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Navarro-Pardo E, Facal D, Campos-Magdaleno M, Pereiro AX, Juncos-Rabadán O. Prevalence of Cognitive Frailty, Do Psychosocial-Related Factors Matter? Brain Sci 2020; 10:brainsci10120968. [PMID: 33322251 PMCID: PMC7763872 DOI: 10.3390/brainsci10120968] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 01/12/2023] Open
Abstract
Cognitive frailty (CF) is a topic of growing interest with implications for the study of preventive interventions in aging. Nevertheless, little research has been done to assess the influence of psychosocial variables on the risk of CF. Our objectives were to estimate the prevalence of CF in a Spanish sample and to explore the influence of psychosocial variables in this prevalence. Physical frailty and cognitive, functional, psychosocial, and socio-demographic aspects were assessed in a sample of 285 participants over 60 years. Univariate and multivariate logistic regression models were carried out. A prevalence of 21.8% (95% CI 17.4-26.9) was established when both frail and pre-frail conditions were included, and a prevalence of 3.2% (95% CI 1.7-5.9) if only frail individuals were considered. Age, educational level, profession and psychological well-being variables significantly predicted CF. Frailty and pre-frailty are high-prevalence health conditions in older adults influenced by socio-demographic, socio-educative and affective factors.
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Affiliation(s)
- Esperanza Navarro-Pardo
- Department of Developmental and Educational Psychology, Universitat de Valencia, 46010 Valencia, Spain;
| | - David Facal
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (M.C.-M.); (A.X.P.); (O.J.-R.)
- Correspondence:
| | - María Campos-Magdaleno
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (M.C.-M.); (A.X.P.); (O.J.-R.)
| | - Arturo X. Pereiro
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (M.C.-M.); (A.X.P.); (O.J.-R.)
| | - Onésimo Juncos-Rabadán
- Department of Developmental Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain; (M.C.-M.); (A.X.P.); (O.J.-R.)
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152
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Botin L, Bertelsen PS, Kayser L, Turner P, Villumsen S, Nøhr C. People Centeredness, Chronic Conditions and Diversity Sensitive eHealth: Exploring Emancipation of the 'Health Care System' and the 'Patient' in Health Informatics. Life (Basel) 2020; 10:life10120329. [PMID: 33297318 PMCID: PMC7762218 DOI: 10.3390/life10120329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Health care systems struggle to consistently deliver integrated high-quality, safe, and patient-centered care to all in an economically sustainable manner. Inequity of access to health care services and variation in diagnostic and treatment outcomes are common. Further, as health care systems become ever more complex, iatrogenesis and counter productivity have emerged as real dangers. In exploring this paradox, this paper considers a subset of those in society living with chronic conditions. Their attributes and circumstances have led to them being marginalized or excluded from ‘end-user’ engagement and/or from their requirements being incorporated into technology supported chronic disease management initiatives. Significantly, these citizens are often the most vulnerable and socially disadvantaged and tend to achieve poorer results and cost more per capita than the ‘average patient’ in their interactions with the health care system. Critically, this paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. This paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating the health system to move towards more socially inclusive eHealth solutions.
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Affiliation(s)
- Lars Botin
- Danish Centre for Health Informatics, Techno-Anthropology & Participation, Aalborg University, DK-9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-51336604
| | - Pernille S. Bertelsen
- Danish Centre for Health Informatics, Techno-Anthropology & Participation, Aalborg University, DK-9000 Aalborg, Denmark;
| | - Lars Kayser
- Health Informatics & Innovation, University of Copenhagen, DK-1353 Copenhagen, Denmark;
| | - Paul Turner
- eHealth Services Research Group (eHSRG), University of Tasmania, Tasmania, TAS 7001, Australia;
| | - Sidsel Villumsen
- Human Resource Development, Central Denmark Region, DK-8200 Aarhus, Denmark;
| | - Christian Nøhr
- Maersk Mc-Kinney Møller Institute, University of Southern Denmark, DK-5230 Odense, Denmark;
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153
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Zupo R, Castellana F, Bortone I, Griseta C, Sardone R, Lampignano L, Lozupone M, Solfrizzi V, Castellana M, Giannelli G, De Pergola G, Boeing H, Panza F. Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty. Ageing Res Rev 2020; 64:101148. [PMID: 32827687 DOI: 10.1016/j.arr.2020.101148] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/11/2022]
Abstract
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
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154
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Fan S, Liang X, Yun T, Pei Z, Hu B, Ismail Z, Yang Z, Xu F. Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study. BMC Geriatr 2020; 20:510. [PMID: 33246409 PMCID: PMC7694410 DOI: 10.1186/s12877-020-01903-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/12/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Frailty and cognitive decline are highly prevalent among older adults. However, the relationship between frailty and mild behavioral impairment (MBI), a dementia risk syndrome characterized by later-life emergence of persistent neuropsychiatric symptoms, has yet to be elucidated. We aimed to evaluate the associations between MBI and frailty in older adults without dementia. METHODS In this cross-sectional study, a consecutive series of 137 older adults without dementia in the Anti-Aging Study, recruited from primary care clinics, were enrolled. Frailty was estimated using the Fried phenotype. MBI was evaluated by the Mild Behavioral Impairment Checklist (MBI-C) at a cut-off point of > 8. Cognition was assessed with the Chinese versions of the Montreal Cognitive Assessment (MoCA-BC) and Mini-mental State Examination (MMSE). Multivariable logistic regression was performed to estimate the relationship between MBI and objective cognition with frailty status. RESULTS At baseline, 30.7% of the older adults had frailty and 18.2% had MBI (MBI+ status). Multivariable logistic regression analysis demonstrated that compared to those without MBI (MBI- status), MBI+ was more likely to have frailty (odds ratio [OR] = 7.44, 95% CI = 1.49-37.21, p = 0.02). Frailty and MBI were both significantly associated with both MMSE and MoCA-BC score (p < 0.05). CONCLUSIONS Both frailty and MBI status were associated with higher odds of cognitive impairment. MBI was significantly associated with an increased risk of having frailty in the absence of dementia. This association merits further study to identify potential strategies for the early detection, prevention and therapeutic intervention of frailty.
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Affiliation(s)
- Shaoyi Fan
- The Second Clinical College of Guangzhou University of Chinese Medicine, 232 East Ring Road, Guangzhou, P. R. China
| | - Ximin Liang
- The Second Clinical College of Guangzhou University of Chinese Medicine, 232 East Ring Road, Guangzhou, P. R. China
| | - Tianchan Yun
- The Second Clinical College of Guangzhou University of Chinese Medicine, 232 East Ring Road, Guangzhou, P. R. China
| | - Zhong Pei
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Second Road, Guangzhou, P. R. China
| | - Bin Hu
- Division of Translational Neuroscience, Department of Clinical Neurosciences, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Zhimin Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, People's Republic of China.
| | - Fuping Xu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, People's Republic of China.
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155
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Lauretani F, Longobucco Y, Ferrari Pellegrini F, De Iorio AM, Fazio C, Federici R, Gallini E, La Porta U, Ravazzoni G, Roberti MF, Salvi M, Zucchini I, Pelà G, Maggio M. Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs. Front Psychol 2020; 11:569629. [PMID: 33324282 PMCID: PMC7725681 DOI: 10.3389/fpsyg.2020.569629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is characterized by the decline and deterioration of functional cells and results in a wide variety of molecular damages and reduced physical and mental capacity. The knowledge on aging process is important because life expectancy is expected to rise until 2050. Aging cannot be considered a homogeneous process and includes different trajectories characterized by states of fitness, frailty, and disability. Frailty is a dynamic condition put between a normal functional state and disability, with reduced capacity to cope with stressors. This geriatric syndrome affects physical, neuropsychological, and social domains and is driven by emotional and spiritual components. Sarcopenia is considered one of the determinants and the biological substrates of physical frailty. Physical and cognitive frailty are separately approached during daily clinical practice. The concept of motoric cognitive syndrome has partially changed this scenario, opening interesting windows toward future approaches. Thus, the purpose of this manuscript is to provide an excursus on current clinical practice, enforced by aneddoctical cases. The analysis of the current state of the art seems to support the urgent need of comprehensive organizational model incorporating physical and cognitive spheres in the same umbrella.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Aurelio Maria De Iorio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Chiara Fazio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Raffaele Federici
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Elena Gallini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Umberto La Porta
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giulia Ravazzoni
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Maria Federica Roberti
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
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156
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Ma Y, Li X, Pan Y, Zhao R, Wang X, Jiang X, Li S. Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. Eur J Neurol 2020; 28:381-388. [PMID: 33030300 DOI: 10.1111/ene.14572] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study. METHODS Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire. RESULTS At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17-14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44-8.44) and CF (OR 3.51, 95% CI 1.18-10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08-4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11-10.50). CONCLUSIONS Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.
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Affiliation(s)
- Y Ma
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Y Pan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - R Zhao
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - X Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China
| | - X Jiang
- Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China
| | - S Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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157
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Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study. Aging (Albany NY) 2020; 12:23129-23145. [PMID: 33221750 PMCID: PMC7746379 DOI: 10.18632/aging.104078] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
Our objectives were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity. We included data of 5113 Chinese older adults (aged 60+ years) who had baseline cognition and physical frailty assessments (2011 wave) and follow-up for 4 years. About 16.0% (n=820) had cognitive impairment; 6.7% (n=342) had physical frailty; and 1.6% (n=82) met criteria for cognitive frailty. Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23–9.40) and death (OR=3.89, 95% CI, 2.25–6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (Pinteractions>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.
