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Arfeen et al. offered a timely and persuasive argument for taking imperial and colonial histories seriously in the study of medical education. Their article rightly draws attention to the ways in which past power asymmetries continue to shape accreditation standards, professional mobility, and institutional hierarchies. This commentary engages with a particular tension in their work: while the authors are careful to critique homogenising categories like "Global North-Global South," the narrative structure of their case studies sometimes leans toward a different set of binaries, specifically the metropole-colony divide that risks reinforcing the very asymmetries they seek to deconstruct. By incorporating recent historical evidence of local agency and emphasizing collaborative authorship as a methodological necessity, this commentary seeks to further the dialogue on how historical insights can transform medical education.
Functional gastrointestinal disorders (FGIDs) and eating disorders (EDs) frequently coexist with one another. It is not unusual for a patient to present with both diseases because they share many similarities with reference to the deeper psychological factors and the connection between the gastrointestinal tract and the brain. Many studies have shown that while the occurrence of FGID in eating disorder patients is noteworthy, it varies greatly, mostly due to disparate research approaches. This review aims to synthesize 2015-2025 evidence on ED-FGID associations, prevalence patterns, bidirectionality, shared psychological mechanisms, and implications for screening and multidisciplinary management. In line with the PRISMA statement, this systematic review retrieved English-language research published within the period of 2015-2025 using a range of databases for studies related to the relationship between EDs and FGIDs. The quality of the observational studies with eligibility criteria met for data retrieval has been appraised using National Institutes of Health standards. The data has been narratively reported instead of meta-analyzed. The criteria are met in nine studies published between 2016 and 2025. The studies include both the cross-sectional type and the cohort type. The overall quality of the studies leans towards being sound. The trend indicates that the co-occurrence between EDs and FGIDs is prominent, with irritable bowel syndrome being most prevalent. The two-way connection between disordered eating and GI symptoms is apparent. The impact of dietary practices, in addition to the psychological underpinning of both anxiety and depression, makes a compelling argument about the relevance of routinely screening patients with FGIDs about eating disorders. The reviewed article emphasizes a close link between EDs and FGIDs in terms of brain-gut overlap, wherein symptoms and eating habits mutually interact and reinforce each other. These findings underscore the importance of routine screening for eating disorders in individuals presenting with FGIDs to improve early identification and multidisciplinary management.
Health equity and the capacity to build it may be better achieved when the approaches of participatory practice and participant observation are more intentionally implemented together in applied, action research. An exploration of the literature compared results from a title and abstract search for the phrases participatory and participant observation. When searched for together, the number of articles that was retrieved was very low, flagging an issue worth consideration. A comparison of the approaches' historical development, theoretical foundations, and practical applications sheds light on their similarities and differences. Participatory practices lean on teaching community members how to conduct action research; plan and implement projects, and advocate for themselves. Participant observation leans on researchers and evaluators being taught about different communities through processes of immersion and deep reflection. Both have positive and negative connections to health equity, capacity building, empowerment, and engagement. Revisiting these approaches as separate strategies for learning provides an opportunity to adapt and reinvigorate their coordinated and robust use, which could lead to novel approaches to action research and more successful treatment of power-imbalances that thwart health equity. Such a revisitation should include consideration of action projects that conceptualize the approaches side by side, actual versus intended use of coordinated approaches, methods for more leveraging of health infrastructure and healthcare education; and potential new approaches to participant observation. Woven throughout this article are the author's perspectives and examples from 25 years of work on community-based, participatory action, ethnographic, and qualitative research, implementation, and evaluation projects.
