Profiles of well-being in French older adults and associations with successful aging and personality: findings from the SHARE project.

Maintaining the well-being of the older adults is a primary concern in gerontology. This study determined different profiles of well-being (WB) and compared the profiles in terms of successful aging (SA), personality, and sociodemographic variables. The study sample consisted of 856 adults aged 65-98 years. WB was taken into account in an eudemonic and hedonic approach. SA was measured by assessing the three distinct components of Rowe and Kahn's model (Successful aging. Gerontol 37(4):433-440. 10.1093/geront/37.4.433, 1997), personality by the Big Five Inventory, and sociodemographic variables. Latent class analyses (LCA) determined the number of WB profiles, and ANOVAs and Chi2 tests to compare them. The LCA revealed three WB profiles: Profile 1 (9.35%, n = 80), Profile 2 (37.38%, n = 320), and Profile 3 (53.27%, n = 456) in which participants reported lower, intermediate, and higher WB scores. Our results confirm that a high level of WB (Profile 3) can be linked to the components of SA and socio-demographic characteristics (age, marital status, level of education, income). This raises questions about the injunctions concerning healthy aging that older people integrate. It's also interesting to note that the intermediate profile (profile 2) can be either close to the "lower WB" profile (Profile 1) in terms of openness, conscientiousness, and agreeableness or to the "higher WB" profile (Profile 3) in terms of extraversion. However the three profiles do not have the same level of neuroticism. These results also showed the importance of adapting the support offered to older people according to their health status and/or individual characteristics.

Protective effects of physical activity on episodic memory during aging are explained by executive functioning.

Aging is marked by a memory decline related to an executive function decline. Physical activity (PA) has beneficial effects on both executive functions and memory, especially in aging. The protective effects of PA on these two cognitive abilities have always been studied separately, despite the well-established relationship between memory and executive functions. Our objective was to explore whether the benefits of PA on memory could be explained by reduced age-related changes in executive functions.Nineteen young adults (27.16 years old) and 25 older adults (69.64 years old) performed a resource-dependent memory task, three executive tasks and completed a PA questionnaire (measuring sports and leisure PA). Age group and PA effects on memory and executive performance were analyzed with generalized linear models. Mediation analyses were calculated using method of causal steps approach with a non-parametric bootstrapping procedure.The results confirmed the effects of age and PA on memory and executive performance. A significant interaction confirmed the protective effect of PA on age-related cognitive performance. PA was positively correlated with performance in both memory and executive tasks, but only in the older adults. Although each predictor alone (age, executive functions and PA) significantly explained memory performance in older adults, only the effect of PA on memory performance remained significant when all the predictors were introduced in the analyses.PA mediates the effects of age and executive functions on memory performance. This suggests that PA protects older adults against memory decline by reducing the decline in executive functioning.

The PAPA Questionnaire: Assessment of Long-Term Engagement in Activities, with Separate Quantification of Their Physical, Cognitive, and Social Components.

Purpose: Engagement in activities promotes healthy living. Evaluating it is a challenging issue. Assessing engagement in activities while differentiating the physical, cognitive, and social component of each activity and taking into account the intensity level involved in each of the three components would be very relevant. Since none of the currently available cognitive reserve and questionnaires on the activities practiced takes into consideration both points, the purpose of this new questionnaire, called Pertinent Activities Practice in Adults (PAPA) questionnaire, is to fill these gaps. Patients and Methods: The questionnaire was developed through a literature review and interviews with older adults (n=177 ≥55 years). The intensity level of each item (none, light, moderate, or high) was determined by the compendium of physical activities for the physical component and consensus for the cognitive and social components, then validated by 56 professional experts (6 groups: physiotherapists, neuropsychologists, occupational therapists, geriatricians, etc.). Results: The PAPA questionnaire includes 75 items that give rise to 4 scores (sedentary lifestyle and physical, cognitive, and social activity scores) weighted by the frequency, duration, and intensity level for each component. The weighted percentage of agreement of the expert groups for the intensity levels was never significantly lower than the minimum target threshold (80% of the hypothetical median) except in a single domain (cognitive) for an expert group non-specialized in cognition. Cronbach's alpha was ≥0.85. Conclusion: This questionnaire, which assesses long-term engagement in activities, with separate quantification of the physical, cognitive, and social components of a wide range of activities, should help guide actions to promote healthy aging and reduce dementia risk.