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158
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Landino K, Tanaka T, Fantoni G, Candia J, Bandinelli S, Ferrucci L. Characterization of the plasma proteomic profile of frailty phenotype. GeroScience 2020; 43:1029-1037. [PMID: 33200349 PMCID: PMC8110642 DOI: 10.1007/s11357-020-00288-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022] Open
Abstract
Frailty is a risk factor for poor health outcomes in older adults. The aim of this study was to identify plasma proteomic biomarkers of frailty in 752 men and women older than 65 years of age from the InCHIANTI study. One thousand three hundred one plasma proteins were measured using an aptamer-based assay. Associations of each protein with frailty status were assessed using logistic regression and four proteins creatine kinase M-type (CKM), B-type (CKB), C-X-C motif chemokine ligand 13 (CXCL13), and thrombospondin 2 (THBS2) were associated with frailty status. Two proteins, cyclin-dependent kinase 5 (CDK5/CDK5R1) and interleukin 1 alpha (IL1A), were associated with worsening of frailty status over time in volunteers free of frailty at baseline. Using partial least squares discriminant analysis (PLS-DA), data of 1301 proteins was able to discriminate between frail and non-frail with a 2% error rate. The proteins with greater discriminatory ability represented the inflammation, blood coagulation, and cell growth pathways. The utility of these proteins as biomarkers of frailty should be further explored.
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Affiliation(s)
- Kristina Landino
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
| | - Toshiko Tanaka
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA.
| | - Giovanna Fantoni
- National Institute on Aging, Intramural Research Program, Clinical Research Core, NIH, Baltimore, MD, 21224, USA
| | - Julián Candia
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, 20892, USA
| | | | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, MD, 21224, USA
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159
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Lorenzo-López L, Blanco-Fandiño J, Cibeira N, Buján A, López-López R, Maseda A, Millán-Calenti JC. Clinical and Neuropsychological Correlates of Prefrailty Syndrome. Front Med (Lausanne) 2020; 7:609359. [PMID: 33240913 PMCID: PMC7680970 DOI: 10.3389/fmed.2020.609359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65-89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediate memory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early detection of specific cognitive dysfunctions may allow opportunities for reversibility.
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Affiliation(s)
- Laura Lorenzo-López
- Universidade da Coruña, Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Servizo Galego de Saúde (SERGAS), A Coruña, Spain
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160
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A multidimensional frailty approach in predicting and preventing dementia. THE LANCET. HEALTHY LONGEVITY 2020; 1:e49-e50. [DOI: 10.1016/s2666-7568(20)30009-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
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161
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Mishra AK, Skubic M, Popescu M, Lane K, Rantz M, Despins LA, Abbott C, Keller J, Robinson EL, Miller S. Tracking personalized functional health in older adults using geriatric assessments. BMC Med Inform Decis Mak 2020; 20:270. [PMID: 33081769 PMCID: PMC7576843 DOI: 10.1186/s12911-020-01283-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Higher levels of functional health in older adults leads to higher quality of life and improves the ability to age-in-place. Tracking functional health objectively could help clinicians to make decisions for interventions in case of health deterioration. Even though several geriatric assessments capture several aspects of functional health, there is limited research in longitudinally tracking personalized functional health of older adults using a combination of these assessments. METHODS We used geriatric assessment data collected from 150 older adults to develop and validate a functional health prediction model based on risks associated with falls, hospitalizations, emergency visits, and death. We used mixed effects logistic regression to construct the model. The geriatric assessments included were Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). Construct validators such as fall risks associated with model predictions, and case studies with functional health trajectories were used to validate the model. RESULTS The model is shown to separate samples with and without adverse health event outcomes with an area under the receiver operating characteristic curve (AUC) of > 0.85. The model could predict emergency visit or hospitalization with an AUC of 0.72 (95% CI 0.65-0.79), fall with an AUC of 0.86 (95% CI 0.83-0.89), fall with hospitalization with an AUC of 0.89 (95% CI 0.85-0.92), and mortality with an AUC of 0.93 (95% CI 0.88-0.97). Multiple comparisons of means using Turkey HSD test show that model prediction means for samples with no adverse health events versus samples with fall, hospitalization, and death were statistically significant (p < 0.001). Case studies for individual residents using predicted functional health trajectories show that changes in model predictions over time correspond to critical health changes in older adults. CONCLUSIONS The personalized functional health tracking may provide clinicians with a longitudinal view of overall functional health in older adults to help address the early detection of deterioration trends and decide appropriate interventions. It can also help older adults and family members take proactive steps to improve functional health.
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Affiliation(s)
- Anup K Mishra
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, 65211, USA.
| | - Marjorie Skubic
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, 65211, USA
| | - Mihail Popescu
- Department of Health Management and Informatics, University of Missouri, Columbia, MO, 65211, USA
| | - Kari Lane
- Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA
| | - Laurel A Despins
- Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA
| | - Carmen Abbott
- School of Health Professions, Physical Therapy, University of Missouri, Columbia, MO, 65211, USA
| | - James Keller
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, 65211, USA
| | - Erin L Robinson
- School of Social Work, University of Missouri, Columbia, MO, 65211, USA
| | - Steve Miller
- Sinclair School of Nursing, University of Missouri, Columbia, MO, 65211, USA
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162
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Majnarić LT, Bekić S, Babič F, Pusztová Ľ, Paralič J. Cluster Analysis of the Associations among Physical Frailty, Cognitive Impairment and Mental Disorders. Med Sci Monit 2020; 26:e924281. [PMID: 32929055 PMCID: PMC7518080 DOI: 10.12659/msm.924281] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Physical frailty, cognitive impairment, and symptoms of anxiety and depression frequently co-occur in later life, but, to date, each has been assessed separately. The present study assessed their patterns in primary care patients aged ≥60 years. Material/Methods This cross-sectional study evaluated 263 primary care patients aged ≥60 years in eastern Croatia in 2018. Physical frailty, cognitive impairment, anxiety and depression, were assessed using the Fried phenotypic model, the Mini-Mental State Examination (MMSE), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS), respectively. Patterns were identified by latent class analysis (LCA), Subjects were assorted by age, level of education, and domains of psychological and cognitive tests to determine clusters. Results Subjects were assorted into four clusters: one cluster of relatively healthy individuals (61.22%), and three pathological clusters, consisting of subjects with mild cognitive impairment (23.95%), cognitive frailty (7.98%), and physical frailty (6.85%). A multivariate, multinomial logistic regression model found that the main determinants of the pathological clusters were increasing age and lower mnestic functions. Lower performance on mnestic tasks was found to significantly determine inclusion in the three pathological clusters. The non-mnestic function, attention, was specifically associated with cognitive impairment, whereas psychological symptoms of anxiety and dysphoria were associated with physical frailty. Conclusions Clustering of physical and cognitive performances, based on combinations of their grades of severity, may be superior to modelling of their respective entities, including the continuity and non-linearity of age-related accumulation of pathologic conditions.
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Affiliation(s)
- Ljiljana Trtica Majnarić
- Department of Internal Medicine, Family Medicine and the History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Public Health, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Bekić
- General Medical Practice, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Ľudmila Pusztová
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
| | - Ján Paralič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Košice, Slovakia
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163
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Um YH, Wang SM, Han KD, Kim NY, Kang DW, Na HR, Lee CU, Lim HK. Differential Impact of Cigarette Smoking on Fracture Risks in Subjective Cognitive Decline and Dementia: A Nationwide Longitudinal Study. Psychiatry Investig 2020; 17:786-795. [PMID: 32750761 PMCID: PMC7449844 DOI: 10.30773/pi.2020.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We aimed to explore the differential impact of cigarette smoking on fracture risks in SCD and dementia. METHODS A nationwide population-based cohort study design was used. Out of all the people aged 66 (n=1,555,103) who went through the National Screening Program from 2009-2014, 968,240 participants with eligible data were included in the study. Time-to-event was calculated as the duration between the NSPTA and fracture incidence. Cox proportional-hazard regression analyses were conducted to evaluate the risk of fractures. RESULTS Increased risk of all [adjusted hazard ratio (aHR)=1.184; 95% confidence interval (CI)=1.184, 1.093-1.283], hip (aHR=1.518; 95% CI=1.168-4.972), vertebral (aHR=1.235; 95% CI=1.101-1.386) fractures were increased in current smokers with more than 20 or more pack years (≥20 py) of SCD group, after adjusting for all relevant confounding factors. In dementia group, however, current smokers ≥20 py were at reduced risk of hip fractures (aHR=0.249; 95% CI=0.089-0.97). CONCLUSION There was a disparate influence of cigarette smoking on the fracture risks in SCD and dementia group. Further studies are warranted to explicate this phenomenon, and personalized preventive measures according to one's cognitive status are imperative, since risk factors of fractures can exert disparate influence on patients at different stage of cognitive trajectory.
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Affiliation(s)
- Yoo Hyun Um
- Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nak-Young Kim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Woo Kang
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae-Ran Na
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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164
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Kwan RY, Lee D, Lee PH, Tse M, Cheung DS, Thiamwong L, Choi KS. Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16596. [PMID: 32735218 PMCID: PMC7428907 DOI: 10.2196/16596] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/12/2020] [Accepted: 06/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. OBJECTIVE We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. METHODS An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. RESULTS We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. CONCLUSIONS Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. TRIAL REGISTRATION HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756.
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Affiliation(s)
- Rick Yc Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong (China)
| | - Deborah Lee
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong (China)
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (China)
| | - Mimi Tse
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong (China)
| | - Daphne Sk Cheung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong (China)
| | - Ladda Thiamwong
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Kup-Sze Choi
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong (China)
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165
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Oizumi H, Miyazaki S, Tabuchi M, Endo T, Omiya Y, Mizoguchi K. Kamikihito Enhances Cognitive Functions and Reward-Related Behaviors of Aged C57BL/6J Mice in an Automated Behavioral Assay System. Front Pharmacol 2020; 11:1037. [PMID: 32765263 PMCID: PMC7379479 DOI: 10.3389/fphar.2020.01037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
The cognitive and psychological domains of frailty in the elderly have drawn increasing attention given the aging of society. However, therapeutics to treat minor deficits in cognition and mental state in the elderly remain an unmet need. Kamikihito (KKT), a traditional Japanese Kampo medicine indicated for neuroses, anxiety, and insomnia, is effective for treating cognitive dysfunction and depressive-like behaviors in animal models, suggesting that it may have therapeutic potential for treating cognitive and/or mental frailty. In this study, we first validated the known anxiolytic effects of KKT in a conventional maze test. We then introduced an automated behavioral assay system, IntelliCage, to evaluate the therapeutic potential of KKT for age-related and diverse central functions by performing sequential behavioral tasks in young and aged mice to assess basal activities, cognitive functions, perseveration, and hedonic-related behaviors. Although young mice treated with KKT did not exhibit changes in diurnal variation, KKT-administered aged mice exhibited an accelerated decline in voluntary activity during the early part of the light period, implying that KKT may promote sleep onset in aged mice. Neither place learning acquisition for gaining rewards nor subsequent behavioral flexibility performance was altered by KKT in the young group, whereas the aged KKT group exhibited significantly enhanced performance in both phases of learning relative to age-matched controls. Conversely, perseverative nose-pokes (NPs) to gain rewards observed during place learning, indicative of compulsivity, were attenuated by KKT in both age groups. Regarding hedonic processing, aged mice exhibited a decreased preference for sweet solutions compared to young mice, which was effectively reversed by KKT treatment. Furthermore, KKT elevated high-effort choices for high-value reward in an effort-based decision-making paradigm in both age groups, implying augmentation of motivational behaviors by KKT. Collectively, KKT exerted various beneficial effects in cognitive and emotional domains, several of which were more evident in aged mice than in young mice, suggesting the potential of KKT for treating cognitive and mental frailty.
