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O'Connor D, Molloy AM, Laird E, Kenny RA, O'Halloran AM. Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment. Proc Nutr Soc 2023; 82:315-328. [PMID: 36938798 DOI: 10.1017/s0029665123002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.
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Affiliation(s)
- Deirdre O'Connor
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon Laird
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Physical Education and Sport, University of Limerick, Limerick, Ireland
| | - Rose Anne Kenny
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling M O'Halloran
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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2
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Low folate predicts accelerated cognitive decline: 8-year follow-up of 3140 older adults in Ireland. Eur J Clin Nutr 2022; 76:950-957. [PMID: 35022554 DOI: 10.1038/s41430-021-01057-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine associations of plasma folate concentrations and risk of global and domain-specific cognitive decline in older people. METHODS Data of 3140 participants from The Irish Longitudinal Study on Ageing (TILDA), a nationally-representative cohort of adults aged ≥50 years were used over 8-year follow-up. Biannual cognitive assessments included the Mini-Mental State Examination (MMSE), verbal fluency and immediate and delayed word recall tests (Waves 1-5) and the Montreal Cognitive Assessment, (MoCA) (Waves 1 and 3). Plasma folate concentrations were measured in stored blood collected at baseline. Mixed effects Poisson and linear regression determined associations between baseline folate concentrations and cognition. RESULTS In multivariable-adjusted models of those aged ≥50 years at baseline, low folate at baseline (<11.2 nmol/L) was associated with higher proportions of MMSE errors (incidence rate ratio [IRR] = 1.10; 95% confidence interval [CI] (1.00, 1.21), lowest vs. highest quintile) over 8 years. Plasma folate <21.8 nmol/L predicted declines in episodic memory for immediate (beta [β] = -0.26; 95% CI (-0.48, -0.03), β = -0.29; 95% CI (-0.50, 0.08) and β = -0.29; (-0.50, -0.08), for lowest three vs. highest quintile) and delayed recall (β = -0.20; 95% CI (-0.38, -0.01), β = -0.18; 95% CI (-0.37, -0.01) and β = -0.19; (-0.36, -0.01) lowest three vs. highest quintile). There were no significant associations in a subsample aged ≥65 years. CONCLUSION In those aged ≥50 years, lower concentrations of folate may have differential relationships with cognitive domains. Folate <11.2 nmol/L predicted a decline in global cognitive function, while <21.8 nmol/L predicted poorer episodic memory. Low folate was associated with accelerated decline in cognitive function and is an important marker for cognitive decline among older people.
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Influences of Folate Supplementation on Homocysteine and Cognition in Patients with Folate Deficiency and Cognitive Impairment. Nutrients 2020; 12:nu12103138. [PMID: 33066591 PMCID: PMC7602498 DOI: 10.3390/nu12103138] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 12/04/2022] Open
Abstract
Although folate deficiency was reported to be associated with hyperhomocysteinemia, influence of folate supplementation on cognition remains controversial. Therefore, we explored the effects of folate supplementation on the cognition and Homocysteine (Hcy) level in relatively short periods in patients with folate deficiency and cognitive impairment. Enrolled 45 patients (mean age of 79.7 ± 7.9 years old) with folate deficiency (<3.6 ng/mL) with cognitive impairment underwent Mini-Mental State Examination (MMSE), and laboratory examinations, including folate, vitamin B12, and Hcy. The degree of hippocampal atrophy in MRI was estimated using a voxel-based specific regional analysis system for Alzheimer’s disease (VSRAD). Patients were administrated folate (5 mg/day), then Hcy, and MMSE score were re-examined after 28 to 63 days. Mean Hcy significantly decreased from 25.0 ± 18.0 to 11.0 ± 4.3 nmol/mL (p < 0.001). Average MMSE scores also significantly changed from 20.1 ± 4.7 to 22.2 ± 4.3 (p < 0.001). The degree of change in the MMSE score and basic Hcy or Hcy change was significantly positively correlated, while degree of hippocampal atrophy in MRI did not. Although several factors should be taken into account, folate supplementation ameliorated cognitive impairment, at least for a short period, in patients with folate deficiency.
