Nutritional status determinants and cognition in the elderly

Icariin, astragaloside a and puerarin mixture attenuates cognitive impairment in APP/PS1 mice via inhibition of ferroptosis-lipid peroxidation

Alzheimer's disease (AD) is a neurodegenerative disease that seriously threatens the quality of life of the elderly. Its pathogenesis has not yet been fully elucidated. Ferroptosis, a cell death caused by excessive accumulation of iron-dependent lipid peroxides, has been implicated in the pathogenesis of AD. Uncontrolled lipid peroxidation is the core process of ferroptosis, and inhibiting lipid peroxidation of ferroptosis may be an important therapeutic target for AD. Based on previous studies, we mixed standards of icariin, astragaloside IV, and puerarin, named the standard mixture YHG, and investigated the effect of YHG on ferroptosis -lipid peroxidation in APP/PS1 mice. DFX, a ferroptosis inhibitor, was used as a control drug. In this study, APP/PS1 mice were used as an AD animal model, and behavioral experiments, iron level detection, Transmission electron microscopy (TEM) observation, lipid peroxidation level detection, antioxidant capacity detection, immunofluorescence, Western blot and real-time qPCR were performed. It was found that YHG could reduce body weight, significantly improve abnormal behaviors and the ultrastructure of hippocampal neurons in APP/PS1 mice. The results of biochemical tests showed that YHG reduced the contents of iron, malondialdehyde (MDA) and lipid peroxide (LPO) in brain tissue and serum, and increased the levels of superoxide dismutase (SOD) and reduced glutathione (GSH). Immunofluorescence, WesternBlot and real-time qPCR results showed that YHG could promote the expression of solute carrier family 7 member 11 (SLC7A11), solute carrier family 3 member 2 (SLC3A2) and glutathione peroxidase 4(GPX4). Inhibited the expression of long-chain acyllipid coenzyme a synthetase 4(ACSL4) and lysophosphatidyltransferase 3 (LPCAT3). This study suggests that the mechanism by which YHG improves cognitive dysfunction in APP/PS1 mice may be related to the inhibition of ferroptosis-lipid peroxidation.

The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review

BACKGROUND

Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous.

OBJECTIVE

We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes).

METHODS

A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded.

RESULTS

Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal.

CONCLUSIONS

Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion.

TRIAL REGISTRATION

OSF Registries 79AFZ; https://osf.io/79afz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44201.

Nutritional Status and Serum Levels of Micronutrients in an Elderly Group Who Participate in the Program for Complementary Food in Older People (PACAM) from the Metropolitan Region, Santiago de Chile

The increase in the Chilean elderly population has promoted public policies to favor an adequate nutrition in later life. This study evaluated the nutritional status, micronutrients intake and serum micronutrients levels of an elderly group beneficiary of the PACAM from the Metropolitan Region, Santiago de Chile. Anthropometric and dietary survey (24 h food recalls) were assessed in 182 elderly individuals (60 and 80 years old). Blood serum collection was used to measure the micronutrient status. The sample was comprised by 12.6%, 46.1%, 28.0% and 13.2% of underweight, normal weight, overweight and obese subjects, respectively. Women presented 11% of underweight, 45% of normal weight and 44% of overweight and obese, while men—18%, 50% and 32%, respectively. Only the 63% of the elderlies consumed PACAM foods, reaching average daily intakes below (50%) the recommended daily serving. Serum deficiencies of 25-hydroxyvitamin D (88%), vitamin B₁₂ (33%) and calcium (36%) were observed, being the highest ones in the PACAM foods women (60–75 years old). Chilean elderlies presented mainly a normal weight; however, an important proportion of overweight/obese subjects was observed. Although PACAM foods consumption significantly increased the micronutrient intake, it was not enough to ensure an adequate serum micronutrient levels in the elderly.

LDL cholesterol and uridine levels in blood are potential nutritional biomarkers for clinical progression in Alzheimer's disease: The NUDAD project

INTRODUCTION

We examined associations between nutritional biomarkers and clinical progression in individuals with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD)-type dementia.

