Adherence to the MIND diet and the odds of mild cognitive impairment in generally healthy older adults: The 3-year DO-HEALTH study.

BACKGROUND: The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet may slow cognitive decline in older adults. A potential mechanism could be possible anti-inflammatory properties of the MIND-diet. OBJECTIVE: To examine whether adherence to the MIND diet at baseline is associated with the odds of mild cognitive impairment (MCI) and changes in biomarkers of inflammation (High-sensitivity C-reactive Protein(hsCRP), interleukin-6(IL-6)) over three years in adults ≥70 years. METHODS: Adherence to the MIND diet was assessed by food frequency questionnaire (FFQ) at baseline and after three years. Presence of MCI based on the Montreal Cognitive Assessment (MoCA) was defined as <26 (MCI26), or <24 (MCI24). We performed a minimally adjusted model controlling for sex, prior fall, linear spline at age 85, time, treatment and study site. The fully adjusted model also adjusted for education, BMI, physical activity, depression score, daily energy intake, and comorbidity score. To assess the change in inflammatory markers from baseline, we used linear-mixed-effect models adjusted for the same variables plus the respective baseline concentrations. Sensitivity analyses accounting for practice effects of repeated cognitive tests using the reliable change index for both MoCA cut-offs were done. RESULTS: We included 2028 of 2157 DO-HEALTH participants (60.5% women; mean age 74.88 years) with complete data. Adherence to the MIND diet at baseline was not associated with cognitive decline over three years, neither at MoCA < 26 (OR (95%CI) = 0.99 (0.94-1.04)) nor at MoCA < 24 (OR (95%CI) = 1.03 (0.96-1.1)). Applying the reliable change index to the two cut-offs confirmed the findings. Further, the MIND diet adherence was not associated with the change in MoCA score from baseline in DO-HEALTH. For inflammatory biomarkers MIND-diet baseline adherence was not associated with changes in hsCRP or IL-6. CONCLUSION: Adherence to the MIND-diet was neither associated with the odds of MCI, nor with hsCRP or IL-6 at baseline. Moreover, change in MIND-diet over three years was not associated with changes in hsCRP or IL-6.

[Evidence of Physical Training Programs for Fall Prevention in Seniors]. / Evidenz körperlicher Trainings-programme zur Sturzprävention bei älteren Menschen.

Evidence of Physical Training Programs for Fall Prevention in Seniors Abstract. It has been shown that physical exercise reduced fall risk by 23-42% in community-dwelling adults aged 65+. This is particularly true for physical exercises with functional, balance and strength components. Growing evidence shows that functional training is particularly effective in reducing fall risk. Functional training is composed by exercises which reflect activities of daily life, supported by weights and other aids.

Prevalence of Physical Activity and Sedentary Behavior Patterns in Generally Healthy European Adults Aged 70 Years and Older-Baseline Results From the DO-HEALTH Clinical Trial.

Background: Physical activity (PA) is important for healthy aging and disease prevention whereas sedentary behavior (SB) accelerates health deterioration. Aim: To investigate activity profiles regarding PA and SB among generally healthy European older adults. Methods: Meeting PA recommendations was defined as ≥150 min/week of moderate and/or ≥75 min/week of vigorous PA. A cut-off of ≥5.5 h/day was used to define time spent with SB. We present prevalence of PA and SB overall and by sex, age, BMI, and country. We examined correlates with multivariate logistic regression models. Results: Two thousand one hundred and fifty-five DO-HEALTH participants completed baseline information on activity profiles [mean age 74.9 years (SD 4.5), 61.8% women]. Overall, 62.2% met PA recommendations and overall, 37.1% spent ≥5.5 h/day with SB. Younger participants (70-74 years), men, and those with BMI <25 kg/m2 met PA recommendations more often. Per country, prevalence of meeting PA recommendations were: Austria 74.4%, France 51.0%, Germany 65.6%, Portugal 46.5%, and Switzerland 66.7%. Regarding SB, prevalence did not differ in all subgroups. In multivariate logistic regression analyses, being male, younger age, lower MoCA scores, and higher SPPB score were associated with greater odds, whereas higher BMI, more years of education, higher GDS score, and residing in Portugal were associated with lower odds of meeting PA recommendations. High BMI and higher MoCA scores were associated with greater odds of high SB. Conclusion: Individualized public health efforts may be warranted even in active older adults, as profiles were less favorable in subgroups of older age, female sex and higher BMI.

Association of Dance-Based Mind-Motor Activities With Falls and Physical Function Among Healthy Older Adults: A Systematic Review and Meta-analysis.

