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Feng L, Wang Y, Zeng D, Wang M, Duan X. Predictors of cognitive decline in older individuals without dementia: An updated meta-analysis. Ann Clin Transl Neurol 2023; 10:497-506. [PMID: 36705073 PMCID: PMC10109353 DOI: 10.1002/acn3.51740] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effect of overall peripheral inflammatory levels on cognitive function, we explored the relationship between established biomarkers of peripheral inflammation (circulating C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) and cognitive decline by performing a review of observational studies and creating an updated summary. METHODS We included literatures exploring the relationship between peripheral levels of CRP, IL-6, and TNF-α and subsequent cognitive decline, published until July 2022, by searching the following databases: PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials, CNKI, and VIP databases. We used random-effects models to pool the odds ratios (ORs) for the risks of subsequent cognitive decline in older adults with high levels of peripheral inflammation. We initially screened out 501 literatures, of which only 17 were ultimately eligible. Overall, there were 19,516 older individuals included in our meta-analysis, and 2134 of them experienced subsequent cognitive change. RESULTS Individuals with high levels of peripheral inflammation may have 14% more chance to develop subsequent cognitive decline than those with low levels (OR = 1.14, 95% CI: 1.03-1.27; p < 0.00001). In the subgroup analysis, the incidence of cognitive decline was higher in individuals with high levels of IL-6. This study further demonstrates the link between systemic inflammation and cognitive status. INTERPRETATION Detecting CRP, IL-6, and TNF-α in peripheral blood is necessary, as they may become effective indicators for forthcoming cognitive performance.
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Affiliation(s)
- Lan Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Yuhao Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Daojun Zeng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Maohua Wang
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
| | - Xiaoxia Duan
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China.,Department of Anesthesiology, Southwest Medical University, Luzhou, China
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2
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De Luca R, Maggio MG, Leonardi S, Marra A, Casella C, Calabrò RS. Is psychosocial rehabilitation useful in older people living in nursing homes? A pilot study on long-term cognitive and behavioural outcomes. Psychogeriatrics 2022; 22:180-186. [PMID: 34894028 DOI: 10.1111/psyg.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/20/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Age-related changes in cognitive and behavioural functions, although common, may vary considerably across individuals and cognitive domains. There is limited evidence focusing on the benefits of training based on cognitive/social learning principles in the elderly. The aim of this study is to investigate the effects of Assertive Social Skill Training (ASST) in improving cognitive and mood outcomes in a sample of older patients living in a Sicilian nursing home. METHODS Forty-seven older subjects were enrolled in this case-control study. Each participant was evaluated by a neuropsychologist, through the administration of a short psychometric battery using the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Geriatric Depression Scale (GDS), at three time points: before (T0), immediately following (T1), and 6 months after the end of the training (T2). Both groups received cognitive behavioural therapy and psychological support, but the experimental group received the ASST protocol (60 sessions, five times a week, for 12 weeks, each session lasting about 60 min), whilst the control group participated in group meetings with recreational activities. RESULTS Post-hoc analysis showed that only patients receiving ASST presented a statistically significant improvement in global cognitive functions (MMSE: P < 0.001), frontal abilities (FAB: P < 0.001), and mood (GDS: P < 0.001); these positive outcomes were maintained at T2. CONCLUSIONS Promising treatments, like the ASST, aimed at potentiating cognitive, behavioural, and social skills, are needed to improve older people's quality of life, especially when they live in nursing homes.
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Affiliation(s)
| | | | | | - Angela Marra
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Carmela Casella
- Department of Neuroscience, AOU Policlinico G. Martino, Messina, Italy
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Lozupone M, D'Urso F, Copetti M, Sardone R, Arcuti S, Castellana F, Galizia I, Lofano L, Veneziani F, Piccininni C, Barulli MR, Grasso A, Battista P, Tortelli R, Capozzo R, Griseta C, Doricchi F, Quaranta N, Resta E, Daniele A, Seripa D, Solfrizzi V, Bellomo A, Logroscino G, Panza F. The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy. Psychiatry Res 2022; 308:114346. [PMID: 34953202 DOI: 10.1016/j.psychres.2021.114346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Abstract
The prevalence of late-life depression (LLD) depends on the study sample, measurements, and diagnostic approaches. We estimated the 30 item-Geriatric Depression Scale (GDS-30) accuracy against the gold standard LLD diagnosis made with the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, focusing on the prevalence of a late-life major depressive disorder (MDD), in a population-based sample of 843 subjects aged>65 years, subdivided into three groups: normal cognition, subjective memory complaints, and mild cognitive impairment. At the optimal cut-off score (≥4), the GDS-30 showed 65.1% sensitivity and 68.4% specificity for LLD (63% and 66% for late-life MDD, respectively). Using the standard cut-off score (≥10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, indicating a lower screening accuracy [area under the curve(AUC):0.728, 95% confidence interval(CI):0.67-0-78]. The GDS-30 performance was associated with educational level, but not with age, gender, cognition, apathy, and somatic/psychiatric multimorbidity. For subjective memory complaints subjects, at the optimal cut-off score (≥7), the GDS-30 showed better discrimination performances (AUC=0.792,95%CI:0.60-0.98), but again the educational level affected the diagnostic performance. In subjective memory complaints subjects, symptom-based scales like the GDS-30 may feature a better performance for diagnosing depression in older age, but the GDS-30 seems to require adjustment to the patient's educational level.
