Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: the Ikaria study

Background

The purpose of this study was to evaluate the impact of adherence to Mediterranean diet on serum uric acid (UA) levels in elderly individuals, without known cardiovascular disease.

Methods

During 2009, 281 females (75 ± 6 years old) and 257 males (75 ± 7 years old) permanent inhabitants of the island, were voluntarily enrolled. A diet score that assesses the inherent characteristics of the Mediterranean diet (MedDietScore, range 0-55) was applied. Serum levels of UA were determined using an enzymatic colorimetric test through the uricase-peroxidase method. Hyperuricaemia was defined as UA > 7 mg/dL in males and 6 mg/dL in females.

Results

Prevalence of hyperuricaemia was 34% in males and 25% in females (p = 0.02). Mean level of adherence to the Mediterranean diet was 35 ± 2. Linear regression analysis revealed that MedDietScore was inversely associated with UA levels (b ± SE: −1.48 ± 0.17, p < 0.001) in the overall sample, after controlling for hypertension, hypercholesterolemia, diabetes mellitus, creatinine clearance, physical activity, and coffee consumption. When the analysis was stratified by gender, MedDietScore was inversely associated with UA levels in males (b ± SE: −1.10 ± 0.42, p = 0.009), but not in females (b ± SE: 0.04 ± 0.41, p = 0.92).

Conclusion

Another cardioprotective effect of Mediterranean diet was revealed, through the modification of UA levels in elderly individuals. The potential different effect size as regards the relationship between diet and UA levels between genders, deserves further investigation.     

Beyond executive function: Non-executive cognitive abilities in individuals with PKU

Individuals with early-treated phenylketonuria (ETPKU) most often present with impairment in executive function (EF) and average intelligence compared to the general population. The topic of this review, which is less often discussed, is non-EF impairments that may be associated with ETPKU. Studies that have included assessment of non-EF cognitive functions such as information processing speed, fine motor skills, and perception and visual–spatial abilities suggest that individuals with ETPKU are compromised in these areas. Those assessing non-EF cognitive functions of language skills, long-term memory, and learning skills have yielded mixed results, with some suggesting impairment and others suggesting intact abilities. Although more studies are required, research to date suggests that mechanisms for non-EF deficits may include prefrontal cortex dopamine deficiency and/or white matter abnormalities related to elevated blood phenylalanine levels. For individuals with ETPKU to reach their full potential in life, it is vital to address the challenges associated with EF and non-EF deficits by identifying impairments and appropriate treatment strategies.     

Assessment of cognitive function in the elderly

Neuropsychological testing of the five basic areas of mental function (attention, language, memory, visuospatial ability, and conceptualization) can be used to help differentiate the effects of normal aging, delirium, depression, and dementing disorders, and in developing appropriate treatment or management plans. The author assesses the meaning of the test results with particular reference to Alzheimer's disease.     

Markers of cognitive function in individuals with metabolic disease: Morquio syndrome and tyrosinemia type III

ABSTRACT

We characterized cognitive function in two metabolic diseases. MPS–IVa (mucopolysaccharidosis IVa, Morquio) and tyrosinemia type III individuals were assessed using tasks of attention, language and oculomotor function. MPS–IVa individuals were slower in visual search, but the display size effects were normal, and slowing was not due to long reaction times (ruling out slow item processing or distraction). Maintaining gaze in an oculomotor task was difficult. Results implicated sustained attention and task initiation or response processing. Shifting attention, accumulating evidence and selecting targets were unaffected. Visual search was also slowed in tyrosinemia type III, and patterns in visual search and fixation tasks pointed to sustained attention impairments, although there were differences from MPS–IVa. Language was impaired in tyrosinemia type III but not MPS–IVa. Metabolic diseases produced selective cognitive effects. Our results, incorporating new methods for developmental data and model selection, illustrate how cognitive data can contribute to understanding function in biochemical brain systems.     

