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GENETIC VARIANTS RELATED TO LIPID METABOLISM AS A RISK FACTOR TO LATE-ONSET ALZHEIMER’S DISEASE

M.A.S. Pinhel, A.M. Crestani, G.F. Sousa-Amorim, M.L. Gregório, J.C. Cação, W.A. Tognola, D. Rossi Silva Souza

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Background: Genetic polymorphisms in genes regulating cholesterol metabolism have been suggested to risk factor of developing Alzheimer’s disease (AD). Objective: to analyze the frequency of polymorphisms apolipoprotein E (APOE-HhaI) and adenosine triphosphate binding cassette transporter 1 (ABCA1-StyI) in patients with late-onset AD. Design: case-control study. Participants: We studied 166 subjects (≥65 years old): Study Group (SG)- 88 patients and Control Group (CG)- 88 without dementia. Setting: The polymorphisms were determined using the polymorphism chain reaction and restriction fragment length polymorphism (PCR-RFLP) methods. It was applied Fisher's exact/chi-square tests (P<0.05). Results: Genotypes with APOE*4 prevailed in SG. The genotypic combination between APOE-HhaI and ABCA1-StyI polymorphisms showed a prevalence of heterozygous genotypes of risk for AD. Conclusion: Although genetic variants for ABCA1-StyI alone does not differentiate patients and controls, the G allele in synergy with APOE*4 allele is highlighted in patients suggesting the influence of ABCA1 in the disease.

CITATION:
M.A.S. Pinhel ; A.M. Crestani ; G.F. Sousa-Amorim ; M.L. Gregório ; J.C. Cação ; W.A. Tognola ; D. Rossi Silva Souza (2017): Genetic variants related to lipid metabolism as a risk factor to late-onset Alzheimer’s disease. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.3

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IDEAL REDUCTION OF CALORIES FOR GREATEST REDUCTION OF BODY FAT AND MAINTENANCE OF LEAN BODY MASS

M. Lombardo, R. Magarotto, F. Marinelli, E. Padua, M. Caprio, G. Annino, A. Bellia, F. Iellamo

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Objectives: This retrospective clinical study was intended to assess the ideal number of calories in the Mediterranean-style diet (MD) required for maximum weight reduction through a greater decrease in fat mass (FM) and maintenance of fat-free mass (FFM). Methods: We analysed the data of 90 non-smoking subjects (56 females, age = 32.5 ± 9.6 years, BMI = 28.3 ± 5.4 kg/m2, data as mean ± SD). The participants underwent two-month individualised MDs with similar macronutrient composition (55% carbohydrate, 30% fat, 15% protein and fibre > 30 g) but different amounts of energy, which varied daily from 374 kcal to 1305 kcal compared with the total energy expenditure measured by metabolic Holter. The sample was divided into nine groups of 10 subjects in order to establish the amount of energy restriction that was most effective in terms of achieving fat loss and maintaining muscle mass. Results: All subject groups had significant improvements in body composition parameters (weight loss = 2.7 ± 1.8 kg, FM loss = 2.2 ± 1.2 kg and FFM loss = 0.5 ± 1.3 kg). Differences between the nine groups were not significant but higher FM loss was observed in groups one, three, six and eight. Groups one and four had the highest FFM increase and groups two, three and eight had the highest FFM loss. Conclusions: These data suggest that increasing the amount of energy restriction in a low-calorie MD might be useless in terms of obtaining a higher FM loss but a lower restriction could be more effective for maintaining FFM.

CITATION:
M. Lombardo ; R. Magarotto ; F. Marinelli ; E. Padua ; M. Caprio ; G. Annino ; A. Bellia ; F. Iellamo (2017): Ideal reduction of calories for greatest reduction of body fat and maintenance of lean body mass. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.1

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EFFECT OF INCREASED DAILY INTAKE OF PROTEIN, COMBINED WITH A PROGRAM OF RESISTANCE EXERCISES, ON THE MUSCLE MASS AND PHYSICAL FUNCTION OF COMMUNITY-DWELLING ELDERLY WOMEN

