Nutritional and psycho-functional status in elderly patients with Alzheimer’s disease

Objectives  

Analysis of variations of nutritional status in relation to psycho-functional conditions in elderly patients with mild to moderate Alzheimer’s disease (AD) by means of bioelectrical impedance vector analysis (BIVA).     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.     

Nutritional status and associated factors among the elderly in Viçosa, Minas Gerais State, Brazil

This cross-sectional study in 2009 focused on the prevalence of underweight and overweight and associated factors in a sample of 621 elderly individuals in Vi?osa, Minas Gerais State, Brazil. Data were obtained through home interviews on nutritional status and socio-demographic and health conditions. Of the total sample, 53.3% were females. Median BMI was 26.40 kg/m2 (range = 15.20-46.82) and was lower for men than for women. Prevalence of overweight was high (45%; 95%CI: 40%-49%), decreased with age, was positively associated with female gender and history of arthritis/arthrosis, and was negatively associated with age 80 years or older and smoking. Prevalence of underweight was high in men (18.2%), increased with age, and was positively associated with worse self-rated health. The findings highlight the importance of health strategies that favor lifestyle changes and healthy eating habits.     

Postural stability in Parkinson’s disease patients’ wives and in elderly women leading different lifestyles

Abstract

The study aimed to determine postural stability of Parkinson’s disease (PD) patients’ wives in comparison with women differing in their lifestyle. (PD) patients’ wives (n?=?44), homemakers (n?=?41), and female students of the University of the Third Age (n?=?43) performed balance tests on a stabilometric platform. The PD patients’ wives were characterized by significantly (p?<?0.001) higher values of mean velocity sway than the homemakers and students (approximately 3.5 and 5?mm/s, respectively) and performed worst in displacement velocity and sway range in both sagittal and frontal plane. The results indicate that the wives of PD patients need support in the area of health training targeted at improving their standing stability.     

Prevalence of tobacco use and associated factors among women in Paraná State, Brazil

This study aimed to estimate the prevalence of tobacco use and to describe the demographic profile of female smokers in Paraná State, Brazil. The study used a cross-sectional population-based design with cluster sampling (n = 2,153) of women 18 years or older in seven cities. Prevalence of smoking was 13.4%, ranging from 10% in Cascavel to 19% in Irati. According to multivariate analysis, city of residence, marital status, and schooling were significantly associated with tobacco use. Women in Irati (OR = 2.08; 95%CI: 1.22-3.54) were more likely to smoke than those in Cambé. Married women and widows were less likely to smoke (OR = 0.47; 95%CI: 0.30-0.73 and OR = 0.43; 95%CI: 0.22-0.87) than single women. Women living with a partner (but not married) were more likely to smoke than single women (OR = 2.49; 95%CI: 1.12-5.53), and women with university degrees were less likely to smoke than those with eight years of school or less (OR = 0.41; 95%CI: 0.22-0.87). The results confirm the need for tobacco control programs that take gender and regional differences into account.     

Dopamine Transporter Genetic Variants and Pesticides in Parkinson’s Disease

Background

Research suggests that independent and joint effects of genetic variability in the dopamine transporter (DAT) locus and pesticides may influence Parkinson’s disease (PD) risk.

Materials

Methods: In 324 incident PD patients and 334 population controls from our rural California case–control study, we genotyped rs2652510, rs2550956 (for the DAT 5′ clades), and the 3′ variable number of tandem repeats (VNTR). Using geographic information system methods, we determined residential exposure to agricultural maneb and paraquat applications. We also collected occupational pesticide use data. Employing logistic regression, we calculated odds ratios (ORs) for clade diplotypes, VNTR genotype, and number of susceptibility (A clade and 9-repeat) alleles and assessed susceptibility allele–pesticide interactions.

Results

PD risk was increased separately in DAT A clade diplotype carriers [AA vs. BB: OR = 1.66; 95% confidence interval (CI), 1.08–2.57] and 3′ VNTR 9/9 carriers (9/9 vs. 10/10: OR = 1.8; 95% CI, 0.96–3.57), and our data suggest a gene dosing effect. Importantly, high exposure to paraquat and maneb in carriers of one susceptibility allele increased PD risk 3-fold (OR = 2.99; 95% CI, 0.88–10.2), and in carriers of two or more alleles more than 4-fold (OR = 4.53; 95% CI, 1.70–12.1). We obtained similar results for occupational pesticide measures.

