JAR life最新文献

Objectives: To investigate whether temporal muscle thickness (TMT) can serve as a predictor of change in nutritional widely used biomarkers in patients at risk of dementia.

Design: Longitudinal observational study.

Setting: Secondary analysis from a 24-week study conducted across three centers in Norway between 2018 and 2020.

Participants: Patients with mild cognitive impairment (MCI) or with two cardiometabolic disorders were included (n = 165).

Measurements: Baseline and longitudinal statistical analysis were carried out to establish the association for outcomes (albumin, weight, C-Reactive Protein and Episodic Memory Quality) with TMT.

Results: At baseline, there was a positive association between TMT and weight (Estimate=1.5157, p = 0.009). At follow-up, positive associations were observed between TMT and albumin levels (Estimate=0.3031, P = 0.048), as well as TMT and weight (Estimate=1.8954, P = 0.001).

Conclusion: TMT is a possible accessible tool in clinical practice for monitoring health variables beyond cognitive decline in patients at risk of dementia.

Objective: This study investigated the effect of 0.2 % chlorhexidine gluconate on oral microbiota dysbiosis in Alzheimer's disease (AD) and explored potential links between oral microbiota and cognition, offering new insights into its role in AD treatment.

Study design: We assessed the impact of 0.2 % chlorhexidine gluconate on the oral microbiota of patients with AD. One hundred patients were divided into two groups based on oral health score (using a cut-off of 8). Subgingival plaque samples were analyzed using 16S rRNA sequencing; no significant differences in bacterial composition were observed between groups at baseline.

Results: Poor oral health correlated with higher oral health scores (P = 0.000), fewer teeth (P = 0.002), lower cognitive levels (P = 0.048), and a higher proportion of patients with diabetes (P = 0.032). After 24 weeks of treatment with 0.2 % chlorhexidine gluconate in a randomized controlled trial, subgingival plaques from 66 patients showed changes in Porphyromonas, Filifactor, Desulfobulbus, Anaeroglobus, Pyramidobacter, Mycoplasma, Dialister, Fretibacterium, and Tannerella (P < 0.05). Treponema and Porphyromonas gingivalis were identified as potential interventional targets.

Conclusion: Chlorhexidine gluconate effectively alters oral flora, reducing harmful bacteria. Targeting specific microbiota disturbances may offer a promising strategy to delay AD onset or slow its progression.

Trial registration: This research was registered with the Chinese Clinical Trial Registry (ChiCTR; Reference: ChiCTR2000032876). Registered: 14th of May 2020; http://www.chictr.org.cn/showprojen.aspx?proj=53555.

Despite the heterogenous challenges of growing older in low- and middle-income settings, there is a deficiency of research explicating food insecurity among older persons. Given rapid population ageing in Sub-Saharan Africa, alongside worsening deprivation, this paper offers an interrogation of existing evidence and exposes concomitant shortfalls in the knowledgebase. Scoping review methodology was employed using PRISMA Guidelines which systematically searched and screened three academic databases. At the global level, climate shifts and natural disasters, pandemics and epidemics such as Coronavirus-2019 and HIV/AIDS affect food insecurity. At a national level, food and welfare systems play a comparatively well-researched role in food insecurity among older persons. Community factors; levels of self-mobilisation or actions of civil society, and intrahousehold dynamics of kinship and associated resource distribution also proved important variables in determining food insecurity. Finally, demographic characteristics; age, marital status, gender, physical and cognitive abilities and coping mechanisms are discussed. In critical review, the work identifies two salient shortcomings in the understanding of food insecurity among older persons. One, extant research fails to account for path dependency, either within the lives of older persons, or socio-economic and political structures surrounding them. The findings, therefore, call for greater impetus upon the adoption of a life-course perspective. Two, scholars have failed to acknowledge older persons' role in shaping these structures and the food/welfare matrix at large. The work concludes by advocating for further theoretical development toward a comprehensive political economy of food insecurity, accounting for changes in the life-course of the individual, and the food, family and welfare systems in which they find themselves.

Background: Performing a Geriatric Assessment (GA) is recommended to help guiding treatment decisions in vulnerable older patients. As a full GA is time consuming and expensive, frailty screening methods are worth investigating. Sarcopenia and the neutrophil-to-lymphocyte ratio (NLR) could be easily available biomarkers related to frailty.

Objectives: We investigated the relationships between NLR, sarcopenia, and frailty, and assessed the potential of NLR as a frailty screening method in older patients with head and neck cancer (HNC). In addition, the relationship between the NLR and each GA item was investigated.

Design: Retrospective study.

Participants and measurements: 148 older (≥ 60 years) patients with HNC who had undergone pretreatment a GA, routine blood sample, handgrip strength (HGS) and head and neck CT or MRI for skeletal muscle mass measurement (SMM). The GA to determine frailty was assessed as outcome. Sarcopenia was defined as the combination of low SMM and low HGS.

Results: The mean age was 70 (6.08 SD) years. A total of 95 (64 %) patients had an elevated NLR and 21 (14 %) had sarcopenia. Based on the GA, 56 (38 %) patients were determined as frail. Patients with an elevated NLR were more likely to be frail and sarcopenic compared to patients with a normal NLR. NLR score showed a significant though weak correlation with frailty (r= - 0.287, p < 0.05). Using GA as reference standard, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy to predict frailty for NLR were 83 %, 47 %, 49 %, 83 % and 61 %, respectively. In multivariate regression analysis, the significant predictors for frailty were comorbidity, skeletal muscle index (SMI), and NLR. For elevated NLR, SMI and frailty were predictors. Elevated NLR was associated with nutritional status (OR 3.56, P = 0.02) and comorbidity (OR 3.81, P = 0.02) as independent GA items.

