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Loda I, D’Angelo E, Marzetti E, Kerminen H. Prevention, Assessment, and Management of Malnutrition in Older Adults with Early Stages of Cognitive Disorders. Nutrients 2024; 16:1566. [PMID: 38892503 PMCID: PMC11173938 DOI: 10.3390/nu16111566] [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: 04/29/2024] [Revised: 05/11/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Malnutrition is common in older adults, and its risk is greater in those living with dementia. Relative to cognitively healthy peers, the prevalence of malnutrition is also increased in individuals with early stages of cognitive disorders owing to pathophysiological, cognitive, and psychosocial changes related to cognitive impairment. Malnutrition is associated with adverse health outcomes, including faster cognitive and functional decline. Here, we provide an overview of the prevention, assessment, and management of malnutrition in older adults, with a special focus on the aspects that are important to consider in individuals with early stages of cognitive disorders. Strategies to prevent malnutrition include systematic screening for malnourishment using validated tools to detect those at risk. If the screening reveals an increased risk of malnutrition, a detailed assessment including the individual's nutritional, medical, and functional status as well as dietary intake should be performed. The management of malnutrition in the early stages of cognitive disorders should be based on the findings of a comprehensive assessment and be personalized according to the individual's specific characteristics. In the article, we also provide an overview of the evidence on vitamin supplements and specific dietary patterns to prevent cognitive decline or attenuate its progression.
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Affiliation(s)
- Irene Loda
- Scuola di Specialità in Geriatria, Università degli Studi di Brescia, Viale Europa 11, 25123 Brescia, Italy;
| | - Emanuela D’Angelo
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
| | - Hanna Kerminen
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy;
- Faculty of Medicine and Health Technology, The Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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Arruda JFDL, Silva LD, Brisson RT, Micheli GDC, Lima MASDD, Rosso ALZD, Fernandes RDCL. Performance of a cost-effective olfactory test to evaluate hyposmia in Parkinson's disease patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-6. [PMID: 38811023 DOI: 10.1055/s-0044-1787139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Parkinson's disease (PD) causes motor and non-motor symptoms such as hyposmia, which is evaluated through olfactory tests in the clinical practice. OBJECTIVE To assess the feasibility of using the modified Connecticut Chemosensory Clinical Research Center (mCCCRC) olfactory test and to compare its performance with the Sniffin' Sticks-12 (SS-12, Burghart Messtechnik GmbH, Wedel, Germany) test. METHODS A transversal case-control study in which the patients were divided into the PD group (PDG) and the control group (CG). The cost and difficulty in handling substances to produce the mCCCRC test kits were evaluated. Sociodemographic characteristics, smoking habits, past coronavirus disease 2019 (COVID-19) infections, self-perception of odor sense, and cognition through the Montreal Cognitive Assessment (MoCA) were also evaluated. The PDG was scored by part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and the Hoehn and Yahr Scale (H&Y) scale. Correlations were assessed through the Spearman rank correlation coefficient test (ρ, or rho). RESULTS The mCCCRC test was easily manufactured and handled at a cost ten times lower compared with the SS-12. The groups (PDG: n = 34; CG: n = 38) were similar in terms of age, sex, level of schooling, smoking habits, and history of COVID-19. The tests results showed moderate correlation (rho = 0.65; p < 0.0001). The CG presented better cognitive performance and scored better in both tests (p < 0.0001). There was a tendency for a negative correlation with age, but good correlation with the MoCA (p = 0.0029). The results of the PDG group showed no correlation with olfactory results and motor performance or disease duration. The self-perception of hyposmia was low in both groups. CONCLUSION The mCCCRC is an easy-to-apply and inexpensive method that demonstrated a similar performance to that of the SS-12 in evaluating olfaction in PD patients and healthy controls.
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Affiliation(s)
- Josevânia Fulgêncio de Lima Arruda
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Liene Duarte Silva
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Rodrigo Tavares Brisson
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Gabriel de Castro Micheli
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Marco Antônio Sales Dantas de Lima
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Ana Lucia Zuma de Rosso
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
| | - Rita de Cássia Leite Fernandes
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Serviço de Neurologia Prof. Sérgio Novis, Rio de Janeiro RJ, Brazil
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Tyner CE, Boulton AJ, Slotkin J, Cohen ML, Weintraub S, Gershon RC, Tulsky DS. Exploring symptom clusters in mild cognitive impairment and dementia with the NIH Toolbox. J Int Neuropsychol Soc 2024:1-12. [PMID: 38361424 PMCID: PMC11327385 DOI: 10.1017/s1355617724000055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations. METHOD Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer's type. RESULTS The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor. CONCLUSION This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.
