Richard N Jones

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Verified

Richard verified their affiliation via an institutional email.

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• ScD
• Professor at Brown University

Nearly 7 million Americans are living with Alzheimer's disease or a related dementia (ADRD). Timely detection, quality of care, and access to services for people with ADRD remain poor. Broad acceptance and implementation of quality standards may help improve care processes, outcomes, and inequities in ADRD care. We review existing quality measures...

Importance The 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act aimed to improve postacute care quality and outcomes. This study examines changes in delirium, a key quality indicator, over 5 years following its implementation. Objective To compare the persistence and resolution of delirium within skilled nursing facilities (SNFs...

INTRODUCTION Alzheimer's disease (AD) diagnosis centers on cognitive impairment despite other early indicators like neuropsychiatric symptoms (NPSs) and amyloid beta (Aβ) accumulation. This study examined how cognition, NPS, and Aβ changes are interrelated over time in individuals without dementia. METHODS Participants were 1247 individuals from t...

Objective Information on the time spent completing cognitive testing is often collected, but such data are not typically considered when quantifying cognition in large-scale community-based surveys. We sought to evaluate the added value of timing data over and above traditional cognitive scores for the measurement of cognition in older adults. Met...

Background “SuperAgers” (SA) are older adults who perform significantly better than their peers and comparable to young adults on objective memory measures. Longitudinal studies show that many do not maintain their SA status over time. The fluctuation in SA stability may reflect changes in executive functioning, hypothesized to contribute to varian...

The use of speeded tests to assess cognition supports the notion that response times on cognitive tests contain meaningful information about cognitive functioning. Although information on the time spent completing cognitive tests is often collected during survey administration, this data is not typically considered when quantifying cognitive functi...

Comparing dementia prevalence across countries and contexts is crucial for effective public health planning. The Harmonized Cognitive Assessment Protocol Project (HCAP) is a global effort to characterize dementia risk using population-representative samples. Using the HCAP studies from the US, England, and India, we evaluated variations of a classi...

Objectives We examined differential item functioning (DIF) of the Center for Epidemiologic Studies Depression Scale (CES-D) items by country and statistically harmonized common cross-national factor scores for the CES-D to aid further cross-national research. Study Design and Setting Data were from Harmonized Cognitive Assessment Protocol (HCAP) st...

Background Although the pathogenesis of delirium is poorly understood, increasing evidence supports a role for inflammation. Previously, individual inflammatory biomarkers have been associated with delirium. Aggregating biomarkers into an index may provide more information than individual biomarkers in predicting certain health outcomes (e.g., mort...

Objectives To summarize the delirium treatment trial literature, identify the unique challenges in delirium treatment trials, and formulate recommendations to address each in older adults. Design A 39-member interprofessional and international expert working group of clinicians (physicians, nurses, and pharmacists) and nonclinicians (biostatistici...

Background Events such as global pandemics can force rapid adoption of new modes of assessment. We describe the evaluation of a modified neuropsychological assessment for web and telephone administration. Methods Telephone and video conferencing‐based neuropsychological assessment procedures were developed and implemented within an ongoing observa...

Delirium occurs frequently in patients with stroke, but the role of preexisting neural substrates in delirium pathogenesis remains unclear. We sought to explore associations between acute and chronic neural substrates of delirium in patients with intracerebral hemorrhage (ICH). Using data from a single-center ICH registry, we identified consecutive...

BACKGROUND Suicide in local jails occurs at a higher rate than in the general population, making it a priority to improve risk screening methods. This article describes a research study that will use administrative data and machine learning modeling to improve suicide risk detection at jail booking. OBJECTIVE This research study is primarily focus...

Objectives Neurocritically ill patients are at high risk for developing delirium, which can worsen the long-term outcomes of this vulnerable population. However, existing delirium assessment tools do not account for neurologic deficits that often interfere with conventional testing and are therefore unreliable in neurocritically ill patients. We ai...

Objective The psychometric rigor of unsupervised, smartphone-based assessments and factors that impact remote protocol engagement is critical to evaluate prior to the use of such methods in clinical contexts. We evaluated the validity of a high-frequency, smartphone-based cognitive assessment protocol, including examining convergence and divergence...

Objectives Mutations in the X-linked endosomal Na+/H+ exchanger 6 (NHE6) cause Christianson syndrome (CS). Here, in the largest study to date, we examine genetic diversity and clinical progression in CS into adulthood. Method Data were collected as part of the International Christianson Syndrome and NHE6 ( SLC9A6 ) Gene Network Study. 44 individua...

