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04/2013 journal articles

IMPACT OF HYPERHOMOCYSTEINEMIA TREATMENT ON COGNITIVE DECLINE DUE TO ALZHEIMER’S DISEASE AND RELATED DISORDERS

W.R. Shankle, J. Hara, M.S. Rafii, J. Russell

J Aging Res Clin Practice 2013;2(4):319-324

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Objectives: Studies have produced conflicting results assessing hyperhomocysteinemia (HYH) treatment with B vitamins in patients with normal cognition, Alzheimer’s disease or a related disorder (ADRD). This study examined whether HYH treatment with Cerefolin®/Cerefolin-NAC® (CFLN) influenced cognitive decline. Design: Retrospective cohort study of subjects followed longitudinally. Setting: Outpatient clinic for cognitive disorders. Participants: Of 934 patients, 109 HYH patients met inclusion criteria to analyze effect of CFLN (N=86: median treatment duration and 90% confidence band = 17.3 [0-52.4] months) vs. no CFLN (N=23). Intervention: CFLN vs. no treatment. Measurements: Cognitive outcome measures included MCI Screen (memory), CERAD Drawings (constructional praxis), Ishihara Number Naming (object recognition), Trails A and B (executive function), and F-A-S test (verbal fluency). Dependent or predictor measures included demographics, functional severity, CFLN and no CFLN treatment duration, ADRD diagnosis, memantine and cholinesterase inhibitor treatment, apolipoprotein E (ApoE) genotype and quantitative MRI volumes. The data were analyzed using linear mixed effects models with covariate adjustment and random effects for functional severity. Results: Treatment duration on vs. off CFLN slowed decline in memory, constructional praxis, and executive function, even after controlling for ApoE genotype and regional brain volumes. CFLN treatment slowed cognitive decline significantly more for patients with milder baseline severity. Conclusion: This retrospective study showed that CFLN significantly slowed cognitive decline among HYH patients. Longer CFLN treatment duration and milder baseline severity were both significant factors. These findings warrant prospective validation.

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EFFECT OF HIGH DOSE FISH OIL SUPPLEMENTATION ON CEREBRAL BLOOD FLOW AND COGNITIVE PERFORMANCE IN PATIENTS WITH MILD COGNITIVE IMPAIRMENT: A PROOF OF CONCEPT STUDY

O. van de Rest, J.A. Claassen, R.P.C. Kessels, J.M. Geleijnse, M.G.M. OldeRikkert, L.C.P.G.M. de Groot

J Aging Res Clin Practice 2013;2(4):325-332

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Objective: The current study aimed to examine the effect of n-3 polyunsaturated fatty acids (PUFAs) on cerebral blood flow and age-related loss of cognitive functioning in subjects diagnosed with mild cognitive impairment (MCI). Design, setting and participants: A total of 20 patients with single or multiple domain MCI took part in this randomized, double-blind, placebo-controlled trial, wherein we investigated the effects of four weeks of daily supplementation with either a high pharmacological dose of 3 g eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) (n=10) or placebo (n=10) on cerebral blood flow and cognitive performance. Measurements: Cerebral blood flow and cortical oxygenation were measured by Transcranial Doppler and Near Infrared Spectroscopy together with blood pressure measurements using Finapres. Cognitive function was assessed by sensitive neuropsychological tests measuring reaction times, episodic memory and attention. Results: Daily supplementation with EPA+DHA for 4 weeks had no effect on cerebral hemodynamics or blood pressure. All subjects improved on most of the neuropsychological tests, but there was no difference between the fish oil and the placebo groups. Conclusions: In this randomized controlled trial in MCI patients, daily supplementation with EPA+DHA for four weeks had no effect on cerebral hemodynamics, blood pressure, or cognitive performance.

