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Han BL, Ma LZ, Han SL, Mi YC, Liu JY, Sheng ZH, Wang HF, Tan L. Explore the Role of Frailty as a Contributor to the Association Between AT(N) Profiles and Cognition in Alzheimer's Disease. J Alzheimers Dis 2024:JAD231489. [PMID: 39093070 DOI: 10.3233/jad-231489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Background The relationship between Alzheimer's disease (AD)-related pathology and cognition was not exactly consistent. Objective To explore whether the association between AD pathology and cognition can be moderated by frailty. Methods We included 1711 participants from the Alzheimer's Disease Neuroimaging Initiative database. Levels of cerebrospinal fluid amyloid-β, p-tau, and t-tau were identified for AD-related pathology based on the amyloid-β/tau/neurodegeneration (AT[N]) framework. Frailty was measured using a modified Frailty Index-11 (mFI-11). Regression and interaction models were utilized to assess the relationship among frailty, AT(N) profiles, and cognition. Moderation models analyzed the correlation between AT(N) profiles and cognition across three frailty levels. All analyses were corrected for age, sex, education, and APOEɛ4 status. Results In this study, frailty (odds ratio [OR] = 1.71, p < 0.001) and AT(N) profiles (OR = 2.00, p < 0.001) were independently associated with cognitive status. The model fit was improved when frailty was added to the model examining the relationship between AT(N) profiles and cognition (p < 0.001). There was a significant interaction between frailty and AT(N) profiles in relation to cognitive status (OR = 1.12, pinteraction = 0.028). Comparable results were obtained when Mini-Mental State Examination scores were utilized as the measure of cognitive performance. The association between AT(N) profiles and cognition was stronger with the levels of frailty. Conclusions Frailty may diminish patients' resilience to AD pathology and accelerate cognitive decline resulting from abnormal AD-related pathology. In summary, frailty contributes to elucidating the relationship between AD-related pathology and cognitive impairment.
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Affiliation(s)
- Bao-Lin Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ling-Zhi Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shuang-Ling Han
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Yin-Chu Mi
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Qingdao, China
| | - Jia-Yao Liu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ze-Hu Sheng
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Hui-Fu Wang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Department of Neurology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Department of Neurology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
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2
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Guillotin S, Fulzele A, Vallet A, de Peredo AG, Mouton‐Barbosa E, Cestac P, Andrieu S, Burlet‐Schiltz O, Delcourt N, Schmidt E. Cerebrospinal fluid proteomic profile of frailty: Results from the PROLIPHYC cohort. Aging Cell 2024; 23:e14168. [PMID: 38698559 PMCID: PMC11258431 DOI: 10.1111/acel.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Frailty is a clinical state reflecting a decrease in physiological reserve capacities, known to affect numerous biological pathways and is associated with health issues, including neurodegenerative diseases. However, how global protein expression is affected in the central nervous system in frail subject remains underexplored. In this post hoc cross-sectional biomarker analysis, we included 90 adults (52-85 years) suspected of normal pressure hydrocephalus (NPH) and presenting with markers of neurodegenerative diseases. We investigated the human proteomic profile of cerebrospinal fluid associated with frailty defined by an established cumulated frailty index (FI, average = 0.32), not enriched for neurology clinical features. Using a label-free quantitative proteomic approach, we identified and quantified 999 proteins of which 13 were positively associated with frailty. Pathway analysis with the top positively frailty-associated proteins revealed enrichment for proteins related to inflammation and immune response. Among the 60 proteins negatively associated with frailty, functional pathways enriched included neurogenesis, synaptogenesis and neuronal guidance. We constructed a frailty prediction model using ridge regression with 932 standardized proteins. Our results showed that the "proteomic model" could become an equivalent predictor of FI in order to study chronological age. This study represents the first comprehensive exploration of the proteomic profile of frailty within cerebrospinal fluid. It sheds light on the physiopathology of frailty, particularly highlighting processes of neuroinflammation and inhibition of neurogenesis. Our findings unveil a range of biological mechanisms that are dysregulated in frailty, in NPH subjects at risk of neurodegenerative impairment, offering new perspectives on frailty phenotyping and prediction.
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Affiliation(s)
- Sophie Guillotin
- Aging‐MAINTAIN Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP)University of ToulouseToulouseFrance
- Poison Control CenterToulouse University HospitalToulouseFrance
| | - Amit Fulzele
- Institute of Pharmacology and Structural Biology (IPBS)University of Toulouse, CNRS, University of Toulouse III (Paul Sabatier (UT3)ToulouseFrance
- Present address:
Institute of Molecular BiologyUniversity of MainzMainzGermany
| | - Alexandra Vallet
- Biological Tissue and Surface Engineering DepartmentINSERM U1059 Sainbiose, Ecole Des Mines of Saint‐EtienneSaint‐EtienneFrance
| | - Anne Gonzalez de Peredo
- Institute of Pharmacology and Structural Biology (IPBS)University of Toulouse, CNRS, University of Toulouse III (Paul Sabatier (UT3)ToulouseFrance
| | - Emmanuelle Mouton‐Barbosa
- Institute of Pharmacology and Structural Biology (IPBS)University of Toulouse, CNRS, University of Toulouse III (Paul Sabatier (UT3)ToulouseFrance
| | - Philippe Cestac
- Aging‐MAINTAIN Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP)University of ToulouseToulouseFrance
- Department of Clinical PharmacyToulouse University HospitalToulouseFrance
| | - Sandrine Andrieu
- Aging‐MAINTAIN Research Team, Center for Epidemiology and Research in POPulation Health (CERPOP)University of ToulouseToulouseFrance
- Department of Epidemiology and Public HealthToulouse University HospitalToulouseFrance
- IHU HealthAgeToulouseFrance
| | - Odile Burlet‐Schiltz
- Institute of Pharmacology and Structural Biology (IPBS)University of Toulouse, CNRS, University of Toulouse III (Paul Sabatier (UT3)ToulouseFrance
| | - Nicolas Delcourt
- Poison Control CenterToulouse University HospitalToulouseFrance
- Toulouse NeuroImaging Center (ToNIC)University of Toulouse, INSERM UPSToulouseFrance
| | - Eric Schmidt
- Toulouse NeuroImaging Center (ToNIC)University of Toulouse, INSERM UPSToulouseFrance
- Department of NeurosurgeryToulouse University HospitalToulouseFrance
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3
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O'Leary TP, Brown RE. Age-related changes in species-typical behaviours in the 5xFAD mouse model of Alzheimer's disease from 4 to 16 months of age. Behav Brain Res 2024; 465:114970. [PMID: 38531510 DOI: 10.1016/j.bbr.2024.114970] [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: 01/15/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
Alzheimer's disease (AD) patients show age-related decreases in the ability to perform activities of daily living and the decline in these activities is related to the severity of neurobiological deterioration underlying the disease. The 5xFAD mouse model of AD shows age-related impairments in sensory- motor and cognitive function, but little is known about changes in species-typical behaviours that may model activities of daily living in AD patients. Therefore, we examined species-typical behaviours used as indices of exploration (rearing) and compulsivity (grooming) across six tests of anxiety-like behaviour or motor function in female 5xFAD mice from 3 to 16 months of age. Robust decreases in rearing were found in 5xFAD mice across all tests after 9 months of age, although few differences were observed in grooming. A fine-scale analysis of grooming, however, revealed a previously unresolved and spatially restricted pattern of grooming in 5xFAD mice at 13-16 months of age. We then examined changes in species-typical behaviours in the home-cage, and show impaired nest building in 5xFAD mice at all ages tested. Lastly, we examined the relationship between reduced species typical behaviours in 5xFAD mice and the presentation of freezing behaviour, a commonly used measure of memory for conditioned fear. These results showed that along with cognitive and sensory-motor behaviour, 5xFAD mice have robust age-related impairments in species-typical behaviours. Therefore, species typical behaviours in 5xFAD mice may help to model the decline in activities of daily living observed in AD patients, and may provide useful behavioural phenotypes for evaluating the pre-clinical efficacy of novel therapeutics for AD.