METHODS

We included 528 individuals (64 ± 8 years, 46% F, follow-up 2.1 ± 0.87 years) with SCD (n = 204), MCI (n = 130), and AD (n = 194). Baseline levels of cholesterol, triglycerides, glucose, homocysteine, folate, vitamin A, B12, E and uridine were measured in blood and S-adenosylmethionine and S-adenosylhomocysteine in cerebrospinal fluid. We determined associations between nutritional biomarkers and clinical progression using Cox proportional hazard models.

RESULTS

Twenty-two (11%) patients with SCD, 45 (35%) patients with MCI, and 100 (52%) patients with AD showed clinical progression. In SCD, higher levels of low-density lipoprotein (LDL) cholesterol were associated with progression (hazard ratio [HR] [95% confidence interval (CI)] 1.88 [1.04 to 3.41]). In AD, lower uridine levels were associated with progression (0.79 [0.63 to 0.99]).

DISCUSSION

Our findings suggest that LDL cholesterol and uridine play a-stage-dependent-role in the clinical progression of AD.

Neuro-nutrients as anti-alzheimer's disease agents: A critical review

Alzheimer's disease (AD) is characterized by a massive neuronal death causing memory loss, cognitive impairment and behavioral alteration that ultimately lead to dementia and death. AD is a multi-factorial pathology controlled by molecular events such as oxidative stress, protein aggregation, mitochondrial dysfunction and neuro inflammation. Nowadays, there is no efficient disease-modifying treatment for AD and epidemiological studies have suggested that diet and nutrition have a significant impact on the development of this disorder. Indeed, some nutrients can protect all kind of cells, including neurons. As prevention is better than cure, life style improvement, with a special emphasis on diet, should seriously be considered as an anti-AD track and intake of nutrients promoting neuronal health is the need of the hour. Diets rich in unsaturated fatty acids, polyphenols and vitamins have been shown to protect against AD, whereas saturated fatty acids-containing diets deprived of polyphenols promote the development of the disease. Thus, Mediterranean diets, mainly composed of fruits, vegetables and omega-3 fatty acids, stand as valuable, mild and preventive anti-AD agents. This review focuses on our current knowledge in the field and how one can fight this devastating neurodegenerative disorder through the simple proper modification of our life style.

Association between cognitive function and supplementation with omega-3 PUFAs and other nutrients in ≥ 75 years old patients: A randomized multicenter study

A few studies have assessed the association between omega-3 polyunsaturated fatty acids (n-3 PUFA) and cognitive impairment (CI) in very old adults. The aim of this study was to evaluate the effect of a multinutrient supplementation rich in n-3 PUFA on the cognitive function in an institutionalized ≥75-year-old population without CI or with mild cognitive impairment (MCI). A multicenter placebo-controlled double-blind randomized trial was conducted between 2012 and 2013. Cognitive function was assessed at baseline and after one year using 4 neuropsychological tests. Nutritional status was assessed using Mini Nutritional Assessment (MNA). Interaction between Mini-Mental State Examination (MMSE) score and nutritional status were analyzed using linear regression models. A total of 99 participants were randomized to receive placebo or pills rich in n-3 PUFA. After 1-year follow-up, both groups decreased their MMSE score (-1.18, SD:0. 53 and -0.82, SD:0. 63, p = 0.67 for the control and the intervention group respectively). The memory subscale of the MMSE showed an improvement (+0.26, SD:0.18) in the intervention group against a worsening in the control group (-0.11, SD: 0.14; p = 0.09 for differences between groups). Patients at intervention group with normal nutritional status (MNA ≥24) showed an improvement in the MMSE (+1.03, p = 0.025 for differences between 1-y and baseline measurements) against a worsening in the group with malnutrition (MNA<24) (-0.4, p = 0.886 for differences between 1-y and baseline; p of interaction p = 0.05). Supplementation with n-3 PUFA did not show an improvement in the global cognitive function in institutionalized elderly people without CI or with MCI. They only suggest an apparent improvement in memory loss if previously they were well nourished.

