Archives of gerontology and geriatrics最新文献_第4页

FI-lab in the emergency department and adverse outcomes among acutely hospitalized older adults 急诊科的 FI 实验室与急诊住院老年人的不良后果。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-10-01 DOI: 10.1016/j.archger.2024.105649

Masaaki Nagae , Hiroyuki Umegaki , Hirotaka Nakashima , Tatsuya Nishiuchi

Background

The emergency department is treating a growing number of older patients with frailty, which has been linked to poorer outcomes. Urgency is generally emphasized in the emergency department based on indicators such as triage scores and early warning scores for decision-making. However, this approach may not be sufficient for frail older people. The Frailty Index-laboratory (FI-lab) has been used as a simple assessment tool for frailty, but it may also reflect disease severity and predict adverse outcomes in the emergency care setting. Therefore, we aimed to evaluate the association between FI-lab in the emergency room and adverse outcomes during hospitalization through comparison with assessments using triage and early warning scores.

Methods

This was a retrospective cohort study conducted in a tertiary hospital. The study included patients aged 65 years or older who were admitted to the general internal medicine ward after being initially evaluated in the emergency department. FI-lab was calculated using 24 laboratory parameters from blood tests. The National Early Warning Score (NEWS), the Japan Triage and Acuity Scale (JTAS), and the modified JTAS were also used as prognostic indicators, and their association with adverse outcomes was compared with that of FI-lab.

Results

In total, 872 patients (mean age, 80.9 years; male, 52.6 %) were analyzed. Patients who died during hospitalization had a higher FI-lab than those who survived. In multiple regression analysis, FI-lab, NEWS, and the modified JTAS were significantly associated with in-hospital death and prolonged length of hospital stay. In contrast, none of these indices were associated with in-hospital falls. The FI-lab was independently associated with the likelihood of discharge to home.

Conclusions

FI-lab evaluated in the emergency department reflected the severity of illness in acutely hospitalized older adults, similarly to NEWS and JTAS, and was a useful indicator for predicting adverse outcomes. These results may indicate the value of FI-lab for older adults in the acute care setting.

背景：急诊科正在收治越来越多的年老体弱患者，这与较差的治疗效果有关。急诊科通常根据分诊评分和预警评分等指标来强调决策的紧迫性。然而，对于体弱的老年人来说，这种方法可能还不够。虚弱指数实验室（FI-lab）已被用作虚弱的简单评估工具，但它也可能反映疾病的严重程度，并预测急诊环境中的不良后果。因此，我们旨在通过与使用分诊和预警评分进行的评估进行比较，评估急诊室中的 FI-lab 与住院期间不良后果之间的关联：这是一项在一家三级医院进行的回顾性队列研究。研究对象包括在急诊科接受初步评估后入住普通内科病房的 65 岁或以上患者。FI-lab 是通过血液化验中的 24 项化验参数计算得出的。国家预警评分（NEWS）、日本分诊和急性量表（JTAS）以及改良的 JTAS 也被用作预后指标，并将它们与不良预后的关系与 FI-lab 的关系进行了比较：共分析了 872 名患者（平均年龄 80.9 岁；男性占 52.6%）。住院期间死亡的患者的 FI-lab 值高于存活的患者。在多元回归分析中，FI-lab、NEWS 和改良 JTAS 与院内死亡和住院时间延长显著相关。相比之下，这些指数都与院内跌倒无关。FI-lab与出院回家的可能性独立相关：在急诊科评估的 FI-lab 反映了急性住院老年人的病情严重程度，与 NEWS 和 JTAS 相似，是预测不良后果的有用指标。这些结果可能表明了FI-lab对急诊环境中老年人的价值。

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引用次数: 0

Change of leisure activity participation and associations with cognitive frailty in older adults: A population-based longitudinal study 老年人参与休闲活动的变化及其与认知能力衰弱的关系：基于人群的纵向研究

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-10-01 DOI: 10.1016/j.archger.2024.105651

Yanyan Li , Meijun Liu , Xiang Li , Yaru Jin , Qinqin Liu , Wendie Zhou , Jiaqi Yu , Tao Huang , Cuili Wang

Objectives

To examine changes in leisure activity participation and their associations with cognitive frailty among older adults.

