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Lai LC, Huang DM, Peng J, Cao XY, Feng XL, Tao PY, Pan X, Pan QN, Fan DJ, Lu SY, Li CL, Pan YF, Dong PX, Chai YD, Huang P, Wu HC, Huang HQ. Depressive symptom mediates the association between the number of chronic diseases and cognitive impairment: a multi-center cross-sectional study based on community older adults. Front Psychiatry 2024; 15:1404229. [PMID: 39086730 PMCID: PMC11288913 DOI: 10.3389/fpsyt.2024.1404229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024] Open
Abstract
Objective The purpose of this study was to understand the relationship between the multiple chronic conditions (MCC), mental health and cognitive function of older adults in the community, and to propose a hypothesis that depressive symptom mediate the number of chronic diseases and cognitive impairment in older adults. Method Participants aged 65 years and older from 35 communities in 14 cities in Guangxi, China were recruited. The residents' depressive symptom (PHQ-9) and cognitive status (AD-8) were evaluated, Chi-square test was used to explore the effects of different socio-demographic characteristics on depressive symptom and cognitive impairment. Pearson correlation analysis and the process model 4 were used to explore the relationship between the number of chronic diseases, depressive symptom and cognitive impairment. Result A total of 11,582 older adults were included in our analysis. The rate of MCC reaching 26.53%. Hypertension combined with diabetes accounts for the highest proportion of two chronic diseases (13.2%). Among the combination of three chronic diseases, the highest incidence of coexisting hypertension combined with cervical/lumbar spondylosis, and rheumatoid arthritis (7.1%). In this study, depression symptoms accounted for 12.9% of older adults aged 65 and above, and cognitive impairment accounted for 27.4%. Female, older age, reside in urban areas, lower educational levels, no spouse, live alone, and MCC were risk factors for depressive symptom and cognitive impairment in older adults (P<0.05). Depressive symptom had a mediating effect in the number of chronic diseases and cognitive impairment, and the mediating effect (1.109) accounted for 44.13% of the total effect (0.247). Conclusion The mental health of the older adult needs to be taken seriously, and improving depressive symptom can reduce the occurrence of cognitive impairment in older patients with MCC to a certain extent.
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Affiliation(s)
- Li-Chong Lai
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dong-Mei Huang
- Rehabilitation Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Peng
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Ying Cao
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Ling Feng
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Pin-Yue Tao
- Anesthesiology Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Pan
- Ear, Nose, Throat, Head and Neck Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qi-Ni Pan
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Deng-Jing Fan
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shu-Yu Lu
- Anesthesiology Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Cai-Li Li
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yan-Fei Pan
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Peng-Xin Dong
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yi-Dan Chai
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ping- Huang
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hai-Chen Wu
- Nursing Department, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-Qiao Huang
- Party Committee Office, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Sun L, Hui L, Li Y, Chen X, Liu R, Ma J. Pathogenesis and research progress in leukoaraiosis. Front Hum Neurosci 2022; 16:902731. [PMID: 36061509 PMCID: PMC9437627 DOI: 10.3389/fnhum.2022.902731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Leukoaraiosis is a common imaging marker of cerebral small vessel disease. In recent years, with the continuous advances in brain imaging technology, the detection rate of leukoaraiosis is higher and its clinical subtypes are gradually gaining attention. Although leukoaraiosis has long been considered an incidental finding with no therapeutic necessity, there is now growing evidence linking it to, among other things, cognitive impairment and a high risk of death after stroke. Due to different research methods, some of the findings are inconsistent and even contradictory. Therefore, a comprehensive and in-depth study of risk factors for leukoaraiosis is of great clinical significance. In this review, we summarize the literature on leukoaraiosis in recent years with the aim of elucidating the disease in terms of various aspects (including pathogenesis, imaging features, and clinical features, etc.).
