Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and ...micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.
Objective
It remains debated whether anemia is associated with depression, independently of physical health factors. We report a large‐scale cross‐sectional study examining this association in adults ...free of chronic disease and medication from the general population.
Method
Hemoglobin levels were measured among 44 173 healthy participants 63% men; mean standard deviation age = 38.4 (11.1) years from the ‘Investigations Préventives et Cliniques’ (IPC) cohort study. Depression was measured with the Questionnaire of Depression 2nd version, Abridged. Logistic regression analyses were performed to examine the association between anemia and depression, while adjusting for a wide range of sociodemographic characteristics and health‐related factors (i.e., sex, age, living status, education level, occupational status, alcohol intake, smoking status, physical activity, and body mass index).
Results
Depressed participants were significantly more likely to have anemia compared to non‐depressed participants, even after adjustment for sociodemographic and health‐related variables odds ratio = 1.36; 95% confidence interval = (1.18; 1.57). Anemia prevalence increased with depression severity, suggesting a dose–response relationship (P for trend <0.001).
Conclusion
In healthy adults from the general population, we found a significant and robust association between depression and anemia. Further studies are needed to assess the longitudinal relationship between both conditions and determine the mechanisms underlying this association.
Blood pressure (BP) postural changes, both orthostatic hypotension (OHYPO) and orthostatic hypertension (OHYPER) are common in older adults. Few studies have investigated their association with ...cognition, particularly for OHYPER, an emerging cardiovascular risk factor. We aimed to assess the association between OHYPO, OHYPER and cognition in non-institutionalized older subjects.
The S.AGES (Sujets ÂGES, Aged Subjects) cohort followed every 6 months for 3 years non-institutionalized subjects aged ≥65 years without dementia at inclusion, in France. OHYPO and OHYPER were respectively defined as a fall or an increase of ≥20 mmHg in systolic BP and/or ≥10 mmHg in diastolic BP after standing from a sitting position. Cognition was assessed using the Mini-Mental State Examination (MMSE). Linear mixed models were used for the analyses.
Among the 3170 subjects included (mean age 78 years, 56% women), 209 (6.5%) had OHYPO and 226 (7.1%) had OHYPER at baseline. After adjustment for demographics, cardiovascular risk factors and disease, seated SBP/DBP and BP lowering treatment, mean MMSE was 0.52 point lower in participants with OHYPER compared to those with normal BP postural changes (β adjusted 95% CI = -0.52 -0.96; -0.09, p = 0.02) and 0.50 point lower in participants with OHYPO compared to those with normal BP postural changes (β adjusted 95% CI = -0.50 -0.95; -0.06, p = 0.03). Sensitivity analyses showed a dose-response relationship between OHYPO and cognition.
Although the absolute differences in MMSE were small, both OHYPO and OHYPER were associated with lower cognition. Orthostatic BP measurements could help identify patients with risk of cognitive impairment. Further studies are needed to assess whether controlling orthostatic BP could be a promising interventional target in preserving cognition among older adults.
Aims International guidelines are frequently not implemented in the elderly population with heart failure (HF). This study determined the management of octogenarians with HF enrolled in Euro Heart ...Failure Survey II (EHFS II) (2004–05). Methods and results We compared the clinical profile, 12 month outcomes, and management modalities between 741 octogenarians (median age 83.7 years) and 2836 younger patients (median age 68.4 years) hospitalized for acute/decompensated HF. Management modalities were also compared with those observed in EHFS I (2000–01). Female gender, new onset HF (de novo), hypertension, atrial fibrillation, co-morbidities, disabilities, and low quality of life were more common in the elderly (all P < 0.001). Mortality rates during hospital stay and during 12 months after discharge were increased in octogenarians (10.7 vs. 5.6% and 28.4 vs. 18.5%, P < 0.001). Underuse and underdosage of medications recommended for HF were observed in the elderly. However, a significant improvement was observed when compared with EHFS I both in the overall HF octogenarian population and in the subgroup with ejection fraction ≤45% for prescription rates of ACE-I/ARBs, beta-blockers, and aldosterone antagonists at discharge (82 vs. 71%; 56 vs. 29%; 54 vs. 18.5%, respectively, all P < 0.01), as well as for recommended combinations and dosage. Prescription rates remained stable for 12 months after discharge in survivors. Conclusion Our study confirms that the contemporary management of very elderly patients with HF remains suboptimal but that the situation is improving.