Wii™ and older adults with dementia: what do caregivers think? / Wii™ et personnes âgées présentant un syndrome démentiel : qu'en pensent les soignants ?

Context: Currently, there are more and more dependent old people with cognitive disorders in nursing homes, who have difficulties, even disabilities, in daily life activities such as washing, dressing, eating or orienting themselves. This represents a significant workload for caregivers. Non-drug approaches have a very wide field of action, impacting the resident as well as his environment. For example, video game such as Wii™ have many advantages (low cost, easy to use, various games) and positive cognitive, motor, social and psychological effects Objectives: The objective of this qualitative study was through the establishment of a Wii™ animation in a nursing home. First, caregivers observed old people with advanced cognitive disorders in order to see changes over their participation. In a second step, these same caregivers were invited to describe their feelings about the participants reception of the Wii™ animation, after three months of using the console. Results: Five residents were observed and presented a gradual improvement in the understanding of the instructions (console usage and game rules), with more motivation and participation. Six caregivers observed these workshops for three months and highlighted positive reactions and final adherence to its implementation, a motivational impact and general positive effects (cognitive and motor stimulation, psychoaffective effects and favored social interactions).

Contexte: L'accueil, en perpétuelle hausse, de personnes âgées dépendantes avec des troubles cognitifs dans les établissements spécialisés représente une charge de travail conséquente pour les soignants. Les jeux vidéo en tant qu'approches non médicamenteuses offrent des avantages de stimulation et ont un champ d'action très large, impactant le résident mais aussi son environnement. Objectifs: L'objectif de cette étude qualitative passe par l'instauration d'un atelier Wii™ en Ehpad. Dans un premier temps, les soignants ont observé des personnes âgées présentant un syndrome démentiel afin de voir les évolutions des comportements au fil de leurs participations. Dans un second temps, ces mêmes soignants ont été invités à décrire leur ressenti face à l'accueil des participants, après trois mois d'utilisation de la console. Résultats: Cinq résidents ont été observés et ont présenté une amélioration progressive de la compréhension des consignes, avec davantage de motivation et de participation. Six soignants ont observé ces ateliers durant trois mois et ont souligné des réactions positives à son instauration, un impact motivationnel et des effets positifs généraux.

Multiple routes to help you roam: A comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults.

Cognitive-motor dual-tasking is a complex activity that predicts falls risk and cognitive impairment in older adults. Cognitive and physical training can both lead to improvements in dual-tasking; however, less is known about what mechanisms underlie these changes. To investigate this, 33 healthy older adults were randomized to one of three training arms: Executive function (EF; n = 10), Aerobic Exercise (AE; n = 10), Gross Motor Abilities (GMA; n = 13) over 12 weeks (1 h, 3×/week). Single and dual-task performance (gait speed, m/s; cognitive accuracy, %) was evaluated before and after training, using the 2-back as concurrent cognitive load. Training arms were designed to improve cognitive and motor functioning, through different mechanisms (i.e., executive functioning - EF, cardiorespiratory fitness - CRF, and energy cost of walking - ECW). Compared to baseline, we observed few changes in dual-task gait speed following training (small effect). However, dual-task cognitive accuracy improved significantly, becoming facilitated by walking (large effect). There were no differences in the magnitude of improvements across training arms. We also found that older adults with lower cognitive ability (i.e., MoCA score < 26; n = 14) improved more on the dual-task cognitive accuracy following training, compared to older adults with higher cognitive ability (i.e., MoCA ≥26; n = 18). Taken together, the results suggest that regardless of the type of intervention, training appears to strengthen cognitive efficiency during dual-tasking, particularly for older adults with lower baseline cognitive status. These gains appear to occur via different mechanisms depending on the form of intervention. Implications of this research are paramount, as we demonstrate multiple routes for improving cognitive-motor dual-tasking in older adults, which may help reduce risk of cognitive impairment.

Effects of equine-assisted interventions on older adults' health: A systematic review.