Validity of the Self- Mini Nutritional Assessment (Self- MNA) for the Evaluation of Nutritional Risk. A Cross- Sectional Study Conducted in General Practice

INTRODUCTION

Malnutrition is a frequent condition in the elderly especially in hospitals and in nursing homes, and even among the free-living elders the prevalence is not negligible (5-10%). Awareness towards malnutrition is still limited. The lack of time for nutritional assessment by the overcommitted healthcare personnel, including the general practitioners (GPs), may represent one possible explanation for limited recognition of malnutrition. Therefore, a self-administered instrument could be useful in raising alert on the GPs and allow early detection of malnutrition and early care provision. The aim of the present study was to analyze the validity of the Self-MNA that takes cue from the Mini Nutritional Assessment- Short Form (MNA-SF) and has been adapted to be self-administered by free-living elderly subjects.

METHODS

Participants were recruited from patients referring to the GP offices in Italy. Nutritional evaluation was performed through the administration of Full-MNA, MNA-SF and Self-MNA. The comorbidity level was assessed through the Cumulative Illness Rating Scale (CIRS). The level of difficulty in filling out the test was reported by the participants, and the time spent to complete the Self-MNA was also registered.

RESULTS

A total of 226 subjects, 125 women and 101 men (75.1 ±8 and 75.3 ± 8 years old, respectively; p=0.89) were enrolled, and 214 (94.7%) of them completed the Self-MNA. According with the Full-MNA test score, 8.4% of women and 3.5% of men were classified as malnourished, whereas 32.7% of women and 31.4% of men were at risk of malnutrition. Agreement between Self-MNA and Full-MNA, and Self-MNA vs. MNA-SF was classified as "moderate" (k = 0.476 and 0.496 respectively; p < 0.001). Self-MNA showed a fair predictive value compared to the Full-MNA and MNA-SF tests (76.6 and 79.9%, respectively) with a barely adequate sensitivity (70.9 and 75.4%, respectively). The analysis of the characteristics of FN (false negative: subjects who were considered at risk of malnutrition or malnourished at Full-MNA but not at Self-MNA) showed that the clinical and functional aspects of these subjects (age, comorbidity and severity, time necessary to complete the Self-MNA, decrease in food intake, severe illness in the past 3 months, dementia and depression, fluid intake, need for feeding assistance, arm and calf circumferences) were very similar to the characteristics of true positive subjects. Patients required 6.7 ± 4.5 minutes to complete the test and 25 subjects (11.7%) needed more than 10 minutes, up to a maximum of 30 minutes. Patients who stated a greater difficulty were older (79.8 ± 7 vs. 73.5 ± 7 years; p<0.001), they were more «malnourished» at Full-MNA (10.7 vs. 1,7%; p= 0.006) and clinical status was characterized by a higher severity index (1.72 ± 0.6 vs. 1.41 ± 0.4; p= 0.008).

CONCLUSION

In the present study we investigated the validity of the Self-MNA in a sample of free-living elderly subjects. The results obtained confirm the validity of the test that may represent a useful tool for the GPs, although some important limitations need to be considered, limiting its use in clinical practice.

Malnutrition and Dysphagia in long-term care: a systematic review

Determining the co-occurrence of malnutrition and dysphagia is important to understand the extent to which swallowing impairment contributes to poor food intake in long-term care (LTC). This review investigated the impact of dysphagia on malnutrition in LTC by synthesizing the results of published literature. Seven electronic databases were used to search for English-language publications reporting malnutrition and dysphagia in LTC facilities from 1946 to 2013. Fourteen studies were eligible for inclusion. Overall, the literature on the co-occurrence of malnutrition and dysphagia in LTC shows a paucity of high-quality evidence. Articles reviewed lacked consistent definitions for both conditions. Methods used to confirm each diagnosis also differed and were of questionable validity. Based on a review of the literature, evidence of the existence of concurrent concerns with respect to malnutrition and dysphagia emerges. The reported frequency of participants in LTC with dysphagia ranges from 7% to 40%, while the percentage of those who were malnourished ranges from 12% to 54%. Due to discrepancies used to describe and measure these conditions, it is difficult to determine the exact prevalence of either condition separately, or in combination. Consequently, the impact of dysphagia on malnutrition must be considered and studied using valid definitions and measures.