Disability poses significant challenges to subjective well-being (SWB), yet many individuals with physical disabilities report unexpectedly high levels of life satisfaction-a phenomenon known as the disability paradox. While quantitative research has identified correlates such as social support and psychological capital, these studies often rely on cross-sectional surveys that capture group trends but fail to illuminate the dynamic, narrative processes through which SWB emerges over the life course, particularly in collectivistic cultures like China where relational and cultural factors may uniquely shape adaptation. This study utilized a mixed-methods approach, employing life tone and life theme analyses within a life story interview framework, supplemented by grounded theory coding procedures. We conducted a qualitative analysis of narratives from 35 Chinese adults with physical disabilities, who also completed psychometric measures of subjective well-being (SWB), social support, and psychological capital. To enhance findings' robustness, we quantitized narrative indicators and performed triangulation by conducting statistical correlation analyses between these narrative metrics and questionnaire scores within the primary sample (N = 35). The results indicate: (1) The factors influencing SWB among individuals with physical disabilities primarily consist of four dimensions: family establishment, life experiences, social support, and self-personality; (2) Although the overall emotional tone among Chinese individuals with physical disabilities leans toward negativity, the overall personality tone exhibits a positive orientation, with the frequency of positive emotional words surpassing negative ones starting from mid-adulthood; (3) Life theme analysis demonstrates that relational themes predominate in the narratives, with interpersonal relationships serving as a central pathway for meaning reconstruction and the generation of subjective well-being; and (4) Significant associations were observed between social support, psychological capital, and the emotional and personality features in the narratives, indicating the joint involvement of internal and external resources in shaping SWB among individuals with physical disabilities. In summary, this study, grounded in a localized narrative perspective across the full life course, elucidates the factors influencing SWB among Chinese individuals with physical disabilities and their cultural specificity, particularly emphasizing the key role of relational factors in fostering resilience and meaning construction within a collectivistic value framework.
This study examines the factors influencing individuals' willingness to pay higher taxes to support long-term care (LTC) services, a pressing issue as aging populations drive rising LTC demand and public spending. We use data from the 2020 and 2022 waves of the OECD's "Risk that Matter" survey, a cross-national survey examining people's perceptions of the social and economic risks they face. We employ generalized linear mixed-effects models configured as logistic regression models, including country-level random intercepts and country-level covariates. We also conduct standard logit regressions for individual countries to analyze local nuances further. The findings reveal that higher income, older age, female gender, left-leaning political orientation, and caregiving responsibilities significantly increase the likelihood of willingness to pay for improved LTC services. At the country level, greater LTC spending as a share of GDP, higher trust in government, and policies offering cash benefits to carers also play a significant role. Overall, the results indicate strong support for additional LTC funding among sizeable demographic groups, especially older respondents and those in higher-income groups. At the same time, political orientation and certain socio-demographic characteristics are associated with differences in support. These findings are relevant for policymakers considering reforms to improve the provision of LTC services.
Recent legislation will substantially reduce Medicaid spending and coverage but also created a temporary Rural Health Transformation Program (RHTP), which may partially offset cuts. The extent to which the RHTP will attenuate rural health care cuts depends both on how the federal government allocates RHTP funds and how states spend the money received. We reviewed RHTP scoring criteria and collected relevant publicly available data for each state. We calculated the number of points likely to be allocated for each measurable scored factor, analyzed funding actually awarded for fiscal year 2026 (FY2026), and evaluated associations with anticipated rural Medicaid funding losses and partisanship. The association between RHTP point allocations and estimated cuts was statistically significant, both overall and when subsetting to the rural facility and population score factors, which include statutorily mandated criteria. However, the measurable state policy- and data-driven factors-which primarily reflect state policy choices-are not significantly associated with expected rural funding cuts. Estimated scores and actual awards for FY2026 favored Republican-leaning states, even after conditioning on anticipated Medicaid cuts or rural population size. Key design choices in RHTP legislation and implementation had important consequences for the distribution of funds.
COVID-19 vaccination hesitancy is antithetical to preventing communicable disease. The study's aim was to determine social ecological factors associated with vaccination acceptance / intent in select developing countries. To examine vaccine acceptance / intent in fifteen developing countries, data was sourced from the Global COVID-19 Trends and Impacts Survey and analyzed with a multi-level, clustered, cross-sectional design. Weighted Generalized Additive Modeling (GAM) with 1,000 stratified cluster bootstraps mitigated intra-cluster correlation and temporal dependencies. Statistically significant linear variables included those age 55 + (OR = 1.204, 95% CI [1.095, 1.324], p < 0.001) and identification as female (OR = 1.538, 95% CI [1.448, 1.630], p < 0.001), which were responsible for increased odds of vaccine acceptance / intent. Percent Fear of Vaccine Side Effects (EDF = 2.50, p < 0.001) demonstrated a nonlinear decline in vaccine acceptance / intent. Time (Month) (EDF = 1.94, p < 0.001) was associated with a concave parabolic trend. Cultural Principal Components (PCs) 1-3, respectively, (EDF = 3.97, p < 0.001). EDF = 4.87, p < 0.001), and (EDF = 4.95, p < 0.001) demonstrated oscillating patterns of vaccine acceptance / intent depending upon cultural score direction and magnitude. All PCs demonstrated lower levels of vaccination acceptance / intent with no definitive cultural leaning. There was, however, a push-pull effect among all three dimensions, demonstrating PCs either drove or suppressed vaccination acceptance / intent. Vaccine decision-making complexities are associated with cultural and individual influences. Such findings could inform future vaccine campaign strategies.
