Omega-3 Supplementation for the Prevention of Cognitive Decline in Older Adults: Does It Depend on Homocysteine Levels?

BACKGROUND: Recent evidence point towards an interaction between omega-3 (n-3) polyunsaturated fatty acids (PUFA) and plasma homocysteine (Hcy). OBJECTIVES: This study tested the hypothesis that effects of red blood cell n-3 PUFA are modified according to baseline plasma Hcy in the large Mulit-domain Alzheimer Prevention Trial (MAPT) throughout the 3-years of treatment with an additional 2 years of observational follow-up. DESIGN: Experimental study. PARTICIPANTS: From the 1680 participants that were randomized in the four groups of the MAPT study (two of which received n-3 PUFA, the other two without n-3 PUFA), 782 were selected because they had baseline data on both Hcy and n-3 PUFA. MEASUREMENTS: Cognitive performance was measured with a broad set of cognitive tests including free and total recall of the cued selective reminding test, digit symbol substitution test, category naming test and Trail-making tests (TMT-A and B) and Clinical dementia rating scale. RESULTS: We found a significant association between TMT-A and red blood cell n-3 PUFA levels in participants with Hcy values ≤16.8 µMol/L after adjustments at baseline (Estimate: -1.3, 95% CI: -2.3; -0.3, p=0.01). Additionally, participants with high Hcy values had a significant worsening after adjustments in TMT-B after a 5-year n-3 PUFA supplementation, compared to low levels of Hcy (Mean difference: 34.8, 95% CI: 7.8;61.7). CONCLUSION: This study shows that Hcy levels could modify the association between red blood cell n-3 PUFA and executive function. People with high Hcy may benefit less from a n-3 PUFA supplementation to prevent cognitive decline.

Defining Vitality Using Physical and Mental Well-Being Measures in Nursing Homes: A Prospective Study.

OBJECTIVES: To propose an objective definition of vitality and to evaluate its predictive value regarding the evolution of functional ability, as well as the risk of hospitalization and mortality in very old NH residents. DESIGN: Observational study. SETTINGS: Nursing homes. PARTICIPANTS: 541 participants. MEASUREMENTS: We operationalized tree definitions of vitality (binary variables discriminating vital from non-vital individuals): Mental vitality, assessed using three items of the geriatric depression scale; Physical vitality measured through hand grip strength test; and combined vitality, which combined mental and physical vitality definitions. Outcome measures were the 1-year evolution of functional ability as measured by a scale of activities of daily living (ADL) (score from 0 to 6) and the incidence of hospitalizations and mortality (time-to-event). RESULTS: First, 204 (37.7%) residents were defined as mentally vital. Second, 139 (27.5%) residents were defined as physically vital. And 52 (9.6%) were defined as vital when combining physical and. Combined vitality was associated with a reduced risk of hospitalization compared to combined non-vitality. Physically vital residents were associated with a reduced risk of mortality. No prospective associations were found between vital and non-vital individuals on the evolution of ADL scores across the three vitality definitions. But mentally vital individuals were associated with a worsening of ADL score. CONCLUSIONS: Better combined vitality seems to be associated with a reduced risk for hospitalizations, but more studies are needed to confirm a valid measurement of vitality in people living in NH in regards to ADL and mortality.

Time Effects on Physical Performance in Older Adults in Nursing Home: A Narrative Review.

OBJECTIVES: To gather available evidence about overtime changes on physical performance in institutionalized elderly. DESIGN, SETTING AND PARTICIPANTS: An electronic search was performed on PubMed database on May 2018. We selected articles reporting the evolution of physical performance in older adults living in care institutions. We looked for data from observational longitudinal studies; data from clinical trials were extracted only for subjects who did not receive exercise intervention. All types of performance-based tests, for upper- and/or lower-body, were scrutinized. RESULTS: Seventeen studies were reviewed; mean age varied from 78.3 to 88 years old. Fourteen studies were randomized controlled trials (RCTs), other three studies were non-randomized trials and a longitudinal observational study. Different tests assessing physical performance were examined: upper limb strength and lower limb strength, static balance, dynamic balance and mobility showed a tendency to decline over time. On average hand grip strength decreased by 2.2% per month, chair stand test by 3.5%, Berg balance scale by 2%, timed up-and-go test by 2.8%, gait speed by 2.1% and short physical performance battery by 2.8%. A minority of studies have shown an improvement in lower limb muscle strength, endurance and gait speed: in these studies, participants did not attend any kind of physical training but took part to social activities or cognitive interventions. CONCLUSION: This review shows how physical performance decreases over time in nursing home residents and quantifies their decline. However, in active controls, there was an improvement in some physical performance measures, which indicates that intervention other than exercise might prevent some loss in physical performance.

