Similarities, differences and overlaps between frailty and Parkinson's disease

Associations between frailty and cognitive impairment in Parkinson´s disease: a cross-sectional study

BACKGROUND

The presence of frailty is common in people with Parkinson's disease, as is cognitive dysfunction. Previous research on frailty has focused on the physical aspects of the pathology.

AIMS

To analyze the relationship between frailty and cognitive impairment in patients with Parkinson's disease and to know which disease characteristics are associated with frailty.

METHODS

An observational, correlational and cross-sectional study was conducted. Participants were recruited from a Home Rehabilitation Service and two Parkinson's Associations. An individualized assessment was carried out by means of a structured interview. Frailty was assessed with the Fried scale and cognitive function with the Mini Mental State Examination and the Parkinson's Disease Cognitive Rating Scale.

RESULTS

90 patients were recruited, 60% men, with a mean age of 73.50 (6.71) years. Frailty was associated with age and disease severity (p < 0.05). Frail patients presented worse cognitive performance relative to pre-frail and robust patients. A negative correlation (coefficient - 0.503) was observed between frailty and measures of patients' cognitive function (p < 0.05).

DISCUSSION

The coexistence of frailty and cognitive impairment should be assessed, as PD patients with both conditions are more vulnerable and have a higher chance of experiencing adverse effects.

CONCLUSION

Frail patients with Parkinson's disease present an impairment of cognitive functions dependent on cortical and subcortical regions, being these regions more preserved in the case of robust. The development of programs for early detection of frailty and cognitive function in these patients is necessary to implement strategic intervention plans focused on reversing frailty and cognitive impairment. PROTOCOL REGISTRATION NUMBER: http://www.

CLINICALTRIALS

gov ID: NCT05388526.

Cross-Sectional and Prospective Associations between Parkinsonism and Parkinson's Disease with Frailty in Latin America

BACKGROUND

Little is known about the relationship between parkinsonism or Parkinson's disease (PD) and frailty in Latin America.

OBJECTIVE

The study aimed to determine the cross-sectional and prospective associations between parkinsonism and PD with frailty in a large multi-country cohort in Latin America. Frailty was assessed using three different models to explore which definitions are more appropriate to screen for frailty in a PD population.

METHODS

12,865 older adults (aged ≥65 years) from the 10/66 population-based cohort study in six Latin American countries were analyzed. Logistic regression models assessed the cross-sectional association between parkinsonism/PD with baseline frailty. Individual country analyses were combined via fixed-effect meta-analysis. In non-frail participants who were followed up for 4 years, Cox proportional hazards regression models assessed the prospective association between parkinsonism/PD with incident frailty accounting for competing risk of mortality.

RESULTS

At baseline, the prevalence of parkinsonism and PD was 7% and 2%, respectively, and the prevalence of frailty varied across the three models with rates of 18% for frailty phenotype, 20% for frailty index and 30% for multidimensional frailty model. PD was associated with baseline and incident frailty after accounting for age, sex, and education: odds ratios and 95% confidence intervals (95% CI) for frailty were 2.49 (95% CIs 1.87-3.31), 2.42 (95% CIs 1.80-3.25), and 1.57 (95% CIs 1.16-2.21), and cause-specific hazard ratios were 1.66 (95% CIs 1.07-2.56), 1.78 (95% CIs 1.05-3.03), and 1.58 (95% CIs 0.91-2.74). Similar results were found for parkinsonism.

CONCLUSION

Parkinsonism and PD were cross-sectionally and prospectively associated with frailty in Latin America. Routine screening for frailty in PD patients may aid earlier detection of those at greater risk of adverse outcomes.

Plant-derived bioactive compounds and their novel role in central nervous system disorder treatment via ATF4 targeting: A systematic literature review

Central nervous system (CNS) disorders exhibit exceedingly intricate pathogenic mechanisms. Pragmatic and effective solutions remain elusive, significantly compromising human life and health. Activating transcription factor 4 (ATF4) participates in the regulation of multiple pathophysiological processes, including CNS disorders. Considering the widespread involvement of ATF4 in the pathological process of CNS disorders, the targeted regulation of ATF4 by plant-derived bioactive compounds (PDBCs) may become a viable strategy for the treatment of CNS disorders. However, the regulatory relationship between PDBCs and ATF4 remains incompletely understood. Here, we aimed to comprehensively review the studies on PDBCs targeting ATF4 to ameliorate CNS disorders, thereby offering novel directions and insights for the treatment of CNS disorders. A computerized search was conducted on PubMed, Embase, Web of Science, and Google Scholar databases to identify preclinical experiments related to PDBCs targeting ATF4 for the treatment of CNS disorders. The search timeframe was from the inception of the databases to December 2023. Two assessors conducted searches using the keywords "ATF4," "Central Nervous System," "Neurological," "Alzheimer's disease," "Parkinson's Disease," "Stroke," "Spinal Cord Injury," "Glioblastoma," "Traumatic Brain Injury," and "Spinal Cord Injury." Overall, 31 studies were included, encompassing assessments of 27 PDBCs. Combining results from in vivo and in vitro studies, we observed that these PDBCs, via ATF4 modulation, prevent the deposition of amyloid-like fibers such as Aβ, tau, and α-synuclein. They regulate ERS, reduce the release of inflammatory factors, restore mitochondrial membrane integrity to prevent oxidative stress, regulate synaptic plasticity, modulate autophagy, and engage anti-apoptotic mechanisms. Consequently, they exert neuroprotective effects in CNS disorders. Numerous PDBCs targeting ATF4 have shown potential in facilitating the restoration of CNS functionality, thereby presenting expansive prospects for the treatment of such disorders. However, future endeavors necessitate high-quality, large-scale, and comprehensive preclinical and clinical studies to further validate this therapeutic potential.