Methods

The study utilized data from the Chinese Longitudinal Healthy Longevity Survey covering 2008–2018. Three distinct intervals represented short-term (2008–2011), medium-term (2008–2014) and long-term (2008–2018) changes in leisure activity participation, and the change patterns of levels of leisure activities based on the tertile were described. Restricted cubic splines (RCS) were used to determine the inflection point of the absolute value of leisure activity participation over two time points. Group-based trajectory modeling identified trajectories of leisure activity participation among participants from 2008 to 2018. Logistic regression analysis examined how changes in leisure activity participation impacted cognitive frailty.

Results

Five patterns of change in leisure activity participation were identified, including the persistently low group, the declining (medium-low, high-low, high-medium) group, persistently medium, rising (low-medium, low-high, medium-high), and persistently high levels of activity. A lower risk of cognitive frailty was found among three groups of persistently medium, rising, and persistently high levels of activity across three distinct intervals and among the declining group over the short-term and long-term intervals but not in the medium-term interval than among the persistently low group, respectively. RCS analysis showed that the inflection point of the association between absolute changes in leisure activity and cognitive frailty was -2.11 (short-term), -0.9 (medium-term), and -3.94 (long-term). Leisure activity trajectories were categorized into persistently low, persistently moderate, and persistently high groups, and both the persistently moderate and persistently high groups exhibited a lower risk of cognitive frailty compared to the persistently low group.

Conclusion

Persistently moderate to high levels and increasing levels of leisure activities can reduce the risk of cognitive frailty in the short, medium, and long term, and even the declining in leisure activity participation less than the threshold could protect against cognitive frailty, particularly in the short and long term.

目的探讨老年人休闲活动参与度的变化及其与认知虚弱的关系。方法该研究利用了中国健康长寿纵向调查（2008-2018 年）的数据。三个不同的区间代表了休闲活动参与的短期（2008-2011 年）、中期（2008-2014 年）和长期（2008-2018 年）变化，并描述了基于梯度的休闲活动水平的变化规律。限制性三次样条（RCS）用于确定两个时间点上休闲活动参与绝对值的拐点。基于群体的轨迹建模确定了参与者从 2008 年到 2018 年的休闲活动参与轨迹。结果确定了休闲活动参与度的五种变化模式，包括持续低水平组、下降（中低、高低、中高）组、持续中等水平组、上升（中低、低高、中高）组和持续高水平组。研究发现，在三个不同的区间内，活动量持续中等、上升和持续高水平的三个组别出现认知功能衰弱的风险较低，在短期和长期区间内，活动量下降组别出现认知功能衰弱的风险较低，但在中期区间内，活动量下降组别出现认知功能衰弱的风险并不比持续低水平组别低。RCS 分析显示，休闲活动绝对值变化与认知虚弱之间的关联拐点分别为-2.11（短期）、-0.9（中期）和-3.94（长期）。休闲活动轨迹分为持续低度组、持续中度组和持续高度组，与持续低度组相比，持续中度组和持续高度组都表现出较低的认知功能衰弱风险。

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引用次数: 0

Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients 肌肉疏松症和口腔状况受损对中风后患者日常生活活动、认知和吞咽功能的双重影响。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-30 DOI: 10.1016/j.archger.2024.105648

Yoshihiro Yoshimura , Hidetaka Wakabayashi , Fumihiko Nagano , Ayaka Matsumoto , Sayuri Shimazu , Ai Shiraishi , Yoshifumi Kido , Takahiro Bise , Takenori Hamada , Kouki Yoneda

Background and aims

Sarcopenia and poor oral health are common in older patients and are associated with negative outcomes. However, evidence of their combined impact on post-stroke rehabilitation outcomes is limited. This study aimed to investigate the combined impact of sarcopenia and impaired oral health on activities of daily living (ADL), cognition, and swallowing outcomes in post-stroke patients.

Methods

A retrospective cohort study was conducted using 1,012 post-stroke patients (median age 75.6 years; 54.1 % men). Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Poor oral health was assessed using the Revised Oral Assessment Guide (ROAG) with a score ≥13 indicating impaired oral status. Functional outcomes were measured using the Functional Independence Measure (FIM) for ADL and cognition, and the Food Intake Level Scale (FILS) for swallowing status.

