Obesity, Apolipoprotein E ε4, and Difficulties in Activities of Daily Living Among Older Adults: a 6-Year Follow-up Study

Longitudinal association of social isolation and loneliness with physical function among in-patients living with schizophrenia

WHAT IS KNOWN ON THE SUBJECT?: People living with schizophrenia have reduced physical function and are more likely to experience loneliness than those without condition. Low physical function is associated with greater loneliness in people with psychosis. However, it is unclear whether social isolation and loneliness contribute to impaired physical function in this population. Loneliness is linked to an increased risk of physical function impairment among older individuals, but research on patients living with schizophrenia is limited. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first to evaluate the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia. It showed that more than one third of the participants experienced a decline in physical function over a 2-year period. Loneliness, rather than social isolation, was associated with an increase in physical function impairment over 2 years among inpatients living with schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare professionals should recognize loneliness as a potential risk factor for impaired physical function among inpatients diagnosed with schizophrenia. It is recommended that people living with schizophrenia are assessed for loneliness and that interventions are offered to alleviate their feelings of loneliness. Implementing interventions to reduce loneliness may help improve physical function and overall quality of life for individuals living with schizophrenia.

ABSTRACT

INTRODUCTION: Patients living with schizophrenia often experience low physical function, which is associated with negative health outcomes. Therefore, investigating the risk factors for physical function is crucial in this population.

AIM

This study examined the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia.

METHODS

Physical function was assessed using measures of activities daily living (ADL), instrumental activities daily living (IADL) and the combination scores of ADL/IADL. Social isolation was indexed with five types of social connection and loneliness was measured using UCLA Loneliness Scale.

RESULTS

Social isolation was not associated with the measures of physical function over 2 years. Loneliness exhibited an association with IADL and ADL/IADL at follow-up, after adjustment for baseline levels of the outcomes. These associations remained when both social isolation and loneliness were simultaneously entered into the model.

DISCUSSION

Loneliness, rather than social isolation, was associated with increased physical function impairment over 2 years among inpatients living with schizophrenia.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should consider loneliness as a potential risk factor for impaired physical function. It would be beneficial to assess patients for loneliness and implement interventions to reduce feelings of loneliness.

Exploring high-protein diets in the context of cardiac rehabilitation

The review aims to explore the potential benefit and risk of high-protein diets (HPD) regarding the comorbidity of sarcopoenia and CVD in the setting of cardiac rehabilitation (CR). CR is standard care for individuals who have experienced a cardiac event, but the current practice of predominantly aerobic exercise, a lower-fat diet and weight loss poorly addresses the issue of sarcopoenia. HPD, especially when combined with resistance exercise (RE), may be valuable adjuncts to current CR practice and benefit both muscle and cardiovascular health. Meta-analyses and randomised controlled trials of HPD and CVD risk show beneficial but variable effects regarding weight loss, the lipid profile, insulin resistance and lean body mass in those living with or high risk of CVD. Meta-analyses of prospective cohort studies on hard CVD endpoints favour lower- and plant-protein diets over higher animal protein, but the evidence is inconsistent. HPD augment the strength and muscle gaining benefits of RE in older populations, but there are no published data in those living with CVD providing promising opportunities for CR research. HPD raise concern regarding renal and bone health, the microbiome, branched chain amino acids and environmental sustainability and findings suggest that plant-based HPD may confer ecological and overall health advantages compared to animal-based HPD. However, incorporating RE with HPD might alleviate certain health risks. In conclusion, a largely plant-based HPD is deemed favourable for CR when combined with RE, but further research regarding efficacy and safety in CR populations is needed.

Brain Homotopic Connectivity in Mild Cognitive Impairment APOE-ε4 Carriers

Individuals with mild cognitive impairment (MCI) are regarded as being at high risk of developing Alzheimer's disease (AD). The apolipoprotein E (APOE) ε4 allele is a well-established genetic risk factor for developing AD. In the present study, by using voxel-mirrored homotopic connectivity (VMHC), we aimed to explore the potential functional disruptions in MCI APOE-ε4 carriers. Resting-state functional magnetic resonance imaging was performed in 35 MCI APOE-ε4 carriers (27 APOE-ε3ε4, 8 APOE-ε4ε4) and 42 MCI APOE-ε4 noncarriers (APOE-ε3ε3). VMHC was employed to investigate the alterations in functional connectivity in MCI APOE-ε4 carriers. We further investigated the seed-based functional connectivity between the VMHC values of altered regions and other brain regions in the two groups. The results showed that MCI APOE-ε4 carriers presented increased VMHC in the inferior frontal gyrus/insula and middle frontal gyrus/superior frontal gyrus in comparison with noncarriers. We found that MCI APOE-ε4 carriers showed increased functional connectivity between the seed regions (bilateral inferior frontal gyri/insula and bilateral middle frontal gyri/superior frontal gyri) and broad brain areas, including the frontal, temporal, parietal, and cerebellar regions. Our findings provide neuroimaging evidence for the modulation of the APOE genotype on the neurodegenerative disease phenotype and may be potentially important for monitoring disease progression in double-high-risk populations of AD.