Apolipoprotein E (APOE) dependent lifetime risks (LTRs) for Alzheimer Disease (AD) are currently not accurately known and odds ratios alone are insufficient to assess these risks. We calculated AD ...LTR in 7351 cases and 10 132 controls from Caucasian ancestry using Rochester (USA) incidence data. At the age of 85 the LTR of AD without reference to APOE genotype was 11% in males and 14% in females. At the same age, this risk ranged from 51% for APOE44 male carriers to 60% for APOE44 female carriers, and from 23% for APOE34 male carriers to 30% for APOE34 female carriers, consistent with semi-dominant inheritance of a moderately penetrant gene. Using PAQUID (France) incidence data, estimates were globally similar except that at age 85 the LTRs reached 68 and 35% for APOE 44 and APOE 34 female carriers, respectively. These risks are more similar to those of major genes in Mendelian diseases, such as BRCA1 in breast cancer, than those of low-risk common alleles identified by recent GWAS in complex diseases. In addition, stratification of our data by age groups clearly demonstrates that APOE4 is a risk factor not only for late-onset but for early-onset AD as well. Together, these results urge a reappraisal of the impact of APOE in Alzheimer disease.
Blood-based biomarkers are a non-invasive solution to predict the risk of conversion of mild cognitive impairment (MCI) to dementia. The utility of free plasma amyloid peptides (not bound to plasma ...proteins and/or cells) as an early indicator of conversion to dementia is still debated, as the results of studies have been contradictory. In this context, we investigated whether plasma levels of the free amyloid peptides Aβ1–42 and Aβ1–40 and the free plasma Aβ1–42/Aβ1–40 ratio are associated with the conversion of MCI to dementia, in particular AD, over three years of follow-up in a subgroup of the BALTAZAR cohort. We also compared their predictive value to that of total plasma Aβ1–42 and Aβ1–40 levels and the total plasma Aβ1–42/Aβ1–40 ratio.
The plasma Aβ1–42 and Aβ1–40 peptide assay was performed using the INNO-BIA kit (Fujirebio Europe). Free amyloid levels (defined by the amyloid fraction directly accessible to antibodies of the assay) were obtained with the undiluted plasma, whereas total amyloid levels were obtained after the dilution of plasma (1/3) with a denaturing buffer. Free and total Aβ1–42 and Aβ1–40 levels were measured at inclusion for a subgroup of participants (N = 106) with mild cognitive impairment (MCI) from the BALTAZAR study (a large-scale longitudinal multicenter cohort with a three-year follow-up). Associations between conversion and the free/total plasma Aβ1–42 and Aβ1–40 levels and Aβ1–42/Aβ1–40 ratio were analyzed using logistic and Cox Proportional Hazards models. Demographic, clinical, cognitive (MMSE, ADL and IADL), APOE, and MRI characteristics (relative hippocampal volume) were compared using non-parametric (Mann-Whitney) or parametric (Student) tests for quantitative variables and Chi-square or Fisher exact tests for qualitative variables.
The risk of conversion to dementia was lower for patients in the highest quartile of free plasma Aβ1–42/Aβ1–40 (≥ 25.8%) than those in the three lower quartiles: hazard ratio = 0.36 (95% confidence interval 0.15–0.87), after adjustment for age, sex, education, and APOE ε4 (p-value = 0.022). This was comparable to the risk of conversion in the highest quartile of total plasma Aβ1–42/Aβ1–40: hazard ratio = 0.37 (95% confidence interval 0.16–0.89, p-value = 0.027). However, while patients in the highest quartile of total plasma Aβ1–42/Aβ1–40 showed higher MMSE scores and a higher hippocampal volume than patients in the three lowest quartiles of total plasma Aβ1–42/Aβ1–40, as well as normal CSF biomarker levels, the patients in the highest quartile of free plasma Aβ1–42/Aβ1–40 did not show any significant differences in MMSE scores, hippocampal volume, or CSF biomarker levels relative to the three lowest quartiles of free plasma Aβ1–42/Aβ1–40.
The free plasma Aβ1–42/Aβ1–40 ratio is associated with a risk of conversion from MCI to dementia within three years, with performance comparable to that of the total plasma Aβ1–42/Aβ1–40 ratio. Threshold levels of the free and total plasma Aβ1–42/Aβ1–40 ratio could be determined, with a 60% lower risk of conversion for patients above the threshold than those below.