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Affiliation(s)
- Hiroaki Oizumi
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, Japan
| | - Shinji Miyazaki
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, Japan
| | - Masahiro Tabuchi
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, Japan
| | | | - Yuji Omiya
- Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, Japan
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166
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Sargent L, Nalls M, Amella EJ, Slattum PW, Mueller M, Bandinelli S, Tian Q, Swift‐Scanlan T, Lageman SK, Singleton A. Shared mechanisms for cognitive impairment and physical frailty: A model for complex systems. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12027. [PMID: 32685657 PMCID: PMC7362211 DOI: 10.1002/trc2.12027] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We describe findings from a large study that provide empirical support for the emerging construct of cognitive frailty and put forth a theoretical framework that may advance the future study of complex aging conditions. While cognitive impairment and physical frailty have long been studied as separate constructs, recent studies suggest they share common etiologies. We aimed to create a population predictive model to gain an understanding of the underlying biological mechanisms for the relationship between physical frailty and cognitive impairment. METHODS Data were obtained from the longitudinal "Invecchaiare in Chianti" (Aging in Chianti, InCHIANTI Study) with a representative sample (n = 1453) of older adults from two small towns in Tuscany, Italy. Our previous work informed the candidate 132 single nucleotide polymorphisms (SNPs) and 155 protein biomarkers we tested in association with clinical outcomes using a tree boosting, machine learning (ML) technique for supervised learning analysis. RESULTS We developed two highly accurate predictive models, with a Model I area under the curve (AUC) of 0.88 (95% confidence interval [CI] 0.83-0.90) and a Model II AUC of 0.86 (95% CI 0.80-0.90). These models indicate cognitive frailty is driven by dysregulation across multiple cellular processes including genetic alterations, nutrient and lipid metabolism, and elevated levels of circulating pro-inflammatory proteins. DISCUSSION While our results establish a foundation for understanding the underlying biological mechanisms for the relationship between cognitive decline and physical frailty, further examination of the molecular pathways associated with our predictive biomarkers is warranted. Our framework is in alignment with other proposed biological underpinnings of Alzheimer's disease such as genetic alterations, immune system dysfunction, and neuroinflammation.
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Affiliation(s)
- Lana Sargent
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
- Virginia Commonwealth University School of NursingRichmondVirginiaUSA
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Mike Nalls
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
- Data Tecnica InternationalGlen EchoMarylandUSA
| | - Elaine J. Amella
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Patricia W. Slattum
- Department of Pharmacotherapy & Outcomes ScienceGeriatric Pharmacotherapy Program, School of PharmacyVirginia Commonwealth UniversityRichmondVAUSA
| | - Martina Mueller
- Medical University of South Carolina School of NursingCharlestonNorth CarolinaUSA
| | - Stefania Bandinelli
- Laboratory of Clinical EpidemiologyInCHIANTI Study GroupLocal Health Unit Tuscany CenterFlorenceItaly
| | - Qu Tian
- Longitudinal Studies SectionTranslational Gerontology BranchNational Institute on AgingBaltimoreMarylandUSA
| | | | - Sarah K. Lageman
- Department of NeurologyVirginia Commonwealth School of MedicineRichmondVirginiaUSA
| | - Andrew Singleton
- Laboratory of NeurogeneticsNational Institute on AgingNational Institutes of HealthBethesdaMarylandUSA
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167
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Sugimoto T, Ono R, Kimura A, Saji N, Niida S, Sakai T, Rakugi H, Toba K, Sakurai T. Impact of Cognitive Frailty on Activities of Daily Living, Cognitive Function, and Conversion to Dementia Among Memory Clinic Patients with Mild Cognitive Impairment. J Alzheimers Dis 2020; 76:895-903. [PMID: 32568192 DOI: 10.3233/jad-191135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Very few studies have investigated the impact of cognitive frailty in clinical settings, especially in memory clinic populations. OBJECTIVE To examine the impact of cognitive frailty on activities of daily living (ADL), cognitive function, and conversion to dementia among memory clinic patients with mild cognitive impairment (MCI). METHODS The subjects of this retrospective study were 248 MCI patients (mean age, 76.3±5.4 years; females, 60.9%). All subjects completed a comprehensive geriatric assessment at baseline and at least one assessment during 3-year follow-up. Frailty was defined by generating a frailty index (FI), and MCI patients with frailty (FI≥0.25) were considered to represent cognitive frailty. As primary outcomes, the Barthel Index, Mini-Mental State Examination, and incident dementia were evaluated during follow-up. At baseline, patients were assessed for apolipoprotein E (APOE) phenotype. A linear mixed model, as well as a Cox proportional hazards regression model with adjustment for confounding variables, was performed. RESULTS Of these patients, 75 (30.2%) were classified as cognitive frail. APOEɛ4 carriers accounted for 26.7% of those with cognitive frailty and 44.5% of those without (p = 0.008). Cognitive frail patients showed a faster ADL decline (estimate, -1.04; standard error, 0.38; p = 0.007) than patients without cognitive frailty. Cognitive frailty was not associated with cognitive decline and incident dementia. CONCLUSION Our findings demonstrated cognitive frailty increases the risk of dependence but not cognitive outcomes. Cognitive frailty may have heterogeneous conditions, including APOEɛ4-related pathologies, which may affect the cognitive trajectories of patients with MCI.
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Affiliation(s)
- Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Ai Kimura
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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168
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Sun Y, Baptista LC, Roberts LM, Jumbo-Lucioni P, McMahon LL, Buford TW, Carter CS. The Gut Microbiome as a Therapeutic Target for Cognitive Impairment. J Gerontol A Biol Sci Med Sci 2020; 75:1242-1250. [PMID: 31811292 PMCID: PMC7302188 DOI: 10.1093/gerona/glz281] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Indexed: 12/12/2022] Open
Abstract
Declining cognitive functions in older individuals have enormous emotional, clinical, and public health consequences. Thus, therapeutics for preserving function and keeping older adults living independently are imperative. Aging is associated dysbiosis, defined as a loss of number and diversity in gut microbiota, which has been linked with various aspects of cognitive functions. Therefore, the gut microbiome has the potential to be an important therapeutic target for symptoms of cognitive impairment. In this review, we summarize the current literature regarding the potential for gut-targeted therapeutic strategies for prevention/treatment of the symptoms of cognitive impairment. Specifically, we discuss four primary therapeutic strategies: wild-type and genetically modified probiotics, fecal microbiota transplantation, physical exercise, and high-fiber diets and specifically link these therapies to reducing inflammation. These strategies may hold promise as treatment paradigm symptoms related to cognitive impairment.
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Affiliation(s)
- Yi Sun
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine.,Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Liliana C Baptista
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine.,Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa M Roberts
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine.,Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia Jumbo-Lucioni
- Department of Pharmaceutical, Social and Administrative Sciences, McWhorter School of Pharmacy, Samford University, Homewood, Alabama
| | - Lori L McMahon
- Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama.,Department of Cell, Developmental, and Integrative Biology, School of Medicine.,Comprehensive Neuroscience Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas W Buford
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine.,Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christy S Carter
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine.,Integrative Center for Healthy Aging, University of Alabama at Birmingham, Birmingham, Alabama
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Rosa G, Giannotti C, Martella L, Massa F, Serafini G, Pardini M, Nobili FM, Monacelli F. Brain Aging, Cardiovascular Diseases, Mixed Dementia, and Frailty in the Oldest Old: From Brain Phenotype to Clinical Expression. J Alzheimers Dis 2020; 75:1083-1103. [DOI: 10.3233/jad-191075] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Gianmarco Rosa
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Martella
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Flavio Mariano Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health DINOGMI, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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170
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Panza F, Lozupone M, Logroscino G. Understanding frailty to predict and prevent dementia. Lancet Neurol 2020; 18:133-134. [PMID: 30663601 DOI: 10.1016/s1474-4422(18)30446-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Geriatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy
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171
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Mahanna-Gabrielli E, Zhang K, Sieber FE, Lin HM, Liu X, Sewell M, Deiner SG, Boockvar KS. Frailty Is Associated With Postoperative Delirium But Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients. Anesth Analg 2020; 130:1516-1523. [PMID: 32384341 PMCID: PMC7875454 DOI: 10.1213/ane.0000000000004773] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Postoperative cognitive dysfunction (POCD) and delirium are the most common perioperative cognitive complications in older adults undergoing surgery. A recent study of cardiac surgery patients suggests that physical frailty is a risk factor for both complications. We sought to examine the relationship between preoperative frailty and postoperative delirium and preoperative frailty and POCD after major noncardiac surgery. METHODS We performed a prospective cohort study of patients >65 years old having major elective noncardiac surgery with general anesthesia. Exclusion criteria were preexisting dementia, inability to consent, cardiac, intracranial, or emergency surgery. Preoperative frailty was determined using the FRAIL scale, a simple questionnaire that categorizes patients as robust, prefrail, or frail. Delirium was assessed with the Confusion Assessment Method for the intensive care unit (CAM-ICU) twice daily, starting in the recovery room until hospital discharge. All patients were assessed with neuropsychological tests (California Verbal Learning Test II, Trail Making Test, subtests from the Wechsler Adult Intelligence Scale, Logical Memory Story A, Immediate and Delayed Recall, Animal and Vegetable verbal fluency, Boston Naming Test, and the Mini-Mental Status Examination) before surgery and at 3 months afterward. RESULTS A total of 178 patients met inclusion criteria; 167 underwent major surgery and 150 were available for follow-up 3 months after surgery. The median age was 70 years old. Thirty-one patients (18.6%) tested as frail, and 72 (43.1%) prefrail before surgery. After adjustment for baseline cognitive score, age, education, surgery duration, American Society of Anesthesiologists (ASA) physical status, type of surgery, and sex, patients who tested frail or prefrail had an estimated 2.7 times the odds of delirium (97.5% confidence interval, 1.0-7.3) when compared to patients who were robust. There was no significant difference between the proportion of POCD between patients who tested as frail, prefrail, or robust. CONCLUSIONS After adjustment for baseline cognition, testing as frail or prefrail with the FRAIL scale is associated with increased odds of postoperative delirium, but not POCD after noncardiac surgery.
