Low circulating adropin levels in late-middle aged African Americans with poor cognitive performance.

We recently reported accelerated cognitive decline in Europeans aged > 70 years with low circulating adropin levels. Adropin is a small, secreted peptide that is highly expressed in the human nervous system. Expression profiling indicate relationships between adropin expression in the human brain and pathways that affect dementia risk. Moreover, increased adropin expression or treatment using synthetic adropin improves cognition in mouse models of aging. Here we report that low circulating adropin concentrations associate with poor cognition (worst quintile for a composite score derived from the MMSE and semantic fluency test) in late-middle aged community-dwelling African Americans (OR = 0.775, P < 0.05; age range 45-65 y, n = 352). The binomial logistic regression controlled for sex, age, education, cardiometabolic disease risk indicators, and obesity. Previous studies using cultured cells from the brains of human donors suggest high expression in astrocytes. In snRNA-seq data from the middle temporal gyrus (MTG) of human donors, adropin expression is higher in astrocytes relative to other cell types. Adropin expression in all cell-types declines with advance age, but is not affected by dementia status. In cultured human astrocytes, adropin expression also declines with donor age. Additional analysis indicated positive correlations between adropin and transcriptomic signatures of energy metabolism and protein synthesis that are adversely affected by donor age. Adropin expression is also suppressed by pro-inflammatory factors. Collectively, these data indicate low circulating adropin levels are a potential early risk indicator of cognitive impairment. Declining adropin expression in the brain is a plausible link between aging, neuroinflammation, and risk of cognitive decline.

Perceptions and knowledge of older adults: An analysis of interprofessional education and medically underserved populations.

This study explored an academic Interprofessional Geriatric Case Competition (IGCC) experience with a focus on medically underserved populations. Our aims were to assess: the perceptions of and knowledge of older adult populations; and the overall IPE (Interprofessional Education) experience of the IGCC participants. A multi-method study approach was used, the Facts on Aging Quiz assessed knowledge and the Carolina Opinions on Care of Older Adults (COCOA) assessed perceptions. A qualitative thematic approach was utilized to explore the themes of the IPE experience. There was a moderate correlation (0.37, p < .001) between perception and knowledge data of the respondents (N = 94), current professionals (54%) and enrolled students (46%). The three emerged themes were as follows: interprofessional/holistic practice; culturally responsive/older adult centered practice; and the impact of Covid-19. The implementation of IPE that centers medically underserved populations has the potential to: enhance students learning, influence the quality of care, and provide pathways to working within these specific populations.

Falls across Health Care Settings: Findings from a Geriatric Screening Program.

Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.

Serum neurofilament light levels are predictive of all-cause mortality in late middle-aged individuals.

BACKGROUND: Blood biomarkers can offer valuable and easily accessible indicators of normal biological processes, pathogenic conditions, and responses to therapeutic interventions. Recent studies found that levels of neurofilament light chain (NfL) in the blood are associated with mortality in three European cohorts of older adults (median ages 73, 93, and 100 years). Whether similar associations exist in younger adults and in other ethnic groups is currently not known. METHODS: We utilized a cohort study that included 294 African Americans (baseline ages 49-65). Serum NfL levels were measured using a Meso Scale Discovery-based assay. Vital status was determined by matching through the National Death Index. FINDINGS: Seventy-two participants (24.5%) died during the 14-15 years of follow up (2000-2014). Baseline serum NfL levels were significantly higher in the decedent group (86.1±65.7 pg/ml vs. 50.1±28.0 pg/ml, p < 0·001). In binomial logistic regression models adjusted for age, gender, education, baseline smoking status, BMI, and total comorbidities (0-11), serum NfL levels remained a strong predictor of all-cause mortality, and sensitivity analyses employing multiple additional covariates did not substantively change the relationship. Further, Kaplan-Meier curves based on serum NfL quartiles showed reduced survival in groups with higher serum NfL levels. INTERPRETATION: This study found a positive association between serum NfL levels and mortality in late middle-aged and older individuals. While our findings support that serum NfL levels may be a useful biomarker for all-cause mortality, further studies are needed to understand the biological mechanisms underlying this association. FUNDING: National Institute on Aging, Saint Louis University.