Objective Lifestyle intervention can produce clinically significant weight loss and reduced disease risk/severity for many individuals with overweight/obesity. Dietary lapses, instances of non-adherence to the recommended dietary goal(s) in lifestyle intervention, are associated with less weight loss and higher energy intake. There are distinct “ty...

INTRODUCTION The Health and Retirement Study International Partner Surveys (HRS IPS) have rich longitudinal data, but the brevity of cognitive batteries is a limitation. METHODS We used data from a substudy of the English Longitudinal Study of Ageing (ELSA) administering detailed cognitive assessments with the Harmonized Cognitive Assessment Proto...

Background A range of strategies are available that can improve the outcomes of older persons particularly in relation to basic activities of daily living during and after an acute care (AC) episode. This paper outlines the original development of outcome-oriented quality indicators (QIs) in relation to common geriatric syndromes and function for t...

Background Cognition is a core component of functional seizures, but the literature on cognition in this disorder has been heterogeneous, with no clear unifying profile emerging from individual studies. The aim of this study was to do a systematic review and meta-analysis of cognitive performance in adults with functional seizures compared with ep...

This study examined educational and occupational inequality as two aspects of social determinants of health that might mediate the longitudinal relationship between racialization and late life cognitive level and change. Participants were 2371 individuals racialized as Black and White from the ACTIVE study who provided occupational data. Data were...

Importance Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that is particularly difficult to treat in military veterans. Noninvasive brain stimulation has significant potential as a novel treatment to reduce PTSD symptoms. Objective To test whether active transcranial direct current stimulation (tDCS) plus virtual reality (VR...

The Harmonized Cognitive Assessment Protocol (HCAP) is a major innovation that provides, for the first time, harmonized data for cross‐national comparisons of later‐life cognitive functions that are sensitive to linguistic, cultural, and educational differences across countries. However, cognitive function does not lend itself to direct comparison...

Objective: Bystander intervention (BI) is a promising approach for promoting collective behavior change that has been applied to several domains, including sexual assault, bullying, and more recently problematic alcohol use. Accurately measuring the strategies that bystanders use to reduce others' alcohol-related risk is an essential step towards...

Objectives Determine if biomarkers of Alzheimer's disease and neural injury may play a role in the prediction of delirium risk. Methods In a cohort of older adults who underwent elective surgery, delirium case‐no delirium control pairs ( N = 70, or 35 matched pairs) were matched by age, sex and vascular comorbidities. Biomarkers from CSF and plasm...

INTRODUCTION We conducted a cross‐national comparison of the association between main lifetime occupational skills and later‐life cognitive function across four economically and socially distinct countries. METHODS Data were from population‐based studies of aging and their Harmonized Cognitive Assessment Protocols (HCAPs) in the US, South Africa,...

Objective: Excessive alcohol use is very prevalent among young adults, and consequences of drinking are often observed by witnesses. Understanding the circumstances under which witnesses of risky alcohol use help others, and whether they perceive these circumstances as an opportunity to engage in bystander intervention are important, but valid mea...

Background Assessment of self‐perceived cognitive decline (SCD) is relevant in the context of Alzheimer’s disease and related disorders, but heterogeneity in measurement limits its interpretability and usability. Selection of optimal content for a questionnaire measuring SCD requires statistical information and expert opinion to ensure reliability...

Background Existing cognitive screening measures fall short in capturing preclinical AD, and cognitive impairment is unrecognized or misdiagnosed in 27‐81% of older adult primary care patients. Digital assessment technology has the potential to deliver more efficient and sensitive cognitive screening, but requires rigorous validation first. We aime...

Background Existing cognitive screening measures fall short in capturing preclinical AD, and cognitive impairment is unrecognized or misdiagnosed in 27‐81% of older adult primary care patients. Digital assessment technology has the potential to deliver more efficient and sensitive cognitive screening, but requires rigorous validation first. We aime...

Repeated measure data design has been used extensively in a wide range of fields, such as brain aging or developmental psychology, to answer important research questions exploring relationships between trajectory of change and external variables. In many cases, such data may be collected from multiple study cohorts and harmonized, with the intentio...

INTRODUCTION We evaluated the accuracy of remote and in‐person digital tests to distinguish between older adults with and without AD pathological change and used the Montreal Cognitive Assessment (MoCA) as a comparison test. METHODS Participants were 69 cognitively normal older adults with known beta‐amyloid (Aβ) PET status. Participants completed...