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FACTORS ASSOCIATED WITH BEING INSUFFICIENTLY PHYSICALLY ACTIVE AMONG THE OLDEST OLD PARTICIPATING IN COMMUNITY GROUPS

R.R. Krug, C. Sacomori, M.A. Lopes, M. Marchesan, G.Z. Mazo

J Aging Res Clin Practice 2013;2(4):334-338

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Introduction: The oldest old are the group with lowest physical activity levels, and many factors can contribute to this. Objective: To analyze which socio-demographic and health related factors are associated with being insufficiently physically active among adults aged 80 years and older participating in community groups. Methods: This research was characterized as cross-sectional descriptive epidemiological research. The study was carried out with 351 “oldest old” participants of 102 community groups for elderly registered in the City Hall of Florianópolis in the state of Santa Catarina. The instruments used were a Fact Sheet to assess socio-demographic and health related characteristics and the International Physical Activity Questionnaire (IPAQ). Descriptive statistics and Multivariate Hierarchical Poisson regression analysis were used adopting a 95% confidence interval. Results: The prevalence of very active oldest old participating in community groups was 45.86%. After adjusted analysis the factors associated with being insufficiently physically active among the oldest old participating in community groups were: higher age strata, lower education level, lower income and worse perceived health status. Conclusion: Physically inactive elderly who show such characteristics should be encouraged to do adequate physical exercise to prevent and reduce the risk of disabilities and diseases caused by the aging process.

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ADVERSE EFFECTS OF EXCESSIVE ANTIOXIDANT SUPPLEMENTS AND THEIR UNDERLYING MECHANISMS

F.S. Al Joudi

J Aging Res Clin Practice 2013;2(4):339--345

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Objectives: The escalating use of antioxidant supplements has been questioned repeatedly although the potential toxicities of antioxidants has not been adequately assessed nor understood. Methods: This work represents a comprehensive insight into the literature seeking potential targets of antioxidants in tissues and cells, with which they would interact to produce their toxic effects. Results: Oxidants are cellular components that drive some cellular key metabolic processes, and appear to weaken certain other metabolic pathways in cancer cells. Excess deactivation by antioxidants may enhance cellular survival through abating apoptotic pathways and enhancing energy production from glycolysis. Furthermore, oxidants are important effectors of immune reactivity as well as metabolic activators of the immune cells that carry out anti-microbial and anti-tumoral activities, and abolishing oxidant activity may hinder these vital functions. Conclusions: It is hypothesized that the critical balance of oxidants-antioxidants can be disrupted by excessive antioxidant consumption, setting a new state of “antioxidant stress”, leading to enhanced growth of cancer cells and to compromised immunity. In addition, the potential molecular mechanisms that may lead to this stress have been thoroughly explored.

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CHANGES IN ANTHROPOMETRIC MEASUREMENTS AND BODY MASS INDEX AMONG CHILEAN ELDERLY

C.B. Yu, L. Villarroel, P.P. Marín

J Aging Res Clin Practice 2013;2(4):346-350

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Objectives: Compare the anthropometric measurements, body mass index (BMI), and nutritional status of the Chilean Elderly from the years 2003 and 2010, and see if there are differences between age groups and by sex. Design, settings, and participants: Data was obtained from the Chilean National Health Survey (ChNHS), of the years 2003 and 2010. These are two cross-sectional studies. The weight, height, abdominal circumference, and BMI were analyzed for a representative sample of Chileans. Main Outcome Measures: Anthropometric measurements, BMI, and the prevalence of underweight, normal, overweight, and obese population of the elderly of Chile, grouped by age (65-74 years, and ≥ 75 years) and sex, when comparing elderly within both periods, as well as comparing them to the rest of the population. Conclusion: There were significant changes in the weight, abdominal circumference, and BMI in the elderly since the years 2003 and 2010. The weight and height of those ≥ 75 years tends to be significantly lower than the rest of the population. We can also appreciate a noticeable increase in the abdominal circumference from the younger adults to those ≥ 65 years. Through the years, there is an increasing trend towards being overweight and obese. Also, the highest prevalence of underweight individuals was seen in those older than 75 years, and within this group, it was mainly composed by women.

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AGE AND MILK CONSUMPTION ARE ASSOCIATED WITH VITAMIN D STATUS IN PRE-MENOPAUSAL SAUDI WOMEN

N.J. Aljohani, L.Z. Abu Zaid, M.A.F. Abbas, A.F. AlKaabba, M. Alghamdi, H.O. Alothman, G. Mohammed, A. Alshahrani