Conclusion: Increased NLR is frequently observed in older HNC patients, often in combination with low SMI and frailty. There is a significant correlation between NLR and frailty. However, the accuracy of NLR to predict frailty based on GA is limited.

Background: Real-world registries ALZ-NET (US) and AD-DMT (Japan) support safety surveillance of anti-amyloid antibodies. Conventional power calculations-dividing required patients by mean per-site caseload-can underestimate the number of centers needed because of patient counts variability.

Objectives: To develop and evaluate a simulation-based method for site-level sample size planning that incorporates inter-site variability.

Design: We developed a simulation using a zero-truncated negative binomial model to reflect caseload heterogeneity. We estimated the required sites (k) to achieve a target precision (95 % confidence interval [CI] width) for ARIA incidence under random and volume-weighted sampling, based on data from published trials. The required number of sites was determined as the point where the CI width met a prespecified precision target (< 0.1).

Setting: Simulated ALZ-NET and AD-DMT registry settings using prevalence and ARIA frequencies from published lecanemab and donanemab trials.

Measurements: Precision (95 % CI width) for estimating ARIA incidence in APOE-ε4 homozygotes; comparison of required site counts as estimated by the three methods.

Results: Under random sampling, our method's site requirement (∼320 sites) was consistent with the ICC-adjusted method, whereas the conventional method underestimated the need (∼220 sites). Critically, our framework showed that strategic volume-weighted sampling could reduce the requirement to as few as 110 sites, surpassing the efficiency of the static analytical methods.

Conclusions: Conventional methods risk underestimating site requirements by ignoring caseload heterogeneity. Our simulation framework provides more realistic estimates and, crucially, quantifies the substantial efficiency gains from strategic recruitment, serving as a flexible tool to optimize registry design.

Background: Fall is one of the most common and severe syndromes of older adults that causes disability. Depression is one of the disorders that can lead to many problems, but the results have been contradictory.

Objectives: This study aimed to determine the relationship between symptoms of depression and falls in older adults.

Design: This observational study.

Setting: We collected the data from the health records of older adults in comprehensive health service centers.

Participants: We selected two groups of older adults (60 years and above) as the case group (400 older adults with a history of falling) and the control group (400 older adults without a history of falling).

Measurements: The history of falling was based on the report of old people during a month ago. Symptoms of Depression has been assessed using the Goldberg General Health Questionnaire (GHQ-28).

Results: 62.5 % of the sample were old women. The elderly males were 74.6 ± 0.47 years, and the elderly women were 72.9 ± 0.34 years. There was no significant relationship between symptoms of depression and falls in older adults (OR = 1.321, P = 0.203). Age (over 75 years) (OR = 4.391, P < 0.001) and living alone (OR = 2.924, P < 0.001), and high school education (OR = 3.947, P = 0.008) are risk factors.

Conclusions: The symptoms of depression are not related to falls in older adults. However, being above 75 years old and living alone increases the risk of falls, and higher education reduces the risk of falls.

Aims: To identify subgroups who may be more likely to respond well to a multidomain intervention among older adults with type 2 diabetes.

Materials and methods: This study was a secondary analysis of the Japan Multimodal Intervention Trial for Prevention of Dementia. A total 531 participants aged 65-85 years with mild cognitive impairment were randomized into intervention (vascular risk management, exercise, nutritional counseling, and cognitive training) and control (health-related information) groups. The outcome was the change in average Z scores of neuropsychological tests from baseline to 18 months. Interactions between intervention and age (65-74, 75-85 years), memory impairment (amnestic, nonamnestic), HbA1c levels (within, outside target range), or APOE genotype (0, ≥1 APOE ε4 alleles) among participants with diabetes were evaluated using the mixed-effects model for repeated measures.

Results: Among 76 participants with diabetes, a significant age × intervention interaction (P = 0.007) was found, which was driven by benefits in the younger age group (Z score difference: 0.33, 95% CI: 0.09 to 0.55) that were not observed in the older age group. Intervention benefits were also detected in those with HbA1c levels outside the target range (Z score difference: 0.31, 95% CI: 0.06 to 0.56), with HbA1c levels × intervention interaction (P = 0.021). No significant interactions were detected between intervention and memory impairment or APOE genotype.

Conclusions: Multidomain interventions may benefit younger older adults or those with overly strict or lenient HbA1c control; however, these findings need confirmation in future studies.

Objective: To examine the effects of a standing intervention on gait speed for older adults living in long term care (LTC) residences.

Design: A parallel superiority cluster randomized controlled trial.

Setting and participants: LTC residences. A total of 95 LTC residents (n = 47 control; n = 48 intervention) participated in the study.

Methods: LTC residences and therefore the residents from the homes were randomized to either the intervention group (standing up to 100 minutes/week) for 22 weeks or the control group (socializing with staff with no encouragement to stand for up to 100 minutes/week) for 22 weeks. The primary outcome is gait speed measured by the 10-meter walking speed test.

Results: A total of 95 participants (n= 47 in the control group and n=48 in the intervention group) age 86 ± 8 years completed the trial, averaging 41.9 ± 30.3 min of standing per week in the intervention group and 48.4 ± 22.8 min of time matched activity in the control group. There was no significant difference between groups in changes in gait speed (β=-0.034, 95 % C.I. (-0.097 0.028)).

Conclusions and implications: This 22-week standing intervention did not improve gait speed in older adults living in LTC residences.Trial registration: clinicaltrials.gov - NCT03796039.