Clinical Interventions in Aging最新文献

Semantic dementia (SD) is a progressive neurodegenerative disorder primarily characterized by core linguistic deficits, notably impaired confrontation naming and single-word comprehension. Associated features include surface dyslexia, prosopagnosia, relatively preserved speech production, and emotional or behavioral abnormalities. Neuroimaging reveals initial asymmetrical atrophy of the anterior temporal pole, with subsequent progression posteriorly and contralaterally. Early detection is challenging due to initial presentation often manifesting as mild word-finding difficulties, furthermore, comorbid behavioral-emotional symptoms and distinct clinical profiles associated with right- versus left-sided atrophy complicate diagnosis. Therefore, this paper comprehensively delineates the principal clinical features of SD, encompassing language deficits, emotional impairment, behavioral disturbances, and other domains. It also reviews structural and functional imaging findings and investigates the relationship between clinical manifestations and patterns of brain injury. To advance understanding of SD's clinical manifestation, the paper introduces the controlled semantic and social-semantic frameworks.

Phytoestrogens (PEs), a class of naturally occurring plant compounds primarily categorized into isoflavones, lignans, flavonoids, coumarins, and stilbenes, exhibit structural similarity to endogenous estrogens and exert regulatory effects through estrogen receptors. This comprehensive review examines the multifaceted roles of PEs in enhancing exercise performance and promoting health among postmenopausal women. Current evidence demonstrates that PEs not only ameliorate characteristic menopausal symptoms but, more significantly, improve physical function through multiple mechanisms: (1) augmenting muscle protein synthesis while mitigating inflammation and oxidative stress to optimize muscular performance; (2) modulating glucolipid metabolism and cardiovascular function to establish physiological foundations for exercise; and (3) preserving bone mineral density and regulating neurotransmitter activity to maintain motor coordination. Although combined PE-exercise interventions demonstrate synergistic benefits, their efficacy is influenced by dosage variations and interindividual metabolic differences. Future investigations should prioritize the development of precision PE applications to optimize kinesiological outcomes and health parameters in postmenopausal populations.

Purpose: Sarcopenia (SP) and osteoporosis (OP) both pose higher risks for adverse health outcomes. This study explored the relationship among sarcopenia, osteoporosis and all-cause mortality.

Patients and methods: This retrospective cohort utilized a tertiary-hospital-based cohort during the years from 2018 to 2024. Patients received dual-energy X-ray absorptiometry scans. Osteoporosis was diagnosed when T-scores of <-2.5 were determined at the L-spine or femoral neck. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 criteria: low muscle strength, low physical performance, and a low appendicular skeletal mass index. We utilized the Cox proportional hazard model and Kaplan-Meier curves to depict observed time to mortality. Post-hoc analysis was applied for subgroup comparison and statistical power calculation. Interaction terms sensitivity analysis was used for analyzing mutually exclusive groups.

Results: A total of 545 patients (median age [interquartile range] 68.7 [52.8-80.7] years; 72.3% women) were analyzed. At baseline, 15.6% had SP alone, 23.1% had OP alone, and 14.3% had both conditions. Over median 0.7 (interquartile range = 0.2-1.4) years of follow-up, 24 deaths occurred. Older age, multimorbidity, sarcopenia, and osteoporosis were significantly associated with higher mortality. In multivariable analysis adjusting for age and multimorbidity, sarcopenia alone was a stronger predictor of mortality compared to osteoporosis alone (hazard ratio [HR] 7.34 vs 3.99), and the mortality HR was 7.34 for sarcopenia with or without osteoporosis higher than 3.99 for osteoporosis with/without sarcopenia. Interaction analysis was not feasible in the four-group comparison, as the interaction term overlapped with the 'both sarcopenia and osteoporosis' group; in the other three groups, the SP×OP interaction was not significant. SP patients were more likely to be older, male, and have lower body mass index, total tissue, and lean mass.

Conclusion: These findings suggest that sarcopenia may be a more important predictor of mortality than osteoporosis in patients, highlighting the need for muscle health assessment.

Background: To explore the precise classification of elderly patients with multimorbidity and identify subgroups with an increased prevalence of related diseases.

Methods: A data-driven clustering analysis (K-means clustering) was conducted on individuals aged 60 years or older with comorbidities. The clustering was based on five essential and routinely measured variables: body mass index (BMI), intrinsic capacity (IC), low-density lipoprotein cholesterol (LDL-c), fasting plasma glucose (FPG), and systolic blood pressure (SBP). Logistic regression models were used to compare the prevalence of diabetes, coronary heart disease, hypertension, osteoporosis, sarcopenia, and frailty among the clusters.

