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Levak N, Lehtisalo J, Thunborg C, Westman E, Andersen P, Andrieu S, Broersen LM, Coley N, Hartmann T, Irving GF, Mangialasche F, Ngandu T, Pantel J, Rosenberg A, Sindi S, Soininen H, Solomon A, Wang R, Kivipelto M. Nutrition guidance within a multimodal intervention improves diet quality in prodromal Alzheimer's disease: Multimodal Preventive Trial for Alzheimer's Disease (MIND-AD mini). Alzheimers Res Ther 2024; 16:147. [PMID: 38961421 PMCID: PMC11221015 DOI: 10.1186/s13195-024-01522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Multimodal lifestyle interventions can benefit overall health, including cognition, in populations at-risk for dementia. However, little is known about the effect of lifestyle interventions in patients with prodromal Alzheimer's disease (AD). Even less is known about dietary intake and adherence to dietary recommendations within this population making it difficult to design tailored interventions for them. METHOD A 6-month MIND-ADmini pilot randomized controlled trial (RCT) was conducted among 93 participants with prodromal AD in Sweden, Finland, Germany, and France. Three arms were included in the RCT: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management, and social stimulation); 2) multimodal lifestyle intervention + medical food product; and 3) regular health advice (control group). Adherence to dietary advice was assessed with a brief food intake questionnaire by using the Healthy Diet Index (HDI) and Mediterranean Diet Adherence Screener (MEDAS). The intake of macro- and micronutrients were analyzed on a subsample using 3-day food records. RESULTS The dietary quality in the intervention groups, pooled together, improved compared to that of the control group at the end of the study, as measured with by HDI (p = 0.026) and MEDAS (p = 0.008). The lifestyle-only group improved significantly more in MEDAS (p = 0.046) and almost significantly in HDI (p = 0.052) compared to the control group, while the lifestyle + medical food group improved in both HDI (p = 0.042) and MEDAS (p = 0.007) during the study. There were no changes in macro- or micronutrient intake for the intervention groups at follow-up; however, the intakes in the control group declined in several vitamins and minerals when adjusted for energy intake. CONCLUSION These results suggest that dietary intervention as part of multimodal lifestyle interventions is feasible and results in improved dietary quality in a population with prodromal AD. Nutrient intakes remained unchanged in the intervention groups while the control group showed a decreasing nutrient density. TRIAL REGISTRATION ClinicalTrials.gov NCT03249688, 2017-07-08.
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Affiliation(s)
- Nicholas Levak
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden.
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Karolinska Vägen 37 A, 171 64, Solna, Sweden.
| | - Jenni Lehtisalo
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Charlotta Thunborg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Eric Westman
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
| | - Pia Andersen
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Karolinska Vägen 37 A, 171 64, Solna, Sweden
| | - Sandrine Andrieu
- Department of Clinical Epidemiology and Public Health, UMR 1295, CHU de Toulouse, and Aging Research Team, CERPOP Inserm, Jules Guesde, 31000, Toulouse, France
- IHU HealthAge, Toulouse, 31059, France
| | | | - Nicola Coley
- Department of Clinical Epidemiology and Public Health, UMR 1295, CHU de Toulouse, and Aging Research Team, CERPOP Inserm, Jules Guesde, 31000, Toulouse, France
- IHU HealthAge, Toulouse, 31059, France
| | - Tobias Hartmann
- German Institute for Dementia Prevention (DIDP), Saarland University, 66424, Homburg, Germany
- Department of Experimental Neurology, Medical Faculty, Saarland University, 66424, Homburg, Germany
| | - Gerd Faxén Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
| | - Francesca Mangialasche
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johannes Pantel
- Institute of General Practice, Goethe University Frankfurt a.M., Frankfurt, Germany
| | - Anna Rosenberg
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Rui Wang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Physical Activity and Health, the Swedish School of Sport and Health Sciences, 114 86, Stockholm, Sweden
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave J5/1 Mezzanine, Madison, WI, 53792, USA
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Center for Alzheimer Research QA32, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Karolinska Vägen 37 A, 171 64, Solna, Sweden
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
- The Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 8, 70210, Kuopio, Finland
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients. Geriatrics (Basel) 2022; 7:geriatrics7050095. [PMID: 36136804 PMCID: PMC9498394 DOI: 10.3390/geriatrics7050095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
In acutely hospitalized older patients (≥65 years), the association between mild cognitive impairment (MCI) and malnutrition is poorly described. We hypothesized that (1) MCI is associated with nutritional status on admission and after discharge; (2) MCI is associated with a change in nutritional status; and (3) a potential association is partly explained by frailty, comorbidity, medication use, and age. We combined data from a randomized controlled trial (control group data) and a prospective cohort study (ClinicalTrials.gov: NCT01964482 and NCT03052192). Nutritional status was assessed on admission and follow-up using the Mini Nutritional Assessment—Short Form. MCI or intact cognition (noMCI) was classified by three cognitive performance tests at follow-up. Data on frailty, comorbidity, medication use, and age were drawn from patient journals. MCI (n = 42) compared to noMCI (n = 47) was associated with poorer nutritional status with an average difference of −1.29 points (CI: −2.30; −0.28) on admission and −1.64 points (CI: −2.57; −0.70) at 4-week follow-up. Only age influenced the estimates of −0.85 (CI: −1.86; 0.17) and −1.29 (CI: −2.25; −0.34), respectively. In acutely hospitalized older patients, there is an association between MCI and poorer nutritional status upon admission and four weeks after discharge. The association is partly explained by higher age.