An Age-Friendly Health System.

BACKGROUND/OBJECTIVES: To describe a screening and intervention program for geriatric syndromes instituted at a rural healthcare system that utilizes the 4Ms of an age-friendly health system, and to provide exercise and cognitive stimulation therapy (CST) as part of an age-friendly health program. DESIGN: Retrospective evaluation of clinical data. SETTING: Rural primary healthcare system. PARTICIPANTS: Older adults aged 65 years and older in Perry County, Missouri. MEASUREMENTS: Screening for geriatric syndromes was done using the Rapid Geriatric Assessment (RGA), which includes the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS). Outcomes for exercise and CST included the Five Times Sit to Stand (FTSS) and Timed Up and Go (TUG) tests, Cornell Scale for Depression in Dementia (CSDD), Saint Louis University Mental Status Examination (SLUMS), and Quality of Life in Alzheimer's Disease (QoL-AD) measures. RESULTS: The RGA was administered to 1,326 individuals of which 36.5% were frail, 42.1% were sarcopenic, 26.1% were at risk for anorexia, and 20.8% had dementia. Of these receiving exercise therapy, both the FTSS and the TUG were improved at 3 months and 12 to 24 months. In the CST group, SLUMS, QoL-AD, and CSDD were improved at 7 weeks and 6 to 12 months. CONCLUSION: It is feasible to introduce a screening program for geriatric syndromes and respond to the results with successful exercise and cognitive stimulation therapy programs.

Serum progranulin levels are associated with frailty in middle-aged individuals.

BACKGROUND AND OBJECTIVE: A recent study identified progranulin as a candidate biomarker for frailty, based on gene expression databases. In the present study, we investigated associations between serum progranulin levels and frailty in a population-based sample of late middle-age and older adults. METHODS: We utilized a cohort study that included 358 African Americans (baseline ages 49-65). Frailty was assessed by three established methods: the interview-based FRAIL scale, the Cardiovascular Health Study (CHS) frailty scale that includes performance-based measurements, and the Frailty Index (FI) that is based on cumulative deficits. Serum levels of the following proteins and metabolites were measured: progranulin, cystatin C, fructosamine, soluble cytokine receptors (interleukin-2 and -6, tumor necrosis factor α-1 and -2), and C-reactive protein. Sarcopenia was assessed using the SARC-F index. Vital status was determined by matching through the National Death Index (NDI). RESULTS: Serum progranulin levels were associated with frailty for all indices (FRAIL, CHS, and FI) but not with sarcopenia. Inflammatory markers indicated by soluble cytokine receptors (sIL-2R, sIL-6R, sTNFR1, sTNFR2) were positively associated serum progranulin. Increased serum progranulin levels at baseline predicted poorer outcomes including future frailty as measured by the FRAIL scale and 15-year all-cause mortality independent of age, gender, and frailty. CONCLUSIONS: Our findings suggest that serum progranulin levels may be a candidate biomarker for physical frailty, independent of sarcopenia. Further studies are needed to validate this association and assess the utility of serum progranulin levels as a potential biomarker for prevalent frailty, for risk for developing incident frailty, and for mortality risk over and above the effect of baseline frailty.

High prevalence of geriatric syndromes in older adults.