The cricothyroid joint in elderly Japanese individuals

Using 15 cricothyroid joint (CT joint) specimens obtained from donated cadavers of elderly individuals, we examined the morphologies of the ceratocricoid ligaments as well as the synovial tissue. The ligaments consistently contained abundant elastic fibers: the fibers tended to be straight on the anterior side in contrast to a mesh-like arrangement on the posterior side. Thick and/or long synovial folds were often evident in the CT joint. The synovial tissue usually contained CD68-positive macrophages, but the positive cells were often restricted to certain parts of the tissue. Factor VIII-positive capillaries were present but few in number, and CD3- or IgM-positive lymphocytes were absent in the synovial tissue. Degenerative changes in the joint cartilage, such as roughness or thinning, were often present, but no cartilage defects were evident. Therefore, in contrast to the small, non-weight-bearing joints of the musculoskeletal system, we considered the degeneration of the CT joint to be a specific, silent form of osteoarthritis. For high-pitched phonation and ossification of the laryngeal cartilage, the CT joint in elderly individuals seemed to maintain its anterior gliding and rotation with the aid of elastic fiber-rich tissues compensating for the loss of congruity between the joint cartilage surfaces.     

Medial temporal lobe volume of nondemented elderly individuals with poor cognitive functions

Poor cognitive performance of elderly individuals with low educational attainment is often difficult to interpret in dementia evaluation. Lack of education, as well as dementia, is often associated with poor cognitive test performance. To elucidate the underlying structural change of low cognitive performance in elderly individuals with low educational attainment, this study examined the relationship between low cognitive performance (LCP) and brain volumes, especially regions vulnerable to Alzheimer's disease, in nondemented elderly Koreans. Individuals with LCP (n=14) were matched on age and education with individuals with normal cognitive performance (n=14). The two groups were compared on the MR-based volumetric measures in the hippocampus, the entorhinal cortex, the amygdala, the temporal lobe, the frontal lobe, the cerebrum, and the intracranial cavity. Intracranial volume (p<.05) and absolute hippocampus (p<.05) and frontal lobe volumes (p<.05) were significantly reduced in individuals with LCP. Normalized volumes of the hippocampus and the frontal lobe did not differ in the two cognitive performance groups. ICV was associated with the K-DRS scores. General cognitive functioning of the LCP individuals, measured with the Korean version of the DRS, did not deteriorate in the 1- or 2-year follow-up cognitive tests. LCP in a nondemented elderly population with limited education appears to be associated with stable lower intelligence rather than increased risk for dementia of the Alzheimer's type.     

Study of phagocytosis of senescent erythrocytes in young and elderly individuals

There is a decrease in the percentage contribution of a heavy density fraction of red blood cells to whole blood with increasing age. The aim of this study was to investigate in the young and elderly the interaction between monocytes and different erythrocyte suspensions: senescent red blood cells, erythrocytes stored with or without serum, and desialylated red blood cells. The results obtained with senescent red blood cells and erythrocytes stored with serum show the involvement of autologous IgG in the selective removal of erythrocytes. These values were higher in elderly individuals, indicating that this process increases with age. Our observation suggest that desialylation is not involved in the increased removal of erythrocytes observed in elderly individuals. Received: 3 October 2002 / Accepted: 11 December 2002 Correspondence to C. Biondi     

Rhabdomyosarcoma in middle-aged and elderly individuals

In a review of a national series of malignant tumors in middle-aged and elderly individuals (over 40 years of age), in all 107 cases primarily diagnosed and reported to the Swedish Cancer Registry as rhabdomyosarcomas during the period 1972-1981, 4 cases were accepted as botryoid, embryonal or alveolar rhabdomyosarcoma, using light-microscopic criteria for the diagnosis. An electron-microscopic and immunohistochemical analysis was performed on the 4 cases along with 7 cases of botryoid, embryonal and alveolar rhabdomyosarcoma in patients of over 40 years of age obtained from our own files. Rhabdomyoblastic differentiation was established ultrastructurally by the presence of myofilaments and Z-like densities in 10 of these 11 cases. There were tumor cells in the formaldehyde-fixed, paraffin-embedded material which were positively stained for desmin in all cases, for myoglobin in 7/11 cases, for vimentin in 5/11 cases and for actin in all cases, using monoclonal antibodies. The demonstration of desmin by the monoclonal antibody which was used on the formaldehyde-fixed, paraffin-embedded material is of particular value in the diagnosis of rhabdomyosarcoma. Another tumor, located in the minor pelvis, lacked the light-microscopic features of botryoid, embryonal or alveolar rhabdomyosarcoma, but presented ultrastructural and immunohistochemical evidence of a rhabdomyoblastic differentiation. This tumor was epithelioid in appearance and shared features with alveolar soft part sarcoma. The label epithelioid rhabdomyosarcoma is proposed for this tumor. Nine pleomorphic sarcomas were selected from the national series as possible pleomorphic rhabdomyosarcomas because of the presence of ribbon-shaped tumor cells with an eosiniphilic cytoplasm. There was no electron-microscopic or immunohistochemical evidence of a myogenic differentiation in any of these 9 tumors. The present investigation indicates that a pleomorphic type of rhabdomyosarcoma, indistinguishable from embryonal, botryoid and alveolar rhabdomyosarcoma, is extremely rare or non-existent.     

