Gerontology最新文献

Introduction: Alterations in gut microbiota have been linked to various neurological diseases, including Parkinson's disease (PD). Modifying the microbiota through probiotics, prebiotics, or synbiotics may help improve symptoms in PD patients. This study aimed to evaluate the efficacy and safety of these supplements in treating PD.

Methods: A systematic search was conducted in several databases, including PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, and Google Scholar, until September 2023. No restrictions were placed on language or publication date. Study quality was assessed, and data were analyzed using meta-analysis techniques and narrative synthesis tables. The certainty of evidence was evaluated using GRADE, and trial sequential analysis was performed for primary outcomes.

Results: Out of 3,608 studies identified, 69 were selected for review, with 16 analyzed qualitatively. Among these, 12 were randomized controlled trials, and 9 were included in the meta-analysis. Compared with the placebo group, the intervention group would improve non-motor symptoms related to constipation (weekly stools [MD]: 1.04; 95% CI: 0.83, 1.25; Bristol scale [MD]: 0.54; 95% CI: 0.38, 0.70; frequency of laxative use [MD]: -0.63; 95% CI: -0.94, -0.33) and could improve motor symptoms (UPDRS-III [MD]: -2.23; 95% CI: -5.00; 0.53), with very low certainty both due to indirectness and significant risk of bias.

Conclusion: With very low to moderate certainty, probiotics, prebiotics, and synbiotics may improve constipation and motor symptoms in PD compared to placebo. These findings suggest a potential benefit, but more high-quality research is needed to confirm these effects and establish stronger evidence.

Background: It is anticipated that demographic trends will result in a notable increase in the number of elderly and geriatric patients globally. Concurrently, atrial fibrillation exhibits a pronounced age-dependent prevalence, thereby anticipating a substantial increase in the number of elderly atrial fibrillation patients. In this context, we have examined the recently published European Society of Cardiology (ESC) guidelines on the management of atrial fibrillation from 2024, analyzing their recommendations and implications for atrial fibrillation management in elderly patients, and critically summarized the recent recommendations.

Summary: In summary, it can be stated that the guideline makes age-dependent recommendations in some areas. Such recommendations can be found in particular for the indication for anticoagulation and for switching anticoagulation therapy from VKA to DOAC, or for atrial fibrillation screening. When it comes to rhythm control and catheter ablation, however, there are few age-specific recommendations and the particularities and heterogeneities of this patient group tend to be underrepresented in the guidelines.

Key messages: Tailored recommendations for elderly patients can be found in the ESC guidelines on the management of atrial fibrillation for atrial fibrillation screening and anticoagulation. In particular, the recommendations on rhythm control and catheter ablation lack specific recommendations for older patients.

Introduction: Progress in spine surgery has significantly improved the safety of procedures for older patients with disabling spine disease. However, postoperative cognitive dysfunction (POCD) remains a concern due to their link with poorer outcomes and higher long-term care risk. This study aimed to determine if pro-neuroinflammatory states accelerate neurodegeneration, contributing to POCD development, and explore whether specific biomarkers could predict POCD risk.

Methods: Patients (aged ≥ 60 years) scheduled for elective spine surgery between February 2018 and March 2020 were enrolled. Biomarkers tested included IL-6, C-reactive protein, S100 calcium-binding protein β, brain-derived neurotrophic factor, serum neurofilament light chain protein (sNFL), gasdermin D, and soluble ectodomain of triggering receptor expressed on myeloid cells 2 (sTREM2), measured preoperatively and postoperatively. Cognitive outcomes were assessed using the CERAD test battery at baseline and 3 months postoperatively.

Results: Postoperative levels of sTREM2 and gasdermin D were significantly associated with cognitive performance changes 3 months after surgery, particularly in memory function. Higher sTREM2 levels were associated with greater cognitive decline, with six out of twelve CERAD items showing an inverse association (e.g., overall β = -0.010, p = 0.0003). Similarly, higher postoperative gasdermin D levels were linked to worse performance, particularly in recognition memory (e.g., word list recognition β = -0.615, p = 0.032). Additionally, higher preoperative sNFL levels were associated with poorer cognitive outcomes across multiple domains.

Conclusions: This study highlights potential associations between neuroinflammation and cognitive decline following spine surgery. Targeting neuroinflammatory pathways could be crucial in mitigating POCD in older patients. Biomarkers may help identify high-risk patients and guide the development of targeted interventions.

Introduction: Hispanics are the fastest growing segment of the elderly population in the USA. An assessment of their English and Spanish language dominance is important to consider for cognitive aging. In this manuscript, we utilized an internet-based study (MindCrowd [MC]) to recruit Hispanic participants from within the USA who differ on their self-reported first spoken language (FSL) and examined the influence of the known three most significant associated factors - age, sex, and educational attainment - on their verbal memory performance.

