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.

Cross-Sectional Associations of Total Plasma Homocysteine with Cortical ß-Amyloid Independently and as a Function of Omega 3 Polyunsaturated Fatty Acid Status in Older Adults at Risk of Dementia.

OBJECTIVES: Elevated total plasma homocysteine is a risk factor for Alzheimer's disease (AD) and there is some evidence that omega-3 polyunsaturated fatty acids (n-3 PUFAs) can modulate the effects of homocysteine-lowering B vitamins on AD related pathologies. Hence we investigated the relationship between total plasma homocysteine and cortical ß-amyloid (Aß) in older adults at risk of dementia. The role of erythrocyte membrane n-3 PUFAs (omega 3 index) on this relationship was also explored. DESIGN: This is a cross-sectional study using data from the Multidomain Alzheimer Preventive Trial (MAPT); a randomised controlled trial. SETTING: French community dwellers aged 70 or over reporting subjective memory complaints, but free from a diagnosis of clinical dementia. PARTICIPANTS: Individuals were from the MAPT trial (n = 177) with data on total plasma homocysteine at baseline and cortical Aß load. MEASUREMENTS: Cortical-to-cerebellar standard uptake value ratios were assessed using [18F] florbetapir positron emission tomography (PET). Total baseline plasma homocysteine was measured using an enzymatic cycling assay. Baseline omega 3 index was measured using gas chromatography. Cross-sectional associations were explored using adjusted multiple linear regression models. RESULTS: We found that total baseline plasma homocysteine was not significantly associated with cortical Aß as demonstrated using multiple linear regression models adjusted for age, sex, education, cognitive status, time interval between baseline and PET-scan, omega-3 index, MAPT group allocation and Apolipoprotein E ε4 status (B-coefficient -0.001, 95 % CI: -0.008,0.006, p = 0.838). Exploratory analysis showed that homocysteine was however significantly associated with cortical Aß in subjects with low baseline omega-3 index (< 4.72 %) after adjustment for Apolipoprotein E ε4 status (B-coefficient 0.041, 95 % CI: 0.017,0.066, p = 0.005, n = 10), but not in subjects with a high baseline omega-3 index (B-coefficient -0.010, 95 % CI: -0.023,0.003, p = 0.132, n = 66). CONCLUSIONS: The role of n-3 PUFAs on the relationship between homocysteine and cerebral Aß warrants further investigation.

Serum vitamin D concentrations are associated with falling and cognitive function in older adults.

OBJECTIVES: To elucidate the mechanism through which vitamin D is associated with decreased falls. DESIGN: This was a convenience sample from a larger observational study examining correlations between vitamin D and 1) falls, 2) motor function, and 3) cognition (n=159). SETTING: Falls data were collected via weekly on-line surveys completed in the participants' homes. Yearly evaluations of motor and cognitive function were conducted in an out-patient setting of a large tertiary medical center. PARTICIPANTS: Participants from the Intelligent Systems for Assessment of Aging Changes Study (ISAAC), a community-based cohort study of independently living older adults over age 70, who had vitamin D concentration within 6 months of clinical evaluations were included in the analysis. RESULTS: Participants mean age was 85 years and 74% were women. Fallers (n=37) had significantly lower vitamin D concentration (32.9ng/ml) compared to non-fallers (39.2ng/ml) (p<0.01). The relationship between vitamin D and falls remained significant after adjusting for age, health status (via CIRS), and supplement use (p=0.004). Vitamin D concentration were significantly associated with cognitive impairment (Clinical Dementia Rating = 0.5) (p=0.02) and MMSE (p<0.01) after adjusting for age, gender, and education. Vitamin D concentrations did not correlate with any motor measures. CONCLUSION: Vitamin D concentrations correlated with cognition and falls, but not with motor measures. Further research is needed to demonstrate a causal relationship between vitamin D and cognitive function and determine if cognition plays a role in falls reduction.

Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging.

OBJECTIVE: To examine the cross-sectional relationship between nutrient status and psychometric and imaging indices of brain health in dementia-free elders. METHODS: Thirty plasma biomarkers of diet were assayed in the Oregon Brain Aging Study cohort (n = 104). Principal component analysis constructed nutrient biomarker patterns (NBPs) and regression models assessed the relationship of these with cognitive and MRI outcomes. RESULTS: Mean age was 87 ± 10 years and 62% of subjects were female. Two NBPs associated with more favorable cognitive and MRI measures: one high in plasma vitamins B (B1, B2, B6, folate, and B12), C, D, and E, and another high in plasma marine ω-3 fatty acids. A third pattern characterized by high trans fat was associated with less favorable cognitive function and less total cerebral brain volume. Depression attenuated the relationship between the marine ω-3 pattern and white matter hyperintensity volume. CONCLUSION: Distinct nutrient biomarker patterns detected in plasma are interpretable and account for a significant degree of variance in both cognitive function and brain volume. Objective and multivariate approaches to the study of nutrition in brain health warrant further study. These findings should be confirmed in a separate population.