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Affiliation(s)
- Madia Lozupone
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy; Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.
| | - Francesca D'Urso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimiliano Copetti
- Biostatistics Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Rodolfo Sardone
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | - Simona Arcuti
- Biostatistics Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Fabio Castellana
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | - Ilaria Galizia
- Psychiatric Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Lofano
- Psychiatric Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Federica Veneziani
- Psychiatric Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Carla Piccininni
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Rosaria Barulli
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Alessandra Grasso
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | | | - Rosanna Tortelli
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Rosa Capozzo
- Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy
| | - Chiara Griseta
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | - Fabrizio Doricchi
- Global Brain Health Institute, University of California, San Francisco, USA
| | - Nicola Quaranta
- Otolaryngology Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Emanuela Resta
- Translational Medicine & Management of Health Systems, University of Foggia, Foggia, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Davide Seripa
- Geriatric Unit, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy; Hematology and Stem Cell Transplant Unit, Vito Fazzi Hospital, ASL Lecce, Lecce, Italy
| | - Vincenzo Solfrizzi
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy; Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy.
| | - Francesco Panza
- Population Health Unit - "Salus in Apulia Study", National Institute of Gastroenterology and Research Hospital IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy; Dipartimento di Psicologia, Sapienza University of Rome, Rome, Italy; Laboratorio di Neuropsicologia dell'Attenzione, Fondazione Santa Lucia IRCCS, Neurorehabilitation Hospital, Rome, Italy.
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Ferreira SA, Stein AM, Stavinski NGDL, Teixeira DDC, Queiroga MR, Bonini JS. Different types of physical exercise in brain activity of older adults: A systematic review. Exp Gerontol 2021; 159:111672. [PMID: 34958870 DOI: 10.1016/j.exger.2021.111672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND To verify the effects of different modalities of physical exercise on brain activity of older adults. METHODS Systematic searches were conducted according to the PICOS strategy and the following databases were searched: PubMed, Web of Science, PsycInfo and Scielo. Two independent evaluators performed the initial selection from reading the title and abstract based on the stipulated eligibility criteria. RESULTS The searches resulted in 1935 titles, of which 97 were duplicated and 1793 were excluded based on reading the titles and abstracts. This phase resulted in 45 articles for detailed analysis. At this stage, 35 articles were excluded because they did not meet the eligibility criteria. The information for qualitative analysis was extracted from 10 articles that met the criteria. CONCLUSION There was improvement in the brain activity of older adults regardless of the type of physical exercise performed (aerobic, neuromuscular, flexibility or neuromotor), but with a discrete advantage for balance and coordination exercises (neuromotor).
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Affiliation(s)
- Sandra Aires Ferreira
- Department of Physical Education, Midwestern Parana State University (UNICENTRO), Guarapuava, Brazil.
| | - Angelica Miki Stein
- Department of Physical Education, Midwestern Parana State University (UNICENTRO), Guarapuava, Brazil; The Human Performance Research Group, Technological Federal University of Paraná (UTFPR), Curitiba, Brazil
| | - Natã Gomes de Lima Stavinski
- Metabolism, Nutrition, and Exercise Laboratory, Physical Education and Sports Center (UEL), State University of Londrina, Londrina, Brazil
| | | | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Parana State University (UNICENTRO), Guarapuava, Brazil; Associated Graduate Program in Physical Education UEM/UEL, Londrina, Brazil
| | - Juliana Sartori Bonini
- Department of Pharmacy, Midwestern Parana State University (UNICENTRO), Guarapuava, Brazil
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De Luca R, Torrisi M, Bramanti A, Maggio MG, Anchesi S, Andaloro A, Caliri S, De Cola MC, Calabrò RS. A multidisciplinary Telehealth approach for community dwelling older adults. Geriatr Nurs 2021; 42:635-642. [PMID: 33823421 DOI: 10.1016/j.gerinurse.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/03/2023]
Abstract
Telemedicine may be used for the continuity of care in several chronic conditions. Sixty frail old people were enrolled along with their primary caregivers, and randomly divided into two groups: 30 of them received a multi-specialist telemedicine care, whilst the other 30 were treated in their usual territory care. All of the patients were evaluated through a clinical and psychometric battery at baseline (T0), after 6 months (T1), and at the end of the study (T2). It was found that telemedicine was more effective than the traditional approach in mood improvement (p < 0.001), behaviour (p < 0.01) and ADL/IADL (p < 0.01/0.04), as well as nutritional status. These changes increased over time (from T0 to T1), the caregivers' burden decreased, and system usability was rated as good. Telemedicine could be considered an important tool to improve the psychological health and quality of the life of older frail patients living at home.