INTRODUCTION: The geriatric syndromes of frailty, sarcopenia, weight loss, and dementia are highly prevalent in elderly individuals across all care continuums. Despite their deleterious impact on quality of life, disability, and mortality in older adults, they are frequently under-recognized. At Saint Louis University, the Rapid Geriatric Assessment (RGA) was developed as a brief screening tool to identify these four geriatric syndromes. MATERIALS AND METHODS: From 2015-2019, the RGA, comprised of the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS) tools and a question on Advance Directives, was administered to 11,344 individuals ≥ 65 years of age across Missouri in community, office-based, hospital, Programs of All-Inclusive Care for the Elderly (PACE), and nursing home care settings. Standard statistical methods were used to calculate the prevalence of frailty, sarcopenia, weight loss, and dementia across the sample. RESULTS: Among the 11,344 individuals screened by the RGA, 41.0% and 30.4% met the screening criteria for pre-frailty and frailty respectively, 42.9% met the screening criteria for sarcopenia, 29.3% were anorectic and at risk for weight loss, and 28.1% screened positive for dementia. The prevalence of frailty, risk for weight loss, sarcopenia, and dementia increased with age and decreased when hospitalized patients and those in the PACE program or nursing home were excluded. CONCLUSIONS: Using the RGA as a valid screening tool, the prevalence of one or more of the geriatric syndromes of frailty, sarcopenia, weight loss, and dementia in older adults across all care continuums is quite high. Management approaches exist for each of these syndromes that can improve outcomes. It is suggested that the brief RGA screening tool be administered to persons 65 and older yearly as part of the Medicare Annual Wellness Visit.

Relationship between sarcopenia and depression in older patients with diabetes: An investigation using the Japanese version of SARC-F.

AIM: The purpose of the present study was to investigate the relationship between sarcopenia and depression in older patients with diabetes using the Japanese version of SARC-F. METHODS: Participants included patients with diabetes aged ≥65 years who were undergoing outpatient treatment at the Ise Red Cross Hospital, Ise, Japan. Depression was measured using the Japanese version of the Patient Health Questionnaire 9, which is a nine-item questionnaire. Sarcopenia was assessed using the Japanese version of SARC-F, a self-administered questionnaire comprising five question items. Multiple logistic regression analysis with depression as the dependent variable and sarcopenia as the explanatory variable was used to calculate the odds ratio for depression in patients with sarcopenia. RESULTS: A total of 275 patients (167 men, 108 women) were the study participants. The adjusted odds ratio for depression in male patients with sarcopenia was 5.76 (95% CI 1.83-18.12, P = 0.003). The adjusted odds ratio for depression in female patients with sarcopenia was 2.62 (95% CI 0.68-10.05, P = 0.159). CONCLUSIONS: A statistically significant relationship was shown between sarcopenia and depression in older male patients with diabetes. We believe that drawing the attention of physicians to sarcopenia prevalence by using the Japanese version of SARC-F will contribute to the detection of depression in older male patients with diabetes. Geriatr Gerontol Int 2018; 18: 1318-1322.

What Did Latino Family Caregivers Expect and Learn From Education Intervention "Caregivers Like Me"?

OBJECTIVE: US Latinos historically have underutilized end-of-life (EOL) resources. This study reports the views of family caregivers before and after education intervention Caregivers Like Me geared to improve knowledge and attitudes regarding EOL resources among Latino caregivers. METHODS: This is a qualitative substudy within a multicentered cross-sectional study design. Educational intervention was offered to family caregivers of Latino elders from 3 different communities, using an audiovisual presentation, including a case-based video telenovela and pre-posttest questionnaires with open-ended questions. This study pertains to the qualitative results for the open-ended questions before and after education intervention. RESULTS: Participants (N = 145) were mostly females (79%) with a mean age of 56 ± 15 years and reported (92%) active learning from intervention. The pretest open-ended question on expected learning identified 2 themes, care for the sick and self-care. It included 5 subthemes and the most common one was how to help the sick. The posttest question on actual learning identified the same 2 themes and 4 subthemes that were similar but different from the pretest. Accepting help and knowledge of services available were the most common. CONCLUSION: The education intervention Caregivers Like Me was able to improve attitudes toward EOL care because participants who wanted to help their loved ones realized that they need to accept professional help and were made aware of the services available.