Blood-brain barrier impairment in Alzheimer disease: stability and functional significance.

OBJECTIVE: To determine the stability and functional significance of blood-brain barrier (BBB) integrity in patients with mild to moderate Alzheimer disease (AD). METHODS: Thirty-six patients (mean age 71 +/- 7 years) with mild to moderate AD (Mini-Mental State Examination [MMSE] 19 +/- 5) participated in a biomarker study involving clinical assessments, brain imaging, and CSF and plasma collection over 1 year. BBB integrity was assessed with the CSF-albumin index (CSF-AI). RESULTS: BBB disruption was present in an important subgroup of patients (n = 8/36, 22%) at all time points measured. CSF-AI was highly reproducible over 1 year with an intraclass correlation of 0.96. Age, sex, and APOE status did not correlate with CSF-AI. Vascular factors (blood pressure, Hachinski ischemia score, MR-derived white matter hyperintensity, body mass index) were not strongly associated with CSF-AI levels (p = 0.066). CSF/plasma IgG ratio correlated with CSF-AI in a manner indicating that peripheral IgG has greater access to the CNS in patients with an impaired BBB. Further evidence for the physiologic significance of the CSF-AI was noted in the form of correlations with rates of disease progression, including annual change on MMSE (r(2) = 0.11, p = 0.023), annual Clinical Dementia Rating sum-of-boxes change (r(2) = 0.29, p = 0.001), and annual ventricular volume change (r(2) = 0.17, p = 0.007). CONCLUSIONS: Blood-brain barrier (BBB) impairment is a stable characteristic over 1 year and present in an important subgroup of patients with Alzheimer disease. Age, gender, APOE status, vascular risk factors, and baseline Mini-Mental State Examination score did not explain the variability in BBB integrity. A role for BBB impairment as a modifier of disease progression is suggested by correlations between CSF-albumin index and measures of disease progression over 1 year.

Prevalence of Cryptosporidium and Giardia infections on two Ohio pig farms with different management systems.

The prevalence of Cryptosporidium and Giardia infections in pigs was investigated by the use of a direct immunofluorescence assay on two Ohio farms with different management systems. Cryptosporidium and Giardia infections were detected only in weanlings on the farm with slotted and wire floors, but in both weanlings and nursing piglets on the farm with porous concrete floors. Giardia infection was also detected in sows on the latter farm. The farm with porous concrete floors had a significantly higher Cryptosporidium infection rate in nursing piglets and Giardia infection rates in weanlings than the farm with slotted and wire floors. Sows were implicated as the source of both Cryptosporidium and Giardia infections for nursing piglets.

Economic impact of an epizootic of pseudorabies in a commercial swine herd in Ohio, achieving test negative status and quarantine release by use of vaccination and test and removal.

The effect of pseudorabies in a commercial farrow-to-finish operation on selected production and economic values was estimated. Pseudorabies was first diagnosed in this herd by circle testing done in March 1988, as a required part of follow up from another herd that had been diagnosed with pseudorabies in the area. A pseudorabies virus vaccination program was initiated in the herd at that time. The mean litter size of pigs born alive varied from 9.26 to 10.02 pigs/litter throughout the study period; however, there was a twofold increase in suckling pig mortality and a 2.6-fold increase in nursery pig mortality when the months of the epizootic were compared with pre-epizootic months. In the 6-month period following the epizootic, suckling pig mortality was three-fold higher than that reported in the preepizootic months. Total net loss for this operation was estimated at $99,700 from when the epizootic started until eradication, when calculating losses directly. The major economic losses (76.5% of total loss) were related to suckling pig mortality, which was $16,240 during the epizootic or $24/inventoried sow/week; $19,395 in the 6 months following the epizootic or $3.8/inventoried sow/week; and $40,628 thereafter until eradication 26 months later or $0.37/inventoried sow/week. Nursery pig mortality losses were 12.6% of total net losses; $754 during the epizootic, $357 in the 6 months after the enzootic, and $11,444 thereafter until eradication 26 months later. Sow culling and deaths accounted for 9.4% of net losses that took place from 6 months after the epizootic until eradication.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs associated with selected preventive practices and with episodes of clinical mastitis in nine herds with low somatic cell counts.