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Affiliation(s)
- Rosaria De Luca
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Michele Torrisi
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Alessia Bramanti
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Maria Grazia Maggio
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Smeralda Anchesi
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Adriana Andaloro
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Santina Caliri
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Maria Cristina De Cola
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy
| | - Rocco Salvatore Calabrò
- Rocco Salvatore Calabrò, IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124 Messina, Italy.
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6
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Zuliani G, Polastri M, Romagnoli T, Marabini L, Seripa D, Cervellati C, Zurlo A, Passaro A, Brombo G. Clinical and demographic parameters predict the progression from mild cognitive impairment to dementia in elderly patients. Aging Clin Exp Res 2020; 33:1895-1902. [PMID: 32918697 PMCID: PMC8249246 DOI: 10.1007/s40520-020-01697-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the possibility of predicting the risk of progression from mild cognitive impairment (MCI) to dementia using a combination of clinical/demographic parameters. METHODS A total of 462 MCI elderly patients (follow-up: 33 months). Variable measured included cognitive functions, age, gender, MCI type, education, comorbidities, clinical chemistry, and functional status. RESULTS Amnestic type (aMCI) represented 63% of the sample, non-amnestic (naMCI) 37%; 190 subjects progressed to dementia, 49% among aMCI, and 28% among naMCI. At Cox multivariate regression analysis, only MMSE (one point increase HR 0.84; 95% CI 0.79-0.90), aMCI (HR 2.35; 95% CI 1.39-3.98), and age (1 year increase HR 1.05; 95% CI 1.01-1.10) were independently associated with progression to dementia. A score was created based on these dichotomized variables (score 0-3): age (≥ or < 78 years), MMSE score (≥ or < 25/30) and aMCI type. The conversion rate progressed from 6% in subjects with score 0 (negative predictive value: 0.94), to 31% in individuals with score 1, to 53% in subjects with score 2, to 72% in individuals with score 3 (positive predictive value: 0.72). ROC curve analysis showed an area under the curve of 0.72 (95% CI 0.66-0.75, p 0.0001). CONCLUSIONS We have described a simple score, based on previously recognized predictors such as age, MMSE, and MCI type, which may be useful for an initial stratification of the risk of progression to dementia in patients affected by MCI. The score might help the clinicians to evaluate the need for more expansive/invasive examinations and for a closer follow-up in MCI patients.
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Affiliation(s)
- Giovanni Zuliani
- Department of Morphology, Surgery, and Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, 44100, Ferrara, Italy.
| | - Michele Polastri
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Tommaso Romagnoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Lisa Marabini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide Seripa
- Research Laboratory, Complex Structure of Geriatrics, Department of Medical Sciences, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - Carlo Cervellati
- Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Amedeo Zurlo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Gloria Brombo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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McCaskey MA, Schättin A, Martin-Niedecken AL, de Bruin ED. Making More of IT: Enabling Intensive Motor Cognitive Rehabilitation Exercises in Geriatrics Using Information Technology Solutions. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4856146. [PMID: 30581853 PMCID: PMC6276519 DOI: 10.1155/2018/4856146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/08/2018] [Indexed: 12/22/2022]
Abstract
Although the health benefits of physical activity and exercise for older people are well established, a largely sedentary lifestyle still prevails in ageing western societies. Finding new ways to make exercise more accessible and acceptable for older adults must be developed to fully unleash its potential in preventing and weakening age-related physical and cognitive decline. Existing barriers to implement effective exercise-based treatment plans include motivational reservations on both the clinician's and patient's side, but also physical limitations caused by disease or deconditioning. Particularly in the more senior population, debilitating conditions do not allow adherence to currently recommended exercise regimes. A major rethinking of age- and user-adapted exercise is overdue. The high intensities required for physical and mental adaptations must be modifiable and personalized according to the functional status of each patient. Emerging information and communication technologies (ICT) have brought forward a plethora of attractive solutions for smart and adapted exercise, but there remains a vast gap between technological advancement and clinical relevance. Where in the beginning ICT for active ageing mainly focussed on aspects of usability and user experience, the current status of IT as applied in ageing populations noticeably shifted toward new services, applications, and devices that can be offered with the aim to prevent, compensate, care, and/or enhance daily life functioning of senior citizens. In this perspective paper, we aim to summarize the current state of the art in ICT-based interventions aimed at improved motor-cognitive control and make suggestions about how these could be combined with high-intensive interval exercise regimes to make rehabilitation for the impaired older adults more effective, and more fun.