H. Mori, Y. Tokuda

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Background: In elderly women, significant loss of muscle mass due to declining levels of estrogen secretion is a health concern. Increasing the recommended dietary allowance of protein intake has been included as a general health guideline to prevent age-related sarcopenia. Objectives: To investigate effects of light-to-moderate resistance training combined with increased protein intake on the muscle mass, strength, and physical function of community-dwelling elderly women. Design: The 12-week training program combined weight-bearing and resistance band exercises, performed 3 times per week. Setting: Hyogo Prefecture, in either City K or Town H. Practical Intervention: Women were randomly allocated to three groups: exercise with protein intake adjusted to the recommended daily allowance (RDA) of 1.0–1.1 g/kg body weight/day (MP+EX group); exercise with protein intake adjusted above the RDA level at 1.2–1.3 g/kg body weight/day (HP+EX group); and a control group receiving classroom-based session on nutrition management, with protein intake adjusted to the RDA level (MP group). Measurements: Body weight and physical composition were measured by multi-frequency bioelectrical impedance analysis. Results: Exercise prevented decreases in muscle mass and strength and in performance of physical function tasks (p<0.05). Increasing dietary intake of protein above RDA level increased muscle mass (p<0.01), walking speed (p<0.01) and knee extensor strength (p<0.05). Conclusion: Adjusting protein intake to 1.2–1.3 g/kg body weight/day, in combination with light-to-moderate resistance training, can improve body composition and physical function in elderly women. The result of this study could be effective in lowering the incidence of age-related sarcopenia.

CITATION:
H. Mori ; Y. Tokuda (2016): Effect of increased daily intake of protein, combined with a program of resistance exercises, on the muscle mass and physical function of community-dwelling elderly women. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.124

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JARCP N°01 - 2017

 

ANTIOXIDANT SUPPLEMENTS IN ALZHEIMER’S DEMENTIA AND MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW

E.J. Pegg

J Aging Res Clin Practice 2017;6:1-8

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Objective: Current treatments have only a modest effect on impairment in Alzheimer’s Dementia (AD) and there is no treatment currently licensed for Mild Cognitive Impairment (MCI). Oxidative stress is postulated to play a role in the pathogenesis of AD and MCI and this provides a rationale for treatment with antioxidant supplements. The aim of this review is to evaluate the effect of antioxidant supplements in people with AD and MCI. Methods: A systematic review of published randomised controlled trials was carried out. 4 electronic databases were searched. Studies were included if they compared the use of a placebo with the following antioxidant supplements in people with AD or MCI: Vitamin e, vitamin c, selenium, alpha lipoic acid, phenols, zinc, curcumin, beta carotene, coenzyme Q10, melatonin. The primary outcome measure was cognitive impairment. Secondary outcome measures included functional impairment, behavioural disturbance and safety. Results: 10 trials were identified which met the inclusion criteria. Outcome data was not suitable for meta-analysis. 5 studies reported a small positive treatment effect on cognition and 1 reported a negative effect. 2 reported a positive treatment effect on functional ability and 1 on behaviour. There were no consistent adverse effects found overall however two studies raised concern of possible worsening of cognition in certain circumstances. Conclusions: The findings of this systematic review do not support the use of antioxidant supplements to slow cognitive, functional or behavioural deterioration in people with AD or MCI. However the majority of included studies had a high or unknown risk of bias. In the one study which had a low overall risk of bias, there was evidence that antioxidant supplements may have a positive effect on functional decline in AD. The overall risk of harm associated with short term antioxidant supplementation appears to be low however caution is warranted. Further studies evaluating the role of oxidative stress in the pathogenesis of AD are suggested.

CITATION:
E.J. Pegg (2016): Antioxidant supplements in Alzheimer’s dementia and mild cognitive impairment: A systematic review. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.121

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KNOWLEDGE OF ALZHEIMER’S DISEASE AND TRAINING NEEDS IN FINAL YEAR MEDICAL AND PHARMACY STUDENTS

C. Scerri

J Aging Res Clin Practice 2017;6:9-13

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Although a significant number of medical and pharmacy professionals come into contact with an increasing number of individuals with Alzheimer’s disease and other dementias, there is concern on the lack of knowledge and skills received during their undergraduate training programmes with the consequence of not providing the required hospital and community care for these individuals following programme completion. The aim of this report is to describe the results of a small scale study investigating the level of knowledge of Alzheimer’s disease and training needs in medical and pharmacy students at the end of their final year of undergraduate training. The findings indicated a lack of in-depth knowledge for both categories of students, in particular on risk factors and pharmacotherapeutic management highlighting an urgent need of refining existent training programmes that equip future medical and pharmacy professionals with the necessary skills in providing adequate care and management for individuals with the disease.