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Affiliation(s)
- Timothy P O'Leary
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Richard E Brown
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada.
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Enduru N, Fernandes BS, Zhao Z. Dissecting the shared genetic architecture between Alzheimer's disease and frailty: a cross-trait meta-analyses of genome-wide association studies. Front Genet 2024; 15:1376050. [PMID: 38706793 PMCID: PMC11069310 DOI: 10.3389/fgene.2024.1376050] [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: 01/24/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction: Frailty is the most common medical condition affecting the aging population, and its prevalence increases in the population aged 65 or more. Frailty is commonly diagnosed using the frailty index (FI) or frailty phenotype (FP) assessments. Observational studies have indicated the association of frailty with Alzheimer's disease (AD). However, the shared genetic and biological mechanism of these comorbidity has not been studied. Methods: To assess the genetic relationship between AD and frailty, we examined it at single nucleotide polymorphism (SNP), gene, and pathway levels. Results: Overall, 16 genome-wide significant loci (15 unique loci) (p meta-analysis < 5 × 10-8) and 22 genes (21 unique genes) were identified between AD and frailty using cross-trait meta-analysis. The 8 shared loci implicated 11 genes: CLRN1-AS1, CRHR1, FERMT2, GRK4, LINC01929, LRFN2, MADD, RP11-368P15.1, RP11-166N6.2, RNA5SP459, and ZNF652 between AD and FI, and 8 shared loci between AD and FFS implicated 11 genes: AFF3, C1QTNF4, CLEC16A, FAM180B, FBXL19, GRK4, LINC01104, MAD1L1, RGS12, ZDHHC5, and ZNF521. The loci 4p16.3 (GRK4) was identified in both meta-analyses. The colocalization analysis supported the results of our meta-analysis in these loci. The gene-based analysis revealed 80 genes between AD and frailty, and 4 genes were initially identified in our meta-analyses: C1QTNF4, CRHR1, MAD1L1, and RGS12. The pathway analysis showed enrichment for lipoprotein particle plasma, amyloid fibril formation, protein kinase regulator, and tau protein binding. Conclusion: Overall, our results provide new insights into the genetics of AD and frailty, suggesting the existence of non-causal shared genetic mechanisms between these conditions.
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Affiliation(s)
- Nitesh Enduru
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Brisa S. Fernandes
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhongming Zhao
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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5
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Buchholz E, Gillespie NA, Hunt JF, Reynolds CA, Rissman RA, Schroeder A, Cortes I, Bell T, Lyons MJ, Kremen WS, Franz CE. Midlife cumulative deficit frailty predicts Alzheimer's disease-related plasma biomarkers in older adults. Age Ageing 2024; 53:afae028. [PMID: 38454901 PMCID: PMC10921085 DOI: 10.1093/ageing/afae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The study explores whether frailty at midlife predicts mortality and levels of biomarkers associated with Alzheimer's disease and related dementias (ADRD) and neurodegeneration by early old age. We also examine the heritability of frailty across this age period. METHODS Participants were 1,286 community-dwelling men from the Vietnam Era Twin Study of Aging at average ages 56, 62 and 68, all without ADRD at baseline. The cumulative deficit frailty index (FI) comprised 37 items assessing multiple physiological systems. Plasma biomarkers at age 68 included beta-amyloid (Aβ40, Aβ42), total tau (t-tau) and neurofilament light chain (NfL). RESULTS Being frail doubled the risk of all-cause mortality by age 68 (OR = 2.44). Age 56 FI significantly predicted age 68 NfL (P = 0.014), Aβ40 (P = 0.001) and Aβ42 (P = 0.023), but not t-tau. Age 62 FI predicted all biomarkers at age 68: NfL (P = 0.023), Aβ40 (P = 0.002), Aβ42 (P = 0.001) and t-tau (P = 0.001). Age 68 FI scores were associated with age 68 levels of NfL (P = 0.027), Aβ40 (P < 0.001), Aβ42 (P = 0.001) and t-tau (P = 0.003). Genetic influences accounted for 45-48% of the variance in frailty and significantly contributed to its stability across 11 years. CONCLUSIONS Frailty during one's 50s doubled the risk of mortality by age 68. A mechanism linking frailty and ADRD may be through its associations with biomarkers related to neurodegeneration. Cumulative deficit frailty increases with age but remains moderately heritable across the age range studied. With environmental factors accounting for about half of its variance, early interventions aimed at reducing frailty may help to reduce risk for ADRD.
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Affiliation(s)
- Erik Buchholz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
- Department of Information Science, University of Arkansas at Little Rock, Little Rock, AR 72204 USA
| | - Nathan A Gillespie
- Virginia Institute for Psychiatric and Behavior Genetics, Virginia Commonwealth University, VA 23298, USA
| | - Jack F Hunt
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
| | - Chandra A Reynolds
- Department of Psychology, University of California Riverside, Riverside, CA 92521, USA
| | - Robert A Rissman
- Department of Neurosciences, University of California, San Diego and VA San Diego Healthcare System, La Jolla, CA 92093, USA
- Alzheimer’s Therapeutic Research Institute, University of Southern California, San Diego, CA 92121, USA
| | - Angelica Schroeder
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
| | - Isaac Cortes
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
| | - Tyler Bell
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
| | - Michael J Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
| | - William S Kremen
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
| | - Carol E Franz
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
- Center for Behavior Genetics of Aging, University of California, La Jolla, San Diego, CA 92093, USA
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6
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Zeidan RS, McElroy T, Rathor L, Martenson MS, Lin Y, Mankowski RT. Sex differences in frailty among older adults. Exp Gerontol 2023; 184:112333. [PMID: 37993077 DOI: 10.1016/j.exger.2023.112333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.
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Affiliation(s)
- Rola S Zeidan
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Taylor McElroy
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Laxmi Rathor
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Matthew S Martenson
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Yi Lin
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
| | - Robert T Mankowski
- Department of Physiology and Aging, College of Medicine, University of Florida, Gainesville, FL, United States of America.