Results

The prevalence of sarcopenia was 45.6 % (492/1,080), impaired oral health was 27.5 % (297/1,080), and the coexistence of both conditions was 12.0 % (130/1,080). The coexistence of sarcopenia and impaired oral health was associated with poorer outcomes compared to either condition alone. After adjusting for confounders, the combination of sarcopenia and impaired oral status showed the strongest negative impact on FIM-motor (B=-8.666, 95 % CI -11.484 to -5.847), FIM-cognition (B=-1.122, 95 % CI -1.987 to -0.256), and FILS (B=-0.785, 95 % CI -1.055 to -0.514) scores at discharge.

Conclusion

The dual burden of sarcopenia and impaired oral health significantly impacts functional recovery in post-stroke patients. Comprehensive assessments and interventions targeting both conditions may optimize rehabilitation outcomes in this population.

背景和目的：肌肉疏松症和口腔健康不良在老年患者中很常见，并与不良后果相关。然而，有关它们对中风后康复结果的综合影响的证据却很有限。本研究旨在调查肌肉疏松症和口腔健康受损对中风后患者日常生活活动（ADL）、认知和吞咽效果的综合影响：我们对 1,012 名中风后患者（中位年龄为 75.6 岁；54.1% 为男性）进行了回顾性队列研究。采用亚洲肌少症工作组 2019 年标准诊断肌少症。口腔健康状况不良采用修订口腔评估指南（ROAG）进行评估，得分≥13分表示口腔状况受损。功能结果采用功能独立性量表（FIM）测量日常活动能力和认知能力，采用食物摄入水平量表（FILS）测量吞咽状况：结果：肌肉疏松症的患病率为 45.6%（492/1,080），口腔健康受损的患病率为 27.5%（297/1,080），同时患有这两种疾病的患病率为 12.0%（130/1,080）。同时患有肌肉疏松症和口腔健康受损的患者的预后要比单独患有这两种疾病的患者差。在对混杂因素进行调整后，肌肉疏松症和口腔健康受损同时存在对出院时的 FIM-运动（B=-8.666，95 % CI -11.484至-5.847）、FIM-认知（B=-1.122，95 % CI -1.987 至-0.256）和 FILS（B=-0.785，95 % CI -1.055 至-0.514）评分产生的负面影响最大：肌肉疏松症和口腔健康受损的双重负担严重影响了脑卒中后患者的功能恢复。针对这两种情况的综合评估和干预措施可优化这类人群的康复效果。

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引用次数: 0

Assessing the feasibility of anticholinergic burden scales and measures in administrative data: A systematic review 评估行政数据中抗胆碱能负担量表和措施的可行性：系统综述。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-30 DOI: 10.1016/j.archger.2024.105646

Valentina M. Srikartika , Ninh Ha , David Youens , Rachael Moorin

Aim

This systematic review aimed to identify and evaluate the quality and adaptability of existing anticholinergic burden scales and measures by using administrative dispensing data.

Method

A comprehensive literature search was conducted using the Medline, Embase, CINAHL, and Google Scholar databases from 2001 to 2022. Studies that introduced, updated, or modified anticholinergic burden scales and measures were included in this review. Quality assessment considered various aspects, including scoring systems, tool development criteria, and specific requirements tailored for administrative data.

Results

Twenty-eight anticholinergic burden scales and measures were identified in 14 countries. The Modified Anticholinergic Risk Scale excelled in the scoring system, while the German Anticholinergic Burden Scale stood out in the scale development process. However, significant variability was observed in methodologies, medication listings, and adaptability to administrative data. Quality assessment considers aspects such as potency, dose, exposure duration, longitudinal measurement, clinical interpretation, and compatibility with administrative data variables. The evaluation also considered tool development criteria including evidence for medication selection, panel expertise, relevance, updating methods, international applicability, validation, and clinical guidance.