Associations of Clinically Relevant Levels of Depressive Symptoms and Antidepressant Use With Mortality in African American Health.

BACKGROUND: The Institute of Medicine has highlighted unequal treatment for African American individuals in health care. We examined the association of underuse of antidepressants in African American individuals with increased mortality. METHODS: We conducted a longitudinal cohort study in Metropolitan St Louis, Missouri, in a population-based study of community-dwelling African American individuals, aged 52 to 68 years. Medication evaluations and clinically relevant levels of depressive symptoms (CRLDS) assessments occurred in 2000 and 2004. The analytic sample included 830 (of 853 total, 97%) participants with complete data. CRLDS was defined as ≥9 on the 11-item Center for Epidemiologic Studies Depression scale. Antidepressant use was determined by in-home medication recording and in-center coding. Participants were placed into 4 exposure categories: persistent CRLDS-no antidepressant (n = 69); intermittent CRLDS-no antidepressant (n = 123); antidepressant treatment (n = 110); and no CRLDS-no antidepressant (n = 528). Logistic regression with backwards elimination of the 9 identified potential confounders was used to examine associations of exposures with all-cause mortality over 6 years (2004-2010). Five sensitivity analyses investigated robustness of the primary findings. RESULTS: The antidepressant group was independently associated with reduced mortality compared with the persistent-no antidepressant group (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08-0.44). Sensitivity analyses showed no substantive differences from the primary model; one indicated that the persistent CRLDS-no antidepressant group experienced significantly increased mortality compared with the no CRLDS-no antidepressant group (OR 2.12, 95% CI 1.10-4.09), whereas the intermittent-no antidepressant group did not (OR 0.83, 95% CI 0.44-1.58). CONCLUSIONS: These results highlight that underuse of antidepressants in African American individuals is associated with increased mortality.

Evaluation of a Video-Based Seminar to Raise Health Care Professionals' Awareness of Culturally Sensitive End-of-Life Care.

CONTEXT: Health care workers serve diverse communities and face challenges in delivering culturally responsive EOL care, especially when caring for Latino elders. OBJECTIVE: The objective of this study was to investigate the effect of a newly developed telenovela, or video soap opera, on health care professionals (HCPs)' awareness of caregivers' stress and patients' cultural approaches to end-of-life (EOL) care decisions. METHODS: A multicenter cross-sectional study among three communities in New York, Miami, and Missouri. Participants from a convenience sample of multidisciplinary HCPs were randomly assigned to view power point presentation with either a control video or an intervention-telenovela about caregiving as part of a one-hour audiovisual seminar and completed a pre- and post-test questionnaire to evaluate reaction and learning. RESULTS: Participants (N = 142) were mostly female (80%) nurses (54%) with a mean age of 44.5 ± 12.4 years and from non-Hispanic white (41%) or Hispanics (37%) ethnicity. In both control and intervention groups, post-test responses demonstrated a high level (87%) of satisfaction with seminar and an increase in openness to discuss EOL issues with culturally diverse patients (P < 0.001). Although both groups reported post-test improvement in awareness of health literacy, cultural competency skills, cultural differences about EOL attitudes, family caregiver stress, and possible interventions, this improvement was significantly higher in the intervention group (P < 0.05) compared with the control group. CONCLUSION: The telenovela was effective in increasing health care workers' awareness of caregivers stress and cultural approach to EOL decisions. There is need for ongoing efforts to educate HCPs on cultural sensitivity to help ethnically diverse caregivers and their patients benefit from EOL care.

Fruit and vegetable intake, physical activity, and depressive symptoms in the African American Health (AAH) study.