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Affiliation(s)
- Elizabeth Mahanna-Gabrielli
- From the Department of Anesthesiology, Perioperative and Pain Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Kathy Zhang
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Frederick E Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hung Mo Lin
- Departments of Anesthesiology, Perioperative and Pain Medicine
| | - Xiaoyu Liu
- Departments of Anesthesiology, Perioperative and Pain Medicine
| | | | - Stacie G Deiner
- Anesthesiology, Perioperative and Pain Medicine, Neurosurgery, Geriatrics and Palliative Care
| | - Kenneth S Boockvar
- Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York
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172
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Hasan TF, Kelley RE, Cornett EM, Urman RD, Kaye AD. Cognitive impairment assessment and interventions to optimize surgical patient outcomes. Best Pract Res Clin Anaesthesiol 2020; 34:225-253. [PMID: 32711831 DOI: 10.1016/j.bpa.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
For elderly patients undergoing elective surgical procedures, preoperative evaluation of cognition is often overlooked. Patients may experience postoperative delirium (POD) and postoperative cognitive decline (POCD), especially those with certain risk factors, including advanced age. Preoperative cognitive impairment is a leading risk factor for both POD and POCD, and studies have noted that identifying these deficiencies is critical during the preoperative period so that appropriate preventive strategies can be implemented. Comprehensive geriatric assessment is a useful approach which evaluates a patient's medical, psycho-social, and functional domains objectively. Various screening tools are available for preoperatively identifying patients with cognitive impairment. The Enhanced Recovery After Surgery (ERAS) protocols have been discussed in the context of prehabilitation as an effort to optimize a patient's physical status prior to surgery and decrease the risk of POD and POCD. Evidence-based protocols are warranted to standardize care in efforts to effectively meet the needs of these patients.
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Affiliation(s)
- Tasneem F Hasan
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Roger E Kelley
- Department of Neurology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, Massachussetts, 02115, USA.
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Ochsner Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71103, USA.
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173
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Li M, Huang Y, Liu Z, Shen R, Chen H, Ma C, Zhang T, Li S, Prince M. The association between frailty and incidence of dementia in Beijing: findings from 10/66 dementia research group population-based cohort study. BMC Geriatr 2020; 20:138. [PMID: 32293307 PMCID: PMC7158148 DOI: 10.1186/s12877-020-01539-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/29/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The relationship between frailty and dementia is unclear and there are very few population-based studies regarding this issue in China. The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence. METHODS A five-year prospective cohort study was carried out in 2022 participants aged 65 years and over in urban and rural sites in Beijing, China. The participants were interviewed by trained community primary health care workers from 2004 to 2009. Frailty was defined using modified Fried frailty phenotype, physical frailty definition, and multidimensional frailty definition. Dementia was diagnosed using the 10/66 dementia criterion for calculating cumulative incidence. Both competing risk regression models and Cox proportional hazards models were applied to examine the associations between frailty at baseline and five-year cumulative incidence of dementia. RESULTS At the end of follow-up the five-year cumulative incidence rates of dementia with frailty and without frailty defined by the modified Fried frailty were 21.0% and 9.6%, those defined by the physical frailty were 19.9% and 9.0%, and those defined by the multidimensional frailty were 22.8% and 8.9%, respectively. Compared with non-frail participants, frail people had a higher risk of incident dementia using multidimensional frailty definition after adjusting covariates based on competing risk regression model (HR = 1.47, 95% CI 1.01~2.17) and Cox proportional hazards model (HR = 1.56, 95% CI 1.07~2.26). The association between frailty and incident dementia was statistically significant in participants in the upper three quartiles of age (aged 68 years and over) using the multidimensional frailty definition based on the competing risk regression model (HR = 1.61, 95% CI 1.06~2.43) and Cox proportional hazard model (HR = 1.76, 95% CI 1.19~2.61). CONCLUSIONS Multidimensional frailty may play an inherent role in incident dementia, especially in the people aged over 68, which is significant for distinguishing high risk people and determining secondary prevention strategies for dementia patients.
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Affiliation(s)
- Minghui Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yueqin Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Zhaorui Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Rui Shen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chao Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Tingting Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Shuran Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Health Committee Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Martin Prince
- Global Health Institute, King's College London, London, UK
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174
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Baptista LC, Sun Y, Carter CS, Buford TW. Crosstalk Between the Gut Microbiome and Bioactive Lipids: Therapeutic Targets in Cognitive Frailty. Front Nutr 2020; 7:17. [PMID: 32219095 PMCID: PMC7078157 DOI: 10.3389/fnut.2020.00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022] Open
Abstract
Cognitive frailty is a geriatric condition defined by the coexistence of cognitive impairment and physical frailty. This "composite" aging phenotype is associated with a higher risk of several adverse health-related outcomes, including dementia. In the last decade, cognitive frailty has gained increased attention from the scientific community that has focused on understanding the clinical impact and the physiological and pathological mechanisms of development and on identifying preventive and/or rehabilitative therapeutic interventions. The emergence of gut microbiome in neural signaling increased the interest in targeting the gut-brain axis as a modulation strategy. Multiple studies on gastroenteric, metabolic, and neurodegenerative diseases support the existence of a wide bidirectional communication network of signaling mediators, e.g., bioactive lipids, that can modulate inflammation, gut permeability, microbiota composition, and the gut-brain axis. This crosstalk between the gut-brain axis, microbiome, and bioactive lipids may emerge as the basis of a promising therapeutic strategy to counteract cognitive frailty. In this review, we summarize the evidence in the literature regarding the link between the gut microbiome, brain, and several families of bioactive lipids. In addition, we also explore the applicability of several bioactive lipid members as a potential routes for therapeutic interventions to combat cognitive frailty.
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Affiliation(s)
- Liliana C. Baptista
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Yi Sun
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christy S. Carter
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Christy S. Carter
| | - Thomas W. Buford
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, AL, United States,Thomas W. Buford ; Twitter: @twbuford
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175
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Ma L, Chan P. Understanding the Physiological Links Between Physical Frailty and Cognitive Decline. Aging Dis 2020; 11:405-418. [PMID: 32257550 PMCID: PMC7069469 DOI: 10.14336/ad.2019.0521] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Declines in both physical and cognitive function are associated with increasing age. Understanding the physiological link between physical frailty and cognitive decline may allow us to develop interventions that prevent and treat both conditions. Although there is significant epidemiological evidence linking physical frailty to cognitive decline, a complete understanding of the underpinning biological basis of the two disorders remains fragmented. This narrative review discusses insights into the potential roles of chronic inflammation, impaired hypothalamic-pituitary axis stress response, imbalanced energy metabolism, mitochondrial dysfunction, oxidative stress, and neuroendocrine dysfunction linking physical frailty with cognitive decline. We highlight the importance of easier identification of strategic approaches delaying the progression and onset of physical frailty and cognitive decline as well as preventing disability in the older population.
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Affiliation(s)
- Lina Ma
- 1Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,2China National Clinical Research Center for Geriatric Medicine, Beijing, China
| | - Piu Chan
- 1Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,2China National Clinical Research Center for Geriatric Medicine, Beijing, China.,3Department of Neurology and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China
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176
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Dixe MDA, Braúna M, Camacho T, Couto F, Apóstolo J. Mild cognitive impairment in older adults: Analysis of some factors. Dement Neuropsychol 2020; 14:28-34. [PMID: 32206195 PMCID: PMC7077858 DOI: 10.1590/1980-57642020dn14-010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mild cognitive decline is a feared aspect of aging associated with frailty
experienced by individuals.
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Affiliation(s)
- Maria Dos Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Mônica Braúna
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Timóteo Camacho
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria (IPLeiria), Leiria, Portugal
| | - Filipa Couto
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - João Apóstolo
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
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177
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Rivan NFM, Shahar S, Rajab NF, Singh DKA, Che Din N, Mahadzir H, Mohamed Sakian NI, Ishak WS, Abd. Rahman MH, Mohammed Z, You YX. Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1547. [PMID: 32121194 PMCID: PMC7084438 DOI: 10.3390/ijerph17051547] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/01/2023]
Abstract
(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.
