Nutritional predictors of cognitive impairment severity in demented elderly patients: The key role of BMI

Introduction

The body mass index (BMI) is commonly used to assess nutritional status and the Mini Mental State Examination (MMSE) is a validated tool for assessing cognitive status in elderly people. Nutritional and cognitive aspects are closely related in dementia.

Objectives

To establish whether BMI predicts cognitive decline in demented patients and whether an ??alarm?? BMI cut-off exists for declining MMSE scores.

Subjects and methods

82 elderly demented patients underwent clinical, bio-chemical and functional assessment.

Design

Transversal study.

Results

The mean BMI was 26.08±4.48 kg/m₂ and the mean MMSE 18.68±5.38. Patients with BMI<25 kg/m₂ had significantly lower MMSE scores (16.5±5.53 vs 20.38±4.64; p 0.001), fat-free mass (FFM; 27.76±8.99 vs 37.38±10.58 kg; p<0.001), fat-free mass index (FFMI; 11.52±3.03 vs 14.67±2.89 kg/m₂; p<0.001), and fat mass (FM; 24.90±6.89 vs 36.86±6.77 kg; p<0.001), as well as lower Mini Nutritional Assessment (MNA) scores (23.80±2.50 vs 25.00±2.29; p=0.03) and higher vitamin B12 levels (460.95±289.80 vs 332.43±82.07 pg/ml; p=0.01). In the sample as a whole, MMSE scores significantly correlated with scores for MNA (r=0.27, p=0.01), FFM (r=0.27, p=0.01), BMI (r=0.19, p=0.05), ADL (r=0.28, p=0.01) and instrumental activities of daily living (IADL; r=0.34, p=0.002). On multiple logistic regression, BMI<25 kg/m₂ was independently associated with the risk of moderate-severe cognitive impairment (OR=2.96; 95% CI; 1.16?C7.55) and female gender was independently associated with severity of dementia (OR=3.14; 95% CI; 1.09?C9.03).

Conclusion

BMI seems to indicate global health status in elderly demented people and a BMI of 25 kg/m² can be considered an ??alarm?? cutoff, lower values coinciding with a worse cognitive status based on MMSE scores.     

Dietary habits and ageing in a sample of Italian older people

Objectives

To analyse dietary habits and explore the role of socioeconomic status in a sample of elderly Italians.

Study design

Observational.

Participants and setting

306 elderly subjects aged 65 and over living in the Marche Region (Italy).

Measurements

Assessment of dietary habits and life-style characteristics using a ??Life-style questionnaire??. Nutritional data collected by means of a 53-item ??Frequency food questionnaire??.

Results

The study revealed differences in dietary patterns and food consumption. Age was negatively related to all food categories. Some socio-economic characteristics (level of education and economic status) were correlated with consumption of many foods, such ad Fish, Red Meat and Diary products. Between-the-sexes differences were also documented.

Conclusion

Our findings showed that the nutritional and dietary habits varied greatly within the sample investigated. The mapping of these dietary and nutritional patterns may be of value for future research in elderly populations, particularly those with low educational status and poor economic means. Conclusively, greater promotion of healthy dietary habits should be targeted towards elderly populations.     

天津市区中老年人血清同型半胱氨酸水平与认知功能调查

目的调查天津市区中老年人血清同型半胱氨酸水平及认知功能状况,为下一步营养干预提供科学依据。方法根据知情同意的原则,随机选取天津市区55~94岁中老年人为研究对象,运用简易精神状态量表(MMSE)测定认知功能,筛查认知损害者;抽空腹静脉血,酶转换法测定血清总同型半胱氨酸(tHcy)含量。采用SPSS软件对认知功能的影响因素进行多元线性回归分析。结果天津市区中老年人血清tHcy含量均值为(15.95±7.29)μmol/L,高同型半胱氨酸血症(hyperhomocysteinemia,HHE)发生率45.4%,男性HHE均值及发生率高于女性(P<0.001);MMSE评分均值(26.74±2.71)分,认知损害(CI)发生率为26.0%,男、女之间MMSE评分均值与CI发生率均无显著差异。认知水平随受教育程度提高而提高、随年龄增加而降低。结论天津市区老年人群中高同型半胱氨酸血症和认知损害发生率高,值得关注。     

The impact of protein supplementation on cognitive performance in frail elderly

Purpose

Maintenance of cognitive abilities is important for elderly to stay independent. With the aging of the population, the call for modifiable factors is emerging. Dietary protein might improve cognitive performance; however, this has hardly been studied. Therefore, we studied the impact of 24-week dietary protein supplementation on cognitive performance in pre-frail and frail elderly people.

