Aging Clinical and Experimental Research最新文献

Background

Malnutrition, post-stroke depression (PSD), post-stroke anxiety (PSA), and post-stroke fatigue (PSF) in stroke survivors have complex relationships and are associated with adverse stroke outcomes.

Aims

This research aims to explore the temporal and directional relationships between malnutrition, PSD, PSA, and PSF after stroke in older adults.

Methods

Patients aged 65 years and older with their first ischemic stroke from two centers were selected and assessed at baseline, 3 months and 12 months. Malnutrition was evaluated using the Controlling Nutritional Status (CONUT) score, the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI). PSD, PSA and PSF were measured with 24-item Hamilton Depression Scale (HAMD-24), 14-item Hamilton Anxiety Scale (HAMA-14) and Fatigue Severity Scale (FSS), respectively. The cross-lagged panel model (CLPM) was employed to investigate the temporal and directional relationships among these variables.

Results

Among the 381 older patients included, 54.33%, 43.57%, and 7.87% were found to have malnutrition according to the CONUT, GNRI, and PNI scores, respectively. Significant bidirectional relationships were found between malnutrition and PSD, as well as between PSD, PSA, and PSF, but no significant bidirectional relationships between malnutrition, PSA and PSF were observed, irrespective of the malnutrition index used (CONUT, GNRI, or PNI).

Conclusions

Nutritional status and post-stroke neuropsychiatric disorders in older stroke survivors are worthy of attention. Specifically, early malnutrition after stroke can predict later PSD and vice versa. PSD, PSA, and PSF are mutually predictable. Further studies are required to investigate the mechanisms of these findings.

Background

Depression is one of the most debilitating mental disorders and a risk factor for many other chronic diseases that are commonly seen in the geriatric population. It has been claimed in previous studies that depression can be associated with obesity in this age group, but there is no common consensus between their results.

Aim

This study aims to evaluate the association between depression metabolic syndrome and obesity phenotypes in community-dwelling older adults living in the East of Iran.

Method and materials

As a part of the Birjand Longitudinal Aging Study, this retrospective cross-sectional study was conducted on participants older than 60. They were categorized based on their body mass index and components of metabolic syndrome into four phenotypes: metabolic non-healthy obese (MNHO), metabolic healthy obese (MHO), metabolic healthy non-obese (MHNO), and metabolic non-healthy non-obese (MNHNO). The relative risk ratio (RRR) of the obesity phenotypes, the severity of depressive symptoms, and the 95% confidence intervals (95% CI) were evaluated by univariate and multinomial logistic regression.

Results

Of 1344 eligible participants, 268 (19.94%) had depression. Moderate, moderate-severe, and severe depression were observed in 179 (13.32%), 67 (4.99%), and 22 (1.64%) participants, respectively. Our findings showed a non-significant increase in the RRR of mild depressive symptoms in MNHO (RRR:1.22, 95% CI 0.56–2.66) and severe symptoms in MNHNO (RRR:1.20, 95% CI 0.02–63.17) females. However, in male participants, the RRR of moderate-severe depressive symptoms only increased non-significantly for the MNHO category (RRR:1.34, 95% CI 0.45–3.98).

Conclusion

We did not observe a meaningful association between depressive symptoms and obesity phenotypes. Also, other than malnutrition or its risk, various severities of depressive symptoms correlate with different sociodemographic and medical risk factors among male and female senior citizens.

Background

The Italian Fund for Alzheimer’s and other dementias approved in 2020 enabled the conducting of a survey in the Italian Centers for Cognitive Disorders and Dementias (CCDDs) to analyse the organization, the administrative features and the professionals’ characteristics.

Aims

To investigate the current use of neuropsychological (NP) tests in Italian CCDDs and the association between the use of a basic set of tests for neuropsychological assessment (NPA) and organizational/structural characteristics of CCDDs.

Methods

A survey was conducted with an online questionnaire in all CCDDs between July 2022 and February 2023. To verify the use of a comprehensive NPA in the diagnosis of cognitive disorders and dementia, we identified a minimum core test (MCT).

Results

The CCDDs using a Minimum Core Test (MCT) significantly increased from 45.7% in 2015 to the current 57.1%. Territorial CCDDs using MCT significantly increased from 24.9% in 2015 to 37% in 2022 (p = 0.004). As multivariable results, the presence of psychologist/neuropsychologist in the staff and the University-based/IRCCS CCDDs increased the probability of using MCT (OR = 9.2; 95% CI 5.6–15.0; p < 0.001 and OR = 5.4; 95% CI 1.9–15.9; p = 0.002, respectively), while CCDDs in Southern Italy-Islands showed a lower probability than those in the North (OR = 0.4; 95% CI 0.2–0.7; p = 0.001).

Discussion

Almost half of CCDDs (43%) do not use MCT in their clinical practice. The presence of the psychologist/neuropsychologist on the staff has a key role in the adoption of MCT and regional differences have increased over the past years. NPA is crucial in the diagnostic process and in characterizing risk profiles in order to implement targeted interventions for risk reduction.

