Prevalent Cardiovascular Disease and Atrial Fibrillation in Relation to Cerebral Small Vessel Disease Burden.

Background/objectives: Cardiovascular disease (CVD) contributes to stroke and dementia. Individuals with CVD have high risk for adverse cognitive outcomes and stroke, possibly due to shared risk factors between CVD, stroke, and dementia, which may be attributed to cerebral small vessel disease (CSVD). We aim to determine the association between prevalent CVD and atrial fibrillation (AF) with CSVD.

Multi-marker cerebral small vessel disease score and risk of incident depression: The Framingham Heart Study.

Background: The vascular depression hypothesis postulates that cerebral small vessel disease (CSVD) contributes to the development of depression. This study examined the relationship between a multi-marker CSVD score derived from brain magnetic resonance imaging (MRI) with incident depression in community-dwelling individuals.

Methods: Framingham Heart Study (FHS) participants free of stroke, dementia, and depression with available data on CSVD MRI markers were included.

Association of MRI visible Perivascular Spaces with Early White Matter Injury.

Background And Purpose: MRI Visible Perivascular Spaces (PVS) are considered markers of cerebral small vessel disease (CSVD) and may reflect dysfunction of brain perivascular drainage. White matter integrity assessed with Diffusion Tensor Imaging (DTI) provides a sensitive assessment of early brain injury, related vascular risk factors and risk of stroke and dementia. We investigated the relation between PVS and white matter integrity in community-dwelling participants.

Relation of MRI visible perivascular spaces with global and regional brain structural connectivity measures: The Framingham Heart Study (FHS).

MRI visible perivascular spaces (PVS) are associated with cognitive impairment and dementia, which are also associated with disrupted network connectivity. PVS may relate to dementia risk through disruption in brain connectivity. We studied the relation between PVS grade and global and regional structural connectivity in Framingham Heart Study participants free of stroke and dementia.

Impaired kidney function, cerebral small vessel disease and cognitive disorders: the Framingham Heart Study.

Background And Hypothesis: It remains unclear whether the relation of chronic kidney disease (CKD) with cognitive dysfunction is independent of blood pressure (BP). We evaluated kidney function in relation to premorbid BP measurements, cerebral small vessel disease (CSVD), and incident mild cognitive impairment (MCI) and dementia in Framingham Offspring Cohort participants.

Methods: We included Framingham Offspring participants free of dementia, attending an examination during midlife (exam cycle 6, baseline) for ascertainment of kidney function status, with brain magnetic resonance imaging late in life (exam cycles 7-9), cognitive outcome data, and available interim hypertension and BP assessments.

Hypertension Trends and White Matter Brain Injury in the Offspring Framingham Heart Study Cohort.

Background: Hypertension is the most potent stroke risk factor and is also related to cerebral small vessel disease. We studied the relation between mid-to-late-life hypertension trends and cerebral white matter injury in community-dwelling individuals from the FHS (Framingham Heart Study).

Methods: FHS Offspring cohort participants with available mid-life and late-life blood pressure measurements and brain magnetic resonance imaging were included.

Relation of MRI-Visible Perivascular Spaces and Other MRI Markers of Cerebral Small Vessel Disease.

Perivascular spaces (PVS) visible on brain MRI signal cerebral small vessel disease (CSVD). The coexistence of PVS with other CSVD manifestations likely increases the risk of adverse neurological outcomes. We related PVS to other CSVD manifestations and brain volumes that are markers of vascular brain injury and neurodegeneration.

MRI Visible Perivascular Spaces and the Risk of Incident Mild Cognitive Impairment in a Community Sample.

Background: Magnetic resonance imaging (MRI) visible perivascular spaces (PVS) are associated with the risk of incident dementia but their association with the early stages of cognitive impairment remains equivocal.

Objective: We examined the association between MRI visible PVS and the risk of incident mild cognitive impairment (MCI) in the community-based Framingham Heart Study (FHS).

Methods: FHS participants aged at least 50 years free of stroke, cognitive impairment, and dementia at the time of MRI were included.

Association of MRI Visible Perivascular Spaces and Neurofilament Light Chain: The Framingham Heart Study.

Background: Neurofilament light chain (NfL) is a marker of neuronal injury. Perivascular spaces (PVS) visible on magnetic resonance imaging (MRI) represent cerebral small vessel disease (CSVD) but their role as markers of neuronal injury needs further clarification.

Objective: To relate PVS burden according to brain topography and plasma NfL.

Inflammatory biomarkers and MRI visible perivascular spaces: The Framingham Heart Study.

We studied the association between inflammatory biomarkers and magnetic resonance imaging (MRI) visible perivascular spaces (PVS) in Framingham Heart Study participants free of stroke and dementia. PVS in the basal ganglia (BG) and centrum semiovale (CSO) were rated with validated methods and categorized based on counts. A mixed score of high PVS burden in neither, one or both regions was also evaluated.

Yoga Versus Education for Veterans with Chronic Low Back Pain: a Randomized Controlled Trial.

Background: Yoga is effective for chronic low back pain (cLBP) in civilians but understudied among Veterans.