Importance: Falls increase morbidity and mortality in adults 65 years and older. The role of dance-based mind-motor activities in preventing falls among healthy older adults is not well established. Objective: To assess the effectiveness of dance-based mind-motor activities in preventing falls. Data Sources: Systematic search included the PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsychINFO, Abstracts in Social Gerontology, AgeLine, AMED, and Scopus databases from database inception to February 18, 2018, using the Medical Subject Headings aged 65 and older, accidental falls, and dancing. Study Selection: This systematic review and meta-analysis included 29 randomized clinical trials that evaluated a dance-based mind-motor activity in healthy older adults with regard to fall risk, fall rate, or well-established measures of physical function in the domains of balance, mobility, and strength. The included studies targeted participants without comorbidities associated with higher fall risk. Dance-based mind-motor activities were defined as coordinated upright mind-motor movements that emphasize dynamic balance, structured through music or an inner rhythm (eg, breathing) and distinctive instructions or choreography, and that involve social interaction. Data Extraction and Synthesis: Standardized independent screening, data extraction, and bias assessment were performed. Data were pooled using random-effects models. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Main Outcomes and Measures: Primary outcomes were risk of falling and rate of falls. For the secondary end points of physical function (balance, mobility, and strength), standardized mean differences (SMDs) were estimated and pooled (Hedges g). Results: In this systematic review and meta-analysis of 29 randomized clinical trials, dance-based mind-motor activities were significantly associated with reduced (37%) risk of falling (risk ratio, 0.63; 95% CI, 0.49-0.80; 8 trials, 1579 participants) and a significantly reduced (31%) rate of falls (incidence rate ratio, 0.69; 95% CI, 0.53-0.89; 7 trials, 2012 participants). In addition, dance-based mind-motor activities were significantly associated with improved physical function in the domains of balance (standardized mean difference [SMD], 0.62; 95% CI, 0.33-0.90; 15 trials, 1476 participants), mobility (SMD, -0.56; 95% CI, -0.81 to -0.31; 13 trials, 1379 participants), and lower body strength (SMD, 0.57; 95% CI, 0.23-0.91; 13 trials, 1613 participants) but not upper body strength (SMD, 0.18; 95% CI, -0.03 to 0.38; 4 trials, 414 participants). Conclusion and Relevance: Among healthy older adults, dance-based mind-motor activities were associated with decreased risk of falling and rate of falls and improved balance, mobility, and lower body strength. This type of activity may be useful in preventing falls in this population.

Safety and feasibility of a Dalcroze eurhythmics and a simple home exercise program among older adults with mild cognitive impairment (MCI) or mild dementia: the MOVE for your MIND pilot trial.

BACKGROUND: Falls represent a major health problem for older adults with cognitive impairment, and the effects of exercise for fall reduction are understudied in this population. This pilot randomized controlled trial evaluated the feasibility, safety, and exploratory effectiveness of a Dalcroze eurhythmics program and a home exercise program designed for fall prevention in older adults with mild cognitive impairment (MCI) or early dementia. METHODS: For this three-arm, single-blind, 12-month randomized controlled pilot trial, we recruited community-dwelling women and men age 65 years and older with MCI or early dementia through participating memory clinics in Zurich, Switzerland. Participants were randomly assigned to a Dalcroze eurhythmics group program, a simple home exercise program (SHEP), or a non-exercise control group. All participants received 800 IU of vitamin D3 per day. The main objective of the study was to test the feasibility of recruitment and safety of the interventions. Additional outcomes included fall rate, gait performance, and cognitive function. RESULTS: Over 12 months, 221 older adults were contacted and 159 (72%) were screened via telephone. Following screening, 12% (19/159) met the inclusion criteria and were willing to participate. One participant withdrew at the end of the baseline visit and 18 were randomized to Dalcroze eurhythmics (n = 7), SHEP (n = 5), or control (n = 6). Adherence was similarly low in the Dalcroze eurhythmics group (56%) and in the SHEP group (62%; p = 0.82). Regarding safety and pilot clinical endpoints, there were no differences between groups. CONCLUSION: The MOVE for your MIND pilot study showed that recruitment of older adults with MCI or early dementia for long-term exercise interventions is challenging. While there were no safety concerns, adherence to both exercise programs was low. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02279316. Registered on 31 October 2014.

Playing a musical instrument is associated with slower cognitive decline in community-dwelling older adults.