•Metabolism of plasma amyloid peptides is altered early in Alzheimer's disease.•In MCI, free plasma amyloid peptides are an indicator of conversion to dementia.•Plasma free Aβ1–42/Aβ1–40 ≥ 25.8%, is associated to lower risk of conversion.
L’ipertensione rappresenta un fattore di rischio per le malattie cardiovascolari negli anziani, anche dopo gli 80 anni. A questa età, l’obiettivo è raggiungere una pressione arteriosa sistolica (PAS) ...compresa tra 150 e 140 mmHg senza ipotensione ortostatica nei soggetti fragili. L’obiettivo è più ambizioso (PAS/pressione arteriosa diastolica < 140/90 mmHg) in un soggetto sano. La scelta del trattamento farmacologico deve essere adattata alle patologie associate e alla politerapia particolarmente frequente. Possono essere utilizzati tutti i farmaci delle seguenti cinque famiglie: diuretici tiazidici, calcioantagonisti, inibitori dell’enzima di conversione dell’angiotensina, antagonisti dei recettori dell’angiotensina 2 e betabloccanti. Tuttavia, i betabloccanti sembrano meno efficaci per la prevenzione degli accidenti vascolari cerebrali. L’implementazione del trattamento antipertensivo segue le raccomandazioni generali, ma deve comunque essere particolarmente progressiva, soprattutto nei soggetti fragili. Nella pratica, dopo gli 80 anni, si raccomanda di non superare la prescrizione di più di tre farmaci antipertensivi e di accontentarsi della riduzione pressoria ottenuta con queste terapie. Il monitoraggio del trattamento comprende il controllo dell’ipotensione ortostatica e dei disturbi idroelettrolitici (ionogramma, creatinina ematica), soprattutto in caso di episodio di scompenso acuto. In queste situazioni (infezione, disidratazione, diarrea, vomito, febbre, caldo estremo, ecc.), il trattamento con diuretici e/o bloccanti del sistema renina-angiotensina può essere temporaneamente sospeso per alcuni giorni.
Orthostatic hypotension is defined as a drop in systolic blood pressure of at least 20mmHg or a drop in diastolic blood pressure of at least 10mmHg within 3minutes of standing. It is a common ...disorder, especially in high-risk populations such as elderly subjects and patients with neurological diseases, and is associated with markedly increased morbidity and mortality. Its management can be challenging, particularly in cases where supine hypertension is associated with severe orthostatic hypotension. Education of the patient, non-pharmacological measures, and drug adaptation are the cornerstones of treatment. Pharmacological treatment should be individualized according to the severity, underlying cause, 24-hour blood pressure profile, and associated coexisting conditions. First-line therapies are midodrine and fludrocortisone, which may need to be combined for optimal care of severe cases.
Summary Dementia is one of the most common neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer's disease) and ...vascular dementia, leading to a devastating loss of independence. In view of increasing longevity of populations worldwide, prevention and treatment of dementia has turned into a major public health challenge. In the past decade, longitudinal studies have shown a close association between high blood pressure in middle age, cognitive decline and dementia, including Alzheimer's disease, in the late life. Pathophysiologically, a summation of cerebrovascular damage, white matter changes and pre-existing asymptomatic Alzheimer's brain lesions may lead to dementia, even when each type of lesion individually is not sufficiently severe to cause it. Longitudinal studies assessing the beneficial role of antihypertensive drugs on cognitive decline and dementia have produced promising results. There are few randomised placebo controlled studies, although some of these have produced positive results. Results of three recent meta-analyses are inconsistent, possibly due to methodological issues. Further long-term randomised trials, designed especially to assess a link between antihypertensive therapy and cognitive decline or dementia are therefore needed.
In the case of venous thromboembolic disease (VTE), physicians are facing more and more difficulties in managing VTE and their treatment in frail patients. These patients could present several risk ...situations such as: chronic kidney disease (CKD), underweight or malnourished, falls, cognitive impairment, multi-medicated patients, cancer and pregnancy. Guidelines typically recommend anticoagulation. There are multiple challenges in the safe use of anticoagulation in frail patients, including bleeding risk, monitoring and adherence, and polypharmacy. The objective of this review is to explore these at-risk situations and to suggest adequate anticoagulation therapy, when possible, in each of these complex situations.
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