Methods: We utilized participants who joined MC after the launch of the updated site in June 2022. Participants were included if they self-reported their age between 18 and 90, their biological sex as either male or female, and their maximum educational attainment and completed the entire 10-min MC cognitive testing experience which includes an assessment of verbal associative memory (paired-associates learning [PAL]). Additionally, we included only those individuals who participated in English; however, the Hispanic cohort was split into two groups depending on their self-reported FSL as either English or Spanish. Propensity matching was also used to create a cohort whose FSL was Spanish and who matched the demographics of the FSL English Hispanic cohort. Regression statistics were used to calculate significance and estimate effect sizes.

Results: Age, biological sex, and educational attainment are all significantly associated with PAL performance in both Hispanic cohorts, regardless of the participant's FSL. Compared to non-Hispanic MC participants, age had a more negative influence on PAL performance in Hispanics, while the association of educational attainment was similar across both groups. Interestingly, FSL Spanish Hispanics demonstrated a less negative association of biological sex with PAL performance. We used propensity score matching as a sensitivity analysis to assess the robustness of our regression findings in the same cohort.

Conclusions: The three known factors associated with verbal memory performance (age, sex, and educational attainment) are also significantly associated with Hispanic individuals, including those who spoke English or Spanish as their FSL. However, the strength of several factors differed across groups, including age and sex. The study highlights the importance of considering factors predicting cognitive aging outcomes in large, well-characterized, but separate demographic groups.

Introduction: Sarcopenia is a growing concern as a geriatric syndrome associated with various adverse health outcomes. Determining its prevalence and identifying risk factors are essential for effective prevention. This systematic review and meta-analysis aimed to estimate the prevalence of sarcopenia and identify the factors associated with sarcopenia in community-dwelling older adults.

Methods: Guided by the PICo framework, we systematically searched six databases for relevant literature. Two reviewers independently assessed the quality of included studies. We performed a meta-analysis to estimate the prevalence of sarcopenia in overall older adults and subgroups. For risk factor analysis, pooled odds ratios (ORs) with 95% CIs were calculated, employing either random or fixed-effects models as appropriate.

Results: A total of 52 eligible studies involving 70,202 older adults were included, among whom 7,488 were male and 9,054 were female. Forty studies were analyzed for both prevalence and related factors, while the remaining 12 were used for prevalence estimation only. The pooled analysis revealed a wide variation in the prevalence of sarcopenia among community-dwelling older adults, ranging from 5.2% to 50.0%, with an overall estimated prevalence of 18.8% (95% CI: 15.6%-22.4%) and substantial heterogeneity (I2 = 99.3%). Subgroup analyses showed that the highest rates were identified in studies using the EWGSOP 2018 definition (25.8%), Europe populations (23.4%), and using the anthropometric equations for muscle mass measurement (23.1%). Moreover, the factors significantly associated with sarcopenia in community-dwelling older adults were older age (OR = 3.3, 95% CI: 2.8-3.8), BMI (OR = 0.7, 95% CI: 0.6-0.9), malnutrition (OR = 3.4, 95% CI: 2.2-5.1), low physical activity (OR = 2.3, 95% CI: 1.8-2.8), current smoking (OR = 1.7, 95% CI: 1.3-2.2), and comorbidities such as osteoporosis (OR = 1.8, 95% CI: 1.3-2.4), osteoarthritis (OR = 1.4, 95% CI: 1.3-1.6), depression (OR = 3.0, 95% CI: 1.9-4.7), diabetes (OR = 2.8, 95% CI: 1.4-5.4), and cognitive impairment (OR = 2.5, 95% CI: 1.9-3.2).

Conclusion: Our findings demonstrate a high prevalence of sarcopenia among community-dwelling older adults, with estimates significantly influenced by geographic region, diagnostic criteria, and muscle mass measurement methods. The findings highlight heterogeneity due to non-standardized diagnostic methods and identify key risk factors including advanced age, low BMI, malnutrition, low physical activity, and comorbidities such as osteoporosis. These results underscore the need for unified diagnostic standards and early community-based interventions targeting modifiable risks.

Introduction: Parkinson's disease (PD) is a progressive neurological disorder caused by a reduction in dopamine in the substantia nigra and striatum of the basal ganglia. Patients with mild to moderate PD have poor hand dexterity, reduced grip strength, and lower self-perceived hand function ability. The aim of the study was to explore the correlation between hand function and balance function in patients with PD.

Methods: Overall, 196 patients with PD who visited the Department of Rehabilitation Medicine and the Department of Neurology of Huashan Hospital affiliated to Fudan University from June 2022 to December 2024 were selected, with Hohn-Yahr stages II-III. The hand function and balance function of the patients were evaluated. The correlation between the hand function and balance function of the patients was observed through the Simple Test for Evaluating Hand Function (STEF), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT).