J Aging Res Clin Practice 2013;2(4):351-354

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Background: There is little evidence published on the prevalence of vitamin d deficiency among Saudi women, in spite of the widespread food fortification and the excellent opportunity of available sun light all over the year. The present cross-sectional study aims to determine the prevalence and risk factors of vitamin D deficiency among premenopausal women visiting commercial centers in Riyadh City. Materials and Methods: A quasi-random technique was employed in the recruitment of subjects from various commercial Malls in Riyadh last May-November, 2012. A total of 256 subjects filled a general questionnaire, height and weight were measured and blood extracted ascertaining total 25-hydroxyvitamin D, calcium, phosphorous and alkaline phophatase from a vitamin D External Quality Assessment (DEQAS)-certified laboratory. Results: Vitamin D deficiency (< 50 nmol/L) was noted in 200 (77.6%) of subjects. Age and milk consumption were the significant predictors of vitamin D status, with 33.9% of variance perceived (p < 0.001). Increased BMI, being married and the presence of muscle pain were all significantly associated with vitamin D deficiency. Conclusion: Nearly 4 out of 5 premenopausal Saudi women shoppers harbor vitamin D deficiency and this is influenced by age and milk consumption. It is clear that the general female public faces an imminent threat of vitamin D deficiency-related diseases unless aggressive public awareness is conducted.

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NUTRITIONAL SUPPLEMENTATION AND MUSCLE MASS PRESERVATION IN ADULTS DURING BED REST: A SYSTEMATIC REVIEW TO INFORM CLINICAL PRACTICE

R. Jamieson, J. Porter

J Aging Res Clin Practice 2013;2(4):355-362

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Background: Nutritional intervention is assumed to protect muscle mass in patients at bed rest. This review found no high quality studies performed in the clinical setting, with evidence limited to the effect of nutritional supplementation on lean muscle mass and functional outcomes. Objectives: This systematic review investigates whether nutritional intervention, in the absence of other countermeasures, is effective in preserving muscle mass during periods of bed rest. It considers relevant studies within a clinical context and critiques the nutritional methodologies used. Evidence review: Studies were identified by electronically searching MEDLINE, CINAHL, EMBASE and PubMed from the earliest available to September 2012, as well as a citation review of relevant papers. Included studies had at least one group receiving oral nutritional supplementation or a higher protein diet during bed rest in comparison to a control group not receiving nutrition intervention. Nutritional methodologies were investigated using a standardised protocol, and a meta-analysis was conducted. Findings: The initial search yielded 310 studies with six of these meeting inclusion criteria for the review. Methodological issues included an absence of detailed recruitment strategies, participants who were mostly young healthy males, and space flight as the primary study context. This limited the ability to extrapolate results to the clinical setting of older hospitalised patients at bed rest. A meta-analysis indicated that nutritional supplementation did not improve lean leg mass during bed rest. Conclusion: High level evidence to support the use of nutritional supplementation in protecting muscle mass during bed rest is lacking, especially in elderly patients under clinical situations. Translational trials are needed to direct clinical practice for healthcare providers.

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SELENIUM STATUS IN A 12 MONTH LONGITUDINAL STUDY OF OLDER TASMANIAN ADULTS

J.M. Beckett, M.J. Ball

J Aging Res Clin Practice 2013;2(4):363-368

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Background: Selenium is important in many areas of health including immune and antioxidant function. Inadequate selenium status in the elderly is common, and may be particularly important as immune function decreases and risk of chronic and other disease increases. Little data has been reported about medium term variation in selenium status. Objectives: To investigate the magnitude of variation in selenium status of older adults over 12 months and the influence of season. Design: A 12 month longitudinal study. Setting: Independent, community dwelling self-selected older adults in 2009 and 2010. Participants: 80 adults (23 men, 57 women) in Australia, aged 60 years or older. Measurements: Dietary selenium intake was assessed using a food frequency questionnaire. Serum selenium concentration was measured using graphite furnace atomic absorption spectroscopy. Results: At commencement, men consumed 80.6 μg, and women 66.8 μg selenium per day, respectively; there was however, no significant difference in serum selenium (1.11 v. 1.09 μmol/l; P = 0.58). Repeated measures nonlinear regression analysis revealed the mean magnitude of variation over 12 months was small and non-significant (0.02 μmol/l; 95% CI -0.01 to 0.05; P = 0.17). Overall there was minimal variation over the study period; greatest variation was observed in subjects in the upper quartile of selenium status at commencement; the mean SD of serum selenium change compared to all others was 0.15 vs. 0.07 μmol/l (95% CI of difference 0.04 to 0.13; P<0.001). Conclusions: In these older adults, selenium status did not vary significantly over 12 months and there was no evidence of a seasonal pattern.