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Affiliation(s)
- Lingqi Sun
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Lin Hui
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Li
- Department of Ultrasound Medicine, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Xian Chen
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Rong Liu
- Department of Neurology, Air Force Hospital of the Western Theater of the Chinese People's Liberation Army, Chengdu, China
| | - Ji Ma
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
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Gronek J, Boraczyński M, Gronek P, Wieliński D, Tarnas J, Marszałek S, Tang YY. Exercise in Aging: Be Balanced. Aging Dis 2021; 12:1140-1149. [PMID: 34341697 PMCID: PMC8279522 DOI: 10.14336/ad.2021.0107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/07/2021] [Indexed: 01/12/2023] Open
Abstract
The beneficial effects of exercise are recognized for preventing physical and cognitive decline during the aging process. However, there is still a gap concerning recommended intensity, volume, frequency and mode of exercise especially for older people. The aim of this study was to investigate an appropriate type of physical activity (PA) model for healthy aging. A commentary of the influence of PA and exercise on healthy aging through an online search of the databases Web of Science, PubMed and Google Scholar. Two living groups can be considered as potential references: modern hunter-gatherer small-scale population and master athletes. Greater physical activity is proposed for healthy aging than that recommended by WHO. Additionally, mindfulness meditation techniques during exercise are recommended especially for persons practicing long-duration exercises. Complex and compound exercise and workouts should include challenging exercises adjusted and balanced to provide clients, especially older people, with noticeable changes and progress.
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Affiliation(s)
- Joanna Gronek
- 1Department of Dance, Poznań University of Physical Education, Poland
| | - Michał Boraczyński
- 2Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury, Poland
| | - Piotr Gronek
- 1Department of Dance, Poznań University of Physical Education, Poland
| | - Dariusz Wieliński
- 3Department of Anthropology and Biometry, Poznań University of Physical Education, Poland
| | - Jacek Tarnas
- 4Department of Physical Education and Lifelong Sports, Poznań University of Physical Education, Poland
| | - Sławomir Marszałek
- 5Department of Physiotherapy, Poznań University of Physical Education, Poland.,6Department of Physiotherapy, Poznań University of Medical Sciences, Poland
| | - Yi-Yuan Tang
- 7Department of Psychological Sciences, Texas Tech University, USA
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Neuroimaging signatures of cerebral small vessel disease and risk of falls in stroke-free older adults living in rural Ecuador. The Atahualpa Project. J Neurol Sci 2019; 402:133-135. [PMID: 31132535 DOI: 10.1016/j.jns.2019.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/26/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to assess the association between neuroimaging signatures of cerebral small vessel disease (cSVD) and the risk of falls in stroke-free older adults living in rural Ecuador. METHODS Risk of falls was evaluated by the Downton Fall Risk Index (DFRI). MRI readings focused on white matter hyperintensities (WMH) of presumed vascular origin, deep cerebral microbleeds (CMB), silent lacunar infarcts (LI), and > 10 enlarged basal ganglia-perivascular spaces (BG-PVS). Logistic regression models were fitted to evaluate whether these neuroimaging signatures were associated with the DFRI, after adjusting for relevant confounders. RESULTS We included 288 participants. The DFRI was positive in 69 (24%). Moderate-to-severe WMH were noticed in 55 individuals (19%), deep CMB in 18 (6%), LI in 23 (8%), and > 10 BG-PVS in 65 (23%). Multivariate models showed a significant association between moderate-to-severe WMH and the DFRI (p = .016). There were no associations between other neuroimaging signatures of cSVD and the DFRI. Age was the single covariable remaining significant in all models. CONCLUSIONS WMH is associated with the DFRI in stroke-free older adults living in a remote rural setting. A target for fall prevention should include the control of factors favoring the development of diffuse subcortical damage of vascular origin.
