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Niebla-Cárdenas A, Bueno-Hernández N, Hernández AP, Fuentes M, Méndez-Sánchez R, Arroyo-Anlló EM, Orera I, Lattanzio G, Juanes-Velasco P, Arias-Hidalgo C, Puente-González AS. Potential protein biomarkers in saliva for detection of frailty syndrome by targeted proteomics. Mech Ageing Dev 2024; 221:111974. [PMID: 39038666 DOI: 10.1016/j.mad.2024.111974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 07/24/2024]
Abstract
Frailty is a physiological geriatric syndrome, caused by immunosenescence, inflammation and alterations at the protein level leading to metabolic and microbiota changes. Currently, this syndrome is evaluated clinically with the Frailty-VIG index. The aim of the study was therefore to investigate the potential suitability of saliva as a non-invasive proximal biological fluid for the characterisation and identification of possible protein-level biomarkers in frailty syndrome. This cross-sectional study was conducted in a rural population of older Spanish adults using the SMR proteomics technique. A differential protein profile of eight potential and surrogate proteins (CYTC, CYTD, CYTS, CYTB, MIF, ALBU, CD44 and B2MG) was detected in saliva, all of which correlated with factors characterising frailty syndrome, such as vascular ageing (arterial stiffness and cardiovascular disease), obesity, mood problems, global cognitive impairment, changes in gait and hand pressure strength. The proteins CYTD (r = 0.415, p = 0.013) and CYTC (r = 0.280, p = 0.026), which were detected differentially in the protein profile, were associated with the Frailty-VIG index. All analysed proteins are associated not only with the clinical symptoms of frailty syndrome, but also with an acute inflammatory response, endothelial cell proliferation and the complement system, among others.
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Affiliation(s)
- Alfonssina Niebla-Cárdenas
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, Salamanca 37007, Spain
| | - Nallely Bueno-Hernández
- Laboratory for Proteomics and Metabolomics, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City 06720, Mexico
| | - Angela-Patricia Hernández
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca 37007, Spain; Department of Pharmaceutical Sciences: Organic Chemistry, Faculty of Pharmacy, University of Salamanca, CIETUS, IBSAL, Salamanca 37007, Spain
| | - Manuel Fuentes
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca 37007, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain
| | - Roberto Méndez-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, Salamanca 37007, Spain; Institute of Biomedical Research of Salamanca (IBSAL). Physiotherapy, functional recovery and therapeutic exercise group, Salamanca 37007, Spain
| | - Eva María Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, Faculty of Psychology, University of Salamanca, Salamanca 37007, Spain
| | - Irene Orera
- Proteomics Research Core Facility, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza 50009, Spain
| | - Giuseppe Lattanzio
- Proteomics Research Core Facility, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza 50009, Spain
| | - Pablo Juanes-Velasco
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca 37007, Spain
| | - Carlota Arias-Hidalgo
- Department of Medicine and Cytometry General Service-Nucleus, CIBERONC CB16/12/00400, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca 37007, Spain
| | - Ana Silvia Puente-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Salamanca, Salamanca 37007, Spain; Proteomics Unit, Cancer Research Centre (IBMCC/CSIC/USAL/IBSAL), Salamanca, Spain.
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Soenarti S, Mahendra AI, Rudijanto A, Soeharto S, Ratnawati R, Maryunani, Marintan S. Cognitive status and low sun exposure as frailty major risk factor among older people in a rural area of East Java, Indonesia: A cross-sectional study. Geriatr Gerontol Int 2024; 24 Suppl 1:170-175. [PMID: 37992737 DOI: 10.1111/ggi.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/24/2023]
Abstract
AIM To reveal the prevalence of frailty and factors that strongly affected the frailty condition among older adults in East Java, Indonesia. METHOD We conducted a cross-sectional study carried out among 400 older adults aged ≥60 years without any acute illness. Data were collected from rural area in two locations in Malang and Pasuruan, East Java, Indonesia, in 2019-2020. For data collection, we used the sociodemographic profile assessment, Fried frailty phenotype, Geriatric Depression Scale, Mini Mental State assessment, sun exposure, handgrip strength, International Physical Activity Questionnaire, walk score, and body mass index. We used logistic regression statistics for data analysis. RESULTS The result showed that 2.5% were robust, 83% were prefrail, and 14.5% were frail. A higher proportion of subjects were aged 60-74 years (83.3%), women (70.3%), with lower educational status (84.5%). Multivariate analysis showed that the intrinsic factors low cognitive status (odds ratio [OR], 3.052 [95% confidence interval (CI), 1.691-5.508]) and older age (OR, 3.073 [95% CI, 1.637-5.767]) were associated with frailty among the older adults in a rural area. Depression was also associated with frailty (OR, 2.458 [95% CI, 0.465-12.985]). From extrinsic factors, we also found that low sun exposure (OR, 2.931 [95% CI, 1.650-5.204]) and unemployment (OR, 1.997 [95% CI, 1.112-3.588]) were associated with frailty. CONCLUSION For the Indonesian elderly in this study, low cognitive status, older age, depression, low sun exposure, and unemployment were associated with frailty. Understanding the modifiable risk factors of frailty can provide a valuable reference for future prevention and intervention. Geriatr Gerontol Int 2024; 24: 170-175.