Conclusion

This review emphasizes the importance of adaptable and robust tools that can work well with administrative data to ensure patient safety and better health outcomes, given the ongoing evolution of anticholinergic medications. The findings of this systematic review provide valuable insights for clinicians and researchers in selecting the most appropriate anticholinergic burden scale or measure according to their specific needs and data sources. This systematic review was registered with PROSPERO (registration ID CRD42023423959).

目的：本系统综述旨在通过使用行政配药数据，确定和评估现有抗胆碱能药物负担量表和测量方法的质量和适应性：方法：使用 Medline、Embase、CINAHL 和 Google Scholar 数据库对 2001 年至 2022 年的文献进行了全面检索。本综述纳入了引入、更新或修改抗胆碱能药物负担量表和测量方法的研究。质量评估考虑了各个方面，包括评分系统、工具开发标准以及针对行政数据的具体要求：结果：在 14 个国家发现了 28 种抗胆碱能负担量表和测量方法。改良抗胆碱能风险量表在评分系统中表现突出，而德国抗胆碱能负担量表则在量表开发过程中脱颖而出。不过，在方法、药物清单和行政数据的适应性等方面存在很大差异。质量评估考虑的方面包括药效、剂量、暴露持续时间、纵向测量、临床解释以及与行政数据变量的兼容性。评估还考虑了工具开发标准，包括药物选择证据、专家小组专业知识、相关性、更新方法、国际适用性、验证和临床指导：鉴于抗胆碱能药物的不断发展，本综述强调了适应性强、功能强大的工具的重要性，这些工具可与管理数据完美结合，以确保患者安全和更好的医疗效果。本系统综述的研究结果为临床医生和研究人员提供了宝贵的见解，帮助他们根据具体需求和数据来源选择最合适的抗胆碱能药物负担量表或测量方法。本系统综述已在 PROSPERO 注册（注册编号为 CRD42023423959）。

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引用次数: 0

Berberine extends healthspan and delays neurodegenerative diseases in Caenorhabditis elegans through ROS-dependent PMK-1/SKN-1 activation 小檗碱通过ROS依赖性PMK-1/SKN-1活化作用延长秀丽隐杆线虫的健康寿命并延缓其神经退行性疾病。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-26 DOI: 10.1016/j.archger.2024.105644

Yi Xiao , Li Zhang , Hanlin Zhou , Yingwen Cui , Keer Chen , Han Zhang , Qinyi Wu , Fang Liu

Oxidative stress, or the chronic generation of reactive oxygen species (ROS), is thought to contribute to the progression of aging and aging related diseases. However, low degree of ROS generation has repeatedly been shown to be associated with beneficial outcomes via activation of protective signaling pathways. Berberine, a natural alkaloid isolated from Rhizomacoptidis, has a long history of medicinal use in both Ayurvedic and traditional Chinese medicine, which possesses anti-cancer, anti-inflammatory and anti-neurodegenerative properties. In this study, we utilize Caenorhabditis elegans to examine the mechanisms by which berberine influences healthspan and neurodegenerative diseases. We find that 10 μM berberine significantly extends healthy lifespan in wild type C. elegans. We further show that berberine generates ROS, which is followed by activation of PMK-1/SKN-1 to extend healthspan. Intriguingly, berberine also delays neurodegenerative diseases such as Alzheimer's and polyglutamine diseases in a PMK-1/SKN-1dependent manner. Our work suggests that berberine may be a viable candidate for the prevention and treatment of aging and aging related diseases.

氧化应激或活性氧（ROS）的慢性生成被认为是导致衰老和与衰老相关疾病进展的原因。然而，通过激活保护性信号通路，低程度的 ROS 生成已多次被证明与有益的结果相关。小檗碱是从Rhizomacoptidis中分离出来的一种天然生物碱，在阿育吠陀医学和传统中医学中有着悠久的药用历史，具有抗癌、抗炎和抗神经退行性病变的特性。在本研究中，我们利用秀丽隐杆线虫研究了小檗碱影响健康寿命和神经退行性疾病的机制。我们发现，10 μM 小檗碱能显著延长野生型秀丽隐杆线虫的健康寿命。我们进一步发现，小檗碱会产生 ROS，继而激活 PMK-1/SKN-1，从而延长健康寿命。有趣的是，小檗碱还能以 PMK-1/SKN-1 依赖性方式延缓神经退行性疾病，如阿尔茨海默氏症和多聚谷氨酰胺疾病。我们的研究表明，小檗碱可能是预防和治疗衰老及衰老相关疾病的可行候选药物。