BACKGROUND: Healthy diet and physical activity (PA) have been associated with reduced depressive symptoms, but few studies have examined them simultaneously in African Americans. AIMS: To investigate fruit and vegetable intake (FVI) and PA as predictors of clinically-relevant levels of depressive symptoms (CRLDS) in African Americans. METHODS: African American Health (AAH) is a population-based longitudinal study of African Americans in St. Louis, MO, who were born in 1936-1950 (inclusive) and empaneled in 2000-01 (wave 1). At wave 8, participants self-reported fruit and vegetable intake (FVI) and completed the Yale Physical Activity Scale. At both waves 8 and 10, the CES-D 11-item scale was used to identify those who met criteria for CRLDS. Sequential logistic regression modeling was used to examine the associations of components of FVI/PA with CRLDS, both cross-sectionally (n = 680, including imputed values) and longitudinally (n = 582, including imputed values). Modeling employed gender, age, perceived income adequacy, and education as potential confounders. RESULTS: Cross-sectionally, vigorous PA, and leisurely walking PA, were independently associated with lower odds of CRLDS in all but the fifth model and green vegetables in all models. Longitudinally, green vegetables and interactions between the FVI summary score, the PA summary score, and other factors at wave 8 were most consistently associated with CRLDS at wave 10. In both cross-sectional and longitudinal models, the socioeconomic variables showed the strongest association as risk factors for CRLDS. LIMITATIONS: Both FVI and PA were self-reported rather than observed, our cohort had limited geographic- and age-ranges, and confidence intervals for some results were broad. CONCLUSIONS: Green vegetables, total FVI, and various aspects of PA showed protective effects regarding CRLDS. Therefore, the promotion of such lifestyles is likely to help prevent CRLDS in this population.

Neighborhood Conditions and Psychosocial Outcomes Among Middle-Aged African Americans.

OBJECTIVE: We examined associations between observed neighborhood conditions (good/adverse) and psychosocial outcomes (stress, depressive symptoms, resilience, and sense of control) among middle-aged and older African Americans. METHODS: The sample included 455 middle-aged and older African Americans examined in Wave 10 of the African American Health (AAH) study. Linear regression was adjusted for attrition, self-selection into neighborhoods, and potential confounders, and stratified by the duration at current address (<5 vs ≥5 years) because of its hypothesized role as an effect modifier. RESULTS: Among individuals who lived at their current address for ≥5 years, residing in neighborhoods with adverse versus good conditions was associated with significantly less stress (standardized ß = -0.18; P = .002) and depressive symptoms (standardized ß = -0.12; P = .048). Among those who lived at their current address for <5 years, residing in neighborhoods with adverse versus good conditions was not significantly associated with stress (standardized ß = 0.18; P = .305) or depressive symptoms (standardized ß = 0.36; P = .080). CONCLUSION: Neighborhood conditions appear to have significant, complex associations with psychosocial factors among middle-aged and older African Americans. This holds important policy implications, especially since adverse neighborhood conditions may still result in adverse physical health outcomes in individuals with >5 years at current residence despite being associated with better psychosocial outcomes.

Cross-Cultural Adaptation and Validation of the Spanish-Language Version of the SARC-F to Assess Sarcopenia in Mexican Community-Dwelling Older Adults.

OBJECTIVES: To cross-culturally adapt and validate the Spanish-language version of the SARC-F in Mexican community-dwelling older adults. DESIGN: Cross-sectional analysis of a prospective cohort. SETTING: The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. PARTICIPANTS: Participants were 487 men and women older than 60 years, living in the designated area in Mexico City. MEASUREMENTS: Information from questionnaires regarding demographic characteristics, comorbidities, mental status, nutritional status, dependence in activities of daily living, frailty, and quality of life. Objective measurements of muscle mass, strength and function were as follows: skeletal muscle mass index (SMI) was taken using dual-energy x-ray, grip strength using a hand dynamometer, 6-meter gait speed using a GAIT Rite instrumented walkway, peak torque and power for knee extension using a isokinetic dynamometer, lower extremity functioning measured by the Short Physical Performance Battery (SPPB), and balance using evaluation on a foam surface, with closed eyes, in the Modified Clinical Test of Sensory Integration. The SARC-F scale translated to Spanish and the consensus panels' criteria from European, international, and Asian sarcopenia working groups were applied to evaluate sarcopenia. RESULTS: The Spanish language version of the SARC-F scale showed reliability (Cronbach alfa = 0.641. All items in the scale correlated to the scale's total score, rho = 0.43 to 0.76), temporal consistency evaluated by test-retest (CCI = 0.80), criterion validity when compared to the consensus panels' criteria (high specificity and negative predictive values). The scale was also correlated to other measures related to sarcopenia (such as age, quality of life, self-rated health status, cognition, dependence in activities of daily living, nutritional status, depression, gait speed, grip strength, peak torque and power for knee extension, SPPB, balance, SMI, and frailty). CONCLUSION: The SARC-F scale was successfully adapted to Spanish language and validated in community-dwelling Mexican older adults.