The specialization of function: cognitive and neural perspectives

A unifying theme that cuts across all research areas and techniques in the cognitive and brain sciences is whether there is specialization of function at levels of processing that are "abstracted away" from sensory inputs and motor outputs. Any theory that articulates claims about specialization of function in the mind/brain confronts the following types of interrelated questions, each of which carries with it certain theoretical commitments. What methods are appropriate for decomposing complex cognitive and neural processes into their constituent parts? How do cognitive processes map onto neural processes, and at what resolution are they related? What types of conclusions can be drawn about the structure of mind from dissociations observed at the neural level, and vice versa? The contributions that form this Special Issue of Cognitive Neuropsychology represent recent reflections on these and other issues from leading researchers in different areas of the cognitive and brain sciences.     

Aortic stenosis in the elderly: challenges in diagnosis and therapy

Severe aortic valve stenosis, remains the main cause of morbidity and mortality in the elderly, reaching a prevalence of 2–7% above the age of 65 years old.Despite its frequency and the development in invasive and noninvasive approach of the disease, several of its aspects remain controversial. This review is focused on the clinical aspects, the indices for assessment severity, newly markers related to prognosis and new therapeutic modalities for the elderly population. The term low flow, low gradient severe aortic stenosis with preserved LV systolic function has revealed a new modality in the field of diagnostic evaluation and therapeutic approach. Aortic valve replacement is the choice therapy for symptomatic severe aortic stenosis. Despite the recent advances in cardiac surgery, the overall operative mortality rate for isolated aortic valve replacement surgery ranges from 2.5% to 4.0% and is higher in octogenarians and can be up to 25% in patients with comorbid conditions. The fact that surgery is not being performed for 30% or more of patients requiring it, a great attention was attracted to the percutaneous transcatheter implantation of a stent-mounted aortic valve. The up to now experience of transcatheter valve implantation in more than 25,000 patients, has shown promising results in terms of mortality and quality of life. Echocardiography still plays the central role for the evaluation of the elderly patient, as it can illustrate the pathophysiological alterations during the course of aortic valve stenosis, and guide appropriate therapy.     

The cognitive neuropsychology of depression in the elderly

BACKGROUND: The cognitive impairment of older depressed patients with late- as opposed to early-onset illness may show important differences, in that patients with early onset may suffer predominantly from impaired episodic memory, and those with late onset mainly from reductions of executive function and processing speed. METHOD: We searched Medline and EMBASE as well as individual papers' reference lists for relevant publications, recording comparisons in neuropsychological test results between early-onset depression (EOD), late-onset depression (LOD) and healthy volunteers. Effect sizes are presented for cognitive domains, such as executive function, processing speed, episodic memory, semantic memory and mental state examination. RESULTS: Patients with LOD showed greater reductions in processing speed and executive function than patients with EOD and controls. Both patient groups showed reduced function in all domains, except mental state, compared with controls.CONCLUSION: Pronounced executive deficits are typical of the late-onset patients described in published studies, while episodic memory impairment is not specific to early-onset illness. Possible reasons and confounders are discussed.     