Discussion

Using two independent pesticide measures, we a) replicated previously reported gene–environment interactions between DAT genetic variants and occupational pesticide exposure in men and b) overcame previous limitations of nonspecific pesticide measures and potential recall bias by employing state records and computer models to estimate residential pesticide exposure.

Conclusion

Our results suggest that DAT genetic variability and pesticide exposure interact to increase PD risk.     

Vitamin D and Sunlight Exposure in Newly-Diagnosed Parkinson’s Disease

Circulating vitamin D has previously been found to be lower in patients with Parkinson’s disease (PD), while the effects of sunlight exposure have not yet been fully investigated. Therefore, we evaluated the associations between serum vitamin D, vitamin D intake, sunlight exposure, and newly-diagnosed PD patients in a Chinese population. This case-control study measured serum 25-hydroxyvitamin D (25(OH)D) levels and sunlight exposure in 201 patients with newly-diagnosed PD and 199 controls without neurodegenerative diseases. Data on vitamin D intake and sunlight exposure were obtained using a self-report questionnaire. Multivariable logistic regressions were employed to evaluate the associations between serum 25(OH)D levels, sunlight exposure, and PD. Adjustments were made for sex, age, smoking, alcohol use, education, BMI, and vitamin D intake. There were significantly lower levels of serum 25(OH)D (20.6 ± 6.5 ng/mL), daily vitamin D intake (8.3 ± 3.7 g/day), and sunlight exposure (9.7 ± 4.1 h/week) in patients with PD compared to healthy controls (p < 0.05). Crude odds ratios (ORs) for PD in the quartiles of serum 25(OH)D were 1 (reference), 0.710 (0.401, 1.257), 0.631 (0.348, 1.209), and 0.483 (0.267, 0.874), respectively. Crude ORs for PD in quartiles of sunlight exposure were 1 (reference), 0.809 (0.454, 1.443), 0.623 (0.345, 1.124) and 0.533 (0.294, 0.966), respectively. A significant positive correlation between serum 25(OH)D and sunlight exposure was found, but serum 25(OH)D was not correlated with daily vitamin D intake. This study indicates that lower levels of serum 25(OH)D and sunlight exposure are significantly associated with an increased risk for PD.     

Alzheimer’s Disease Dietary Supplements in Websites

Consumer demand for health information and health services has rapidly evolved to capture and even propel the movement to online health information seeking. Seventeen percent (52 million) of health information internet users will look for information about memory loss, dementia and Alzheimer’s disease (AD) (Fox Pew Internet & American life project: Online health search. Report. Pew Research Center. http://pewinternet.org/Reports/2006/Online-Health-Search-2006.aspx 2006, Pew Research Center. http://pewinternet.org/Reports/2011/HealthTopics.aspx 2011). We examined the content of the 25 most frequently retrieved websites marketing AD dietary supplements. We found that the majority of websites and their products claimed AD-related benefits, including improvement and enhancement of function, treatment for AD, prevention of AD, maintenance of function, delayed progression of AD, and decreased symptoms. Supplements were described as effective, natural, powerful or strong, dependable and pure or of high quality. Peer reviewed references to proper scientific studies were infrequent on websites. Statements highlighting the risks of dietary supplements were as common as statements mitigating or minimizing these risks. Different strategies were used to promote supplements such as popular appeals and testimonials. Further enforcement of relevant policy is needed and preparation of clinicians to deal with requests of patients and caregivers is indicated.     

Consumption of fish and Alzheimer’s Disease

Alzheimer’s Disease (AD) has been described as ‘one of the most disabling and burdensome health conditions worldwide’ and is responsible for approximately 70% of dementia in the elderly. Based on the current prevalence of AD, an aging world population and the associated projected health care requirements, it is estimated that by 2050, the prevalence of AD will reach 104 million with around 43% requiring ongoing health care. If the onset of AD can be reduced by as little as one year, the prevalence could be reduced by 10%. There is substantial commonality in research findings to date around the positive influence of seafood consumption in reducing the risk of dementia and AD. Emerging concern about the sustainability of global fisheries supports the recommendation of selective consumption of sustainable wild caught and increased emphasis on production of farmed fish supplies to meet consumption needs.     