CITATION:
C. Scerri (2016): Knowledge of Alzheimer’s disease and training needs in final year medical and pharmacy students. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.122

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HYDROGEN: THERAPEUTIC POTENTIAL IN WELLNESS AND MEDICINE

M. Lemaire, F. Barbier

J Aging Res Clin Practice 2017;6:14-22

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Persistent oxidative stress plays an important role in a variety of pathologies, and the search for an effective and well tolerated antioxidant agent continues. Molecular hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. The non-specific mechanism of hydrogen as a therapeutic antioxidant gives it broad therapeutic potential across a wide range of medical applications, as has been shown by a substantial volume of preclinical data, as well as a growing body of clinical evidence. This review provides an overview of the therapeutic potential of hydrogen, in ageing and wellness applications as well as medical applications, including acute ischemia/reperfusion injury, inflammation and ulceration, metabolic disorders, neurodegenerative disorders, and cancer (anti-cancer effects, radiation toxicities, and side effects of cisplatin) with an emphasis on clinical data. Overall, this review shows that hydrogen is an effective antioxidant, anti-inflammatory and cytoprotective agent.

CITATION:
M. Lemaire ; F. Barbier (2017): Hydrogen: therapeutic potential in wellness and medicine. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.2

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RELATIVE VALIDITY OF SHORT QUESTIONNAIRES TO ASSESS MEDITERRANEAN DIET OR LOW-FAT DIET ADHERENCE

K. Miura, T.R. Entwistle, J.E. Fildes, A.C. Green

J Aging Res Clin Practice 2017;6:23-27

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Background: Short diet questionnaires can quickly identify dietary habits with minimal burden for users but they require validation for use in specific populations. Objective: To assess relative validity against a food frequency questionnaire (FFQ) of two short questionnaires to assess a Mediterranean diet and a low-fat diet, respectively, among organ transplant recipients as a part of a pilot study. Design: Cross-sectional validation study. Setting: Heart or lung transplant recipients completed two short dietary questionnaires and a full semi-quantitative FFQ as the reference methods, on 3 separate days. Participants: Sixteen heart (n=8) or lung (n=8) transplant recipients aged 16 years or more, at least 6-months post-transplant and clinically stable patients in Manchester, UK. Measurements: Two short dietary questionnaires to assess their Mediterranean diet and low-fat diet and a semi-quantitative FFQ. Relative validity was assessed by comparing the scores derived from each short questionnaire with that of the FFQ. Agreement was assessed using the limits of agreement (LOA), and the agreement was expressed as a ratio of the score from the short dietary to the FFQ score with a ratio of 1.00 indicating perfect agreement. The agreement was formally tested by the two one-sided t-test procedure. Results: The mean agreement was 0.99 (95% LOA 0.60–1.38) for the Mediterranean and 1.04 (95% LOA 0.42–1.64) for the low-fat diet. The two one-sided t-test procedure showed the short questionnaires and the reference method were equivalent (Mediterranean diet overall p=0.004; low-fat diet overall p<0.001). Conclusions: Dietary habits to measure Mediterranean diet and a low-fat diet by short dietary questionnaires and full FFQ were comparable among organ transplant recipients.