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Fiocco AJ, Krieger L, D'Amico D, Parrott MD, Laurin D, Gaudreau P, Greenwood C, Ferland G. A systematic review of existing peripheral biomarkers of cognitive aging: Is there enough evidence for biomarker proxies in behavioral modification interventions?: An initiative in association with the nutrition, exercise and lifestyle team of the Canadian Consortium on Neurodegeneration in Aging. Ageing Res Rev 2019; 52:72-119. [PMID: 31059801 DOI: 10.1016/j.arr.2019.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/09/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
Peripheral biomarkers have shown significant value in predicting brain health and may serve as a useful proxy measurement in the assessment of evidence-based lifestyle behavior modification programs, including physical activity and nutrition programs, that aim to maintain cognitive function in late life. The aim of this systematic review was to elucidate which peripheral biomarkers are robustly associated with cognitive function among relatively healthy non-demented older adults. Following the standards for systematic reviews (PICO, PRIMSA), and employing MEDLINE and Scopus search engines, 222 articles were included in the review. Based on the review of biomarker proxies of cognitive health, it is recommended that a comprehensive biomarker panel, or biomarker signature, be developed as a clinical end point for behavior modification trials aimed at enhancing cognitive function in late life. The biomarker signature should take a multisystemic approach, including lipid, immune/inflammatory, and metabolic biomarkers in the biological signature index of cognitive health.
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Affiliation(s)
| | - Laura Krieger
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Danielle D'Amico
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | | | - Danielle Laurin
- Laval University, Centre de recherche du CHU de Québec, QC, Canada
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Goes VF, Mello-Carpes PB, de Oliveira LO, Hack J, Magro M, Bonini JS. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's. Rev Lat Am Enfermagem 2016; 22:317-24. [PMID: 26107841 PMCID: PMC4292605 DOI: 10.1590/0104-1169.3252.2418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 12/19/2013] [Indexed: 11/25/2022] Open
Abstract
Objective to evaluate the risk of dysphagia and its relationship with the stage of
Alzheimer's Disease, as well as the relationship between the risk of
dysphagia and nutritional status and caloric intake in elderly people with
Alzheimer's disease. Methods the sample consisted of 30 subjects of both genders with probable
Alzheimer's disease. The stage of the disease, nutritional status, energy
intake, and risk of dysphagia were assessed. Results it was found that increased risk of dysphagia is associated with the advance
in the stages of Alzheimer's disease and that even patients in the early
stages of disease have a slight risk of developing dysphagia. No association
was found between nutritional status and the risk of dysphagia. High levels
of inadequate intake of micronutrients were also verified in the patients.
Conclusion an association between dysphagia and the development of Alzheimer's disease
was found. The results indicate the need to monitor the presence of
dysphagia and the micronutrient intake in patients with Alzheimer's
disease.
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Affiliation(s)
| | | | | | - Jaqueline Hack
- Departamento de Nutrição, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brasil
| | - Marcela Magro
- Departamento de Nutrição, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brasil
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Hughes CF, Ward M, Hoey L, McNulty H. Vitamin B12 and ageing: current issues and interaction with folate. Ann Clin Biochem 2013; 50:315-29. [DOI: 10.1177/0004563212473279] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A compromised vitamin B12 status is common in older people despite dietary intakes that typically far exceed current recommendations. The maintenance of an optimal status of vitamin B12 is not only dependent on adequate dietary intake but more critically on effective absorption which diminishes with age. The measurement of vitamin B12 is complicated by the lack of a gold standard assay. There are a number of direct and functional indicators of vitamin B12 status; however, none of these are without limitations and should be used in combination. Vitamin B12 is of public health importance, not only because deficiency leads to megaloblastic anaemia and irreversible nerve damage, but also because emerging evidence links low B12 to an increased risk of a number of age-related diseases, including cardiovascular disease, cognitive dysfunction, dementia and osteoporosis. Furthermore, there are concerns relating to potential adverse effects for older adults with low vitamin B12 status of over-exposure to folic acid in countries where there is mandatory fortification of food with folic acid. The aim of this review is to examine the known and emerging issues related to vitamin B12 in ageing, its assessment and inter-relationship with folate.
