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Poster Session Imonday, December 7, 2015 Neuropsychopharmacology (2015) 40, S106–S271 & 2015 American College of Neuropsychopharmacology. All rights reserved 0893-133X/15 www.neuropsychopharmacology.org Poster Session I from the Forest Research Institute/ Actavis; NIH/ NCCIH; Monday, December 7, 2015 NIMH M2. Mental Healthcare Access and the Underserved: Are M1. Changes in the Functional Brain Connectivity and Our State-of-the-Art Treatments Getting to those who Verbal Memory Performance Following Yoga or Need It Most? Memory Training in Older Adults with Subjective Memory Complaints Daniel Jimenez*, Benjamin Cook, Margarita Alegria, Stephen Bartels, Charles Reynolds, Philip Harvey Helen Lavretsky*, Hongyu Yang, Harris Eyre, Amber Leaver, Katherine Narr, Dharma Khalsa University of Miami Miller School of Medicine, Miami, Florida, United States University of California Los Angeles Semel Institute for Neuroscience & Human Behavior, Los Angeles, Background: Disparities in mental health service use by racial/ California, United States ethnic minority older adults are well-documented. Attention is now turning to the question of whether racial/ethnic Background: Mind-body interventions, such as yoga, are disparities in mental healthcare are increasing or diminishing. used to reduce stress in the community samples. However, The net effect of changes in healthcare organization and clinical efficacy of such interventions for cognition remains immigration, along with any explicit policies designed to unclear. To-date, no studies have explored the effect of yoga reduce disparities, is not clear. The purpose of this study is to on cognition and resting state functional Magnetic Reso- examine national trends in the use of mental health services by nance Imaging (rs-fMRI). The present study was to explore older racial/ethnic minority adults. Specifically, we measured neural effects of yoga vs memory training in older adults trends in mental healthcare disparities to determine whether with subjective memory complaints. racial/ethnic disparities have increased, decreased, or Methods: Older participants (ageZ55 years) with subjective remained constant over time. memory complaints were randomized to receive yoga Methods: Four, two-year longitudinal datasets from Panels intervention or active ‘‘gold-standard’’ control (memory 9-14 (2004-2012) of the Medical Expenditure Panel Surveys enhancement training (MET)) for 12 weeks. rs-fMRI was were combined to estimate trends in racial/ethnic dispa- used to map correlations between brain network and rities in mental healthcare among older adults (aged 65 þ ) memory performance changes over time. Default mode with probable mental health need. The sample included network (DMN), language and superior parietal networks 33,469 older adults, aged 65 þ (21,566 non-Latino Whites, were chosen as networks of interest to analyze the 5,526 Blacks; 4,447 Latinos; and 1,930 Asians). Mental association with changes in verbal and visuospatial memory health service utilization was defined as engaging in performance (recall after 30 min. delay). outpatient care or filling a prescription medication. Out- Results: Fourteen yoga and 11 MET participants completed patient care included primary care provider (PCP) or the study. Both groups demonstrated improved memory specialist mental health care (services received from a performance with no group differences. We observed no psychiatrist, psychologist, counselor, or social worker). group differences in the functional connectivity over the Outpatient care was considered to be a mental health care course of the study. Increased DMN connectivity correlated visit if the treatment was recorded for a disorder covered by with improved verbal memory in the frontal medial cortex, ICD-9 codes related to mood, anxiety, psychosis, substance pregenual anterior cingulate cortex, right middle frontal use, personality, behavioral and developmental disorders. cortex, posterior cingulate cortex, and left lateral occipital Similarly, psychotropic medications were defined as any cortex. Increased connectivity in the language processing prescription drug claim with any of the above ICD-9 codes network also positively correlated with verbal memory attached to it. Psychotropic drug fill is a prescribed performance in the left inferior frontal gyrus. However, medicine refill without a mental health care visit or changes in superior parietal network negatively correlated outpatient or office-based visits to assess the progress of with visuospatial memory improvements in medial parietal the medications. cortex. Results: Racial/ethnic disparities in any use of mental Conclusions: Our pilot study suggests that yoga can be as healthcare persisted from 2004-2012. Black-White and effective as MET in improving