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引用次数: 0

Decision-making under uncertainty in healthy and cognitively impaired aging: A systematic review and meta-analysis 健康和认知功能受损的老年人在不确定情况下的决策：系统回顾和荟萃分析。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-26 DOI: 10.1016/j.archger.2024.105643

Ilaria Corbo, Francesca Favieri, Giuseppe Forte, Maria Casagrande

Decision-making (DM) is a complex cognitive behavior that involves gathering information and assessing options to identify choices under risky and uncertain conditions. Mild Cognitive Impairment (MCI) is a construct that includes a constellation of symptoms ranging from behavioral to cognitive impairments. This cluster of symptoms is frequently associated with poor decision-making. This study aimed to examine decision-making in pathological aging, specifically MCI. Therefore, we conducted a systematic review and meta-analysis to evaluate these relationships. According to the PRISMA 2020 Statement, nine studies were selected for the systematic review and eight for the meta-analysis. The results highlighted that MCI is associated with impaired decision-making in risky and ambiguous situations.

The systematic review reported that MCI was associated with impaired decision-making in ambiguous and in risky conditions. In contrast, the meta-analysis showed significant differences in overall decision-making and particularly in ambiguous conditions. This difficulty may be due to different impairments that affect MCI. The difficulty in advantageous decision-making could be due to different brain alterations in MCI, which could lead to problems in tasks requiring feedback-based responses.

These findings advance our understanding of decision-making in aging and suggest how decision-making alterations in MCI would affect the totality of executive functions and daily activities.

决策（DM）是一种复杂的认知行为，涉及收集信息和评估选项，以确定在风险和不确定条件下的选择。轻度认知障碍（MCI）是一种包括从行为到认知障碍等一系列症状的结构。这一系列症状往往与决策能力差有关。本研究旨在探讨病理衰老（尤其是 MCI）中的决策问题。因此，我们进行了系统回顾和荟萃分析来评估这些关系。根据 PRISMA 2020 声明，我们选择了 9 项研究进行系统回顾，8 项研究进行荟萃分析。结果表明，MCI 与风险和模糊情况下的决策能力受损有关。系统综述报告显示，MCI 与模糊和危险情况下的决策能力受损有关。与此相反，荟萃分析表明，在整体决策方面存在显著差异，尤其是在模棱两可的情况下。这种困难可能是由于影响 MCI 的不同损伤造成的。优势决策的困难可能是由于 MCI 患者的大脑发生了不同程度的改变，这可能会导致他们在完成需要基于反馈做出反应的任务时出现问题。这些研究结果加深了我们对衰老决策的理解，并表明MCI患者的决策改变将如何影响整个执行功能和日常活动。

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引用次数: 0

The association between anemia, hospitalization, and all-cause mortality in patients with heart failure managed in primary care: An analysis of the Swedish heart failure registry 在初级医疗机构接受治疗的心力衰竭患者中，贫血、住院治疗和全因死亡率之间的关系：瑞典心力衰竭登记分析。

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-26 DOI: 10.1016/j.archger.2024.105645

Anna Ugarph-Morawski , Per Wändell , Lina Benson , Gianluigi Savarese , Lars H Lund , Ulf Dahlström , Björn Eriksson , Magnus Edner

Background

Many patients with heart failure (HF) are managed in primary care, and comorbidities are common. Anemia is one frequent comorbidity. The aim of this study was to assess the prevalence, comorbidities, and prognosis of HF patients in primary care who have anemia.

Method

We linked data on 9300 patients managed in primary care from the nationwide SwedeHF registry with other Swedish national register data. A multivariable logistic regression model with anemia as a dependent variable was performed. Multivariate Cox proportional hazards regression analysis was used to model the time to event.