Results: A total of 350 elderly patients with a mean age of 78.74 ± 8.27 years were included. Four subtypes of elderly patients with multimorbidity were identified, with significant differences in disease prevalence observed among the groups. Specifically, cluster 1 included 70 participants who exhibited the highest levels of LDL-c and BMI, as well as relatively higher IC scores. Cluster 2 consisted of 117 participants, who had the highest IC scores among all clusters and similar BMI levels to cluster 1. Cluster 3 included 77 participants and was distinguished by the highest SBP levels. Cluster 4, comprising 86 participants, had the lowest IC and BMI levels. Compared with cluster 2, cluster 4 had significantly higher prevalence of hypertension and frailty. Cluster 3 and 4 had higher prevalence of coronary heart disease compared with cluster 1, and cluster 4 had the highest prevalence of osteoporosis and sarcopenia.

Conclusion: There is significant pathophysiological heterogeneity among individuals with elderly multimorbidity. This classification method provides a crucial foundation for understanding disease complexity in this population. Future research, including intervention studies based on these classifications, is needed to evaluate their potential clinical utility.

Background: Older adults with cognitive impairment are vulnerable to the adverse effects of cumulative use of medications with anticholinergic properties. However, existing research on hospitalisation risk in this population remains limited and often lacks focus on the specific causes of admission. This study aims to investigate the role of anticholinergic burden and its association with hospitalisation risk and reasons for admission among older adults with mild cognitive impairment or dementia.

Methods: This retrospective study included older adults with mild cognitive impairment or dementia attending the memory clinic between January to December 2022. Collected data from the electronic medical records includes sociodemographic information, comorbidities, cognitive and functional assessment, neuropsychiatric symptoms, and medication history. Anticholinergic burden was assessed using the Anticholinergic Cognitive Burden (ACB) score. Cox proportional hazard analysis was performed to assess the association between ACB scores and hospitalisation risk. The underlying causes of hospital admissions were compared across the different ACB score groups.

Results: A total of 657 older adults were included in the analysis, with a mean age of 80.66 (SD 7.39) years. Anticholinergic medication use was seen in 35.5%, with a mean ACB score of 0.8 (SD 1.3). Higher ACB scores were associated with nursing home residency, presence of neuropsychiatric symptom, poorer cognitive and physical function, and a greater number of prescribed medications compared to those with no anticholinergic burden. Older adults with ACB scores of 1-2 had an increased risk of hospitalisation (Hazard Ratio(HR)=1.84,95% CI:1.17-2.90) in univariate analysis, but this association was diminished after adjusting for confounders. The most common reasons for hospital admission were pneumonia (5.7%), acute kidney injury (3.8%), delirium (2.6%) and falls (2.6%). Notably, individuals hospitalised for serious adverse cardiovascular events or infected pressure ulcers had significantly higher ACB scores.

Conclusion: One-third of older adults with mild cognitive impairment or dementia use anticholinergic medications, potentially worsening health outcomes. These findings underscore the importance of regular medication review and deprescribing strategies to minimise anticholinergic burden in this vulnerable population.

Purpose: Caring for people with dementia (PwD) is demanding, particularly for family caregivers in lower-middle-income countries like Vietnam, where support is limited. This study assessed the feasibility and preliminary impact of a smartphone-based psychoeducational program for caregivers of PwD.

Participants and methods: In a pilot randomized controlled trial, 60 family caregivers were recruited from the Geriatrics Department of a public hospital and randomly assigned (1:1) to either an intervention or a usual care group. Eligible participants were aged 18 or older, primarily responsible for daily care, had at least a primary education, used a smartphone with internet access and Zalo, and reported moderate stress. The intervention group received a 7-week psychoeducational program via Zalo, featuring videos and interactive group chats. Feasibility was assessed through recruitment, retention, and data collection rates. Engagement and acceptability were measured through caregiver participation and feedback. Preliminary effects on depression, anxiety, stress, dementia knowledge, caregiver burden, social support, and health-related quality of life were explored.

Results: Of the 62 caregivers approached, 60 enrolled (96.7%), and 54 completed the study (90% retention). Assessment completion rates were 96.7% immediately after the intervention and 93.1% at the 3-month follow-up. Over 85% of participants were engaged weekly, and all participants rated the program content positively. Acceptability was high, with more than 89% expressing satisfaction with the content, format, and duration. Preliminary findings indicated improvements in psychological distress, dementia knowledge, caregiver burden, and quality of life.