Objective: Determine whether yoga is more effective than an educational book for improving disability and pain among Veterans with cLBP.

Design, Setting, And Participants: Veterans diagnosed with cLBP at a VA medical center enrolled in a randomized controlled trial from March to December of 2015.

Lighter sleep is associated with higher enlarged perivascular spaces burden in middle-aged and elderly individuals.

Background: While healthy sleep is suggested to promote glymphatic clearance in the brain, poorer sleep may be associated with higher enlarged perivascular spaces (ePVS) burden, potentially representing impaired perivascular drainage. This study aims to evaluate the association between ePVS burden and polysomnographic sleep characteristics in a large community-based sample.

Methods: 552 dementia and stroke-free Framingham Heart Study participants (age: 58.

A Thoracic Surgery-Specific Risk Assessment Model to Prevent Perioperative Venous Thromboembolism.

Background: The risk of venous thromboembolism (VTE) in patients undergoing resection in the setting of lung cancer represents a major challenge to improving postoperative outcomes. The Caprini risk assessment model has been validated in general surgery to determine a role for extended chemoprophylaxis to reduce VTE events. Our goal was to simplify this burdensome model for the unique needs of this thoracic surgical population to better guide anticoagulation decision-making.

MRI-Visible Perivascular Spaces and Risk of Incident Dementia: The Framingham Heart Study.

Background And Objectives: Perivascular spaces (PVS) visible on MRI scans may represent key aspects in the pathophysiology of stroke and dementia, including cerebral small vessel disease and glymphatic dysfunction. This study aimed to determine the association between MRI-visible PVS burden and the risk of incident dementia.

Methods: This study included community-dwelling Framingham Heart Study Original and Offspring cohort participants with available brain MRI-PVS ratings, free of stroke and dementia.

Older adults' perspectives on primary care telemedicine during the COVID-19 pandemic.

Background: Prior to the COVID-19 pandemic there were many barriers to telemedicine primary care for adults ≥65 years including insurance coverage restrictions and having lower digital access and literacy. With the pandemic, insurance coverage broadened and many older adults utilized telemedicine creating an opportunity to learn from their experiences to inform future policy.

Methods: Between April 2020 and June 2021, we conducted a cross-sectional multimethod study of English-speaking, cognitively-intact, adults ≥65, who had a phone-only and/or video telemedicine visit with their primary care physician within one large Massachusetts health system (10 different practices) since March 2020.

Association of Apolipoprotein E ɛ4 Allele with Enlarged Perivascular Spaces.

Objective: Enlarged perivascular spaces have emerged as markers of cerebral small vessel disease and are linked to perivascular drainage dysfunction. The apolipoprotein E-ɛ4 (APOE-ɛ4) allele is the strongest genetic risk factor for cerebral amyloid angiopathy and Alzheimer's neuropathology, but the underlying mechanisms remain unclear. We studied the relationship between APOE-ɛ4 and the topography and burden of enlarged perivascular spaces to elucidate underlying mechanisms between APOE-ɛ4 and adverse clinical outcomes.

Strategies for discussing long-term prognosis when deciding on cancer screening for adults over age 75.

Background: Consideration of older adults' 10-year prognosis is necessary for high-quality cancer screening decisions. However, few primary care providers (PCPs) discuss long-term (10-year) prognosis with older adults.

Methods: To learn PCPs' and older adults' perspectives on and to develop strategies for discussing long-term prognosis in the context of cancer screening decisions, we conducted qualitative individual interviews with adults 76-89 and focus groups or individual interviews with PCPs.

Primary Care Providers' Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older.

Clinicians need to find decision aids (DAs) useful for their successful implementation. Therefore, we aimed to conduct an exploratory study to learn primary care clinicians' (PCPs) perspectives on a mammography DA for women ≥75 to inform its implementation. We sent a cross-sectional survey to 135 PCPs whose patients had participated in a randomized trial of the DA.

Variation in Breast Cancer Risk Model Estimates Among Women in Their 40s Seen in Primary Care.

The Gail, Breast Cancer Surveillance Consortium (BCSC), and Tyrer-Cuzick breast cancer risk prediction models are recommended for use in primary care. Calculating breast cancer risk is particularly important for women in their 40s when deciding on mammography, with some guidelines recommending screening for those with 5-year risk similar to women age 50 (≥1.1%).

Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older.

Background: To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75 years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment.

Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD.

Mind-body modalities are promising strategies to maintain the benefits gained after completion of conventional pulmonary rehabilitation in persons with COPD. In this pilot randomised controlled study we examined Tai Chi in persons with COPD after completing pulmonary rehabilitation. Participants were randomised 2:2:1 to Tai Chi (TC), usual care (UC) or group walking (GW) for 24 weeks.

Exploring Tai Chi Exercise and Mind-Body Breathing in Patients with COPD in a Randomized Controlled Feasibility Trial.

In this pilot feasibility randomized controlled trial, participants with moderate to severe COPD were randomized to a 12-week tai chi or MBB intervention. Participants were assessed at baseline, 12 weeks, and 24 weeks. Feasibility, as assessed by intervention adherence, was the primary outcome.