Results

The median age (IQR) was 81 (74–86) years, and 45 % of the patients were female. A total of 2852 (30.7 %) had anemia. Anemia was more common in men, in those ≥75 years, and in those with kidney dysfunction. A total of 695 (10.8 %) of patients without and 520 (18.2 %) with anemia had cancer. Cancer was independently associated with anemia (OR 1.5, 95 % CI 1.3–1.7). Other comorbidities significantly associated with anemia were peripheral artery disease (OR 1.39, 95 % CI 1.18–1.65), diabetes (OR 1.29, 95 % CI 1.16–1.44), and liver disease (OR 1.64, 95 % CI 1.09–2.46). If anemia was present, prognosis was worse. Risk of all-cause hospitalization was higher (adjusted HR 1.3, 95 % CI 1.2–1.4), as was risk of all-cause mortality (adjusted HR 1.4, 95 % CI 1.3–1.5).

Conclusions

Anemia is common in primary care patients with HF. It is associated with worse prognosis and comorbidities, most notably cancer.

背景：许多心力衰竭（HF）患者都在基层医疗机构接受治疗，合并症很常见。贫血是一种常见的合并症。本研究旨在评估初级医疗机构中患有贫血的心力衰竭患者的患病率、合并症和预后：方法：我们将全国范围内的瑞典高血压登记册中的 9300 名初级医疗患者的数据与其他瑞典国家登记册数据进行了关联。我们建立了一个以贫血为因变量的多变量逻辑回归模型。多变量考克斯比例危险回归分析用于建立事件发生时间模型：中位年龄（IQR）为 81（74-86）岁，45% 的患者为女性。共有 2852 人（30.7%）患有贫血。男性、年龄≥75 岁者和肾功能不全者更容易出现贫血。在没有贫血和患有贫血的患者中，分别有 695 人（10.8%）和 520 人（18.2%）患有癌症。癌症与贫血密切相关（OR 1.5，95 % CI 1.3-1.7）。其他与贫血明显相关的合并症有外周动脉疾病（OR 1.39，95 % CI 1.18-1.65）、糖尿病（OR 1.29，95 % CI 1.16-1.44）和肝病（OR 1.64，95 % CI 1.09-2.46）。如果存在贫血，预后会更差。全因住院风险较高（调整后 HR 1.3，95 % CI 1.2-1.4），全因死亡风险也较高（调整后 HR 1.4，95 % CI 1.3-1.5）：结论：贫血在初级保健的高血压患者中很常见。结论：贫血在基层医疗机构的高血压患者中很常见，它与预后不良和合并症（尤其是癌症）有关。

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引用次数: 0

Impact of social isolation on change in brain volume in community-dwelling older Japanese people: The NEIGE Study 社会隔离对居住在社区的日本老年人脑容量变化的影响：NEIGE 研究

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-23 DOI: 10.1016/j.archger.2024.105642

Hiroshi Murayama , Ai Iizuka , Masaki Machida , Shiho Amagasa , Shigeru Inoue , Takeo Fujiwara , Yugo Shobugawa

Background

Several studies have shown that social isolation is a risk factor for cognitive decline and dementia; however, its neurological mechanisms are not fully understood. Using longitudinal data, this study examined the effects of social isolation on hippocampal and total gray matter volumes in community-dwelling older Japanese individuals.

Methods

Data were obtained from the Neuron to Environmental Impact Across Generations (NEIGE) Study conducted in Tokamachi City (Niigata Prefecture, Japan), including 279 community-dwelling persons aged 65–84 years who underwent brain magnetic resonance imaging in 2017 and 2021 (male: 47.6 %; mean age: 73.0 years). We investigated two dimensions of social isolation: poor social networks and solitary living.

Results

Multiple regression analysis with inverse probability weighting showed that individuals with a social contact frequency of <1 time/week had a greater decrease in hippocampal volume than those with a contact frequency of more than or equal to 4 times/week, whereas those who lived alone tended to have a smaller decrease in hippocampal volume than those who lived with others. We found no association between the frequency of social contact, living alone, and total gray matter volume. Furthermore, there was no interaction between sex and age for any of the outcomes.

Conclusion

Our longitudinal analysis suggested that the relationship between social isolation and dementia onset may be mediated by hippocampal atrophy; however, the direction of the influence depends on the isolation type. These findings are expected to contribute to the elucidation of the social mechanisms underlying dementia onset.