Predictors of Long-Term Mortality in Oldest Old Patients (90+) Hospitalized to Medical Wards via the Emergency Department: The SAFES Cohort

OBJECTIVES

To identify risk factors for long-term mortality in patients aged 90 years and over who are admitted to hospital through the emergency department.

DESIGN

Prospective cohort study (SAFES cohort; Sujet Agé Fragile - Évaluation Suivi).

SETTING

8 university teaching hospitals and one regional, non-academic hospital in France.

PARTICIPANTS

Among 1306 patients in the SAFES cohort, 291 patients aged 90 or over were included.

MEASUREMENTS

At inclusion, we recorded socio-demographic data (age, sex, level of education, living alone or in an institution, number of children, presence of helper/caregiver), and data from geriatric evaluation (dependence status, risk of depression, dementia, delirium, nutritional status, walking disorders, risk of falls, comorbidities, risk of pressure sores). Vital status at 36 months was obtained from the treating physician, the general practitioner, administrative registers, or during follow-up consultations.

RESULTS

Among 291 patients included, 190 (65.3%) had died at 36 months. Risk factors for mortality at 36 months identified by multivariate analysis were risk of malnutrition (HR 1.6, 95%CI 1.1-2.3, p=0.004) and delirium (HR 1.6, 95%CI 1.1-2.3, p=0.01).

CONCLUSION

Risk of malnutrition and presence of delirium are risk factors for mortality at 36 months in subjects aged 90 years and over hospitalized through the emergency department.

Which characteristics of nursing home residents influence differences in malnutrition prevalence? An international comparison of The Netherlands, Germany and Austria

Prevalence rates of malnutrition vary considerably internationally, partly due to differences in measurement methodology and instruments. In the present study, the same measurement methodology and instruments were used in The Netherlands, Germany and Austria. The aim of the present study was to investigate whether resident characteristics influence possible differences in malnutrition prevalence between countries. The study followed a cross-sectional, multi-centre design that measured malnutrition in nursing home residents from The Netherlands, Germany and Austria. Resident data were gathered using a standardised questionnaire. Malnutrition was operationalised using BMI, unintentional weight loss and nutritional intake. Data were analysed using an association model. The prevalence rates of malnutrition in The Netherlands, Germany and Austria were 18·3, 20·1 and 22·5 %, respectively. The multivariate generalised estimating equation (GEE) logistic regression analysis showed that sex, age, care dependency, the mean number of diseases and some specific diseases were influencing factors for whether the resident was malnourished or not. The OR of malnutrition in the three countries declined after including the influencing factors resulting from the multivariate GEE analysis. The present study reveals that differences in the prevalence rates of malnutrition in nursing homes in The Netherlands, Germany and Austria are influenced by different resident characteristics. Since other country-related factors could also play an important role in influencing differences in the prevalence rates of malnutrition between the countries (structural and process factors of malnutrition care policy). We recommend the investigation of these factors in future studies.

Importance and management of micronutrient deficiencies in patients with Alzheimer's disease

Alzheimer's disease (AD) is the most common form of dementia, and it generally affects the elderly. It has been suggested that diet is an intensively modifiable lifestyle factor that might reduce the risk of AD. Because epidemiological studies generally report the potential neuronal protective effects of various micronutrients, the aim of this study was to perform a literature review on the major nutrients that are related to AD, including selenium, vitamins C and E, transition metals, vitamin D, B-complex vitamins, and omega-3 fatty acids.

Dietary patterns are associated with cognition among older people with mild cognitive impairment

There has been increasing interest in the influence of diet on cognition in the elderly. This study examined the cross-sectional association between dietary patterns and cognition in a sample of 249 people aged 65–90 years with mild cognitive impairment (MCI). Two dietary patterns; whole and processed food; were identified using factor analysis from a 107-item; self-completed Food Frequency Questionnaire. Logistic regression analyses showed that participants in the highest tertile of the processed food pattern score were more likely to have poorer cognitive functioning; in the lowest tertile of executive function (OR 2.55; 95% CI: 1.08–6.03); as assessed by the Cambridge Cognitive Examination. In a group of older people with MCI; a diet high in processed foods was associated with some level of cognitive impairment.