Sitting activities involve trunk leaning, which requires precise coordination of the head, trunk, and pelvis to maintain the center of pressure (COP) within limits of stability. However, how the movement in each segment is associated with COP displacement remains unclear. Twenty-eight healthy volunteers performed seated trunk leaning twice in left, right, forward, and backward directions. COP displacements and angular changes were measured in head, trunk, and pelvic tilt in all directions, and additionally in the hip during forward-backward leaning. Within-session reliability of measured indices was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman analyses, and relationships between segment angle changes and COP displacements were examined using mixed-effects models. ICCs between two trials showed substantial to very high correlations (ICC = 0.84-0.95), and Bland-Altman analyses showed neither fixed nor proportional bias, suggesting sufficient reliability. Pelvic tilt angle changes were significantly associated with COP displacements during left-right and forward-backward leaning (p < 0.001). Head, trunk, and hip angle changes were also significantly associated with COP displacement during forward-backward leaning (all p < 0.01). Pelvic tilt was associated with COP displacement during leaning, regardless of direction, indicating the importance of pelvic shifts in strategies for maintaining sitting balance in healthy adults.
As infants acquire postural control, they learn to keep balance over a progressively smaller base of support. We systematically tested the development of postural control from a floor sit, where infants' thighs and lower legs are supported by the ground, to a bench sit, where infants' lower legs are unsupported. Six- to 9-month-old infants (N = 25) began in a floor sit with their thighs on a stationary platform and lower legs on a platform that was lowered in 2-cm increments until infants were in a bench sit with feet dangling in the air or they lost balance and fell. Each decrease in the height of the bottom platform decreased infants' base of support and made postural control more challenging. Although bench sitting was presumably novel, all infants maintained balance in a bench sit if their feet rested on the ground. However, infants' trunk control predicted their ability to maintain balance with their feet dangling in the air. Infants with more trunk control compensated for decreased support by progressively increasing their trunk-thigh angle (leaning backward rather than forward) and hence keeping their center of mass within their decreasing base of support. Thus, improvements in trunk control provide infants with more efficient postural-control strategies to cope with novel threats to balance. We suggest that flexibility and adaptability are integral to learning to sit and prepare infants for the next challenges in motor development.
Artificial hydration (AH) in terminally ill cancer patients remains ethically and clinically controversial. Although evidence suggests limited benefit near the end of life, AH is frequently administered, particularly in East Asian settings where it may carry symbolic meaning. This study conceptualized physician decision-making as a clinical spectrum and examined demographic, clinical, and ethical factors associated with AH decision orientations. A nationwide cross-sectional survey of palliative care-trained physicians in Taiwan assessed clinical practices and ethical domains (autonomy, beneficence, non-maleficence, justice, cultural, and emotional factors). Scenario-based scores were used to derive continuation, withdrawal, and variability indices. Two-step cluster analysis identified decision-orientation profiles. Group differences were analyzed using ANOVA, chi-square tests, and multinomial logistic regression. Among 377 respondents, four decision-orientation clusters emerged: contextual/proportional, selective continuation, conservative/continuation-leaning balancing, and consistent withdrawal. Several demographic and professional characteristics differed across clusters. Ethical domains also differed significantly. Multinomial regression showed that cultural and emotional factors were associated with contextual/proportional orientation, whereas beneficence independently predicted selective continuation orientation. Hydration volume and consideration of life expectancy differed across clusters, supporting behavioral distinctions among decision orientations. AH decision-making reflects multiple context-sensitive physician orientations shaped by both ethical considerations and professional characteristics, rather than a binary continuation-withdrawal model.
This exploratory study aimed to utilize patient-specific computational fluid dynamics (CFD) simulations to evaluate and compare the hemodynamic effects of different fenestration stent configurations following in situ fenestration thoracic endovascular aortic repair (ISF-TEVAR). Six patient-specific aortic models (pre- and postoperative) were reconstructed from CTA images of three ISF-TEVAR patients with distinct fenestration stent configurations. The hemodynamic parameters of the aortic arch and its main branches (including pressure, flow velocity, flow volume, and vascular wall shear stress (WSS)) were systematically analyzed to evaluate the effects of the stent configuration. Marked increases in pressure drop and WSS were observed in the left subclavian artery (LSA) in cases with higher stent compression. Compared to forward-leaning stent orientation, a near-perpendicular insertion was associated with more pronounced complex and disordered flow patterns around the fenestration site. In this small case series, different fenestration stent configurations significantly influenced local hemodynamics, particularly in the LSA. Minimizing stent compression and, where anatomically feasible, adopting a forward-leaning orientation may help reduce adverse hemodynamic effects. These preliminary findings highlight the potential utility of patient-specific CFD simulation in preoperative planning for ISF-TEVAR, though further studies with larger cohorts are needed to validate these observations.