背景多项研究表明，社会隔离是认知能力下降和痴呆症的一个风险因素；然而，人们对其神经机制还不完全了解。本研究利用纵向数据，研究了社会隔离对社区居住的日本老年人海马体和总灰质体积的影响。方法数据来自在十日町市（日本新泻县）进行的神经元对环境的跨代影响（NEIGE）研究，包括 279 名 65-84 岁的社区居住者，他们在 2017 年和 2021 年接受了脑磁共振成像检查（男性：47.6%；平均年龄：73.0 岁）。我们调查了社会隔离的两个维度：社会网络不健全和独居。结果使用反概率加权的多元回归分析表明，社会接触频率为<1次/周的人比接触频率大于或等于4次/周的人的海马体积下降幅度更大，而独居者的海马体积下降幅度往往小于与他人共同生活的人。我们发现，社会接触频率、独居和灰质总体积之间没有关联。结论我们的纵向分析表明，社会隔离与痴呆症发病之间的关系可能是由海马体萎缩介导的；但是，影响的方向取决于隔离的类型。这些发现有望为阐明痴呆症发病的社会机制做出贡献。

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引用次数: 0

Risk of antimuscarinic initiation with cholinesterase inhibitor use in Alzheimer's disease 阿尔茨海默病患者在使用胆碱酯酶抑制剂时开始服用抗心绞痛药的风险

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-17 DOI: 10.1016/j.archger.2024.105629

Soumya G. Chikermane, Jieni Li, Rajender R. Aparasu

Background

The use of cholinesterase inhibitors (CHEIs) is commonly associated with urinary incontinence in patients with Alzheimer's disease (AD). This study evaluated the risk of antimuscarinic initiation drugs with the use of CHEIs in AD patients.

Methods

The study used a nested case-control study design involving 2013–2015 Medicare data of AD patients 65 years and older without antimuscarinic use in 2013. Cases were defined as those who initiated antimuscarinic treatment in 2014–2015. Controls with no antimuscarinic use were selected through incidence density sampling and matched to cases on age using a variable-ratio method. The CHEI utilization pattern was classified as current (event-30 days), recent (event-31 to event-90 days), and past (event-91 to event-180 days). Conditional logistic regression was used to assess the association between CHEI use and the risk of antimuscarinic initiation.

Results

This study included 1,909 cases and 9,064 controls. The adjusted model found that overall CHEI (Adjusted Odds Ratio [aOR] = 1.90, 95 % Confidence Interval [CI]: 1.58–2.28) and current CHEI use (aOR = 1.62, 95 % CI: 1.18–2.21) were associated with an increase in the risk of antimuscarinic initiation compared to non-CHEI use. In addition, the current use of donepezil and rivastigmine significantly increased the risk of antimuscarinic initiation by 48 % (95 % CI: 1.03–2.12) and 171 % (95 % CI: 1.46–5.03), respectively.

Conclusion

The study found an increased risk of antimuscarinic initiation with the current use of CHEIs, particularly with donepezil and rivastigmine. These findings underscore the need for careful medication management to minimize prescribing cascades and associated consequences in AD.

背景使用胆碱酯酶抑制剂（CHEIs）通常与阿尔茨海默病（AD）患者尿失禁有关。本研究评估了AD患者在使用CHEIs时服用抗心律失常药物的风险。方法本研究采用嵌套病例对照研究设计，涉及2013-2015年65岁及以上AD患者的医疗保险数据，这些患者在2013年未服用抗心律失常药物。病例定义为在 2014-2015 年开始接受抗马司卡因治疗的患者。未使用抗马司卡因药物的对照组通过发病密度抽样选出，并采用可变比率法与病例进行年龄匹配。CHEI使用模式分为当前（事件-30天）、近期（事件-31至事件-90天）和过去（事件-91至事件-180天）。条件逻辑回归用于评估CHEI使用与开始使用抗心律失常药物风险之间的关联。调整后的模型发现，与不使用CHEI相比，总体使用CHEI（调整后的风险比[aOR] = 1.90，95% 置信区间[CI]：1.58-2.28）和当前使用CHEI（aOR = 1.62，95% 置信区间[CI]：1.18-2.21）与开始使用抗马司卡因类药物的风险增加有关。此外，目前使用多奈哌齐和利巴斯明会显著增加开始使用抗心绞痛药的风险，分别增加了 48% (95 % CI: 1.03-2.12) 和 171% (95 % CI: 1.46-5.03)。这些发现强调了谨慎用药管理的必要性，以最大限度地减少AD患者的处方级联和相关后果。

