Frailty is Associated With Frontal Cortex-Related Cognitive Function in Patients With Alzheimer Disease.

OBJECTIVE: We compared the cognitive functions of Alzheimer disease (AD) patients who were robust, frail or pre-frail and hypothesized that declines in frontal cortex-related neuropsychological function would be associated with frailty. METHOD: One hundred and sixty outpatients aged 65 years or older with mild AD were enrolled. Cognitive function was assessed using the Cognitive Ability Screening Instrument and further classified into 4 clusters (recent memory, frontal cortex cluster, posterior cortex cluster, and orientation). Other variables included depressive mood, daily activities, body mass index, handgrip strength (HGS), and normal gait speed (NGS). RESULTS: Performance in daily activities, and slower NGS than robust group. Both the frail and pre-frail groups had lower HGS and more depressive symptoms than robust group. Generalized linear with ordinal logistic analysis showed that increment in age, slowing in NGS, and worse frontal cortex cluster function associated with being in a higher level of frailty. The patients with depression symptoms were the odds of being in a higher level of frailty compared to those without depression symptoms. CONCLUSIONS: In addition to physical and psychological symptoms, frailty is associated with specific cognitive domains in patients with AD. A multidimensional approach should be used to assess the impact of intervention programs focusing on frail patients with AD.

Sarcopenia in female patients with Alzheimer's disease are more likely to have lower levels of haemoglobin and 25-hydroxyvitamin D.

AIM: Few studies have investigated sarcopenia in patients with cognitive impairment. However, identifying the characteristics and factors associated with sarcopenia in these patients may help to decrease the risk of falls, prevent disabilities, and maintain an independent life, all of which can affect the quality of life of both patient and caregiver. Therefore, the aim of this study was to investigate associated factors of sarcopenia in patients with mild to moderate Alzheimer's disease. METHODS: This cross-sectional study enrolled 125 outpatients aged 65 to 89 years (mean age 79.5 ± 7.9 years) from January 2018 to December 2018. In addition to demographic characteristics, cognitive status, depressive mood, activities of daily living, body mass index (BMI), handgrip strength, gait speed, muscle mass, and serum levels of 25-hydroxyvitamin D (Vit D), haemoglobin (Hb), albumin and creatinine were assessed. Sarcopenia was defined based on the presence of low muscle mass and either low muscle strength or low physical performance. RESULTS: Overall, 29.6% of the patients had sarcopenia. The patients with sarcopenia were mostly male, significantly older, and had a lower BMI and lower levels of Vit D. The female patients with sarcopenia were more likely to have lower levels of Hb. Multiple logistic regression showed that sarcopenia was associated with BMI in both genders. The level of Vit D was associated with sarcopenia in the female patients, whereas age was associated with sarcopenia in the male patients. CONCLUSIONS: A low BMI may be a dementia-related risk factor for sarcopenia. The female patients with sarcopenia were more likely to have lower levels of Hb and Vit D. There may be different risk profiles for sarcopenia in men and women with Alzheimer's disease. Further studies are needed to devise different nutritional support for muscle weakness in patients with cognitive decline by gender.

Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with Alzheimer's disease.

OBJECTIVES: This study aimed to investigate factors associated with frailty in patients with mild to moderate Alzheimer's disease (AD). METHODS: One hundred fifty-seven outpatients aged 65 years or older with mild to moderate AD were enrolled from January 2018 to December 2018. Cognitive status, depressive mood, activities of daily livings (ADLs), body mass index, handgrip strength (HGS), usual gait speed (UGS), and serum levels of 25-hydroxyvitamin D, hemoglobin (Hb), albumin, and creatinine were assessed. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: fatigue, resistance, ambulation, illness, and unintentional weight loss. RESULTS: The prevalence of frailty was 15.9%. Those classified as being frail were significantly older, had worse cognitive function, worse ADLs, slower UGS, and lower level of Hb compared to those classified as being pre-frail and those robust, respectively. The pre-frail group was significantly older, had worse ADLs, and slower UGS compared to the robust group. Both the frail and pre-frail groups had more depressive symptoms and weaker HGS than the robust group. Multiple logistic regression analysis showed that cognitive function, UGS, level of Hb, and depressive symptoms were associated with frailty, and that only depressive symptoms were associated with pre-frailty. CONCLUSIONS: Depressive symptoms were a common risk factor for pre-frailty and frailty in patients with AD. Hb levels and UGS were associated with being frail. Preventing frailty in patients with AD should be approached from both physiological and psychological aspects.

Higher levels of thyroxine may predict a favorable response to donepezil treatment in patients with Alzheimer disease: a prospective, case-control study.