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Hossain S, Beydoun MA, Evans MK, Zonderman AB, Kuczmarski MF. Caregiver Status and Diet Quality in Community-Dwelling Adults. Nutrients 2021; 13:nu13061803. [PMID: 34073304 PMCID: PMC8227086 DOI: 10.3390/nu13061803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 02/03/2023] Open
Abstract
Objective: We investigated cross-sectional and longitudinal associations of diet quality with middle-aged caregiver status. Methods: Caregiving in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American (AA)) was measured at waves 3 (2009–2013) and 4 (2013–2017) (mean follow-up time 4.1 years). Diet quality was assessed by the Healthy Eating Index 2010 (HEI-2010) derived from two separate 24 h diet recalls. Multivariable ordinary least square regression was performed for cross-sectional analyses of the association of wave 4 caregiving with wave 4 HEI-2010. Wave 3 caregiving was examined both cross-sectionally and with annual rate of change in HEI using mixed-effects linear regression Models. Multivariable models were adjusted for age, sex, and poverty status. Results: Cross-sectional analyses at wave 4 demonstrate an inverse association of frequent caregiving (“Daily or Weekly” vs. “Never”) for grandchildren with HEI-2010 total score (i.e., lower diet quality) among Whites (β = −2.83 ± 1.19, p = 0.03, Model 2) and AAs (β = −1.84 ± 0.79, p = 0.02,). The “cross-sectional” analysis pertaining to grandchildren caregiving frequency suggested that frequent caregiving (i.e., “Daily or Weekly” vs. “Never” (β = −2.90 ± 1.17, p = 0.04)) only among Whites was inversely related to HEI-2010 total score. Total HEI-2010 score was also related to caring (Model 1), for the elderly over “5 years vs. Never” among Whites (−7.31 ± 3.54, p = 0.04, Model 2). Longitudinally, we found slight potential improvement in diet quality over time (“Daily or Weekly” vs. Never by TIME interaction: +0.88 ± 0.38, p = 0.02) with frequent caregiving among Whites, but not so among AAs. Conclusions: Frequent caring for grandchildren had an inverse relationship with the diet quality of White and AA urban middle-aged caregivers, while caring for elderly was inversely linked to diet quality among Whites only. Longitudinal studies should address the paucity of research on caregivers’ nutritional quality.
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Affiliation(s)
- Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA; (M.A.B.); (M.K.E.); (A.B.Z.)
- Correspondence: ; Tel.: +1-410-558-8545
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA; (M.A.B.); (M.K.E.); (A.B.Z.)
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA; (M.A.B.); (M.K.E.); (A.B.Z.)
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, MD 21224, USA; (M.A.B.); (M.K.E.); (A.B.Z.)
| | - Marie F. Kuczmarski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE 19716, USA;
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Reynish E, Hapca S, Walesby R, Pusram A, Bu F, Burton JK, Cvoro V, Galloway J, Ebbesen Laidlaw H, Latimer M, McDermott S, Rutherford AC, Wilcock G, Donnan P, Guthrie B. Understanding health-care outcomes of older people with cognitive impairment and/or dementia admitted to hospital: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cognitive impairment is common in older people admitted to hospital, but previous research has focused on single conditions.
Objective
This project sits in phase 0/1 of the Medical Research Council Framework for the Development and Evaluation of Complex Interventions. It aims to develop an understanding of current health-care outcomes. This will be used in the future development of a multidomain intervention for people with confusion (dementia and cognitive impairment) in general hospitals. The research was conducted from January 2015 to June 2018 and used data from people admitted between 2012 and 2013.
Design
For the review of outcomes, the systematic review identified peer-reviewed quantitative epidemiology measuring prevalence and associations with outcomes. Screening for duplication and relevance was followed by full-text review, quality assessment and a narrative review (141 papers). A survey sought opinion on the key outcomes for people with dementia and/or confusion and their carers in the acute hospital (n = 78). For the analysis of outcomes including cost, the prospective cohort study was in a medical admissions unit in an acute hospital in one Scottish health board covering 10% of the Scottish population. The participants (n = 6724) were older people (aged ≥ 65 years) with or without a cognitive spectrum disorder who were admitted as medical emergencies between January 2012 and December 2013 and who underwent a structured nurse assessment. ‘Cognitive spectrum disorder’ was defined as any combination of delirium, known dementia or an Abbreviated Mental Test score of < 8 out of 10 points. The main outcome measures were living at home 30 days after discharge, mortality within 2 years of admission, length of stay, re-admission within 2 years of admission and cost.
Data sources
Scottish Morbidity Records 01 was linked to the Older Persons Routine Acute Assessment data set.
Results
In the systematic review, methodological heterogeneity, especially concerning diagnostic criteria, means that there is significant overlap in conditions of patients presenting to general hospitals with confusion. Patients and their families expect that patients are discharged in the same or a better condition than they were in on admission or, failing that, that they have a satisfactory experience of their admission. Cognitive spectrum disorders were present in more than one-third of patients aged ≥ 65 years, and in over half of those aged ≥ 85 years. Outcomes were worse in those patients with cognitive spectrum disorders than in those without: length of stay 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year mortality or re-admission 62.4% vs. 51.5%, respectively (all p < 0.01). There was relatively little difference by cognitive spectrum disorder type; for example, the presence of any cognitive spectrum disorder was associated with an increased mortality over the entire period of follow-up, but with different temporal patterns depending on the type of cognitive spectrum disorder. The cost of admission was higher for those with cognitive spectrum disorders, but the average daily cost was lower.
Limitations
A lack of diagnosis and/or standardisation of diagnosis for dementia and/or delirium was a limitation for the systematic review, the quantitative study and the economic study. The economic study was limited to in-hospital costs as data for social or informal care costs were unavailable. The survey was conducted online, limiting its reach to older carers and those people with cognitive spectrum disorders.