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Affiliation(s)
- Catherine F Hughes
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Mary Ward
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Leane Hoey
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
| | - Helene McNulty
- The Northern Ireland Centre for Food and Health, University of Ulster, Coleraine BT52 1SA, Northern Ireland, UK
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Gao QY, Chen HM, Chen YX, Wang YC, Wang ZH, Tang JT, Ge ZZ, Chen XY, Sheng JQ, Fang DC, Yu CG, Zheng P, Fang JY. Folic Acid Prevents the Initial Occurrence of Sporadic Colorectal Adenoma in Chinese Older than 50 Years of Age: A Randomized Clinical Trial. Cancer Prev Res (Phila) 2013; 6:744-52. [DOI: 10.1158/1940-6207.capr-13-0013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Albani D, Tettamanti M, Batelli S, Polito L, Dusi S, Ateri E, Forloni G, Lucca U. Interleukin-1α, interleukin-1β and tumor necrosis factor-α genetic variants and risk of dementia in the very old: evidence from the "Monzino 80-plus" prospective study. AGE (DORDRECHT, NETHERLANDS) 2012; 34:519-526. [PMID: 21509504 PMCID: PMC3312635 DOI: 10.1007/s11357-011-9249-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 04/04/2011] [Indexed: 05/30/2023]
Abstract
The association among single nucleotide polymorphisms in inflammatory genes as interleukin-1 alpha (IL-1α), interleukin-1 beta (IL-1β) or tumor necrosis factor alpha (TNF-α) and dementia has been explored mostly in Alzheimer's disease, while few data addressing their association with dementia in very old people are available. We performed a prospective, door-to-door population-based study of 80 years or older residents in eight municipalities of Varese province, Italy (the Monzino 80-plus study). No difference was found by a cross-sectional approach comparing IL-1α rs1800587, IL-1β rs3087258 and TNF-α rs1799724 genotypic and allelic frequencies between those affected and not affected by dementia. After a 5-year follow-up, the elderly carriers of T-allele of TNF-α rs1799724 were at an increased risk of dementia (p = 0.03). This association was no more significant adjusting for the apolipoprotein E epsilon-4 allele (APOE-ε4, p = 0.26), which was an independent predictor of dementia onset (p = 0.0002). In short, in this Italian population of oldest olds, dementia was associated to the APOE-ε4 allele only.
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Affiliation(s)
- Diego Albani
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
- Mario Negri Institute for Pharmacological Research, Via Giuseppe La Masa 19, 20156 Milan, Italy
| | - Mauro Tettamanti
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Sara Batelli
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
- Gene Center, University of Munich, Munich, Germany
| | - Letizia Polito
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
- Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Sabrina Dusi
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
- Unit of Molecular Neurogenetics, The Foundation ‘Carlo Besta’ Institute of Neurology, Milan, Italy
| | - Eleonora Ateri
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Gianluigi Forloni
- Laboratory of Biology of Neurodegenerative Disorders, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Ugo Lucca
- Laboratory of Geriatric Neuropsychiatry, Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
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10
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Gender differences in folate status are associated with cognition in healthy Irish elderly adults. Proc Nutr Soc 2011. [DOI: 10.1017/s0029665111001042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chang N, Kim E, Kim KN, Kim H, Kim SY, Jeong BS. Folate nutrition is related to neuropsychological functions in the elderly. Nutr Res Pract 2009; 3:43-8. [PMID: 20016701 PMCID: PMC2788167 DOI: 10.4162/nrp.2009.3.1.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/10/2009] [Accepted: 02/15/2009] [Indexed: 11/04/2022] Open
Abstract
We investigated the nutritional state of B vitamins and the neuropsychological functions in 25 subjects, aged 63.1 +/- 6.3 years, residing in rural areas of Korea. Nutritional states of thiamin, riboflavin, and pyridoxine were assessed enzymatically in the erythrocytes, and folate concentrations were measured microbiologically in the plasma and erythrocytes. A battery of composite neuropsychological test was administered to the subjects. Plasma folate was correlated with the total intelligence score (p=0.049). Folate levels in the erythrocytes were correlated with the performance intelligence scores such as block design (p=0.017) and picture arrangement (p=0.016). The red cell folate was correlated with memory scores such as general memory (p=0.009) and delayed recall (p=0.000). Although it did not reach statistical significance, verbal memory (p=0.053) was highly correlated with the red cell folate. The red cell folate was also correlated positively with the percent of conceptual level response number score (p=0.029), and negatively with the grooved pegboard test score for the non-dominant hand (p=0.010). Fine motor coordination was also influenced by folate nutrition, as finger tapping scores in both hands were significantly correlated with red cell folate (dominant hand; p=0.026, non-dominant hand; p=0.004). Other B vitamins such as thiamin, riboflavin, and vitamin B(6) were not as strongly correlated with neuropsychological function test scores as folate was. These results suggest that folate nutrition influences neuropsychological function test scores significantly in humans. Further studies are needed to explore the relationship between folate or other vitamin B nutrition and neuropsychological functions and the implications thereof.