BACKGROUND: Elucidating behavioral protective factors for cognitive decline and dementia can have a far-reaching impact. AIMS: To describe the association of present and past musical instrument playing with cognitive function in cognitively intact older adults. METHOD: A post hoc observational analysis of the Zurich Disability Prevention Trial. Past and present musical instrument playing was correlated with Mini-Mental State Examination (MMSE) and EuroQol-Visual Analogue Scale (EQ-VAS) using linear regression at baseline and mixed-model linear regression over 1 year. RESULTS: Two hundred community dwelling adults age 70 and older (mean age 77.7) were included. There were 48.5% (97/200) participants, who ever played a musical instrument; 35% (70/200) played in the past and 13.5% (27/200) played at present. At baseline, present players had a suggestively higher adjusted-MMSE than never players (28.9 vs. 28.5, p value 0.059). Over 12 months, compared to never players, ever players showed a significantly better improvement from baseline in adjusted-MMSE (0.29 vs. - 0.12, p value 0.007). The association remained significant even after restricting to participants without higher education (p value 0.03). Over time, no differences were observed for EQ-VAS (p value 0.45). However, past players had the largest decline in health-related quality of life at 12 months. DISCUSSION: The support for a protective association in our observational study suggests the need for clinical trials to examine the effect of playing a musical instrument on cognitive function and decline. Both returning to play after an interruption and learning to play from the beginning should be examined. CONCLUSIONS: Present and past musical instrument playing may assist in preserving cognitive function in community-dwelling older adults.

Is There an Association Between Pain and Magnetic Resonance Imaging Parameters in Patients With Lumbar Spinal Stenosis?

STUDY DESIGN: A prospective multicenter cohort study. OBJECTIVE: The aim of this study was to identify an association between pain and magnetic resonance imaging (MRI) parameters in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA: At present, the relationship between abnormal MRI findings and pain in patients with LSS is still unclear. METHODS: First, we conducted a systematic literature search. We identified relationships of relevant MRI parameters and pain in patients with LSS. Second, we addressed the study question with a thorough descriptive and graphical analysis to establish a relationship between MRI parameters and pain using data of the LSS outcome study (LSOS). RESULTS: In the systematic review including four papers about the associations between radiological findings in the MRI and pain, the authors of two articles reported no association and two of them did. Of the latters, only one study found a moderate correlation between leg pain measured by Visual Analog Scale (VAS) and the degree of stenosis assessed by spine surgeons. In the data of the LSOS study, we could not identify a relevant association between any of the MRI parameters and buttock, leg, and back pain, quantified by the Spinal Stenosis Measure (SSM) and the Numeric Rating Scale (NRS). Even by restricting the analysis to the level of the lumbar spine with the most prominent radiological "stenosis," no relevant association could be shown. CONCLUSION: Despite a thorough analysis of the data, we were not able to prove any correlation between radiological findings (MRI) and the severity of pain. There is a need for innovative "methods/techniques" to learn more about the causal relationship between radiological findings and the patients' pain-related complaints. LEVEL OF EVIDENCE: 2.

Could less be more when assessing patient-rated outcome in spinal stenosis?

STUDY DESIGN: Longitudinal study of the measurement properties of a brief outcome instrument. OBJECTIVE: In patients undergoing surgery for lumbar spinal stenosis, we compared the responsiveness of the Core Outcome Measures Index (COMI) with that of the condition-specific Swiss Spinal Stenosis Measure (SSM), an instrument developed to assess patients with neurogenic claudication. SUMMARY OF BACKGROUND DATA: The COMI is a validated multidimensional questionnaire for assessing the key outcomes of importance to patients with back problems. Being brief, it is associated with minimal respondent burden and high completion rates. However, for a given pathology, intuitively it may be expected to be less responsive than a condition-specific instrument. METHODS: A total of 91 patients (73±8 yr; 53% males) completed the following questionnaires before surgery: COMI, SSM, Roland Morris Disability Questionnaire, back trouble "Feeling Thermometer," pain numeric rating scale, EuroQoL-visual analogue scale. Twelve months postoperatively, 78/91 (86%) completed all the questionnaires again; they also rated the "global treatment outcome" (GTO; rated 1-5) and SSM "satisfaction with treatment result" (SSM-sat; rated 1-4), which were used as external criteria of treatment success. RESULTS: Scores for the external criteria of success (GTO/SSM-sat) correlated with the change scores (baseline to 12 mo) in COMI (r=0.57) and SSM (r=0.54) to a similar extent. Using receiver operating characteristics, with GTO or SSM-sat dichotomized as external criterion, the area under the curve was similar for the COMI change score (0.86-0.90) and the SSM (sub)scales (0.80-0.90). CONCLUSION: With either SSM-sat or GTO serving as the external criterion, COMI was as responsive as the SSM. The COMI is well able to detect important change in lumbar spinal stenosis and has the added benefit of reducing the response burden for the patient and facilitating outcome comparisons with other spinal pathologies. LEVEL OF EVIDENCE: 2.