Katherine Carroll Britt

Introduction: Language barriers perpetuate health care disparities, yet traditional data sources overlook inequities in relationship‑based care. This study uses artificial intelligence to examine language‑related disparities in spiritual care, a domain largely documented in unstructured clinical notes. Methods: We analyzed electronic health records of 7,360 deceased adults aged ≥65 years from a tertiary hospital (2010–2023). Natural language processing identified spiritual care documentation, and structured flowsheets captured formal chaplain visits. Logistic regression assessed associations between patient language and spiritual care access and timing. Results: Non‑English speakers had 59% lower odds of receiving formal spiritual care (odds ratio = 0.41, p = .003) and received support nearly 10 months later (median 136 vs. 432 days, p = .020). Among non‑English speakers, non-chaplain providers more often first documented spiritual needs. Discussion: Artificial intelligence–supported analysis of unstructured documentation revealed language‑related disparities missed by structured data, offering a culturally grounded approach to identifying inequities in relationship‑based care.

Background: Older adults living with mild cognitive impairment (MCI) or Alzheimer’s disease and related dementias (AD/ADRD) and their care partners face substantial daily challenges that evolve with disease progression and extend far beyond the clinical setting, including symptom management, care coordination, healthcare navigation, and planning for future care needs. Understanding these challenges is essential for developing innovative solutions to provide ongoing and targeted support. In this study, we explored questions, challenges, and support needs dementia dyads experienced following diagnosis to inform the development of an artificial intelligence (AI)-based chatbot designed to provide ongoing support for dementia dyads. Methods: We recruited 11 community-dwelling dyads comprising persons living with MCI or mild AD/ADRD and their care partners, one additional care partner, and 12 dementia care experts from academic medical centers, clinics, and aging organizations in the U.S. We conducted semi-structured interviews and analyzed them using conventional content analysis. Results: Participants described interconnected questions, challenges, and support needs that evolved while navigating life with MCI or AD/ADRD. Questions centered around day-to-day care management, medical concerns, behavioral symptom management, diagnosis and prognosis, safety, and resources and services. Challenges included care partner overwhelm, limited dementia knowledge, condition-related uncertainty, healthcare system navigation difficulties, financial constraints, and technology-related barriers. Participants identified needs for ongoing education, personalized care planning, resource navigation, logistical support and follow-up, culturally responsive care, and social and emotional support. Conclusions: Dementia dyads experience substantial informational, emotional, and practical support needs in the early stages of MCI and AD/ADRD. Findings suggest that post-diagnostic support should extend beyond information provision alone to provide ongoing, personalized, and practical guidance that helps dyads navigate changing needs, resources, and everyday dementia care. These findings are informing the development of an AI-based chatbot intended to complement existing dementia care by extending access to education, practical guidance, and resource navigation between clinical encounters.

Rural populations in the United States are at heightened risk for Alzheimer's disease and related dementias (AD/ADRD), are diagnosed later, and experience faster decline compared to urban counterparts, which may be attributed to socioeconomic, geographic, and healthcare access barriers. Many AD/ADRD risk factors are modifiable, yet few interventions are tailored to rural contexts. We conducted a scoping review across five databases on interventions that support dementia risk reduction, delay cognitive decline, or improve early detection of cognitive impairment and care. Eighteen studies clustered across three areas: dementia risk reduction ( n = 5), delaying cognitive decline ( n = 5), and early detection of cognitive impairment and cognitive care ( n = 8). Interventions were predominantly community‐based and leveraged telehealth workforces to address rural access barriers; however, few integrated care across the rural dementia continuum or explicitly addressed structural inequities. Promising AD/ADRD interventions have been implemented in rural communities, although additional effectiveness and implementation research is needed before broader scale‐up. Future studies should evaluate scalable, community‐engaged and workforce‐supported interventions that span the rural dementia continuum and address structural barriers to equitable implementation.

This study examined the association between perceived stress and mental/physical health (SF-12) and the moderating role of positive and negative religious coping using data ( n = 5,059) from three cohorts (the Hispanic Community Health Study/Study of Latinos ( n = 585), Nurses’ Health Study II ( n = 3,882), and The Strong Heart Study ( n = 592)) which included Hispanic/Latino, non-Hispanic White, and American Indian individuals in the USA. By incorporating cohorts representing historically underserved racial and ethnic populations, this study contributes to the limited literature examining religious coping styles and stress across diverse groups. We examined the interaction between positive and negative religious coping and stress on mental/physical health, controlling for age, income, marital status, and education. Greater perceived stress was associated with poorer mental health [ β = − 1.04 (− 1.37,− 0.7), p < 0.0001], but not worse physical health. Concerning moderation, positive religious coping attenuated [ β = 0.23 (0.11, 0.35), p < 0.0001] and negative religious coping worsened [ β = − 0.45 (− 0.88,− 0.02), p = 0.0034] the association between perceived stress and mental health in the combined analysis. Of note, patterns varied across cohorts, indicating that the role of religious coping style in shaping stress–health relationships may differ across cultural and religious contexts. Our findings highlight the importance of considering both positive and negative religious coping styles when examining psychosocial stress and mental health outcomes across diverse populations.