Objective: Equine-assisted interventions (EAI) can improve a variety of health problems in older adults and thus promote their well-being. This systematic review aimed to synthesize studies on EAI to understand better their effects on the health of older adults. Method: A systematic search guided by the PRISMA 2020 approach was performed on specific databases: Medline (PubMed), EMBASE, PsycINFO, and Cochrane Library. Peer-reviewed articles published in the English language from inception to June 2022 were retrieved. Methodological quality was established using the modified version of the Downs and Black checklist. Results: A total of 244 studies were retrieved, and 13 eligible studies were finally included. Three health domains were investigated: physical (balance, gait, and muscular strength), psychological (quality of life and cognitive assessment), and physiological (hormonal measures, cerebral and muscular activity). Among the eight studies investigating the physical dimension, four studies highlighted a positive effect of EAI on balance, four for gait, and three for strength. Regarding the three studies investigating the psychological dimension, two studies showed a positive effect of EAI on quality of life. Lastly, the four studies investigating the physiological dimensions all demonstrated a positive effect of EAI on hormonal measures and cerebral and muscular activity. Conclusion: Nevertheless, this systematic review provides promising findings regarding the positive effects of EAI on physical, psychological, and physiological health in older adults. Research on EAI should therefore be pursued rigorously to promote this non-pharmacological intervention in an older adult population.

Associations Between Frailty and Inflammation, Physical, and Psycho-Social Health in Older Adults: A Systematic Review.

Frailty is a complex geriatric syndrome with multifactorial associated mechanisms that need to be examined more deeply to help reverse the adverse health-related outcomes. Specific inflammatory and physical health markers have been associated with the onset of frailty, but the associations between these factors and psycho-social health outcomes seem less studied. This systematic review aimed to identify, in the same study design, the potential associations between frailty and markers of inflammation, and physical or psycho-social health. A literature search was performed from inception until March 2021 using Medline, Psycinfo, and EMBASE. Three raters evaluated the articles and selected 22 studies, using inclusion and exclusion criteria (n = 17,373; 91.6% from community-dwelling samples). Regarding biomarkers, 95% of the included studies showed significant links between inflammation [especially the higher levels of C-reactive protein (CRP) and interleukin-6 (IL-6)], and frailty status. Approximately 86% of the included studies showed strong links between physical health decline (such as lower levels of hemoglobin, presence of comorbidities, or lower physical performance), and frailty status. At most, 13 studies among the 22 included ones evaluated psycho-social variables and mixed results were observed regarding the relationships with frailty. Results are discussed in terms of questioning the medical perception of global health, centering mostly on the physical dimension. Therefore, the development of future research studies involving a more exhaustive view of frailty and global (bio-psycho-social) health is strongly encouraged.

Episodic memory and aging: Benefits of physical activity depend on the executive resources required for the task.

Physical activity has beneficial effects on executive functions and episodic memory, two processes affected by aging. These benefits seem to depend on the type of memory task, but only a few studies have evaluated them despite their importance in understanding aging. This study aimed to confirm that the benefits of physical activity on episodic memory in older adults vary according to the executive resources required by the memory task, comparing free recall and cued recall. Thirty-seven young adults and 37 older adults performed two memory tasks and an updating task. The two groups had a similar level of physical activity over the preceding 12 months, assessed by a questionnaire. Both the memory and the updating tasks were performed better by the younger than the older adults. A similar cueing effect was observed in the two groups. Physical activity was positively correlated with updating and free recall, but not with cued-recall, and only in older adults. Regression analyses indicated that physical activity accounted for 24% of the variance in free recall in older adults. Updating did not predict free recall (ns) when physical activity was entered in the analysis. The present results show that the benefits of physical activity vary with age and episodic memory task. Only free-recall performance, which relies on updating, seems to depend on physical activity, suggesting that the executive resources required for the task play an important role in the effect of physical activity on memory performance. This should be investigated in greater depth in subsequent studies.

A Comparison of the Effect of Physical Activity and Cognitive Training on Dual-Task Performance in Older Adults.