The Association of ApoE ε4 Status with Lower Limb Function and Handgrip Strength in Older Adults.

BACKGROUND/OBJECTIVES: Apolipoprotein (ApoE ε4) status has been associated with various cardiovascular diseases and Alzheimer's Disease. Some studies have found a possible relationship between the presence of an ApoE ε4 allele and the decrease of motor function in healthy older adults. The objective of this study was to measure the cross-sectional and prospective associations of ApoE ε4 status with lower limb function and handgrip strength in older adults. DESIGN: Longitudinal observational study using data from a randomized controlled trial. SETTING: Community-dwelling older adults. PARTICIPANTS: 1300 older adults (≥70 years old) with ApoE ε4 status from the Multidomain Alzheimer's Preventive Trial (MAPT) were followed for three years. MEASUREMENTS: Lower-limb function was measured with the Short Physical Performance Battery (SPPB) and muscle strength was measured with a handgrip strength dynamometer. ApoE ε4 status was assessed with a blood draw. Mixed-effect linear regressions were used to examine cross-sectional as well as prospective associations between ApoE ε4 status and the outcomes. RESULTS: No significant cross-sectional or prospective associations were found between ApoE ε4 status, lower-limb function and handgrip strength in our study. CONCLUSIONS: ApoE ε4 status was not associated with motor function in older adults.

Is Fat Mass Cross-Sectionally Associated with Cortical Aß Load in the Human Brain?

OBJECTIVES: The objective of this study was to examine the relationship of fat mass (FM) with brain amyloid (Aß) load in older adults. METHODS: Data from the Multidomain Alzheimer's Preventive Trial (MAPT) for Positron emission tomography and dual-energy X-ray absorptiometry (DXA) were used. Linear regressions controlling for appendicular muscle, age, education, clinical dementia rating scale and Apolipoprotein-E were performed to explore the relationships between FM, trunk FM and Aß-load. RESULTS: Thirty-nine participants (75.7 ± 4.2 years old) with an average BMI of 27.5 ± 4.0 kg/m2 were analyzed in this study. There were significant and positive associations of both total and trunk FM with Aß load [0.01 (0.002-0.02) and 0.02 (0.001-0.04), respectively]; however, when adding ApoE-ε4 as a confounder, associations were no longer significant. CONCLUSIONS: This study has found associations between FM as measured by DXA and cerebral Aß load, suggesting that excessive FM might be involved in AD pathology.

Shifting from Declines to Improvements: Associations between a Meaningful Walking Speed Change and Cognitive Evolution over Three Years in Older Adults.

BACKGROUND: Although the close relationship between mobility and cognitive declines is well-known, literature has very little questioned whether improvement in walking speed over time could be associated with improvements in cognitive functions. The objective of this study was to examine the associations between a clinically meaningful improvement in walking speed and global and specific cognitive changes in older adults. DESIGN: Prospective cohort study. SETTING: Multidomain Alzheimer Preventive Trial (MAPT) study. PARTICIPANTS: Three-hundred participants from the control group of the MAPT study (mean age 74.8 ± 4.2; 57% women). MEASUREMENTS: The 4-m usual walking speed, global cognition, memory, executive functions, and processing speed measures were collected at baseline, and at 6, 12, 24 and 36 months. Participants were categorized into three groups according to their walking speed change over the three-year study: 1/ Non-Improvers (participants not presenting an increase ≥0.05m/sec on walking speed; n=138); 2/ Improvers (increase ≥0.05m/sec; n=40); Cyclic (≥0.05m/sec improvement at some time points without maintaining it through the whole period; n=122). RESULTS: Adjusted mixed-effect linear regressions revealed that walking speed improvers did not significantly differ from participants who never or temporarily improved their walking speed on all of global and specific cognitive functions over three years. Nevertheless, a sensitivity analysis (excluding participants with a non-clinical walking speed improvement) indicated specific cognitive trajectories per group associated with better episodic memory scores for Improvers compared to non-improvers (ß=2.41, 95% CI=.12 - 4.71; p=.039). CONCLUSION: This study found that the overtime trajectories of cognitive functions did not differ as a function of clinically meaningful walking speed changes in older adults. Nevertheless, secondary analyses provided new insights on the relationship between walking speed and specific cognitive functions. The novelty of this approach (switching from declines to improvements) should be considered in future large-scale, observational longitudinal studies.