Six-month outcome of elderly people hospitalized via the emergency department: the SAFES cohort

BACKGROUND

The objective of the study was to identify factors predictive of 6-month institutionalization or mortality in frail elderly patients after acute hospitalization.

METHODS

A prospective cohort of elderly subjects 75 years and older was set up in nine French teaching hospitals. Data obtained from a comprehensive geriatric assessment were used in a Cox model to predict 6-month institutionalization or mortality. Institutionalization was defined as incident admission either to a nursing home or other long-term care facility during the follow-up period.

RESULTS

Crude institutionalization and death rates after 6 months of follow-up were 18% and 24%, respectively. Independent predictors of institutionalization were: living alone (HR=1.83; 95% CI=1.27-2.62) or a higher number of children (HR=0.86; 95% CI=0.78-0.96), balance problems (HR=1.72; 95% CI=1.19-2.47), malnutrition or risk thereof (HR=1.93; 95% CI=1.24-3.01), and dementia syndrome (HR=1.88; 95% CI=1.32-2.67). Factors found to be independently related to 6-month mortality were exclusively medical factors: malnutrition or risk thereof (HR=1.92; 95% CI=1.17-3.16), delirium (HR=1.80; 95% CI=1.24-2.62), and a high level of comorbidity (HR=1.62; 95% CI=1.09-2.40). Institutionalization (HR=1.92; 95% CI=1.37-2.71) and unplanned readmission (HR=4.47; 95% CI=3.16-2.71) within the follow-up period were also found as independent predictors.

CONCLUSION

The main factors predictive of 6-month outcome identified in this study are modifiable by global and multidisciplinary interventions. Their early identification and management would make it possible to modify frail elderly subjects' prognosis favorably.

A high-fat diet induces lower expression of retinoid receptors and their target genes GAP-43/neuromodulin and RC3/neurogranin in the rat brain

Numerous studies have reported an association between cognitive impairment in old age and nutritional factors, including dietary fat. Retinoic acid (RA) plays a central role in the maintenance of cognitive processes via its nuclear receptors (NR), retinoic acid receptor (RAR) and retinoid X receptor (RXR), and the control of target genes, e.g. the synaptic plasticity markers GAP-43/neuromodulin and RC3/neurogranin. Given the relationship between RA and the fatty acid signalling pathways mediated by their respective NR (RAR/RXR and PPAR), we investigated the effect of a high-fat diet (HFD) on (1) PUFA status in the plasma and brain, and (2) the expression of RA and fatty acid NR (RARbeta, RXRbetagamma and PPARdelta), and synaptic plasticity genes (GAP-43 and RC3), in young male Wistar rats. In the striatum of rats given a HFD for 8 weeks, real-time PCR (RT-PCR) revealed a decrease in mRNA levels of RARbeta ( - 14 %) and PPARdelta ( - 13 %) along with an increase in RXRbetagamma (+52 %). Concomitantly, RT-PCR and Western blot analysis revealed (1) a clear reduction in striatal mRNA and protein levels of RC3 ( - 24 and - 26 %, respectively) and GAP-43 ( - 10 and - 42 %, respectively), which was confirmed by in situ hybridisation, and (2) decreased hippocampal RC3 and GAP-43 protein levels (approximately 25 %). Additionally, HFD rats exhibited a significant decrease in plasma ( - 59 %) and brain ( - 6 %) n-3 PUFA content, mainly due to the loss of DHA. These results suggest that dietary fat induces neurobiological alterations by modulating the brain RA signalling pathway and n-3 PUFA content, which have been previously correlated with cognitive impairment.