OBJECTIVES: Studies suggest that cognitive training and physical activity can improve age-related deficits in dual-task performances. However, both of these interventions have never been compared in the same study. This article investigates the improvement in dual-task performance in 2 types of exercise training groups and a cognitive training group and explores if there are specific dual-task components that are more sensitive or more likely to improve following each type of training. METHODS: Seventy-eight healthy inactive participants older than the age of 60 (M = 69.98, SD = 5.56) were randomized to one of three 12-week training programs: aerobic training (AET) = 26, gross motor abilities (GMA) = 27, and cognition (COG) = 25. Before and after the training program, the participants underwent physical fitness tests, and cognitive evaluations involving a computerized cognitive dual task. The AET consisted of high- and low-intensity aerobic training, the GMA of full-body exercises focusing on agility, balance, coordination, and stretching, and the COG of tablet-based exercises focusing on executive functions. RESULTS: Repeated-measures analysis of variance on reaction time data revealed a group × time interaction (F(2,75) = 11.91, p < .01) with COG having the greatest improvement, followed by a significant improvement in the GMA group. Secondary analysis revealed the COG to also improve the intraindividual variability in reaction time (F(1,24) = 8.62, p < .01), while the GMA improved the dual-task cost (F(1,26) = 12.74, p < .01). DISCUSSION: The results show that physical and cognitive training can help enhance dual-task performance by improving different aspects of the task, suggesting that different mechanisms are in play.

Bridging the Gap between Research and the Community: Implementing Physical and Cognitive Interventions to Improve Spontaneous Walking Speed in Older Adults.

The application of interventions to enhance mobility in ecological settings remain understudied. This study was developed to evaluate the feasibility of training methods in a community centre and to evaluate their impact on mobility outcomes. Fifty-four participants were randomized to one of three 12-week training programs (three times/week): aerobic (AE), gross motor abilities (GMA) or cognitive (COG). Feasibility was evaluated by calculating adherence, feedback from participants and long-term participation. The impact of these interventions on mobility was assessed by comparing pre- and post-program on Timed-up-and-go (TUG) and spontaneous walking speed (SWS) performances. Results showed relatively high rates of adherence (85.1%) and long-term participation (66.7%), along with favorable feedbacks. SWS significantly improved in COG (0.10 ± 0.11 m.s-1; p = 0.004) and AE (0.06 ± 0.11 m.s-1; p = 0.017) groups, and TUG performance was maintained in all groups. Results of this feasibility study demonstrated successful implementation of physical and cognitive training programs, encouraging the development of real-world applications.

A comparison of physical exercise and cognitive training interventions to improve determinants of functional mobility in healthy older adults.

OBJECTIVES: Mobility is a complex but crucial clinical outcome in older adults. Past observational studies have highlighted that cardiorespiratory fitness (CRF), energy cost of walking (ECW), and cognitive switching abilities are associated with mobility performance, making these key determinants of mobility intervention targets to enhance mobility in older adults. The objective of this study was to compare, in the same design, the impact of three training methods - each known to improve either CRF, ECW, or cognitive switching abilities - on mobility in healthy older adults. METHODS: Seventy-eight participants (69.28 ± 4.85yo) were randomly assigned to one of three twelve-week interventions: Aerobic Exercise (AE; n = 26), Gross Motor Abilities (GMA; n = 27), or Cognitive (COG; n = 25) training. Each intervention was designed to improve one of the three key determinants of mobility (CRF, ECW, and cognitive switching). Primary outcomes (usual gait speed, and TUG performance) and the three mobility determinants were measured before and after the intervention. RESULTS: Repeated-measures ANOVAs showed a time effect for TUG performance (F(1,75) = 14.92, p < .001): all groups equally improved after the intervention (ΔTUGpost-pre, in seconds, with 95% CI: AE = -0.44 [-0.81 to -0.08]; GMA = -0.60 [-1.10 to -0.10]; COG = -0.33 [-0.71 to 0.05]). No significant between group differences were observed. CRF was improved in the AE group only (Hedges' G = 0.27, small effect), ECW and cognitive switching improved the most in the GMA (Hedges' G = -0.78, moderate effect) and COG groups (Hedges' G = -1.93, large effect) respectively. Smaller improvements in ECW were observed following AE and COG trainings (Hedges' G: AE = -0.39, COG = -0.36, both small effects) as well as in cognitive switching following AE and GMA training (Hedges' G: AE = -0.42, GMA = -0.21, both small effects). DISCUSSION: This study provides further support to the notion that multiple interventional approaches (aerobic, gross motor exercise, or cognitive training) can be employed to improve functional mobility in older adults, giving them, and professionals, more options to promote healthy ageing.