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Affiliation(s)
- Callie E Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
| | - Matthew L Cohen
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
- Department of Communication Sciences & Disorders, University of Delaware, Newark, DE, USA
- Delaware Center for Cognitive Aging Research, University of Delaware, Newark, DE, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Zhou C, Yang C, Ai Y, Fang X, Zhang A, Wang Y, Hu H. Valid olfactory impairment tests can help identify mild cognitive impairment: an updated meta-analysis. Front Aging Neurosci 2024; 16:1349196. [PMID: 38419646 PMCID: PMC10900519 DOI: 10.3389/fnagi.2024.1349196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Background Olfactory testing is emerging as a potentially effective screening method for identifying mild cognitive impairment in the elderly population. Objective Olfactory impairment is comorbid with mild cognitive impairment (MCI) in older adults but is not well-documented in subdomains of either olfactory or subtypes of cognitive impairments in older adults. This meta-analysis was aimed at synthesizing the differentiated relationships with updated studies. Methods A systematic search was conducted in seven databases from their availability to April 2023. A total of 38 publications were included, including 3,828 MCI patients and 8,160 healthy older adults. Two investigators independently performed the literature review, quality assessment, and data extraction. The meta-analyses were conducted with Stata to estimate the average effects and causes of the heterogeneity. Results Compared to normal adults, MCI patients had severe impairments in olfactory function and severe deficits in specific domains of odor identification and discrimination. Olfactory impairment was more severe in patients with amnestic mild cognitive impairment than in patients with non-amnestic MCI. Diverse test instruments of olfactory function caused large heterogeneity in effect sizes. Conclusion Valid olfactory tests can be complementary tools for accurate screening of MCI in older adults.
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Affiliation(s)
- Chunyi Zhou
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Chongming Yang
- Research Support Center, College of Family, Home, and Social Sciences, Brigham Young University, Provo, UT, United States
| | - Yating Ai
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Xueling Fang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Ailin Zhang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Yuncui Wang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
- Engineering Research Center of TCM Protection Technology and New Product Development for the Elderly Brain Health, Ministry of Education, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
| | - Hui Hu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
- Engineering Research Center of TCM Protection Technology and New Product Development for the Elderly Brain Health, Ministry of Education, Wuhan, China
- Hubei Shizhen Laboratory, Wuhan, China
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Guo J, Dove A, Wang J, Laukka EJ, Ekström I, Dunk MM, Bennett DA, Xu W. Trajectories of olfactory identification preceding incident mild cognitive impairment and dementia: a longitudinal study. EBioMedicine 2023; 98:104862. [PMID: 38251465 PMCID: PMC10628348 DOI: 10.1016/j.ebiom.2023.104862] [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: 07/11/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The pattern of olfactory identification change in the early phases of dementing disorders is unclear. We aimed to assess olfactory identification trajectories preceding incident mild cognitive impairment (MCI) and dementia and explore the role of brain pathologies in these trajectories. METHODS Within the Rush Memory and Aging Project, 1318 dementia-free older adults were followed annually for up to 11 years. Olfactory identification was assessed using the Brief Smell Identification Test annually. Of 900 cognitively intact participants, incident MCI and dementia were diagnosed following standard criteria. Over follow-up, 518 participants died and underwent brain autopsies for neuropathological assessment. Data were analyzed using mixed-effect models with backward timescales. FINDINGS Compared to participants who remained cognitively intact, olfactory identification declined faster among those who developed MCI (β -0.09 [95% CI -0.13, -0.05]), leading to a significantly lower olfactory identification starting from five years preceding MCI diagnosis (mean difference at year -5: -0.39 [-0.71, -0.07]). Among participants with incident MCI, olfactory identification declined faster in those who developed dementia compared to those who did not (β -0.19 [-0.36, -0.01]), leading to a significantly lower olfactory identification starting from three years preceding dementia diagnosis (mean difference at year -3: -0.95 [-1.67, -0.23]). A faster decline in olfactory identification was associated with higher burdens of global Alzheimer's disease pathology, neurofibrillary tangles, and amyloid beta load. INTERPRETATION Olfactory identification declined faster preceding dementia disorders and Alzheimer's pathology may underlie these faster declines. FUNDING This study was funded by the National Institutes of Health (R01AG17917) and Swedish Research Council (2021-01647).
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Affiliation(s)
- Jie Guo
- Department of Nutrition and Health, China Agricultural University, Beijing, China; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Abigail Dove
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jiao Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China; Department of Epidemiology, College of Preventive Medicine, The Army Medical University (Third Military Medical University), Chongqing, China
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Ingrid Ekström
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Michelle M Dunk
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Center for International Collaborative Research on Environment, Nutrition, and Public Health, Tianjin, China
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Olfactory Impairment Correlates with Executive Functions Disorders and Other Specific Cognitive Dysfunctions in Parkinson's Disease. BIOLOGY 2023; 12:biology12010112. [PMID: 36671804 PMCID: PMC9855400 DOI: 10.3390/biology12010112] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Olfactory and cognitive disorders represent important non-motor symptoms in Parkinson's disease (PD). No clear evidence was reported about association of specific cognitive domains and olfactory impairment. OBJECTIVE The aim of this study was to evaluate the association between olfactory dysfunction and specific cognitive domains in PD patients compared to controls. METHODS 178 PD patients and 98 controls were enrolled and evaluated for odor threshold (OT), discrimination (OD), identification (OI), and TDI score using the Sniffin' Sticks test. Cognitive function was evaluated using the Montreal Cognitive Assessment scale with six sub-scores: Orientation (OIS), Attention (AIS), Language (LIS), Visuospatial (VIS), Memory (MIS), and Executive index scores (EIS). RESULTS Statistically significant correlations were observed between OT versus, LIS, and between TDI score versus EIS. Multivariate linear regression analysis, including age and sex which are well-known predictors of olfactory dysfunction, showed that, among specific cognitive domains, only LIS was significant predictor for OT, VIS was a significant predictor for OD, while both EIS and AIS were significant predictors for OI, and finally only EIS was significant predictor for TDI score. CONCLUSIONS Olfactory disorders in PD patients appear commonly related to dysfunction of specific cognitive domains, with strict association between global olfactory impairment and executive function deficits.
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