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Affiliation(s)
- Sri Soenarti
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
- Clinical Epidemiology and Evidence Based Medicine Study Group, Faculty of Medicine, Brawijaya University, Malang, Indonesia
- Center of Study Degenerative Disease, Brawijaya University, Malang, Indonesia
| | - Aditya Indra Mahendra
- Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Achmad Rudijanto
- Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Setyawati Soeharto
- Department of Pharmacology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Retty Ratnawati
- Department of Physiology, Faculty of Medicine, Brawijaya University, Malang, Indonesia
| | - Maryunani
- Faculty of Economics and Bussiness, Brawijaya University, Malang, Indonesia
| | - Silmy Marintan
- Geriatric Division, Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, Indonesia
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Zhao M, Qu T, Li Y, Wang Y, Li M, Wang K. Interaction effects of anxiety and outdoor activity spaces on frailty among nursing home residents in Jinan, China: Is there a gender difference? Front Public Health 2023; 11:1133340. [PMID: 36908457 PMCID: PMC9999001 DOI: 10.3389/fpubh.2023.1133340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
Background Anxiety and the physical environment are critical factors influencing frailty among older adults; however, the interaction effect of anxiety and the physical environment, such as outdoor activity spaces, on frailty has not been examined. This study aimed to investigate the interaction effect of anxiety and outdoor activity spaces on frailty and to identify differences by gender. Methods A total of 353 nursing home residents (197 women; 156 men; age ≥ 60 years) from 27 Chinese nursing homes were included in the analysis. Anxiety and frailty were analyzed using the Generalized Anxiety Disorder Scale and the FRAIL-NH Scale, respectively. Outdoor activity spaces were assessed through on-site observations using self-designed items. Demographic and socioeconomic information and health-related covariates were also collected. Interaction effect analyses were conducted using multilevel mixed-effects linear models. Results Anxiety and outdoor activity spaces had an interaction effect on frailty among nursing home residents (β = -1.32, 95% CI: -2.44, -0.20). However, further analysis demonstrated that this interaction effect was only significant in older women (β = -1.60, 95% CI: -2.93, -0.27) but not in older men (β = -0.23, 95% CI: -2.29, 1.82). Conclusions This study highlighted that gender differences should be considered when preventing frailty in older adults with anxiety. Furthermore, it may be beneficial for nursing homes to provide outdoor activity spaces and create a supportive living environment to help delay or reverse frailty among female nursing home residents.
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Affiliation(s)
- Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tiange Qu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yang Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaqi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Holanda CMDA, Nóbrega PVDN, Maciel ÁCC. Physical performance as a predictor of mortality in nursing home residents: A five-year survival analysis. Geriatr Nurs 2022; 47:151-158. [PMID: 35914492 DOI: 10.1016/j.gerinurse.2022.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/04/2022]
Abstract
This study developed a five-year survival analysis to verify the relationship between the Short Physical Performance Battery (SPPB) and death in older adults residing in nursing homes (NHs). A total of 114 residents of NHs in Northeast Brazil participated in the follow-up. In addition to the SPPB, the older adults answered questions about sociodemographic and health condition information. The relationship between physical performance and mortality was evaluated using the Kaplan Meier survival curves and Cox proportional regression. As a result, 61.40% of the participants presented low performance and 41.22% died. Low physical performance increased the chance of death by 2.77 times in five years (adjusted Hazard Ratio 2.77; 95% CI 1.40-5.50; p < 0.01). Low SPPB Gait Speed Test also represented a 2.58-fold increased risk of dying (adjusted HR 2.58; 95% CI 1.38-4.83; p < 0.01). The results of this study showed that low physical performance can predict the mortality of older adults residing in NHs over five years.
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Affiliation(s)
- Cristina Marques de Almeida Holanda
- Postgraduate program in Physiotherapy, Federal University of Rio Grande do Norte, Avenue Senador Salgado Filho, Natal-RN-Brazil, CEP: 59200-000.
| | | | - Álvaro Campos Cavalcanti Maciel
- Department of Physiotherapy, Federal University of Rio Grande do Norte, Avenue Senador Salgado Filho, Natal-RN-Brazil. CEP: 59200-000
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Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R. Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M. Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V. Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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Le NP, Varadhan R, Fried LP, Cappola AR. Cortisol and Dehydroepiandrosterone Response to Adrenocorticotropic Hormone and Frailty in Older Women. J Gerontol A Biol Sci Med Sci 2021; 76:901-905. [PMID: 32502234 DOI: 10.1093/gerona/glaa134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The response to adrenocorticotropic hormone (ACTH) is poorly characterized in old-old adults and may provide insight into the physiologic response to stress. METHOD We performed a standard 250 µg ACTH stimulation test in a home-based substudy of 51 women aged 85-96 years enrolled in the Women's Health and Aging Study II who were not taking corticosteroids. We examined the cortisol and dehydroepiandrosterone (DHEA) responses at 0, 30, 60, and 120 minutes, overall and by frailty status. RESULTS The peak cortisol response to ACTH could not be determined, with the highest levels at the 120-minute time point. Pre- and post-ACTH stimulated cortisol levels did not differ by frailty status over this time frame, with no difference in the characteristics of the dose-response curves. Pre- and post-ACTH stimulated DHEA levels also did not differ by frailty status, though the dose-response curves suggested divergence after stimulation, with a more rapid DHEA response with increasing frailty. CONCLUSIONS Our data demonstrate a robust cortisol response to ACTH challenge testing, but inadequate negative feedback in old-old women, resulting in prolonged exposure to cortisol. Future studies should examine dynamic cortisol and DHEA responses in this age group, using a less potent ACTH stimulus and longer collection period.
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Affiliation(s)
- Nina P Le
- Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia
| | - Ravi Varadhan
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Linda P Fried
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Anne R Cappola
- Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia
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Suh M. [Influences of Autonomic Function, Salivary Cortisol and Physical Activity on Cognitive Functions in Institutionalized Older Adults with Mild Cognitive Impairment: Based on Neurovisceral Integration Model]. J Korean Acad Nurs 2021; 51:294-304. [PMID: 34215708 DOI: 10.4040/jkan.20282] [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: 12/11/2020] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model. METHODS Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol. RESULTS Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result. CONCLUSION Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.
