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O'Connor D, Molloy AM, Laird E, Kenny RA, O'Halloran AM. Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment. Proc Nutr Soc 2023; 82:315-328. [PMID: 36938798 DOI: 10.1017/s0029665123002707] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Age-related frailty and cognitive decline are complex multidimensional conditions that significantly impact the ability of older adults to sustain functional capacity and independence. While underlying causes remain poorly understood, nutrition continually emerges as one associated risk element. Many studies have addressed the importance of adequate nutrition in delaying the onset of these conditions, but the specific role of micronutrients is not well established. The consideration of pre-frailty as an outcome variable is also limited in the current literature. In this review, we focus on the potential value of maintaining micronutrient sufficiency to sustaining the health of the ageing population. Using data from the Irish longitudinal study on ageing, we consider several vitamins known to have a high prevalence of low status in older adults and their impact on pre-frailty, frailty and cognitive impairment. They include vitamin B12 and folate, both of which are associated with multiple biological mechanisms involved in long-term health, in particular in cognitive function; vitamin D, which has been associated with increased risk of musculoskeletal disorders, depression and other chronic diseases; and the carotenoids, lutein and zeaxanthin, that may help mitigate the risk of frailty and cognitive decline via their antioxidant and anti-inflammatory properties. We show that low concentrations of folate and carotenoids are implicated in poorer cognitive health and that the co-occurrence of multiple nutrient deficiencies confers greatest risk for frailty and pre-frailty in the Irish longitudinal study on ageing cohort. These health associations contribute to evidence needed to optimise micronutrient status for health in the older adult population.
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Affiliation(s)
- Deirdre O'Connor
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Anne M Molloy
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Eamon Laird
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Physical Education and Sport, University of Limerick, Limerick, Ireland
| | - Rose Anne Kenny
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Aisling M O'Halloran
- TILDA, Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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2
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Zhuang Y, Wang X, Zhang X, Fang Q, Zhang X, Song Y. The relationship between dietary patterns derived from inflammation and cognitive impairment in patients undergoing hemodialysis. Front Nutr 2023; 10:1218592. [PMID: 37599702 PMCID: PMC10434788 DOI: 10.3389/fnut.2023.1218592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Dietary patterns were shown to be closely related to inflammation, which was independently associated with cognitive impairment (CI) in patients undergoing hemodialysis (HD). However, it remains unclear the influence of dietary patterns derived from inflammation on CI in this population. This study aimed to examine the association between dietary patterns derived from C-reactive protein (CRP) and interleukin-6 (IL-6) and CI in patients undergoing HD. Methods Dietary intake was obtained from the simplified quantitative food frequency questionnaire. Reduced rank regression (RRR) was used to extract two dietary patterns, with IL-6 and CRP as response variables. Cognitive function was examined by the Montreal Cognitive Assessment (Beijing version). Venous blood was drawn for measuring IL-6 and CRP levels. Multivariable logistic regression was used to investigate the association between dietary patterns and CI. Results Dietary pattern derived from IL-6 was not significantly associated with CI. The third quartile of dietary pattern, which used CRP as the response variable, significantly contributed to the increased risk of CI (AOR 8.62, 95% CI 1.47-50.67) after controlling age, sex, education level, marital status, and residential pattern (p-for-trend = 0.028). After considering hypertension and diabetes, physical activity level, anxiety and depression, smoking and drinking status, social support, energy intake, and the dietary pattern derived from IL-6 (p-for-trend = 0.026), the relationship between the dietary pattern derived from CRP and CI remained significant (AOR 14.54, 95% CI 1.40-151.13). Conclusion Dietary pattern associated with high CRP level, including high intake of rice, liquor, fruit, tea and coffee and low intake of dark vegetables and juice, contributed to the increased risk of CI. The association between the consumption of seafood, sweet beverages, and alcohol and CI is yet to be established. However, they may be dietary contributing factors to inflammation in patients undergoing HD.
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Affiliation(s)
- Yan Zhuang
- Medical School (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Xinmei Wang
- Blood Purification Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xuanrui Zhang
- Medical School (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Qian Fang
- Medical School (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Xinyi Zhang
- Medical School (School of Nursing), Nantong University, Nantong, Jiangsu, China
| | - Yan Song
- Medical School (School of Nursing), Nantong University, Nantong, Jiangsu, China
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3
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Tan HK, Narasimhalu K, Ting SKS, Hameed S, Chang HM, De Silva DA, Chen CLH, Tan EK. B-vitamin supplementation on mitigating post-stroke cognition and neuropsychiatric sequelae: A randomized controlled trial. Int J Stroke 2023; 18:163-172. [PMID: 35195052 DOI: 10.1177/17474930221085880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE A third of stroke patients suffer from post-stroke cognitive decline, depressive symptoms, and anxiety symptoms. B-vitamin supplementation provides a possible safe and affordable treatment to mitigate post-stroke neuropsychiatric sequelae via reducing homocysteine levels. Our study aims to examine the effect of B-vitamin supplementation in the prevention of post-stroke cognitive decline, depressive symptoms, and anxiety symptoms. Our secondary aims were to investigate associations between baseline factors and the three outcomes. METHODS Patients were recruited as part of a Singaporean substudy of a randomized controlled trial that examined the effect of B-vitamin supplementation on recurrent cardiovascular events. Cognitive decline, depressive symptoms, and anxiety symptoms were assessed with neuropsychological assessments and Hospital Anxiety and Depression Scale 6 monthly. Cox regression analyses were performed to determine treatment efficacy. Logistic regression used to examine factors associated with cognitive decline, depressive symptoms, and anxiety symptoms. RESULTS A total of 707 were included in the analyses. Survival and hazards ratio analysis showed no treatment effect of B-vitamins on cognitive decline, depressive symptoms, and anxiety symptoms. Cognitive decline was only associated with age. Depressive symptoms were associated with large anterior cerebral infarcts and hyperlipidemia. CONCLUSIONS Our study showed no benefit of supplementation with B-vitamins for post-stroke cognitive decline, depressive symptoms, or anxiety symptoms. Depressive symptoms were associated with larger anterior cerebral infarcts, which may be reflective of the disability associated with larger infarcts.
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Affiliation(s)
| | - Kaavya Narasimhalu
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Simon Kang Seng Ting
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Shahul Hameed
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Hui Meng Chang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
| | | | - Eng King Tan
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
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4
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Song Y, Quan M, Li T, Jia J. Serum Homocysteine, Vitamin B12, Folate, and Their Association with Mild Cognitive Impairment and Subtypes of Dementia. J Alzheimers Dis 2022; 90:681-691. [PMID: 36155508 DOI: 10.3233/jad-220410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although elevated levels of homocysteine (Hcy) are associated with cognitive impairment and dementia, the relevance of Hcy, vitamin B12, and folate levels to subtypes of dementia are still unknown. OBJECTIVE To investigate the changes of Hcy, vitamin B12, and folate levels in mild cognitive impairment (MCI) and subtypes of dementia including Alzheimer's disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD), and Lewy body dementia (LBD), and their relationships with cognitive function and magnetic resonance imaging (MRI) markers. METHODS We measured serum levels of Hcy, vitamin B12, and folate in 257 subjects. Each subject underwent cognitive function assessment and brain MRI test. The Fazekas and temporal lobe atrophy (MTA) visual rating scales were used to assess the degree of white matter hyperintensities and MTA, respectively. RESULTS Serum levels of Hcy was higher and vitamin B12 was lower in AD, VaD, FTD, and LBD groups than cognitively normal controls. No significant differences of folate levels were found among 6 groups. Hcy levels were positively correlated with MTA total score in AD (r = 0.448, p < 0.001). Vitamin B12 levels were positively correlated with MoCA in VaD (r = 0.497), and negatively correlated with MTA total score in AD (r = - 0.325) (ps < 0.05). Hyperhomocysteinemia may increase the risk of AD (OR = 2.744), VaD (OR = 3.600), and FTD (OR = 3.244) in the adjusted model (ps < 0.05). CONCLUSION Hcy and vitamin B12 levels are associated with MTA in AD. Vitamin B12 levels are associated with general cognition in VaD. Hyperhomocysteinemia is a risk factor for not only AD and VaD but also FTD.
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Affiliation(s)
- Yang Song
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China
| | - Meina Quan
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China
| | - Tingting Li
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China
| | - Jianping Jia
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, P.R. China.,Beijing Key Laboratory of Geriatric Cognitive Disorders, Beijing, P.R. China.,Clinical Center for Neurodegenerative Disease and Memory Impairment, Capital Medical University, Beijing, P.R. China.,Center of Alzheimer's Disease, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, P.R. China.,Key Laboratory of Neurodegenerative Diseases, Ministry of Education, Beijing, P.R. China
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5
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Luzzi S, Cherubini V, Falsetti L, Viticchi G, Silvestrini M, Toraldo A. Homocysteine, Cognitive Functions, and Degenerative Dementias: State of the Art. Biomedicines 2022; 10:2741. [PMID: 36359260 PMCID: PMC9687733 DOI: 10.3390/biomedicines10112741] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 07/30/2023] Open
Abstract
There is strong evidence that homocysteine is a risk factor not only for cerebrovascular diseases but also for degenerative dementias. A recent consensus statement renewed the importance and the role of high levels of homocysteine in cognitive decline in several forms of degenerative dementia, such as Alzheimer's disease. Although the molecular mechanisms by which homocysteine causes cell dysfunction are known, both the impact of homocysteine on specific cognitive functions and the relationship between homocysteine level and non-Alzheimer dementias have been poorly investigated. Most of the studies addressing the impact of hyperhomocysteinemia on dementias have not examined the profile of performance across different cognitive domains, and have only relied on screening tests, which provide a very general and coarse-grained picture of the cognitive status of the patients. Yet, trying to understand whether hyperhomocysteinemia is associated with the impairment of specific cognitive functions would be crucial, as it would be, in parallel, learning whether some brain circuits are particularly susceptible to the damage caused by hyperhomocysteinemia. These steps would allow one to (i) understand the actual role of homocysteine in the pathogenesis of cognitive decline and (ii) improve the diagnostic accuracy, differential diagnosis and prognostic implications. This review is aimed at exploring and revising the state of the art of these two strictly related domains. Suggestions for future research are provided.