[A population-based study on factors associated with performance on the Mini-Mental State Examination in the elderly: the Bambuí Study]

The aim of this study was to examine factors associated with cognitive functioning in community-dwelling older adults with low schooling. 1,588 subjects residing in Bambuí, Minas Gerais State, Brazil, and aged > 60 years participated in this cross-sectional study. Multivariate ordinal logistic regression was used to assess associations between exploratory variables and the Mini-Mental State Examination score (MMSE): < 13 (below the 5th percentile), 14-21 (between the 5th percentile and the lowest quintile), and > 22. Lower MMSE scores were significantly and independently associated with age > 80 years (OR: 2.20; 95%CI: 1.52-3.48), male gender (OR: 2.20; 95%CI: 1.52-3.38), < 3 complete years of schooling (OR: 5.92; 95%CI: 3.92-8.94), lack of spouse (OR: 1.91; 95%CI: 1.39-2.62), vegetable and fruit consumption less than 5 times a week (OR: 1.94; 95%CI: 1.39-2.62), and depressive symptoms (OR: 1.94; 95%CI: 1.39-2.62). The results suggest that individuals with poor MMSE performance also have other markers of vulnerability.

Dietary deficiency increases presenilin expression, gamma-secretase activity, and Abeta levels: potentiation by ApoE genotype and alleviation by S-adenosyl methionine

Apolipoprotein E4 (ApoE4) is a risk factor for Alzheimer's disease (AD). Whether this risk arises from a deficient function of E4 or the lack of protection provided by E2 or E3 is unclear. Previous studies demonstrate that deprivation of folate and vitamin E, coupled with dietary iron as a pro-oxidant, for 1 month displayed increased presenilin 1 (PS-1) expression, gamma-secretase, and Abeta generation in mice lacking ApoE (ApoE-/- mice). While ApoE-/- mice are a model for ApoE deficiency, they may not reflect the entire range of consequences of E4 expression. We therefore compared herein the impact of the above deficient diet on mice expressing human E2, E3, or E4. As folate deficiency is accompanied by a decrease in the major methyl donor, S-adenosyl methionine (SAM), additional mice received the deficient diet plus SAM. E2 was more protective than murine ApoE or E3 and E4. Surprisingly, PS-1 and gamma-secretase were over-expressed in E3 to the same extent as in E4 even under a complete diet, and were not alleviated by SAM supplementation. Abeta increased only in E4 mice maintained under the complete diet, and was alleviated by SAM supplementation. These findings suggest dietary compromise can potentiate latent risk factors for AD.

The prevention of dementia

OBJECTIVE

Dementia is prevalent in older adults and the population is ageing. Many factors have been associated with dementia and anything that may aid the prevention of dementia is of importance.

METHOD

The literature in this area was evaluated and information relating to the various factors that may impact upon the prevention of dementia is presented below.

RESULTS

Factors that have been associated with a possible increased risk of developing dementia include high blood pressure, (at least in midlife), high body mass index, smoking and possibly diabetes although the evidence is mixed. There is currently no clear evidence with regard to cholesterol and metabolic syndrome although both may be implicated. Having education and maintaining a Mediterranean diet, including vegetable, fruit and fish intake, have been linked to a lower incidence of dementia as has low to moderate alcohol intake. Although care must be taken with the latter given the different characteristics of the studies reporting on alcohol and dementia.

CONCLUSION

It may be that risk and protective factors vary with age, however, in the absence of prophylactic treatment it seems likely that the maintenance of a healthy lifestyle may represent the best option with regard to the prevention of dementia.

[Factors predictive of long-term mortality in patients aged 75 years or older hospitalized from the emergency department: the SAFES cohort]

OBJECTIVES

To identify the factors predictive of long-term mortality among a cohort of subjects aged 75 years or older hospitalized from the emergency department.

METHODS

Variables from the standardized geriatric assessment of members of the multicenter SAFES cohort were applied to a Cox model to predict mortality over a 3-year follow-up.

RESULTS

This cohort comprised 1306 patients with a mean age of 85+/-6 years. Half the patients died during the 3 years of follow-up. After adjustment for center, social and demographic variables (age, sex, educational level, and community or institutional residence) and level of comorbidity, the variables that significantly influenced mortality over the next 36 months were: severe malnutrition (p<0.03), dementia (p<0.001) and/or confusion (p<0.001), walking problems (p=0.001) and recent hospitalization (p<0.001). No significant association was found between depression and mortality (p=0.40).