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7
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Reduced cerebral blood flow of lingual gyrus associated with both cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. J Neurol Sci 2022; 437:120266. [DOI: 10.1016/j.jns.2022.120266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/20/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
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8
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Siejka TP, Srikanth VK, Hubbard RE, Moran C, Beare R, Wood AG, Collyer TA, Gujjari S, Phan TG, Callisaya ML. Frailty is associated with cognitive decline independent of cerebral small vessel disease and brain atrophy. J Gerontol A Biol Sci Med Sci 2022; 77:1819-1826. [PMID: 35363862 PMCID: PMC9434440 DOI: 10.1093/gerona/glac078] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background To examine the effect of frailty on cognitive decline independent of cerebral small vessel disease (cSVD) and brain atrophy, and whether associations between neuropathology and cognition differed depending on frailty status. Methods The Tasmanian Study of Cognition and Gait was a population-based longitudinal cohort study with data collected at 3 phases from 2005 to 2012. Participants aged 60–85 were randomly selected from the electoral roll. Various data were used to operationalize a 36-item frailty index (FI) at baseline. Brain MRI was undertaken to obtain baseline measures of neuropathology. A neuropsychological battery was used to assess cognition at each time point. Generalized linear mixed models were used to examine the effect of frailty and MRI measures on cognition over time. The associations between MRI measures and cognition were explored after stratifying the sample by baseline frailty status. All analyses were adjusted for age, sex, and education. Results A total of 385 participants were included at baseline. The mean age was 72.5 years (standard deviation [SD] 7.0), 44% were female (n = 171). In fully adjusted linear mixed models, frailty (FI × time β −0.001, 95% confidence interval [CI] −0.003, −0.001, p = .03) was associated with decline in global cognition, independent of brain atrophy, and cSVD. The association between cSVD and global cognition was significant only in those with low levels of frailty (p = .03). Conclusion These findings suggest that frailty is an important factor in early cognitive dysfunction, and measuring frailty may prove useful to help identify future risk of cognitive decline.
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Affiliation(s)
| | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Ruth E Hubbard
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chris Moran
- Alfred Health, Melbourne, Victoria, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richard Beare
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda G Wood
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,School of Life and Health Sciences & Aston Brain Centre, Aston University, United Kingdom.,School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, Geelong, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Thanh G Phan
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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9
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Sugimoto T, Arai H, Sakurai T. An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions. Geriatr Gerontol Int 2021; 22:99-109. [PMID: 34882939 DOI: 10.1111/ggi.14322] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023]
Abstract
Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut-derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2021; ••: ••-••.
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Affiliation(s)
- Taiki Sugimoto
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Department of Prevention and Care Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan.,Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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10
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Amanzio M, Palermo S, Stanziano M, D'Agata F, Galati A, Gentile S, Castellano G, Bartoli M, Cipriani GE, Rubino E, Fonio P, Rainero I. Investigating Neuroimaging Correlates of Early Frailty in Patients With Behavioral Variant Frontotemporal Dementia: A MRI and FDG-PET Study. Front Aging Neurosci 2021; 13:637796. [PMID: 33935684 PMCID: PMC8079404 DOI: 10.3389/fnagi.2021.637796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/19/2021] [Indexed: 01/20/2023] Open
Abstract
Frailty is a dynamic clinical condition characterized by the reduction of interconnections among different psychobiological domains, which leads to a homeostatic vulnerability. The association between physical frailty and cognitive dysfunctions is a possible predictor of poor prognosis in patients with neurodegenerative disorders. However, this construct has not been fully analyzed by a multidimensional neuropsychogeriatric assessment matched with multimodal neuroimaging methods in patients with behavioral variant frontotemporal dementia (bvFTD). We have investigated cognitive dysfunctions and frailty status, assessed by both a neuropsychological evaluation and the Multidimensional Prognostic Index (MPI), in a sample of 18 bvFTD patients and compared to matched healthy controls. Gray matter (GM) volume (as assessed by voxel-based morphometry) and metabolism (on 18fluorodeoxyglucose positron emission tomography) were first separately compared between groups, then voxelwise compared and correlated to each other within patients. Linear regression of the MPI was performed on those voxels presenting a significant correlation between altered GM volume and metabolism. The neuropsychological assessment reflected the diagnoses and the functional-anatomical alterations documented by neuroimaging analyses. In particular, the majority of patients presented significant executive dysfunction and mood changes in terms of apathy, depression, and anxiety. In the overall MPI score, the patients fell in the lower range (indicating an early frailty status). On imaging, they exhibited a bilateral decrease of GM density and hypometabolism involving the frontal pole, the anterior opercular region, and the anterior cingulate cortex. Greater atrophy than hypometabolism was observed in the bilateral orbitofrontal cortex, the triangular part of the inferior frontal gyrus, and the ventral striatum, whereas the contrary was detected in the bilateral dorsal anterior cingulate cortex and pre-supplementary motor area. MPI scores significantly correlated only with the co-occurrence of a decrease of GM density and hypometabolism in the right anterior insular cortex, but not with the separate pathological phenomena. Our results show a correlation between a specific pattern of co-occurring GM atrophy and hypometabolism with early frailty in bvFTD patients. These aspects, combined with executive dysfunction and mood changes, may lead to an increased risk of poor prognosis, highlighting a potentially critical and precocious role of the insula in the pathogenesis of frailty.