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INCREASED NITROGEN INTAKE FOLLOWING HIP ARTHROPLASTY EXPEDITES MUSCLE STRENGTH RECOVERY

A.A. Ferrando, M.M. Bamman, S.E. Schutzler, H.J. Spencer, A.M. Dawson, R.P. Evans, R.R. Wolfe

J Aging Res Clin Practice 2013;2(4):369-375

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Background: Objectives: The aim of this study was to investigate the effects of increased nitrogen intake, via amino acid supplementation, on strength and functional recovery after THA. Design: Prospective, randomized clinical trial. Setting: Academic medical center; orthopedic clinic. Participants: Patients scheduled to receive elective hip arthroplasty. Intervention: Patients were randomly assigned to receive usual care (UC; n = 8, 55 ± 7 (SD) y) or 15 g of essential amino acid supplementation 3 times per day (EAA; n = 8, 55 ± 8 y) for 8 weeks. Measurements: Leg strength (maximal voluntary contraction of the quadriceps) was measured by hand-held dynamometer, and function by 4 meter walk and a chair stand test pre-surgery, 2, and 8 weeks post-surgery. Results: Improvement in leg strength was greater in the EAA group, as was the rate of improvement from weeks 2 to 8 post-surgery. Improved strength was realized without an increase in lean mass. Both groups improved chair stand and 4 meter walk times. EAA supplementation increased total protein intake by 0.6g/kg/d (EAA 1.7 g/kg/d vs UC 1.1 g/kg/d). Conclusions: Increased nitrogen intake via amino acid supplementation improves the rate of recovery of leg muscle strength following THA. Key words: Essential amino acids, hip arthroplasty, paximal voluntary contraction, leg strength and function.

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USEFULNESS OF CLINICO-BIOLOGICAL INDICES IN THE ASSESSMENT OF MALNUTRITION AND ITS RELATED MORTALITY AND COMPLICATIONS RISKS IN ELDERLY PATIENTS

J. Abroug, O. Harzallah, M. Mahjoub, R.Klii, A. Sriha, F. Neffati, I. Hellara, S. El Mhamdi, A. Hamzaoui, H. Mribeh, H. Gamra, M.F. Najjar, M. Soussi Soltani, A. Kamel, I. Khochtali, S. Mahjoub

J Aging Res Clin Practice 2013;2(4):376-381

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Background: To date, no standard is currently available for the assessment of malnutrition and its complications. Many tools are available but most of them are partially or not validated. Objectives: In this work we aimed to evaluate the nutritional state of elderly people meaning the MNA test and to assess the prognosis and mortality risk related to malnutrition in elderly patients. Methods: 662 patients (mean age: 73 years, sex ratio: 0.6) older than 65 years were included in this study. They were recruited either from primary (438 outpatients) than from tertiary healthcare centers (224 inpatients). Patient’s nutritional state was evaluated by anthropometric parameters, by biological tests (albumin, transthyretin, orosomucoide and crp) and by MNA form. Prognostic indices (GNRI and PRI) were calculated for each patient in order to assess malnutrition related mortality and complications risks. Results: According to MNA test, 6.65% patients (44/662) were malnourished. Among these patients, albumin, transthyretrine and orosomucoide levels were decreased in respectively 52%, 62% and 89% of cases. The mean GNRI in malnourished elderly patients was 104 +/- 20. According to this index, malnutrition related risk of mortality and complications was major in 25%, moderate in 14.3% and low in 14.5% of cases. The PINI was on average at 33+/- 10. The malnutrition related-risk was appraised by PINI as low in 6.5%, moderate in 12.7% and high in 7% of cases and the vital prognosis was engaged in 35% of malnourished patients. Conclusion: Our study showed that clinico-biological indices are a good tool for the assessment of nutritional status and malnutrition’s complications in elderly patients.