CITATION:
K. Miura ; T.R. Entwistle ; J.E. Fildes ; A.C. Green (2017): Relative validity of short questionnaires to assess Mediterranean diet or low-fat diet adherence. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.4

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INTERVENTIONS FOR INDIVIDUALS WITH YOUNG-ONSET DEMENTIA. A REVIEW OF THE LITERATURE

M. Aplaon, P. Belchior, I. Gélinas, N. Bier, A. Aboujaoudé

J Aging Res Clin Practice 2017;6:28-31

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Objective: The aim of this study was to conduct a scoping review of the literature to investigate non-pharmacological interventions for individuals with young-onset dementia and examine their success. Methods: A comprehensive review of the literature was conducted. The following databases were included in our search: Ovid Medline, PsycINFO, Pubmed, CINHAL. Studies were retained if they were 1) peer-reviewed; 2) published in English; 3) focused on non-pharmacological interventions; 4)designed for persons with dementia; and 5) diagnosis before the age of 65. Results: A total of 7 articles met our inclusion criteria and were included in the study. Of those, four consisted in social programs involving the community as part of the intervention, two focused on a cognitive based intervention and one focused on a cognitive behavioral intervention. The social interventions were successful in improving the mood and well-being of participants as well as providing respite for caregivers. The cognitive interventions were successful in improving perceived functional outcomes and affective symptoms of participants. Discussion: A discussion of each intervention including their benefits for individuals with young-onset dementia and their caregivers is presented.

CITATION:
M. Aplaon ; P. Belchior ; I. Gélinas ; N. Bier ; A. Aboujaoudé (2016): Interventions for individuals with young-onset dementia. A review of the literature. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.123

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PSYCHOMETRIC PROPERTIES OF THE SUBJECTIVE-OBJECTIVE MALNUTRITION RISK ASSESSMENT (SOMRA) IN A STUDY OF SWEDISH PEOPLE AGED ? 60 YEARS

M. Naseer, C.Fagerström

J Aging Res Clin Practice 2017;6:32-39

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Objective: This study aimed to investigate the risk of malnutrition and to evaluate the psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA), SOMRA cut-offs and Swedish-Guidelines on Malnutrition Risk Assessment (SGMRA) for Swedish people aged ≥ 60 years. Setting: This study included both older people living at home and those in special housing. Participants: 1222 of the 1402 subjects aged ≥ 60 years who had participated in the baseline survey (2001–2003) as part of the ongoing National Study on Aging and Care-Blekinge (SNAC-B) were included because they had provided complete information on Mini-Nutritional Assessment (MNA). Measurements: The risk of malnutrition was estimated by the SOMRA, MNA, and SGMRA. To measure concurrent validity, the Receiver Operating Characteristics (ROC) curve, Cohen’s kappa (κ) and Spearman’s rank correlation coefficient rho (rs) were used. Youden’s index (J) was computed to assess the optimal cut-off on SOMRA. Cronbach’s alpha (α) was used to test reliability. Results: The risks of malnutrition measured by SOMRA, MNA and SGMRA were 6.5%, 8.6% and 20.9%, respectively. The risk was higher among older people living in special housing compared to those at home (p < 0.05). Different optimal cut-offs on SOMRA were observed for residents living at home (≥ 1) and those in special housing (≥ 3). Compared to SGMRA, the SOMRA and SOMRA cut-off ≥ 3 gave higher values for J (0.68, 0.81, and 0.84, respectively), κ (0.59, 0.77, and 0.84, respectively) and rs (0.64, 0.78, and 0.84, respectively) for the older people in special housing. The reliability for SOMRA was α = 0.71. Conclusion: The risk of malnutrition was higher among older people in special housing than among those living at home. For the people in special housing, the SOMRA and SOMRA cut-off ≥ 3 showed higher concurrent validity with MNA compared to the SGMRA, but not for older people living at home. SOMRA includes six items, takes less time to implement and is composed of both subjective and anthropometric measurements; therefore, it is suitable for use in special housing and/or clinical settings to identify the risk of malnutrition or the need for nutritional support.

CITATION:
M. Naseer ; C.Fagerström (2016): Psychometric Properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA) in a Study of Swedish People Aged ≥ 60 Years. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.125

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COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL