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Affiliation(s)
- Namsoo Chang
- Department of Nutritional Science and Food Management, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, Seoul 120-750, Korea
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Grünblatt E, Zehetmayer S, Bartl J, Löffler C, Wichart I, Rainer MK, Jungwirth S, Bauer P, Danielczyk W, Tragl KH, Riederer P, Fischer P. Genetic risk factors and markers for Alzheimer's disease and/or depression in the VITA study. J Psychiatr Res 2009; 43:298-308. [PMID: 18603262 DOI: 10.1016/j.jpsychires.2008.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 05/27/2008] [Accepted: 05/28/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In ageing population, both Alzheimer's disease (AD) and depression are common. Significant depressive symptoms are often co-morbid with cognitive impairment and dementia. In this study, we attempted to find various factors and markers for both AD and depression in a longitudinal cohort, the Vienna-Transdanube-Aging (VITA)-study. METHODS The VITA-Study consisted of 305 healthy subjects, 174 subjects with depression only, 55 subjects diagnosed with AD only and 72 subjects with depression as well as AD. Associations between AD and/or depression to gene polymorphisms APO E (epsilon4), choline acetyltransferase (ChAT) 4G to A, serotonin-transporter gene promoter-length, dopamine-D4-receptor, ciliary-neurotrophic-factor-null mutation and brain-derived neurotrophic factor (C270T) and to various known factors were analyzed. RESULTS AD and depression were significant associated. Significant risk factors found for AD were low education, low folic acid and depressive-symptoms, while for depression were low education and higher nonsteroidal anti-inflammatory drugs (NSAID) consume. Moreover, the ChAT polymorphism associated significant to depression. Gender, education, and ChAT significantly associated with the combination AD and/or depression. CONCLUSION Such studies must be conducted cautiously, as co-morbidities and gene-environmental-social influences may sway the results dramatically. We found in the VITA-study significant association between depression and AD and between ChAT polymorphism and depression.
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Affiliation(s)
- Edna Grünblatt
- Ludwig Boltzmann Society, L. Boltzmann Institute of Aging Research, Vienna, Austria.
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Del Bo R, Ghezzi S, Scarlato M, Albani D, Galimberti D, Lucca U, Tettamanti M, Scarpini E, Forloni G, Bresolin N, Comi GP. Role of VEGF gene variability in longevity: A lesson from the Italian population. Neurobiol Aging 2008; 29:1917-22. [PMID: 17574707 DOI: 10.1016/j.neurobiolaging.2007.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 04/03/2007] [Accepted: 05/01/2007] [Indexed: 11/27/2022]
Abstract
Vascular endothelial growth factor (VEGF) gene polymorphisms have been associated with an increased risk of developing a wide variety of disorders from diabetes to neurodegenerative diseases suggesting functions not confined to its vascular effects originally described. Based on the VEGF protective roles undisclosed in pathological conditions, we evaluate whether VEGF variability might be a determinant also for longevity. Four polymorphisms (-2578C/A, -1190G/A, -1154G/A and -634G/C) within the VEGF gene promoter region in 490 unrelated Italian healthy subjects have been analysed. Significant changes of allele, genotype (-2578/AA versus -2578/CC: OR=2.08, p=0.007; -1190/AA versus -1190/GG: OR=2.01, p=0.011) and haplotype (AAGG: 10.4% versus 14.9%, p=0.03) frequency distributions were observed between young/elderly (25-84 years old) and long-lived (85-99 years old) subjects. These results suggest that VEGF gene variability can be inserted among the genetic factors influencing the lifespan.
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Affiliation(s)
- Roberto Del Bo
- Department of Neurological Sciences, Dino Ferrari Centre, University of Milan, IRCCS Foundation Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Padiglione Ponti, Milano, Italy.
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Lucca U, Tettamanti M, Quadri P. The Italian version of Consortium to Establish a Registry of Alzheimer's Disease (CERAD). Alzheimers Dement 2008; 4:310. [DOI: 10.1016/j.jalz.2008.05.2478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 05/09/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Ugo Lucca
- Instituto di Ricerche Farmacologiche “Mario Negri,”MilanItaly
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