Cholinergic neurons of the medial forebrain are considered important contributors to brain plasticity and neuromodulation. A reduction of cholinergic innervation can lead to pathophysiological ...changes of neurotransmission and is observed in Alzheimer's disease. Here we report on six patients with mild to moderate Alzheimer's disease (AD) treated with bilateral low-frequency deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM). During a four-week double-blind sham-controlled phase and a subsequent 11-month follow-up open label period, clinical outcome was assessed by neuropsychological examination using the Alzheimer's Disease Assessment Scale-cognitive subscale as the primary outcome measure. Electroencephalography and (18)F-fluoro-desoxyglucose positron emission tomography were, besides others, secondary endpoints. On the basis of stable or improved primary outcome parameters twelve months after surgery, four of the six patients were considered responders. No severe or non-transitional side effects related to the stimulation were observed. Taking into account all limitations of a pilot study, we conclude that DBS of the NBM is both technically feasible and well tolerated.
Background
Anemia and hypoalbuminemia (HA) are acknowledged independent risk factors for morbidity and mortality in geriatric patients and are associated with nutritional status and frailty. Data ...exist regarding the association between albumin and frailty, anemia and frailty as well as frailty and nutritional status; however, there is a lack of information on the association between HA, anemia and nutritional status in older people.
Patients and methods
This study retrospectively analyzed 626 patients admitted to a German geriatrics department (average age 81.1 years, 68.2 % female and 31.8 % male) for anemia and HA. Data from the comprehensive geriatric assessment (CGA) and from the mini-nutritional assessment (MNA) were available in all patients.
Results
Patients with anemia suffered significantly more often from HA (
p
< 0.001) than patients without anemia, with an odds ratio (OR) of 1.99 (95 % confidence interval CI: 1.2-3.2) and of 5.41 (CI 95 %: 2.3-12.6) in patients at risk for malnutrition and in malnourished patients, respectively. A moderately significant association was seen between hemoglobin (Hb) and albumin values (Pearson’s correlation
r
= 0.330;
p
< 0.001) as well as between albumin values and the Barthel index (Spearman’s correlation
r
= 0.210;
p
< 0.001).
Conclusion
Anemia appears to be a risk factor for HA in inpatients with malnutrition and the observed association between albumin and Hb warrants further research. Geriatric inpatients with anemia should be evaluated in terms of the presence of malnutrition risk and HA.
Objective
The progression of Alzheimer’s disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the ...progression of AD. DBS is an approved method in the treatment of Parkinson’s disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status.
Design
A 1-year phase I proof-of-concept study.
Setting
The Department of Psychiatry and Psychotherapy at the University of Cologne.
Participants
We assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent. Intervention: Bilateral low-frequency DBS of the nucleus basalis of Meynert.
Measurements
Nutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate.
Results
With a normal body mass index (BMI) at baseline (mean 23.75 kg/m
2
) and after 1 year (mean 24.59 kg/m
2
), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman’s rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman’s rho = −0.829, p = 0.042).
Conclusion
Patients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
Perioperative nutritional therapy Schulz, R-J; Maurmann, M; Noreik, M
Zeitschrift für Gerontologie und Geriatrie
47, Številka:
2
Journal Article
Recenzirano
There is no difference in medical and nutritional therapy between elderly and young surgical patients. However, based on the high prevalence of malnutrition or a risk for malnutrition and the ...associated risk for complications, elderly surgical patients should receive special attention.
This article addresses the options in perioperative nutritional therapy and gives an overview on current guidelines and study results.
The article includes a literature review of current national and international guidelines in the field of surgery and geriatrics. Cochrane reviews, systematic reviews, meta-analyses, and significant single studies are also included.
Contrary to former approaches, national and international organizations recommend to keep the duration of pre- and postoperative fasting as short as possible. The benefits of nutritional therapy in stabilization and improvement of the nutritional status of surgical patients has already been shown in several patient groups like patients undergoing major abdominal surgeries. For other patients groups, like patients with sepsis, further studies are needed to evaluate the benefit of a perioperative nutritional intervention.
Perioperative Ernährungstherapie Schulz, R.-J.; Maurmann, M.; Noreik, M.