D. Zintchouk, T. Lauritzen, E.M. Damsgaard

J Aging Res Clin Practice 2017;6:40-47

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Objective: To investigate the effect of comprehensive geriatric care (CGC) in elderly referred to a rehabilitation unit. This article describes the considerations behind the study. Design: Participants were randomized to either CGC or standard care. Setting: Participants were recruited from two community care rehabilitation units in Aarhus Municipality, Denmark, in the period between 2012 and 2015. Participants: Inclusion: Elderly patients aged 65 and older admitted from home or hospital. Exclusion: Persons receiving palliative care or assessed by a geriatrician during the past month. Intervention: Medical history, physical examination, blood tests, medication adjustment and follow-up by a geriatrician. The control group received standard care with the general practitioners (GPs) as back-up. Outcomes: Primary outcome: Hospital contacts drawn from national registers. Secondary outcomes: GPs contacts, institutionalization, medication status and mortality collected from national registers, activities of daily living (ADL), physical and cognitive function and quality of life measures collected by a blinded occupational therapist. All outcomes were assessed at day 10, 30 and 90 after arrival at the rehabilitation unit. Conclusion: A new model of care for elderly referred to community rehabilitation was developed and implemented. The potential benefits of this model were compared with usual care in a community rehabilitation unit in a pragmatic randomized clinical trial. We hypothesized that the geriatrician-performed CGC in elderly referred to a rehabilitation unit will reduce the hospital contacts by 25 % without increase in mortality and in contacts to GPs and home care services. We expect that this model will prevent deterioration in ADL, physical and cognitive functioning, and reduce the risk of institutionalization. If the results are positive, community rehabilitation services should be encouraged to change their routines for treatment of this population accordingly.

CITATION:
D. Zintchouk ; T. Lauritzen ; E.M. Damsgaard (2016): COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.126

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FOLATE AND SYNTHETIC FOLIC ACID INTAKE, SERUM B VITAMIN AND HOMOCYSTEINE CONCENTRATIONS, AND COGNITIVE IMPAIRMENT IN ELDERLY BRAZILIANS

V. Ferri Ross Perucha, R. de Cássia de Aquino, N. Gaspareto, E.M. Guerra-Shinohara, P. Mendonça da Silva Amorim, V. d’Almeida

J Aging Res Clin Practice 2017;6:48-55

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Background: An increased risk of cognitive decline in the elderly with B12 deficiency has been associated with excessive synthetic folic acid in food fortification and supplements. Objectives: To assess the dietary folate and folic acid intake from food fortification, as well as serum vitamin B12, folate, iron, and homocysteine concentrations among the elderly and their relationships with cognitive changes. Design: Cross-sectional, observational study. Setting and Participants: Community-dwelling elderly (N = 40), predominantly female (90%), with an average age of 69 years. Measurements: Dietary intake information was collected using four 24-hour dietary recalls, adjusted for iron and folic acid in fortified flour and supplements. Serum vitamin B12, B6, folate, iron, and homocysteine concentrations were determined. Cognitive function was assessed using the Mini-Mental State Examination, adjusted for educational level. Results: Possible serum vitamin B12 deficiency (<258 pmol/L) was present in 5% of the elderly participants, while 27.5% had possible functional deficiency (<400 pmol/L). No serum folate deficiency (<6.8 nmol/L) was observed; however, 15% had possible deficiency (<13.6 nmol/L), and 7.5% had supraphysiological levels. Hyperhomocysteinemia (≥15 µmol/L) was present in 65% of the sample. Almost half of the participants (47.5%) showed cognitive impairment. There were no significant relationships between the Mini-Mental State Examination results and the B12, folate, iron, and homocysteine concentrations. However, the participants with serum vitamin B12 levels <400 pmol/L tended to have poorer Mini-Mental State Examination scores, which were related to older age (P = 0.045) and changes in the oral cavity (P = 0.034). In addition, folic acid consumption was inversely related with serum vitamin B12 levels (P = 0.030). Macrocytosis was not observed. Conclusions: Although Mini-Mental State Examination-assessed cognitive impairment was not related with the investigated biochemical variables, increased folic acid consumption seems to have a negative impact on vitamin B12 metabolism; therefore, fortification may be contributing to functional disability and masking hematological signs in the elderly.

CITATION:
V. Ferri Ross Perucha ; R. de Cássia de Aquino ; N. Gaspareto ; E.M. Guerra-Shinohara ; P. Mendonça da Silva Amorim ; V. d’Almeida (2017): Folate and synthetic folic acid intake, serum B vitamin and homocysteine concentrations, and cognitive impairment in elderly Brazilians. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.5

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