORTS 2024年第1期8卷 189-202页

作者： Moore, Arelis Davis, Nicole J. Dolins, Madeline Barkley, Ethan Reese, Ann Meggett, Kinsey Bailey-Taylor, Melissa J. Clemson Univ Dept Languages Clemson SC 29634 USA NHCGNE Sch Nursing Gerontol Nursing Clemson SC USA Univ South Carolina Sch Med Greenville Greenville SC USA Med Univ South Carolina MUSC Charleston SC USA Ctr Success Aging Div Geriatr Med Memory Hlth Program Prisma Hlth Upstate Greenville SC USA Clemson Univ Dept Publ Hlth Sci Clemson SC 29634 USA Clemson Univ Sch Hlth Res 406 Edwards Hall Clemson SC 29634 USA

Background: Alzheimer's disease and related dementias (ADRD) disproportionately impact Latinx and other communities of color in the United States. The challenges for patients with ADRD and their informal caretakers can be attributed, in part, to the gaps that exist within health care services and systems. Objective: To understand the perspectives of barriers, beliefs, knowledge, and needs for the Latinx informal caregivers that take care of relatives with ADRD in the Upstate of South Carolina, region of Appalachia. Methods: This study was approved by the GHS-Prisma Health and Clemson University IRB, Study #Pro00086707. In-depth phone interviews were conducted with a sample of Latinx informal caregivers. A descriptive and interpretive phenomenological approach was used for analysis. Participants were recruited through community partnerships with local organizations. Results: Salient themes identified in this study included the relevance of caregiver's degree of awareness about the disease and a perspective of Alzheimer's disease as a progressive and degenerative disease. Critical moments identified encompassed challenges related to patient engagement with the outside world, their attitudes, and behaviors, as well as caregiver-related challenges with access to culturally and linguistically relevant resources needed to provide proper care. Caregivers identified several culturally relevant coping strategies used and motivators in providing care for their relatives with ADRD. Conclusions: Linguistically and culturally sensitive programs and resources that account for knowledge, assets, and needs of Latinx informal caregivers of ADRD patients are needed to improve the quality of care and decrease disparities in health outcomes for Latinx older adults.

关键词： Alzheimer's disease Alzheimer's disease and related dementias assessment of healthcare needs coping strategies culturally appropriate services family caregiver informal caregiver Latinx/Latino/Hispanic

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