[Sarcopenia as a non-motor symptom of Parkinson's disease]

Sarcopenia is a progressive generalized skeletal muscle disease that is accompanied by an accelerated loss of muscle mass and function, affecting the quality of life and the ability to perform self-care. The prevalence of sarcopenia in the world today ranges from 10 to 25%, which represents a certain danger as it is a prognostic factor for possible injury and increased disability in the elderly population. Sarcopenia often accompanies a large number of different diseases, including neurodegenerative ones, so it is actively studied in this category of patients, for example, as one of the early symptoms of Parkinson's disease (PD). PD and sarcopenia have overlapping pathophysiological mechanisms of muscle fiber loss: inflammation, muscle autophagy, oxidative stress and apoptosis. Loss of muscle mass due to malnutrition is common in PD. According to some studies, the prevalence of sarcopenia in PD varies from 6 to 55.8%; weakness and sarcopenia are more common in patients with PD than in society as a whole, which is associated with an unfavorable course of the disease. The presence of both diseases simultaneously in one patient can impose certain restrictions on the treatment of the patient, worsen his physical and mental condition, which determines the need for early detection of sarcopenia in patients with PD.

miR-221 and Parkinson's disease: A biomarker with therapeutic potential

Parkinson's disease (PD) is a neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra, leading to various motor and non-motor symptoms. Several cellular and molecular mechanisms such as alpha-synuclein (α-syn) accumulation, mitochondrial dysfunction, oxidative stress and neuroinflammation are involved in the pathogenesis of this disease. MicroRNAs (miRNAs) play important roles in post-transcriptional gene regulation. They are typically about 21-25 nucleotides in length and are involved in the regulation of gene expression by binding to the messenger RNA (mRNA) molecules. miRNAs like miR-221 play important roles in various biological processes, including development, cell proliferation, differentiation and apoptosis. miR-221 promotes neuronal survival against oxidative stress and neurite outgrowth and neuronal differentiation. Additionally, the role of miR-221 in PD has been investigated in several studies. According to the results of these studies, (1) miR-221 protects PC12 cells against oxidative stress induced by 6-hydroxydopamine; (2) miR-221 prevents Bax/caspase-3 signalling activation by stopping Bim; (3) miR-221 has moderate predictive power for PD; (4) miR-221 directly targets PTEN, and PTEN over-expression eliminates the protective action of miR-221 on p-AKT expression in PC12 cells; and (5) miRNA-221 controls cell viability and apoptosis by manipulating the Akt signalling pathway in PD. This review study suggested that miR-221 has the potential to be used as a clinical biomarker for PD diagnosis and stage assignment.

Frailty and cognitive impairment in Parkinson’s disease: a systematic review

BACKGROUND

Frailty can lead to increased vulnerability in older people and patients with Parkinson's disease (pwPD) and worsen their health conditions. These patients can also develop cognitive function impairment. The objective is to analyze whether there is a relationship between frailty and cognitive impairment in pwPD, and to find out which instruments to use for its evaluation.

METHODS

Publications were searched in PubMed, Medline, Web of Science, Cinalh, Cochrane Library, Embase, Phycinfo, and Scopus. The results were measured with the instruments that are used to assess frailty and cognitive impairment, and analyze their relationship.

RESULTS

Two hundred seventy-one articles were identified, of which 12 met the inclusion criteria. All studies assessed frailty and cognitive function in pwPD. Five studies analyzed the relationship between frailty and cognitive impairment. The most used instruments were the Fried scale followed by the Clinical Frailty Scale (CFS) for frailty. Cognitive impairment was mostly evaluated with the Mini-Mental State Examination and the Montreal Cognitive Assessment. The prevalence data ranged from 20.2 to 51.5% with the Fried scale and from 35.6 to 83.9% with the CFS. Cognitive impairment was present in 15 to 45.2% of the pwPD.

CONCLUSION

Analysis of the included studies shows a relationship between frailty and cognitive impairment in pwPD. There was significant variability in the application of the scales used, which influences the prevalence data. More observational and experimental studies are needed to provide more evidence on this association and to determine which is the optimal tool to identify frailty in pwPD using multidimensional scales.

Assessment of Physical Fitness and Risk Factors for the Occurrence of the Frailty Syndrome among Social Welfare Homes' Residents over 60 Years of Age in Poland

The study aimed at assessing physical fitness and occurrence of the frailty syndrome among social welfare homes’ residents as well as defining factors which determine the level of frailty and its occurrence. The examination included 198 residents (115 females and 83 males of average age 75.5 ± 10.21) and was carried out with the use of the Short Physical Performance Battery (SPPB) test with the following cut-off points: 0−6—frail, 7−9—pre-frail, 10−12—non-frail. The research additionally collected data regarding age, gender, number of chronic diseases, education level, type of prior work and current physical activity. In addition, the height and weight of the respondents were measured. The frailty syndrome was found in more than a half of the examinees (104; 52.53%), the pre-frailty state in 30.30% (n = 60) and 17.17% (n = 34) were non-frail. The average result of the SPPB test was 6.52 ± 2.73, which proves a moderate limitation of the sample group’s fitness. No significant differences were noted between female and male respondents (p = 0.27). The multifactorial linear regression model showed that independent and direct frailty syndrome predicators included age, number of chronic diseases and regular physical activity (p < 0.05). In conclusion, promoting and encouraging regular, age and interest-related forms of physical activity among seniors might foster the maintenance of their physiological reservoir and functional efficiency.