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引用次数: 0

Effects of non-pharmacological interventions on gut microbiota and intestinal permeability in older adults: A systematic review 非药物干预对老年人肠道微生物群和肠道渗透性的影响：系统综述

IF 3.5 3区医学 Q2 GERIATRICS & GERONTOLOGY

Archives of gerontology and geriatrics

Pub Date : 2024-09-16 DOI: 10.1016/j.archger.2024.105640

Hazwanie Iliana Hairul Hisham , Siong Meng Lim , Chin Fen Neoh , Abu Bakar Abdul Majeed , Suzana Shahar , Kalavathy Ramasamy

This systematic review appraised previous findings of non-pharmacological interventions on gut microbiota and/ or intestinal permeability in older adults. A literature search was performed using PubMed, Scopus, ScienceDirect and the Cochrane Library. Relevant studies were shortlisted based on the inclusion and exclusion criteria, and evaluated for risks of bias using the “Cochrane Collaboration's Risk of Bias 2” and the “NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group”. The primary outcomes were the effects of non-pharmacological interventions on gut microbiota diversity and composition, and intestinal permeability in older adults. Out of 85,114 studies, 38 were shortlisted. Generally, the non-pharmacological interventions were beneficial against dysbiosis and the leaky gut in older adults. Considering specific interventions with two or more studies that reported consistent outcomes, a pattern was observed amongst the Mediterranean diet (MD), polyphenol-rich (PR) diet and supplements (i.e., probiotics, prebiotics and synbiotics). As for the other interventions, the very few studies that have been conducted did not allow a strong conclusion to be made just yet. The MD (single and multidomain interventions) restored gut microbiota by increasing species richness (alpha diversity) and reduced intestinal permeability (zonulin) and inflammation (CRP). The PR diet only showed slight changes in the gut microbiota but improved the gut barrier by reducing zonulin, CRP and IL-6. Probiotics, prebiotics and synbiotics increased the genus Bifidobacterium spp. which are considered beneficial bacteria. This review has uncovered insights into the relationship between gut microbiota and intestinal epithelial barriers of specific non-pharmacological interventions in older adults.

本系统性综述评估了以往对老年人肠道微生物群和/或肠道渗透性进行非药物干预的研究结果。我们使用 PubMed、Scopus、ScienceDirect 和 Cochrane 图书馆进行了文献检索。根据纳入和排除标准筛选出相关研究，并使用 "Cochrane 协作的偏倚风险 2 "和 "NIH 无对照组前后（前-后）研究质量评估工具 "对偏倚风险进行评估。主要结果是非药物干预对老年人肠道微生物群多样性和组成以及肠道渗透性的影响。在 85 114 项研究中，有 38 项入围。一般来说，非药物干预对老年人肠道菌群失调和肠道渗漏有益。考虑到有两项或更多研究报告了一致结果的特定干预措施，在地中海饮食（MD）、富含多酚（PR）饮食和补充剂（即益生菌、益生元和合成益生菌）中观察到了一种模式。至于其他干预措施，由于开展的研究极少，目前还无法得出有力的结论。MD（单域和多域干预）通过增加物种丰富度（α多样性）恢复了肠道微生物群，并降低了肠道渗透性（zonulin）和炎症（CRP）。PR 饮食只显示出肠道微生物群的轻微变化，但通过降低 zonulin、CRP 和 IL-6 改善了肠道屏障。益生菌、益生元和合成益生菌增加了被认为是有益菌的双歧杆菌属。本综述揭示了老年人肠道微生物群与特定非药物干预措施的肠道上皮屏障之间的关系。

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引用次数: 0