CONCLUSION

A predictive approach to mortality at 3 years is possible with simple scales widely used in geriatrics. Correction of malnutrition, recognition and management of cognitive disorders, and functional rehabilitation must be included in the priorities of care.

Vascular risk factors and cognitive function among 3763 participants in the Hypertension in the Very Elderly Trial (HYVET): a cross-sectional analysis

BACKGROUND

It is well known that the global population is aging and that those over the age of 80 are the fastest growing part of this expansion. Also known is that prevalence of hypertension and cognitive decline both increase with increasing age.

METHOD

The Hypertension in the Very Elderly Trial (HYVET) was a double blind placebo-controlled trial of antihypertensive treatment (indapamide SR 1.5 mg +/- perindopril 2-4 mg) and recruited only those hypertensives who were aged 80 or over and were without a diagnosis of dementia at baseline. Systolic blood pressure had to be in the range 160-199 mmHg and diastolic pressure <110 mmHg. Cognitive function was assessed at baseline using the Mini-mental State Examination prior to randomization into the trial. Also collected at baseline was information relating to sociodemographic, clinical, cardiovascular and biochemical factors which may impact upon cognitive function. This paper reports on the baseline cognitive function data from the HYVET trial and its relationship to these factors.

RESULTS

The mean age of the 3763 HYVET participants who had full cognitive function data at baseline was 83.6 years; 60 percent were female. The median MMSE score at baseline was 26 and, in multivariate analyses, higher at younger age, with male gender, higher educational level, having higher creatinine, higher total cholesterol and lower high-density lipoprotein cholesterol.

CONCLUSIONS

This is the first such study to examine a large number of very elderly hypertensives and it shows some similar patterns to those seen in younger elderly groups.

Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study

OBJECTIVES

The aim of the study was, by early identification of deleterious prognostic factors that are open to remediation, to be in a position to assign elderly patients to different mortality risk groups to improve management.

DESIGN

Prospective multicentre cohort.

SETTING

Nine French teaching hospitals.

PARTICIPANTS

One thousand three hundred and six (1 306) patients aged 75 and over, hospitalised after having passed through Emergency Department (ED).

MEASUREMENTS

Patients were assessed using Comprehensive Geriatric Assessment (CGA) tools. A Cox survival analysis was performed to identify prognostic variables for six-week mortality. Receiver Operating Characteristics analysis was used to study the discriminant power of the model. A mortality risk score is proposed to define three risk groups for six-week mortality.

RESULTS

Crude mortality rate after a six week follow-up was 10.6% (n=135). Prognostic factors identified were: malnutrition risk (HR=2.1; 95% CI: 1.1-3.8; p=.02), delirium (HR=1.7; 95% CI: 1.2-2.5; p=.006), and dependency: moderate dependency (HR=4.9; 95% CI: 1.5-16.5; p=.01) or severe dependency (HR=10.3; 95% CI: 3.2-33.1; p < .001). The discriminant power of the model was good: the c-statistic representing the area under the curve was 0.71 (95% IC: 0.67 - 0.75; p < .001). The six-week mortality rate increased significantly (p < .001) across the three risk groups: 1.1% (n=269; 95% CI=0.5-1.7) in the lowest risk group, 11.1% (n=854; 95% CI=9.4-12.9) in the intermediate risk group, and 22.4% (n=125; 95% CI=20.1-24.7) in the highest risk group.

CONCLUSIONS

A simple score has been calculated (using only three variables from the CGA) and a practical schedule proposed to characterise patients according to the degree of mortality risk. Each of these three variables (malnutrition risk, delirium, and dependency) identified as independent prognostic factors can lead to a targeted therapeutic option to prevent early mortality.