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Affiliation(s)
- Nurul Fatin Malek Rivan
- Nutritional Sciences Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Suzana Shahar
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Nor Fadilah Rajab
- Biomedical Science Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme & Centre for Healthy Ageing and Wellness (H-CARE), Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Normah Che Din
- Health Psychology Programme and Centre of Rehabilitation Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Hazlina Mahadzir
- Internal Medicine & Geriatric Department, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Batu 9 Cheras, Kuala Lumpur 50300, Malaysia;
| | - Noor Ibrahim Mohamed Sakian
- Occupational Therapy Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Wan Syafira Ishak
- Audiology Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Mohd Harimi Abd. Rahman
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Zainora Mohammed
- Optometry and Vision Sciences Programme, Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (M.H.A.R.); (Z.M.)
| | - Yee Xing You
- Dietetics Programme and Centre for Healthy Ageing and Wellness (H-CARE), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
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178
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Scassellati C, Ciani M, Galoforo AC, Zanardini R, Bonvicini C, Geroldi C. Molecular mechanisms in cognitive frailty: potential therapeutic targets for oxygen-ozone treatment. Mech Ageing Dev 2020; 186:111210. [PMID: 31982474 DOI: 10.1016/j.mad.2020.111210] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
In the last decade, cognitive frailty has gained great attention from the scientific community. It is characterized by high inflammation and oxidant state, endocrine and metabolic alterations, mitochondria dysfunctions and slowdown in regenerative processes and immune system, with a complex and multifactorial aetiology. Although several treatments are available, challenges regarding the efficacy and the costs persist. Here, we proposed an alternative non-pharmacological, non-side-effect, low cost therapy based on anti-inflammation, antioxidant, regenerative and anti-pathogens properties of ozone, through the activation of several molecular mechanisms (Nrf2-ARE, NF-κB, NFAT, AP-1, HIFα). We highlighted how these specific processes could be implicated in cognitive frailty to identify putative therapeutic targets for its treatment. The oxigen-ozone (O2-O3) therapy has never been tested for cognitive frailty. This work provides thus wide scientific background to build a consistent rationale for testing for the first time this therapy, that could modulate the immune, inflammatory, oxidant, metabolic, endocrine, microbiota and regenerative processes impaired in cognitive frailty. Although insights are needed, the O2-O3 therapy could represent a faster, easier, inexpensive monodomain intervention working in absence of side effects for cognitive frailty.
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Affiliation(s)
- Catia Scassellati
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Miriam Ciani
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Carlo Galoforo
- Oxygen-Ozone Therapy Scientific Society (SIOOT), Gorle, Italy; University of Pavia, Pavia, Italy
| | - Roberta Zanardini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristian Bonvicini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Cristina Geroldi
- Alzheimer Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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179
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Lozupone M, La Montagna M, Di Gioia I, Sardone R, Resta E, Daniele A, Giannelli G, Bellomo A, Panza F. Social Frailty in the COVID-19 Pandemic Era. Front Psychiatry 2020; 11:577113. [PMID: 33240129 PMCID: PMC7669751 DOI: 10.3389/fpsyt.2020.577113] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
Special attention and efforts to protect from or reduce health-related outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus triggering coronavirus disease 2019 (COVID-19), should be applied in susceptible populations, including frail older people. In particular, the early death cases occurred primarily in older people with a frailty status, possibly due to a weaker immune system fostering faster progression of the viral infection. Frailty is an age-related multidimensional clinical condition defined as a non-specific state of vulnerability, identifying older people at increased risk of falls, institutionalization, hospitalization, disability, dementia, and death. Among frailty phenotypes, social frailty has been least studied. It considers the role of socioeconomic context as a vulnerability status later in life. COVID-19 does not affect all populations equally, and social inequalities contribute to drive the spread of infections. It was known that the perception of social isolation, e.g., loneliness, affects mental and physical health, but the implicated molecular mechanisms, also related to the immune system, and its associated cognitive and health-related sequelae, are poorly understood. The increasing psychological distress derived by prolonged exposure to stress due to the lockdown scenario, and the reduced sources of support, contributed to making heavy demands on personal resources, i.e., self-efficacy and interpersonal variables. So, perceived loneliness may be a factor associated with psychological distress and an outcome in itself. In the COVID-19 pandemic era, a correct assessment of social frailty may be essential in terms of the prevention of late-life neuropsychiatric disorders.
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Affiliation(s)
- Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Ilaria Di Gioia
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
| | - Emanuela Resta
- Department of Cardiac, Thoracic, and Vascular Science, Institute of Respiratory Disease, University of Bari Aldo Moro, Bari, Italy.,Translational Medicine and Management of Health Systems, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy.,Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Gianluigi Giannelli
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Panza
- Population Health Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis," Research Hospital, Bari, Italy
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180
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Ruan Q, Xiao F, Gong K, Zhang W, Zhang M, Ruan J, Zhang X, Chen Q, Yu Z. Prevalence of Cognitive Frailty Phenotypes and Associated Factors in a Community-Dwelling Elderly Population. J Nutr Health Aging 2020; 24:172-180. [PMID: 32003407 DOI: 10.1007/s12603-019-1286-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Cognitive frailty was notable target for the prevention of adverse health outcomes in future. The goal of this study was to use a population-based survey to investigate cognitive frailty phenotypes and potentially sociodemographic factors in elderly Chinese individuals. DESIGN Cross-sectional study. SETTING General community. PARTICIPANTS A total of 5328 elderly adults (aged 60 years or older, mean age 71.36 years) enrolled in the Shanghai study of health promotion for elderly individuals with frailty. MEASUREMENTS The 5-item FRAIL scale and the 3-item Rapid Cognitive Screen tools were used to assess physical frailty and cognitive impairment, including dementia or mild cognitive impairment (MCI). Physical frailty was diagnosed by limitations in 3 or more of the FRAIL scale domains and pre-physical frailty by 1-2 limitations. Subjective cognitive decline (SCD) and pre-MCI SCD, was diagnosed with two self-report measures based on memory and other cognitive domains in elderly adults. RESULTS Of the participating individuals, 97.17% (n= 5177, female 53.4%) were eligible. Notably, 9.67%, 41.61% and 35.20% of participants were MCI, SCD and pre-MCI SCD; 35.86% and 4.41% exhibited physical pre-frailty and frailty; and 19.86% and 6.30% exhibited reversible and potential reversible cognitive frailty. Logistic regression analyses indicated that physical frailty phenotypes were significantly associated with MCI with SCD, and pre-MCI with SCD. Older single females with a high education level were more likely to exhibit the reversible cognitive frailty; and younger elderly individuals with a middle education level were at lower risk for potentially reversible cognitive frailty. CONCLUSIONS The prevalence of pre-physical and reversible cognitive frailty was high in elderly individuals and age was the most significant risk factor for all types of frailty phenotypes. To promote the rapid screening protocol of cognitive frailty in community-dwelling elderly is important to find high-risk population, implement effective intervention, and decrease adverse prognosis.
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Affiliation(s)
- Q Ruan
- Dr Zhuowei Yu, Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, 221 West Yan An Road, Shanghai 200040, P.R. China, Tel: 86-21-62483180 Fax: 86-21-62484981
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181
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Shin J, Han SH, Choi J. Exposure to Ambient Air Pollution and Cognitive Impairment in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193767. [PMID: 31591354 PMCID: PMC6801547 DOI: 10.3390/ijerph16193767] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/14/2019] [Accepted: 10/04/2019] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the associations between ambient air pollutants and cognitive impairment in Korean older adults. The cognitive function of 2,896 participants aged 70 to 84 years was measured using the Korean version of the mini-mental state examination, the digit span test, the word list learning test, and the frontal assessment battery. After matching the average concentrations of particulate matter (PM) <10 μm in size (PM10) and <2.5 μm (PM2.5), NO2, CO, SO2, and O3 between 2013 and 2017, the association between air pollutants and cognitive scales was analyzed using a linear mixed regression and a multiple logistic regression analysis (after adjusting for age, sex, health related behaviors, socioeconomic status, comorbidity, and meteorological data). Exposure to PM2.5, PM10, NO2, SO2, and CO was associated with cognitive impairment above and beyond age or education level effects. Specifically, PM2.5 was negatively associated with most components of the cognitive scales (interquartile range for PM2.5: 2.0 μg/m3, odds ratio for poor global cognition: 2.28, 95% confidence interval: 1.60-3.26). These associations may be affected by sex, residence area, or alcohol intake. Conclusively, air pollutants, especially PM2.5, were associated with cognitive impairment, including global cognition, attention, memory, and executive function in Korean older adults aged ≥70 years.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
| | - Seol-Heui Han
- Department of Neurology, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
| | - Jaekyung Choi
- Department of Family Medicine, Research Institute on Healthy aging, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul 05030, Korea.
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Isik AT, Soysal P, Solmi M, Veronese N. Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review. Int J Geriatr Psychiatry 2019; 34:1326-1334. [PMID: 30198597 DOI: 10.1002/gps.4965] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. METHODS We searched PubMed and Google Scholar for potential eligible articles. RESULTS Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. CONCLUSION Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.
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Affiliation(s)
- Ahmet Turan Isik
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Centro Neuroscienze Cognitive, University of Padua, Padua, Italy
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy.,Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
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183
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Solfrizzi V, Scafato E, Lozupone M, Seripa D, Schilardi A, Custodero C, Sardone R, Galluzzo L, Gandin C, Baldereschi M, Di Carlo A, Inzitari D, Giannelli G, Daniele A, Sabbà C, Logroscino G, Panza F. Biopsychosocial frailty and the risk of incident dementia: The Italian longitudinal study on aging. Alzheimers Dement 2019; 15:1019-1028. [PMID: 31278052 DOI: 10.1016/j.jalz.2019.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/18/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Frailty is a critical intermediate status of the aging process including physical, cognitive, and psychosocial domains/phenotypes. We operationalized a new biopsychosocial frailty (BF) construct, estimating its impact on the risk of incident dementia and its subtypes. METHODS In 2171 older individuals from the population-based Italian Longitudinal Study on Aging (ILSA), we identified by latent class procedures the BF construct as the physical frail status plus at least one of the two items of the 30-item Geriatric Depression Scale impaired (items 3/10). RESULTS Over a 3.5-year follow-up, participants with BF showed an increased risk of overall dementia (hazard ratio [HR]: 2.16, 95% confidence interval [CI]:1.07-4.37), particularly vascular dementia (VaD) (HR: 3.21, 95% CI: 1.05-9.75). Similarly, over a 7-year follow-up, an increased risk of overall dementia (HR: 1.84, 95% CI: 1.06-3.20), particularly VaD (HR: 2.53, 95% CI: 1.08-5.91), was also observed. DISCUSSION In a large cohort of Italian older individuals without cognitive impairment at baseline, a BF model was a short- and long-term predictor of overall dementia, particularly VaD.