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Morley JE, Vellas B. Patient-Centered (P4) Medicine and the Older Person. J Am Med Dir Assoc 2019; 18:455-459. [PMID: 28549701 DOI: 10.1016/j.jamda.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse University Hospital and INSERM U1027, Toulouse, France
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Esteban-Cornejo I, Cabanas-Sánchez V, Higueras-Fresnillo S, Ortega FB, Kramer AF, Rodriguez-Artalejo F, Martinez-Gomez D. Cognitive Frailty and Mortality in a National Cohort of Older Adults: the Role of Physical Activity. Mayo Clin Proc 2019; 94:1180-1189. [PMID: 30871783 DOI: 10.1016/j.mayocp.2018.10.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/23/2018] [Accepted: 10/31/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine the association between cognitive frailty and long-term all-cause mortality and the stratified and combined associations of physical activity and cognitive frailty with long-term all-cause mortality in a population-based cohort of older adults from Spain. PATIENTS AND METHODS A representative cohort of 3677 noninstitutionalized individuals from Spain aged 60 years or older was recruited between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014. Information on self-reported physical activity and cognitive frailty status were collected at baseline. Analyses were performed with Cox regression after adjustment for confounders. RESULTS The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths. The hazard ratio (HR) for all-cause mortality among participants with cognitive frailty compared with robust participants was 1.69 (95% CI, 1.43-2.01). Being active was associated with a mortality reduction of 36% (95% CI, 21%-47%) in cognitively frail individuals. Compared with those who were robust and active, participants with cognitive frailty who were inactive had the highest mortality risk (HR, 2.13; 95% CI, 1.73-2.61), which was equivalent to being 6.8 (95% CI, 5.33-7.99) years older. CONCLUSION Cognitive frailty was more markedly associated with increased mortality in inactive older adults, and being active reduced the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve survival among cognitively frail older adults.
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Affiliation(s)
- Irene Esteban-Cornejo
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA; PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain.
| | - Verónica Cabanas-Sánchez
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Sara Higueras-Fresnillo
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Arthur F Kramer
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA; Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - David Martinez-Gomez
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain; IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
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7
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Morley JE. Cognition and Chronic Disease. J Am Med Dir Assoc 2019; 18:369-371. [PMID: 28433119 DOI: 10.1016/j.jamda.2017.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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8
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Panza F, Lozupone M, Solfrizzi V, Sardone R, Dibello V, Di Lena L, D'Urso F, Stallone R, Petruzzi M, Giannelli G, Quaranta N, Bellomo A, Greco A, Daniele A, Seripa D, Logroscino G. Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention. J Alzheimers Dis 2019; 62:993-1012. [PMID: 29562543 PMCID: PMC5870024 DOI: 10.3233/jad-170963] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Frailty, a critical intermediate status of the aging process that is at increased risk for negative health-related events, includes physical, cognitive, and psychosocial domains or phenotypes. Cognitive frailty is a condition recently defined by operationalized criteria describing coexisting physical frailty and mild cognitive impairment (MCI), with two proposed subtypes: potentially reversible cognitive frailty (physical frailty/MCI) and reversible cognitive frailty (physical frailty/pre-MCI subjective cognitive decline). In the present article, we reviewed the framework for the definition, different models, and the current epidemiology of cognitive frailty, also describing neurobiological mechanisms, and exploring the possible prevention of the cognitive frailty progression. Several studies suggested a relevant heterogeneity with prevalence estimates ranging 1.0–22.0% (10.7–22.0% in clinical-based settings and 1.0–4.4% in population-based settings). Cross-sectional and longitudinal population-based studies showed that different cognitive frailty models may be associated with increased risk of functional disability, worsened quality of life, hospitalization, mortality, incidence of dementia, vascular dementia, and neurocognitive disorders. The operationalization of clinical constructs based on cognitive impairment related to physical causes (physical frailty, motor function decline, or other physical factors) appears to be interesting for dementia secondary prevention given the increased risk for progression to dementia of these clinical entities. Multidomain interventions have the potential to be effective in preventing cognitive frailty. In the near future, we need to establish more reliable clinical and research criteria, using different operational definitions for frailty and cognitive impairment, and useful clinical, biological, and imaging markers to implement intervention programs targeted to improve frailty, so preventing also late-life cognitive disorders.
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Affiliation(s)
- Francesco Panza
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.,Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Madia Lozupone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Solfrizzi
- Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari "Aldo Moro", Bari, Italy
| | - Rodolfo Sardone
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Vittorio Dibello
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Luca Di Lena
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | - Francesca D'Urso
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Roberta Stallone
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro, Bari, Italy
| | - Gianluigi Giannelli
- National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte Bari, Italy
| | | | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatric Unit, University of Foggia, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
| | - Davide Seripa
- Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
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Abstract
Cognitive decline occurs in all persons during the aging process. Eventually, this can result in mild cognitive impairment and dementia. There are more than 100 causes of dementia. A multifocal approach to slowing cognitive decline (Mediterranean diet, exercise, computer games, socialization, and treatment of cardiovascular risk factors) appears to be effective.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA.