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Affiliation(s)
- Minhee Suh
- Department of Nursing, College of Medicine, Inha University, Incheon, Korea.
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Comorbid depressive and anxiety symptoms and frailty among older adults: Findings from the West China health and aging trend study. J Affect Disord 2020; 277:970-976. [PMID: 33065841 DOI: 10.1016/j.jad.2020.08.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depression and anxiety are two common mental disorders in older people. Studies have reported that depression is strongly associate with frailty, but few studies focus on anxiety disorder and comorbid two mental disorders. In this study, we aimed to identify associations between comorbid depressive and anxiety symptoms with frailty in older adults. METHODS 4,103 community-dwellings adults aged 60 and older from the baseline of the West China Health and Aging Trend (WCHAT) study were included. Frailty was measured by the Fried frailty phenotype criteria. The 15-item Geriatric Depression Scale (GDS-15) and 7-item Generalized Anxiety Disorder Scale (GAD-7) assessed for depressive and anxiety symptoms with a cut-off value of 5. Multinomial logistic regression was used to explore the association between different depressive and anxiety status and frailty. RESULTS 8.7% of old adults suffered comorbid depressive and anxiety symptoms in the present study. The prevalence of pre-frailty and frailty was 47.0% and 6.7%, respectively. After adjusting for covariates, individuals with comorbid depressive and anxiety symptoms had higher odds of being pre-frail (OR=1.86, 95% CI=1.41, 2.45) and frail (OR=7.03, 95% CI=4.48, 11.05) compared to those without depressive and anxiety symptoms. In the comorbidity group, those with severe comorbid symptoms also had higher prevalence of pre-frailty and frailty. LIMITATIONS Depressive and anxiety symptom assessments were based on screening tools. CONCLUSIONS This study suggested comorbid depressive and anxiety symptoms were associated with frailty among Chinese older adults. Further efforts to screen and target depression and anxiety comorbidity may be warranted.
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Singh S, Atkinson EJ, Achenbach SJ, LeBrasseur N, Bancos I. Frailty in Patients With Mild Autonomous Cortisol Secretion is Higher Than in Patients with Nonfunctioning Adrenal Tumors. J Clin Endocrinol Metab 2020; 105:5867964. [PMID: 32628749 PMCID: PMC7382051 DOI: 10.1210/clinem/dgaa410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Mild autonomous cortisol secretion (MACS) affects up to 50% of patients with adrenal adenomas. Frailty is a syndrome characterized by the loss of physiological reserves and an increase in vulnerability, and it serves as a marker of declining health. OBJECTIVE To compare frailty in patients with MACS versus patients with nonfunctioning adrenal tumors (NFAT). DESIGN Retrospective study, 2003-2018. SETTING Referral center. PATIENTS Patients >20 years of age with adrenal adenoma and MACS (1 mg overnight dexamethasone suppression (DST) of 1.9-5 µg/dL) and NFAT (DST <1.9 µg/dL). MAIN OUTCOME MEASURE Frailty index (range 0-1), calculated using a 47-variable deficit model. RESULTS Patients with MACS (n = 168) demonstrated a higher age-, sex-, and body mass index-adjusted prevalence of hypertension (71% vs 60%), cardiac arrhythmias (50% vs 40%), and chronic kidney disease (25% vs 17%), but a lower prevalence of asthma (5% vs 14%) than patients with NFAT (n = 275). Patients with MACS reported more symptoms of weakness (21% vs 11%), falls (7% vs 2%), and sleep difficulty (26% vs 15%) as compared with NFAT. Age-, sex- and BMI-adjusted frailty index was higher in patients with MACS vs patients with NFAT (0.17 vs 0.15; P = 0.009). Using a frailty index cutoff of 0.25, 24% of patients with MACS were frail, versus 18% of patients with NFAT (P = 0.028). CONCLUSION Patients with MACS exhibit a greater burden of comorbid conditions, adverse symptoms, and frailty than patients with NFAT. Future prospective studies are needed to further characterize frailty, examine its responsiveness to adrenalectomy, and assess its influence on health outcomes in patients with MACS.
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Affiliation(s)
- Sumitabh Singh
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth J Atkinson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sara J Achenbach
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nathan LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
- Correspondence and Reprint Requests: Irina Bancos, MD, Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905. E-mail:
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Lemus Barrios GA, Morales Benavidez DC, López Salazar AM, Henao V, González-Robledo G. Evaluación de la fragilidad en la enfermedad cardiovascular: Un reto necesario. REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ma L, Chan P. Understanding the Physiological Links Between Physical Frailty and Cognitive Decline. Aging Dis 2020; 11:405-418. [PMID: 32257550 PMCID: PMC7069469 DOI: 10.14336/ad.2019.0521] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Declines in both physical and cognitive function are associated with increasing age. Understanding the physiological link between physical frailty and cognitive decline may allow us to develop interventions that prevent and treat both conditions. Although there is significant epidemiological evidence linking physical frailty to cognitive decline, a complete understanding of the underpinning biological basis of the two disorders remains fragmented. This narrative review discusses insights into the potential roles of chronic inflammation, impaired hypothalamic-pituitary axis stress response, imbalanced energy metabolism, mitochondrial dysfunction, oxidative stress, and neuroendocrine dysfunction linking physical frailty with cognitive decline. We highlight the importance of easier identification of strategic approaches delaying the progression and onset of physical frailty and cognitive decline as well as preventing disability in the older population.