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Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy
- European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
- Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Orbassano, Italy
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), Brussels, Belgium
| | - Mario Stanziano
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,”Milan, Italy
- Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Federico D'Agata
- Neuroradiology Unit, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Antonello Galati
- Nuclear Medicine, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino,”Turin, Italy
| | - Salvatore Gentile
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Giancarlo Castellano
- Neuroradiology Unit, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | | | | | - Elisa Rubino
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
| | - Paolo Fonio
- Department of Diagnostic Imaging and Radiotherapy, Radiology Institute, Azienda Ospedaliera Universitaria “Città della Salute e della Scienza di Torino,” University of Turin, Turin, Italy
| | - Innocenzo Rainero
- Centro Interdipartimentale di Studi Avanzati in Neuroscienze - National Institute of Turin (NIT), Orbassano, Italy
- Aging Brain and Memory Clinic, Neurology I, Department of Neuroscience “Rita Levi Montalcini,” University of Turin, Turin, Italy
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11
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Castillo-Mariqueo L, Giménez-Llort L. Translational Modeling of Psychomotor Function in Normal and AD-Pathological Aging With Special Concerns on the Effects of Social Isolation. FRONTIERS IN AGING 2021; 2:648567. [PMID: 35822009 PMCID: PMC9261363 DOI: 10.3389/fragi.2021.648567] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 01/10/2023]
Abstract
One year after the start of the COVID-19 pandemic, its secondary impacts can be globally observed. Some of them result from physical distancing and severe social contact restrictions by policies still imposed to stop the fast spread of new variants of this infectious disease. People with Alzheimer's disease (AD) and other dementias can also be significantly affected by the reduction of their activity programs, the loss of partners, and social isolation. Searching for the closest translational scenario, the increased mortality rates in male 3xTg-AD mice modeling advanced stages of the disease can provide a scenario of “naturalistic isolation.” Our most recent work has shown its impact worsening AD-cognitive and emotional profiles, AD-brain asymmetry, and eliciting hyperactivity and bizarre behaviors. Here, we further investigated the psychomotor function through six different psychomotor analysis in a set of 13-month-old 3xTg-AD mice and their non-transgenic counterparts with normal aging. The subgroup of male 3xTg-AD mice that lost their partners lived alone for the last 2–3 months after 10 months of social life. AD's functional limitations were shown as increased physical frailty phenotype, poor or deficient psychomotor performance, including bizarre behavior, in variables involving information processing and decision-making (exploratory activity and spontaneous gait), that worsened with isolation. Paradoxical muscular strength and better motor performance (endurance and learning) was shown in variables related to physical work and found enhanced by isolation, in agreement with the hyperactivity and the appearance of bizarre behaviors previously reported. Despite the isolation, a delayed appearance of motor deficits related to physical resistance and tolerance to exercise was found in the 3xTg-AD mice, probably because of the interplay of hyperactivity and mortality/survivor bias. The translation of these results to the clinical setting offers a guide to generate flexible and personalized rehabilitation strategies adaptable to the restrictions of the COVID-19 pandemic.
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Affiliation(s)
- Lidia Castillo-Mariqueo
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lydia Giménez-Llort
- Institut de Neurociències, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- *Correspondence: Lydia Giménez-Llort
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12
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Gendron WH, Fertan E, Pelletier S, Roddick KM, O'Leary TP, Anini Y, Brown RE. Age related weight loss in female 5xFAD mice from 3 to 12 months of age. Behav Brain Res 2021; 406:113214. [PMID: 33677013 DOI: 10.1016/j.bbr.2021.113214] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023]
Abstract
In addition to cognitive decline, patients with Alzheimer's disease (AD) exhibit sensory, motor, and neuropsychiatric deficits. Many AD patients also show weight loss, suggesting that AD may involve a metabolic syndrome. The 5xFAD mouse model shows age-related weight loss compared to wildtype controls, and thus may exhibit metabolic dysfunction. This longitudinal study measured age-related weight loss in female 5xFAD and B6SJL/JF2 wild-type mice from 3 to 12 months of age, and examines some of the behavioural and physiological phenotypes in these mice that have been proposed to contribute to this weight loss. Because some mice had to be singly housed during the study, we also examined genotype by housing interactions. The 5xFAD mice weighed less and ate less than WT littermates starting at 6 months of age, exhibited less home cage activity, had higher frailty scores, less white adipose tissue, and lower leptin expression. At 9 and 12 months of age, heavier 5xFAD mice performed better on the rotarod, suggesting that metabolic deficits which begin between 6 and 9 months of age may exacerbate the behavioural deficits in 5xFAD mice. These results indicate that the 5xFAD mouse is a useful model to study the behavioural and metabolic changes in AD.
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Affiliation(s)
- William H Gendron
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Emre Fertan
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Stephanie Pelletier
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kyle M Roddick
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Timothy P O'Leary
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Younes Anini
- Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Richard E Brown
- Departments of Psychology and Neuroscience, Halifax, Nova Scotia, B3H 4R2, Canada; Departments of Physiology and Biophysics, Halifax, Nova Scotia, B3H 4R2, Canada.
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13
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Ibáñez-del Valle V, Navarro-Martínez R, Ballestar-Tarín ML, Cauli O. Salivary Inflammatory Molecules as Biomarkers of Sleep Alterations: A Scoping Review. Diagnostics (Basel) 2021; 11:diagnostics11020278. [PMID: 33579032 PMCID: PMC7916754 DOI: 10.3390/diagnostics11020278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
Poor sleep quality and sleep disorders are the most common problems in people, affecting health-related quality of life. Various studies show an association between sleep disorders and altered levels of stress hormones and inflammatory cytokines measured in saliva. The main objective of this article is to provide an analysis of the current evidence related to changes in inflammatory markers in the saliva and their associations with sleep quality measurement (both objective and subjective methods) in healthy subjects and in sleep-related disorders. To that end, a scoping review was carried out, following the PRISMA criteria in the bibliographic search in several databases: PubMed, EBSCO, and SCOPUS. Eleven of the articles are from the adult population and two from the child-youth population. They mainly measure the relationship between sleep and interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNFα) alpha, as well as other inflammatory markers such as myeloperoxidase (MPO) and prostaglandin-endoperoxide synthase 2. An analysis shows the relationship between these salivary biomarkers and sleep quality, especially in the case of IL-6 in both healthy subjects and several pathologies associated with sleep-disorders. The results for TNFα and IL-1β measurements are still inconclusive and the difference with IL-6 was assessed. Two studies reported interventions that result in sleep improvement and are accompanied by the normalization of inflammatory changes detected in the saliva. As it is an easy-to-apply and non-invasive method, the measurement of salivary cytokines can be very useful in chronobiology studies. Further studies are required to determine the sensitivity of salivary inflammatory markers in monitoring biological rhythms and acting as biomarkers in the detection of sleep disorders and sleep interventions.
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Affiliation(s)
- Vanessa Ibáñez-del Valle
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain; (V.I.-d.V.); (R.N.-M.); (M.L.B.-T.)
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Active Ageing, University of Valencia, 4610 Valencia, Spain
| | - Rut Navarro-Martínez
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain; (V.I.-d.V.); (R.N.-M.); (M.L.B.-T.)
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Active Ageing, University of Valencia, 4610 Valencia, Spain
| | - Maria Luisa Ballestar-Tarín
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain; (V.I.-d.V.); (R.N.-M.); (M.L.B.-T.)
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, c/Jaume Roig s/n, 46010 Valencia, Spain; (V.I.-d.V.); (R.N.-M.); (M.L.B.-T.)