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Affiliation(s)
- M. A. McCaskey
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Health Sciences and Technology, The Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - A. Schättin
- Department of Health Sciences and Technology, The Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - A. L. Martin-Niedecken
- Department of Design, Subject Area Game Design, Zurich University of the Arts, Zurich, Switzerland
| | - E. D. de Bruin
- Department of Health Sciences and Technology, The Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
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Guercio GD, Panizzutti R. Potential and Challenges for the Clinical Use of d-Serine As a Cognitive Enhancer. Front Psychiatry 2018; 9:14. [PMID: 29459833 PMCID: PMC5807334 DOI: 10.3389/fpsyt.2018.00014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/17/2018] [Indexed: 12/16/2022] Open
Abstract
After 25 years of its discovery in the rat brain, d-serine is a recognized modulator of synaptic plasticity and cognitive processes through its actions on the NMDA-glutamate receptor. Importantly, cognitive impairment is a core feature of conditions, such as schizophrenia, Alzheimer's disease, depression, and aging, and is associated to disturbances in NMDA-glutamate receptors. The d-serine pathway has been associated with cognitive deficits and these conditions, and, for this reason, d-serine signaling is subject of intense research to probe its role in aiding diagnosis and therapy. Nevertheless, this has not resulted in new therapies being incorporated into clinical practice. Therefore, in this review we will address many questions that need to be solved by future studies, regarding d-serine pharmacokinetics, possible side effects, other strategies to modulate its levels, and combination with other therapies to increase its efficacy.
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Affiliation(s)
- Gerson D. Guercio
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rogerio Panizzutti
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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9
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Bradburn S, Sarginson J, Murgatroyd CA. Association of Peripheral Interleukin-6 with Global Cognitive Decline in Non-demented Adults: A Meta-Analysis of Prospective Studies. Front Aging Neurosci 2018; 9:438. [PMID: 29358917 PMCID: PMC5766662 DOI: 10.3389/fnagi.2017.00438] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/19/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Elevated biomarkers of systemic inflammation have been reported in individuals with cognitive decline, however, most of the literature concerns cross-sectional analyses that have produced mixed results. This study investigates the etiology of this association by performing meta-analyses on prospective studies investigating the relationship between baseline interleukin-6 (IL-6), an established marker of peripheral inflammation, with cognitive decline risk in non-demented adults at follow-up. Methods: We reviewed studies reporting peripheral IL-6 with future cognitive decline, up to February 2017 by searching the PubMed, Science Direct, Scopus and Google Scholar databases. Studies which contained odds ratios (ORs) for the association between circulating baseline IL-6 and longitudinal cognitive performance in non-demented community dwelling older adults were pooled in random-effects models. Results: The literature search retrieved 5,642 potential articles, of which 7 articles containing 8 independent aging cohorts were eligible for review. Collectively, these studies included 15,828 participants at baseline. Those with high circulating IL-6 were 1.42 times more likely to experience global cognitive decline at follow-up, over a 2–7-year period, compared to those with low IL-6 (OR 1.42, 95% CI 1.18–1.70; p < 0.001). Subgroup and sensitivity analyses suggests that this association is independent of the study sample size, duration of follow-up and cognitive assessments used. Conclusions: These results add further evidence for the association between high peripheral inflammation, as measured by blood IL-6, and global cognitive decline. Measuring circulating IL-6 may be a useful indication for future cognitive health.
