Plasma MCP-1 and changes on cognitive function in community-dwelling older adults

Background

Monocyte Chemoattractant Protein-1 (MCP-1), a glial-derived chemokine, mediates neuroinflammation and may regulate memory outcomes among older adults. We aimed to explore the associations of plasma MCP-1 levels (alone and in combination with β-amyloid deposition—Aβ_42/40) with overall and domain-specific cognitive evolution among older adults.

Methods

Secondary analyses including 1097 subjects (mean age = 75.3 years ± 4.4; 63.8% women) from the Multidomain Alzheimer Preventive Trial (MAPT). MCP-1 (higher is worse) and Aβ_42/40 (lower is worse) were measured in plasma collected at year 1. MCP-1 in continuous and as a dichotomy (values in the highest quartile (MCP-1⁺)) were used, as well as a dichotomy of Aβ_42/40. Outcomes were measured annually over 4 years and included the following: cognitive composite z-score (CCS), the Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) sum of boxes (overall cognitive function); composite executive function z-score, composite attention z-score, Free and Cued Selective Reminding Test (FCSRT - memory).

Results

Plasma MCP-1 as a continuous variable was associated with the worsening of episodic memory over 4 years of follow-up, specifically in measures of free and cued delayed recall. MCP-1⁺ was associated with worse evolution in the CCS (4-year between-group difference: β = −0.14, 95%CI = −0.26, −0.02) and the CDR sum of boxes (2-year: β = 0.19, 95%CI = 0.06, 0.32). In domain-specific analyses, MCP-1⁺ was associated with declines in the FCSRT delayed recall sub-domains. In the presence of low Aβ_42/40, MCP-1⁺ was not associated with greater declines in cognitive functions. The interaction with continuous biomarker values Aβ_42/40× MCP-1 × time was significant in models with CDR sum of boxes and FCSRT DTR as dependent variables.

Conclusions

Baseline plasma MCP-1 levels were associated with longitudinal declines in overall cognitive and episodic memory performance in older adults over a 4-year follow-up. How plasma MCP-1 interacts with Aβ_42/40 to determine cognitive decline at different stages of cognitive decline/dementia should be clarified by further research. The MCP-1 association on cognitive decline was strongest in those with amyloid plaques, as measured by blood plasma Aβ_42/40.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13195-021-00940-2.

Biomarkers of mitochondrial dysfunction and inflammaging in older adults and blood pressure variability

Most physiopathological mechanisms underlying blood pressure variability (BPV) are implicated in aging. Vascular aging is associated with chronic low-grade inflammation occurring in late life, known as "inflammaging" and the hallmark "mitochondrial dysfunction" due to age-related stress. We aimed to determine whether plasma levels of the pleiotropic stress-related mitokine growth/differentiation factor 15 (GDF-15) and two inflammatory biomarkers, interleukin 6 (IL-6) and tumor necrosis factor receptor 1 (TNFR-1), are associated with visit-to-visit BPV in a population of community-dwelling older adults. The study population consisted of 1096 community-dwelling participants [median age 75 (72-78) years; 699 females, 63.7%] aged ≥ 70 years from the MAPT study. Plasma blood sample was collected 12 months after enrolment and BP was assessed up to seven times over a 4-year period. Systolic (SBPV) and diastolic BPV (DBPV) were determined through several indicators taking into account BP change over time, the order of measurements and formulas independent of mean BP levels. Higher values of GDF-15 were significantly associated with increased SBPV (all indicators) after adjustment for relevant covariates [adjusted 1-SD increase in GDF-15: β (SE) = 0.07 (0.04), p < 0.044, for coefficient of variation%]. GDF-15 levels were not associated with DBPV. No significant associations were found between IL-6 and BPV, whereas TNFR1 was only partially related to DBPV. Unlike inflammation biomarkers, higher GDF-15 levels were associated with greater SBPV. Our findings support the age-related process of mitochondrial dysfunction underlying BP instability, suggesting that BPV might be a potential marker of aging.

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

BACKGROUND/AIMS

Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients.

METHODS

We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline.

RESULTS

A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7-45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24-4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22-3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06-2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03-2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001).

CONCLUSION

The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes.

Effectiveness of light paths coupled with personal emergency response systems in preventing functional decline among the elderly

INTRODUCTION

The elderly population is at high risk of functional decline, which will induce significant costs due to long-term care. Dependency could be delayed by preventing one of its major determinants: falls. Light paths coupled with personal emergency response systems could prevent the functional decline through fall prevention.

METHODS

This study aimed to evaluate the effectiveness of light paths coupled with personal emergency response systems on the functional decline in an elderly population living at home. It is a secondary analysis on data from a previous cohort. In all, 190 older adults (aged 65 years or more) living at home participated. Participants in the exposed group were equipped with home-based technologies: light paths coupled with personal emergency response systems. The participants' functional status was assessed using the Functional Autonomy Measurement System scale at baseline (T0) and at the end of the study (T12-month). Baseline characteristics were evaluated by a comprehensive geriatric assessment.

RESULTS

After 1 year, 43% of the unexposed group had functional decline versus 16% of the exposed group. Light paths coupled with personal emergency response systems were significantly associated with a decrease in the functional decline (Δ Functional Autonomy Measurement System ⩾ 5) at home (odds ratio = 0.24, 95% confidence interval (0.11-0.54), p = 0.002).