- Frailty and Cognitive Impairment Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Active Ageing, University of Valencia, 4610 Valencia, Spain
- Correspondence:
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14
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Mladenovic Djordjevic AN, Kapetanou M, Loncarevic-Vasiljkovic N, Todorovic S, Athanasopoulou S, Jovic M, Prvulovic M, Taoufik E, Matsas R, Kanazir S, Gonos ES. Pharmacological intervention in a transgenic mouse model improves Alzheimer's-associated pathological phenotype: Involvement of proteasome activation. Free Radic Biol Med 2021; 162:88-103. [PMID: 33279620 PMCID: PMC7889698 DOI: 10.1016/j.freeradbiomed.2020.11.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 12/16/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia worldwide, characterized by a progressive decline in a variety of cognitive and non-cognitive functions. The amyloid beta protein cascade hypothesis places the formation of amyloid beta protein aggregates on the first position in the complex pathological cascade leading to neurodegeneration, and therefore AD might be considered to be a protein-misfolding disease. The Ubiquitin Proteasome System (UPS), being the primary protein degradation mechanism with a fundamental role in the maintenance of proteostasis, has been identified as a putative therapeutic target to delay and/or to decelerate the progression of neurodegenerative disorders that are characterized by accumulated/aggregated proteins. The purpose of this study was to test if the activation of proteasome in vivo can alleviate AD pathology. Specifically by using two compounds with complementary modes of proteasome activation and documented antioxidant and redox regulating properties in the 5xFAD transgenic mice model of AD, we ameliorated a number of AD related deficits. Shortly after proteasome activation we detected significantly reduced amyloid-beta load correlated with improved motor functions, reduced anxiety and frailty level. Essentially, to our knowledge this is the first report to demonstrate a dual activation of the proteasome and its downstream effects. In conclusion, these findings open up new directions for future therapeutic potential of proteasome-mediated proteolysis enhancement.
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Affiliation(s)
- Aleksandra N Mladenovic Djordjevic
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia.
| | - Marianna Kapetanou
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vassileos Constantinou Ave., 11635, Athens, Greece
| | - Natasa Loncarevic-Vasiljkovic
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia; Molecular Nutrition and Health Lab, CEDOC - Centro de Estudos de Doenças Crónicas, NOVA Medical School / Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Edifício CEDOC II, Rua Câmara Pestana 6, 1150-082, Lisboa, Portugal
| | - Smilja Todorovic
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia
| | - Sofia Athanasopoulou
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vassileos Constantinou Ave., 11635, Athens, Greece; Department of Biology, Faculty of Medicine, University of Thessaly, Biopolis, 41500, Larissa, Greece
| | - Milena Jovic
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia
| | - Milica Prvulovic
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia
| | - Era Taoufik
- Laboratory of Cellular and Molecular Neurobiology-Stem Cells, Department of Neurobiology, Hellenic Pasteur Institute, 127 Vasilissis Sofias Avenue, 11521, Athens, Greece
| | - Rebecca Matsas
- Laboratory of Cellular and Molecular Neurobiology-Stem Cells, Department of Neurobiology, Hellenic Pasteur Institute, 127 Vasilissis Sofias Avenue, 11521, Athens, Greece
| | - Selma Kanazir
- Department for Neurobiology, Institute for Biological Research "Sinisa Stankovic", National Institute of Republic of Serbia, University of Belgrade, Boulevard Despota Stefana, 142, 11000, Belgrade, Serbia
| | - Efstathios S Gonos
- Institute of Chemical Biology, National Hellenic Research Foundation, 48 Vassileos Constantinou Ave., 11635, Athens, Greece.
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15
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Biomarkers and phenotypic expression in Alzheimer's disease: exploring the contribution of frailty in the Alzheimer's Disease Neuroimaging Initiative. GeroScience 2020; 43:1039-1051. [PMID: 33210215 PMCID: PMC8110661 DOI: 10.1007/s11357-020-00293-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
The present study aimed at investigating if the main biomarkers of Alzheimer’s disease (AD) neuropathology and their association with cognitive disturbances and dementia are modified by the individual’s frailty status. We performed a cross-sectional analysis of data from participants with normal cognition, mild cognitive impairment (MCI), and AD dementia enrolled in the Alzheimer’s Disease Neuroimaging Initiative 2 (ADNI2) study. Frailty was operationalized by computing a 40-item Frailty Index (FI). The following AD biomarkers were considered and analyzed according to the participants’ frailty status: CSF Aβ1-42, 181P-tau, and T-tau; MRI-based hippocampus volume; cortical glucose metabolism at the FDG PET imaging; amyloid deposition at the 18F-AV-45 PET imaging. Logistic regression models, adjusted for age, sex, and education, were performed to explore the association of biomarkers with cognitive status at different FI levels. Subjects with higher FI scores had lower CSF levels of Aβ1-42, hippocampus volumes at the MRI, and glucose metabolism at the FDG PET imaging, and a higher amyloid deposition at the 18F-AV-45 PET. No significant differences were observed among the two frailty groups concerning ApoE genotype, CSF T-tau, and P-tau. Increasing frailty levels were associated with a weakened relationship between dementia and 18F-AV-45 uptake and hippocampus volume and with a stronger relationship of dementia with FDG PET. Frailty contributes to the discrepancies between AD pathology and clinical manifestations and influences the association of AD pathological modifications with cognitive changes. AD and dementia should increasingly be conceived as “complex diseases of aging,” determined by multiple, simultaneous, and interacting pathophysiological processes.
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16
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Sugimoto T, Ono R, Kimura A, Saji N, Niida S, Toba K, Sakurai T. Cross-Sectional Association Between Cognitive Frailty and White Matter Hyperintensity Among Memory Clinic Patients. J Alzheimers Dis 2020; 72:605-612. [PMID: 31594230 DOI: 10.3233/jad-190622] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cognitive frailty (CF) is defined as simultaneous presence of physical frailty (PF) and cognitive impairment among older adults without dementia. Although white matter hyperintensities (WMH) as expressions of cerebral small vessel disease are associated with physical and cognitive decline and could manifest as CF, this association remains yet to be clarified. OBJECTS To clarify the association between CF and WMH among memory clinic patients. METHODS The subjects of this cross-sectional study were 121 cognitively normal (CN) and 212 mildly cognitively impaired (MCI) patients who presented to the Memory Clinic at the National Center for Geriatrics and Gerontology of Japan. PF status was defined based on the definition proposed by Fried and colleagues. CF was defined as simultaneous presence of pre-PF or PF and MCI. WMH volumes were measured using an automatic segmentation application. Multiple liner regression analyses with adjustment for cardiovascular risk factors were performed. RESULTS Of all subjects, 77 (63.6%) and 22 (18.2%) CN patients and 132 (62.3%) and 65 (30.7%) MCI patients were categorized into pre-PF and PF, respectively. Multiple liner regression analysis showed that those with CF had higher WMH volumes than those without (β= 0.23). When categorized into six groups according to PF and cognitive status, the PF/CN (β= 0.15), pre-PF/MCI (β= 0.41), and PF/MCI (β= 0.34) groups had higher WMH volumes than the non-PF/CN group. CONCLUSIONS This study showed increased WMH volumes in CF and PF, indicating that WMH could be one of the key underlying brain pathologies of CF.