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Affiliation(s)
- Simona Luzzi
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Veronica Cherubini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Lorenzo Falsetti
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Giovanna Viticchi
- Neurology Unit, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, 60126 Ancona, Italy
| | - Mauro Silvestrini
- Neurology Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Alessio Toraldo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Milan Center for Neuroscience (NeuroMI), 20126 Milan, Italy
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Wang L, Chen J, Li J, Hu F, Xie Y, Zhou X, Shen S, Zhou W, Zhu L, Wang T, Tu J, Bao H, Cheng X. Threshold effect of plasma total homocysteine levels on cognitive function among hypertensive patients in China: A cross-sectional study. Front Neurol 2022; 13:890499. [PMID: 36061998 PMCID: PMC9434013 DOI: 10.3389/fneur.2022.890499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increased plasma total homocysteine (tHcy) is an influencing factor of cognitive impairment in the general population. However, studies on the relationship between the risk of cognitive impairment and plasma tHcy levels in patients with hypertension are limited. This study aimed to explore the association between plasma tHcy levels and cognitive function assessed by MMSE scores among hypertensive patients in China. Methods A total of 9,527 subjects from the Chinese Hypertension Registry Study participated in this study. Plasma tHcy levels were quantified by high-performance liquid chromatography using a fluorescence detector. Cognitive assessment was performed using the Mini-Mental State Examination (MMSE). Linear regression models, two piecewise linear regression models, and smoothing curve fitting were applied to determine the relationship between plasma tHcy levels and cognitive function. Results This analysis included 9,527 Chinese hypertensive adults. Based on the results of linear regression models, a negative relationship was identified between plasma tHcy levels and MMSE scores [beta coefficient (β) per standard deviation (SD) increase: −0.26, 95% confidence interval (CI) −0.35, −0.16, P < 0.001]. The fully adjusted smooth curve fitting presented a nonlinear between plasma tHcy levels and MMSE scores. The threshold effect analysis showed that the inflection point of tHcy was about 27.1 μmol/L. The effect size [β (95% CI)] per SD increase in plasma tHcy concentrations on MMSE scores was −0.93 (−1.24, −0.6) on the left side and −0.07 (−0.24, 0.10) on the right side of the inflection point (P-value for log-likelihood ratio (LLR) test was <0.001). Moreover, subgroup analyses revealed that sex could influence the negative association between plasma tHcy levels and MMSE scores up to a specific threshold (P-value for interaction <0.001). Linear regression models indicated that there was an enhanced inverse association between tHcy levels and MMSE scores in female patients with tHcy concentrations less than 26.9 μmol/L compared to male patients with tHcy concentrations less than 32.0 μmol/L. Conclusions Plasma tHcy levels had a threshold effect on MMSE scores among hypertensive patients in China. Increased plasma tHcy levels were independently inversely associated with cognitive decline among hypertensive patients with tHcy concentrations <27.1 μmol/L.
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Affiliation(s)
- Li Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | | | - Junpei Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Feng Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Yanyou Xie
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Xinlei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Si Shen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Huihui Bao
| | - Xiaoshu Cheng
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Jiangxi Sub-center of National Clinical Research Center for Cardiovascular Diseases, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Xiaoshu Cheng
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Eskandari V. Repurposing the natural compounds as potential therapeutic agents for COVID-19 based on the molecular docking study of the main protease and the receptor-binding domain of spike protein. J Mol Model 2022; 28:153. [PMID: 35578055 PMCID: PMC9110024 DOI: 10.1007/s00894-022-05138-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/26/2022] [Indexed: 12/03/2022]
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV-2) enters the cell by interacting with the human angiotensin-converting enzyme 2 (ACE2) receptor through the receptor-binding domain (RBD) of spike (S) protein. In the cell, the viral 3-chymotrypsin-like cysteine protease (3CLpro) enzyme is essential for its life cycle and controls coronavirus replication. Therefore, the S-RBD and 3CLpro are hot targets for drug discovery against SARS-CoV-2. This study was to identify repurposing drugs using in silico screening, docking, and molecular dynamics simulation. The study identified bentiamine, folic acid, benfotiamine, and vitamin B12 against the RBD of S protein and bentiamine, folic acid, fursultiamine, and riboflavin to 3CLpro. The strong and stable binding of these safe and cheap vitamins at the important residues (R403, K417, Y449, Y453, N501, and Y505) in the S-protein–ACE2 interface and 3CLpro binding site residues especially active site residues (His 41 and Cys 145), indicating that they could be valuable repurpose drugs for inhibiting SARS-CoV-2 entry into the host and replication.
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Affiliation(s)
- Vajiheh Eskandari
- Department of Biology, Faculty of Science, University of Zanjan, Zanjan, Iran.
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8
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Vitamin B12 as a Cholinergic System Modulator and Blood Brain Barrier Integrity Restorer in Alzheimer's Disease. Eur J Pharm Sci 2022; 174:106201. [PMID: 35523375 DOI: 10.1016/j.ejps.2022.106201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 12/22/2022]
Abstract
So far, the cholinergic hypothesis of Alzheimer's disease (AD) remains the fundamental explanation for the complex etiopathology of AD. However, therapeutics raising synaptic acetylcholine (Ach) or having cholinergic receptors agonistic activity had shown limited clinical efficacy, possibly, due to lacking capability to aggregate cholinergic receptors within the degenerated cholinergic neurons. Vitamin-B12 (B12) is an epigenetic modifier. It has a specific CNS transport system via the cubam receptors. The later enclose a cholinergic aggregator; agrin protein, suggesting that B12 administration may cause cholinergic receptors aggregation. Further, B12 involvement in homocysteine (Hcy) metabolism may restore blood brain barrier (BBB) integrity disrupted by elevated Hcy levels in AD. Here in, using a pharmacological model of cholinergic amnesia, three different B12 doses were compared to the standard of care; donepezil (DON) regarding cholinergic system modulation, and Hcy metabolic pathways. Further, AD-associated cerebro-vascular pathology was assessed by morphometric analyses of cerebro-vasculature morphology and ultrastructure using scanning and transmission electron-microscopes, respectively. Consequent effect on key AD-hallmarks and behavioral cognitive tests was also examined. The highest B12-tested dose (B12-HD) showed the greatest hippocampal cholinergic modulation with dose-dependent preferential upregulation of one cholinergic receptor over the other. Altered Hcy metabolism was proved to be a consequence of cholinergic disruption that was variably reversed by different B12 doses. In spite of equipotent effect of DON and B12-HD therapies in decreasing β-amyloid synthesis, B12-HD-treated group revealed the greatest restoration of BBB integrity indicating superior capability of β-amyloid clearance. Therefore, B12-HD therapy may represent a promising AD-modifying agent with extra-ability over conventional cholinergic modulators to aggregate cholinergic receptors.
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Chen X, Yang J, Zhang H, Huang Y, Cao Y, Yan S, Zong G, Zheng Y, Wang X, Yuan C. Plasma folate levels in relation to cognitive impairment: a community-based cohort of older adults in China. Eur J Nutr 2022; 61:2837-2845. [PMID: 35303753 DOI: 10.1007/s00394-022-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/04/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Lower plasma level of folate has been associated with an increased risk of age-related cognitive impairment. However, studies that examined this relation have yielded mixed results. We aimed to examine the prospective association of plasma folate level with risk of cognitive impairment in a community-based prospective cohort of older adults in China. METHODS This study included 615 participants (mean age: 76.3 years) without baseline cognitive impairment from the Rugao Longevity and Ageing Study (RuLAS). We used logistic regression to examine the prospective association between baseline plasma folate and risk of cognitive impairment in the next two years. Fasting blood samples were collected and assayed for plasma folate level at baseline. Cognitive impairment was defined as Hasegawa Dementia Scale (HDS) score ≤ 21.5 points. RESULTS During two years' follow-up, 20.7% of the participants developed cognitive impairment. After controlled for age, gender, and plasma homocysteine, a higher level of plasma folate was associated with lower odds of cognitive impairment. The corresponding odds ratio (OR) with 95% confidence interval was 0.41 (0.19-0.89) comparing participants at extreme quintiles of plasma folate (median level 17.2 vs. 6.3 nmol/L). The associations were similar after further adjustment for major demographic and lifestyle factors (OR = 0.42, 0.18-0.98). Moreover, the inverse association was particularly stronger among males (OR = 0.12, 0.03-0.52) but was non-significant among females. CONCLUSION Our findings support a potential beneficial role of higher plasma folate levels in cognitive function in older Chinese adults, particularly among males. Future studies with larger sample size and longer follow-up are warranted to confirm these findings and to identify the optimal plasma folate level for cognitive function.
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Affiliation(s)
- Xiao Chen
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiaxi Yang
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Zhang
- Human Phenome Institute, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuhui Huang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yaying Cao
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Shiyu Yan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Geng Zong
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yan Zheng
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Xiaofeng Wang
- Human Phenome Institute, Fudan University, Shanghai, China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
| | - Changzheng Yuan
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. .,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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10
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Sashindran V, Aggarwal V, Khera A. Prevalence of Vitamin B12 deficiency in elderly population (>60 years) presenting with dementia to outpatient department. Med J Armed Forces India 2022; 78:94-98. [PMID: 35035050 PMCID: PMC8737092 DOI: 10.1016/j.mjafi.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 11/07/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Vitamin B12 deficiency is an easily treatable cause of reversible dementia. It is likely to be more common in Indian population due to traditionally vegetarian culture. This study was conducted to estimate the prevalence of Vitamin B12 deficiency in elderly patients (>60 years) with dementia attending outpatient department. METHODS This study was conducted in two phases. The first phase was a cross sectional observational study to estimate the prevalence of Vitamin B12 deficiency in the elderly population with dementia. The second phase was a pilot study done in subjects with Vitamin B12 deficiency to assess the change in cognition following Vitamin B12 supplementation. RESULTS Out of 2920 study eligible subjects, 200 were diagnosed as dementia with Mini Mental Status Examination (MMSE) score of ≤ 24. Vitamin B12 deficiency was seen in 7.5% of patients. Vitamin B12 deficiency was associated with shorter and more severe dementia. Macrocytosis was more common in Vitamin B12 deficiency (p value < 0.001) where as vegetarian diet did not show significant correlation (p value 0.69). There was significant improvement in the median MMSE score in the intervention group with increase in MMSE by 2 points at 6-8 weeks and 3 points at 12 weeks (p value 0.009 and 0.003 by Mann Whitney test). CONCLUSION Prevalence of Vitamin B12 deficiency in dementia was 7.5%. It was associated with macrocytosis, shorter duration and more severe dementia. There was a significant improvement in median MMSE score at 6 weeks and 12 weeks following Vitamin B12 supplementation.
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Affiliation(s)
| | - Vivek Aggarwal
- Associate Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India,Corresponding author.
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Clegg ME, Tarrado Ribes A, Reynolds R, Kliem K, Stergiadis S. A comparative assessment of the nutritional composition of dairy and plant-based dairy alternatives available for sale in the UK and the implications for consumers' dietary intakes. Food Res Int 2021; 148:110586. [PMID: 34507731 DOI: 10.1016/j.foodres.2021.110586] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/26/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022]
Abstract
The popularity of plant-based dairy alternatives (PBDAs) products has grown exponentially in recent years creating a new market of PBDA. The aim of this study was to compare the nutritional content of plant-based alternatives of milk, yogurt and cheese with dairy equivalents and the impact on nutritional intake across the lifespan when they are substituted into UK diets. Nutritional information from cow's milk, yogurt, cheese and PBDAs available on the UK market was collected via manufacturers information. The products were categorised according to primary plant-based ingredient/s and compared with the equivalent dairy product. The National Diet and Nutrition Survey data was used to calculate the intake of milk, yogurt and cheese across all age groups and the energy and nutrient intake was calculated. Plant-based milk, cheese and yogurt alternative categories were then substituted for dairy intakes, and energy and nutrient intakes were calculated and compared to UK Dietary Reference Values. A total of 299 PBDA products were identified consisting of 136 milk alternatives, 55 yogurt alternatives and 109 cheese alternatives. All PBDAs were more expensive than dairy products. Milk contained more energy, saturated fat, carbohydrates, protein, vitamin B2, vitamin B12 and iodine, and less fibre and free sugars, than plant-based milk alternatives (P < 0.05). There were significant differences between yogurt and cheese and their corresponding PBDAs for energy, fat, saturated fat, carbohydrate, sugars, fibre protein, salt, and calcium (P < 0.05). These differences were reflected in the nutrient intakes of different age groups and the results demonstrated that PBDA may be useful as practical replacements of dairy products but cannot be considered nutritional replacements.