Whole-body movements in everyday tasks challenge the neuromuscular system. Prior studies have shown that appropriate postural control supports both task success and postural balance during quiet standing or under modest postural demands. However, it remains unclear how the central nervous system controls whole-body posture under high-demand conditions, such as maximal leaning postures. Here, we investigated how varying postural demands influence task performance in whole-body tasks. We used an upper-body reaching task in which participants leaned their upper body mediolaterally to reach a target without falling. Our task required various upper-body positions and accelerations by varying target positions and time constraints to reach a target. Therefore, our task induced participants to different magnitudes of destabilizing torque, which is defined as postural demand. Task performance in response to different target positions and time constraints was evaluated based on reaching accuracy. Target position, time constraint, and movement distance significantly affected reaching accuracy. Specifically, participants could accurately reach targets requiring upright or moderately leaning postures. However, when targets required greater leaning postures, participants failed to reach them. Furthermore, the detrimental effects of shorter time constraints and longer movement distances on reaching accuracy became more pronounced when target positions required greater leaning postures. These findings demonstrate that reaching accuracy was preserved under low to modest postural demands, but deteriorated once postural demands became high.
Language choices in autism-related social media discourse reflect ideological models and shape public understanding. Although neuroaffirmative and identity-first language is increasingly visible, cross-linguistic patterns on social media remain poorly understood. These platforms provide a valuable setting to observe how autistic identity and competing medical and neuroaffirmative frameworks circulate internationally. This observational multilingual study analyzed 678 public posts collected through stratified keyword sampling in English, Spanish, French, Norwegian, and Georgian. Posts were normalized, anonymized, and classified using multilingual lexicons and sentence-embedding-assisted disambiguation. Variables included theoretical frame (medical, neuroaffirmative, both, neutral), linguistic style (identity-first, person-first), sentiment (-5 to +5), and engagement metrics. Descriptive statistics and longitudinal trend analyses were conducted. Medical and neuroaffirmative discourse coexisted across languages. Spanish showed the highest medical framing (45.1%), while English (43.4%) and French (36.4%) favored neuroaffirmative discourse; Norwegian and Georgian leaned neutral. Identity-first language predominated overall, with person-first usage most frequent in Norwegian and minimal in Georgian. Sentiment was largely neutral. Engagement varied by language, with identity-first posts generating the highest interaction in English. Neuroaffirmative discourse increased across all languages after 2023. Autism discourse on X/Twitter reflects a global but uneven shift toward neuroaffirmative and identity-first language shaped by linguistic and cultural context, positioning social media as a key arena for renegotiating autistic identity and expertise.
Substance use and adverse childhood experiences (ACEs) remain major risk factors for health, education, and social relationships, with the effects of ACEs persisting into adulthood. This study aimed to investigate the association between substance use (alcohol, tobacco and tobacco products, and illicit drugs) and ACEs among young adults in higher learning institutions in Mombasa County, Kenya. The analytical cross-sectional study collected data on having ever experienced any form of ACEs and substance use (alcohol, tobacco and tobacco products, and illicit drugs). A total of 849 participants were randomly sampled from 11 higher leaning institutions in the county. Questionnaires collected information on ACEs and substance use, with ACEs scores used to assess association with the three substances. Descriptive statistics were used for exploratory data analysis, while Chi-square tests and logistic regression assessed the relationship between ACEs and the use of the three substances. The overall ACEs prevalence was 88.1% (95%CI: 86.0%-90.3%). Among the three substances, alcohol had the highest prevalence at 45.6% (95%CI: 42.4%-49.1%). Exposure to physical abuse (adjusted odds ratio (aOR) = 1.8 (95% CI: 1.0-3.1), p = 0.044), emotional neglect (aOR = 1.6 (95% CI: 1.2-2.2), p = 0.002), emotional abuse (aOR = 2.0 (95% CI: 1.1-3.5), p = 0.019), sexual abuse (aOR = 2.2 (95% CI: 1.3-3.8), p = 0.003) and parent/guardian alcoholic (aOR = 1.8 (95% CI: 1.3-2.5), p < 0.001) was significantly associated with higher prevalence of alcohol use. Exposure to emotional neglect (aOR = 1.5 (95% CI: 1.0-2.1), p = 0.039) and collective violence (aOR = 2.0 (95% CI: 1.3-3.2), p = 0.001) was significantly associated with higher prevalence of tobacco and tobacco products use. The use of illicit drugs was significantly associated among those who had experienced emotional abuse (aOR = 1.9 (95% CI: 1.1-3.3), p = 0.019) and those who had a household member imprisoned (aOR = 1.6 (95% CI: 1.1-2.3), p = 0.024). This study found that most young adults in colleges and universities had experienced at least one ACE and reported substance use, with prevalence higher among those exposed to ACEs. This emphasizes the need for targeted approaches within higher learning institutions supporting early detection and prevention of ACEs and their associated consequences such as adult substance use.
Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors globally, with liver cirrhosis (LC) recognized as a significant precursor. Xenobiotic metabolism plays a pivotal role in liver diseases, where the liver's primary function as a detoxifying organ directly influences health and tumor development. Therefore, exploring the function of genes associated with xenobiotic metabolism in patients with HCC and LC is crucial for advancing diagnosis and treatment strategies. This study integrated bulk transcriptome RNA sequencing and single-cell RNA sequencing data of HCC and LC from the GEO database. Differential expression analysis, GO and DO enrichment analyses, and PPI network construction were performed to identify hub genes. ROC curve analysis was used to assess the diagnostic value of these genes, and potential therapeutic drugs were predicted using drug databases. The expression of the identified hub genes was validated in clinical tissue samples (≥ 10 pairs) by qRT-PCR and Western blot. Functional assays, including wound healing, transwell migration, and invasion assays, were conducted following siRNA-mediated knockdown of selected hub genes in Huh7 hepatoma cells. We identified five key xenobiotic metabolism-related hub genes: AKR1C3, CYB5A, ADH1C, MAOA, and ALDH2. These genes were significantly overexpressed in HCC and LC tissues compared with normal tissues and were associated with xenobiotic metabolism, substance abuse, alcohol use disorders, and cancer. ROC curve analysis indicated that these hub genes have high diagnostic value in HCC and LC. Potential drug prediction identified six compounds, including retinal, isopropanol, and disulfiram, which may have therapeutic effects. Clinical tissue validation confirmed that all five hub genes were significantly upregulated at both mRNA and protein levels in HCC and LC tissues compared with normal controls (p < 0.05). Functional experiments demonstrated that knockdown of ALDH2 or AKR1C3 significantly impaired the migration and invasion abilities of Huh7 cells, with a reduction of over 50% in transwell assays (p < 0.05). This study systematically analyzed the expression characteristics and functional significance of xenobiotic metabolism-related genes in HCC and LC by integrating multiple high-throughput sequencing technologies. Experimental validation confirmed the upregulation of these hub genes in clinical tissues and demonstrated that ALDH2 and AKR1C3 promote hepatoma cell migration and invasion, providing experimental evidence for their potential roles in disease progression. Potential drugs targeting these hub genes were preliminarily investigated.
Myofibrillar myopathies (MFMs) are a group of protein aggregate diseases characterized by abnormal protein aggregations and myofibrillar disintegration. Myotilinopathy, also named MFM3 or limb-girdle muscular dystrophy type 1A (LGMD1A), is caused by myotilin mutations. Myotilin is degraded by the ubiquitin-proteasome system; however, when this pathway is overloaded under pathophysiological conditions, the protein quality control system leans on the autophagy-lysosome pathway (ALP) to mediate degradation of aggregates. BCL2-associated athanogene 3 (BAG3) protein facilitates aggresome formation and initiates ALP. In this study, we assessed our strategy of reducing the aggregate burden in muscle by overexpressing human BAG3 in TgT57I mice, a model for LGMD1A. Overexpression was achieved by systemic delivery of AAVrh74.tMCK.hBAG3, and outcome measures included functional, histological, and molecular studies. The hBAG3-treated cohort demonstrated increased rotarod duration, treadmill running distance, grip strength, and maximum tetanic response compared to the untreated cohort. Myotilin aggregate burden was significantly decreased, and autophagy levels were normalized in the treated group. As an adaptive response, hBAG3 normalized the endogenous Bag1/Bag3 ratio to that of 3-month-old TgT57I mice. This study provides evidence that our strategy of reducing the aggregate burden in muscle by overexpressing BAG3 may be used as a treatment for protein aggregate myopathies.