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Affiliation(s)
- Vincenzo Solfrizzi
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy.
| | - Emanuele Scafato
- National Centre on Addiction and Doping, Istituto Superiore di Sanità (ISS), Roma, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Andrea Schilardi
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Lucia Galluzzo
- Department of Cardiovascular, Dysmetabolic and Ageing-Associated Diseases, Istituto Superiore di Sanità (ISS), Roma, Italy
| | - Claudia Gandin
- National Centre on Addiction and Doping, Istituto Superiore di Sanità (ISS), Roma, Italy
| | - Marzia Baldereschi
- Institute of Neuroscience, Italian National Research Council (CNR), Firenze, Italy
| | - Antonio Di Carlo
- Institute of Neuroscience, Italian National Research Council (CNR), Firenze, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council (CNR), Firenze, Italy; Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Sabbà
- "C. Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
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184
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Esteban-Cornejo I, Cabanas-Sánchez V, Higueras-Fresnillo S, Ortega FB, Kramer AF, Rodriguez-Artalejo F, Martinez-Gomez D. Cognitive Frailty and Mortality in a National Cohort of Older Adults: the Role of Physical Activity. Mayo Clin Proc 2019; 94:1180-1189. [PMID: 30871783 DOI: 10.1016/j.mayocp.2018.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the association between cognitive frailty and long-term all-cause mortality and the stratified and combined associations of physical activity and cognitive frailty with long-term all-cause mortality in a population-based cohort of older adults from Spain. PATIENTS AND METHODS A representative cohort of 3677 noninstitutionalized individuals from Spain aged 60 years or older was recruited between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014. Information on self-reported physical activity and cognitive frailty status were collected at baseline. Analyses were performed with Cox regression after adjustment for confounders. RESULTS The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths. The hazard ratio (HR) for all-cause mortality among participants with cognitive frailty compared with robust participants was 1.69 (95% CI, 1.43-2.01). Being active was associated with a mortality reduction of 36% (95% CI, 21%-47%) in cognitively frail individuals. Compared with those who were robust and active, participants with cognitive frailty who were inactive had the highest mortality risk (HR, 2.13; 95% CI, 1.73-2.61), which was equivalent to being 6.8 (95% CI, 5.33-7.99) years older. CONCLUSION Cognitive frailty was more markedly associated with increased mortality in inactive older adults, and being active reduced the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve survival among cognitively frail older adults.
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Affiliation(s)
- Irene Esteban-Cornejo
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA; PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
| | - Verónica Cabanas-Sánchez
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Sara Higueras-Fresnillo
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Arthur F Kramer
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA; Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - David Martinez-Gomez
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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185
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Solfrizzi V, Agosti P, Lozupone M, Custodero C, Schilardi A, Valiani V, Sardone R, Dibello V, Di Lena L, Lamanna A, Stallone R, Bellomo A, Greco A, Daniele A, Seripa D, Sabbà C, Logroscino G, Panza F. Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. J Alzheimers Dis 2019; 64:S229-S254. [PMID: 29865058 DOI: 10.3233/jad-179940] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The link diet-cognitive function/dementia has been largely investigated in observational studies; however, there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we systematically reviewed RCTs published in the last four years (2014-2017) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation (i.e., dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches) as well as possible underlying mechanisms of nutritional prevention. From the 35 included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function. For fatty acid supplementation, mainly long-chain polyunsaturated fatty acids, there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains, magnetic resonance imaging (MRI) findings, and/or cognitive-related biomarkers also in selected subgroups of older subjects, although some results were conflicting. There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and/or MRI findings. Finally, there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions, dementia incidence, or cognitive-related biomarkers in cognitively healthy older subjects.
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Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy.,Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Vittorio Dibello
- Department of Interdisciplinary Medicine (DIM), Section of Dentistry, University of Bari Aldo, Moro, Bari, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Angela Lamanna
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Roberta Stallone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Carlo Sabbà
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.,Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
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186
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Rietman ML, Hulsegge G, Nooyens ACJ, Dollé MET, Picavet HSJ, Bakker SJL, Gansevoort RT, Spijkerman AMW, Verschuren WMM. Trajectories of (Bio)markers During the Development of Cognitive Frailty in the Doetinchem Cohort Study. Front Neurol 2019; 10:497. [PMID: 31214102 PMCID: PMC6555275 DOI: 10.3389/fneur.2019.00497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/24/2019] [Indexed: 01/31/2023] Open
Abstract
Background: Long-term changes in (bio)markers for cognitive frailty are not well characterized. Therefore, our aim is to explore (bio)marker trajectories in adults who became cognitively frail compared to age- and sex-matched controls who did not become cognitively frail over a 15 year follow-up. We hypothesize that those who become cognitively frail have more unfavorable trajectories of (bio)markers compared to controls. Methods: The Doetinchem Cohort Study is a longitudinal population-based study that started in 1987-1991 in men and women aged 20-59 years, with follow-up examinations every 5 years. For the current analyses, we used data of 17 potentially relevant (bio)markers (e.g., body mass index (BMI), urea) from rounds 2 to 5 (1993-2012). A global cognitive functioning score (based on memory, speed, and flexibility) was calculated for each round and transformed into education and examination round-adjusted z-scores. The z-score that corresponded to the 10th percentile in round 5 (z-score = -0.77) was applied as cut-off point for incident cognitive frailty in rounds 2-5. In total, 455 incident cognitively frail cases were identified retrospectively and were compared with 910 age- and sex-matched controls. Trajectories up to 15 years before and 10 years after incident cognitive frailty were analyzed using generalized estimating equations with stratification for sex and adjustment for age and, if appropriate, medication use. Results were further adjusted for level of education, depressive symptoms, BMI, and lifestyle factors. Results: In men, (bio)marker trajectories did not differ as they ran parallel and the difference in levels was not statistically significant between those who became cognitively frail compared to controls. In women, total cholesterol trajectories first increased and thereafter decreased in cognitively frail women and steadily increased in controls, gamma-glutamyltransferase trajectories were more or less stable in cognitively frail women and increased in controls, and urea trajectories increased in cognitively frail women and remained more or less stable in controls. Results were similar after additional adjustment for potential confounders. Conclusions: Out of the 17 (bio)markers included in this explorative study, differential trajectories for three biomarkers were observed in women. We do not yet consider any of the studied (bio)markers as promising biomarkers for cognitive frailty.
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Affiliation(s)
- M Liset Rietman
- National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gerben Hulsegge
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Astrid C J Nooyens
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Martijn E T Dollé
- National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - H Susan J Picavet
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, Netherlands
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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187
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Marcusson J, Nord M, Johansson MM, Alwin J, Levin LÅ, Dannapfel P, Thomas K, Poksinska B, Sverker A, Olaison A, Cedersund E, Kelfve S, Motel-Klingebiel A, Hellström I, Kullberg A, Böttiger Y, Dong HJ, Peolsson A, Wass M, Lyth J, Andersson A. Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden. BMJ Open 2019; 9:e027847. [PMID: 31122995 PMCID: PMC6538001 DOI: 10.1136/bmjopen-2018-027847] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER NCT03180606.
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Affiliation(s)
- Jan Marcusson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Magnus Nord
- Family Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria M Johansson
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jenny Alwin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars-Åke Levin
- Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Petra Dannapfel
- Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Kristin Thomas
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Susanne Kelfve
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | | | - Ingrid Hellström
- Department of Social and Welfare Studies, Faculty of Health Sciences, Norrköping University, Norrköping, Sweden
| | - Agneta Kullberg
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Ylva Böttiger
- Clinical Pharmacology, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Huan-Ji Dong
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Anneli Peolsson
- Physiotherapy, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Wass
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
| | - Agneta Andersson
- Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
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188
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Segaux L, Oubaya N, Broussier A, Baude M, Canouï-Poitrine F, Naga H, Laurent M, Leissing-Desprez C, Audureau E, Ferrat E, Chailloleau C, Fromentin I, David JP, Bastuji-Garin S. Identification of five frailty profiles in community-dwelling individuals aged 50-75: A latent class analysis of the SUCCEED survey data. Maturitas 2019; 127:1-11. [PMID: 31351514 DOI: 10.1016/j.maturitas.2019.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/24/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to identify frailty profiles in individuals aged 50-75 by considering frailty as an unobservable latent variable in a latent class analysis (LCA). STUDY DESIGN 589 prospectively enrolled community-dwelling individuals aged 50-75 (median: 61.7 years) had undergone a standardized, multidomain assessment in 2010-2015. Adverse health outcomes (non-accidental falls, fractures, unplanned hospitalizations, and death) that had occurred since the assessment were recorded in 2016-2017. MAIN OUTCOME MEASURES The LCA used nine indicators (unintentional weight loss, relative slowness, weakness, impaired balance, osteoporosis, impaired cognitive functions, executive dysfunction, depression, and hearing impairment) and three covariates (age, gender, and consultation for health complaints). The resulting profiles were characterized by the Fried phenotype and adverse health outcomes. RESULTS We identified five profiles: "fit" (LC1, 29.7% of the participants; median age: 59 years); "weight loss, relative slowness, and osteoporosis" (LC2, 33.2%; 63 years); "weakness and osteopenia" (LC3, 21.9%; 60 years); "impaired physical and executive functions" (LC4, 11%; 67 years); and "impaired balance, cognitive functions, and depression" (LC5, 4.3%; 70 years). Almost all members of LC3 and LC4 were female, and were more likely than members of other profiles to have a frail or pre-frail Fried phenotype. Non-accidental falls were significantly more frequent in LC4. LC5 (almost all males) had the highest number of comorbidities and cardiovascular risk factors but none was frail. CONCLUSIONS Our data-driven approach covered most geriatric assessment domains and identified five frailty profiles. With a view to tailoring interventions and prevention, frailty needs to be detected among young seniors.