The function of elastic fibers in the arteries: Beyond elasticity

The main components of elastic fibers, elastin and fibrillin-containing microfibrils play a structural and mechanical role in the arteries and their essential function is to provide elasticity and resilience to the tissues. However, through control of the quiescent contractile phenotype of arterial smooth muscle cells, elastin also acts as an autocrine factor and, via the binding of ‘latent transforming growth factor (TGF)-β binding protein (LTBP) – latency-associated peptide (LAP) – TGF-β’ complexes, fibrillins regulate the activation and availability of TGF-βs. These recent discoveries are detailed in this review.     

The residual cognitive competence of elderly females

Factors described by Horn as affected by aging were hypothesized to physiologically define functional intelligence. Fifty female volunteers, who ranged in age from 68 to 98, were grouped as either Independent or Partially Dependent. Duke Activity Questionnaires validated group placement. Tasks derived from the Horn factors of attention, memory, and reasoning, as well as the Mini-Mental State and the WAIS-R Similarities and Digits Forward and Backward, assessed cognitive status. The tasks were more often sensitive to increased dependence than to age and generally supported the nomination of Horn's factors to identify “biological” intelligence. An unusual finding, low to negative correlations between educational and cognitive skills, was cited as relevant evidence of fluid loss.     

Masticatory function and cognitive function

Recent studies have suggest that masticatory (chewing) function is useful for maintaining neurocognitive function in the elderly. For example, a reduced ability to masticate, such as that resulting from toothlessness or soft-diet feeding, causes learning and memory deficits in aged animals and pathologic changes in the hippocampus. In addition, occlusal disharmony impairs hippocampal memory processes via chronic stress, and induces similar hippocampal pathology. Chewing, however, rescues stress-induced suppression of long-term potentiation in the hippocampus and the stress-induced impairment of hippocampal-dependent learning. These findings strongly suggest a link between mastication and neurocognitive function.     

Longitudinal change in cognitive performance among individuals with mild cognitive impairment

The authors used mixed-effects growth models to examine longitudinal change in neuropsychological performance over a 4-year period among 197 individuals who were either normal or had mild cognitive impairment (MCI) at baseline. At follow-up, the participants were divided into 4 groups: (a) controls: participants who were normal at both baseline and follow-up (n = 33), (b) stables: participants with MCI whose Clinical Dementia Rating-Sum of Boxes (CDR-SB) score did not differ between the first and last evaluations (n = 22), (c) decliners: participants with MCI whose CDR-SB score declined between the first and last evaluations (n = 95), and (d) converters: participants who received a clinical diagnosis of Alzheimer's disease during the follow-up period (n = 47). Only the Episodic Memory factor showed a significantly greater rate of decline over the follow-up period among the converters. Two other factors were significantly lower in converters at baseline in comparison with other groups (the executive function factor and the general knowledge factor), but the rate of decline over time did not differ. Individuals with an APOE epsilon4 allele scored lower on the episodic memory and executive function factors at baseline.     

Effects of acute tryptophan depletion on cognitive function in Alzheimer's disease and in the healthy elderly

BACKGROUND: The cholinergic system is profoundly impaired in senile dementia of Alzheimer type (SDAT) and replacement therapy produces only modest clinical benefits. The serotonergic system is also impaired and may contribute both to cognitive and non-cognitive symptoms in SDAT. To investigate this further we assessed the effects of lowering brain serotonin using the technique of acute tryptophan depletion on cognitive function in patients with SDAT and in age matched control subjects. METHOD: Sixteen patients with probable SDAT and 17 healthy elderly subjects received two amino acid drinks in a within subject, double-blind, placebo-controlled, counterbalanced, crossover design. One of the drinks was nutritionally balanced and contained tryptophan (placebo), the other was identical but contained no tryptophan. A battery of detailed neuropsychological tests was performed between 4 and 6 h after the drink. Mood rating scales and other ratings of behavioural and emotional symptoms were also performed on both occasions. RESULTS: Acute tryptophan depletion resulted in impairment on tasks of working memory in both groups. There was no group specific effect. Female SDAT subjects performed better on a task of pattern recognition during acute tryptophan depletion compared with placebo. There were no changes in behavioural symptoms during acute tryptophan depletion in either group. CONCLUSION: Compromised serotonergic function may be an important contributor to cognitive decline in SDAT and in ageing. Strategies targeting specific 5HT receptors may be helpful in SDAT.