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Affiliation(s)
- Lina Ma
- 1Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,2China National Clinical Research Center for Geriatric Medicine, Beijing, China
| | - Piu Chan
- 1Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing Institute of Geriatrics, Beijing, China.,2China National Clinical Research Center for Geriatric Medicine, Beijing, China.,3Department of Neurology and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China.,4Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Parkinson Disease Center of Beijing Institute for Brain Disorders, Beijing, China
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12
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Furtado GE, Carvalho HM, Loureiro M, Patrício M, Uba-Chupel M, Colado JC, Hogervorst E, Ferreira JP, Teixeira AM. Chair-based exercise programs in institutionalized older women: Salivary steroid hormones, disabilities and frailty changes. Exp Gerontol 2020; 130:110790. [DOI: 10.1016/j.exger.2019.110790] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/02/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022]
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Ruiz JG, Rodriguez-Suarez M, Tang F, Aparicio-Ugarriza R, Ferri-Guerra J, Mohammed NY, Mintzer MJ. Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans. Int J Geriatr Psychiatry 2020; 35:37-44. [PMID: 31608502 DOI: 10.1002/gps.5212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/15/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults. OBJECTIVE To determine the effects of concurrent frailty and depression on all-cause hospitalizations. METHODS/DESIGN Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations. RESULTS Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157). CONCLUSIONS Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.
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Affiliation(s)
- Jorge G Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Mercedes Rodriguez-Suarez
- Miller School of Medicine, University of Miami, Miami, FL.,Mental Health Service, Miami VA Healthcare System, Miami, FL
| | - Fei Tang
- Research Service, Miami VA Healthcare System, Miami, FL
| | - Raquel Aparicio-Ugarriza
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Juliana Ferri-Guerra
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Nadeem Y Mohammed
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL
| | - Michael J Mintzer
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.,Miller School of Medicine, University of Miami, Miami, FL.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL
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Individual differences in glucocorticoid regulation: Does it relate to disease risk and resilience? Front Neuroendocrinol 2020; 56:100803. [PMID: 31697962 PMCID: PMC7189329 DOI: 10.1016/j.yfrne.2019.100803] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/03/2019] [Accepted: 10/29/2019] [Indexed: 12/17/2022]
Abstract
Glucocorticoid (GC) signaling varies among individuals, and this variation may relate to individual differences in health outcomes. To determine if and which aspects of signaling (basal, circadian, integrative, or reactivity) are associated with specific health outcomes, we reviewed recent studies that relate GCs to health outcomes. We identified papers through PubMed and reviewed 100 original research articles related to mental health, cardiovascular health, cancer, diabetes, obesity, pulmonary health, sleep, and fitness. Many studies reported elevated GC secretion associated with worse health, but this was only particularly true for integrative GC measures. On the other hand, accentuated cortisol awakening response and a steeper circadian rhythm were both associated with positive health outcomes. Overall, relationships between GC secretion and health outcomes were relatively weak. This systematic review of relationships between GC metrics and health outcomes highlights the importance of careful consideration when selecting methods to measure GC regulation in health research.
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Marcos-Pérez D, Sánchez-Flores M, Maseda A, Lorenzo-López L, Millán-Calenti JC, Pásaro E, Laffon B, Valdiglesias V. Serum cortisol but not oxidative stress biomarkers are related to frailty: results of a cross-sectional study in Spanish older adults. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2019; 82:815-825. [PMID: 31405343 DOI: 10.1080/15287394.2019.1654639] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Frailty is a multidimensional geriatric syndrome of loss of reserves and increased vulnerability to negative health outcomes. Cortisol, the major hormone of the hypothalamic pituitary adrenal (HPA) axis, and oxidative stress may be influenced by multiple endogenous and environmental factors throughout the lifespan, triggering changes in organism functioning. Association of elevated levels of cortisol and oxidative stress biomarkers with aging and several age-related diseases is well documented. However, the possible role of these factors on frailty status in older adults has not been extensively studied. Hence, the aim of this study was to conduct a cross-sectional study in 252 older adults (≥65 years old) classified according to their frailty status. Plasma cortisol and biomarkers related to oxidative stress including reactive oxygen/nitrogen species, oxidative DNA damage, and total antioxidant capacity were determined in non-frail, pre-frail, and frail subjects. Results showed significantly increasing cortisol concentrations with frailty burden, but no marked association between any oxidative stress biomarker and frailty status. In addition, dependence on activities of daily living and 10-year mortality risk were also correlated with elevated cortisol levels. Current results support the hypothesis that age-related HPA axis dysregulation is associated with frailty status, although further research is necessary to establish the role of cortisol in the pathophysiology of frailty.