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Affiliation(s)
- Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Rei Ono
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Ai Kimura
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Cognition and Behavior Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Rockwood K, Andrew MK, Aubertin‐Leheudre M, Belleville S, Bherer L, Bowles SK, Kehler DS, Lim A, Middleton L, Phillips N, Wallace LM. CCCDTD5: Reducing the risk of later-life dementia. Evidence informing the Fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD-5). ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12083. [PMID: 33204818 PMCID: PMC7656906 DOI: 10.1002/trc2.12083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
The Fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD-5) was a year-long process to synthesize the best available evidence on several topics. Our group undertook evaluation of risk reduction, in eight domains: nutrition; physical activity; hearing; sleep; cognitive training and stimulation; social engagement and education; frailty; and medications. Here we describe the rationale for the undertaking and summarize the background evidence-this is also tabulated in the Appendix. We further comment specifically on the relationship between age and dementia, and offer some suggestions for how reducing the risk of dementia in the seventh decade and beyond might be considered if we are to improve prospects for prevention in the near term. We draw to attention that a well-specified model of success in dementia prevention need not equate to the elimination of cognitive impairment in late life.
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Affiliation(s)
- Kenneth Rockwood
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Melissa K. Andrew
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Sylvie Belleville
- Research CenterInstitut Universitaire de Gériatrie de MontréalMontréalQuebecCanada
- Psychology DepartmentUniversité de MontréalMontréalCanada
| | - Louis Bherer
- Département de Médecine, Faculté de médecine, Université de Montréal, Centre de recherche, Institut de cardiologie de Montréal, Centre de rechercheInstitut universitaire de gériatrie de MontréalMontréalQuébecCanada
| | - Susan K. Bowles
- Division of Geriatric MedicineDalhousie UniversityHalifaxNova ScotiaCanada
- College of PharmacyDalhousie UniversityHalifaxNova ScotiaCanada
| | - D Scott Kehler
- School of PhysiotherapyDalhousie UniversityHalifaxNova ScotiaCanada
| | - Andrew Lim
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Laura Middleton
- Department of KinesiologyUniversity of WaterlooWaterlooOntarioCanada
| | - Natalie Phillips
- Department of PsychologyConcordia UniversityMontréalQuébecCanada
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18
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Grande G, Rizzuto D, Vetrano DL, Marseglia A, Vanacore N, Laukka EJ, Welmer AK, Fratiglioni L. Cognitive and physical markers of prodromal dementia: A 12-year-long population study. Alzheimers Dement 2020; 16:153-161. [PMID: 31914224 PMCID: PMC7984067 DOI: 10.1002/alz.12002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/18/2019] [Accepted: 10/24/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim is to test whether adding a simple physical test such as walking speed (WS) to the neuropsychological assessment increases the predictive ability to detect dementia. METHODS The 2546 dementia-free people from the SNAC-K study were grouped into four profiles: (1) healthy profile; (2) isolated cognitive impairment, no dementia (CIND, scoring 1.5 standard deviation below age-specific means on ≥1 cognitive domains); (3) isolated slow WS (<0.8 m/s); (4) CIND+ slow WS. The hazard of dementia (Cox regression), the positive and negative predictive values (PPV, NPV), and the area under the curve (AUC) were estimated. RESULTS Participants with CIND +slow WS demonstrated the highest hazard of dementia (3.4; 95% confidence interval [CI]: 2.5-4.8). The AUC increased from 0.69 for isolated CIND to 0.83 for CIND+ slow WS. Such an increase was due to the improvement of the PPV, the NPV remaining optimal. DISCUSSION Adding WS to the cognitive assessment dramatically increases the diagnostic accuracy of prodromal dementia.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Geriatrics, Catholic University, Rome, Italy.,Centro di Medicina dell'Invecchiamento, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | - Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Centre, Stockholm, Sweden
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19
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Sathyan S, Ayers E, Gao T, Milman S, Barzilai N, Rockwood K, Verghese J. Frailty and Risk of Incident Motoric Cognitive Risk Syndrome. J Alzheimers Dis 2020; 71:S85-S93. [PMID: 31450502 DOI: 10.3233/jad-190517] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Frailty is highly prevalent among older adults, and associated with cognitive decline. Relationship between frailty and motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by the presence of subjective cognitive complaints and slow gait, is yet to be elucidated. OBJECTIVE To examine whether frailty increases the risk of developing incident MCR. METHODS We analyzed 641 adults, aged 65 and above, participating in the LonGenity study. Frailty was defined using a 41-point cumulative deficit frailty index (FI). MCR was diagnosed at baseline and annual follow-up visits using established criteria. Cox proportional hazard models were used to study the association of baseline frailty with incident MCR, and reported as hazard ratio (HR) with 95% confidence intervals (CI) adjusted for age, sex, and education. RESULTS At baseline, 70 participants (10·9%) had prevalent MCR. Of the remaining 571 non-MCR participants (mean age 75.0, 57.3% women), 70 developed incident MCR (median follow-up 2.6 years). Higher frailty scores at baseline were associated with an increased risk of incident MCR (HR for each 0.01 increase in the FI: 1.07; 95% CI 1.03-1.11; p = 0.0002). The result was unchanged even after excluding mobility related or chronic illnesses items from the FI as well as accounting for reverse causation, competing risk of death, baseline cognitive status, social vulnerability, and excluding participants with mild cognitive impairment syndrome. CONCLUSIONS Higher levels of frailty increase risk for developing MCR and suggest shared mechanisms. This association merits further study to identify strategies to prevent cognitive decline.
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Affiliation(s)
- Sanish Sathyan
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tina Gao
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sofiya Milman
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kenneth Rockwood
- Divisions of Geriatric Medicine & Neurology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joe Verghese
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Wallace LMK, Theou O, Darvesh S, Bennett DA, Buchman AS, Andrew MK, Kirkland SA, Fisk JD, Rockwood K. Neuropathologic burden and the degree of frailty in relation to global cognition and dementia. Neurology 2020; 95:e3269-e3279. [PMID: 32989103 DOI: 10.1212/wnl.0000000000010944] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To test the hypothesis that degree of frailty and neuropathologic burden independently contribute to global cognition and odds of dementia. METHODS This was a secondary analysis of a prospective cohort study of older adults living in Illinois. Participants underwent an annual neuropsychological and clinical evaluation. We included 625 participants (mean age 89.7 ± 6.1 years; 67.5% female) who died and underwent autopsy. We quantified neuropathology using an index measure of 10 neuropathologic features: β-amyloid deposition, hippocampal sclerosis, Lewy bodies, tangle density, TDP-43, cerebral amyloid angiopathy, arteriolosclerosis, atherosclerosis, and gross and chronic cerebral infarcts. Clinical consensus determined dementia status, which we coded as no cognitive impairment, mild cognitive impairment, or dementia. A battery of 19 tests spanning multiple domains quantified global cognition. We operationalized frailty using a 41-item frailty index. We employed regression analyses to model relationships between neuropathology, frailty, and dementia. RESULTS Both frailty and a neuropathology index were independently associated with global cognition and dementia status. These results held after controlling for traditional pathologic measures in a sample of participants with Alzheimer clinical syndrome. Frailty improved the fit of the model for dementia status (χ2[2] 72.64; p < 0.0001) and explained an additional 11%-12% of the variance in the outcomes. CONCLUSION Dementia is a multiply determined condition, to which both general health, as captured by frailty, and neuropathology significantly contribute. This integrative view of dementia and health has implications for prevention and therapy; specifically, future research should evaluate frailty as a means of dementia risk reduction.
