Understanding cognitive frailty in aging adults: prevalence, risk factors, pathogenesis and non-pharmacological interventions

The worldwide increase in the aged population raises health concerns for elderly individuals. Cognitive frailty of the elderly (apart from those suffering from Alzheimer´s disease or other type of dementia) is a complex construct associated with aging, which is composed of physical and cognitive components, while physical frailty and cognitive impairment mutually affect each other. Although the prevalence of cognitive frailty in community-dwelling older adults without neurodegenerative disease is low, it can rise dramatically in clinical settings. Early identification of this condition can contribute to delaying the adverse outcomes that lead to higher mortality rates. This review aims to define cognitive frailty, its prevalence, risk factors, and pathogenesis, while highlighting the need for further research on identification, prevention, and non-pharmacological management of cognitive frailty in older adults in view of promoting healthy aging and secondary prevention strategies for dementia (Fig. 1, Ref. 93). Keywords: cognitive frailty, older adults, risk factors, nutrition, exercise.

Improvement in cardiovascular risk markers by the combined effect of natural polyphenols and vitamins in patients after kidney transplantation

OBJECTIVES

The aim of this study was to evaluate the potential of supportive therapy by natural polyphenols combined with vitamins C and E on kidney function and risk factors of cardiovascular diseases in renal transplant recipients (RTR).

BACKGROUND

Transplant patients have an altered lipid profile associated with the development of cardiovascular disease, which is a major cause of graft loss and mortality in patients.

METHODS

The study included 29 renal transplant recipients with mean graft function levels. The lipoprotein (atherogenic and non-atherogenic) subfractions were identified and quantified in plasma by polyacrylamide gel electrophoresis.

RESULTS

After supplementation, glomerular filtration rate (GFR) was increased by 8 %, serum creatinine was decreased by 6.7 % and significant changes were found in atherogenic LDL subfractions. The effect of supplementation was observed in arylesterase and lactonase activities of paraoxonase 1 which increased by 9.3 % and 8.1 %, respectively. In addition, significantly decreased levels of neopterin (by 16 %) and asymmetric dimethylarginine (ADMA) (by 7.9 %) were found.

CONCLUSION

We could summarize that supportive therapy improves the renal function (GFR, serum creatinine), and reduces the risk of cardiovascular disease by affecting important risk markers of atherosclerosis (lipid profile, paraoxonase 1 activity, neopterin and ADMA) in RTR (Tab. 4, Fig. 1, Ref. 53).

Gender differences in LDL and HDL subfractions in atherogenic and nonatherogenic phenotypes

OBJECTIVES

The aim of our study was to examine the role of low density lipoprotein (LDL)-subfractions in individuals with the atherogenic and non-atherogenic phenotype and the gender differences in lipoprotein subfractions including small dense LDL (sdLDL) and small high density lipoprotein (sHDL) subfractions representing the most atherogenic lipoprotein subfractions.

DESIGN & METHODS

35 persons in the atherogenic group (AG) (with sdLDL_3-7 subfractions ≥6 mg/dl) and 104 individuals in the non-atherogenic group (NAG) (sdLDL_3-7 subfractions <6 mg/dl) were included in our study. To analyze plasma lipoprotein subfractions, a polyacrylamide gel electrophoresis-the Lipoprint system was used.

RESULTS

Males compared to females in the AG had significantly higher levels of atherogenic lipoprotein subfractions such as HDL_8, HDL₉ and HDL₁₀. All participants in AG had significantly lower levels of intermediate density lipoprotein IDL-A than those in NAG but significantly higher levels of IDL-B and IDL-C. Males in the AG compared to NAG had significantly lower levels of LDL₁ and higher levels of LDL₂ and LDL_3-7 subfractions. In the NAG LDL₂ positively correlated with sHDL subfractions while in the AG with the large HDL subfraction.

CONCLUSION

Results of our study demonstrate more atherogenic profile in males compared to females and a double role of LDL2 subfraction in the atherogenic process depending on the phenotype (atherogenic/non-atherogenic) of individuals.

Effect of natural polyphenols on thromboxane levels in children with Crohn's disease

OBJECTIVES

The aim of this study was to investigate the relationship between thromboxane levels and oxidative stress in children with Crohn´s disease (CD), and examine the effect of natural polyphenolic compounds on thromboxane levels.

METHODS

This study involved 14 children suffering from CD and 15 healthy controls. Patients were receiving the polyphenolic extract Pycnogenol for 10 weeks. Plasma levels of the static and dynamic forms of thromboxane B2 as well as their metabolite 11-dehydro thromboxane B2 in urine were determined.