Purpose A majority of individuals living in the United States do not meet recommended physical activity guidelines, despite the numerous physical and mental health benefits. Previous research suggests there are numerous barriers to performing physical activity, but there is less research on how these barriers cluster together; particularly in non-c...

Background Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide preven...

Mutations in the X-linked endosomal Na+/H+ Exchanger 6 (NHE6) causes Christianson Syndrome (CS). In the largest study to date, we examine genetic diversity and clinical progression, including cerebellar degeneration, in CS into adulthood. Data were collected as part of the International Christianson Syndrome and NHE6 (SLC9A6) Gene Network Study. Fo...

Background Examining the associations of social determinants of health (SDOH) with postoperative delirium in older adults will broaden our understanding of this potentially devastating condition. We explored the association between SDOH factors and incident postoperative delirium. Methods A retrospective study of a prospective cohort of patients e...

Background Suicide and suicidal behavior during adolescence have been steadily increasing over the past two decades. The preponderance of interventions focuses on crisis intervention, underlying psychiatric disorders, regulating negative affect, and reducing cognitive distortions. However, low positive affectivity may be a mechanism that contribute...

Background The Successful Aging after Elective Surgery (SAGES) II Study was designed to examine the relationship between delirium and Alzheimer's disease and related dementias (AD/ADRD), by capturing novel fluid biomarkers, neuroimaging markers, and neurophysiological measurements. The goal of this paper is to provide the first complete description...

Objective To assess domains of social determinants of health (SDoH) and their associations with cognition and quality of life. Method This investigation uses baseline data from individuals participating in the ACTIVE trial (n = 2505) to reproduce the SDoH domains described in Healthy People 2030 (economic stability, health care, education, neighbo...

Background The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonise general and domain-specific cognitive scores from HCAP studies across six countries, and evaluate reliability and...

Objectives: This article sought to determine (1) whether occupational complexity (OC) explains individual differences in cognition at baseline, (2) whether this relationship is differentially related to cognition by Black/White race, and (3) whether OC mediates some or all of the Black/White race-related variance in late life cognition. Methods: 23...

INTRODUCTION We used cultural neuropsychology‐informed procedures to derive and validate harmonized scores representing memory and language across population‐based studies in the United States and Mexico. METHODS Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS‐HCAP) and the Mexican Health and Aging Stud...

Background. Recent jail detention is a marker for trait and state suicide risk in community-based populations. However, healthcare providers are typically unaware that their client was in jail and few post-release suicide prevention efforts exist. This protocol paper describes an effectiveness-implementation trial evaluating community suicide preve...

Background: Antipsychotics are commonly used to manage postoperative delirium. Recent studies reported that haloperidol use has declined, and atypical antipsychotic use has increased over time. Objective: To compare the risk for in-hospital adverse events associated with oral haloperidol, olanzapine, quetiapine, and risperidone in older patients...

Objective: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS). Method: The HCAP battery was compiled from existing measure...

Approximately 30% of autistic children are considered minimally verbal. The field lacks an efficient and reliable measure of communicative capacity among minimally verbal autistic children. Improved methods are needed to determine which children are at greatest risk for minimally verbal outcomes to better target interventions. Here, we present the...

Introduction: Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to e...

Background Identifying factors that confer resilience to developing delirium is critical given the negative impact of delirium on clinical care and risk for mortality. Here, we investigated a cohort of cognitively normal older adults undergoing elective surgery and examined the role of pre‐operative memory function and cortical thickness in the inc...

Background: The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criteri...

Objective Delirium is associated with worse outcomes in patients with stroke and neurocritical illness, but delirium detection in these patients can be challenging with existing screening tools. To address this gap, we aimed to develop and evaluate machine learning models that detect episodes of post-stroke delirium based on data from wearable acti...

Objective: To demonstrate measurement precision of cognitive domains in the Alzheimer's Disease Neuroimaging Initiative (ADNI) data set. Method: Participants with normal cognition (NC), mild cognitive impairment (MCI), and Alzheimer's disease (AD) were included from all ADNI waves. We used data from each person's last study visit to calibrate sc...

Objective: Self-perceived cognitive functioning, considered highly relevant in the context of aging and dementia, is assessed in numerous ways-hindering the comparison of findings across studies and settings. Therefore, the present study aimed to link item-level self-report questionnaire data from international aging studies. Method: We harmoniz...