The role of polyunsaturated fatty acids (PUFAs) in development, aging and substance abuse disorders: review and propositions

The polyunsaturated fatty acids (PUFAs), especially omega-3 and -6, play an important role in the functioning of membranes. Therefore, changes in their physical properties might entail impairment of the neurotransmission between cells. Studies emphasize the importance of omega-3 intakes, but they also highlight the need of a balance between omega-6 and -3, whose ideal ratio should be 4:1. The Western diet has very high amounts of saturated fat and omega-6, which might contribute, at least partially, to physiopathologies and high incidence as well as prevalence of psychiatric and neurodegenerative diseases. This narrow review aimed at systematizing the studies on the importance of PUFAs in some particular cases, that is, the extremes of life: pre- and post-natal development, and cognitive aging. Additionally, it aimed at studying the association between PUFAs and substance abuse disorders. We used the databases LILACs, MEDLINE and PUBMED.

Folate deprivation increases tau phosphorylation by homocysteine-induced calcium influx and by inhibition of phosphatase activity: Alleviation by S-adenosyl methionine

Several recent studies have indicated that increased levels of homocysteine (HC), including that resulting from deficiency in folate, increases tau phosphorylation. Some studies indicate that this is accomplished via HC-dependent activation of NMDA channels and resultant activation of calcium-dependent kinase pathways, while others suggest that the increase in tau phosphorylation is derived via HC-dependent inhibition of methylation of phosphatases and resultant inhibition of phosphatase activity. We demonstrate herein in SH-SY-5Y human neuroblastoma that both of these phenomena contribute to the increase in phospho-tau immunoreactivity following folate deprivation, and that supplementation with S-adenosyl methionine (SAM) prevents both the increase in kinase activity and the decrease in phosphatase activity. These findings demonstrate that the divergent neuropathological consequences of folate deprivation includes multiple pathways that converge upon tau phosphorylation, and further support the notion that dietary supplementation with SAM may reduce or delay neurodegeneration.

Nutritional risk and cognitive impairment in the elderly

The purpose of this study was to determine the relationship between nutritional risk and cognitive impairment in the elderly living in the community. Data obtained from 2934 subjects (912 men and 2022 women) aged above 60 years was analyzed from the Gwangju Dementia and Mild Cognitive Impairment Study (GDEMCIS). The study questionnaire comprised demographic characteristics, history of current and past illnesses, drug history, Korean version-Mini Mental State Examination (K-MMSE), and Nutritional Screening Initiative (NSI) checklist. Additionally, we examined the blood pressure, fasting serum glucose level, lipid profile, body mass index, and ApoE genotype. Of the total, 1942 (66.2%) demonstrated good nutritional state (NSI checklist score< or =2) and 992 (33.8%) were at moderate or high nutritional risk (NSI checklist score>2). Multiple logistic regression analysis revealed that moderate or high nutritional risk subjects were associated with an increased risk of cognitive impairment (K-MMSE score< or =17) after adjustment for age, sex, educational level, and Korean version of Short form Geriatric Depression Scale (K-SGDS) score (Odds ratio=OR=1.71, 95%; confidence interval=CI=1.17-2.50). These results suggest that nutritional risk may be associated with cognitive impairment in the elderly.

Somatotype in Alzheimer's disease

BACKGROUND

The clinical picture of Alzheimer's disease includes anthropometric and body composition variations. Somatotyping is a practical non-invasive method to assess body type.

OBJECTIVE

The objective of this study was to describe the somatotype of a sample of Alzheimer's patients.

METHODS

The sample consisted of 55 Alzheimer disease individuals in the mild-moderate stage (17 men, mean age = 76.9 +/- 7.2 years; 38 women, mean age = 79.6 +/- 6.4 years). The pathological subjects were compared with a control group consisting of 280 healthy individuals (134 men, mean age = 74.2 +/- 7.3 years; 146 women, mean age = 74.9 +/- 7.4 years). The Heath-Carter somatotype was applied.

RESULTS

The Alzheimer patients (mean somatotype: 6.1-5.5-0.8 in men, 7.0-5.3-0.7 in women) are less mesomorphic and more ectomorphic than the controls (mean somatotype: 6.1-6.3-0.6 in men, 7.7-6.3-0.4 in women), the differences being significant in women (mesomorphy, p = 0.000; ectomorphy, p = 0.012).

CONCLUSION

Alzheimer patients show peculiar somatometric characteristics. The somatotype technique could represent a suitable tool for the study and monitoring of physical variations.