Conclusions

Our results could help to identify good practices aimed at improving dementia diagnosis. An intervention by health policymakers is urgently needed with the aim of improving diagnostic appropriateness and overcoming regional differences.

The Mediterranean diet has gained significant attention for its potential health benefits on diverse pathological conditions including osteoarthritis (OA), a prevalent degenerative joint disease characterized by cartilage breakdown and inflammation. Numerous observational studies have suggested that adherence to the Mediterranean diet, may have protective effects against OA. The abundance of antioxidants and anti-inflammatory compounds and omega-3 fatty acids, among the Mediterranean diet components is believed to contribute to its beneficial effects on OA. Research investigating the association between the Mediterranean diet and OA has shown promising results. Several observational studies have reported that adherence to the Mediterranean diet is associated with a reduced risk of developing OA and with lower severity of OA symptoms. Additionally, intervention studies have demonstrated improvements in pain, function, and quality of life among OA patients following a Mediterranean diet intervention. Furthermore, emerging evidence suggests potential mechanisms underlying the protective effects of the Mediterranean diet against OA, including its ability to reduce inflammation, oxidative stress, and cartilage degradation. However, further well-designed randomized controlled trials and mechanistic studies are needed to elucidate the precise mechanisms and establish causality. In conclusion, the Mediterranean diet appears to be a promising dietary approach for the prevention and management of OA. Its rich array of nutrients and bioactive compounds may exert protective effects against OA development and progression, although more research is warranted to confirm these findings and elucidate underlying mechanisms.

Graphical abstract

Objectives

The frailty index is widely used in clinical and community settings to assess health status. This study aimed to identify the potential phenotypes of frail older adults and examine their relationship with health consequences compared with existing frailty measures.

Methods

The 11-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5,334 individuals aged ≥ 50 years, were analyzed using random-effects panel logit models. We identified three frailty phenotypes: energy-based frailty (EBF), sarcopenia-based frailty (SBF), and hybrid-based frailty (HBF). Existing frailty measures such as the Study of Osteoporotic Fractures (SOF), Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL), and Fried scales were applied. We examined their correlation with health outcomes, such as falls and fractures, depression, comorbidities, hospitalization, emergency department visits, and mortality, adjusting for individual-level characteristics.

Results

Individuals with only EBF were found to be at a lower risk of falls and fractures than their counterparts with only SBF (adjusted odds ratio [AOR] = 0.13, 95% confidence interval [CI] = 0.03–0.46). Depression was less likely in the SBF group than in the EBF group (AOR = 0.02, 95% CI = 0.01–0.05). Hybrid-based frail older adults were more likely to be hospitalized (AOR = 1.84, 95% CI = 1.08–3.14) and have emergency department visits (AOR = 2.03, 95% CI = 1.15–3.58). Frailty assessed using existing measures was associated with adverse health outcomes.

Conclusion

The proposed frailty phenotype classification differs from the existing frailty measures in its ability to distinguish the corresponding phenotypes underlying various health consequences. Governments may develop strategies based on frailty phenotypes to mitigate adverse health consequences.

Background and aims

This study set out to examine the stiffness of the gastrocnemius medialis (GM) and Achilles tendon across postmenopausal women with osteosarcopenia (OS), osteoporosis (OP), and normal bone mineral density. Furthermore, we explored the relationship between muscle-tendon stiffness and postural sway during a curve-tracking task in both sagittal (AP) and frontal (ML) planes.

Methods

Seventy-three women volunteered to participate in this study. The participants were classified into OS (T-score ≤ − 2.5 and muscle mass below 5.5 kg/m²), OP (T-score ≤ − 2.5), and healthy (T-score >-1) groups. The shear wave elastography was used to determine GM and Achilles tendon stiffness during rest and activation. The postural sway was recorded using a force plate during the performance-based curve tracking (CT) task.

Results

The stiffness of the GM and Achilles tendon was found to be significantly lower in the OS group compared to the OP and healthy groups (P < 0.05). In the CT task, the OS group exhibited a significant decrease in the mean absolute (P = 0.011) and RMS error (P = 0.022) in the ML direction compared to the OP group. Additionally, a positive correlation was found between the ML mean absolute error and both GM and Achilles’s stiffness during rest and activation (P < 0.05).

Discussion and conclusion

The OS group exhibited the lowest muscle-tendon stiffness. The GM and Achilles stiffness was positively correlated with poor performance-based balance, particularly in the ML direction. This may increase the risk of falls and subsequent hip fractures during simple daily weight- shifting activities in women with osteosarcopenia.

Background

Growth differentiation factor 15 (GDF15) is a crucial biomarker in various physiological and pathological processes. While elevated GDF15 levels are linked to increased mortality risk, the role of DNA methylation (DNAm)-predicted GDF15 in predicting mortality has not been extensively studied. The purpose of the study is to investigate the association between DNAm-predicted GDF15 levels and all-cause and cardiovascular disease (CVD) mortality in a nationally representative cohort.