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Affiliation(s)
- Diego Marcos-Pérez
- Department of Psychology, Area of Psychobiology, Faculty of Education Sciences, Universidade da Coruña, DICOMOSA Group , Coruña , Spain
- Department of Cell and Molecular Biology, Faculty of Sciences, Universidade da Coruña , Coruña , Spain
| | - María Sánchez-Flores
- Department of Psychology, Area of Psychobiology, Faculty of Education Sciences, Universidade da Coruña, DICOMOSA Group , Coruña , Spain
- Department of Cell and Molecular Biology, Faculty of Sciences, Universidade da Coruña , Coruña , Spain
| | - Ana Maseda
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC) , Coruña , Spain
| | - Laura Lorenzo-López
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC) , Coruña , Spain
| | - José C Millán-Calenti
- Universidade da Coruña, Gerontology Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC) , Coruña , Spain
| | - Eduardo Pásaro
- Department of Psychology, Area of Psychobiology, Faculty of Education Sciences, Universidade da Coruña, DICOMOSA Group , Coruña , Spain
| | - Blanca Laffon
- Department of Psychology, Area of Psychobiology, Faculty of Education Sciences, Universidade da Coruña, DICOMOSA Group , Coruña , Spain
| | - Vanessa Valdiglesias
- Department of Psychology, Area of Psychobiology, Faculty of Education Sciences, Universidade da Coruña, DICOMOSA Group , Coruña , Spain
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Ruan Q, D'onofrio G, Wu T, Greco A, Sancarlo D, Yu Z. Sexual dimorphism of frailty and cognitive impairment: Potential underlying mechanisms (Review). Mol Med Rep 2017; 16:3023-3033. [PMID: 28713963 DOI: 10.3892/mmr.2017.6988] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 01/01/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to assess systematically gender differences in susceptibility to frailty and cognitive performance decline, and the underlying mechanisms. A systematic assessment was performed of the identified reviews of cohort, mechanistic and epidemiological studies. The selection criteria of the present study included: i) Sexual dimorphism of frailty, ii) sexual dimorphism of subjective memory decline (impairment) and atrophy of hippocampus during early life, iii) sexual dimorphism of late‑onset Alzheimer's disease and iv) sexual dimorphism mechanisms underlying frailty and cognitive impairment. Males exhibit a susceptibility to poor memory performance and a severe atrophy of the hippocampus during early life and females demonstrate a higher prevalence for frailty and late‑life dementia. The different alterations within the hypothalamic‑pituitary‑gonadal/adrenal axis, particularly with regard to gonadal hormones, cortisol and dehydroepiandrosterone/sulfate‑bound dehydroepiandrosterone prior to and following andropause in males and menopause in females, serve important roles in sexual dimorphism of frailty and cognitive impairment. These endocrine changes may accelerate immunosenescence, weaken neuroprotective and neurotrophic effects, and promote muscle catabolism. The present study suggested that these age‑associated endocrine alterations interact with gender‑specific genetic and epigenetic factors, together with immunosenescence and iron accumulation. Environment factors, including psychological factors, are additional potential causes of the sexual dimorphism of frailty and cognitive impairment.
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Affiliation(s)
- Qingwei Ruan
- Department of Geriatrics, Shanghai Key Laboratory of Clinical Geriatrics, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
| | - Grazia D'onofrio
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, The Scientific Institute for Research and Health Care, Home for Relief of the Suffering Hospital, San Giovanni Rotondo, Foggia I‑71013, Italy
| | - Tao Wu
- Department of Geriatrics, Shanghai Key Laboratory of Clinical Geriatrics, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, The Scientific Institute for Research and Health Care, Home for Relief of the Suffering Hospital, San Giovanni Rotondo, Foggia I‑71013, Italy
| | - Daniele Sancarlo
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, The Scientific Institute for Research and Health Care, Home for Relief of the Suffering Hospital, San Giovanni Rotondo, Foggia I‑71013, Italy
| | - Zhuowei Yu
- Department of Geriatrics, Shanghai Key Laboratory of Clinical Geriatrics, Shanghai Institute of Geriatrics and Gerontology, Huadong Hospital and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China
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Moraes H, Deslandes A, Maciel-Pinheiro PDT, Corrêa H, Laks J. Cortisol, DHEA, and depression in the elderly: the influence of physical capacity. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:456-61. [PMID: 27332070 DOI: 10.1590/0004-282x20160059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/31/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. METHOD Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. RESULTS Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. CONCLUSIONS The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.
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Affiliation(s)
- Helena Moraes
- Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ , Brasil, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brasil;,Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Desordens Relacionadas, Rio de Janeiro RJ , Brasil, Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Desordens Relacionadas, Rio de Janeiro RJ, Brasil
| | - Andrea Deslandes
- Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ , Brasil, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brasil;,Universidade do Estado do Rio de Janeiro, Universidade Estadual do Rio de Janeiro, Instituto de Educação Física e Desportos, Rio de Janeiro RJ , Brasil, Universidade Estadual do Rio de Janeiro, Instituto de Educação Física e Desportos, Rio de Janeiro RJ, Brasil
| | - Paulo de Tarso Maciel-Pinheiro
- Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ , Brasil, Universidade Federal do Rio de Janeiro, Laboratório de Neurociência do Exercício, Rio de Janeiro RJ, Brasil;,Universidade Federal Fluminense, Universidade Federal Fluminense, Rio de Janeiro RJ , Brasil, Universidade Federal Fluminense, Programa de Pós Graduação Neurologia/Neurociências, Rio de Janeiro RJ, Brasil;,Universidade Federal Fluminense, Universidade Federal Fluminense, Instituto de Educação Física, Rio de Janeiro RJ , Brasil, Universidade Federal Fluminense, Instituto de Educação Física, Rio de Janeiro RJ, Brasil
| | - Humberto Corrêa
- Universidade Federal de Minas Gerais, Universidade Federal de Minhas Gerais, Belo Horizonte MG , Brasil, Universidade Federal de Minhas Gerais, Belo Horizonte MG, Brasil
| | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Desordens Relacionadas, Rio de Janeiro RJ , Brasil, Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Centro de Doença de Alzheimer e Desordens Relacionadas, Rio de Janeiro RJ, Brasil;,Instituto Vital Brasil, Centro de Estudos e Pesquisas do Envelhecimento, Rio de Janeiro RJ , Brasil, Instituto Vital Brasil, Centro de Estudos e Pesquisas do Envelhecimento, Rio de Janeiro RJ, Brasil
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Gray WK, Richardson J, McGuire J, Dewhurst F, Elder V, Weeks J, Walker RW, Dotchin CL. Frailty Screening in Low- and Middle-Income Countries: A Systematic Review. J Am Geriatr Soc 2016; 64:806-23. [PMID: 27100577 DOI: 10.1111/jgs.14069] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To conduct a systematic review of frailty screening tools used in low- and middle-income countries (LMICs). DESIGN Systematic review. SETTING LMICs, as defined by the World Bank on June 30, 2014. PARTICIPANTS Elderly adults (as defined by the authors) living in LMICs. MEASUREMENTS Studies were included if the population under consideration lived in a LMIC, the study involved an assessment of frailty, the study population was elderly adults, and the full text of the study was available in English. The Medline, Embase, CINAHL and PsychINFO databases were searched up to June 30, 2014. RESULTS Seventy studies with data from 22 LMICs were included in the review. Brazil, Mexico, and China provided data for 60 of the 70 studies (85.7%), and 15 countries contributed data to only one study. Thirty-six studies used the Fried criteria to assess frailty, 20 used a Frailty Index, and eight used the Edmonton Frailty Scale; none of the assessment tools used had been fully validated for use in a LMIC. CONCLUSION There has been a rapid increase in the number of published studies of frailty in LMICs over the last 5 years. Further validation of the assessment tools used to identify frail elderly people in LMICs is needed if they are to be efficient in identifying those most in need of health care in such settings.