Statin use moderates the beneficial effects of aerobic exercise on older adults' performances on the Stroop test: A subanalysis.

Aerobic training can lead to improved cognition in older adults and this effect can be explained by enhanced cardiorespiratory fitness. However, statins could limit the physical benefits of aerobic training by altering the mechanisms through which exercise improves cognition. Whether statins could have an effect on the cognitive benefits associated with aerobic training remains to be elucidated. The objective of this study was to determine whether the cognitive benefits of aerobic training were comparable in statin users and non-users. A total of 144 sedentary participants (>60 y.o.; 106 non-users, 38 statin users) were included. Participants were either part of an aerobic training group (n = 75) or a control group (n = 69). Cognition was assessed using the Stroop test. Analyses were performed on z-score changes from pre to post-intervention of Stroop reaction time (RT) and number of errors, using Two-factor ANCOVAs, while controlling for potential confounding factors (age, education, BMI, Charlson Comorbidity Index, sex, protocol and handgrip strength). The moderating effect of statins on the cognitive changes associated with aerobic training was determined through moderation analyses. An interaction effect on the Stroop switching condition was detected between intervention and statin intake (F [1, 140] = 5.659, P < 0.01). The intervention effect on switching RT was moderated by statin intake, where intervention improved switching RT only in non-users (Effect = 0.1678; P < 0.01). Statins could limit the cognitive benefits of aerobic training on switching capacities in some patients. Future randomized studies including a larger number of participants and looking at different types of statins should be conducted to confirm these results.

Sex-moderated association between body composition and cognition in older adults.

BACKGROUND: Some studies have reported an association between body composition and cognition in older adults, but underlying mechanisms and physiological factors remain poorly understood. Moreover, sex-related differences in metabolic health and age-related cognitive decline have gained major interest lately. The present study investigated the potential moderating effect of sex on the relationship between body composition and cognition in older adults. METHODS: Global cognition, assessed by the Montreal Cognitive Assessment (MoCA), and body composition, measured using dual-energy x-ray absorptiometry (DXA), were analyzed in 155 women and 65 men aged 60 years old or more. Moderation analyses were computed to determine if sex moderates the effect of the different body composition parameters on the MoCA while controlling for the body mass index and the level of education of the participants. RESULTS: Sex moderated the association between total lean mass, trunk lean mass, arms lean mass, and the MoCA score. These body composition parameters were positively associated with cognition only in men. Fat mass was not associated with cognition in any sex. CONCLUSION: Overall, higher lean mass and in particular trunk and arms lean mass was associated with higher cognitive abilities in older men. Longitudinal studies or intervention studies are needed to further identify physiological mechanisms that sustain the relationship between lean mass and cognition.

Lifestyle multidomain intervention, omega-3 supplementation, or both for reducing the risk of developing clinically relevant depressive symptoms in older adults with memory complaints? Secondary analysis from the MAPT trial.

BACKGROUND: We tested the associations of a lifestyle multidomain intervention (MI), omega-3 supplementation (O3) or their combination with the change of clinically meaningful depressive symptoms in older adults. METHODS: Secondary analysis of the 3-year Multidomain Alzheimer Preventive Trial (MAPT), in which 1679 people, ≥70 years with memory complaints were randomized into: MI, O3, MI + O3, or placebo. MI was composed of nutritional and physical activity counselling and cognitive training. O3 supplementation corresponded to a daily dose of 1000 mg of omega-3. Discrete-time cox regressions were performed for each outcome. Three binary variables of incidence of depressive symptoms were created from the 15-item geriatric depression scale (GDS-15): minimum clinically meaningful depressive symptoms (≥2-point increase in GDS-15), moderate depressive symptoms (GDS-15 ≥ 5), and severe depressive symptoms (GDS-15 ≥ 10) DS. RESULTS: Discrete-time cox proportional hazards have found no associations for all of the analysis. The incidence of severe depressive symptoms across groups were, respectively: 1.1, 2.4, 2.3 and 2.5 per 100 person year for MI + O3, for O3, for MI, for placebo. There was a trend for a decreased risk of developing severe DS compared to placebo in the MI + O3 group (p = 0.085 after adjustment). CONCLUSIONS: To conclude, we did not find any association of a lifestyle multidomain intervention with the onset of clinically depressive symptoms in older adults with memory complaints. A study with a more intensive multidomain intervention might bring further insights on this topic.