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Affiliation(s)
- Steven Bradburn
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jane Sarginson
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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10
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Knols RH, Swanenburg J, De Bon D, Gennaro F, Wolf M, Krüger B, Bettex D, de Bruin ED. Investigating the Usability and Acute Effects of a Bedside Video Console to Prefrontal Cortical Activity Alterations: A Preclinical Study in Healthy Elderly. Front Syst Neurosci 2017; 11:85. [PMID: 29234277 PMCID: PMC5712300 DOI: 10.3389/fnsys.2017.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022] Open
Abstract
Elderly people at risk of developing cognitive decline; e.g., following surgery, may benefit from structured, challenging, and repetitive cognitive video training. This study assessed usability and acute effects of a newly developed bedside console (COPHYCON). Fifteen healthy elderly individuals performed a one-time 80-min intervention, including cognitive video games aimed at improving awareness and selective attention. Perceived usefulness and perceived ease of use (Technology Acceptance Model) were assessed together with measures of the achieved game level, reaction times, (in-) correct responses during ALERT and SELECT game play. Further, prefrontal cortical involvement of the regional cerebral hemoglobin saturation (rS02%) assessed with functional near infrared spectroscopy (fNIRS) (n = 5) and EEG power (n = 10) was analyzed. All participants completed the study without any adverse events. Perceived usefulness and perceived ease of use (TAM scores range 1-7) of the system varied between 3.9 and 6.3. The game levels reached for awareness varied between 9 and 11 (initial score 8-10), for reaction speed between 439 and 469 ms, and for correct responses between 74.1 and 78.8%. The highest level for the selective attention games was 2 (initial score 1), where reaction speed varied between 439 and 469 ms, correct responses between 96.2 and 98.5%, respectively. The decrease of rS02% in the right prefrontal cortex during gameplay was significantly (p < 0.001) lower, compared to the left prefrontal cortex. Four participants yielded significant lower rS02% measures after exergaming with the ALERT games (p < 0.000), but not with the SELECT games. EEG recordings of theta power significantly decreased in the averaged ~0.25-0.75 time interval for the left prefrontal cortex sensor across the cognitive game levels between the ALERT 1 and SELECT 1, as well as between SELECT 1 and 2 games. Participants rated the usability of the COPHYCON training positively. Further results indicate that video gaming may be an effective measure to affect prefrontal cortical functioning in elderly. The results warrant a clinical explorative study investigating the feasibility of the COPHYCON in a clinical setting.
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Affiliation(s)
- Ruud H. Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Jaap Swanenburg
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital, University of Zürich, Zurich, Switzerland
| | - Dino De Bon
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Federico Gennaro
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Krüger
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
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De Luca R, Bramanti A, De Cola MC, Trifiletti A, Tomasello P, Torrisi M, Reitano S, Leo A, Bramanti P, Calabrò RS. Tele-health-care in the elderly living in nursing home: the first Sicilian multimodal approach. Aging Clin Exp Res 2016; 28:753-9. [PMID: 26420423 DOI: 10.1007/s40520-015-0463-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The continued aging of the population is affecting the health of the industrialized countries, with an increasing burden for the healthcare system. Thus, during the last decade, we assisted to relevant progress in the medical treatment and rehabilitation techniques and devices, including the development of telemedicine for geriatric care. AIM To demonstrate the effectiveness of a novel tele-health-care model allowing a better management of elderly living in nursing homes. METHODS Fifty-nine elderly patients (19 males and 40 females; mean age 79.1 (±9.2), were randomly divided into two groups: the experimental group that performed a proper telemonitoring with a multimodal approach (including monitoring of the vital signs and neurological/psychological counseling), and the control group, which underwent standard in-home nursing care. Neurobehavioral symptoms and quality of life were assessed in both the groups at baseline, and after the telecare protocol's end. RESULTS The experimental group had a statistically significant reduction in Geriatric Depression Scale (p < 0.01) and Brief Psychiatric Rating Scale (p < 0.05) scores, and an improvement in their quality of life. Moreover, mean blood pressure and heart rate were lower in the experimental than in the control group (p < 0.05), and admission to health care services was higher in the control than in the experimental group (p < 0.05). CONCLUSIONS Telemedicine can be considered as an important tool in improving health and quality of life in the elderly living in nursing homes, and potentially reducing healthcare service access, hospitalization, and costs.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Maria Cristina De Cola
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonino Trifiletti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Provvidenza Tomasello
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Michele Torrisi
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Simone Reitano
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy
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12
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Schättin A, Baur K, Stutz J, Wolf P, de Bruin ED. Effects of Physical Exercise Combined with Nutritional Supplements on Aging Brain Related Structures and Functions: A Systematic Review. Front Aging Neurosci 2016; 8:161. [PMID: 27458371 PMCID: PMC4933713 DOI: 10.3389/fnagi.2016.00161] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/20/2016] [Indexed: 01/12/2023] Open
Abstract
Age-related decline in gray and white brain matter goes together with cognitive depletion. To influence cognitive functioning in elderly, several types of physical exercise and nutritional intervention have been performed. This paper systematically reviews the potential additive and complementary effects of nutrition/nutritional supplements and physical exercise on cognition. The search strategy was developed for EMBASE, Medline, PubMed, Cochrane, CINAHL, and PsycInfo databases and focused on the research question: “Is the combination of physical exercise with nutrition/nutritional supplementation more effective than nutrition/nutritional supplementation or physical exercise alone in effecting on brain structure, metabolism, and/or function?” Both mammalian and human studies were included. In humans, randomized controlled trials that evaluated the effects of nutrition/nutritional supplements and physical exercise on cognitive functioning and associated parameters in healthy elderly (>65 years) were included. The systematic search included English and German language literature without any limitation of publication date. The search strategy yielded a total of 3129 references of which 67 studies met the inclusion criteria; 43 human and 24 mammalian, mainly rodent, studies. Three out of 43 human studies investigated a nutrition/physical exercise combination and reported no additive effects. In rodent studies, additive effects were found for docosahexaenoic acid supplementation when combined with physical exercise. Although feasible combinations of physical exercise/nutritional supplements are available for influencing the brain, only a few studies evaluated which possible combinations of nutrition/nutritional supplementation and physical exercise might have an effect on brain structure, metabolism and/or function. The reason for no clear effects of combinatory approaches in humans might be explained by the misfit between the combinations of nutritional methods with the physical interventions in the sense that they were not selected on sharing of similar neuronal mechanisms. Based on the results from this systematic review, future human studies should focus on the combined effect of docosahexaenoic acid supplementation and physical exercise that contains elements of (motor) learning.