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Affiliation(s)
- Miriam E Clegg
- Department of Food and Nutritional Sciences, Harry Nursten Building, University of Reading, Whiteknights, Reading RG6 6DZ, UK; Institute for Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6AH, UK.
| | - Ariana Tarrado Ribes
- Department of Food and Nutritional Sciences, Harry Nursten Building, University of Reading, Whiteknights, Reading RG6 6DZ, UK
| | - Reece Reynolds
- Department of Food and Nutritional Sciences, Harry Nursten Building, University of Reading, Whiteknights, Reading RG6 6DZ, UK
| | - Kirsty Kliem
- Department of Animal Sciences, School of Agriculture, Policy and Development, University of Reading, New Agriculture Building, Earley Gate, PO Box 237, Reading RG6 6EU, UK; Institute for Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6AH, UK
| | - Sokratis Stergiadis
- Department of Animal Sciences, School of Agriculture, Policy and Development, University of Reading, New Agriculture Building, Earley Gate, PO Box 237, Reading RG6 6EU, UK; Institute for Food, Nutrition and Health, University of Reading, Whiteknights, Reading RG6 6AH, UK.
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12
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Chong RQ, Gelissen I, Chaar B, Penm J, Cheung JMY, Harnett JE. Do medicines commonly used by older adults impact their nutrient status? EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 3:100067. [PMID: 35480616 PMCID: PMC9031754 DOI: 10.1016/j.rcsop.2021.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 01/04/2023] Open
Abstract
Background Chronic health conditions and polypharmacy are common among the older population and associated with increased risks of adverse events, medicine-interactions, geriatric syndromes, falls and mortality. Poor nutrition is also common in older people. Causal associations between medication use and older people's nutrient status is seldom discussed. Objectives The objectives of this review were to summarise the literature reporting associations between medicines commonly prescribed to older adults and nutrient deficiencies, and to discuss the clinical implications and management. Methods Medicine information resources (n = 5) were searched for information about nutrient deficiencies associated with common medicines used by older people and listed within the top 50 medicines prescribed by volume on the Australian Pharmaceutical Benefits Scheme. This was followed by a search for clinical studies published on PubMed from inception to April 2020. Data was extracted, tabulated and summarised with clinical information relevant to pharmacists and clinicians involved in the care of older people taking medicines. Results A total of 23 clinical studies were identified reporting medicine-induced nutrient deficiencies in older adults. Vitamin B12, sodium, magnesium were identified as the 3 main nutrients susceptible to deficiency by medicines used to treat cardiovascular disease, neurological conditions, gastrointestinal conditions, and diabetes. The coenzyme CoQ10 was depleted by statins. Conclusion: Certain medicines commonly prescribed to older adults are associated with nutrient deficiencies that may be clinically significant. Given the high prevalence of comorbidities and polypharmacy it is possible that some of these individual drug-induced nutrient deficiencies are compounded, warranting both clinical and research attention.
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Affiliation(s)
| | | | | | | | | | - Joanna E. Harnett
- Corresponding author at: The University of Sydney, School of Pharmacy, Building A15, Camperdown Campus, Sydney 2006, Australia.
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13
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Li S, Guo Y, Men J, Fu H, Xu T. The preventive efficacy of vitamin B supplements on the cognitive decline of elderly adults: a systematic review and meta-analysis. BMC Geriatr 2021; 21:367. [PMID: 34134667 PMCID: PMC8207668 DOI: 10.1186/s12877-021-02253-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/03/2021] [Indexed: 11/11/2022] Open
Abstract
Background The irreversibility of cognitive impairment of Alzheimer’s disease (AD) prompts that preventing or delaying the onset of AD should be a public health priority. Vitamin B supplements can lower the serum homocysteine (Hcy) level, but whether it can prevent cognitive decline or not remains unclear. We aimed to evaluate the preventive efficacy of vitamin B supplements on the cognitive decline of elderly adults. Methods We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, Science Direct, PsycINFO from inception to December 1, 2019, and then updated the retrieved results on June 1, 2020. The randomized controlled trials (RCTs) which evaluated the efficacy of vitamin B in mild cognitive impairment (MCI) patients or elderly adults without cognitive impairment were selected. Standardized mean difference (SMD) or mean difference (MD) as well as their 95 % confidence interval (CI) were calculated by performing random effects models or fixed effects models. Results A total of 21 RCTs involving 7571 participants were included for meta-analysis. The forest plots showed that there is significant effect in global cognitive function (15 RCTs, SMD: 0.36; 95 % CI: 0.18 to 0.54, P < 0.01) and Hcy (11 RCTs, MD: -4.59; 95 %CI: -5.51 to -3.67, P < 0.01), but there is no effect in information processing speed (10 RCTs, SMD: 0.06; 95 % CI: -0.12 to 0.25, P = 0.49), episodic memory (15 RCTs, SMD: 0.10; 95 % CI: -0.04 to 0.25, P = 0.16), executive function (11 RCTs, SMD: -0.21; 95 % CI: -0.49 to 0.06, P = 0.13). The value of effect size and heterogeneity did not vary apparently when excluding the low-quality studies, so we could believe that the results of meta-analysis were robust. Conclusions Vitamin B supplements might delay or maintain the cognitive decline of elderly adults. We can recommend that the vitamin B supplements should be considered as a preventive medication to MCI patients or elderly adults without cognitive impairment. More well-designed RCTs with large sample sizes were required to clarify the preventive efficacy in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02253-3.
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Affiliation(s)
- Shufeng Li
- Department of Health Statistics, Fenyang College of Shanxi Medical University, 032200, Fenyang, Shanxi, China
| | - Yuchen Guo
- Fuwai Hospital, Chinese Academy of Medical Sciences, Xicheng District 100032, Beijing, China
| | - Jie Men
- Department of Basic Medicine, Fenyang College of Shanxi Medical University, 032200, Fenyang, Shanxi, China
| | - Hanlin Fu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, 410008, Changsha, Hunan, China
| | - Ting Xu
- Department of Health Statistics, Fenyang College of Shanxi Medical University, 032200, Fenyang, Shanxi, China. .,Department of Physiology, Fenyang College of Shanxi Medical University, 032200, Fenyang, Shanxi, China.
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14
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Fu J, Liu Q, Zhang M, Sun C, Du Y, Zhu Y, Lin H, Jin M, Ma F, Li W, Liu H, Yan J, Chen Y, Wang G, Huang G. Association between methionine cycle metabolite-related diets and mild cognitive impairment in older Chinese adults: a population-based observational study. Nutr Neurosci 2021; 25:1495-1508. [PMID: 33494658 DOI: 10.1080/1028415x.2021.1872959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Homocysteine (Hcy) and folate, involved in a common metabolic pathway supplying essential methyl groups for DNA and protein synthesis, have been found to be associated with cognitive function. Moreover, diet may influence methionine cycle metabolites (MCM) as well as mild cognitive impairment (MCI), but MCM-related dietary patterns are unclear in an older population. OBJECTIVE The study aimed to identify MCM-related dietary patterns of older Chinese adults, and examine their association with the prevalence of MCI in a large population-based study. METHODS This study included 4457 participants ≥ 60 years of age from the Tianjin Elderly Nutrition and Cognition Cohort study. Dietary data were collected using a valid self-administered food frequency questionnaire, and factor analysis was used to identify major dietary patterns in the population. MCM-based dietary patterns were derived using reduced rank regression (RRR) based on serum folate and Hcy as response variables. RESULTS Compared with the participants in the lowest quartile of vegetarian pattern and processed foods pattern, the odds ratios (ORs) of MCI in the highest quartile were 0.72 (95% CI 0.53-0.98) and 1.39 (95% CI 1.03-1.88), respectively. In the MCM-based dietary patterns derived using RRR, the ORs for MCI for the highest quartile of MCM patterns I and II were 0.58 (95% CI 0.44-0.78) and 1.38 (95% CI 1.04-1.83), respectively, compared with participants in the lower quartile. CONCLUSIONS Findings from this large population-based study suggested that adopting an MCM-related dietary pattern, especially avoiding processed foods, can decrease the occurrence of MCI.
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Affiliation(s)
- Jingzhu Fu
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Qian Liu
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Meilin Zhang
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Changqing Sun
- Neurosurgical Department of Baodi Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Yue Du
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China.,Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Yun Zhu
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China.,Department of Epidemiology & Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Hongyan Lin
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Mengdi Jin
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Fei Ma
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China.,Department of Epidemiology & Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Wen Li
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Huan Liu
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
| | - Jing Yan
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China.,Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Yongjie Chen
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China.,Department of Epidemiology & Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China
| | - Guangshun Wang
- Department of Tumor, Baodi Clinical College of Tianjin Medical University, Tianjin, People's Republic of China
| | - Guowei Huang
- Department of Nutrition & Food Science, School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, People's Republic of China
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15
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Scassellati C, Ciani M, Maj C, Geroldi C, Zanetti O, Gennarelli M, Bonvicini C. Behavioral and Psychological Symptoms of Dementia (BPSD): Clinical Characterization and Genetic Correlates in an Italian Alzheimer's Disease Cohort. J Pers Med 2020; 10:jpm10030090. [PMID: 32823921 PMCID: PMC7563608 DOI: 10.3390/jpm10030090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The occurrence of Behavioral and Psychological Symptoms of Dementia (BPSD) in Alzheimer's Disease (AD) patients hampers the clinical management and exacerbates the burden for caregivers. The definition of the clinical distribution of BPSD symptoms, and the extent to which symptoms are genetically determined, are still open to debate. Moreover, genetic factors that underline BPSD symptoms still need to be identified. PURPOSE To characterize our Italian AD cohort according to specific BPSD symptoms as well as to endophenotypes. To evaluate the associations between the considered BPSD traits and COMT, MTHFR, and APOE genetic variants. METHODS AD patients (n = 362) underwent neuropsychological examination and genotyping. BPSD were assessed with the Neuropsychiatric Inventory scale. RESULTS APOE and MTHFR variants were significantly associated with specific single BPSD symptoms. Furthermore, "Psychosis" and "Hyperactivity" resulted in the most severe endophenotypes, with APOE and MTHFR implicated as both single risk factors and "genexgene" interactions. CONCLUSIONS We strongly suggest the combined use of both BPSD single symptoms/endophenotypes and the "genexgene" interactions as valid strategies for expanding the knowledge about the BPSD aetiopathogenetic mechanisms.
