Immunogenicity and Reactogenicity of Messenger RNA Coronavirus Disease 2019 Vaccine Booster Administered by Intradermal or Intramuscular Route in Thai Older Adults

BACKGROUND

Intradermal (ID) vaccination may alleviate COVID-19 vaccine shortages and vaccine hesitancy.

METHODS

Persons aged ≥65 years who were vaccinated with 2-dose ChAdOx1 12-24 weeks earlier were randomized to receive a booster vaccination by either ID (20 µg mRNA-1273 or 10 µg BNT162b2) or intramuscular (IM) (100 µg mRNA-1273 or 30 µg BNT162b2) route. Anti-receptor-binding domain (RBD) immunoglobulin G (IgG), neutralizing antibody (NAb), and interferon gamma (IFN-γ)-producing cells were measured at 2-4 weeks following vaccination.

RESULTS

Of 210 participants enrolled, 70.5% were female and median age was 77.5 (interquartile range, 71-84) years. Following booster dose, both ID vaccinations induced 37% lower levels of anti-RBD IgG compared with IM vaccination of the same vaccine. NAb titers against ancestral and Omicron BA.1 were highest following IM mRNA-1273 (geometric mean, 1718 and 617), followed by ID mRNA-1273 (1212 and 318), IM BNT162b2 (713 and 230), and ID BNT162b2 (587 and 148), respectively. Spike-specific IFN-γ responses were similar or higher in the ID groups compared with IM groups. ID route tended to have fewer systemic adverse events (AEs), although more local AEs were reported in the ID mRNA-1273 group.

CONCLUSIONS

Fractional ID vaccination induced lower humoral but comparable cellular immunity compared to IM and may be an alternative for older people.

CLINICAL TRIALS REGISTRATION

TCTR20220112002.

Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic

BACKGROUND

Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation.

METHODS

A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control.

RESULTS

The main diagnoses of dementia were Alzheimer's disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson's disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms.

CONCLUSIONS

Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.

The benefits of a novel chicken-based oral nutritional supplement for older adults: A double-blind randomized controlled trial

BACKGROUND AND OBJECTIVES

A considerable proportion of older adults are lactose intolerant. The aim of this study was to investigate the clinical safety, efficacy, and tolerability of a chicken-based oral nutritional supplement (ONS).

METHODS AND STUDY DESIGN

Double-blind randomized controlled trial. Subjects in the intervention group received chicken-based ONS, and those in the control group received a similarly flavored oral fluid placebo. All subjects were followed-up every two months for a total of 6 months.

RESULTS

Thirty-eight older adults aged ≥70 years were recruited. The mean age and BMI were 81.5±5.6 years and 19.6±2.5 kg/m2. At the end of this trial, there was no statistically significant change in sarcopenia-related variables in the intervention group. However, the higher-level physical activity (PA) group within the intervention group had a significantly improved usual gait speed (UGS) compared to the lower-level PA group (p=0.04). The adjusted mean differences in UGS between the high and low level PA groups in the intervention and placebo groups were 0.149 m/sec and 0.083 m/sec, respectively. Significant difference was observed for changes in two bone markers between the intervention and placebo groups.

CONCLUSIONS

The chicken-based ONS evaluated in this study was well-tolerated. No improvement of sarcopenia-related components was shown by the study ONS. Up to nearly an 80% increase in adjusted mean difference in UGS between the high and low level PA groups was observed in the nutritional intervention group compared to the zero-protein calorie placebo group. Significant improvement in age-related bone resorption was the earliest advantage of taking our ONS.

Medication nonadherence in elderly patients in a Thai geriatric clinic

Background: Medication nonadherence is common in elderly patients and is a major cause of morbidity. However, it is not well-described in the literature and to our knowledge has never been studied in Thais.

Objective: To investigate the extent, causes, and contributing factors of medication nonadherence in older patients in a geriatric clinic.

Material and Methods: We conducted a cross-sectional study at Siriraj Hospital, a university teaching hospital in Bangkok. We assessed baseline demographic data, comorbid diseases, Thai Mental State Examination (TMSE), functional status (basic and basic activities of daily living), type and number of medications used, and medication adherence.

Results: There were 153 participants in this study. Medication nonadherence, in the administration of prescribed drugs only, was found in 34% of the participants. Nonadherence to administration of prescribed drugs and to the advice regarding over-the-counter drugs was 42.5%. Nonadherence to the administration of prescribed drugs and to the advice regarding over-the-counter drugs, and herbal and dietary supplements was 54.9%. Three most common causes of medication nonadherence were misunderstanding or lack of the knowledge (25.6%), the development of adverse drug events (18.9%), and because of a suggestion by a friend or family member (16.2%).

Conclusion: Medication nonadherence is common in elderly Thais attending geriatric clinics. We recommend clinicians be aware of this problem and develop a system to improve medication adherence. The clarification of reasons for prescribing is crucial. We recommend emphasis on educating patients, family members, and the public about the risk of nonadherence and of using nonprescribed medications.