Conclusions
Cognitive spectrum disorders are common in older inpatients and are associated with considerably worse health-care outcomes, with significant overlap between individual cognitive spectrum disorders. This suggests the need for health-care systems to systematically identify and develop care pathways for older people with cognitive spectrum disorders, and avoid focusing on only condition-specific pathways.
Future work
Development and evaluation of a multidomain intervention for the management of patients with cognitive spectrum disorders in hospital.
Study registration
This study is registered as PROSPERO CRD42015024492.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Emma Reynish
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Simona Hapca
- School of Medicine, University of Dundee, Dundee, UK
| | - Rebecca Walesby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Angela Pusram
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Feifei Bu
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Jennifer K Burton
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Vera Cvoro
- Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - James Galloway
- Health Informatics Centre, University of Dundee, Dundee, UK
| | | | - Marion Latimer
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | | | - Gordon Wilcock
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Peter Donnan
- School of Medicine, University of Dundee, Dundee, UK
| | - Bruce Guthrie
- School of Medicine, University of Dundee, Dundee, UK
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Alsayyad E, Helmy AA, Kishk NA, Farghaly M, Ragab AH, El-Jaafary SI. Gender difference in health issues and cognitive functions among an Egyptian normal elderly population. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-0146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Aging is associated with changes in cognitive functions. However, many other factors may affect cognitive functions and this interaction needs further assessment.
Objectives
To detect gender differences in sleep quality, nutritional status, and health-related quality of life and their impact on performance in verbal fluency tasks among apparently healthy elderly.
Subjects and methods
The study was conducted on 102 normal aged subjects, 51 males and 51 females. Subjects were divided according to age into group ≥ 60 years and group < 60 years as a control. They were subjected to clinical assessment, Medical outcome study Short-Form 36-item Health Survey, Pittsburgh sleep quality index, mini nutritional assessment and Category Verbal fluency for animals and girls’ names.
Results
Among the older group, females had significantly poorer physical and mental health, sleep quality and nutritional status than males (p value 0.001, 0.003, 0.012, and 0.014, respectively). Older females had significantly lower performance in verbal fluency (girls’ names) compared to younger females (p value 0.013), but no significant gender difference was found among the older group. Verbal fluency tasks are correlated to the level of education in both males and females (r 0.392 and 0.42, p value 0.029 and 0.019, respectively), However, in older males, it is also correlated to sleep latency (r 0.41 and p value 0.021).
Conclusion
Older females had poorer sleep quality, lower health-related quality of life and lower nutritional status. No gender difference was found in verbal fluency tasks. Although no single variable could independently affect verbal fluency, education remains the main player in the difference in performance.
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The Relationship Between Dementia Subtypes and Nutritional Parameters in Older Adults. J Am Med Dir Assoc 2020; 21:1430-1435. [DOI: 10.1016/j.jamda.2020.06.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
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Tsutsumiuchi K, Wakabayashi H, Maeda K, Shamoto H. Impact of malnutrition on post-stroke cognitive impairment in convalescent rehabilitation ward inpatients. Eur Geriatr Med 2020; 12:167-174. [PMID: 32940865 DOI: 10.1007/s41999-020-00393-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the relationship between malnutrition risk on admission and improvement in post-stroke cognitive impairment (PSCI). METHODS This retrospective cohort study included 90 patients with PSCI with a Mini-Mental State Examination (MMSE) score ≤ 23, who were admitted to a rehabilitation hospital between July 2013 and December 2015. We assessed the malnutrition risk using the Mini Nutritional Assessment-Short Form (MNA-SF) and cognitive improvement using the Functional Independence Measure cognitive subscale (cognitive FIM) gain. Participants were classified into the malnourished (MNA-SF score ≤ 7) and adequately nourished groups (≥ 8). The patients' age, modified Rankin Scale score, time to hospitalization, and length of stay were recorded. The relationship between nutritional status and cognitive FIM was determined using a multivariate regression model. RESULTS The study included 47 men and 43 women, with a mean age of 75.0 (standard deviation: 8.7) years. The number of patients in the malnourished and adequately nourished groups were 68 (75.6%) and 22 (24.4%), respectively. The median MMSE score was 19 (interquartile range 15-22), and the median cognitive FIM score at admission was 17 (interquartile range 11-21.8). Univariate analysis showed no significant difference in cognitive FIM gain between the malnourished and adequately nourished groups (P = 0.781). Multivariate regression analysis showed that the MNA-SF score (beta = 0.84, P = 0.009) and cognitive FIM at admission (beta = - 0.347, P < 0.001) were independently related to cognitive FIM gain. CONCLUSION Most patients with PSCI were malnourished; malnutrition on admission for rehabilitation was associated with poor improvement after PSCI.