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Affiliation(s)
- Catia Scassellati
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy; (C.S.); (C.M.); (M.G.)
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy
| | - Miriam Ciani
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy;
| | - Carlo Maj
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy; (C.S.); (C.M.); (M.G.)
- Institute of Genomic Statistics and Bioinformatics, University of Bonn, 53127 Bonn, Germany
| | - Cristina Geroldi
- Alzheimer’s Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy; (C.G.); (O.Z.)
| | - Orazio Zanetti
- Alzheimer’s Research Unit-Memory Clinic, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy; (C.G.); (O.Z.)
| | - Massimo Gennarelli
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy; (C.S.); (C.M.); (M.G.)
- Section of Biology and Genetic, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy
| | - Cristian Bonvicini
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25123 Brescia, Italy;
- Correspondence:
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16
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Plasma concentrations of vitamin B 12 and folate and global cognitive function in an older population: cross-sectional findings from The Irish Longitudinal Study on Ageing (TILDA). Br J Nutr 2020; 124:602-610. [PMID: 32329423 DOI: 10.1017/s0007114520001427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.
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17
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Effects of aquatic exercise on insulin-like growth factor-1, brain-derived neurotrophic factor, vascular endothelial growth factor, and cognitive function in elderly women. Exp Gerontol 2020; 132:110842. [DOI: 10.1016/j.exger.2020.110842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 01/08/2023]
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18
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Elsherbiny NM, Sharma I, Kira D, Alhusban S, Samra YA, Jadeja R, Martin P, Al-Shabrawey M, Tawfik A. Homocysteine Induces Inflammation in Retina and Brain. Biomolecules 2020; 10:biom10030393. [PMID: 32138265 PMCID: PMC7175372 DOI: 10.3390/biom10030393] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/23/2020] [Accepted: 02/29/2020] [Indexed: 02/03/2023] Open
Abstract
Homocysteine (Hcy) is an amino acid that requires vitamins B12 and folic acid for its metabolism. Vitamins B12 and folic acid deficiencies lead to hyperhomocysteinemia (HHcy, elevated Hcy), which is linked to the development of diabetic retinopathy (DR), age-related macular degeneration (AMD), and Alzheimer’s disease (AD). The goal of the current study was to explore inflammation as an underlying mechanism of HHcy-induced pathology in age related diseases such as AMD, DR, and AD. Mice with HHcy due to a lack of the enzyme cystathionine-β-synthase (CBS) and wild-type mice were evaluated for microglia activation and inflammatory markers using immuno-fluorescence (IF). Tissue lysates isolated from the brain hippocampal area from mice with HHcy were evaluated for inflammatory cytokines using the multiplex assay. Human retinal endothelial cells, retinal pigment epithelial cells, and monocyte cell lines treated with/without Hcy were evaluated for inflammatory cytokines and NFκB activation using the multiplex assay, western blot analysis, and IF. HHcy induced inflammatory responses in mouse brain, retina, cultured retinal, and microglial cells. NFκB was activated and cytokine array analysis showed marked increase in pro-inflammatory cytokines and downregulation of anti-inflammatory cytokines. Therefore, elimination of excess Hcy or reduction of inflammation is a promising intervention for mitigating damage associated with HHcy in aging diseases such as DR, AMD, and AD.
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Affiliation(s)
- Nehal M. Elsherbiny
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Isha Sharma
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
| | - Dina Kira
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
| | - Suhib Alhusban
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
| | - Yara A. Samra
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Ravirajsinh Jadeja
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Biochemistry, Medical College of Georgia (MCG), Augusta University, Augusta, GA 30912, USA
| | - Pamela Martin
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Biochemistry, Medical College of Georgia (MCG), Augusta University, Augusta, GA 30912, USA
- Department of Ophthalmology, MCG, Augusta University, Augusta, GA 30912, USA
| | - Mohamed Al-Shabrawey
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Ophthalmology, MCG, Augusta University, Augusta, GA 30912, USA
- Department of Cellular Biology and Anatomy, Medical College of Georgia (MCG), Augusta University, Augusta, GA 30912, USA
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Amany Tawfik
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (N.M.E.); (I.S.); (D.K.); (S.A.); (Y.A.S.); (M.A.-S.)
- James and Jean Culver Vision Discovery Institute, MCG, Augusta University, Augusta, GA 30912, USA; (R.J.); (P.M.)
- Department of Ophthalmology, MCG, Augusta University, Augusta, GA 30912, USA
- Department of Cellular Biology and Anatomy, Medical College of Georgia (MCG), Augusta University, Augusta, GA 30912, USA
- Correspondence:
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19
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Joint Conference of Geriatric and Neurologic Section of Hellenic Society of Physical and Rehabilitation Medicine with Psychogeriatric Section of Greek Psychiatric Society "World Alzheimer's Day". J Frailty Sarcopenia Falls 2019; 4:122-126. [PMID: 32300727 PMCID: PMC7155309 DOI: 10.22540/jfsf-04-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Voluntary fortification is ineffective to maintain the vitamin B12 and folate status of older Irish adults: evidence from the Irish Longitudinal Study on Ageing (TILDA). Br J Nutr 2019; 120:111-120. [PMID: 29936926 DOI: 10.1017/s0007114518001356] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mandatory fortification of staple grains with folic acid and/or vitamin B12 (B12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 ≥50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B12 status (45 nmol/l) was observed in 8·9 %, whereas high B12 status was observed in 3·1 % (>601 pmol/l). The largest positive predictor of B12 concentration was self-reported B12 injection and/or supplement use (coefficient 51·5 pmol/; 95 % CI 9·4, 93·6; P=0·016) followed by sex and geographic location. The largest negative predictor was metformin use (-33·6; 95 % CI -51·9, -15·4; P<0·0001). The largest positive predictor of folate concentration was folic acid supplement use (6·0; 95 % CI 3·0, 9·0 nmol/l; P<0·001) followed by being female and statin medications. The largest negative predictor was geographic location (-5·7; 95 % CI -6·7, -4·6; P<0·0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.
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21
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O'Halloran AM, Laird EJ, Feeney J, Healy M, Moran R, Beatty S, Nolan JM, Molloy AM, Kenny RA. Circulating Micronutrient Biomarkers Are Associated With 3 Measures of Frailty: Evidence From the Irish Longitudinal Study on Ageing. J Am Med Dir Assoc 2019; 21:240-247.e5. [PMID: 31401047 DOI: 10.1016/j.jamda.2019.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the associations between 3 frailty instruments and circulating micronutrients in a large representative sample of older adults. DESIGN Cross-sectional data from a nationally representative cohort study conducted between October 2009 and July 2011. PARTICIPANTS AND SETTING Adults age ≥50 years (n = 4068) living in the community in Ireland. MEASUREMENTS Circulating micronutrients (lutein, zeaxanthin, folate, vitamin B-12, and vitamin D) were measured, transformed, and standardized. Frailty was assessed using the Frailty Phenotype, the Frailty Index, and the FRAIL Scale (fatigue, resistance, ambulation, illnesses, and loss of weight), instruments. Multinomial logistic regression determined associations between micronutrients and prefrailty or frailty. Models were adjusted for sociodemographic, lifestyle, health, and seasonal factors. RESULTS Adjusting for age, sex, and educational attainment, all 3 measures of frailty were associated with lower levels of lutein [relative risk ratios (RRRs): 0.43‒0.63], zeaxanthin (RRRs: 0.49‒0.63), and vitamin D (RRRs: 0.51‒0.75), and with the accumulation of micronutrient insufficiencies (RRRs: 1.42‒1.90). Attenuated but significant associations were also observed with all measures of prefrailty for lutein, vitamin D, and number of micronutrient insufficiencies. The associations with frailty persisted following additional adjustment for social, lifestyle, and health and seasonal factors, and following multiple test correction. CONCLUSIONS AND IMPLICATIONS We have presented the most consistent evidence in the largest study to date that micronutrient concentrations are associated with prefrailty and frailty in older adults. Our data suggest that low micronutrient status has potential as an easily modifiable marker and intervention target for frailty and supports further investigation into micronutrient supplementation and fortification to prevent frailty and disability among older adults.
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Affiliation(s)
- Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland.
| | - Eamon J Laird
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, Laboratory Medicine and Molecular Pathology, St James's Hospital, Dublin, Ireland
| | - Rachel Moran
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - John M Nolan
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | | | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Medical Gerontology, Trinity College, Dublin, Ireland; Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
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22
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Ostrakhovitch EA, Tabibzadeh S. Homocysteine and age-associated disorders. Ageing Res Rev 2019; 49:144-164. [PMID: 30391754 DOI: 10.1016/j.arr.2018.10.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Abstract
There are numerous theories of aging, a process which still seems inevitable. Aging leads to cancer and multi-systemic disorders as well as chronic diseases. Decline in age- associated cellular functions leads to neurodegeneration and cognitive decline that affect the quality of life. Accumulation of damage, mutations, metabolic changes, failure in cellular energy production and clearance of altered proteins over the lifetime, and hyperhomocysteinemia, ultimately result in tissue degeneration. The decline in renal functions, nutritional deficiencies, deregulation of methionine cycle and deficiencies of homocysteine remethylation and transsulfuration cofactors cause elevation of homocysteine with advancing age. Abnormal accumulation of homocysteine is a risk factor of cardiovascular, neurodegenerative and chronic kidney disease. Moreover, approximately 50% of people, aged 65 years and older develop hypertension and are at a high risk of developing cardiovascular insufficiency and incurable neurodegenerative disorders. Increasing evidence suggests inverse relation between cognitive impairment, cerebrovascular and cardiovascular events and renal function. Oxidative stress, inactivation of nitric oxide synthase pathway and mitochondria dysfunction associated with impaired homocysteine metabolism lead to aging tissue degeneration. In this review, we examine impact of high homocysteine levels on changes observed with aging that contribute to development and progression of age associated diseases.
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Affiliation(s)
- E A Ostrakhovitch
- Frontiers in Bioscience Research Institute in Aging and Cancer, Irvine, CA, USA.
| | - S Tabibzadeh
- Frontiers in Bioscience Research Institute in Aging and Cancer, Irvine, CA, USA.