Neighborhood heterogeneity in health and well-being among the elderly in India – Evidence from Study on global AGEing and adult health (SAGE)

We establish a rationale for a multilevel approach in examining health among older adults. Using data on a nationally representative sample of 6560 Indian adults aged 50 years and older, we examine the extent of contextual variation between neighborhoods, after accounting for the compositional effect of individuals’ background characteristics, across multiple dimensions of elderly health. The variance apportioned to neighborhoods in null intercept-only models varied widely across different health outcomes examined in the elderly – while neighborhoods accounted for only 4% of the total variation in high blood pressure at exam, 23% of the total variation in self-rated poor quality of life could be attributed to neighborhood-level differences. In models that accounted for state, place of residence, and demographic and socioeconomic characteristics of individuals, the contribution of neighborhood to the total variation for most health outcomes was attenuated (2–11%) but persisted to exist. Our findings underscore the importance of neighborhoods in studying the health and well-being of the elderly in India.     

Multiple Antioxidants in the Prevention and Treatment of Parkinson’s Disease

Parkinson’s disease (PD) is one of the major progressive neurological disorders for which no preventative or long-term effective treatment strategies are available. Epidemiologic studies have failed to identify specific environmental, dietary or lifestyle risk factors for PD except for toxic exposure to manganese, meperidine (Demerol®, the “designer drug” version of which often contains a toxic byproduct of the synthesis, 1-methyl-4-phenyl 1,2,3,6 tetrahydropyridine [MPTP]), and some herbicides and pesticides. The search for genetic risk factors such as mutation, overexpression or underexpression of nuclear genes in DA neurons in idiopathic PD has not been successful as yet. Polymorphism in certain genes appears to be a risk factor, but there is no direct evidence for the causal relationship between polymorphism and increased risk of PD. In familial PD, mutation in the α-synuclein gene is associated with the disease, but a direct role of this gene in degeneration of DA neurons remains to be established. Although mutations in the Parkin gene has been associated with autosomal recessive juvenile Parkinson’s disease, the role of this gene mutation in causing degeneration of DA neurons has not been defined. We have reported that in hereditary PD, a mutation in the α-synuclein gene may increase the sensitivity of DA neurons to neurotoxins. We hypothesize that, in idiopathic PD, epigenetic (mitochondria, membranes, protein modifications) rather than genetic events are primary targets which, when impaired, initiate degeneration in DA neurons, eventually leading to cell death. Although the nature of neurotoxins that cause degeneration in DA neurons in PD is not well understood, oxidative stress is one of the intermediary risk factors that could initiate and/or promote degeneration of DA neurons. Therefore, supplementation with antioxidants may prevent or reduce the rate of progression of this disease. Supplementation with multiple antioxidants at appropriate doses is essential because various types of free radicals are produced, antioxidants vary in their ability to quench different free radicals and cellular environments vary with respect to their lipid and aqueous phases. L-dihydroxyphenylalanine (L-dopa) is one of the agents used in the treatment of PD. Since L-dopa is known to produce free radicals during its normal metabolism, the combination of L-dopa with high levels of multiple antioxidants may improve the efficacy of L-dopa therapy.     

Nutritional status and dietary habits in Parkinson’s disease patients in Ghana

ObjectiveDietary treatment is important for the management of Parkinson’s disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country.MethodsFifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia).ResultsThe mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively.ConclusionThis study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.     

Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients?

Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.     

The nutritional status of Dutch elderly patients with Parkinson’s disease

Objectives: To assess the prevalence of (risk of) undernutrition in Dutch elder Parkinson’s disease patients as well as it’s risk factors. Design: Observational cross-sectional study. Setting: An outpatient clinic at the department Neurology of Medical Centre Leeuwarden, a large teaching hospital. Participants: 102 outpatients with Parkinson’s disease aged 65 years and older were recruited. Measurements: Data regarding various aspects of undernutrition including socio-demographic aspect, disease characterisitics, nutritional status, appetite and overall-physical and psychological functioning were collected. Results: Undernutrition was diagnosed in 2.0% and 20.5% of the patients were categorized as being at risk of undernutrition. Care dependency and appetite were the two risk factors with the highest predictive value for an unfavorable nutritional status. Conclusion: Of Dutch elderly patients with Parkinson’s Disease 22.5% had an unfavourable nutritional status. Dependency and appetite were the two risk factors with the highest predictive value fort his outcome. Because undernutrition can be regarded as a geriatric syndrome a comprehensive nutritional assessment should be done followed by nutritional interventions next to interventions focused on the risk factors. Further studies are needed to evaluate these interventions.