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Affiliation(s)
- Lindsay M K Wallace
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Olga Theou
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Sultan Darvesh
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - David A Bennett
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Aron S Buchman
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Melissa K Andrew
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Susan A Kirkland
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - John D Fisk
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL
| | - Kenneth Rockwood
- From the Departments of Medicine (L.M.K.W., O.T., S.D., M.K.A., J.D.F., K.R.), Physiotherapy (O.T.), Community Health and Epidemiology (S.K.), and Psychiatry (J.D.F.), Dalhousie University, Halifax, Canada; and Rush Alzheimer's Disease Center (D.A.B., A.S.B.), Rush University Medical Center, Chicago, IL.
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21
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Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396:413-446. [PMID: 32738937 PMCID: PMC7392084 DOI: 10.1016/s0140-6736(20)30367-6] [Citation(s) in RCA: 4425] [Impact Index Per Article: 1106.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - David Ames
- National Ageing Research Institute and Academic Unit for Psychiatry of Old Age, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Sube Banerjee
- Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Alistair Burns
- Department of Old Age Psychiatry, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Nick Fox
- Dementia Research Centre, UK Dementia Research Institute, University College London, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Division of Psychiatry, University College London, London, UK; Barnet, Enfield, and Haringey Mental Health Trust, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MA, USA
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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22
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Vidal PP, Vienne-Jumeau A, Moreau A, Vidal C, Wang D, Audiffren J, Bargiotas I, Barrois R, Buffat S, Dubost C, Ghidaglia JM, Labourdette C, Mantilla J, Oudre L, Quijoux F, Robert M, Yelnik AP, Ricard D, Vayatis N. An opinion paper on the maintenance of robustness: Towards a multimodal and intergenerational approach using digital twins. Aging Med (Milton) 2020; 3:188-194. [PMID: 33103039 PMCID: PMC7574634 DOI: 10.1002/agm2.12115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/29/2022] Open
Abstract
The increasing number of frail elderly people in our aging society is becoming problematic: about 11% of community‐dwelling older persons are frail and another 42% are pre‐frail. Consequently, a major challenge in the coming years will be to test people over the age of 60 years to detect pre‐frailty at the earliest stage and to return them to robustness using the targeted interventions that are becoming increasingly available. This challenge requires individual longitudinal monitoring (ILM) or follow‐up of community‐dwelling older persons using quantitative approaches. This paper briefly describes an effort to tackle this challenge. Extending the detection of the pre‐frail stages to other population groups is also suggested. Appropriate algorithms have been used to begin the tracing of faint physiological signals in order to detect transitions from robustness to pre‐frailty states and from pre‐frailty to frailty states. It is hoped that these studies will allow older adults to receive preventive treatment at the correct institutions and by the appropriate professionals as early as possible, which will prevent loss of autonomy. Altogether, ILM is conceived as an emerging property of databases (“digital twins”) and not the reverse. Furthermore, ILM should facilitate a coordinated set of actions by the caregivers, which is a complex challenge in itself. This approach should be gradually extended to all ages, because frailty has no age, as is testified by overwork, burnout, and post‐traumatic syndrome.
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Affiliation(s)
- Pierre-Paul Vidal
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Centre Borelli CNRS Paris University Paris France
| | | | - Albane Moreau
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France
| | - Catherine Vidal
- Centre Borelli CNRS Paris University Paris France.,ENT Department Salpetriere Hospital Paris France
| | - Danping Wang
- Institute of Information and Control Hangzhou Dianzi University Zhejiang China.,Plateforme Sensorimotricité Paris University - CNRS - INSERM Paris France
| | | | | | - Remi Barrois
- Centre Borelli CNRS Paris University Paris France
| | | | - Clément Dubost
- Centre Borelli CNRS Paris University Paris France.,Hôpital d'instruction des armées Bégin Saint-Mandé France
| | | | | | | | - Laurent Oudre
- L2TI Sorbonne Paris Nord University Villetaneuse France
| | | | - Matthieu Robert
- Centre Borelli CNRS Paris University Paris France.,Service d'ophtalmologie AP-HP Hôpital Universitaire Necker-Enfants Malades Paris France
| | - Alain P Yelnik
- Centre Borelli CNRS Paris University Paris France.,PRM Department GH St Louis Lariboisière F. Widal Paris University Paris France
| | - Damien Ricard
- Centre Borelli CNRS Paris University Paris France.,Service de Neurologie Hôpital d'Instruction des Armées de Percy Service de Santé des Armées Clamart France.,École d'application du Val-de-Grâce Service de Santé des Armée Paris France
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23
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Shen S, Zeng X, Xu L, Chen L, Liu Z, Chu J, Yang Y, Wu X, Chen X. Association between motoric cognitive risk syndrome and frailty among older Chinese adults. BMC Geriatr 2020; 20:110. [PMID: 32192446 PMCID: PMC7081673 DOI: 10.1186/s12877-020-01511-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Motoric cognitive risk syndrome (MCR) is a newly proposed predementia syndrome incorporating subjective cognitive complaints and slow gait. Previous studies have reported that subjective cognitive complaints and slow gait are associated with frailty in cognitively unimpaired older adults, but little is known about the link between MCR and frailty in older adults. Therefore, the aim of the study was to explore the associations of MCR and its components with frailty in older Chinese adults. METHODS In an observational cross-sectional study, a total of 429 older adults aged 60 years and older were admitted to the geriatric department. According to MCR criteria, all participants were classified into 4 groups: 1) the MCR group; 2) the subjective cognitive complaints only group; 3) the slow gait only group; and 4) the healthy control group. Physical frailty was assessed by the Clinical Frailty Scale (CFS). Multivariate logistic regression analysis was used to examine the association between MCR and frailty in older adults. RESULTS The prevalence rates of subjective cognitive complaints, slow gait and MCR were 15.9, 10.0 and 4.0%, respectively. After adjusting for confounding variables, the logistic regression analysis showed that slow gait (odds ratio [OR]: 3.40, 95% confidence interval [CI]: 1.40-8.23, P = 0.007) and MCR (OR: 5.53, 95% CI: 1.46-20.89, P = 0.012) were independently associated with frailty, but subjective cognitive complaints were not. CONCLUSIONS MCR and slow gait were significantly associated with frailty in older Chinese adults. Further studies should prospectively determine the causal relationship between MCR and frailty.
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Affiliation(s)
- Shanshan Shen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xingkun Zeng
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Liyu Xu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Lingyan Chen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Zixia Liu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Jiaojiao Chu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Yinghong Yang
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xiushao Wu
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China
| | - Xujiao Chen
- Department of Geriatric, Zhejiang Hospital, No. 12 Lingyin Road, Hangzhou, 310013, Zhejiang Province, China.