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23
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Kim M, Basharat A, Santosh R, Mehdi SF, Razvi Z, Yoo SK, Lowell B, Kumar A, Brima W, Danoff A, Dankner R, Bergman M, Pavlov VA, Yang H, Roth J. Reuniting overnutrition and undernutrition, macronutrients, and micronutrients. Diabetes Metab Res Rev 2019; 35:e3072. [PMID: 30171821 DOI: 10.1002/dmrr.3072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/20/2018] [Accepted: 08/26/2018] [Indexed: 12/15/2022]
Abstract
Over-nutrition and its late consequences are a dominant theme in medicine today. In addition to the health hazards brought on by over-nutrition, the medical community has recently accumulated a roster of health benefits with obesity, grouped under "obesity paradox." Throughout the world and throughout history until the 20th century, under-nutrition was a dominant evolutionary force. Under-nutrition brings with it a mix of benefits and detriments that are opposite to and continuous with those of over-nutrition. This continuum yields J-shaped or U-shaped curves relating body mass index to mortality. The overweight have an elevated risk of dying in middle age of degenerative diseases while the underweight are at increased risk of premature death from infectious conditions. Micronutrient deficiencies, major concerns of nutritional science in the 20th century, are being neglected. This "hidden hunger" is now surprisingly prevalent in all weight groups, even among the overweight. Because micronutrient replacement is safe, inexpensive, and predictably effective, it is now an exceptionally attractive target for therapy across the spectrum of weight and age. Nutrition-related conditions worthy of special attention from caregivers include excess vitamin A, excess vitamin D, and deficiency of magnesium.
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Affiliation(s)
- Miji Kim
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Anam Basharat
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Ramchandani Santosh
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Syed F Mehdi
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Zanali Razvi
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Sun K Yoo
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Barbara Lowell
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Amrat Kumar
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Wunnie Brima
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, New York, USA
| | - Ann Danoff
- Department of Medicine, Cpl. Michael J Crescenz Veterans Administration Medical Center, Philadelphia, PA, USA
| | - Rachel Dankner
- Department of Epidemiology and Preventive Medicine, School of Public Health, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Bergman
- Department of Medicine, Division of Endocrinology, NYU School of Medicine, New York, NY, USA
| | - Valentin A Pavlov
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
- Center for Biomedical Science and Center for Bioelectric Medicine, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Huan Yang
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
- Center for Biomedical Science and Center for Bioelectric Medicine, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
| | - Jesse Roth
- Laboratory of Diabetes and Diabetes-Related Disorders, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
- Department of Medicine, Albert Einstein College of Medicine, New York, USA
- Center for Biomedical Science and Center for Bioelectric Medicine, The Feinstein Institute for Medical Research, Northwell Health, New York, USA
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24
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Zajac IT, Herreen D, Bastiaans K, Dhillon VS, Fenech M. The Effect of Whey and Soy Protein Isolates on Cognitive Function in Older Australians with Low Vitamin B 12: A Randomised Controlled Crossover Trial. Nutrients 2018; 11:nu11010019. [PMID: 30577611 PMCID: PMC6357102 DOI: 10.3390/nu11010019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 01/01/2023] Open
Abstract
Whey protein isolate (WPI) is high in vitamin B12 and folate. These and other related markers (holotranscobalamin, methylmalonic acid and homocysteine) have been linked with cognitive health. This study explored the efficacy of WPI for improving cognitive function via delivery of vitamin B12. Moderately vitamin B12-deficient participants aged between 45 and 75 years (n = 56) were recruited into this randomised controlled crossover trial. Participants (55% female) consumed 50 g whey (WPI; active) or soy protein isolate (SPI; control) for eight weeks. Following a 16-week washout phase, they consumed the alternative supplement. Consumption of WPI significantly improved active B12 and folate status but did not result in direct improvements in cognitive function. However, there was evidence of improvement in reaction time (p = 0.02) and reasoning speed (p = 0.04) in the SPI condition for females. Additional analyses showed that changes in active B12, HcY and folate measures during WPI treatment correlated with improvements in cognitive function (all p < 0.05). Results indicate that WPI itself did not result in improved cognitive function but some evidence of benefit of SPI for females was found. However, consistent with previous research, we present further evidence of a role for active B12, HcY and folate in supporting cognitive improvement in adults with low B vitamin status.
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Affiliation(s)
- Ian T Zajac
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia.
| | - Danielle Herreen
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Kathryn Bastiaans
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Varinderpal S Dhillon
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
| | - Michael Fenech
- Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), 5000 Adelaide, South Australia, Australia
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25
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Hofman DL, Champ CL, Lawton CL, Henderson M, Dye L. A systematic review of cognitive functioning in early treated adults with phenylketonuria. Orphanet J Rare Dis 2018; 13:150. [PMID: 30165883 PMCID: PMC6117942 DOI: 10.1186/s13023-018-0893-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/16/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Even though early dietary management of phenylketonuria (PKU) successfully prevents severe neurological impairments, deficits in cognitive functioning are still observed. These deficits are believed to be the result of elevated levels of phenylalanine throughout life. Research on cognitive functioning in adults with PKU (AwPKU) often focuses on domains shown to be compromised in children with PKU, such as attention and executive functions, whereas other cognitive domains have received less attention. This systematic review aimed to provide an overview of cognitive functioning across domains examined in early treated (ET) AwPKU. METHODS A systematic search was performed in Ovid MEDLINE(R), PsycINFO, Web of Science, Cochrane, Scopus, Embase, ScienceDirect, and PubMed for observational studies on cognitive performance in ET AwPKU. RESULTS Twenty-two peer-reviewed publications, reporting on outcomes from 16 studies were reviewed. Collectively, the results most consistently showed deficits in vigilance, working memory and motor skills. Deficits in other cognitive domains were less consistently observed or were understudied. Furthermore, despite reports of several associations between cognitive performance and phenylalanine (Phe) levels throughout life the relationship remains unclear. Inconsistencies in findings across studies could be explained by the highly heterogeneous nature of study samples, resulting in large inter- and intra-variability in Phe levels, as well as the use of a variety of tests across cognitive domains, which differ in sensitivity. The long-term cognitive outcomes of early and continuous management of PKU remain unclear. CONCLUSIONS To better understand the development of cognitive deficits in ET AwPKU, future research would benefit from 1) (inter)national multicentre-studies; 2) more homogeneous study samples; 3) the inclusion of other nutritional measures that might influence cognitive functioning (e.g. Phe fluctuations, Phe:Tyrosine ratio and micronutrients such as vitamin B12); and 4) careful selection of appropriate cognitive tests.
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Affiliation(s)
| | | | | | - Mick Henderson
- Biochemical Genetics, Specialist Laboratory Medicine, St James’s University Hospital, Block 46, Leeds, LS9 7TF UK
| | - Louise Dye
- School of Psychology, University of Leeds, Leeds, LS2 9JT UK
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26
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Soni RM, Tiwari SC, Mahdi AA, Kohli N. Serum Homocysteine and Behavioral and Psychological Symptoms of Dementia: Is There Any Correlation in Alzheimer's Disease? Ann Neurosci 2018; 25:152-159. [PMID: 30814822 DOI: 10.1159/000487068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background There are studies showing the relation between serum B12, folate and Behavioral and Psychological symptoms of Dementia (BPSD) in Alzheimer's disease (AD). Serum levels of these vitamins do not reflect actual disease status and therefore checking the serum Homocysteine level is considered a better test. Homocysteine has been found to be associated with cognitive impairment and various psychiatric disorders. Purpose This study was planned to identify the correlation between serum homocysteine levels and BPSD in AD patients. Methods AD patients (n = 18) and healthy controls (n = 18) were included in the study. Diagnosis of AD was confirmed using International Classification Disease-10. AD patients were assessed using Mini Mental Status Examination (MMSE), Clinical Dementia Rating scale (CDR), Global Deterioration scale (GDS), and Neuropsychiatric inventory (NPI). Healthy controls were assessed on MMSE and Mini International Neuropsychiatric Interview. Serum homocysteine, vitamin B12, and folate levels were measured in all study subjects. Results Patients with AD had statistically significant higher serum levels of homocysteine as compared to the control group, while the levels of vitamin B12 and folate did not differ significantly. There was statistically significant positive correlation of serum homocysteine levels with total NPI score as well as with NPI sub-domains particularly delusion, agitation/aggression, and depression/dysphoria. Serum homocysteine levels did not correlate significantly with MMSE, CDR, and GDS scores. Conclusion Correlation was observed between serum homocysteine levels and behavioral and psychological symptoms of AD. There is a possibility of etiological role, but the underlying pathophysiological mechanisms need to be elucidated. Whether patients will benefit or not with supplements of vitamin B12 and folate requires further research. This was a cross-sectional study and findings should not be generalized. Further prospective longitudinal studies with a large number of patients are needed.
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Affiliation(s)
- Ravi M Soni
- Department of Geriatric Mnetal Health, King George's Medical University, Lucknow, India
| | - Sarvada C Tiwari
- Department of Geriatric Mnetal Health, King George's Medical University, Lucknow, India
| | - Abbas A Mahdi
- Department of Bichemistry, King George's Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
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27
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Kim S, Choi BY, Nam JH, Kim MK, Oh DH, Yang YJ. Cognitive impairment is associated with elevated serum homocysteine levels among older adults. Eur J Nutr 2018; 58:399-408. [PMID: 29322314 DOI: 10.1007/s00394-017-1604-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/31/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to examine the associations between the risk of cognitive impairment and the serum levels of folate, vitamin B12, and homocysteine (Hcy). METHODS Subjects were persons aged 60-79 years who participated in the Yangpyeong Cohort study between 2011 and 2012. Cognitive impairment and normal subjects consisted of 100 pairs of old adults matched by age, sex, and education levels. Cognitive function was evaluated with the Korean version of the Mini-Mental State Examination for Dementia Screening (MMSE-DS). Pearson's partial correlation coefficients and conditional multiple logistic regression analysis were applied to determine the associations between cognitive function and the serum levels of folate, vitamin B12, and Hcy. RESULTS Compared with the matched normal group, the cognitive impairment group had higher proportions of folate deficiency (< 3 ng/mL) and hyperhomocysteinemia (≥ 15 µmol/L). Serum Hcy concentrations were inversely associated with serum folate (r = - 0.234, p = 0.001) and MMSE-DS score (r = - 0.150, p = 0.037) after adjusting for age, sex, and education. The high Hcy group showed a higher prevalence of cognitive impairment (4th vs. 1st quartile, OR 3.30, 95% CI 1.12-9.72, p for trend = 0.014) after adjusting for exercise. CONCLUSIONS The present findings suggest a putative protective role of high serum folate and normal Hcy against cognitive impairment among older adults.
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Affiliation(s)
- Sunghee Kim
- Department of Clinical Nutrition, Graduated School of Health Sciences, Dongduk Women's University, 60, Hwarang-ro 13-gil, Seongbuk-gu, Seoul, 02748, Republic of Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jung Hyun Nam
- Department of Psychiatry, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Mi Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Dong Hoon Oh
- Seulha Mental Health Clinic, 2, Nohyeong 8-gil 4F, Jeju-si, Jeju-do, 63083, Republic of Korea.,Institute for Health and Society, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Yoon Jung Yang
- Department of Foods and Nutrition, College of Natural Sciences, Dongduk Women's University, 60, Hwarang-ro 13-gil, Seongbuk-gu, Seoul, 02748, Republic of Korea.