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Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Shams A, Morley JE. Editorial: Autonomic Neuropathy and Cardiovascular Disease in Aging. J Nutr Health Aging 2018; 22:1028-1033. [PMID: 30379298 DOI: 10.1007/s12603-018-1097-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Shams
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Morley JE. Editorial: Bidirectional Communication Between Brain and Muscle. J Nutr Health Aging 2018; 22:1144-1145. [PMID: 30498818 DOI: 10.1007/s12603-018-1141-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Messinger-Rapport BJ, Little MO, Morley JE, Gammack JK. Clinical Update on Nursing Home Medicine: 2017. J Am Med Dir Assoc 2017; 18:928-940. [PMID: 29080572 DOI: 10.1016/j.jamda.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023]
Abstract
This is the 11th annual Clinical Update from the AMDA meeting article. This year the topics covered are hypertension after the Systolic Blood Pressure Intervention Trial; chronic obstructive pulmonary disease risk factors, diagnosis and management including end-of-life planning, and the difficulties with exacerbations such as breathlessness; diagnosis and treatment of cognitive impairment and dementia; and wound care and pressure ulcer management.
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Affiliation(s)
| | - Milta O Little
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
| | - John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Julie K Gammack
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO
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Abstract
PURPOSE OF REVIEW Physical and cognitive frailty are interrelated and synergistic syndromes more frequently seen in old age, which represent intermediate stages between aging successfully and disability. Poor nutrition is a fundamental determinant for both conditions, while various dietary components are proposed to prevent and/or improve them. This updated review discusses the possible influence of nutritional factors on cognitive frailty and its potential mediators. RECENT FINDINGS Oxidative stress, low-grade systemic inflammation, neuroinflammation, and altered autophagy, all associated with obesity, metabolic syndrome and insulin resistance, are proposed mechanisms to explain the influence of nutrition on cognitive health. Even if no single food or supplement has definitively demonstrated to affect physical frailty and cognitive impairment, combining various dietary and lifestyle components in the Mediterranean dietary pattern has shown benefit. SUMMARY Cognitive frailty is a potential useful construct for the early detection of cognitive impairment and physical frailty, in order to implement timely interventions. Validation of this construct is eagerly needed. Nutritional status is a fundamental part of physical frailty, and potentially important in the prevention of cognitive decline. Identifying and treating protein/calorie and individual nutrients insufficiency is mandatory in all older adults. Conversely, overeating in middle age has been associated with cognitive decline in older age. A lifelong balance diet, such as the Mediterranean diet, combined with regular physical and mental exercise, is perhaps the best preventive strategy against cognitive decline in old age.
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Affiliation(s)
- Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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16
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Morley JE. Frailty and sarcopenia in elderly. Wien Klin Wochenschr 2016; 128:439-445. [PMID: 27670855 DOI: 10.1007/s00508-016-1087-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022]
Abstract
Frailty is a pre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized. Two major frailty definitions exist. The physical phenotype of frailty and the multiple deficit model. A simple frailty screening tool-FRAIL-has been validated. Treatment of frailty involves resistance exercise, optimization of nutrition, and treatment of fatigue (sleep apnea, depression), treatable causes of weight loss and adjustment of polypharmacy. Sarcopenia (decline in function with low muscle mass) is a major cause of frailty. A simple sarcopenia screening tool-SARC-F-has been validated. The multiple causes of sarcopenia are reviewed. Optimal treatment is resistance exercise, leucine-enriched essential amino acids and vitamin D replacement.
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Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, 63104, St. Louis, MO, USA.
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Morley JE. Psychoimmunology and Aging: A Tribute to George Freeman Solomon. J Am Med Dir Assoc 2015; 16:901-4. [PMID: 26432626 DOI: 10.1016/j.jamda.2015.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St Louis, MO.
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Clinical Update on Nursing Home Medicine: 2015. J Am Med Dir Assoc 2015; 16:911-22. [DOI: 10.1016/j.jamda.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 01/21/2023]
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