Conclusion: This is the first study in Vietnam to evaluate a smartphone-based psychoeducational intervention for caregivers of PwD. The program was feasible, well-accepted, and showed potential benefits. It offers a promising, scalable support model for caregivers in resource-limited settings and warrants further investigation in a larger trial.

Background: Currently, dual-energy X-ray absorptiometry (DEXA) and quantitative CT (QCT) are commonly used in clinical practice to measure bone mineral density (BMD), offering diagnostic value but involving radiation and inability to visualize bone microstructure. This study aims to assess lumbar spine bone microstructure changes in normal, osteopenic, and osteoporotic groups using IVIM-DWI and IDEAL-IQ sequences to provide useful information for clinical practice.

Methods: A total of 346 patients (50-87 years, 232 females, 114 males) underwent spinal DEXA and MRI. Based on the BMD obtained from DEXA, the patients were stratified into: normal (n=79), osteopenia (n=92), and OP (n=175) groups. Then to evaluated the results of IVIM-DWI and IDEAL-IQ and extracted quantitative parameters from regions of interest covering the L1 to L4 vertebrae. Group comparisons used One-way analysis of variance and the Kruskal‒Wallis H-test. Receiver operating characteristic (ROC) and Spearman's analyses evaluated diagnostic performance and correlations.

Results: Significant differences existed in the ADCslow, f, FF and R2* between groups (P<0.05). BMD was weakly positively correlated with ADCslow, f, and R2* (r=0.494, 0.153, 0.182, 0.029, P<0.001) but a negative correlation with FF (r=-0.402, P<0.001). BMD and the ADCslow and R2* decreased but FF increased with age (P<0.05 for all), whereas no significant association existed between age and ADCfast or f value (P>0.05). FF had the highest areas under the curve (AUCs) (0.624, 0.831 and 0.747) and sensitivity (72.2%, 70.9% and 81.5%) in differentiating normal from osteopenia patients, normal from osteoporosis patients, and osteopenia from osteoporosis patients, respectively. ADCslow and f had the highest specificity (88%) in differentiating between normal and osteopenia patients, while ADCslow had the highest specificity (91.4%) in differentiating between normal and osteoporosis patients.

Conclusion: Quantitative parameters extracted from IVIM-DWI and IDEAL-IQ have the potential to become good biomarkers for diagnosing OP.

Background: Handgrip strength (HGS) is a key diagnostic tool for sarcopenia, yet the comparative prognostic value of the hydraulic dynamometer and pneumatic vigorimeter in hospitalized older adults remains unclear. This study is the first to examine the vigorimeter as a predictor of in-hospital mortality in this setting.

Methods: This prospective cohort study included 376 hospitalized older adults (mean age: 82.7 years) across acute, rehabilitation, and long-term care wards. HGS was assessed using both the dynamometer and vigorimeter, applying two sets of cut-offs per instrument. Sarcopenia was confirmed using bioelectrical impedance analysis to calculate the fat-free mass index (FFMI), with four diagnostic criteria combining HGS and FFMI thresholds. Associations between HGS, sarcopenia, and mortality were evaluated using logistic regression and Cox proportional hazards models, with Kaplan-Meier curves illustrating survival differences.

Results: Higher HGS measured by the vigorimeter was independently associated with reduced in-hospital mortality (OR 0.96, 95% CI 0.93-0.98, p = 0.001), whereas no significant association was found for dynamometer-measured HGS. Confirmed sarcopenia was significantly associated with mortality for two diagnostic criteria (criterion 2: vigorimeter with DO-HEALTH1 cut-offs: OR 1.77, 95% CI 1.01-3.10, p = 0.047; criterion 4: vigorimeter with DO-HEALTH2 cut-offs: OR 1.76, 95% CI 1.01-3.07, p = 0.048), although no significant association was observed with time-to-mortality. Kaplan-Meier curves demonstrated significant survival differences only for vigorimeter-based HGS cut-offs (p = 0.04). Male sex and falls during hospitalization were associated with increased mortality, while admission to rehabilitation or long-term care wards was associated with reduced mortality.

Conclusion: Vigorimeter-based HGS, especially using DO-HEALTH1 cut-offs, demonstrated superior prognostic value for in-hospital mortality compared to the dynamometer. These findings support the clinical utility of the vigorimeter for risk stratification and care planning in hospitalized older adults, particularly in settings where subtle neuromuscular deficits may influence outcomes.