DISCUSSION

This study suggests that light paths coupled with personal emergency response systems prevent the functional decline over 12 months. This result may encourage the prescription and use of home-based technologies to postpone dependency and institutionalization, but they need a larger cost-effectiveness study to demonstrate the efficiency of these technologies.

Preventing and managing indoor falls with home-based technologies in mild and moderate Alzheimer's disease patients: pilot study in a community dwelling

BACKGROUND

Alzheimer's disease (AD) is known to increase the risk of falls. We aim to determine the effectiveness of home-based technologies coupled with teleassistance service (HBTec-TS) in older people with AD.

METHODS

A study of falls and the HBTec-TS system (with a light path combined with a teleassistance service) was conducted in the community. The 96 subjects, drawn from a random population of frail elderly people registered as receiving an allocation for lost autonomy from the county, were aged 65 or more and had mild-to-moderate AD with 1 year of follow-up; 49 were in the intervention group and 47 in the control group.

RESULTS

A total of 16 (32.7%) elderly people fell in the group with HBTec-TS versus 30 (63.8%) in the group without HBTec-TS. The use of HBTec-TS was significantly associated with a reduction in the number of indoor falls among elderly people with mild-to-moderate AD (OR = 0.37, 95% CI = 0.15-0.88, p = 0.0245).

CONCLUSION

The use of the HBTec-TS significantly reduced the incidence of primary indoor falling needing GP intervention or attendance at an emergency room among elderly people with AD and mild-to-moderate dementia.

Background levels of metals in St. Lawrence River sediments: implications for sediment quality criteria and environmental management

Preindustrial sediments dredged from the St. Lawrence Seaway are often considered potentially toxic relative to interim sediment quality criteria. The aim of the present study was to better document the background levels of target metals that were once used to define the minimal threshold of these criteria. Three extractions were performed on sediment samples to evaluate the distribution and potential bioavailability of trace metals. The results showed that the background levels established for the criteria are representative of contaminant concentrations observed in preindustrial sediments but not of the postglacial marine clays underlying these sediments. Chromium, nickel, and copper concentrations in postglacial marine clays, when solubilized by strong acids, exceeded the minimal effect threshold, whereas chromium and nickel frequently exceeded the toxic effect threshold and therefore are problematic in terms of applying sediment quality assessment criteria. The results suggest that these trace metals are mostly associated with inert silicates in postglacial marine clays and are unlikely to be bioavailable to aquatic organisms. Postglacial marine clays should be better considered differently than are sediments in regard to the sediment quality criteria implementation. Accordingly, the use of tools to identify the postglacial material may become necessary if a particular management disposition should be established for this sedimentary material. Total recoverable aluminum concentrations in sediments, in conjunction with other physical characteristics, was shown to be an interesting tool to identify this specific material. The normalization of metals concentrations with total recoverable aluminum concentrations would take account of natural mineralogical and textural variability of freshwater sediments in the quality assessment process.

Exposure of caged mussels to metals in a primary-treated municipal wastewater plume

The biological availability of metals in municipal wastewater effluents is strongly influenced by the physical and chemical conditions of both the effluent and the receiving water. Aquatic organisms are exposed to both dissolved and particulate (food ingestion) forms of these metals. In the present study, the distribution of metals in specific tissues was used to distinguish between exposure routes (i.e. dissolved vs. particulate phase) and to examine metal bioavailability in mussels exposed to municipal effluents. Caged Elliptio complanata mussels were deployed at sites located between 1.5 km upstream and 12 km downstream of a major effluent outfall in the St. Lawrence River. Metals in surface water samples were fractionated by filtration techniques to determine their dissolved, truly-dissolved (<10 kDa), total-particulate and acid-reactive-particulate forms. At the end of the exposure period (90 days), pooled mussel soft tissues (digestive gland, gills, gonad, foot and mantle) were analyzed for several metals. The results showed that gills and digestive gland were generally the most important target tissues for metal bioaccumulation, while gill/digestive gland metal ratios suggest that both exposure routes should be considered for mussels exposed to municipal effluents. We also found that Ag and Cd in the dispersion plume nearest the outfall, in contrast to other metals such as Cu and Zn, are more closely associated with colloids and were generally less bioavailable than at the reference site in the St. Lawrence River.

Distribution and fate of metals in the dispersion plume of a major municipal effluent

The environmental impacts of municipal wastewater discharges on receiving waters are numerous and inputs of contaminants such as metals can cause toxicity to organisms in receiving waters. The effluents generated by the treatment plant of the city of Montreal, Canada, the largest such facility in the St. Lawrence Valley, was investigated to determine the environmental fate of trace metals in the receiving waters. Total and extractable metal concentrations were determined and physico-chemical parameters were measured to characterize the receiving waters and evaluate their influence on the fate and behaviour of metals released from the urban effluent. Our results showed that particulate metals near the effluent discharge point are highly reactive and their distribution seems to be significantly influenced by the abundance of HCl-reactive iron and manganese, which act as trace-metal carriers. The partitioning of metals between dissolved and particulate phases varies along the effluent dispersion plume and therefore could strongly influence the exposure routes for aquatic organisms that are exposed to the various contaminants released from the effluent.