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Affiliation(s)
- Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich) Zurich, Switzerland
| | - Kilian Baur
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH Zurich) Zurich, Switzerland
| | - Jan Stutz
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich) Zurich, Switzerland
| | - Peter Wolf
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH Zurich) Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich) Zurich, Switzerland
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13
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Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment. World Neurosurg 2016; 90:348-356. [DOI: 10.1016/j.wneu.2016.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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Eggenberger P, Wolf M, Schumann M, de Bruin ED. Exergame and Balance Training Modulate Prefrontal Brain Activity during Walking and Enhance Executive Function in Older Adults. Front Aging Neurosci 2016; 8:66. [PMID: 27148041 PMCID: PMC4828439 DOI: 10.3389/fnagi.2016.00066] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/21/2016] [Indexed: 11/13/2022] Open
Abstract
Different types of exercise training have the potential to induce structural and functional brain plasticity in the elderly. Thereby, functional brain adaptations were observed during cognitive tasks in functional magnetic resonance imaging studies that correlated with improved cognitive performance. This study aimed to investigate if exercise training induces functional brain plasticity during challenging treadmill walking and elicits associated changes in cognitive executive functions. Forty-two elderly participants were recruited and randomly assigned to either interactive cognitive-motor video game dancing (DANCE) or balance and stretching training (BALANCE). The 8-week intervention included three sessions of 30 min per week and was completed by 33 participants (mean age 74.9 ± 6.9 years). Prefrontal cortex (PFC) activity during preferred and fast walking speed on a treadmill was assessed applying functional near infrared spectroscopy pre- and post-intervention. Additionally, executive functions comprising shifting, inhibition, and working memory were assessed. The results showed that both interventions significantly reduced left and right hemispheric PFC oxygenation during the acceleration of walking (p < 0.05 or trend, r = 0.25-0.36), while DANCE showed a larger reduction at the end of the 30-s walking task compared to BALANCE in the left PFC [F (1, 31) = 3.54, p = 0.035, r = 0.32]. These exercise training induced modulations in PFC oxygenation correlated with improved executive functions (p < 0.05 or trend, r = 0.31-0.50). The observed reductions in PFC activity may release cognitive resources to focus attention on other processes while walking, which could be relevant to improve mobility and falls prevention in the elderly. This study provides a deeper understanding of the associations between exercise training, brain function during walking, and cognition in older adults.
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Affiliation(s)
- Patrick Eggenberger
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich Zurich, Switzerland
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Department of Neonatology, University Hospital Zurich Zurich, Switzerland
| | - Martina Schumann
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich Zurich, Switzerland
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH ZurichZurich, Switzerland; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht UniversityMaastricht, Netherlands; Centre for Evidence Based Physiotherapy, Maastricht UniversityMaastricht, Netherlands
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15
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Martocchia A, Stefanelli M, Falaschi GM, Toussan L, Ferri C, Falaschi P. Recent advances in the role of cortisol and metabolic syndrome in age-related degenerative diseases. Aging Clin Exp Res 2016; 28:17-23. [PMID: 25813987 DOI: 10.1007/s40520-015-0353-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 03/13/2015] [Indexed: 12/28/2022]
Abstract
The metabolic syndrome (MetS) presents an increasing prevalence in elderly people. A significant role in MetS is played by the stress response and cortisol. The hypothalamic-pituitary-adrenal (HPA) axis activity is increased by central (loss of hippocampal glucocorticoid receptors) and peripheral (11β-hydroxysteroid dehydrogenase type 1, 11β-HSD1, hyperactivity) mechanisms. The HPA hyperactivity has been found in chronic diseases affecting the endocrine (abdominal obesity with MetS, type 2 diabetes), cardiovascular (atherosclerosis, essential hypertension), and nervous systems (dementia, depression), in aging. A novel therapeutic approach (11β-HSD1 inhibition) is promising in treating the HPA axis hyperactivity in chronic diseases with MetS. A large-scale national clinical trial (AGICO, AGIng, and COrtisol study) has been proposed by our group to evaluate the role of cortisol and MetS in the main pathologies of aging (vascular and degenerative dementia, cardiovascular diseases, type 2 diabetes, abdominal obesity).