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Affiliation(s)
- Keita Tsutsumiuchi
- Department of Rehabilitation, Takarazuka Rehabilitation Hospital, 22-2, Tsurunosou, Takarazuka-shi, Hyogo, 665-0833, Japan. .,Department of Rehabilitation, Ikoma Hospital, 8 Tsukumo, Hirone-aza, Inagawa-chou, Kawabe-gun, Hyogo, 666-0252, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Hiroshi Shamoto
- Takano Hospital, 214 Higashimachi, Shimokitaba, Hironomachi, Futaba-gun, Fukushima, 979-0402, Japan.,Department of Disaster and Comprehensive Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
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Barbosa R, Midão L, Almada M, Costa E. Cognitive performance in older adults across Europe based on the SHARE database. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:584-599. [PMID: 32741311 DOI: 10.1080/13825585.2020.1799927] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With ageing mental health issues, as age-related cognitive decline, increase. This study aims to evaluate the prevalence of cognitive impairment among older European adults and to evaluate its association with clinical and sociodemographic variables, using SHARE. Numeracy, temporal orientation, verbal fluency, and memory were the measures used to evaluate cognitive performance. From 44 963 individuals included, mean age was 70.0±9.0 years old and 56.3% were female. Overall prevalence of impairment was of 13.0% (temporal orientation), 24.8% (numeracy), 27.6% (verbal fluency) and 50.5% (memory). Men showed higher impairment prevalence in temporal orientation and memory and lower in numeracy and verbal fluency. Age, fewer years of education, difficulties performing iADLs, physical inactivity, and poor self-perceived health were independently associated with impairment in all cognitive abilities. These results showed the burden of cognitive impairment across Europe. Factors identified as associated should be taken in consideration to develop effective interventions to prevent cognitive decline.
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Affiliation(s)
- Rui Barbosa
- UCIBIO REQUIMTE, Faculty of Pharmacy, Competences Center on Active and Healthy Ageing, University of Porto , Porto, Portugal
| | - Luís Midão
- UCIBIO REQUIMTE, ICBAS, Competences Center on Active and Healthy Ageing, University of Porto , Porto, Portugal
| | - Marta Almada
- UCIBIO REQUIMTE, Faculty of Pharmacy, Competences Center on Active and Healthy Ageing, University of Porto , Porto, Portugal
| | - Elísio Costa
- UCIBIO REQUIMTE, Faculty of Pharmacy, Competences Center on Active and Healthy Ageing, University of Porto , Porto, Portugal
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Assis APM, de Oliveira BTN, Gomes AL, Soares ADN, Guimarães NS, Gomes JMG. The association between nutritional status, advanced activities of daily living, and cognitive function among Brazilian older adults living in care homes. Geriatr Nurs 2020; 41:899-904. [PMID: 32653259 DOI: 10.1016/j.gerinurse.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
Institutionalized older adults are at greater risk of malnutrition, which is associated with cognitive impairment. This study investigated the association between nutritional status, advanced activities of daily living (AADL), and cognitive function among Brazilian older adults living in care homes. This cross-sectional study was conducted on 95 older adults (73.3 ± 12.5 years). Socio-demographic variables, cognitive function (measured by Mini Mental State Examination - MMSE), AADL, Mini Nutritional Assessment (MNA), and anthropometric variables were assessed. Regarding MNA, 37.8% were malnourished, 47.3% were at risk of malnutrition, and 14.9% were well-nourished. Malnourished participants (37.8%) and those with fewer number of AADL (82.3%) showed cognitive decline (MMSE < 24) (p = 0.000 and 0.030, respectively). Inadequate waist-hip ratio was associated with cognitive decline (OR 9.3; 95% IC, 9.06 - 9.85; p = 0.03). Nutritional status and AADL were associated with cognitive function. Nutritional assessment helps to early identify malnutrition and possibly to prevent cognitive impairment.
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Affiliation(s)
| | | | - Arlindo Leandro Gomes
- Instituto Federal do Sudeste de Minas Gerais, Campus Barbacena, Barbacena, MG, Brazil
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The Interplay of Diet Quality and Alzheimer's Disease Genetic Risk Score in Relation to Cognitive Performance Among Urban African Americans. Nutrients 2019; 11:nu11092181. [PMID: 31514322 PMCID: PMC6769979 DOI: 10.3390/nu11092181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 12/23/2022] Open
Abstract
We examined the interactive associations of poor diet quality and Alzheimer’s Disease (AD) genetic risk with cognitive performance among 304 African American adults (mean age~57 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. In this cross-sectional study, selected participants had complete predictors and covariate data with 13 cognitive test scores as outcomes. Healthy Eating Index-2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH), and mean adequacy ratio (MAR) were measured. A genetic risk score for AD in HANDLS (hAlzScore) was computed from 12 selected single nucleotide polymorphisms (SNPs). Our key hypotheses were tested using linear regression models. The hAlzScore was directly associated with poor performance in verbal memory (−0.4 ± 0.2, 0.01) and immediate visual memory (0.4 ± 0.2, 0.03) measured in seconds, in women only. The hAlzScore interacted synergistically with poorer diet quality to determine lower cognitive performance on a test of verbal fluency. Among numerous SNP × diet quality interactions for models of cognitive performance as outcomes, only one passed correction for multiple testing, namely verbal fluency. Our results suggest that improved diet quality can potentially modify performance on cognitive tests of verbal fluency among individuals with higher AD genetic risk.
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Rubin LH, Gustafson D, Hawkins KL, Zhang L, Jacobson LP, Becker JT, Munro CA, Lake JE, Martin E, Levine A, Brown TT, Sacktor N, Erlandson KM. Midlife adiposity predicts cognitive decline in the prospective Multicenter AIDS Cohort Study. Neurology 2019; 93:e261-e271. [PMID: 31201294 PMCID: PMC6656644 DOI: 10.1212/wnl.0000000000007779] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/11/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Obesity is a common, modifiable cardiovascular and cerebrovascular risk factor. Among people with HIV, obesity may contribute to multisystem dysregulation including cognitive impairment. We examined body mass index (BMI) and central obesity (waist circumference [WC]) in association with domain-specific cognitive function and 10-year cognitive decline in men with HIV infection (MWH) vs HIV-uninfected (HIV-) men. METHODS A total of 316 MWH and 656 HIV- Multicenter AIDS Cohort Study participants ≥40 years at baseline, with neuropsychological testing every 2 years and concurrent BMI and WC measurements, were included. MWH were included if taking ≥2 antiretroviral agents and had HIV-1 RNA <400 copies/mL at >80% of visits. Mixed-effects models included all visits from 1996 to 2015, stratified by HIV serostatus, and adjusted for sociodemographic, behavioral, and clinical characteristics. At baseline and follow-up, 8% of MWH and 15% of HIV- men and 41% of MWH and 56% of HIV- men were ≥60 years, respectively. RESULTS Cross-sectionally, higher BMI was inversely associated with motor function in MWH and HIV- men, and attention/working memory in HIV- men. WC was inversely associated with motor function in MWH and HIV- men. Longitudinal associations indicated an obese BMI was associated with a less steep decline in motor function in MWH whereas in HIV- men, obesity was associated with a greater decline in motor function, learning, and memory. WC, or central obesity, showed similar patterns of associations. CONCLUSION Higher adiposity is associated with lower cognition cross-sectionally and greater cognitive decline, particularly in HIV- men. Overweight and obesity may be important predictors of neurologic outcomes and avenues for prevention and intervention.