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Affiliation(s)
- William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jenny Richardson
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jackie McGuire
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Vasanthi Elder
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Julie Weeks
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Viña J, Tarazona-Santabalbina FJ, Pérez-Ros P, Martínez-Arnau FM, Borras C, Olaso-Gonzalez G, Salvador-Pascual A, Gomez-Cabrera MC. Biology of frailty: Modulation of ageing genes and its importance to prevent age-associated loss of function. Mol Aspects Med 2016; 50:88-108. [PMID: 27164416 DOI: 10.1016/j.mam.2016.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Frailty is associated with loss of functional reserve as well as with the prediction of adverse events in the old population. The traditional criteria of frailty are based on five physical determinations described in the Cardiovascular Health Study. We propose that biological and genetic markers of frailty should be used to increase the predictive capacity of the established clinical indeces. In recent times, research for biological markers of frailty has gained impetus. Finding a biological markers with diagnostic and prognostic capacity would be a major milestone to identify frailty risk, and also pre-frailty status. In the first section of the manuscript, we review the available biomarkers that help to monitor and prevent the evolution and the efficacy of interventions to delay the onset of frailty and to prevent its progression to incapacity. We also discuss the contribution of genetics to frailty. There are scientific bases that support that genetics influences frailty, although environmental factors probably will have the highest contribution. We review the known SNPs of the genes associated with frailty and classify them, taking into account the pathway in which they are involved. We also highlight the importance of longevity genes and their possible relation with frailty, citing centenarians who reach a very old age as an example of successful ageing. Finally, the reversibility of frailty is discussed. It can potentially be treated with nutritional or pharmacological interventions. However, physical exercise seems to be the most effective strategy to treat and prevent frailty. The last section of the manuscript is devoted to explaining the recommendations on the appropriate design of an exercise protocol to maximize its beneficial effects in a population of frail individuals.
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Affiliation(s)
- Jose Viña
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | | | - Pilar Pérez-Ros
- School of Nursing, Catholic University of Valencia San Vicente Mártir, Spain
| | | | - Consuelo Borras
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Gloria Olaso-Gonzalez
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Andrea Salvador-Pascual
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain
| | - Mari Carmen Gomez-Cabrera
- Department of Physiology, Investigación Hospital Clínico Universitario/INCLIVA, University of Valencia, Spain.
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Influence of Frailty Phenotype Items on Functional Capacity and Falls Occurrence in Frail Community-Dwelling Older Adults. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Buigues C, Padilla-Sánchez C, Garrido JF, Navarro-Martínez R, Ruiz-Ros V, Cauli O. The relationship between depression and frailty syndrome: a systematic review. Aging Ment Health 2016; 19:762-72. [PMID: 25319638 DOI: 10.1080/13607863.2014.967174] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Frailty is a geriatric syndrome characterised by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Frailty and depressive symptoms are common issues facing older adults and may be associated. It is not clear if the depression facilitates the appearance of frailty syndrome or vice versa or these two coexist independently in the same individuals. METHOD We performed searches in several databases (Embase, PubMed, CINAHL, Scopus, and PsycINFO) papers published between November 2003 to February 2014 about frailty syndrome and depression in people aged 65 and older published and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on the prevalence and co-occurrence of frailty and depression in older individuals and of frailty criteria among depressed patients. RESULTS Depression and frailty occur in a significant proportion of frail older individuals. Common pathophysiological alterations and biomarkers in the two syndromes have been recently described. CONCLUSION Studies on the causal relationship between the two syndromes are clearly necessary in the future.
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Affiliation(s)
- Cristina Buigues
- a Department of Nursing , University of Valencia , Valencia , Spain
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Lucertini F, Ponzio E, Di Palma M, Galati C, Federici A, Barbadoro P, D’Errico MM, Prospero E, Ambrogini P, Cuppini R, Lattanzi D, Minelli A. High Cardiorespiratory Fitness Is Negatively Associated with Daily Cortisol Output in Healthy Aging Men. PLoS One 2015; 10:e0141970. [PMID: 26529517 PMCID: PMC4631391 DOI: 10.1371/journal.pone.0141970] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/15/2015] [Indexed: 12/11/2022] Open
Abstract
Physical fitness has salutary psychological and physical effects in older adults by promoting neuroplasticity and adaptation to stress. In aging, however, the effects of fitness on the hypothalamic-pituitary-adrenal (HPA) axis are mixed. We investigated the association between cardiorespiratory fitness and HPA activity in healthy elderly men (n = 22, mean age 68 y; smokers, obese subjects, those taking drugs or reporting recent stressful events were excluded), by measuring in saliva: i) daily pattern of cortisol secretion (6 samples: 30' post-awakening, and at 12.00, 15.00, 18.00, 21.00, 24.00 h); and ii) the cortisol response to a mental challenge. Cardiorespiratory fitness (VO2max) was estimated using the Rockport Walking Test and the participants were assigned to high-fit (HF, ≥60°, n = 10) and low-fit (LF, ≤35°, n = 12) groups according to age-specific percentiles of VO2max distribution in the general population. At all daytimes, basal cortisol levels were lower in the HF than the LF group, most notably in the evening and midnight samples, with a significant main effect of physical fitness for cortisol levels overall; the area-under-the-curve for total daily cortisol output was significantly smaller in the HF group. Among the subjects who responded to mental stress (baseline-to-peak increment >1.5 nmol/L; n = 13, 5 LF, 8 HF), the amplitude of cortisol response and the steepness of recovery decline displayed an increasing trend in the HF subjects, although between-group differences failed to reach the threshold for significance. In conclusion, cardiorespiratory fitness in healthy aging men is negatively correlated with daily cortisol output and contributes to buffering the HPA dysregulation that occurs with advancing age, thus possibly playing a beneficial role in contrasting age-related cognitive and physical decline.