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Affiliation(s)
- Antonio Martocchia
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa 1035, 00199, Rome, Italy.
| | - Manuela Stefanelli
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa 1035, 00199, Rome, Italy
| | - Giulia Maria Falaschi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale S. Salvatore, Delta 6 Building, Coppito, 67100, L'Aquila, Italy
| | - Lavinia Toussan
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa 1035, 00199, Rome, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Viale S. Salvatore, Delta 6 Building, Coppito, 67100, L'Aquila, Italy
| | - Paolo Falaschi
- Geriatric Unit, Faculty of Medicine and Psychology, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa 1035, 00199, Rome, Italy.
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16
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Eggenberger P, Schumacher V, Angst M, Theill N, de Bruin ED. Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up. Clin Interv Aging 2015; 10:1335-49. [PMID: 26316729 PMCID: PMC4544626 DOI: 10.2147/cia.s87732] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Cognitive impairment is a health problem that concerns almost every second elderly person. Physical and cognitive training have differential positive effects on cognition, but have been rarely applied in combination. This study evaluates synergistic effects of multicomponent physical exercise complemented with novel simultaneous cognitive training on cognition in older adults. We hypothesized that simultaneous cognitive–physical components would add training specific cognitive benefits compared to exclusively physical training. Methods Seniors, older than 70 years, without cognitive impairment, were randomly assigned to either: 1) virtual reality video game dancing (DANCE), 2) treadmill walking with simultaneous verbal memory training (MEMORY), or 3) treadmill walking (PHYS). Each program was complemented with strength and balance exercises. Two 1-hour training sessions per week over 6 months were applied. Cognitive performance was assessed at baseline, after 3 and 6 months, and at 1-year follow-up. Multiple regression analyses with planned comparisons were calculated. Results Eighty-nine participants were randomized to the three groups initially, 71 completed the training, while 47 were available at 1-year follow-up. Advantages of the simultaneous cognitive–physical programs were found in two dimensions of executive function. “Shifting attention” showed a time×intervention interaction in favor of DANCE/MEMORY versus PHYS (F[2, 68] =1.95, trend P=0.075, r=0.17); and “working memory” showed a time×intervention interaction in favor of DANCE versus MEMORY (F[1, 136] =2.71, trend P=0.051, R2=0.006). Performance improvements in executive functions, long-term visual memory (episodic memory), and processing speed were maintained at follow-up in all groups. Conclusion Particular executive functions benefit from simultaneous cognitive–physical training compared to exclusively physical multicomponent training. Cognitive–physical training programs may counteract widespread cognitive impairments in the elderly.
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Affiliation(s)
- Patrick Eggenberger
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Vera Schumacher
- Department of Gerontopsychology and Gerontology, University of Zurich, Zurich, Switzerland ; University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Marius Angst
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Nathan Theill
- Division of Psychiatry Research, University of Zurich, Schlieren, Switzerland ; Center for Gerontology, University of Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Switzerland ; CAPHRI School for Public Health and Primary Care, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands ; Centre for Evidence Based Physiotherapy, Maastricht University, Maastricht, the Netherlands
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17
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Broggi M, Romito L, Redaelli V, Franzini A. Normal Pressure Hydrocephalus and Parkinsonism: The Essential Teamwork Between the Neurosurgeon and the Neurologist. World Neurosurg 2014; 82:e837-8. [DOI: 10.1016/j.wneu.2014.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
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Hippocampal atrophy in people with memory deficits: results from the population-based IPREA study. Int Psychogeriatr 2014; 26:1067-81. [PMID: 24524645 DOI: 10.1017/s1041610213002627] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clinical studies have shown that hippocampal atrophy is present before dementia in people with memory deficits and can predict dementia development. The question remains whether this association holds in the general population. This is of interest for the possible use of hippocampal atrophy to screen population for preventive interventions. The aim of this study was to assess hippocampal volume and shape abnormalities in elderly adults with memory deficits in a cross-sectional population-based study. METHODS We included individuals participating in the Italian Project on the Epidemiology of Alzheimer Disease (IPREA) study: 75 cognitively normal individuals (HC), 31 individuals with memory deficits (MEM), and 31 individuals with memory deficits not otherwise specified (MEMnos). Hippocampal volumes and shape were extracted through manual tracing and the growing and adaptive meshes (GAMEs) shape-modeling algorithm. We investigated between-group differences in hippocampal volume and shape, and correlations with memory deficits. RESULTS In MEM participants, hippocampal volumes were significantly smaller than in HC and were mildly associated with worse memory scores. Memory-associated shape changes mapped to the anterior hippocampus. Shape-based analysis detected no significant difference between MEM and HC, while MEMnos showed shape changes in the posterior hippocampus compared with HC and MEM groups. CONCLUSIONS These findings support the discriminant validity of hippocampal volumetry as a biomarker of memory impairment in the general population. The detection of shape changes in MEMnos but not in MEM participants suggests that shape-based biomarkers might lack sensitivity to detect Alzheimer's-like pathology in the general population.