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Affiliation(s)
- Leah H Rubin
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles.
| | - Deborah Gustafson
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Kellie L Hawkins
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Long Zhang
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Lisa P Jacobson
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - James T Becker
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Cynthia A Munro
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Jordan E Lake
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Eileen Martin
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Andrew Levine
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Todd T Brown
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Ned Sacktor
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
| | - Kristine M Erlandson
- From the Departments of Neurology (L.H.R., C.A.M., N.S.), Psychiatry (C.A.M.), and Medicine (T.T.B.), Johns Hopkins University School of Medicine; Department of Epidemiology (L.H.R., L.Z., L.P.J.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Neurology (D.G.), State University of New York Downstate Medical Center, Brooklyn; University of Colorado (K.L.H., K.M.E.), Aurora; Denver Public Health (K.L.H.), CO; Department of Neurology (J.T.B.), University of Pittsburgh, PA; Department of Medicine (J.E.L.), University of Texas Health Science Center at Houston; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago, IL; and Department of Neurology (A.L.), David Geffen School of Medicine at the University of California, Los Angeles
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Tasci I, Safer U, Naharci MI. Multiple Antihyperglycemic Drug Use is Associated with Undernutrition Among Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Diabetes Ther 2019; 10:1005-1018. [PMID: 30924077 PMCID: PMC6531590 DOI: 10.1007/s13300-019-0602-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Undernutrition is prevalent in older age. Current management of type 2 diabetes mellitus (T2DM) requires modified diet patterns; however, older adults with diabetes may also be at the risk of undernutrition due to age, disease, and medication-related factors. Our objectives in this study were to examine the proportion and associations of undernutrition among community-dwelling older adults with T2DM. METHODS This prospective, cross-sectional study involved older outpatient adults (≥ 65 years) with and without T2DM. We assessed the nutritional status using the Mini Nutritional Assessment-Short Form. Undernutrition referred to being either at risk of malnutrition or malnourished. Variables independently associated with undernutrition were evaluated by logistic regression analysis. RESULTS Five hundred forty-six older adults [n = 215 with T2DM and n = 331 control; mean (SD) age, 74.9 (6.3) years; 388 (71.1%) female] were included in the study. The frequency of undernutrition was 31.1%, which was higher in patients with T2DM than in those without (36.7% vs. 27.5%, p < 0.05). However, the difference was no longer significant after adjustment for covariates (gender, lower education, lower body mass index, cardiovascular disease, multimorbidity, cognitive performance, functional performance, depressive symptoms, and polypharmacy). In the T2DM group, the ratio of multiple antihyperglycemic drug use (≥ 2) was higher in those with undernutrition compared with normal nutritional status (78.5% vs. 59.6%, p = 0.005). On multivariable analysis, decreased functional performance, depressive symptoms, and use of multiple antihyperglycemic drugs were associated with undernutrition in patients with T2DM. CONCLUSIONS Undernutrition was more common among older adults with T2DM compared with the control group. Undernutrition was further dependent on chronic conditions and diabetes management.
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Affiliation(s)
- Ilker Tasci
- Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey.
- Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey.
| | - Umut Safer
- Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey
- Department (s) of Internal Medicine and Palliative Care, Turkish Ministry of Health, Sancaktepe Sehit Profesor İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ilkin Naharci
- Department of Internal Medicine, University of Health Sciences, Gulhane Faculty of Medicine, Ankara, Turkey
- Department of Internal Medicine, Turkish Ministry of Health, Gulhane Training and Research Hospital, Ankara, Turkey
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Appetite, Metabolism and Hormonal Regulation in Normal Ageing and Dementia. Diseases 2018; 6:diseases6030066. [PMID: 30036957 PMCID: PMC6164971 DOI: 10.3390/diseases6030066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022] Open
Abstract
Feeding and nutrition follow the growth trajectory of the course of life. The profound physiological changes that human body experiences during ageing affect separate aspects of food intake, from tastant perception to satiety. Concurrent morbidities, such as neurodegeneration, as seen in dementia, and metabolic syndrome, may further shape nutritional behaviours, status and adequacy. In an effort to fill the gap between the exhausting basic research and the actual needs of professionals caring for the exponentially expanding ageing population, the current review addresses major factors relevant to appetite and eating disturbances. Does age alter the perception of food modalities? Is food generally still perceived as alluring and delicious with age? Is there an interplay between ageing, cognitive decline, and malnutrition? What tools can we adopt for proper and timely monitoring? Finally, what anatomical and pathophysiological evidence exists to support a hypothesis of central regulation of metabolic perturbations in normal and accelerated cognitive impairment, and how can we benefit from it in health practice?