Results: The hand function of the patients was positively correlated with the balance function. The right hand STEF test was negatively correlated with the total Berg score at the opening period (r = -0.563, p < 0.01) and was positively correlated with the duration of TUGT (r = 0.527, p < 0.01). The results obtained with the left hand were similar to those of the right hand.

Conclusion: Improved hand function correlates with better balance and shorter completion times on the Timed Up and Go Test (TUGT). Hand function assessments may therefore predict balance performance in patients. Future research should determine whether these functions are interdependent or operate independently.

Introduction: Sarcopenia is an age-related condition characterised by low muscle mass and function, associated with poorer outcomes. Its prevalence and prognostic role in multiple myeloma (MM) remain unclear, as most studies only consider muscle mass defined by computed tomography (CT) scan and disregard muscle function. This study aimed to describe the prevalence of sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) definition in older patients with MM and to analyse its associations with other geriatric syndromes and survival outcomes.

Methods: This is a prospective study of patients aged ≥65 years with newly diagnosed MM who underwent a Comprehensive Geriatric Assessment (CGA), including handgrip strength and gait speed. Their initial positron emission tomography-computed tomography images were evaluated in terms of muscle mass, subcutaneous and visceral adipose tissue at the third lumbar vertebral level (L3). Medical records were reviewed in January 2025 to collect mortality and follow-up data.

Results: Of 52 patients included (55.1% women; median age 77.6 ± 5.9 years), 32 (61.5%) had probable sarcopenia (low muscle strength), and four (12.5%) had confirmed sarcopenia (low muscle strength and low muscle mass). No significant differences were found in frailty or malnutrition between sarcopenic and non-sarcopenic participants. Sarcopenic patients had significantly shorter overall survival (OS) compared with non-sarcopenic patients (43.1 vs. 18.0 months, p = 0.001), and low muscle mass was independently associated with poorer survival outcomes (hazard ratio [HR]: 46.8; 95% confidence interval [CI]: 1.9-1,146.9). In contrast, no significant differences were observed for progression-free survival (PFS), although low muscle mass remained significantly associated with an increased risk of progression (HR: 25.34; 95% CI: 1.72-374.27).

Conclusion: This is the first study to include both muscle quantity (muscle mass) and function (muscle strength) as the correct approach for sarcopenia evaluation in older patients with MM. Patients with sarcopenia may have reduced OS, and low skeletal muscle mass index was also associated with shorter PFS, but further studies with larger cohorts are needed to confirm its prognostic value.

In the article by Yong et al. entitled "Impact of Informal Caregiving at Older Ages on Loneliness and Social Networks in Singapore" [Gerontology. 2025;71:990-1002; https://doi.org/10.1159/000548267], there is an error in the Results section. The word "effective" should read "effect." The corrected sentence is: "The average treatment effect represents an additive effect; i.e., if all older adults were informal caregivers, the loneliness score would be different (higher) by 0.31 points."

Introduction: Older adults with mild cognitive impairment (MCI) are at elevated risk for falls and related complications. However, longitudinal data on fall incidence and functional recovery in high-risk individuals following a severe fall remain limited. This study aimed to compare 12-month fall incidence, cognitive and physical function, and physical activity in older adults with and without probable MCI who presented to the emergency department (ED) after a severe fall but were not hospitalized.

Methods: Data were collected from the SeFallED study, a prospective observational study of community-dwelling older adults (≥60 years) presenting to the ED due to a fall and discharged within 72 h of a fall. Participants were classified into older adults with and without probable MCI based on Montreal Cognitive Assessment scores (cut-off ≤24). Primary outcomes were recurrent falls and those demanding medical attention, assessed monthly via telephone interviews over 12 months. Secondary outcomes included cognitive performance, physical function (Short Physical Performance Battery, gait speed, postural sway), life-space mobility, and physical activity (accelerometry, self-report).

Results: Older adults with probable MCI (n = 116) were significantly more likely to experience a recurrent fall (52.6% vs. 36.5%; p = 0.012) and a fall requiring medical attention (33.6% vs. 11.9%; p < 0.001) than older adults without MCI (n = 126), as shown by chi-square tests. RM-ANCOVA indicated that cognitive performance improved in older adults with probable MCI over time, but no significant group differences emerged in physical function or physical activity. Life-space mobility remained consistently lower in older adults with probable MCI.

Conclusion: Despite comparable physical function, older adults with probable MCI are at substantially higher risk of experiencing recurrent falls, including falls requiring medical attention. Further research should investigate whether incorporating a cognitive screening in the ED and initiating secondary falls prevention strategies at the earliest opportunity can reduce fall incidence, particularly among older adults with MCI.