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DEMOGRAPHICS, ACTIVITIES OF DAILY LIVING AND CARE NEEDS IN ELDERLY CHINESE VETERANS: BASELINE INFORMATION OF A CROSS-SECTIONAL SURVEY FOR NEUROLOGICAL DISEASES IN BEIJING MILITARY COMMUNITY

J.-P. Tan, J. Liu, L.-N. Wang, Y.-M. Zhao, H.-G. Xie, X. Zhang, W. Wang, Z.-F. Wang, J.-J. Jia, M.-W. Zhu

J Aging Res Clin Practice 2013;2(4):382-385

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Background: Objectice: In China, veterans form a special group who live in veterans’ communities, and facilitate research in elderly populations that include formerly underrepresented males and well-educated individuals. The aim of the paper was to analyze activities of daily living and care needs in elderly Chinese veterans living in Beijing. Design and Setting: A cross-sectional study with 44 veterans’ communities in Beijing for investigations. Participants: Veterans aged ≥60 years and lived in veterans’ community for more than 1 consecutive month. Measurements: We collected the information of demographics and past medical history and evaluated functional status and care needs. Functional status was evaluated by the Chinese version of activities of daily living (ADL) scale. Results: 95.8% of veterans were ≥70 years old, 30.8% were ≥80 years old and 94.4% were males. The proportions of veterans rated as dependent, by personal ADL (PADL) and instrumental ADL (IADL) were 24.7% and 34.6% respectively. Age was positively correlated with the proportions of PADL and IADL dependent veterans and veterans requiring care (24.1%). Spouses and housemaids were primary caregivers. 62.5% of veterans were empty nesters, who were less rated as IADL dependent than non-empty nesters. Conclusions: In our study, ADL dependent is associated with age and some neurological diseases, such as dementia, Parkinson’s disease, hemorrhagic stroke, ischemic stroke, insomnia. Therefore, it is necessary to perform a cross-sectional survey for neurological diseases in the setting of Beijing military community.

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RELATION BETWEEN HANDGRIP STRENGTH AND VITAMIN D IN COMMUNITY-DWELLING ELDERLY

S.A. Abdul-Rahman, H.M.F. Wahba, A.K. Mortagy

J Aging Res Clin Practice 2013;2(4):387-391

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Background: Grip strength is a predictor of morbidity, mortality and disability. Vitamin D deficiency is common in elderly and causes weakness in the proximal muscles. Objective: To assess the relationship between grip strength and vitamin D level in community-dwelling elderly. Design: Cross-sectional study. Setting: Outpatient clinic of Ain Shams University Hospitals. Participants: Community dwelling elderly who are 60 years old or more were included. Measurements: Correlate serum 25(OH)D level to grip strength (using Baseline® pneumatic squeeze handheld dynamometer). Results: Low vitamin D level is associated with decreased grip strength independent of age, sex, type of occupation and body mass index. Vitamin D, age and sex all significantly affect grip strength. Conclusion: Low vitamin D, advancing age and female sex are all associated with lower grip strength.

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EPIDEMIOLOGY, RISK FACTORS AND DURATION OF EXTENDED SPECTRUM BETA-LACTAMASE-PRODUCING ENTEROBACTERIACEAE CARRIAGE IN LONG-TERM-CARE FACILITIES

C. Vallet, T. Guillard, A. Debreuve-Theresette, L. Brasme, E. Tardieu, O. Bajolet, F. Munsch, E. Bertin, J. Madoux, F. Bureau-Chalot, C. de Champs

J Aging Res Clin Practice 2013;2(4):392-396

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Objectives: To check the long-term care facilities reputation as high risk of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) cross-transmission. To evaluate the prevalence, incidence, risk factors and colonization duration of ESBL-E anal carriage in long term care institution for elderly patients. Design: A six-month prospective longitudinal study. Setting: 120 bed long-term care facilities at a teaching hospital. Participants: 115 patients. Intervention: rectal swabs or stools specimen patients sampled at inclusion and then monthly for ESBL-E detection. Measurements: Participants’ characteristics (e. g. gender, age, Charlson index, functional activities), body mass index (BMI), nutritional parameters, feeding and meal management, C-Reactive Protein, serum albumin level, glycated haemoglobin. Results: Incidence density, prevalence and median duration of ESBL-E carriage were respectively 0.38 /1000 (95 % confidence interval 0.10-0.66) patient days, 4.4 % (95 % confidence interval 0.6-8.1) and 74 (interquartile range 26) days. The estimated probability of negativation was 59 % at 62 days. The main risk factors were male sex, stays in acute care unit during the survey and diet nature. Conclusion: Incidence density, prevalence, and rate of cross-transmission were low. Colonization duration could be linked to bacteria clonal characters.

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