Cognitive changes of older adults with an equivocal amyloid load.

BACKGROUND: Observational and interventional studies addressing the link between amyloid (Aß) burden and cognitive decline are increasing, but a clear definition of amyloid positivity is still lacking. This may represent a great stake for therapeutic studies enrolling Aß + patients only. The main objective of this study was to define a population with "equivocal" amyloid status, and evaluate their cognitive changes. METHODS: Sixty-five participants over 75 years old, from the Control group of the interventional MAPT study, at risk to develop Alzheimer's disease, were included. Participants were classified into three groups in terms of amyloid load: Aß +, Aß - and Equivocal participants (according to visual reading, global standardized uptake (SUVR) cut-offs, or a k-mean clustering method). The cognitive changes over time (memory, executive functions, attention and processing speed) of this Equivocal group were then compared to Aß + and Aß - participants. RESULTS: When classified by visual read, Equivocal participants' memory scores were comparable to the Aß- participants, and greater than in Aß + participants over time. Secondary analyses, using SUVR cut-offs classification, showed different trajectories with Equivocal participants being comparable to the Aß + participants, and lower than Aß-, on executive performance over time. CONCLUSIONS: This original work pointed out a population that may be of great interest for interventional studies, raising the question of how amyloid status should be defined and integrated in such studies. These findings should be replicated in future studies on larger datasets, to confirm what methodological approach would be the most suitable to highlight this specific neuroimaging entity.

Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility.

OBJECTIVES: With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined. DESIGN: Cross-sectional study. SETTING: University Hospital of Caen (France) and advertisements in medical offices. PARTICIPANTS: Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women). MEASUREMENTS: Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed. RESULTS: Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions. CONCLUSION: Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.

Reduced gait and postural stability under challenging conditions in fallers with upper limb fracture.

BACKGROUND: While most fractures are caused by falls, not all falls result in fractures. Risk factors for falls are well established, but only weak associations have been demonstrated for risk factors for fractures. Conflicting results on the implication of bone mineral density (BMD) suggest that other risk factors should be studied, such as gait and balance disorders. AIMS: Gait and postural stability in challenging conditions were, therefore, compared between fallers with and without fracture. METHODS: We enrolled 80 adults aged 55 and older who fell in the previous year. We compared gait and posture after obstacle crossing between fallers with an upper-limb fracture (n = 38), and fallers without fracture (n = 42). Data on BMD, body mass index, handgrip strength, fear of falling, number of comorbidities, number of falls, global cognition, executive functioning and education level were collected. RESULTS: Compared to fallers without fracture, fallers with fracture had significant lower gait velocity (Likelihood-Ratio = 4.93; P = 0.03) and lower postural stability during stabilization after obstacle crossing (Likelihood-Ratio = 10.99; P < 0.001). In addition, fallers with fracture had lower handgrip strength (Likelihood-Ratio = 9.92; P = 0.002), lower education level (Likelihood-Ratio = 8.32; P = 0.004), poorer executive functions (Likelihood-Ratio = 5.81; P = 0.02, higher fear of falling (Likelihood-Ratio = 5.55; P = 0.02) and were more likely women (Likelihood-Ratio = 17.55; P < 0.001), compared to fallers without fracture. DISCUSSION: This study demonstrated that the main difference between fallers with upper-limb fracture and fallers without fracture is mobility in dynamic condition. Poor executive function and low muscular strength could also be involved. CONCLUSIONS: These factors should be taken into account when assessing risk factors for fracture and implementing preventive programs. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov. NCT02292316.

Effects of a 3-Year Multi-Domain Intervention with or without Omega-3 Supplementation on Cognitive Functions in Older Subjects with Increased CAIDE Dementia Scores.