The Effect of Exercise and Social Activity Interventions on Nutritional Status in Older Adults with Dementia Living in Nursing Homes: A Randomised Controlled Trial.

OBJECTIVES: Examine the effects of a 24-week exercise intervention against a social intervention on body weight, body mass index (BMI) and nutritional status in PWD living in nursing homes. DESIGN: Randomized controlled trial. PARTICIPANTS: Ninety-one older people with dementia living in nursing homes. INTERVENTIONS: Exercise (n=44) or social-based activities (n=47), taking place twice per week, for 60 minutes/session, during 24 weeks. MEASUREMENTS: Nutritional status was measured with the mini-nutritional assessment (MNA), weight and BMI. RESULTS: After the 24-week intervention, none of MNA (B-coeff. 1.28; 95% CI -2.55 to 0.02), weight (-0.06; -1.58 to 1.45) and BMI (-0.05; -0.85 to 0.74) differed significantly between groups after adjustment for multiplicity. In the social group, MNA significantly improved while it remained stable in the exercise group. The percentage of at-risk and malnourished patients reduced in both groups by more than 6%. CONCLUSION: The results suggest that social activities have as good effects as exercise activities on nutritional status in PWD nursing home residents.

Sixteen weeks of resistance training decrease plasma heat shock protein 72 (eHSP72) and increase muscle mass without affecting high sensitivity inflammatory markers' levels in sarcopenic men.

BACKGROUND: Sarcopenia has been associated with increased systemic inflammation and risk of physical disability in older adults. Recently, extracellular heat shock protein 72 (eHSP72) was proposed as a biomarker of sarcopenia but its response to interventions designed to increase muscle mass has never been evaluated. AIMS: The present study was designed to (1) assess eHSP72 levels following resistance training and, (2) determine whether changes in eHSP72 correlate to changes in muscle mass and inflammatory markers. METHODS: A total of 26 sarcopenic men participated in a 16-week resistance training program. The following variables were measured pre-post-intervention: plasma HSP72, serum high sensitivity (hs) inflammatory markers: interleukin-6 (hsIL-6), C-reactive protein (hsCRP), and tumor necrosis factor alpha (hsTNF-α), lean body mass (LBM) and appendicular muscle mass index (appMMI). RESULTS: eHSP72 was detected in 47 % of our participants and its level significantly decreased (P = 0.04) after the intervention, with a concomitant increase in several LBM variables and appMMI (all P < 0.035). Serum hsIL-6, hsCRP and hsTNF-α changes did not reach significance. Baseline hsIL-6 and hsCRP levels were negatively correlated with several LBM variables but solely baseline hsIL-6 was associated with changes in appLBM. No correlations were found between changes in measured variables. DISCUSSION: Attenuation of eHSP72 following resistance training in parallel with increase in LBM variables showed a concordance between the evolution of this biomarker and a clinical outcome relevant to sarcopenia. CONCLUSION: Nevertheless, the low bloodstream detection rate of eHSP72 in a sarcopenic otherwise healthy population might limit its use in clinical settings for now.

Changes in muscle mass and strength after menopause.

Menopause is associated with a natural decline in estrogen, that increases visceral fat mass, decreases bone mass density, muscle mass, and strength. This review will examine the role of menopause transition and associated decrease in hormonal status with regards to those changes. We will also overview the efficiency of physical exercise and nutrition on muscle subcharacteristics. Studying changes in muscle mass associated with menopause is important, because of the high number of postmenopausal women in developed countries and the related risk of physical incapacity. Among modifiable factors, low physical activity and protein intakes are the best contributors to sarcopenia and the loss of strength in postmenopausal women. On the other hand, some biological factors, namely oxidative stress, inflammation, estrogen and other hormone deficiency are predictors of these phenomena. Interestingly, some methods have the potential to attenuate the loss of muscle mass and strength such as exercise, and supplement intake.