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Affiliation(s)
- Francesco Lucertini
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Elisa Ponzio
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Michael Di Palma
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
| | - Claudia Galati
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
| | - Ario Federici
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Marcello M. D’Errico
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Emilia Prospero
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Ambrogini
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
| | - Riccardo Cuppini
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
| | - Davide Lattanzi
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
| | - Andrea Minelli
- Department of Earth, Life and Environmental Sciences (DiSTeVA), University of Urbino Carlo Bo, Urbino, Italy
- * E-mail:
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Cordeiro LM, Paulino JDL, Bessa MEP, Borges CL, Leite SFP. Qualidade de vida do idoso fragilizado e institucionalizado. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo Avaliar a qualidade de vida de idosos frágeis institucionalizados. Métodos Estudo transversal com a inclusão de 33 idosos frágeis e pré-frágeis, classificados a partir da Escala de Fragilidade de Edmonton. Foram aplicados: um instrumento para caracterização dos aspectos sociodemográficos e o instrumento World Health Organization Quality of Life for Older Persons para avaliação da qualidade de vida. Resultados Houve predomínio do sexo feminino (54,5%) e a média de idade foi de 76,8 anos (±9,3). Observou-se associação significativa entre a qualidade de vida e todas suas facetas, e houve forte relação entre qualidade de vida e “atividades passadas, presentes e futuras” (r=0,715; p<0,001). Conclusão A presença de fragilidade não interferiu diretamente na qualidade de vida de idosos e apresentou associação significativa com motivo de institucionalização.
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Abstract
Human aging is associated with increasing frailty and morbidity which can result in significant disability. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis may contribute to aging-related diseases like depression, cognitive deficits, and Alzheimer's disease in some older individuals. In addition to neuro-cognitive dysfunction, it has also been associated with declining physical performance possibly due to sarcopenia. This article reviews the pathophysiology of HPA dysfunction with respect to increased basal adrenocorticotropic hormone (ACTH) and cortisol secretion, decreased glucocorticoid (GC) negative feedback at the level of the paraventricular nucleus (PVN) of the hypothalamus, hippocampus (HC), and prefrontal cortex (PFC), and flattening of diurnal pattern of cortisol release. It is possible that the increased cortisol secretion is secondary to peripheral conversion from cortisone. There is a decline in pregnolone secretion and C-19 steroids (DHEA) with aging. There is a small decrease in aldosterone with aging, but a subset of the older population have a genetic predisposition to develop hyperaldosteronism due to the increased ACTH stimulation. The understanding of the HPA axis and aging remains a complex area with conflicting studies leading to controversial interpretations.
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Affiliation(s)
- Deepashree Gupta
- Division of Endocrinology, Saint Louis University, Missouri, St. Louis; Divisions of Endocrinology and Geriatric Medicine, Saint Louis University, Missouri, St. Louis
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Halil M, Cemal Kizilarslanoglu M, Emin Kuyumcu M, Yesil Y, Cruz Jentoft AJ. Cognitive aspects of frailty: mechanisms behind the link between frailty and cognitive impairment. J Nutr Health Aging 2015; 19:276-83. [PMID: 25732212 DOI: 10.1007/s12603-014-0535-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Whereas physical impairment is the main hallmark of frailty, evidence suggests that other dimensions, such as psychological, cognitive and social factors also contribute to this multidimensional condition. Cognition is now considered a relevant domain of frailty. Cognitive and physical frailty interact: cognitive problems and dementia are more prevalent in physically frail individuals, and those with cognitive impairment are more prone to become frail. Disentangling the relationship between cognition and frailty may lead to new intervention strategies for the prevention and treatment of both conditions. Both frailty and cognitive decline share common potential mechanisms. This review examines the relationship between frailty and cognitive decline and explores the role of vascular changes, hormones, vitamin D, inflammation, insulin resistance, and nutrition in the development of physical frailty and cognitive problems, as potential underlying mechanisms behind this link. Dual tasking studies may be a useful way to explore and understand the relation between cognitive and physical frailty. Further studies are needed to elucidate this complex relation to improve the outcomes of frailty.
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Affiliation(s)
- M Halil
- Muhammet Cemal Kizilarslanoglu, MD, Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, 06100 Ankara, Turkey, Tel: +903123053071, Fax: +903123097620, e-mail:
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Fernández-Garrido J, Ruiz-Ros V, Buigues C, Navarro-Martinez R, Cauli O. Clinical features of prefrail older individuals and emerging peripheral biomarkers: a systematic review. Arch Gerontol Geriatr 2014; 59:7-17. [PMID: 24679669 DOI: 10.1016/j.archger.2014.02.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 01/04/2023]
Abstract
Frailty is a geriatric syndrome characterized by the clinical presentation of identifiable physical alterations such as loss of muscle mass and strength, energy and exercise tolerance, and decreased physiological reserve. Individuals with one or two of these alterations are defined as prefrail. The clinical features of prefrail older individuals have been investigated to a lesser extent compared to the frail population, even though this intermediate stage may provide insights into the mechanisms involved in the physical decline associated with aging and it is considered to be potentially reversible. We performed searches in the Medline, Embase, Scopus, Cinahl, and Cochrane databases from January 1995 to July 2013 for papers about the identification of prefrail people aged 65 and older published either in English or Spanish, and the reference lists of from the articles retrieved were pearled in order to identify any which may have been missed in the initial search. Two independent reviewers extracted descriptive information on frailty criteria and outcomes from the selected papers: of the 277 articles retrieved from the searches and 25 articles retrieved from pearling, 84 met the study inclusion criteria. The prevalence of prefrailty ranges between 35% and 50% in individuals aged over 60, is more common in women, and the age and the number of comorbidities in these individuals is similar to their frail counterparts. Weakness is the most prevalent symptom in prefrail individuals although there are some sex differences. Some serum biomarkers seem to discriminate prefrail from non-frail individuals but further research would be required to confirm this.