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24
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Female dominant association of sarcopenia and physical frailty in mild cognitive impairment and Alzheimer's disease. J Clin Neurosci 2019; 70:96-101. [PMID: 31444048 DOI: 10.1016/j.jocn.2019.08.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/06/2019] [Indexed: 12/27/2022]
Abstract
Associations of sarcopenia and physical frailty in cognitive and affective (depression, apathy, and behavioral and psychological symptoms of dementia) functions of mild cognitive impairment (MCI) and Alzheimer's disease (AD) were not fully evaluated previously, especially not for gender differences. 165 AD, 84 MCI, and 48 control participants (175 female, 122 male) were evaluated for cognitive, affective, activities of daily living (ADL), and physical functions associated with sarcopenia and physical frailty. In both sexes, cognitive and affective functions, ADL, and physical functions worsened in MCI and AD compared to control subjects. Physical dysfunctions, especially slow gait speed (3 m up and go test), were significantly associated with cognitive, affective, and ADL declines in participants (control subjects, MCI, and AD) of each gender, which were especially noticeable in females. The present study may be the first to suggest significant associations of sarcopenia and physical frailty with cognitive and affective functions of MCI and AD, especially in females.
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25
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Association of Glucose Fluctuations with Sarcopenia in Older Adults with Type 2 Diabetes Mellitus. J Clin Med 2019; 8:jcm8030319. [PMID: 30845785 PMCID: PMC6463152 DOI: 10.3390/jcm8030319] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus accelerates loss of muscle mass and strength. Patients with Alzheimer’s disease (AD) also show these conditions, even in the early stages of AD. The mechanism linking glucose management with these muscle changes has not been elucidated but has implications for clarifying these associations and developing preventive strategies to maintain functional capacity. This study included 69 type 2 diabetes patients with a diagnosis of cognitive impairment (n = 32) and patients with normal cognition (n = 37). We investigated the prevalence of sarcopenia in diabetes patients with and without cognitive impairment and examined the association of glucose alterations with sarcopenia. Daily glucose levels were evaluated using self-monitoring of blood glucose, and we focused on the effects of glucose fluctuations, postprandial hyperglycemia, and the frequency of hypoglycemia on sarcopenia. Diabetes patients with cognitive impairment displayed a high prevalence of sarcopenia, and glucose fluctuations were independently associated with sarcopenia, even after adjusting for glycated hemoglobin A1c (HbA1c) levels and associated factors. In particular, glucose fluctuations were significantly associated with a low muscle mass, low grip strength, and slow walking speed. Our observation suggests the importance of glucose management by considering glucose fluctuations to prevent the development of disability.
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26
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Wallace LMK, Theou O, Godin J, Andrew MK, Bennett DA, Rockwood K. Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project. Lancet Neurol 2019; 18:177-184. [PMID: 30663607 PMCID: PMC11062500 DOI: 10.1016/s1474-4422(18)30371-5] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Some people with substantial Alzheimer's disease pathology at autopsy had shown few characteristic clinical symptoms or signs of the disease, whereas others with little Alzheimer's disease pathology have been diagnosed with Alzheimer's dementia. We aimed to examine whether frailty, which is associated with both age and dementia, moderates the relationship between Alzheimer's disease pathology and Alzheimer's dementia. METHODS We did a cross-sectional analysis of data from participants of the Rush Memory and Aging Project, a clinical-pathological cohort study of older adults (older than 59 years) without known dementia at baseline, living in Illinois, USA. Participants in the cohort study underwent annual neuropsychological and clinical evaluations. In the present cross-sectional analysis, we included those participants who did not have any form of dementia or who had Alzheimer's dementia at the time of their last clinical assessment and who had died and for whom complete autopsy data were available. Alzheimer's disease pathology was quantified by a summary measure of neurofibrillary tangles and neuritic and diffuse plaques. Clinical diagnosis of Alzheimer's dementia was based on clinician consensus. Frailty was operationalised retrospectively using health variable information obtained at each clincial evaluation using the deficit accumulation approach (41-item frailty index). Logistic regression and moderation modelling were used to assess relationships between Alzheimer's disease pathology, frailty, and Alzheimer's dementia. All analyses were adjusted for age, sex, and education. FINDINGS Up to data cutoff (Jan 20, 2017), we included 456 participants (mean age at death 89·7 years [SD 6·1]; 316 [69%] women). 242 (53%) had a diagnosis of possible or probable Alzheimer's dementia at their last clinical assessment. Frailty (odds ratio 1·76, 95% CI 1·54-2·02; p<0·0001) and Alzheimer's disease pathology (4·81, 3·31-7·01; p<0·0001) were independently associated with Alzheimer's dementia, after adjusting for age, sex, and education. When frailty was added to the model for the relationship between Alzheimer's disease pathology and Alzheimer's dementia, model fit improved (p<0·0001). There was a significant interaction between frailty and Alzheimer's disease pathology (odds ratio 0·73, 95% CI 0·57-0·94; pinteraction=0·015). People with an increased frailty score had a weakened direct link between Alzheimer's disease pathology and Alzheimer's dementia; that is, people with a low amount of frailty were better able to tolerate Alzheimer's disease pathology, whereas those with higher amounts of frailty were more likely both to have more Alzheimer's disease pathology and for it to be expressed as dementia. INTERPRETATION The degree of frailty among people of the same age modifies the association between Alzheimer's disease pathology and Alzheimer's dementia. That frailty is related to both odds of Alzheimer's dementia and disease expression has implications for clinical management, since individuals with even a low level of Alzheimer's disease pathology might be at risk for dementia if they have high amounts of frailty. Further research should assess how frailty and cognition change over time to better elucidate this complex relationship. FUNDING None.
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Affiliation(s)
- Lindsay M K Wallace
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Olga Theou
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Judith Godin
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David A Bennett
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Kenneth Rockwood
- Geriatric Medicine Research, Centre for Health Care of the Elderly, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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27
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Rockwood K, Howlett SE. Fifteen years of progress in understanding frailty and health in aging. BMC Med 2018; 16:220. [PMID: 30477486 PMCID: PMC6258409 DOI: 10.1186/s12916-018-1223-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 02/26/2023] Open
Abstract
The notion of frailty has evolved for more than 15 years. Although there is no consensus definition, frailty reflects a state of increased vulnerability to adverse health outcomes for individuals of the same chronological age. Two commonly used clinical tools, the frailty index and the frailty phenotype, both measure health-related deficits. The frailty index is a ratio of the number of deficits that an individual has accumulated divided by all deficits measured, whereas the phenotype specifies frailty as represented by poor performance in three of five criteria (i.e., weight loss, exhaustion, weakness, slowness, lack of activity). From human studies, animal models of both approaches have been developed and are beginning to shed light on mechanisms underlying frailty, the influence of frailty on disease expression, and new interventions to attenuate frailty. Currently, back-translation to humans is occurring. As we start to understand subcellular mechanisms involved in damage and repair as well as their response to treatment, we will begin to understand the molecular basis of aging and, thus, of frailty.
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Affiliation(s)
- Kenneth Rockwood
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Susan E Howlett
- Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
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