Political orientation has been shown to correlate with fertility, raising the possibility that demographic processes contribute to long-term ideological change. Using data from the US General Social Survey, we analyze completed fertility across 17 birth cohorts (1898-1982) to examine how political orientation has contributed to fertility decline in the United States and whether emerging selective forces can be detected. Earlier cohorts show little difference in fertility by political orientation. From the 1943-1947 birth cohort onward, however, a pronounced divergence emerges: individuals with right-wing political orientations maintain fertility at or above replacement level, whereas fertility among left-wing individuals declines sharply to well below replacement. Applying Lande-Arnold selection gradient analyses, we find increasing directional selection that may favor right-wing political orientation over time, while education shows consistent negative associations with fertility and religiosity positive but weaker effects. Separate analysis of Black and White Americans reveals, however, that the increasingly stronger association between political orientation and fertility in more recent cohorts holds only true for whites but not for blacks. Nonetheless, these findings suggest that recent fertility decline in the United States is driven disproportionately by left-leaning individuals and point to contemporary demographic processes that may gradually shift the ideological composition of populations.
To map real-world management of paediatric differentiated thyroid carcinoma (DTC) across Europe and identify targets for harmonization. Cross-sectional, web-based survey of centres providing paediatric DTC care. One consolidated response per centre was requested from a clinician overseeing paediatric DTC. The instrument covered centre profile/multidisciplinary tumour (MDT) board organization; staging and guideline use; risk stratification and dynamic response; diagnostics; surgery/lymph node management; radioactive iodine therapy (RAIT) policy and activity selection; and thyroid-stimulating hormone targets, follow-up, shared-care/transition. Analyses were descriptive at centre level. Forty-two centres from 18 countries participated in the survey. Response denominators varied by item. Among responding centres, ≈75% were university or academic hospitals, ≈70% used a paediatric age cut-off of ≤18 years, and ≈60% reported having a dedicated MDT board. Staging and guideline use were heterogeneous: centres most often reported mixed or centre-specific guidance, followed by the American Thyroid Association (ATA) 2015 guideline, national guidelines, and the European Thyroid Association (ETA) 2022 guideline. Dynamic response-to-therapy categories were commonly used. For unilateral presumed low-risk disease, hemithyroidectomy was the usual initial surgery in approximately two-thirds to three-quarters of centres, whereas total thyroidectomy was less common. For low-risk patients, RAIT policy were split between de-escalation and risk-adapted use. When administered, RAIT activity was determined using weight-based, dosimetric, or fixed empirical approaches. Country-level patterns suggested clustering around ETA-leaning, ATA-leaning, and national guideline frameworks. Across Europe, centres broadly endorse risk-adapted care but diverge at key decision nodes-extent of surgery, formal risk framework, and RAIT in low-risk disease-reflecting guidance plurality and organizational context. Leveraging existing infrastructures offers pragmatic avenues to reduce unwarranted variation while generating paediatric-specific evidence to refine recommendations.
Though depression impacts over 10% of the oldest-old, the contribution of brain health on changes in depression is unknown. This study included 225 participants from LifeAfter90 with magnetic resonance imaging, amyloid positron emission tomography (PET), and repeated Geriatric Depression Scale (GDS) data. We fit linear mixed-effects models for associations of neuroimaging markers with depressive symptom change adjusted for age, gender, race and ethnicity, and education. At baseline, average GDS scores were 2.6 (SD = 2.3) out of 15 possible points, average age was 93.3 (SD = 2.3) years, 56% female, and 22% Black, 25% Asian, 18% Hispanic/Latino, 28% Non-Hispanic White, and 7% as Multiracial/other. Greater baseline occipital volume was associated with slower GDS increase (β = - 0.29; 95% CI - 0.54, - 0.05). Greater baseline free water was associated with faster GDS increase (β = 0.31; 95% CI 0.05, 0.57). Estimates for other neuroimaging biomarkers leaned towards slower, but non-significant, increases in GDS. Estimates were not in the expected direction for amyloid PET and null for frontal cortex volume. Our findings suggest that lower cortical volume and greater white matter injury is associated with increases in depressive symptoms among the oldest old, even for those with low levels of baseline depressive symptoms.