The Role of Catheter Angiography in the Diagnosis of Central Nervous System Vasculitis.

BACKGROUND: Central nervous system vasculitis (CNSV) is a rare disorder, the pathophysiology of which is not fully understood. It involves a combination of inflammation and thrombosis. CNSV is most commonly associated with headache, gradual changes in mental status, and focal neurological symptoms. Diagnosis requires the effective use of history, laboratory testing, imaging, and biopsy. Catheter angiography can be a powerful tool in the diagnosis when common and low-frequency angiographic manifestations of CNSV are considered. We review these manifestations and their place in the diagnostic algorithm of CNSV. SUMMARY: We reviewed the PubMed database for case series of CNSV that included 5 or more patients. Demographic and angiographic findings were collected. Angiographic findings were dichotomized between common and low-frequency findings. A system for incorporating these findings into clinical decision-making is proposed. KEY MESSAGE: CNSV is a diagnostic challenge due to the absence of a true gold standard test. In the absence of such a test, catheter angiography remains a central piece of the diagnostic puzzle when appropriately employed and interpreted.

Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice.

OBJECTIVES: To validate the (Brazilian) Portuguese-translated version of the SARC-F questionnaire and to verify its performance in the separate sarcopenia screening and muscle function evaluation contexts. In addition, by associating SARC-F to an anthropometric measurement (as an estimate of muscle mass), to test for improvements in its sarcopenia screening efficacy. DESIGN: Cross-sectional study. SETTING: Urban population of Pelotas, a middle-sized city in Southern Brazil. PARTICIPANTS: Subsample of 179 community-dwelling elderly aged 60 years or older derived from a population-based study (COMO VAI?). MEASUREMENTS: Sarcopenia was evaluated using the European Working Group on Sarcopenia in Older People's diagnostic criteria: dual-energy X-ray absorptiometry, handgrip strength, and walking speed test. Participants also completed SARC-F and their calf circumference (CC) was measured. SARC-F and CC were combined into an original score. The questionnaires' performances were evaluated through receiver operating characteristic curves, sensitivity/specificity analyses, and Pearson χ2. RESULTS: Sarcopenia was identified in 15 (8.4%) participants by the European Working Group on Sarcopenia in Older People's criteria. Areas under the receiver operating characteristic curves of SARC-F were 0.592 (95% confidence interval (CI) 0.445, 0.739) screening for sarcopenia and 0.779 (95% CI 0.710, 0.846) evaluating muscle function (P < .001). The SARC-F+CC association significantly improved SARC-F's sarcopenia screening performance [area under the curve: 0.736 (95% CI 0.575, 0.897); comparing with SARC-F alone: P = .027]. A substantial improvement in sensitivity was achieved without compromising the remaining parameters. CONCLUSIONS: Despite the satisfactory performance evaluating muscle function, SARC-F alone has not achieved adequate results as a sarcopenia screening tool. However, the SARC-F+CC association significantly improved SARC-F's sarcopenia screening performance, enabling its use in the clinical practice.