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Affiliation(s)
- Lauriane Segaux
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Clinical Research Unit (URC Mondor), Créteil, France.
| | - Nadia Oubaya
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Amaury Broussier
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Marjolaine Baude
- AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Florence Canouï-Poitrine
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Henri Naga
- AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Marie Laurent
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Albert Chenevier, Department of Geriatrics, Créteil, France
| | - Claire Leissing-Desprez
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Etienne Audureau
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
| | - Emilie Ferrat
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; UPEC, Faculté de médecine de Créteil, Primary Care Department, Créteil, France
| | | | - Isabelle Fromentin
- AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Jean-Philippe David
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; AP-HP, Hôpital Henri-Mondor/Emile Roux, Department of Geriatrics, Créteil, France
| | - Sylvie Bastuji-Garin
- Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France; Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Clinical Research Unit (URC Mondor), Créteil, France; AP-HP, Hôpital Henri-Mondor, Department of Public Health, Créteil, France
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Abstract
Stroke remains a leading cause of disability and death worldwide despite significant scientific and therapeutic advances. Therefore, there is a critical need to improve stroke prevention and treatment. In this review, we describe several examples that leverage nucleic acid therapeutics to improve stroke care through prevention, acute treatment, and recovery. Aptamer systems are under development to increase the safety and efficacy of antithrombotic and thrombolytic treatment, which represent the mainstay of medical stroke therapy. Antisense oligonucleotide therapy has shown some promise in treating stroke causes that are genetically determined and resistant to classic prevention approaches such as elevated lipoprotein (a) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Targeting microRNAs may be attractive because they regulate factors involved in neuronal cell death and reperfusion-associated injury, as well as neurorestorative pathways. Lastly, microRNAs may aid reliable etiologic classification of stroke subtypes, which is important for effective secondary stroke prevention.
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Affiliation(s)
- Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave, North, Worcester, MA, 01655, USA.
| | - Yunis Mayasi
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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190
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Falck RS, Davis JC, Best JR, Crockett RA, Liu-Ambrose T. Impact of exercise training on physical and cognitive function among older adults: a systematic review and meta-analysis. Neurobiol Aging 2019; 79:119-130. [PMID: 31051329 DOI: 10.1016/j.neurobiolaging.2019.03.007] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 01/01/2023]
Abstract
Exercise plays a key role in healthy aging by promoting both physical and cognitive function. Physical function and cognitive function appear to be interrelated and may share common mechanisms. Thus, exercise-induced improvements in physical function and cognitive function may co-occur and be associated with each other. However, no systematic review has specifically assessed and compared the effects of exercise on both physical function and cognitive function in older adults, and the association between changes in both outcomes after exercise training. Thus, we conducted a systematic review and meta-analysis (N = 48 studies) among older adults (60+ years). These data suggest exercise training has a significant benefit for both physical function (g = 0.39; p < 0.001) and cognitive function (g = 0.24; p < 0.001). At the study level, there was a positive correlation between the size of the exercise-induced effect on physical function and on cognitive function (b = 0.41; p = 0.002). Our results indicate exercise improves both physical and cognitive function, reiterating the notion that exercise is a panacea for aging well.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - John R Best
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Rachel A Crockett
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
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191
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Borges MK, Canevelli M, Cesari M, Aprahamian I. Frailty as a Predictor of Cognitive Disorders: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2019; 6:26. [PMID: 30838210 PMCID: PMC6389599 DOI: 10.3389/fmed.2019.00026] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 02/01/2023] Open
Abstract
Background/Aim: Current evidence in the literature supports associations between frailty, cognitive impairment, and dementia. The study aim was to describe the risk of cognitive disorders associated with physical frailty in older adults from community-based studies. Methods: We performed a systematic review and meta-analysis, using MEDLINE, PsycINFO, Scopus, and Web of Science as databases for the search. Cohort and longitudinal studies were included in qualitative analysis and quantitative synthesis. For inclusion, studies had to assess dementia and cognitive impairment as a primary or secondary outcome, and describe the prevalence of frailty among participants at baseline and follow-up. Results: Of the 2,210 studies retrieved by the systematic review, 6 relevant studies were included in a meta-analysis. Baseline frailty was significantly associated with an increased risk of geriatric cognitive disorders (pooled OR = 1.80, 95% CI = 1.11–2.92; p = 0.02). Heterogeneity across the studies was significant (I2 = 79%). Conclusions: The analyses confirmed that frail older adults were at higher risk of incident cognitive disorders than non-frail elders. Frailty status seems to be most associated with the risk of incident dementia. Frailty may represent a risk factor for dementia and could constitute a novel modifiable target in early cognitive impairment.
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Affiliation(s)
- Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Canevelli
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedadale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics and Psychiatry Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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192
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Wallace LMK, Theou O, Godin J, Andrew MK, Bennett DA, Rockwood K. Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project. Lancet Neurol 2019; 18:177-184. [PMID: 30663607 PMCID: PMC11062500 DOI: 10.1016/s1474-4422(18)30371-5] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Some people with substantial Alzheimer's disease pathology at autopsy had shown few characteristic clinical symptoms or signs of the disease, whereas others with little Alzheimer's disease pathology have been diagnosed with Alzheimer's dementia. We aimed to examine whether frailty, which is associated with both age and dementia, moderates the relationship between Alzheimer's disease pathology and Alzheimer's dementia. METHODS We did a cross-sectional analysis of data from participants of the Rush Memory and Aging Project, a clinical-pathological cohort study of older adults (older than 59 years) without known dementia at baseline, living in Illinois, USA. Participants in the cohort study underwent annual neuropsychological and clinical evaluations. In the present cross-sectional analysis, we included those participants who did not have any form of dementia or who had Alzheimer's dementia at the time of their last clinical assessment and who had died and for whom complete autopsy data were available. Alzheimer's disease pathology was quantified by a summary measure of neurofibrillary tangles and neuritic and diffuse plaques. Clinical diagnosis of Alzheimer's dementia was based on clinician consensus. Frailty was operationalised retrospectively using health variable information obtained at each clincial evaluation using the deficit accumulation approach (41-item frailty index). Logistic regression and moderation modelling were used to assess relationships between Alzheimer's disease pathology, frailty, and Alzheimer's dementia. All analyses were adjusted for age, sex, and education. FINDINGS Up to data cutoff (Jan 20, 2017), we included 456 participants (mean age at death 89·7 years [SD 6·1]; 316 [69%] women). 242 (53%) had a diagnosis of possible or probable Alzheimer's dementia at their last clinical assessment. Frailty (odds ratio 1·76, 95% CI 1·54-2·02; p<0·0001) and Alzheimer's disease pathology (4·81, 3·31-7·01; p<0·0001) were independently associated with Alzheimer's dementia, after adjusting for age, sex, and education. When frailty was added to the model for the relationship between Alzheimer's disease pathology and Alzheimer's dementia, model fit improved (p<0·0001). There was a significant interaction between frailty and Alzheimer's disease pathology (odds ratio 0·73, 95% CI 0·57-0·94; pinteraction=0·015). People with an increased frailty score had a weakened direct link between Alzheimer's disease pathology and Alzheimer's dementia; that is, people with a low amount of frailty were better able to tolerate Alzheimer's disease pathology, whereas those with higher amounts of frailty were more likely both to have more Alzheimer's disease pathology and for it to be expressed as dementia. INTERPRETATION The degree of frailty among people of the same age modifies the association between Alzheimer's disease pathology and Alzheimer's dementia. That frailty is related to both odds of Alzheimer's dementia and disease expression has implications for clinical management, since individuals with even a low level of Alzheimer's disease pathology might be at risk for dementia if they have high amounts of frailty. Further research should assess how frailty and cognition change over time to better elucidate this complex relationship. FUNDING None.
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Affiliation(s)
- Lindsay M K Wallace
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Olga Theou
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David A Bennett
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Kenneth Rockwood
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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193
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Tseng SH, Liu LK, Peng LN, Wang PN, Loh CH, Chen LK. Development and Validation of a Tool to Screen for Cognitive Frailty among Community-Dwelling Elders. J Nutr Health Aging 2019; 23:904-909. [PMID: 31641743 DOI: 10.1007/s12603-019-1235-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Reciprocal age-related impairments in physical and cognitive functioning have been termed 'cognitive frailty', which is associated with adverse health outcomes and is a potential target for preventing or delaying the onset of disability in older people. However, cognitive frailty as currently defined is challenging to diagnose. To facilitate earlier diagnosis and intervention, we conducted this study to develop and validate a simple evidence-based instrument to identify community-dwelling elders at risk of cognitive frailty. DESIGN Retrospective analyses of data from the I-Lan Longitudinal Aging Study (ILAS) to develop a prediction model, and from the Longitudinal Aging Study of Taipei (LAST) for external validation. SETTING Community-dwelling adults from Taipei City, New Taipei City and Yilan (I-Lan) County, Taiwan. PARTICIPANTS 1271 community residents ≥65 years old, without impaired global cognition or dependency for activities of daily living/instrumental activities of daily living. MEASUREMENTS Demographic characteristics, anthropometric measurements, medical history, Mini-Mental State Examination, Montreal Cognitive Assessment, Functional Autonomy Measuring System, Functional Assessment Staging Test, Center for Epidemiologic Studies Depression Scale, handgrip strength, 6-metre walk speed. METHODS Baseline characteristics of groups with/without cognitive frailty were analyzed and factors differing significantly in univariate analysis input to binary logistic regression to develop a cognitive frailty risk (CFR) score. RESULTS The prevalence of cognitive frailty was 15.8% overall; ILAS 21.4%, LAST 8.4%. Predictors of CFR comprised: age ≥75 years; female sex; waist circumference ≥90 cm (male), ≥80 cm (female); calf circumference <33 cm (male), <32 cm (female); memory deficits; and diabetes mellitus. CFR ≥5/14 had sensitivity of 70%, specificity of 60%, and predictive accuracy of 72%. CONCLUSIONS A CFR score based on simple history-taking and anthropometric measurements integrates age, sex, cardiometabolic risk, memory deficits, sarcopenia, and nutrition, with validated predictive accuracy, and could be performed easily in community settings to identify seniors with cognitive frailty for appropriate interventions.