Introduction Although a majority of the American public prefer to die at home, a large percentage of Parkinson’s disease patients die in acute care hospitals. We examine trends in the clinical and demographic characteristics of Parkinson’s disease patients who die in a hospital to identify populations potentially vulnerable to unwanted inpatient mo...

Motor skill learning has been linked to functional and structural changes in the brain. Musicians and athletes undergo intensive motor training through the practice of an instrument or sport and have demonstrated use-dependent plasticity that may be subserved by long-term potentiation (LTP) processes. We know less, however, about whether the brains...

Importance: The study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia. Objective: To examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delir...

Background Older surgical patients have an increased risk for postoperative complications, driving up healthcare costs. We determined if postoperative co-management of older surgery patients is associated with postoperative outcomes and hospital costs. Methods Retrospective data were collected for patients ≥70 years old undergoing colorectal surge...

Telephone-administered cognitive assessments are a cost-effective, feasible, and sometimes necessary alternative to in-person assessments. However, there is a scarcity of information in large cohort studies concerning mode effects, or differences in cognitive performance attributable to assessment method instead of underlying cognition, as a potent...

Nationally representative data are critical for understanding the causes, costs and consequences of dementia and MCI in the US and can better inform policies aimed at reducing their impact on patients, families, and public programs. Because research on dementia is often based on highly selected samples of older adults who are disproportionately Whi...

Introduction: One-year health-care costs associated with delirium in older hospitalized patients with and without Alzheimer's disease and related dementias (ADRD) have not been examined previously. Methods: Medicare costs were determined prospectively at discharge, and at 30, 90, and 365 days in a cohort (n = 311) of older adults after hospital...

Importance Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study...

Background: Delirium occurs frequently in patients with stroke and neurocritical illness but is often underrecognized. We developed a novel delirium screening tool designed specifically for neurocritical care patients called the fluctuating mental status evaluation (FMSE) and aimed to test its usability and accuracy in a representative cohort of p...

Background: The Successful Aging after Elective Surgery (SAGES) II study was designed to increase knowledge of the pathophysiology and linkages between delirium and dementia. We examine novel biomarkers potentially associated with delirium, including inflammation, Alzheimer's disease (AD) pathology and neurodegeneration, neuroimaging markers, and...

Objectives: Cognitive abilities have been implicated as predictors of mortality in older adults. This study examines the effects of cognitive training on mortality 20 years post-intervention. Methods: Data come from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized control trial (N = 2802). Participants were cogn...

Evidence-based treatment for Latinx/Hispanic (L/H) with suicidal behaviors (SB) is scarce. This study evaluated the acceptability and preliminary efficacy of a socio-cognitive-behavioral therapy protocol for SB (SCBT-SB) with L/H adolescents and the feasibility of conducting a randomized controlled trial (RCT) of SCBT-SB compared to treatment-as-us...

Objectives: Telephone-administered cognitive assessments are a cost-effective and sometimes necessary alternative to face-to-face assessments. There is limited information in large studies concerning mode effects, or differences in cognition attributable to assessment method, as a potential measurement threat. We evaluated mode effects on cognitiv...

Objectives Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. Methods An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Bos...

Due to cost and participant burden, neuroimaging studies are often performed in relatively small samples of voluntary participants. This may lead to selection bias. It is important to identify factors associated with participation in neuroimaging studies and understand their effect on outcome measures. We investigated the effect of postoperative de...

Objective We explored the associations of dual sensory impairment (DSI) with long-term depressive and anxiety symptoms as well as low perceived social support (LPSS) as a modifier of these associations. Methods Multinomial logistic regression models were used to examine the associations of DSI and single sensory impairment (hearing [pure-tone aver...

Introduction: The large number of heterogeneous instruments in active use for identification of delirium prevents direct comparison of studies and the ability to combine results. In a recent systematic review we performed, we recommended four commonly used and well-validated instruments and subsequently harmonized them using advanced psychometric...

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homewor...

Objective: To describe a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States (U.S.) and Mexico with the Harmonized Cognitive Assessment Protocol (HCAP). Method: We performed a comprehensive review of the administration, scoring, and coding procedures for each cognitive test item administer...

Background: The neuroinflammatory response to surgery can be characterized by peripheral acute plasma protein changes in blood, but corresponding, persisting alterations in cerebrospinal fluid (CSF) proteins remain mostly unknown. Using the SOMAscan assay, we define acute and longer-term proteome changes associated with surgery in plasma and CSF....