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28
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Farina N, Jernerén F, Turner C, Hart K, Tabet N. Homocysteine concentrations in the cognitive progression of Alzheimer's disease. Exp Gerontol 2017; 99:146-150. [PMID: 29024723 DOI: 10.1016/j.exger.2017.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/04/2017] [Accepted: 10/08/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Hyperhomocysteinemia in Alzheimer's disease (AD) is widely reported and appears to worsen as the disease progresses. While active dietary intervention with vitamins B12 and folate decreases homocysteine blood levels, with promising clinical outcomes in Mild Cognitive Impairment (MCI), this so far has not been replicated in established AD populations. The aim of the study is to explore the relationship between hyperhomocystenemia and relevant vitamins as the disease progresses. METHODS In this longitudinal cohort study, 38 participants with mild to moderate AD were followed for an average period of 13months. Plasma folate, vitamin B12 and homocysteine concentrations were measured at baseline and at follow-up. Dietary intake of B vitamins was also measured. Spearman's correlations were conducted by homocysteine and B vitamin status. RESULTS As expected, cognitive status significantly declined over the follow-up period and this was paralleled by a significant increase in homocysteine concentrations (p=0.006). However, during this follow-up period there was no significant decline in neither dietary intake, nor the corresponding blood concentrations of vitamin B12/folate, with both remaining within normal values. Changes in blood concentrations of B vitamins were not associated with changes in homocysteine levels (p>0.05). CONCLUSION In this study, the increase in homocysteine observed in AD patients as the disease progresses cannot be solely explained by dietary and blood levels of folate and vitamin B12. Other dietary and non-dietary factors may contribute to hyperhomocysteinemia and its toxic effect in AD, which needs to be explored to optimise timely intervention strategies.
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Affiliation(s)
- Nicolas Farina
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, BN1 9RY, UK.
| | - Fredrik Jernerén
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Cheryl Turner
- Department of Pharmacology, University of Oxford, Oxford OX1 3QT, UK
| | - Kathryn Hart
- Department of Nutritional Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Naji Tabet
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, BN1 9RY, UK; Dementia Research Unit, Sussex Partnership NHS Foundation Trust, Crowborough TN6 1HB, UK
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Mehl-Madrona L, Mainguy B. Collaborative Management of Neurocognitive Disorders in Primary Care: Explorations of an Attempt at Culture Change. Perm J 2017; 21:16-027. [PMID: 28333613 DOI: 10.7812/tpp/16-027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Minor neurocognitive disorder (MiND; previously mild cognitive impairment) is a transitional zone between normal cognitive function and early stages of major neurocognitive disorder (previously called dementia). Of people with MiND, 5% to 10% progress to major neurocognitive disorder. Simple interventions such as memory activities, balance exercises, and anti-inflammatory diets have been shown to improve cognitive ability. Also, education and support in group settings have proved beneficial for patients with MiND. DESIGN Survey evaluation of outcomes of geriatric consultation and prospective educational study. MAIN OUTCOME MEASURES We collaborated with an academic training program to introduce into primary care the ideas of educational activities and participation in group medical care for people with MiND. Educational programs were developed and presented to family medicine residents and practicing physicians, and their knowledge was assessed before and after education. RESULTS Two group programs were implemented: one at our hospital and one at a local skilled nursing facility. These were initially envisioned as time-limited, but participants insisted on their continuance. Thirty-two different patients attended the groups for at least six sessions. Participants enthusiastically reported positive change on qualitative interviews and showed improvement in cognition, balance, and self-esteem. Family medicine residents and practicing physicians both shifted toward lifestyle medicine and significantly changed their views on the efficacy of treatments. Despite these activities, community physicians making referrals for geriatric consultations did not change their discussions with patients and families about exercise, diet, cognitive enhancement, and socialization for MiND. CONCLUSION Group visits that emphasized support for increased exercise, improved diet, more movement and balance, and cognitive enhancement appear to please and benefit patients with MiND. Physicians are more open to these approaches with training after initial skepticism. A struggle exists to convince the profession that lifestyle change may be beneficial in MiND.
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Affiliation(s)
- Lewis Mehl-Madrona
- Faculty Physician at the Eastern Maine Medical Center Family Medicine Residency in Bangor and Associate Professor of Family Medicine at the Univerity of New England in Augusta, ME. He is also affiliated with the Coyote Institute in Orono, ME.
| | - Barbara Mainguy
- Psychotherapist and Reiki practitioner. She is the Education Director at the Coyote Institute in Orono, ME.
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30
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Wang X, Hui Z, Dai X, Terry PD, Zhang Y, Ma M, Wang M, Deng F, Gu W, Lei S, Li L, Ma M, Zhang B. Micronutrient-Fortified Milk and Academic Performance among Chinese Middle School Students: A Cluster-Randomized Controlled Trial. Nutrients 2017; 9:nu9030226. [PMID: 28257107 PMCID: PMC5372889 DOI: 10.3390/nu9030226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/28/2017] [Indexed: 11/16/2022] Open
Abstract
Many children suffer from nutritional deficiencies that may negatively affect their academic performance. This cluster-randomized controlled trial aimed to test the effects of micronutrient-fortified milk in Chinese students. Participants received either micronutrient-fortified (n = 177) or unfortified (n = 183) milk for six months. Academic performance, motivation, and learning strategies were estimated by end-of-term tests and the Motivated Strategies for Learning Questionnaire. Blood samples were analyzed for micronutrients. In total, 296 students (82.2%) completed this study. Compared with the control group, students in the intervention group reported higher scores in several academic subjects (p < 0.05), including languages, mathematics, ethics, and physical performance at the end of follow-up. Students in the intervention group showed greater self-efficacy and use of cognitive strategies in learning, and reported less test anxiety (p < 0.001). Moreover, vitamin B2 deficiency (odds ratio (OR) = 0.18, 95% confidence interval (CI): 0.11~0.30) and iron deficiency (OR = 0.34, 95% CI: 0.14~0.81) were less likely in the students of the intervention group, whereas vitamin D, vitamin B12, and selenium deficiencies were not significantly different. “Cognitive strategy” had a partial mediating effect on the test scores of English (95% CI: 1.26~3.79) and Chinese (95% CI: 0.53~2.21). Our findings suggest that micronutrient-fortified milk may improve students’ academic performance, motivation, and learning strategies.
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Affiliation(s)
- Xiaoqin Wang
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Zhaozhao Hui
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Xiaoling Dai
- Department of Nursing, Shaanxi Provincial Tumor Hospital, Xi'an 710061, China.
| | - Paul D Terry
- Department of Medicine, University of Tennessee Medical Center, Knoxville, TN 37996, USA.
| | - Yue Zhang
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Mei Ma
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Mingxu Wang
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Fu Deng
- Xi'an Tie Yi High School, Xi'an 710000, China.
| | - Wei Gu
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Shuangyan Lei
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Ling Li
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Mingyue Ma
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
| | - Bin Zhang
- Department of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China.
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Association of Nutrients with Biomarkers of Alzheimer's Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 987:257-268. [PMID: 28971464 DOI: 10.1007/978-3-319-57379-3_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Prospective cohort studies, cross-sectional surveys, autopsy studies and intervention clinical trials that investigated the association between nutrients and Alzheimer's disease (AD) have been reviewed. To estimate the relationship between specific nutrient intake and the risk of AD, Cochrane Library, PubMed, EMBASE, and the Fisher Center for Alzheimer's Research Foundation were searched for this purpose. Most published observational studies found an inverse relationship between vitamins, n-3 fatty acids and AD. The majority of intervention studies support the beneficial effect of combined vitamins and n-3 fatty acids providing them in the early stages of the disease. Only vitamin E and Zn supplementation failed to show any significant difference on the study population. On the other hand, high dietary intake of saturated fat and brain metal accumulation were positively associated with the incidence of AD.
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Erfanparast A, Tamaddonfard E, Nemati S. Effects of intra-hippocampal microinjection of vitamin B 12 on the orofacial pain and memory impairments induced by scopolamine and orofacial pain in rats. Physiol Behav 2016; 170:68-77. [PMID: 27998753 DOI: 10.1016/j.physbeh.2016.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/05/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
Abstract
In the present study, we investigated the effects of microinjection of vitamin B12 into the hippocampus on the orofacial pain and memory impairments induced by scopolamine and orofacial pain. In ketamine-xylazine anesthetized rats, the right and left sides of the dorsal hippocampus (CA1) were implanted with two guide cannulas. Orofacial pain was induced by subcutaneous injection of formalin (1.5%, 50μl) into the right vibrissa pad, and the durations of face rubbing were recorded at 3-min blocks for 45min. Morris water maze (MWM) was used for evaluation of learning and memory. Finally, locomotor activity was assessed using an open-field test. Vitamin B12 attenuated both phases of formalin-induced orofacial pain. Prior administration of naloxone and naloxonazine, but not naltrindole and nor-binaltorphimine, prevented this effect. Vitamin B12 and physostigmine decreased latency time as well as traveled distance in Morris water maze. In addition, these chemicals improved scopolamine-induced memory impairment. The memory impairment induced by orofacial pain was improved by vitamin B12 and physostigmine used alone. Naloxone prevented, whereas physostigmine enhanced the memory improving effect of vitamin B12 in the pain-induced memory impairment. All the above-mentioned chemicals did not alter locomotor activity. The results of the present study showed that at the level of the dorsal hippocampus, vitamin B12 modulated orofacial pain through a mu-opioid receptor mechanism. In addition, vitamin B12 contributed to hippocampal cholinergic system in processing of memory. Moreover, cholinergic and opioid systems may be involved in improving effect of vitamin B12 on pain-induced memory impairment.