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Affiliation(s)
- S-H Tseng
- Liang-Kung Chen, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan, ; Or Li-Ning Peng, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan, E-mail address:
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194
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Kwan RYC, Leung AYM, Yee A, Lau LT, Xu XY, Dai DLK. Cognitive Frailty and Its Association with Nutrition and Depression in Community-Dwelling Older People. J Nutr Health Aging 2019; 23:943-948. [PMID: 31781723 DOI: 10.1007/s12603-019-1258-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cognitive frailty is a condition where physical frailty and mild cognitive impairment (MCI) co-exist. It is associated with increased risk of dementia and dependency. Previous studies reported that malnutrition and depression are associated with physical frailty and MCI; however, their relationships with cognitive frailty remained to be explored. The aims of this study were to examine the association of nutrition and depression with cognitive frailty, in comparison to having physical frailty or MCI alone. METHODS This study employed a cross-sectional design. Data collection was conducted in the community settings on the older people without dementia. Dependent variables were cognitive frailty, physical frailty, and MCI. The independent variables were depression and nutrition. Multi-nominal regression was employed to examine the relationships between the dependent and independent variables. The associations were adjusted by four known co-variates, including age, gender, education and APOE ε4 carrier status. RESULTS A total of 185 participants were recruited from four community centres and one elderly hostel and completed the data collection. Approximately 44.9% of the older people with physical frailty and 82.5% of elderly with MCI belonged to cognitive frailty. Multi-nominal regression models showed that depression is positively associated with cognitive frailty and with physical frailty, but not associated with solely MCI. Nutrition is negatively associated with cognitive frailty, but not associated with physical frailty or MCI alone. CONCLUSION Cognitive frailty is associated with malnutrition and depression. Therapeutic interventions managing depression and malnutrition may focus the older people with cognitive frailty to improve efficacy and cost-effectiveness.
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Affiliation(s)
- R Y C Kwan
- David L.K. Dai, Hong Kong Alzheimer's Disease Association, G/F, Wang Yip House, Wang Tau Hom Estate, Hong Kong Tel: (852) 2338 1120 Fax: (852) 23380772
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195
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Panza F, Lozupone M, Sardone R, Battista P, Piccininni M, Dibello V, La Montagna M, Stallone R, Venezia P, Liguori A, Giannelli G, Bellomo A, Greco A, Daniele A, Seripa D, Quaranta N, Logroscino G. Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life. Ther Adv Chronic Dis 2018; 10:2040622318811000. [PMID: 31452865 PMCID: PMC6700845 DOI: 10.1177/2040622318811000] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/12/2018] [Indexed: 01/12/2023] Open
Abstract
The peripheral hearing alterations and central auditory processing disorder (CAPD) associated with age-related hearing loss (ARHL), may impact cognitive disorders in older age. In older age, ARHL is also a significant marker for frailty, another age-related multidimensional clinical condition with a nonspecific state of vulnerability, reduced multisystem physiological reserve, and decreased resistance to different stressors (i.e. sensorial impairments, psychosocial stress, diseases, injuries). The multidimensional nature of frailty required an approach based on different pathogeneses because this clinical condition may include sensorial, physical, social, nutritional, cognitive, and psychological phenotypes. In the present narrative review, the cumulative epidemiological evidence coming from several longitudinal population-based studies, suggested convincing links between peripheral ARHL and incident cognitive decline and dementia. Moreover, a few longitudinal case-control and population-based studies also suggested that age-related CAPD in ARHL, may be central in determining an increased risk of incident cognitive decline, dementia, and Alzheimer's disease (AD). Cumulative meta-analytic evidence confirmed cross-sectional and longitudinal association of both peripheral ARHL and age-related CAPD with different domains of cognitive functions, mild cognitive impairment, and dementia, while the association with dementia subtypes such as AD and vascular dementia remained unclear. However, ARHL may represent a modifiable condition and a possible target for secondary prevention of cognitive impairment in older age, social isolation, late-life depression, and frailty. Further research is required to determine whether broader hearing rehabilitative interventions including coordinated counseling and environmental accommodations could delay or halt cognitive and global decline in the oldest old with both ARHL and dementia.
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Affiliation(s)
- Francesco Panza
- Department of Basic Medical Sciences,
Neurosciences, and Sense Organs, Neurodegenerative Disease Unit, University
of Bari ‘Aldo Moro’, Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology ‘Saverio
de Bellis’, Research Hospital, Castellana Grotte Bari, Italy
| | - Petronilla Battista
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
- Istituti Clinici Scientifici Maugeri SPA SB,
IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Marco Piccininni
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
| | - Vittorio Dibello
- National Institute of Gastroenterology ‘Saverio
de Bellis’, Research Hospital, Castellana Grotte Bari, Italy
- Interdisciplinary Department of Medicine (DIM),
Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical and
Experimental Medicine, University of Foggia, Foggia, Italy
| | - Roberta Stallone
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
- National Institute of Gastroenterology ‘Saverio
de Bellis’, Research Hospital, Castellana Grotte Bari, Italy
| | - Pietro Venezia
- Department of Prosthodontics, Section of
Dentistry, University of Catania, Catania, Italy
| | - Angelo Liguori
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology ‘Saverio
de Bellis’, Research Hospital, Castellana Grotte Bari, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and
Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit, Fondazione IRCCS ‘Casa Sollievo
della Sofferenza’, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of
Sacred Heart, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli
IRCCS, Rome, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS ‘Casa Sollievo
della Sofferenza’, San Giovanni Rotondo, Foggia, Italy
| | - Nicola Quaranta
- Otolaryngology Unit, University of Bari Aldo
Moro, Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of
Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo
Moro, Bari, Italy
- Neurodegenerative Disease Unit, Department of
Clinical Research in Neurology, University of Bari Aldo Moro, ‘Pia
Fondazione Cardinale G. Panico’, Tricase, Lecce, Italy
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196
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Solfrizzi V, Agosti P, Lozupone M, Custodero C, Schilardi A, Valiani V, Santamato A, Sardone R, Dibello V, Di Lena L, Stallone R, Ranieri M, Bellomo A, Greco A, Daniele A, Seripa D, Sabbà C, Logroscino G, Panza F. Nutritional interventions and cognitive-related outcomes in patients with late-life cognitive disorders: A systematic review. Neurosci Biobehav Rev 2018; 95:480-498. [PMID: 30395922 DOI: 10.1016/j.neubiorev.2018.10.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/27/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
There have been a large number of observational studies on the impact of nutrition on neuroprotection, however, there was a lack of evidence from randomized clinical trials (RCTs). In the present systematic review, from the 32 included RCTs published in the last four years (2014-2017) in patients aged 60 years and older with different late-life cognitive disorders, nutritional intervention through medical food/nutraceutical supplementation and multidomain approach improved magnetic resonance imaging findings and other cognitive-related biomarkers, but without clear effect on cognition in mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Antioxidant-rich foods (nuts, grapes, cherries) and fatty acid supplementation, mainly n-3 polyunsaturated fatty acids (PUFA), improved specific cognitive domains and cognitive-related outcomes in MCI, mild-to-moderate dementia, and AD. Antioxidant vitamin and trace element supplementations improved only cognitive-related outcomes and biomarkers, high-dose B vitamin supplementation in AD and MCI patients improved cognitive outcomes in the subjects with a high baseline plasma n-3 PUFA, while folic acid supplementation had positive impact on specific cognitive domains in those with high homocysteine.
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Affiliation(s)
- Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy.
| | - Pasquale Agosti
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Carlo Custodero
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Schilardi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Vincenzo Valiani
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Vittorio Dibello
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Roberta Stallone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy; Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari AldoMoro, Bari, Italy
| | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Section, "OORR Hospital", University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Carlo Sabbà
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari 'Aldo Moro', Bari, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Francesco Panza
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
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197
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Abbasi M, Rolfson D, Khera AS, Dabravolskaj J, Dent E, Xia L. Identification and management of frailty in the primary care setting. CMAJ 2018; 190:E1134-E1140. [PMID: 30249759 PMCID: PMC6157492 DOI: 10.1503/cmaj.171509] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Marjan Abbasi
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Darryl Rolfson
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Amandeep S Khera
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Julia Dabravolskaj
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Elsa Dent
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
| | - Linda Xia
- Faculty of Medicine and Dentistry, Departments of Medicine (Rolfson); Family Medicine (Khera, Xia), Division of Care of Elderly (Abbasi), University of Alberta; Edmonton Oliver Primary Care Network (Dabravolskaj), Edmonton, Alta.; Torrens University of Adelaide (Dent), Adelaide, South Australia
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Ticinesi A, Tana C, Nouvenne A, Prati B, Lauretani F, Meschi T. Gut microbiota, cognitive frailty and dementia in older individuals: a systematic review. Clin Interv Aging 2018; 13:1497-1511. [PMID: 30214170 PMCID: PMC6120508 DOI: 10.2147/cia.s139163] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cognitive frailty, defined as the coexistence of mild cognitive impairment symptoms and physical frailty phenotype in older persons, is increasingly considered the main geriatric condition predisposing to dementia. Recent studies have demonstrated that gut microbiota may be involved in frailty physiopathology by promoting chronic inflammation and anabolic resistance. The contribution of gut microbiota to the development of cognitive impairment and dementia is less defined, even though the concept of "gut-brain axis" has been well demonstrated for other neuropsychiatric disorders. The aim of this systematic review was to summarize the current state-of-the-art literature on the gut microbiota alterations associated with cognitive frailty, mild cognitive impairment and dementia and elucidate the effects of pre- or probiotic administration on cognitive symptom modulation in animal models of aging and human beings. We identified 47 papers with original data (31 from animal studies and 16 from human studies) suitable for inclusion according to our aims. We concluded that several observational and intervention studies performed in animal models of dementia (mainly Alzheimer's disease) support the concept of a gut-brain regulation of cognitive symptoms. Modulation of vagal activity and bacterial synthesis of substances active on host neural metabolism, inflammation and amyloid deposition are the main mechanisms involved in this physiopathologic link. Conversely, there is a substantial lack of human data, both from observational and intervention studies, preventing to formulate any clinical recommendation on this topic. Gut microbiota modulation of cognitive function represents, however, a promising area of research for identifying novel preventive and treatment strategies against dementia.
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Affiliation(s)
- Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy,
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
- Microbiome Research Hub, University of Parma, Parma, Italy,
| | - Claudio Tana
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
| | - Antonio Nouvenne
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
- Microbiome Research Hub, University of Parma, Parma, Italy,
| | - Beatrice Prati
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
| | - Fulvio Lauretani
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy,
- Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy,
- Microbiome Research Hub, University of Parma, Parma, Italy,
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