Findings from recent Alzheimer's disease prevention trials have shown subjects with increased dementia score based upon mid-life cardiovascular risk factors, to benefit from multi-domain intervention strategies to some extent. The effects of such interventions on cognitive functions remains yet to be well-established. This study is a secondary analysis of the MAPT study, 1,293 older subjects (mean age 75 years) with high CAIDE score (i.e., ≥6) were classified according to the four intervention groups: 1) multi-domain intervention plus placebo, 2) isolated supplementation with Omega-3 polyunsaturated fatty acid (n-3 PUFA), 3) combination of the two interventions, and 4) placebo alone. Linear mixed-model repeated-measures analyses were used to assess the cognitive changes according to various neuropsychological test scores between intervention groups compared to the placebo at 36 months from baseline. Compared to the placebo, group with multi-domain intervention in combination withn-3PUFA was found to show significant improvement in the delayed total recall test of the free and cued selective reminding test (FCSRT) (mean±standard error(SE) = 0.20±0.10) and MMSE orientation test (mean±SE = 0.15±0.06) at 36 months. Isolated multi-domain intervention group showed significant less decline in the MMSE orientation test (mean±SE = 0.12±0.06) compared to the placebo. There was significant less improvement (mean±SE = - 1.01±0.46) in the FCSRT free recall test in the n-3 PUFA intervention group compared to the placebo at 36 months. Our findings show high-risk subjects for dementia screened with CAIDE dementia score might benefit from multi-domain intervention strategies as in the MAPT study, particularly in the orientation and delayed recall domain.

A web-based multidomain lifestyle intervention with connected devices for older adults: research protocol of the eMIND pilot randomized controlled trial.

BACKGROUND: Multidomain interventions composed of nutritional counseling, exercise and cognitive trainings have shown encouraging results as effective preventive strategies delaying age-related declines. However, these interventions are time- and resource-consuming. The use of Information and Communication Technologies (ICT) might facilitate the translation from research into real-world practice and reach a massive number of people. AIM: This article describes the protocol of the eMIND study, a randomized controlled trial (RCT) using a web-based multidomain intervention for older adults. METHODS: One hundred and twenty older adults (≥ 65 years), with a spontaneous memory complaint, will be randomly assigned to a six-month web-based multidomain (nutritional counseling, physical and cognitive trainings) intervention group with a connected accelerometer (number of steps, energy expenditure), or to a control group with access to general information on healthy aging plus the accelerometer, but no access to the multidomain intervention. The main outcome is the feasibility/acceptability of the web-based intervention. Secondary clinical outcomes include: cognitive functions, physical performance, nutritional status and cost-effectiveness. RESULTS: We expect a high amount of adherers (ie, > 75% compliance to the protocol) to reflect the feasibility. Acceptability, assessed through interviews, should allow us to understand motivators and barriers to this ICT intervention. We also expect to provide data on its effects on various clinical outcomes and efficiency. CONCLUSION AND DISCUSSION: The eMIND study will provide crucial information to help developing a future and larger web-based multidomain lifestyle RCT, which should facilitate the translation of this ICT intervention from the research world into real-life clinical practice for the healthcare of older adults.

A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults.

BACKGROUND: Spontaneous walking speed (SWS) is one of the most important indicators of health in older adults. Studies have shown benefits of physical trainings on SWS in older adults but the impact of cognitive training and multidomain interventions remains understudied. AIMS: This original study aimed at comparing the impact of aerobic/resistance exercise, computerized cognitive training and the combination of both interventions compared with active control conditions on SWS in healthy older adults. METHODS: Ninety community-dwelling older adults were randomly assigned to four different combinations composed of two active interventions: physical aerobic/resistance and cognitive dual-task trainings, and two active control conditions: stretching exercises and computer lessons. The four combinations were the following: (1) aerobic/resistance and cognitive dual task (n = 28), (2) aerobic/resistance and computer lessons (n = 21), (3) stretching exercises and cognitive dual task and (n = 23), (4) stretching exercises and computer lessons (n = 18). Training sessions were held three times/week for three months. SWS for 30 s was assessed before and after the intervention. RESULTS: Repeated-measures ANOVA showed a main effect of time and a significant three-way interaction suggesting differential improvement in SWS according to training combinations. A clinical meaningful improvement in SWS was observed in groups 1-3 (0.08-0.14 m/s; effect sizes: small to moderate) but not in the active control group 4. DISCUSSION: Results of this study suggest that aerobic/resistance exercise and computerized dual-task training are two non-pharmacological interventions by which SWS, a functional vital sign, can be clinically improved in older adults. CONCLUSION: This original study pointed out different tools to prevent functional decline in older people.