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Affiliation(s)
- Amir Erfanparast
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia 57153-1177, Iran.
| | - Esmaeal Tamaddonfard
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia 57153-1177, Iran
| | - Shaghayegh Nemati
- Division of Physiology, Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia 57153-1177, Iran
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Kim HY, Lee JS, Youn JC, Chang MJ. Food and nutrient intake status of Korean elderly by degree of cognitive function. ACTA ACUST UNITED AC 2016. [DOI: 10.4163/jnh.2016.49.5.313] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hye-Young Kim
- Department of Food & Nutrition, Yongin University, Yongin 17092, Korea
| | - Jung-Sug Lee
- Department of Food & Nutrition, Kookmin University, Seoul 02707, Korea
| | - Jong-Chul Youn
- Department of Neuropsychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin 17089, Korea
| | - Moon-Jeong Chang
- Department of Food & Nutrition, Kookmin University, Seoul 02707, Korea
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Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, Vandewoude M, Wirth R, Schneider SM. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34:1052-73. [PMID: 26522922 DOI: 10.1016/j.clnu.2015.09.004] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. OBJECTIVE It is the purpose of these guidelines to cover these issues with evidence-based recommendations. METHODS The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. RESULTS 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. CONCLUSION Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki (AUTH), Greece
| | - Gerd Faxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Krankenhaus Hietzing, Vienna, Austria
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Merja H Suominen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Vandewoude
- Department of Geriatrics, Medical School, University of Antwerp, Belgium
| | - Rainer Wirth
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany; St. Marien-Hospital Borken, Department for Internal Medicine and Geriatrics, Borken, Germany
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Nice, France
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Han Y, Xi Q, Dai W, Yang S, Gao L, Su Y, Zhang X. Abnormal transsulfuration metabolism and reduced antioxidant capacity in Chinese children with autism spectrum disorders. Int J Dev Neurosci 2015; 46:27-32. [DOI: 10.1016/j.ijdevneu.2015.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 06/20/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yu Han
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Qian‐qian Xi
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Wei Dai
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Shu‐han Yang
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Lei Gao
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Yuan‐yuan Su
- School of Public HealthTianjin Medical UniversityTianjinChina
| | - Xin Zhang
- School of Public HealthTianjin Medical UniversityTianjinChina
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Kim J, Yu A, Choi BY, Nam JH, Kim MK, Oh DH, Yang YJ. Dietary Patterns Derived by Cluster Analysis are Associated with Cognitive Function among Korean Older Adults. Nutrients 2015; 7:4154-69. [PMID: 26035243 PMCID: PMC4488778 DOI: 10.3390/nu7064154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/12/2015] [Indexed: 01/08/2023] Open
Abstract
The objective of this study was to investigate major dietary patterns among older Korean adults through cluster analysis and to determine an association between dietary patterns and cognitive function. This is a cross-sectional study. The data from the Korean Multi-Rural Communities Cohort Study was used. Participants included 765 participants aged 60 years and over. A quantitative food frequency questionnaire with 106 items was used to investigate dietary intake. The Korean version of the MMSE-KC (Mini-Mental Status Examination-Korean version) was used to assess cognitive function. Two major dietary patterns were identified using K-means cluster analysis. The "MFDF" dietary pattern indicated high consumption of Multigrain rice, Fish, Dairy products, Fruits and fruit juices, while the "WNC" dietary pattern referred to higher intakes of White rice, Noodles, and Coffee. Means of the total MMSE-KC and orientation score of the participants in the MFDF dietary pattern were higher than those of the WNC dietary pattern. Compared with the WNC dietary pattern, the MFDF dietary pattern showed a lower risk of cognitive impairment after adjusting for covariates (OR 0.64, 95% CI 0.44-0.94). The MFDF dietary pattern, with high consumption of multigrain rice, fish, dairy products, and fruits may be related to better cognition among Korean older adults.
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Affiliation(s)
- Jihye Kim
- Department of clinical nutrition, Graduate School of Health Sciences, Dongduk Women's University, 23-1 Wolgok-dong, Sungbuk-gu, Seoul 136-714, Korea.
| | - Areum Yu
- Department of clinical nutrition, Graduate School of Health Sciences, Dongduk Women's University, 23-1 Wolgok-dong, Sungbuk-gu, Seoul 136-714, Korea.
| | - Bo Youl Choi
- Department of Preventive Medicine, College of Medicine, Hanyang University, 17 Haengdang Dong, Sungdong Gu, Seoul 133-791, Korea.
| | - Jung Hyun Nam
- Department of Psychiatry, College of Medicine, Hanyang University, 17 Haengdang Dong, Sungdong Gu, Seoul 133-791, Korea.
| | - Mi Kyung Kim
- Department of Preventive Medicine, College of Medicine, Hanyang University, 17 Haengdang Dong, Sungdong Gu, Seoul 133-791, Korea.
| | - Dong Hoon Oh
- Department of Psychiatry, College of Medicine, Hanyang University, 17 Haengdang Dong, Sungdong Gu, Seoul 133-791, Korea.
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Ham AC, Enneman AW, van Dijk SC, Oliai Araghi S, Swart KMA, Sohl E, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RAM, van Schoor NM, van der Cammen TJM, Zillikens MC, de Jonge R, Lips P, de Groot LCPGM, van Meurs JBJ, Uitterlinden AG, Witkamp RF, Stricker BHC, van der Velde N. Associations between medication use and homocysteine levels in an older population, and potential mediation by vitamin B12 and folate: data from the B-PROOF Study. Drugs Aging 2015; 31:611-21. [PMID: 24993981 DOI: 10.1007/s40266-014-0192-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elevated homocysteine levels are a risk indicator for cardiovascular disease, fractures and cognitive decline. Previous studies indicated associations between homocysteine levels and medication use, including antihypertensive, lipid-lowering and antidiabetic medication. However, results were often contradictory and inconclusive. Our objective was to study the associations established previously in more detail by sub-classifying medication groups, and investigate the potential mediating role of vitamin B12 and folate status. MATERIALS AND METHODS Baseline data from the B-PROOF (B-vitamins for the PRevention Of Osteoporotic Fractures) study were used. We included 2,912 participants aged ≥65 years, with homocysteine levels of 12-50 μmol/L and creatinine levels ≤150 μmol/L, for whom self-reported medication data were available. We used multivariable linear regression models and analysis of covariance to assess the association between medication use and plasma homocysteine levels, and the potential mediation by serum vitamin B12 and folate. RESULTS The mean age was 74 years (standard deviation, 6.5), 50 % were women, and median homocysteine levels were 14 µmol/L [interquartile range, 13-17 µmol/L]. Higher mean homocysteine levels were observed in users vs. non-users for diuretics (15.2 vs. 14.9, p = 0.043), high-ceiling sulphonamide diuretics (16.0 vs. 14.9, p < 0.001), medication acting via the renin-angiotensin system (15.2 vs. 14.9, p = 0.029) and metformin (15.6 vs. 15.1, p = 0.006). Non-selective β-blocker use was associated with lower mean homocysteine levels (14.4 vs. 15.0, p = 0.019). Only this association was mediated by an underlying association with vitamin B12 and folate levels. CONCLUSION The associations between homocysteine levels and medication use appear to be fairly modest. Our results suggest that medication use is unlikely to contribute to clinically relevant changes in plasma homocysteine levels.
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Affiliation(s)
- Annelies C Ham
- Department of Internal Medicine, Erasmus MC, Geriatric Section, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Li M, Wang F, Huang Y, Du F, Zhong C, Olaleye OE, Jia W, Li Y, Xu F, Dong J, Li J, Lim JBR, Zhao B, Jia L, Li L, Li C. Systemic Exposure to and Disposition of Catechols Derived from Salvia miltiorrhiza Roots (Danshen) after Intravenous Dosing DanHong Injection in Human Subjects, Rats, and Dogs. Drug Metab Dispos 2015; 43:679-90. [DOI: 10.1124/dmd.114.061473] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimer's and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.
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Affiliation(s)
| | | | - Amanda McRae
- Department of Preclinical Sciences. Faculty of Medical Sciences, University of the West Indies, St Augustine
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Mitchell ES, Conus N, Kaput J. B vitamin polymorphisms and behavior: evidence of associations with neurodevelopment, depression, schizophrenia, bipolar disorder and cognitive decline. Neurosci Biobehav Rev 2014; 47:307-20. [PMID: 25173634 DOI: 10.1016/j.neubiorev.2014.08.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 07/11/2014] [Accepted: 08/18/2014] [Indexed: 11/16/2022]
Abstract
The B vitamins folic acid, vitamin B12 and B6 are essential for neuronal function, and severe deficiencies have been linked to increased risk of neurodevelopmental disorders, psychiatric disease and dementia. Polymorphisms of genes involved in B vitamin absorption, metabolism and function, such as methylene tetrahydrofolate reductase (MTHFR), cystathionine β synthase (CβS), transcobalamin 2 receptor (TCN2) and methionine synthase reductase (MTRR), have also been linked to increased incidence of psychiatric and cognitive disorders. However, the effects of these polymorphisms are often quite small and many studies failed to show any meaningful or consistent associations. This review discusses previous findings from clinical studies and highlights gaps in knowledge. Future studies assessing B vitamin-associated polymorphisms must take into account not just traditional demographics, but subjects' overall diet, relevant biomarkers of nutritional status and also analyze related genetic factors that may exacerbate behavioral effects or nutritional status.
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Affiliation(s)
- E Siobhan Mitchell
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland.
| | - Nelly Conus
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
| | - Jim Kaput
- Nestle Institute of Health Science, Innovation Park, EPFL Campus, Lausanne 1015, Switzerland
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Kim J, Yu A, Choi BY, Nam JH, Kim MK, Oh DH, Kim K, Yang YJ. Dietary patterns and cognitive function in Korean older adults. Eur J Nutr 2014; 54:309-18. [PMID: 24842708 DOI: 10.1007/s00394-014-0713-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 05/05/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The objectives of this study were to identify major dietary patterns and to investigate the association between dietary patterns and cognitive function in older adults. METHODS This is a cross-sectional study. The data from the Korean Multi-Rural Communities Cohort Study, which is a part of the Korean Genome Epidemiology Study, were used. There were 806 (340 men and 466 women) subjects aged ≥ 60 years. Usual dietary intake was assessed using a quantitative food frequency questionnaire with 106 food items. Cognitive function was assessed using the Korean version Mini-Mental State Examination (MMSE-KC). We conducted factor analysis using the principal component analysis method to identify the major dietary patterns. The association between major dietary patterns and cognitive function was investigated by logistic regression analysis. RESULTS Three major dietary patterns were identified and assigned descriptive names based on the food items with high loadings: "prudent" pattern, "bread, egg, and dairy" pattern, and "white rice only" pattern. As the white rice only pattern scores increased, a significant decreasing trend for MMSE-KC scores was observed after adjusting for covariates. The bread, egg, and dairy pattern was inversely related to the risk of cognitive impairment, and the white rice only pattern was positively associated with the risk of cognitive impairment. CONCLUSIONS This study suggests that specific dietary patterns were significantly associated with cognitive impairment in older adults. In particular, like the white rice only pattern, a rice-centered diet without well-balanced meals may increase the risk of cognitive impairment. However, since our study is a cross-sectional design, the possibility of reverse causality should be considered.
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Affiliation(s)
- Jihye Kim
- Department of Clinical Nutrition, Graduate School of Health Sciences, Dongduk Women's University, 23-1 Wolgok-dong, Sungbuk-gu, Seoul, 136-714, Republic of Korea
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Dietary and lifestyle guidelines for the prevention of Alzheimer's disease. Neurobiol Aging 2014; 35 Suppl 2:S74-8. [PMID: 24913896 DOI: 10.1016/j.neurobiolaging.2014.03.033] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/04/2014] [Accepted: 03/14/2014] [Indexed: 12/16/2022]
Abstract
Risk of developing Alzheimer's disease is increased by older age, genetic factors, and several medical risk factors. Studies have also suggested that dietary and lifestyle factors may influence risk, raising the possibility that preventive strategies may be effective. This body of research is incomplete. However, because the most scientifically supported lifestyle factors for Alzheimer's disease are known factors for cardiovascular diseases and diabetes, it is reasonable to provide preliminary guidance to help individuals who wish to reduce their risk. At the International Conference on Nutrition and the Brain, Washington, DC, July 19-20, 2013, speakers were asked to comment on possible guidelines for Alzheimer's disease prevention, with an aim of developing a set of practical, albeit preliminary, steps to be recommended to members of the public. From this discussion, 7 guidelines emerged related to healthful diet and exercise habits.