Zeitschrift für Gerontologie und Geriatrie,
02/2014, Letnik:
47, Številka:
2
Journal Article
Recenzirano
Zusammenfassung
Hintergrund
In der medizinischen und ernährungstherapeutischen Betreuung chirurgischer Patienten besteht allgemein kein Unterschied zwischen älteren und jüngeren Personen. Aufgrund ...der hohen Prävalenz einer Mangelernährung oder eines Risikos für Mangelernährung und dem damit verbundenen Komplikationsrisiko sollte jedoch älteren Patienten eine besondere Aufmerksamkeit zukommen.
Ziel der Arbeit
Dieser Leitartikel befasst sich mit den Möglichkeiten der perioperativen Ernährungstherapie und gibt einen Überblick über aktuelle Leitlinien und Forschungsergebnisse.
Material und Methoden
Zur Erstellung dieses Artikels wurden die aktuellen deutschen, europäischen und amerikanischen Leitlinien im Bereich der Chirurgie und Geriatrie gesichtet. Ebenso wurden Cochrane-Reviews, systematische Reviews, Meta-Analysen sowie, falls von Signifikanz, Einzelstudien aufgenommen.
Ergebnisse
Entgegen der früheren Vorgehensweise wird heute von den nationalen und internationalen Fachgesellschaften eine möglichst kurze Nüchternphase vor und nach einem chirurgischen Eingriff empfohlen. Die Vorteile einer Ernährungstherapie zur Stabilisierung und Verbesserung des Ernährungszustands von chirurgischen Patienten konnten bereits für einige Patientengruppen, wie Patienten mit einem großen abdominellen Eingriff, gezeigt werden. Für andere Patientengruppen, z. B. Patienten mit Sepsis, sind weitere Studien nötig, um den möglichen Nutzen einer perioperativen Ernährungsintervention in dieser Gruppe zu evaluieren.
OBJECTIVEThe progression of Alzheimer's disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the ...progression of AD. DBS is an approved method in the treatment of Parkinson's disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status.DESIGNA 1-year phase I proof-of-concept study.SETTINGThe Department of Psychiatry and Psychotherapy at the University of Cologne.PARTICIPANTSWe assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent.INTERVENTIONBilateral low-frequency DBS of the nucleus basalis of Meynert.MEASUREMENTSNutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate.RESULTSWith a normal body mass index (BMI) at baseline (mean 23.75 kg/m²) and after 1 year (mean 24.59 kg/m²), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman's rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman's rho = -0.829, p = 0.042).CONCLUSIONPatients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, ...given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data.
The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% 95% CI -2.11 to 1.44, p = 0.709; SF versus control = -0.11% 95% CI -1.92 to 1.69, p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L 95% CI -0.48, 0.19), BS: -0.39 mmol/L 95% CI -0.59, -0.19, SF: -0.14 mmol/L 95% CI -0.34, 0.07), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings.
In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level.
ISRCTN14279335.
Interventions to reduce the saturated fat (SFA) content of food purchases may help reduce SFA consumption and lower cardiovascular risk. This factorial RCT aimed to examine the effect of altering the ...default order of foods and being offered a swap on the SFA content of food selected during an online shopping experiment.
UK adults who were the primary grocery shoppers for their household were recruited online and invited to select items in a custom-made experimental online supermarket using a 10-item shopping list. Participants were randomly allocated to one of four groups (i) to see products within a category ranked in ascending order of SFA content, (ii) receive an offer to swap to a product with less SFA, (iii) a combination of both interventions, or (iv) no intervention. The primary outcome was the difference in percentage energy from SFA in the shopping basket between any of the four groups. The outcome assessors and statistician were blinded to intervention allocation.
Between March and July 2018, 1240 participants were evenly randomised and 1088 who completed the task were analysed (88%). Participants were 65% female and aged 38y (SD 12). Compared with no intervention (n = 275) where the percentage energy from SFA was 25.7% (SD 5.6%), altering the order of foods (n = 261) reduced SFA by mean difference (95%CI) -5.0% (- 6.3 to - 3.6) and offering swaps (n = 279) by - 2.0% (- 3.3 to - 0.6). The combined intervention (n = 273) was significantly more effective than swaps alone (- 3.4% (- 4.7 to - 2.1)) but not different than altering the order alone (- 0.4% (- 1.8 to 0.9)), p = 0.04 for interaction.
Altering the default order to show foods in ascending order of SFA and offering a swap with lower SFA reduced percentage energy from SFA in an experimental online supermarket. Environmental-level interventions, such as altering the default order, may be a more promising way to improve food purchasing than individual-level ones, such as offering swaps.
ISRCTN13729526 https://doi.org/10.1186/ISRCTN13729526 26th February 2018.
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