RESULTS

In comparison to controls, CD patients had significantly higher levels of the static and dynamic forms of thromboxane B2. Pycnogenol decreased the level of the dynamic form of thromboxane B2 after 10 weeks of administration.

CONCLUSIONS

Paediatric Crohn's disease is associated with higher thromboxane levels. Our results indicate that Pycnogenol administration reduces thromboxane levels, which may positively influence some clinical symptoms of CD such as thromboembolic episodes (Tab. 3, Ref. 49).

Natural polyphenols improve erectile function and lipid profile in patients suffering from erectile dysfunction

OBJECTIVES

Erectile dysfunction (ED) is characterised as the inability to achieve or maintain an erection to complete sexual intercourse. ED may be considered as an early complication of diabetes mellitus (DM). The aim of this study was to assess the effect of registered food supplement, natural polyphenolic extract from the French maritime pine bark, Pycnogenol (PYC) on erectile function and lipid profile in ED patients.

METHODS

53 patients with ED were divided into two groups (32 with DM, 21 non-DM) in randomised, blinded and placebo-controlled study. During 3-month intervention with PYC or placebo and one month after the end of the intervention patients were investigated for ED with validated questionnaire International Index of Erectile Function-5 (IIEF-5); lipid profile, glycaemia was analysed in each group.

RESULTS

In a randomised, blinded and placebo-controlled study, we found that natural polyphenolic extract, Pycnogenol improved erectile function in DM group by 45 % compared to the NDM group, where the improvement was also significant, but only by 22 %. Total cholesterol, LDL-cholesterol and glucose level was lowered by PYC in patients with DM. Glucose level was not affected by PYC in non-DM. Placebo showed no effect on monitored parameters in both groups.

CONCLUSION

Administration of Pycnogenol leads in improvement of erectile function in patients with ED and diabetes (DM group) by 45 %, in NDM group by 22 %, in lowering of total-, LDL-cholesterol by 20 % and 21 % and glycaemia by 22 % in DM (Tab. 2, Fig. 2, Ref. 19).

Rat liver intoxication with CCl4: biochemistry, histology, and mass spectrometry

This work provides complex characterisation of cirrhotic rat liver tissue induced by carbon tetrachloride using biochemical and histopathological analyses, and also presents a novel approach, secondary ion mass spectrometry (SIMS). According to our knowledge, this is the first report that compares these three different approaches in study of liver damage. We observed increased levels of triacylglycerols and total cholesterol in the liver and decreased levels of those parameters in the plasma. Histopathological observations include fat accumulation in the cells and changes in internal configuration of cells such as shift of position of organelles from the centre to the edge. The damage to the rat tissue is additionally determined by SIMS analysis, which characterizes, among other substances, diacylglycerols, cholesterol and fatty acids, such as linoleic and oleic acids. Interestingly, unlike other observed particles, a marked difference in SIMS intensity for diacylglycerol C37H69O4 positive fragment at 575.5 m/u was observed. In fact, there was one order of magnitude difference between intoxicated liver samples and controls and this molecular signal seems to be a potential chemical indicator of the damage. The SIMS images are consistent with histopathological results and they additionally provide information about distribution of chemical compound which is a new potential tool for the liver disease characterisation on molecular level.

Sex differences in the blood antioxidant defense system in juvenile rats with various genetic predispositions to hypertension

This study investigated the contribution of blood oxidative stress (OS) to the development of hypertension, as well as sex differences in the antioxidant defense system (ADS) in genetic models of hypertension. Nine-week-old normotensive Wistar-Kyoto (WKY) rats, borderline hypertensive rats (BHR) and spontaneously hypertensive rats (SHR) of both sexes were used. Systolic blood pressure (SBP) was determined by tail-cuff plethysmography, the trolox equivalent antioxidant capacity (TEAC) and the concentration of lipid peroxides (LP) were determined in plasma. The activity of the antioxidant enzymes Cu/Zn-superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) was determined in erythrocytes. SBP was significantly elevated in BHR and SHR in both sexes. BHR and SHR males had a higher SBP than the respective females. Sex-dependent differences in the ADS were found only in SHR, in which TEAC, SOD and CAT were significantly higher in males than in females. No differences in TEAC, SOD, CAT and GPx were observed between BHR (males and females) and WKY controls. LP levels were similar in all the groups investigated. Significant positive correlations were observed between SBP and both SOD and CAT. TEAC correlated positively with SOD and LP. As no signs of oxidative damage to lipids were found in young BHR and SHR of either sex, OS in the blood does not seem to be causatively related to the development of hypertension in these rats. However, despite activated antioxidant defenses, the positive correlation between plasma TEAC and LP suggests that oxidative damage is progressing slowly and therefore it seems to be a consequence rather than the cause of hypertension.