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Affiliation(s)
| | - Vicente Ruiz-Ros
- Department of Nursing, Faculty of Nursing, University of Valencia, Valencia, Spain; Cardiology Department, Hospital Clinico Universitario, Universidad of Valencia, Valencia, Spain
| | - Cristina Buigues
- Department of Nursing, Faculty of Nursing, University of Valencia, Valencia, Spain
| | - Rut Navarro-Martinez
- Department of Nursing, Faculty of Nursing, University of Valencia, Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing, University of Valencia, Valencia, Spain.
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Johar H, Emeny RT, Bidlingmaier M, Reincke M, Thorand B, Peters A, Heier M, Ladwig KH. Blunted diurnal cortisol pattern is associated with frailty: a cross-sectional study of 745 participants aged 65 to 90 years. J Clin Endocrinol Metab 2014; 99:E464-8. [PMID: 24564322 DOI: 10.1210/jc.2013-3079] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The role of neuroendocrine alterations in the etiology of frailty syndrome is still poorly understood. Hypothalamic-pituitary-adrenal axis dysregulation is a plausible candidate pathway contributing to frailty. Thus, we sought to examine the associations of diurnal cortisol secretion with frailty in older adults. METHODS A cross-sectional analysis was conducted among 745 study participants (age 65-90 years, mean age 75.1 years) of the population-based KORA Age study. Associations between salivary cortisol measures at awakening (morning 1 [M1]), 30 minutes after awakening (M2), and evening (E) and frailty criteria were determined. RESULTS Lower cortisol levels in the first morning sample (M1) (P = .18) and M2 (P = .14) and increased E levels (P = .004) were observed in prefrail (35.17%, n = 262) and frail (3.36%, n = 25) individuals, in a dose-response manner. Frailty was strongly associated with smaller ratios of morning to evening levels; M1 to E ratio (P = .02) and M2 to E ratio (P = .003). Higher evening cortisol levels were associated with a 24% increased risk of a prefrail state (odds ratio, 1.22; 95% confidence interval, 1.03-1.44). A smaller morning to evening ratio was associated with an increased risk of low grip strength (1.42, 1.09-1.86) and gait speed (1.31, 1.02-1.68). CONCLUSION Frailty status is associated with blunted cortisol reactivity as demonstrated by lower morning and higher evening salivary cortisol levels.
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Affiliation(s)
- Hamimatunnisa Johar
- Institute of Epidemiology II (H.J., R.T.E., B.T., A.P., M.H., K.-H.L.), Helmholtz Zentrum München, German Research Centre for Environmental Health, 85764 Neuherberg, Germany; Medizinische Klinik und Poliklinik IV (M.B., M.R.), Klinikum der Ludwig-Maximilians-Universität München, 80336 Munich, Germany; and Department of Psychosomatic Medicine and Psychotherapy (K.-H.L.), Klinikum rechts der Isar, Technische Universität München, 81675 Munich, Germany
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Abstract
Frailty is now a definable clinical syndrome with a simple screening test. Age-related changes in hormones play a major role in the development of frailty by reducing muscle mass and strength (sarcopenia). Selective Androgen Receptor Molecules and ghrelin agonists are being developed to treat sarcopenia. The role of Activin Type IIB soluble receptors and Follistatin-like 3 mimetics is less certain because of side effects. Exercise (resistance and aerobic), vitamin D and protein supplementation, and reduction of polypharmacy are keys to the treatment of frailty.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA.
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Chu H, Yang CY, Lin Y, Ou KL, Lee TY, O'Brien AP, Chou KR. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biol Res Nurs 2013; 16:209-17. [PMID: 23639952 DOI: 10.1177/1099800413485410] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aims of this study were to determine the effectiveness of group music therapy for improving depression and delaying the deterioration of cognitive functions in elderly persons with dementia. METHOD The study had a prospective, parallel-group design with permuted-block randomization. Older persons with dementia (N = 104) were randomly assigned to the experimental or control group. The experimental group received 12 sessions of group music therapy (two 30-min sessions per week for 6 weeks), and the control group received usual care. Data were collected 4 times: (1) 1 week before the intervention, (2) the 6th session of the intervention, (3) the 12th session of the intervention, and (4) 1 month after the final session. RESULTS Group music therapy reduced depression in persons with dementia. Improvements in depression occurred immediately after music therapy and were apparent throughout the course of therapy. The cortisol level did not significantly decrease after the group music therapy. Cognitive function significantly improved slightly at the 6th session, the 12th session, and 1 month after the sessions ended; in particular, short-term recall function improved. The group music therapy intervention had the greatest impact in subjects with mild and moderate dementia. CONCLUSION The group music intervention is a noninvasive and inexpensive therapy that appeared to reduce elders' depression. It also delayed the deterioration of cognitive functions, particularly short-term recall function. Group music therapy may be an appropriate intervention among elderly persons with mild and moderate dementia.
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Affiliation(s)
- Hsin Chu
- 1Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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