INTRODUCTION: Alzheimer’s disease and related dementias (AD/ADRD) arise from cumulative environmental, social, behavioral, and biological influences across the life course. The neural exposome framework conceptualizes how exogenous, behavioral, and endogenous factors interact to shape brain health; however, its application to preclinical AD/ADRD research, particularly in rural populations, remains limited. METHODS: We developed and piloted a community-embedded, decentralized research model to operationalize the neural exposome framework among cognitively unimpaired adults aged 45+ in two rural Midwestern U.S. communities, integrating environmental, social, behavioral, geospatial, and biological measures to evaluate exposure-related neurobiological and cognitive vulnerability. RESULTS: This approach demonstrated high feasibility and acceptability, achieving strong recruitment, retention, data completeness, and multidomain biomarker collection in rural community-based settings DISCUSSION: Pilot findings support the feasibility of neural exposome-informed research in rural U.S. communities and highlight its potential to advance prevention-oriented research on brain health and AD/ADRD.

Introduction. Stable religious participation may have beneficial contributions to cognitive and mental health; however, less is known about how changes in religious participation, such as disengagement or increased engagement in church activities, affect these health outcomes and whether there are differences between racial groups. This study aimed to examine the association between changes in church activity and cognitive, functional, and mental health in older adults, and explore differences by race. Methods. Using data from the University of Pennsylvania Alzheimer’s Disease Research Center Aging Brain Cohort in 2021-2022, we examined associations between self-reported change in church activity with cognitive and functional health (Global Clinical Dementia Score (CDR) and total CDR) and neuropsychiatric symptoms (Neuropsychiatric Inventory) in cognitively normal older adults (n=158). We used multivariable regression analysis, controlling for self-reported age, sex, education, and social interaction, to examine differences between individuals who identified as either Black or White. Results. Controlling for covariates, Black participants who reported substantially more or less church activity in the last year had lower cognition and function (Global CDR, β = 0.19, 95%CI [0.04, 0.34], p<0.05) and Total CDR (β = 0.30, 95% CI [0.01, 0.58], p = 0.042), and more neuropsychiatric symptoms (β = 0.63, 95% CI [0.02, 1.24], p<0.045). No significance was found in White older adults. Black older adults reporting major changes in church activity experienced lower cognitive, functional, and mental health. Conclusion. To explore if church activity changes could be an early sign of cognitive, functional, and mental health decline, longitudinal studies are needed.

Background/Objectives: This systematic review summarizes the evidence regarding potential mechanisms underlying the relationship between spiritual practices and cognitive health in adults. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methods: An extensive search of six electronic databases (i.e., PubMed, PsycINFO, Embase, Sociological Abstracts, ATLA, CINAHL) was conducted using keywords related to spiritual practices, religious activities, and cognitive health from 1 January 2000 to December 2025. The quality of the included studies was assessed using the Mixed Methods Appraisal tool aligned with the study design. Results: A total of 34 studies were selected for final inclusion in this review, and a narrative synthesis is provided. The studies were conducted throughout the world, with most studies conducted in North America and Asia. Short- and medium-term effects of spiritual practices on cognitive health were identified across heterogeneous practices ranging from meditation, tai chi and yoga to general spiritual and religious activities. Across the strongest evidence, 73% of the randomized control trials examined reported better cognitive health among the more spiritually active; neurobiological factors of decreased inflammation and improved immune response helped to explain these effects. A total of 5 studies examined mediators, while 29 studies contained only secondary outcomes for determining potential mechanisms. Informed by findings across psychosocial, behavioral, and neurobiological pathways, a conceptual model was created and needs testing. Conclusions: Possible mechanisms for spiritual effects on cognition may be through mental health and neurobiological factors, although more rigorous and long-term studies are needed.

Religion and spirituality (R/S) may be associated with better cognitive health, yet most published studies have been conducted in primarily White populations without investigating association variations by gender and race. A cross-sectional analysis of 1041 community-dwelling diverse older adults from the Philadelphia Healthy Brain Aging (PHBA) cohort study was conducted using multiple regression analysis. We examined associations between facets of R/S and total cognitive scores and performed stratification analysis separately by gender and race to explore potential gender- and race-specific variations. Higher non-organizational R/S was associated with lower cognitive scores, while greater religious and spiritual coping was associated with higher cognitive scores, controlling for age, education, chronic conditions, race, and financial constraints. Across gender and race variations, non-organizational R/S was associated with lower cognitive scores in women alone, with no variations across race. Higher religious and spiritual coping was associated with higher cognitive scores in both Black and White women, but not men, while higher religious and spiritual healing was associated with lower cognitive scores in Black women only. Associations between religious and spiritual facets and cognitive health differ across gender and race; longitudinal studies are needed.