French maritime pine bark extract (Pycnogenol®) reduces thromboxane generation in blood from diabetic male rats

The protective effect of Pycnogenol against cardiovascular diseases was clearly demonstrated. Nevertheless, little is known about its antithrombotic effect, especially in diabetes associated with enhanced thromboxane synthesis leading to severe vascular complications. Therefore, the main purpose of our study was to evaluate the effect of long-term Pycnogenol intake on synthesis of prothrombotic thromboxane A(2) (TXA(2)) in animal model of insulin-dependent diabetes. The levels of main plasma TXA(2) metabolite, thromboxane B(2) (TXB(2)), were assessed by enzyme-linked immunosorbent assay. Diabetes was induced in Wistar male rats by single injection of streptozotocin, resulting after 8 weeks in significant body weight reduction, increased plasma glucose concentrations, and decreased plasma C-peptide levels, compared to non-diabetic animals. There was no significant reduction of plasma glucose concentrations after Pycnogenol ingestion. It was found, however, that daily administration of either Pycnogenol (5mg/kg b.wt.) or acetylsalicylic acid (ASA, 10mg/kg b.wt.) significantly reduced plasma TXB(2) concentrations, and this inhibitory effect was higher in the latter case. Nonetheless, simultaneous administration of Pycnogenol and ASA did not improve effectiveness of ASA-mediated decrease in TXB(2) generation. The results of the present study suggest that Pycnogenol might have a beneficial antithrombotic effect when administered alone or as a supplementation of standard antiplatelet therapy in diabetic patients.

The redox state of glutathione in erythrocytes of individuals with Down syndrome

BACKGROUND

The redox state of glutathione has been used as indicator for the redox environment of the cell.

OBJECTIVES

To investigate relationships between the redox environments, the SOD activity, total antioxidant status and the oxidation stress markers production (MDA and lipofuscin).

METHODS

Individuals with Down syndrome and age-matched healthy controls were enrolled into a study. Some parameters of oxidative stress in serum were determined: reduced glutathione, oxidized glutathione, redox potential of this couple (Eh), activity of superoxide dismutase in the red blood cells as well as malondialdehyde and lipofuscin.

RESULTS

In the group of persons with DS statistically significant decrease in the GSH concentration was found, however, no differences in the GSSG concentration versus controls was observed. The redox potential values for couple GSH/GSSG are a statistically significantly increased in DS individuals compared to controls.

CONCLUSION

In this study we highlighted the different ways of view at the role of GSH in metabolism of persons with DS. It is useful to look at the GSH and GSSG concentrations separately as well as at redox potential value, which influence total redox state of organism (Tab. 2, Fig. 3, Ref. 30) Full Text (Free, PDF) www.bmj.sk.

Does pycnogenol intensify the efficacy of acetylsalicylic acid in the inhibition of platelet function? In vitro experience

INTRODUCTION

Some compounds of herbal origin, such as Pycnogenol (PYC), have been considered as an aid in antiplatelet therapy. Pycnogenol, a French maritime pine bark extract, is a complex mixture of polyphenols that has the ability to reduce human smoking-induced platelet aggregation. The aim of this study was to evaluate the in vitro ability of PYC to improve the efficacy of acetylsalicylic acid (ASA) in the inhibition of platelet function.

MATERIAL/METHODS

Whole blood, anticoagulated with hirudin, was drawn from 38 volunteers (40.4+/-13.8 years old) and incubated with PYC (10, 50, 100 microg/ml) or/and ASA (25, 100 micromol/l) for 20 min at RT.PYC was dissolved in water (water-PYC group, n=20) or ethanol (ethanol-PYC group, n=18). To investigate platelet functions, PFA-100 closure-time determination, whole-blood electrical aggregation (WBEA), and PRP aggregation were employed. Collagen (1 microg/ml) and ADP (5 micromol/l) were used as platelet agonists.

RESULTS

A compounding effect of ASA and PYC to inhibit platelet function recorded in collagen-induced aggregation in PRP was observed, but only when ethanol-dissolved PYC was used. The inhibitory effect of PYC (alone) was most profound in platelets activated with ADP. At all concentrations, PYC significantly inhibited platelet aggregation only in the ethanol-PYC group.

CONCLUSIONS

It was found that under in vitro conditions, ethanol-dissolved PYC deepened the efficacy of ASA to inhibit platelet function. This study confirmed the direct and compounding (with ASA) inhibitory effect of PYC on platelets. These observations encourage the concept that the combined use of ASA and PYC may be beneficial in patients with impaired response to ASA therapy.