BACKGROUND: Cholinergic hypothesis has been advanced as an etiology of Alzheimer disease (AD) on the basis of the presynaptic deficit found in the diseased brains, and cholinesterase inhibitors (ChEIs) are the treatment of choice for these patients. However, only about half of treatment efficacy was found. Because increasing evidence supports an extensive interrelationship between thyroid hormones (THs), cortisol level and the cholinergic system, the aim of the present study was to evaluate thyroid function and cortisol level in patients with mild to moderate AD before and after ChEIs treatment, and to identify possible variations in response. This was a prospective, case-control, follow-up study. Levels of cortisol and THs were evaluated in 21 outpatients with mild to moderate AD and 20 normal controls. All patients were treated with 5 mg/day of donepezil (DPZ) and were reevaluated after 24-26 weeks of treatment. RESULTS: The patients had worse cognitive function, higher cortisol level, and lower levels of triiodothyronine (T3) and its free fraction than the controls. There were no significant differences in global cognitive function or cortisol level after treatment, however, significant reductions in T3 and thyroxin (T4) levels were observed. Responders had higher levels of T4 than non-responders, followed by a significant reduction after treatment. CONCLUSIONS: These results suggest that relatively higher levels of T4 may predict a favorable response to DPZ treatment. Further studies are warranted to confirm the relationship between THs and ChEIs therapy in AD and to explore new therapeutic strategies. On the other hand, cortisol levels are more likely to respond to interventions for stress-related neuropsychiatric symptoms in patients with AD rather than ChEIs treatment. Further studies are warranted to investigate the association between cortisol level and the severity of stress-related neuropsychiatric symptoms in patients with AD.

Assessing and simulating the major pathway and hydrogeochemical transport of arsenic in the Beitou-Guandu area, Taiwan.

This study involved assessing and simulating the probable major pathways (surface and subsurface flow) and hydrogeochemical transport of arsenic (As) in the Beitou-Guandu area, Taiwan. A one-dimensional (1-D) generic, reactive, chemical transport model (PHREEQC) was adopted. The calibrated model showed that As transported to the downstream Guandu plain and Tan Shui river mouth accounted for 50.7 and approximately 100 % of the As in the subsurface flow pathway, respectively, suggesting that subsurface flow constituted a major As pathway. The highest As water concentration occurred near the Beitou geothermal valley because of the low pH and high redox potential in both the surface and subsurface pathways. However, As may be scavenged by aqueous Fe(II) in a reducing environment. The As concentrations in the downstream Guandu plain and Guandu wetland decreased as the simulated time increased, resulting in the adsorption of As on the surface of Fe oxydroxides and limiting the mobility of As in the surface flow pathway. The major retardation mechanism of As mobility in the subsurface flow pathway of the Guandu plain and Guandu wetland was governed by the adsorption reactions of iron-oxide and iron-sulfide minerals. The 1-D transport model was applied to predict the evolution of As in the subsurface flow pathway from 2013 to 2020. The results indicated that the As concentrations in all cells gradually increased. The geochemical redox reactions of As in the subsurface pathway subsequently led to the oxidization of As-bearing sulfides, causing As concentrations to rise substantially in the hillside area.

Association between antipsychotic use and risk of acute myocardial infarction: a nationwide case-crossover study.

BACKGROUND: Antipsychotic medications have been increasingly and more widely prescribed despite continued uncertainty about their association with the incidence of acute myocardial infarction (AMI). METHODS AND RESULTS: We investigated the risk of AMI associated with antipsychotic treatment in 56 910 patients with schizophrenia, mood disorders, or dementia first hospitalized or visiting an emergency room for AMI in 1999 to 2009. A case-crossover design was used to compare the distributions of antipsychotic exposure for the same patient across 1 to 30 and 91 to 120 days just before the AMI event. Adjustments were made for comedications and outpatient visits. The adjusted odds ratio of AMI risk was 2.52 (95% confidence interval, 2.37-2.68) for any antipsychotics, 2.32 (95% confidence interval, 2.17-2.47) for first-generation antipsychotics, and 2.74 (95% confidence interval, 2.49-3.02) for second-generation antipsychotics. The risk significantly increased (P<0.001) with elevations in dosage and in short-term use (≤30 days). Male patients, elderly patients, and patients with dementia were at significantly increased risk (all P<0.001). Physically healthier patients with no preexisting diabetes mellitus, hypertension, or dyslipidemia were at significantly greater risk (P<0.001), largely because they had been exposed to higher doses of antipsychotics (P<0.001). A study of the selected binding of antipsychotics to 14 neurotransmitter receptors revealed only dopamine type 3 receptor antagonism to be significantly associated with AMI risk (adjusted odds ratio, 2.59; 95% confidence interval, 2.43-2.75; P<0.0001). CONCLUSIONS: Antipsychotic use may be associated with a transient increase in risk for AMI, possibly mediated by dopamine type 3 receptor blockades. Further education on drug safety and research into the underlying biological mechanisms are needed.