verbal memory performance Asian-White disparities remained constant. Latino-White in association with increased DMN connectivity. These pilot disparities increased over time. A similar pattern was found findings highlight the potential clinical use of yoga for when type of services was analyzed. Black-White and Asian- subjective cognitive complaints that should be confirmed in White disparities in use of outpatient services and larger studies. prescription drugs remained constant while Latino-White Keywords: Non-Pharmacological Therapy, fMRI, cognitive disparities in the use of these services increased. aging, brain connectivity, yoga Conclusions: The mental healthcare system continues to Disclosures: Funded by the Alzheimer’s Research and provide less care to racial/ethnic minority older adults than Prevention Foundation. Other sources of funding: grant to older Whites, suggesting the need for policy initiatives to ACNP 54th Annual Meeting Abstracts S107 improve services for these racial/ethnic minority groups. 6-Trial Bushke Selective Reminding Test (Bushke) and Face- Alternative, non-traditional treatments as well as new delivery Name Associative Memory (FN), were conducted post-scan. approaches are two ways to address this persistent problem. Results: Chronological age did not vary appreciably between For example, health promotion interventions bring mental groups (F ¼ 1.29, p4.25). However, LC-mass spectrometry and physical health benefits to older adults. Moreover, they and immunoassay results confirmed that serum estradiol are non-stigmatizing, culturally relevant and salient. The use (F ¼ 11.5, po0.001) and progesterone (F ¼ 15.9, po.001) of community health workers in the delivery of mental health levels declined while FSH levels rose (F ¼ 35.0, po0.001) over services is an efficient use of scarce resources and can be an the menopausal transition in women. Functional MRI results effective tool to engage older racial/ethnic minority adults revealed robust changes in HIPP BOLD signal as a function of into mental health services. reproductive stage. Postmenopausal women showed an Keywords: disparities, mental health service use, older attenuated HIPP BOLD response during verbal encoding adults compared to premenopausal women (small volume corrected, Disclosures: Nothing to disclose. left HIPP, p ¼ .005; right HIPP, p o.05). Men also exhibited a weaker HIPP response compared to premenopausal women (left, p ¼ .002; right, p ¼ .005), a sex difference that was M3. Depletion of Sex Steroid Hormones in Mid-Life attenuated in postmenopausal women. Neuropsychological Alters Hippocampal Activity during Verbal Memory testing revealed that Buschke and FN were sensitive to Encoding: A Population-Based fMRI Study of Sex reproductive age. Pre- and perimenopausal women out- Differences in Memory Decline performed men on Buschke (Delayed Recall [F (3,164) ¼ 5.89, p ¼ .001] and FN Cued Recall [F (3,162) ¼ 7.87, Emily Jacobs*, Blair Weiss, Dorene Rentz, po.001), a sex difference that was attenuated in postmeno- Sue Whitfield-Gabrieli, Anne Remington, Harlyn Aizley, pausal women. Finally, across all women, higher levels of Anne Klibanski, Jill Goldstein DHEA-S were associated with multiple indicators of better Harvard Medical School, Cambridge, Massachusetts, verbal memory performance (Bushke Delayed Recall, r ¼ .30, United States p ¼ .01, n ¼ 70; 30 Min Recall, r ¼ .29, po.02; and Total Recall, r ¼ .26, po.03). For men, higher testosterone levels Background: Maintaining intact memory function with aging were also associated with better performance (Bushke Multi- is one of the most important public health challenges of our ple Choice, r ¼ .31, po.02). Finally, greater recruitment of left time. We know that intervening early with high risk hippocampus during verbal encoding was related to better FN individuals is critical for the attenuation or prevention of associative memory performance in women (Free Recall, disability, but we have yet to identify early targets for r ¼ .29, p ¼ .034) and multiple indicators of verbal memory in treatment. Memory circuitry contains relatively dense popula- men (including Bushke Total Recall, Delayed Recall and FN tions of sex steroid receptors, with some of the highest Free Recall, all r4.3, p o.05). concentrations in hippocampus (HIPP). Experimental work Conclusions: Our results suggest that the loss of ovarian in animals and imaging studies in humans have established estradiol during menopause and secondary estrogenic support the role of steroid hormones in regulating hippocampal from DHEAS may play a significant role in shaping memory structure and function. Converging evidence indicates that circuitry function and/or memory performance. We observed ovarian decline in women plays a mechanistic role in the HIPP
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