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Park M, Song JA, Lee M, Jeong H, Lim S, Lee H, Kim CG, Kim JS, Kim KS, Lee YW, Lim YM, Park YS, Yoon JC, Kim KW, Hong GRS. National study of the nutritional status of Korean older adults with dementia who are living in long-term care settings. Jpn J Nurs Sci 2018; 15:318-329. [PMID: 29345106 DOI: 10.1111/jjns.12203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 08/24/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023]
Abstract
AIM To evaluate the nutritional status of older adults with dementia who were living in long-term care settings. METHODS As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data. RESULTS The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status. CONCLUSION The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.
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Affiliation(s)
- Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Jun-Ah Song
- College of Nursing, Korea University, Seoul, South Korea
| | - Mihyun Lee
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Hyun Jeong
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Soyeun Lim
- College of Nursing, Korea University, Seoul, South Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, South Korea
| | - Chun-Gill Kim
- Division of Nursing, Hallym University, Chuncheon, South Korea
| | - Jeong S Kim
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Kyung S Kim
- Department of Nursing, Namseoul University, Cheonan, South Korea
| | - Young W Lee
- Department of Nursing, Inha University, Incheon, South Korea
| | - Young M Lim
- Department of Nursing, Yonsei University, Wonju, South Korea
| | - Young S Park
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| | - Jong C Yoon
- Department of Psychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin, South Korea
| | - Ki W Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
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Franx BAA, Arnoldussen IAC, Kiliaan AJ, Gustafson DR. Weight Loss in Patients with Dementia: Considering the Potential Impact of Pharmacotherapy. Drugs Aging 2017; 34:425-436. [PMID: 28478593 DOI: 10.1007/s40266-017-0462-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unintentional body weight loss is common in patients with dementia and is linked to cognitive impairment and poorer disease outcomes. It is proposed that some dementia medications with market approval, while aiming to improve cognitive and functional outcomes of a patient with dementia, are associated with reported body weight or body mass index loss. This review presents evidence in the published literature on body weight loss in dementia, describes selected theories behind body weight loss, evaluates the potential impact of approved dementia pharmacotherapies on body weight, considers the potential role for medical foods, understands the potential influence of treatments for neuropsychiatric symptoms and signs, and finally, summarizes this important area.
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Affiliation(s)
- Bart A A Franx
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse A C Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA. .,Neuropsychiatric Epidemiology Unit (EPINEP), Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Department of Health and Education, University of Skövde, Skövde, Sweden.
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Soysal P, Isik AT. Effects of Acetylcholinesterase Inhibitors on Nutritional Status in Elderly Patients with Dementia: A 6-month Follow-up Study. J Nutr Health Aging 2016; 20:398-403. [PMID: 26999239 DOI: 10.1007/s12603-015-0603-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Nutritional status is one of the factors that affects disease progression, morbidity and mortality in elderly patients with dementia. The present study aimed to evaluate the effect of acetylcholinesterase inhibitor (AchEI) therapy on nutritional status and food intake in the elderly. DESIGN, SETTING AND PARTICIPANTS Newly diagnosed patients with dementia, who underwent comprehensive geriatric assessment (CGA) and were followed at regular intervals, were retrospectively evaluated. A total of 116 patients, who began to receive AchEI therapy and completed 6-month follow-up period under this treatment, were enrolled in the study. MEASUREMENTS Socio-demographic characteristics and data on comorbidity, polypharmacy, cognitive function, depression, activities of daily living and nutritional status (weight, Body Mass Index (BMI), Mini Nutritional Assessment (MNA)-Short Form) were recorded. RESULTS The mean age of the patients was 78.0±8.9 years. There was no significant difference between baseline and 6-month BMI, weight and MNA scores of dementia patients who received AchEI therapy (p>0.05). With regard to the relation between changes in BMI, weight and MNA on the 6th month versus baseline, and donepezil, rivastigmine and galantamine therapies, no difference was determined (p>0.05). However, no worsening in food intake was observed (kappa: 0.377). When the effects of each AchEI on food intake were compared, food intake in rivastigmine treated patients was not decreased as much as it was in galantamine or donepezil treated patients (p<0.05). CONCLUSION AchEI therapy has no unfavorable effect on nutritional status or weight in elderly patients with different types of dementia, but it seems that food intake is better in those treated by rivastigmine patch.