Introduction: The early detection of cognitive impairment is one of the most important challenges in Alzheimer's disease (AD) research. The use of brief, short-term repeated test sessions via mobile app has demonstrated similar or better reliability and validity compared to standard in-clinic assessments in adult samples. The present study examine...

Importance: The ability to rate delirium severity is key to providing optimal care for older adults, and such ratings would allow clinicians to target patients with severe delirium and monitor response to treatment, recovery time, and prognosis; assess nursing burden and staffing needs; and, ultimately, provide more appropriate patient-centered ca...

Background: There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally. Methods: Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with i...

Background As global populations age, cross-national comparisons of cognitive health and dementia risk are increasingly valuable. It remains unclear, however, whether country-level differences in cognitive function are attributable to population differences or bias due to incommensurate measurement. To demonstrate an effective method for cross-nati...

Background: Delirium occurs frequently in patients with stroke but is often underrecognized. We aimed to develop a novel delirium screening tool designed specifically for stroke patients, and to test its feasibility and accuracy in a pilot study. Methods: We designed an easy-to-use 5-point instrument called the Fluctuating Mental Status Evaluation...

Background: Delirium is an acute cognitive disturbance frequently characterized by abnormal levels of motor activity and sleep-wake cycle disruption. However, the degree to which delirium affects activity patterns in the acute period after stroke is unclear. We aimed to examine these patterns in a cohort of patients with intracerebral hemorrhage (I...

Background: The ability to rate delirium severity is key to providing optimal care for persons with Alzheimer's Disease and Related Dementias (ADRD). Such ratings would allow clinicians to assess response to treatment, recovery time and prognosis, nursing burden and staffing needs, and to provide nuanced, appropriate patient-centered care. Given t...

Hearing (HI) and vision impairment (VI) are each independently associated with long-term depressive and anxiety symptoms, but the joint effects of both (DSI) may be associated with a greater risk of belonging to long-term chronically high depressive and anxiety trajectory classes. Multinomial logistic regression models adjusted by demographics and...

Hearing and vision impairment are each independently associated with incident mobility disability and disability in activities of daily living (ADL). Whether dual sensory impairment (DSI) in both hearing (pure-tone average >25 dB) and vision (impaired visual acuity and/or impaired contrast sensitivity) is associated with greater risk of incident mo...

Modern psychometric methods allow for cocalibration of cognition across cross-national surveys, given the presence of common tests across studies. For narrow cognitive domains, there may not be common tests due to cultural and linguistic differences in testing. We developed a novel method to facilitate cocalibration that entails (1) identifying a c...

Some caregivers of persons with Alzheimer’s Disease and related dementias (ADRD) are known to be under high levels of burden, which is associated with higher levels of anxiety, depression, and stress. Previous research has established anxiety, depression, and stress are associated with binge drinking, but little research has examined binge drinking...

Advanced parental age at offspring birth has been associated with autism spectrum disorder (ASD). The objective of the current study was to investigate associations between parental age at birth and autism severity. The Rhode Island Consortium for Autism Research and Treatment (RI-CART) study represents a community-based sample with a range of auti...

Background Delirium is common in older adults and is a risk factor for long‐term cognitive decline. Efforts to conceptualize risk factors for delirium have focused on the time period proximate to the episode, and the role of early‐life exposures on delirium risk is poorly understood. Social and historical factors interact with psychological and bio...

Background For the item analysis project of the Subjective Cognitive Decline Initiative (SCD‐I) Working Group, we have pooled item level data from North American, European, and Australian cognitive aging studies. As a step toward developing a questionnaire that can be used across settings and studies, we examined similarly worded groups of items an...

Background Not everyone with mild cognitive impairment (MCI) progresses to Alzheimer’s dementia (AD). Predicting who will decline is important. We previously reported that 6‐months change scores for language, but not for memory, executive functioning, or visuospatial functions, identified a high‐risk subgroup. Here we consider more specific languag...

Background Subjective Cognitive Decline (SCD) in the absence of objective cognitive impairment has been linked to progression to Alzheimer’s Disease and Related Disorders dementia. Demographic characteristics might bias the measurement of SCD, but it remains unclear how these characteristics relate to SCD. As part of the international SCD‐I item an...

Harmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological instruments vary in many respects, including language, administration techniques and cultural differences,...