Methods

Data from NHANES 1999–2002 were analyzed. DNAm-predicted GDF15 levels were estimated using a regression model. Weighted multivariate Cox regressions were employed to assess the relationship between DNAm-predicted GDF15 and mortality outcomes. Restricted cubic splines were used to explore dose-response relationships, and subgroup analyses were conducted to enhance result reliability.

Results

Higher DNAm-predicted GDF15 levels were significantly associated with increased all-cause mortality risk (HR = 1.08, 95% CI: 1.02–1.15). Participants in the highest DNAm-predicted GDF15 tertile showed significantly higher all-cause mortality risk (HR = 1.56, 95% CI: 1.16–2.10) and a 2.52-fold increased risk of cardiovascular mortality (HR = 2.52, 95% CI: 1.22–5.19). Kaplan-Meier curves revealed decreasing survival probability with higher DNAm-predicted GDF15 tertiles. Restricted cubic spline analysis demonstrated a non-linear dose-response relationship between DNAm-predicted GDF15 levels and cardiovascular mortality. The positive correlation between DNAm-predicted GDF15 and mortality remained robust in most of subgroups.

Conclusions

DNAm-predicted GDF15 independently predicts all-cause and cardiovascular mortality. This association persists across multiple models and stratified subgroups, supporting GDF15’s value as a biomarker for mortality risk stratification. Future research should elucidate underlying biological mechanisms and evaluate GDF15’s clinical utility in guiding mortality risk reduction interventions.

Backgrounds

Whether excess visceral fat tissue increases the risk of death in older individuals remains controversial.

Aims

To investigate the association between the Chinese Visceral Adiposity Index (CVAI) and all-cause mortality risk in older Chinese individuals.

Methods

This cohort study utilized data of individuals aged ≥ 65 years in 2014 to 2018 wave from the Chinese Longitudinal Healthy Longevity Survey database. Older individuals in the 2014 wave were included and followed up in 2018. CVAI was calculated based on age, body size, and blood lipid parameters, with higher values indicating increased visceral fat. Survival status was determined from official death certificates, local primary healthcare providers, or the family members of participants. Kaplan-Meier survival curve and log-rank test were employed to analyze cumulative mortality risk through CVAI tertiles (tertile 1: CVAI index < 97.34; tertile 2: 97.43 ≤ CVAI index < 132.21; and tertile 3: CVAI index ≥ 132.21). A Cox proportional hazards regression model was used to assess the relationship between the CVAI groups and all-cause mortality risk. Additionally, a sensitivity analysis was performed by excluding participants who died within the first year of follow-up. A subgroup analysis was performed based on age and sex, and a restricted cubic spline plot was created to analyze the dose-response relationship between CVAI and mortality risk.

Results

A total of 1414 individuals were included, and the mean age of the participants was 84.6 (standard deviation: 10.9) years, of which 46.4% were women and 32.8% were died during a median follow-up time of 36.4 months. In the multivariable adjusted Cox regression model, we observed a significantly lower risk of mortality in the CVAI tertile 2 and 3 groups than in the tertile 1 group. The hazard ratios (HR) of the tertile 2 and 3 groups were 0.68 (95% CI, approximately 0.52–0.89) and 0.63 (95% CI, approximately 0.48–0.82), respectively. Subgroup analysis revealed that the protective effect of higher CVAI levels on mortality was more pronounced in participants aged 65–79 years and in women.

Conclusion

Our study established a linear relationship between CVAI and mortality risk among community-dwelling older adults, with higher CVAI levels associated with a lower risk of all-cause mortality. These findings highlight the potential importance of visceral adiposity in predicting mortality risk in community-dwelling older adults.

Background

The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline lowered the diagnostic threshold for hypertension to a systolic/diastolic blood pressure (SBP/DBP) of 130/80 mmHg. However, the predictive value of DBP for cardiovascular (CV) risk assessment diminishes with aging. The study aimed to explore whether the new diagnostic threshold for diastolic hypertension is associated with increased risk of CV organ damage and major adverse cardiovascular events (MACEs) in older adults.

Methods

1181 individuals aged 65 years or older with SBP < 130 mmHg were enrolled a prospective cohort study. They were classified into Low (< 70 mmHg), Optimal (70 to < 80 mmHg), and High (80 to < 90 mmHg) DBP groups. Cardiac, vascular, and renal organ damage were measured at baseline. The endpoint of the study was MACEs.

Results

Among 1181 participants (average age 71.9 years, 44.8% men), 172 MACEs were observed during an average follow-up of 6.4 years. We found no significant differences in CV organ damage or MACEs rates (Log-rank P = 0.73) among three groups. In multivariable Cox regression, compared to the Optimal DBP group, no significant increase in CV risk was observed in the Low DBP group (hazard ratio [HR] 1.02, [95% CI 0.68–1.52], P = 0.93) or the High DBP group (HR 1.04, [95% CI 0.72–1.49], P = 0.85). Propensity score matching showed consistent results.

Conclusion

In older adults with SBP < 130 mmHg, DBP values 80–89 mmHg were not associated with higher risk of CV organ damage, events or mortality.