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Affiliation(s)
- P Soysal
- Prof .Dr. Ahmet Turan ISIK, Dokuz Eylul Universitesi Tıp Fakultesi, Geriatri Bilim Dalı Yaşlanan Beyin ve Demans Unitesi, 35340 Balcova - Izmir / Turkey, Tel: +90 232 412 43 41, Fax:+90 232 412 43 49, E-Mail:
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Lyngroth AL, Hernes SMS, Madsen BO, Söderhamn U, Grov EK. Nutritional screening of patients at a memory clinic - association between patients’ and their relatives’ self-reports. J Clin Nurs 2016; 25:760-8. [DOI: 10.1111/jocn.13093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 01/27/2023]
Affiliation(s)
| | - Susanne Miriam Sørensen Hernes
- Department of Clinical Science, University of Bergen and Department of Geriatrics and Internal Medicine; Sorlandet Hospital Arendal; Arendal Stoa Norway
| | - Bengt-Ove Madsen
- The Memory Clinic; Sorlandet Hospital Arendal; Arendal Stoa Norway
| | - Ulrika Söderhamn
- Faculty of Health and Sports Sciences; University of Agder; Grimstad Norway
| | - Ellen Karine Grov
- Department of Nursing and Health
Promotion; Oslo and Akershus University of Applied Sciences; Oslo Norway
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Association between mild cognitive impairment and dementia and undernutrition among elderly people in Central Africa: some results from the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme. Br J Nutr 2015; 114:306-15. [PMID: 26099336 DOI: 10.1017/s0007114515001749] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Several studies in Western countries have shown an association between cognitive disorders and low BMI or weight loss in elderly people. However, few data are available in Africa. We analysed the association between cognitive disorders and undernutrition among elderly people in Central Africa. A cross-sectional, multicentre, population-based study using a two-phase design was carried out in subjects aged 65 years and above in the Central African Republic (CAR) and the Republic of Congo (ROC). All subjects were interviewed using the Community Screening Interview for Dementia, and those with low performance were clinically assessed by a neurologist and underwent further psychometrical tests. Diagnostic and Statistical Manual-IV and Petersen's criteria were required for the diagnoses of dementia and mild cognitive impairment (MCI), respectively. Undernutrition was evaluated using mid-upper arm circumference (MUAC) < 24 cm, BMI < 18.5 kg/m(2) and arm muscular circumference (AMC) < 5th percentile. Multivariate binary logistic regression models were used to estimate the associations. In CAR, MCI was associated with MUAC < 24 cm (OR 0.7, 95% CI 0.4, 1.0) and dementia with BMI < 18.5 kg/m(2) (OR 2.3, 95% CI 1.6, 3.1), AMC < 5th percentile (OR 2.3, 95% CI 1.1, 4.6) and MUAC < 24 cm (OR 1.8, 95% CI 1.4, 2.4). In ROC, both MCI and dementia were associated with all markers of undernutrition, but only AMC < 5th percentile was significantly associated with MCI (OR 3.1, 95% CI 1.9, 4.8). In conclusion, cognitive disorders were associated with undernutrition. However, further studies are needed to elucidate the relationship between MCI and undernutrition in CAR.
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Koh F, Charlton K, Walton K, McMahon AT. Role of dietary protein and thiamine intakes on cognitive function in healthy older people: a systematic review. Nutrients 2015; 7:2415-39. [PMID: 25849949 PMCID: PMC4425152 DOI: 10.3390/nu7042415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 12/05/2022] Open
Abstract
The effectiveness of nutritional interventions to prevent and maintain cognitive functioning in older adults has been gaining interest due to global population ageing. A systematic literature review was conducted to obtain and appraise relevant studies on the effects of dietary protein or thiamine on cognitive function in healthy older adults. Studies that reported on the use of nutritional supplementations and/or populations with significant cognitive impairment were excluded. Seventeen eligible studies were included. Evidence supporting an association between higher protein and/or thiamine intakes and better cognitive function is weak. There was no evidence to support the role of specific protein food sources, such as types of meat, on cognitive function. Some cross-sectional and case-control studies reported better cognition in those with higher dietary thiamine intakes, but the data remains inconclusive. Adequate protein and thiamine intake is more likely associated with achieving a good overall nutritional status which affects cognitive function rather than single nutrients. A lack of experimental studies in this area prevents the translation of these dietary messages for optimal cognitive functioning and delaying the decline in cognition with advancing age.
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Affiliation(s)
- Freda Koh
- School of Medicine, University of Wollongong, New South Wales 2522, Australia.
| | - Karen Charlton
- School of Medicine, University of Wollongong, New South Wales 2522, Australia.
| | - Karen Walton
- School of Medicine, University of Wollongong, New South Wales 2522, Australia.
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Tian CR, Qian L, Shen XZ, Li JJ, Wen JT. Distribution of serum total protein in elderly Chinese. PLoS One 2014; 9:e101242. [PMID: 24967900 PMCID: PMC4072719 DOI: 10.1371/journal.pone.0101242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022] Open
Abstract
The serum total protein levels of the elderly possibly decrease gradually with aging. However, serum total protein levels are not suitable as a uniform reference standard for the elderly at different ages and genders. Thus, we investigated the total serum protein distribution in different gender and age groups of 11,453 elderly individuals aged ≥60 years and without liver or renal disease from Lianyungang, Jiangsu, China. The total protein levels (TPL) of these individuals exhibited normal distribution (Z = 1.206, P = 0.109), whereas the reference range (95% CI) was 54.1 g/L to 82.3 g/L. TPL was higher in females than in males for those aged between 60 and 75 years, whereas no significant difference was observed for those aged between 80 and 95 years. TPL was negatively correlated with age in males (r = −0.1342, P<0.05), females (r = −0.304, P<0.05), and the total group (r = −0.2136, P<0.05). TPL also decreased with aging and showed a faster rate in women than in men. These results indicated that an appropriate range of serum total protein based on age and gender differences should be used for clinical applications.