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Rauh-Pfeiffer A, Handel U, Demmelmair H, Peissner W, Niesser M, Moretti D, Martens V, Wiseman S, Weichert J, Heene M, Bühner M, Koletzko B. Three-month B vitamin supplementation in pre-school children affects folate status and homocysteine, but not cognitive performance. Eur J Nutr 2014; 53:1445-56. [PMID: 24481688 DOI: 10.1007/s00394-013-0647-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/18/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Suboptimal vitamin B status might affect cognitive performance in early childhood. We tested the hypothesis that short-term supplementation with folic acid and selected B vitamins improves cognitive function in healthy children in a population with relatively low folate status. METHODS We screened 1,002 kindergarten children for suboptimal folate status by assessing the total urinary para-aminobenzoylglutamate excretion. Two hundred and fifty low ranking subjects were recruited into a double blind, randomized, controlled trial to receive daily a sachet containing 220 μg folic acid, 1.1 mg vitamin B2, 0.73 mg B6, 1.2 μg B12 and 130 mg calcium, or calcium only for 3 months. Primary outcomes were changes in verbal IQ, short-term memory and processing speed between baseline and study end. Secondary outcomes were urinary markers of folate and vitamin B12 status, acetyl-para-aminobenzoylglutamate and methylmalonic acid, respectively, and, in a subgroup of 120 participants, blood folate and plasma homocysteine. RESULTS Pre- and post-intervention cognitive measurements were completed by 115 children in the intervention and 122 in the control group. Compared to control, median blood folate increased by about 50% (P for difference, P < 0.0001). Homocysteine decreased by 1.1 μmol/L compared to baseline, no change was seen in the control group (P for difference P < 0.0001) and acetyl-para-aminobenzoylglutamate was 4 nmol/mmol higher compared to control at the end of the intervention (P < 0.0001). We found no relevant differences between the groups for the cognitive measures. CONCLUSION Short-term improvement of folate and homocysteine status in healthy children does not appear to affect cognitive performance.
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Affiliation(s)
- Astrid Rauh-Pfeiffer
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Lindwurmstraße 4, 80337, Munich, Germany,
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Abstract
Optimal functioning of the central and peripheral nervous system is dependent on a constant supply of appropriate nutrients. Particularly important for optimal functioning of the nervous system is cobalamin (vitamin B12). Cobalamin deficiency is particularly common in the elderly and after gastric surgery. Many patients with clinically expressed cobalamin deficiency have intrinsic factor-related malabsorption such as that seen in pernicious anemia. The commonly recognized neurological manifestations of cobalamin deficiency include a myelopathy with or without an associated neuropathy. This review deals with neurological aspects of vitamin B12 deficiency and attempts to highlight recent developments.
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Affiliation(s)
- Neeraj Kumar
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Abstract
A large number of causal agents produce spinal cord lesions in the tropics. Most etiologies found in temperate regions also occur in the tropics including trauma, herniated discs, tumors, epidural abscess, and congenital malformations. However, infectious and nutritional disorders occur with higher prevalence in tropical regions. Among the most common infectious etiologies are tuberculous Pott's disease, brucellosis, and neuroborreliosis. Parasitic diseases such as schistosomiasis, neurocysticercosis, and eosinophilic meningitis are frequent causes of nontraumatic paraplegia. The retrovirus HTLV-1 is a cause of tropical spastic paraparesis. Nutritional causes of paraparesis include deficiencies of vitamin B12 and folate; endemic clusters of konzo and tropical ataxic myeloneuropathy are associated in Africa with malnutrition and excessive consumption of cyanide-containing bitter cassava. Other toxic etiologies of tropical paraplegia include lathyrism and fluorosis. Nutritional forms of myelopathy are associated often with optic and sensory neuropathy, hence the name tropical myeloneuropathies. Acute transverse myelopathy is seen in association with vaccination, infections, and fibrocartilaginous embolism of the nucleus pulposus. Multiple sclerosis and optic myelopathy occur in the tropics but with lesser prevalence than in temperate regions. The advent of modern imaging in the tropics, including computed tomography and magnetic resonance imaging, has allowed better diagnosis and treatment of these conditions that are a frequent cause of death and disability.
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Kim H, Lee KJ. Serum homocysteine levels are correlated with behavioral and psychological symptoms of Alzheimer's disease. Neuropsychiatr Dis Treat 2014; 10:1887-96. [PMID: 25336954 PMCID: PMC4200070 DOI: 10.2147/ndt.s68980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Homocysteine has been associated with cognitive impairment and various psychiatric symptoms. This study was designed to clarify whether a relationship exists between the serum levels of homocysteine and the behavioral and psychological symptoms of dementia. METHODS Patients with Alzheimer's disease (n=77) and control subjects (n=37) were included in this study. History taking, physical examination, and cognitive assessment were carried out as part of the investigation for the diagnosis of Alzheimer's disease based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The Mini-Mental State Examination, Global Deterioration Scale, Clinical Dementia Rating, and the Korean version of the Neuropsychiatric Inventory were applied to all patients. The patients' serum homocysteine, folate, and vitamin B12 levels were measured. RESULTS Patients with Alzheimer's disease had statistically significantly lower Mini-Mental State Examination scores and higher serum homocysteine levels compared to the control subjects. Mean serum folate and vitamin B12 concentration were significantly lower in patients with Alzheimer's disease compared to control subjects. A statistically significant positive correlation was found between the serum homocysteine levels and the Neuropsychiatric Inventory subdomains, including delusion, agitation/aggression, depression/dysphoria, elation/euphoria, apathy/indifference, and disinhibition. No statistically significant correlation was found between the serum homocysteine concentration and the Mini-Mental State Examination, Global Deterioration Scale, or Clinical Dementia Rating. CONCLUSION Associations between the serum homocysteine levels and behavioral and psychological symptoms of dementia were observed, raising the possibility of an etiological role. However, the correlations between the folate or vitamin B12 levels and the Neuropsychiatric Inventory scores were not significant. The pathophysiological mechanisms underlying these findings remain to be elucidated. This was a cross-sectional study and the findings should be confirmed by repetitive, prospective longitudinal studies in a larger group of patients with neurodegenerative disorders.
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Affiliation(s)
- Hyun Kim
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Kang Joon Lee
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
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Andreeva VA, Galan P, Arnaud J, Julia C, Hercberg S, Kesse-Guyot E. Midlife iron status is inversely associated with subsequent cognitive performance, particularly in perimenopausal women. J Nutr 2013; 143:1974-81. [PMID: 24089418 DOI: 10.3945/jn.113.177089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The link between iron status and cognition has been established in infants and children, yet evidence in adults is scant and heterogeneous. We examined sex- and menopause-specific cross-time associations of iron status with cognition in the French Supplémentation en Vitamines et Minéraux Antioxydants Study cohort (1539 men, 1431 pre-/perimenopausal women, 962 postmenopausal women). Serum ferritin and hemoglobin data were obtained in 1995. Cognition was assessed after a mean of 13 y through 6 validated instruments, including the RI-48 cued recall test, phonemic and semantic fluency tasks, forward and backward digit span tasks, and a trail-making test. The standardized individual test scores were summed to form a composite cognitive performance measure. Associations between ferritin and hemoglobin and subsequent cognitive performance were examined through multivariable linear regression. Among men, no significant associations were observed. In postmenopausal women, an inverse association was found between ferritin and phonemic fluency (adjusted β: -0.11; 95% CI: -0.21, -0.01). Significant inverse associations between ferritin and both the composite cognitive measure (adjusted β: -0.09; 95% CI: -0.17, -0.00) and the forward digit span scores (adjusted β: -0.13; 95% CI: -0.22, -0.03) were observed only among premenopausal women aged ≥ 46 y at baseline. No significant findings with hemoglobin emerged. This study supports an inverse association between midlife iron status and subsequent cognitive performance that is sex- and menopause-dependent. Given the urgent need for prevention research on age-related disorders, future investigations of iron status and cognition are warranted. The study is registered at www.clinicaltrials.gov as NCT00272428.
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Affiliation(s)
- Valentina A Andreeva
- Nutritional Epidemiology Research Unit, Sorbonne-Paris-Cité, UMR University of Paris XIII, INSERM U557/INRA U1125/CNAM, Bobigny, France; 4CHU Institut de Biologie et Pathologie, Unité de Biochimie Hormonale et Nutritionnelle, INSERM U1055, Grenoble, France 5Department of Public Health, Avicenne Hospital, Bobigny, France
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Interactions between plasma concentrations of folate and markers of vitamin B(12) status with cognitive performance in elderly people not exposed to folic acid fortification: the Hordaland Health Study. Br J Nutr 2013; 111:1085-95. [PMID: 24229560 DOI: 10.1017/s000711451300336x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A combination of high folate with low vitamin B12 plasma status has been associated with cognitive impairment in a population exposed to mandatory folic acid fortification. The objective of the present study was to examine the interactions between plasma concentrations of folate and vitamin B12 markers in relation to cognitive performance in Norwegian elderly who were unexposed to mandatory or voluntary folic acid fortification. Cognitive performance was assessed by six cognitive tests in 2203 individuals aged 72-74 years. A combined score was calculated using principal component analysis. The associations of folate concentrations, vitamin B12 markers (total vitamin B12, holotranscobalamin (holoTC) and methylmalonic acid (MMA)) and their interactions in relation to cognitive performance were evaluated by quantile regression and least-squares regression, adjusted for sex, education, apo-ɛ4 genotype, history of CVD/hypertension and creatinine. Cross-sectional analyses revealed an interaction (P= 0·009) between plasma concentrations of folate and vitamin B12 in relation to cognitive performance. Plasma vitamin B12 concentrations in the lowest quartile ( < 274 pmol/l) combined with plasma folate concentrations in the highest quartile (>18·5 nmol/l) were associated with a reduced risk of cognitive impairment compared with plasma concentrations in the middle quartiles of both vitamins (OR 0·22, 95 % CI 0·05, 0·92). The interaction between folate and holoTC or MMA in relation to cognitive performance was not significant. In conclusion, this large study population unexposed to mandatory folic acid fortification showed that plasma folate, but not plasma vitamin B12, was associated with cognitive performance. Among the elderly participants with vitamin B12 concentrations in the lower range, the association between plasma folate and cognitive performance was strongest.
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Ahmad S, Kumar KA, Basak T, Bhardwaj G, Yadav DK, Lalitha A, Chandak GR, Raghunath M, Sengupta S. PPAR signaling pathway is a key modulator of liver proteome in pups born to vitamin B12 deficient rats. J Proteomics 2013; 91:297-308. [DOI: 10.1016/j.jprot.2013.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/22/2013] [Accepted: 07/26/2013] [Indexed: 02/02/2023]
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