Health expectancies in the older Thai population

This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005-2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.

Caregiver burden and needs of dementia caregivers in Thailand: a cross-sectional study

OBJECTIVE

To identify the burdens of Thai dementia caregivers and to determine the services that could support them in this function.

MATERIAL AND METHOD

The authors surveyed 88 dementia caregivers attending "Caregiver Day". The questionnaire contained Caregiver Burden Inventory. The answers range from "not at all descriptive" (zero) to "very descriptive" (4). The authors also explored baseline characteristics of caregivers and care recipients as well as caregiver's needs of a supporting system.

RESULTS

There was an 82% response rate. Responses in time-dependence burden distributed almost equally in the five possible scales. In developmental and physical burden, caregivers rate scores mainly from 0-2. The scores in social and emotional burden ranged mainly between 0-1. Dependency in basic activities of daily living correlated with higher caregiver burden (odd ratio 7.48, 95% confidence interval 1.42-39.53, p = 0.02), while sex and kinship did not. The top three caregiver's needs were 1) caregiver education and training, 2) telephone line provided for caregiver consultation and 3) special system in a hospital provided for dementia patients to have rapid access to see a doctor.

CONCLUSION

Caring for dementia patients can lead to high caregiver burden, particularly those caring for dependent patients. Physical and developmental burdens are affected more than social and emotional burdens. Culture, relationship quality and resources (coping, outlook on life and social support) might be contributing factors of this difference.

Digit span and verbal fluency tests in patients with mild cognitive impairment and normal subjects in Thai-community

BACKGROUND

Far too little attention has been paid to the difference of Digit Span test and category verbal fluency test (CVFT) between normal and mild cognitive impairment (MCI) subjects.

OBJECTIVE

To investigate the difference of Digit Span test and CVFT between normal subjects and patients with MCI and study the influence of age, gender, and education on the task performance.

MATERIAL AND METHOD

The authors collected data of 77 participants diagnosed with amnestic MCI (from 517 participants screened) and 30 normal subjects aged 50 or over enrolled from communities in Bangkok. The Digit Span test and CVFT (semantic fluency and Controlled word association test for letter fluency) were used to evaluate the subjects.

RESULTS

MCI patients had significantly lower digit span score, in both Digits Forward and Digits Backward, poorer performance on semantic fluency for animals and fruits and letter fluency test. The logistic regression model of MCI diagnosis showed that only Digits Backward score was a predictor of MCI diagnosis (OR 0.643 for each increment of 1 digit, p = 0.009, 95% confidence interval 0.462-0.896). The cut-off point of Digit Backward score was 4 and yielded sensitivity of 77% and specificity of 57%. Females had lower scores than males in every test except semantic fluency for fruits. The digit span and semantic fluency scores decreased as age increased but letter fluency increased correspondently with age. The digit span and CVFT scores increased in parallel with the increase of education.

CONCLUSION

MCI patients had poorer performance on the Digit Span and CVFT tests than normal age and education matched subjects. Digits Backward test can predict the MCI diagnosis. Age, gender and education have an impact on the performance of the tests.

Neuropsychiatric symptoms in the community-based patients with mild cognitive impairment and the influence of demographic factors

OBJECTIVE

To investigate the pattern of neuropsychiatric symptoms of MCI patients in the Thai population and the influence of demographic factors on the symptoms.

METHODS

One hundred and seven participants aged 50 and over diagnosed with MCI (n = 77) and normal (n = 30) were recruited from a community-based unit. The Neuropsychiatric Inventory (NPI) was used to assess behavioral disturbances in the subjects.

RESULTS

Compared to normal subjects, MCI patients had higher incidence of anxiety (53% vs 27%, p = 0.013), dysphoria (46% vs 17%, p = 0.006), and sleep problem (45% vs 23%, p = 0.035). Although marginally significant, apathy was more common in MCI patients (12% vs 0%, p = 0.059). The mean total NPI score and NPI distress score were higher in the MCI group (6.8 vs 1.9, p < 0.0005 and 2.9 vs 0.6, p = 0.01, respectively). The MCI patients aged over 65 had higher incidence of hallucinations (18.9% vs 0%, p = 0.018). Males and patients of poor financial status had higher percentage of dysphoria compared to female and patients with better financial status (65% vs 38.5%, p = 0.041 and 75% vs 37.9%, p = 0.008, respectively). Patients with poor financial status also had higher percentage of anxiety (81.3% vs 44.5%, p = 0.01).

CONCLUSIONS

MCI is associated with significant neuropsychiatric symptoms which caused caregiver distress. In this study, the pattern of neuropsychiatric symptoms in a Thai MCI population was similar to those reported in western countries. Age, sex, educational level and financial status influenced the neuropsychiatric symptoms of MCI patients.