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Affiliation(s)
- Chang-Rong Tian
- Department of Geriatrics, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Li Qian
- Department of Microbiology Laboratory, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Xiao-Zhu Shen
- Department of Geriatrics, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Jia-Jing Li
- Department of Electronic and Information Engineering Center, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Jiang-Tao Wen
- Department of Clinical Science Experiment Center, The Second People's Hospital of Lianyungang, Xinpu, China
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El Zoghbi M, Boulos C, Amal AH, Saleh N, Awada S, Rachidi S, Bawab W, Salameh P. Association between cognitive function and nutritional status in elderly: A cross-sectional study in three institutions of Beirut—Lebanon. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.gmhc.2013.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Castro-Costa É, Peixoto SV, Firmo JO, Uchoa E, Lima-Costa MFF. The association between nutritional status and cognitive impairment in brazilian community-dwelling older adults assessed using a range of anthropometric measures - the Bambui study. Dement Neuropsychol 2013; 7:403-409. [PMID: 29213865 PMCID: PMC5619502 DOI: 10.1590/s1980-57642013dn74000008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 11/15/2013] [Indexed: 12/25/2022] Open
Abstract
In most studies, body mass index (BMI) has been used as the main measurement of nutritional status. However, BMI does not differentiate between body fat and muscle mass. OBJECTIVE To investigate the association between nutritional status and cognitive impairment in a population of Brazilian elderly. METHODS Participants (n=1,496) from the Bambuí Cohort Study of Aging were selected based on the results for the two variables nutritional status and cognitive impairment (MMSE score). Gender, age, education, lifestyle, ApoE, chronic diseases, depressive symptoms, current use of hypnotic or sedative medication and functional disability were used as confounding factors for adjusting the logistic regression. RESULTS Cognitive impairment was associated with lower BMI (OR: 0.91; CI: 0.86-0.95), waist circumference (OR: 0.97; CI: 0.95-0.99), triceps skinfold thickness (OR: 0.92; CI: 0.89-0.96) among the younger participants (60-69 years), while lower arm muscle circumference (OR: 0.88; CI: 0.80-0.98) and corrected arm muscle area (OR: 0.96; CI: 0.93-0.99) were associated with cognitive impairment among the older participants (70 years and over). CONCLUSION There was a difference of association between anthropometric measures and cognitive impairment after stratifying by age group. In the group aged between 60 and 69, cognitive impairment was associated with measures related to fat mass, while in the group aged over 70, cognitive impairment was associated with measures related to muscle mass. This finding suggests that investigation of nutritional status in the elderly using anthropometric measures should not be restricted only to the use of BMI, and should also, differ according to age.
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Affiliation(s)
- Érico Castro-Costa
- Núcleo de Estudos em Saúde Publica e
Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
| | - Sérgio V. Peixoto
- Núcleo de Estudos em Saúde Publica e
Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
- Escola de Enfermagem, Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
| | - Josélia O.A. Firmo
- Núcleo de Estudos em Saúde Publica e
Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
| | - Elizabeth Uchoa
- Núcleo de Estudos em Saúde Publica e
Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
| | - Maria Fernanda F. Lima-Costa
- Núcleo de Estudos em Saúde Publica e
Envelhecimento, Fundação Oswaldo Cruz/Universidade Federal de Minas
Gerais, Belo Horizonte MG, Brazil
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Gao L, Dong B, Hao QK, Ding X. Association between cognitive impairment and eating habits in elderly Chinese subjects over 90 years of age. J Int Med Res 2013; 41:1362-9. [PMID: 23760916 DOI: 10.1177/0300060513479868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Eating habits may have a key influence on cognitive function, however, the relationship between dietary intake and cognitive impairment in the elderly Chinese population has not been explored. The present study investigated the association between cognitive impairment and eating habits in elderly Chinese subjects >90 years of age. METHODS This study comprised data from subjects included in the 2005 Project of Longevity and Ageing in Dujiangyan, China. Subjects were divided into two groups: cognitive impairment group and normal group. Sociodemographic and dietary habit data were collected and cognitive function was assessed in all subjects using the Mini-Mental State Examination. RESULTS Data from 763 subjects (249 men, 514 women) were included. There was no statistically significant difference in eating habits between the two groups. Education level in the cognitive impairment group was significantly lower than in the normal group. Significant between-group differences were detected in factors relating to subjects' professions. CONCLUSIONS Eating habits were not related to cognitive impairment in elderly Chinese people >90 years of age.
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Affiliation(s)
- Lingyun Gao
- West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
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Geriatric syndromes increased the nutritional risk in elderly cancer patients independently from tumour site and metastatic status. The ELCAPA-05 cohort study. Clin Nutr 2013; 33:330-5. [PMID: 23786899 DOI: 10.1016/j.clnu.2013.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/12/2013] [Accepted: 05/22/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS We assessed the prevalence and risk factors of malnutrition in elderly cancer patients. METHODS We studied a prospective cohort of solid cancer patients aged ≥70 years at referral to two geriatric oncology clinics between 2007 and 2010. Nutrition was evaluated using the Mini-Nutritional Assessment (MNA) using validated cut-offs (<17: malnutrition, 17-23.5: at-risk for malnutrition). Patients with non-digestive tumours (breast, prostate, urinary tract) and with digestive (colorectal, upper digestive tract and liver) were analysed separately using multinomial logistic regression. RESULTS Of 643 consecutive patients, 519 had available data (median age, 80; men, 48.2%; metastases, 46.3%; digestive cancer 47.8%). In non-digestive group, 13.3% had malnutrition versus 28.6% in digestive group. The link between metastasis and malnutrition was significantly higher in non-digestive group (adjusted odds ratio [ORa ], 25.25; 95%CI: 5.97-106.8) than in digestive group (ORa, 2.59; 1.08-6.24; p for heterogeneity = 0.04). Other factors independently associated with malnutrition were cognitive impairment (ORa MMMSE ≤ 24 versus > 24 in non-digestive group: 16.68; 4.89-56.90 and in digestive group: 3.93; 1.34-11.50), and depressed mood (ORa MiniGDS ≥1 versus <1 in non-digestive group: 11.11; 3.32-37.17 and in digestive group: 3.25; 1.29-8.15) and fall risk (ORa fall risk versus no fall risk in non-digestive group: 4.68; 1.77-12.37; in digestive group: 100% of malnourished patients were faller's). CONCLUSION We highlighted, in elderly cancer patients, the high prevalence of malnutrition and that geriatrics syndromes (i.e. cognitive impairment, depressed mood and fall risk) were independent risk factors for malnutrition. Moreover, metastatic status was significantly much more strongly associated with malnutrition in non-digestive than digestive tumours.
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