Nine dairy herds (mean size, 149 cows) with bulk-tank milk somatic cell counts of less than 300,000 cells/ml and greater than 80% of cows with Dairy Herd Improvement Association linear somatic cell counts less than or equal to 4 were selected for study. Each herd was monitored for 12 consecutive months. Duplicate quarter-milk specimens were collected from each cow for bacteriologic culturing at beginning of lactation, cessation of lactation, and at the time of each clinical episode of mastitis. Streptococcus agalactiae was never isolated and Staphylococcus aureus was isolated from less than 1% of all quarters. There were 554 episodes of clinical mastitis. During the year of study, the incidence rate of clinical mastitis varied from 15.6 to 63.7% of cows among the 9 herds. Mean costs per cow per year in herd for mastitis prevention were: $10 for paper towels, $3 for nonlactating cow treatment, and $10 for teat disinfectants. Mean cost associated with clinical mastitis was $107/episode. Approximately 84% ($90) of the costs attributed to a clinical episode were associated with decreased milk production and nonsalable milk. Costs of medication and professional veterinary fees per clinical episode varied significantly among the 9 herds. Three of the herds did not have a veterinarian treat a clinical episode of mastitis during the year of study even though 2 of these herds had the first and third highest incidence rates of clinical mastitis. When calculated on a per cow in herd basis, mean costs of $40/cow/year were attributed to clinical mastitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Field survey of clinical mastitis in low somatic cell count herds.

Nine commercial dairy herds, each with low herd milk somatic cell counts, were monitored for 1 yr to determine prevalence of intramammary infections and rates of clinical mastitis. Staphylococcus species was the bacterial group most frequently isolated from quarters at calving and at drying off. Environmental streptococci and coliform intramammary infections totaled less than 6% of quarters at both calving and at drying off. Staphylococcus aureus were isolated from less than 1% of quarters and Streptococcus agalactiae from 0% of quarters at both calving and drying off. A total of 646 clinical cases of mastitis were diagnosed in 548 quarters of 406 cows. Mean rate of clinical mastitis among herds was .457 clinical cases/305 cow-days. Rates of clinical mastitis ranged among herds from .273 to .748 clinical cases/305 cow-days. Coliforms and bacteriologically negative and environmental streptococci accounted for 82.3% of clinical cases. Rates of clinical mastitis and severity of clinical signs differed among herds, seasons of the year, parity groups, and stages of lactation. Rates of clinical mastitis were highest during summer, in first lactation cows, and during the first 7 d of lactation.

Bacterial counts in bedding materials used on nine commercial dairies.

Bacterial counts were monitored for 1 yr in bedding materials used on nine commercial dairies. Organic materials used to bed lactating cows had significantly higher moisture content and gram-negative bacterial, coliform, Klebsiella species, and streptococcal counts than did inorganic materials. Klebsiella species counts were higher in sawdust than in chopped straw. Streptococcal counts were higher in chopped straw than sawdust. Bacterial counts did not differ between sand and crushed limestone. Gram-negative bacterial and coliform counts were higher during summer and fall than in winter and spring months. Streptococcal counts did not differ among seasons of the year. Linear relationships were significant between total rates of clinical mastitis during lactation and both gram-negative bacterial and Klebsiella species counts in lactating cow bedding. These data indicate that bacterial populations differed between both types of bedding and among seasons of the year. Rates of clinical mastitis were related to bacterial counts in bedding.

Bacterial and Somatic Cell Counts in Bulk Tank Milk from Nine Well Managed Herds1.

Factors associated with bulk tank milk bacterial and somatic cell counts were investigated for one year on nine well managed dairies. Geometric mean total bacterial count among dairies was 4.4 × 103 colony cfu/ml. Geometric mean bulk tank milk somatic cell counts among herds was 265 × 103ml. Bacterial counts in bulk tank milk were correlated with rates of coliform and environmental streptococcal clinical mastitis cases. Rates of total clinical cases were also correlated with bulk tank milk somatic cell counts. Correlations were measured among bulk tank milk bacterial counts and gram-negative bacterial, coliform, Klebsiella species, and streptococcal counts in materials used to bed lactating cows. Total bacterial and staphylococcal bulk tank milk counts increased when synthetic rubber liners were used greater than 800 quarter milkings. Correlations measured indicated that monitoring bulk tank milk may be an effective means of detecting management changes in herds with low bacterial and milk somatic cell counts.

Serratia liquefaciens mastitis in a dairy herd.

Serratia liquefaciens mastitis was detected and investigated in a 41-cow Holstein herd. Twenty cows were treated for mastitis over a 3-month period. Serratia liquefaciens was isolated from milk samples obtained from 8 of 12 cows tested during the epizootic. Results of an epidemiologic investigation suggested that extensive frostbite of the teats decreased the udder defense. Poor milking technique and hygiene were responsible for increased exposure of the damaged teats to potential udder pathogens. Treatment of each cow resulted in initial clinical improvement, but exacerbations occurred in 75% of the cows with documented S liquefaciens infections.