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Terranova C, Cardin F, Pietra LD, Zen M, Bruttocao A, Militello C. Ethical and medico-legal implications of capacity of patients in geriatric surgery. MEDICINE, SCIENCE, AND THE LAW 2013; 53:166-171. [PMID: 23842478 DOI: 10.1177/0025802412473963] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aim of this study was to assess the decision-making capacity of elderly patients hospitalized in a geriatric surgery division, and the clinician's ability to assess that capacity. SUBJECTS AND METHODS The study was conducted on patients (aged >66 years) undergoing surgical procedures. Exclusion criteria were a diagnosis of psychogeriatric disorders interfering with decision-making capacity; hearing or visual impairment; and inability to communicate. Patients previously declared legally incompetent were also excluded. The methodological approach consisted of additional interviews to collect data on patients' awareness of the reasons for their hospitalization, their informed consent, and their ability to sign a consent form. The interview was integrated with a clinical-behavioral assessment by means of the Mini-Mental State Examination and the Clock Drawing Test. Data were collected anonymously. RESULTS The inclusion criteria were met by 123 patients, with a mean age ± SD of 77.65 ± 7.91 years (range 67-98). Their mean (±SD) Mini-Mental State Examination and the Clock Drawing Test scores were 24.53 ± 4.29 and 5.36 ± 2.41, respectively. Mild-to-severe cognitive impairment was identified in 39 patients (31.7%). The consent form was signed by 111 patients (90.25%), including 33 patients (29.72%) with mild-severe cognitive impairment; 18 patients (16.21%) were unaware of the reason for their admission to hospital. DISCUSSION Many factors may interfere with elderly patients' ability to give their valid consent to treatment, and this study reveals that clinicians may overestimate their patients' decision-making capacity. Physicians should be aware of this problem, and intellectual capacity assessments and/or enhanced consent procedures should be considered when treating elderly patients.
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Affiliation(s)
- Claudio Terranova
- Legal Medicine Unit, Department of Molecular Medicine, Padova University Hospital, Italy.
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Clark VH, Resnick SM, Doshi J, Beason-Held LL, Zhou Y, Ferrucci L, Wong DF, Kraut MA, Davatzikos C. Longitudinal imaging pattern analysis (SPARE-CD index) detects early structural and functional changes before cognitive decline in healthy older adults. Neurobiol Aging 2012; 33:2733-45. [PMID: 22365049 DOI: 10.1016/j.neurobiolaging.2012.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 01/21/2023]
Abstract
This article investigates longitudinal imaging characteristics of early cognitive decline during normal aging, leveraging on high-dimensional imaging pattern classification methods for the development of early biomarkers of cognitive decline. By combining magnetic resonance imaging (MRI) and resting positron emission tomography (PET) cerebral blood flow (CBF) images, an individualized score is generated using high-dimensional pattern classification, which predicts subsequent cognitive decline in cognitively normal older adults of the Baltimore Longitudinal Study of Aging. The resulting score, termed SPARE-CD (Spatial Pattern of Abnormality for Recognition of Early Cognitive Decline), analyzed longitudinally for 143 cognitively normal subjects over 8 years, shows functional and structural changes well before (2.3-2.9 years) changes in neurocognitive testing (California Verbal Learning Test [CVLT] scores) can be measured. Additionally, this score is found to be correlated to the [(11)C] Pittsburgh compound B (PiB) PET mean distribution volume ratio at a later time. This work indicates that MRI and PET images, combined with advanced pattern recognition methods, may be useful for very early detection of cognitive decline.
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Affiliation(s)
- Vanessa H Clark
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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