Methods

Pre-frail and frail elderly subjects, according to the Fried criteria, randomly received a protein drink containing 15 g protein or a placebo drink twice a day. Cognitive performance was measured at baseline and after 24 weeks by means of a sensitive neuropsychological test battery. In addition, reaction time was assessed after both 12 and 24 weeks of intervention. Domain scores were calculated for the domains episodic memory, attention and working memory, information processing speed, and executive functioning. Analyses of covariance were used to determine differences between groups. Linear mixed models were used to determine differences in reaction time over time and per treatment.

Results

In total, 65 subjects (79 ± 8 years) with a median Mini-Mental State Examination score of 28 (interquartile range 26–30) were included. Reaction time improved more in the protein group (68 ms) than in the placebo group (18 ms, P = 0.03). Dietary protein had no significant effect on any of the cognitive domain scores.

Conclusions

Protein supplementation might improve reaction time performance in pre-frail and frail elderly, but did not improve other cognitive functions.     

Hypovitaminosis D in psychogeriatric inpatients

Objectives

This study investigated the rate of hypovitaminosis D in psychogeriatric inpatients and explored whether any associations exist between vitamin D levels, cognitive function, and psychiatric diagnoses.

Design

Retrospective medical record review from November 2000 through November 2010.

Setting

Geriatric psychiatric ward of an academic tertiary care hospital.

Participants

Psychiatric inpatients aged 65 years or older.

Measurements and analysis methods

Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at admission. Associations between 25(OH)D levels, Mini-Mental State Examination (MMSE) scores were analyzed using Spearman correlations, and psychiatric diagnoses were analyzed using logistic regression models and Fisher’s exact tests.

Results

In 141 subjects (mean age, 77. In 141 subjects (mean age, 77.8 years; 86 [61%] female; 135 [96%] white), the most frequent diagnoses were major depressive disorder in 81 patients (57%), dementia in 38 (27%), delirium in 13 (9%), anxiety in 12 (8.5%), and bipolar disorder in 11 (8%). Mean MMSE score was 24±6.4 (range, 3–30). Forty-three subjects (30.4%) had mild to moderate vitamin D deficiency [25(OH)D, 10–24 ng/mL], and 6 (4.2%) had severe deficiency [25(OH)D <10 ng/mL].

Conclusions

Hypovitaminosis D was common in elderly psychiatric inpatients. No associations were found between vitamin D levels and global cognitive function or psychiatric diagnoses.     

Nutritional status of the elderly in rural North China: A cross-sectional study

Objectives

This study aimed to describe the nutritional status of elderly people living in a rural area of North China.

Design

Community-based, cross-sectional prevalence survey.

Setting

3 rural towns of Lvliang City, Shanxi Province, China.

Participants

A sample of 1845 community residents (29.1% of those eligible) 55 years or older (birth before 1958-01-01).

Measurements

The participants were assessed regarding demographic characteristics, height, weight, as well as having a physical examination and blood sampling for serum cholesterol, total homocysteine (tHcy), folate, and vitamin B12 levels.

Results

991 (53.7%) were female and 139 (7.5%) did not complete the anthropometric measurement. Prevalence of underweight and obesity was 3.5% and 24.9% in men and 6.7% and 31.0% in women (P = 0.003, P = 0.005, respectively). Prevalence of hypercholesterolemia and hypocholesterolemia was 13.5% and 52.6% in men and 25.0% and 34.3% in women (P < 0.001, P < 0.001, respectively). Prevalence of high LDL-c concentrations was 8.8% in men and 16.8% in women (P < 0.001). The mean serum tHcy in men (28.8 ± 20.1 μmmol/l) was significantly higher than in women (21.0 ± 15.1 μmmol/L, P < 0.001). Prevalence of hyperhomocysteinemia (defined as > 15μmmol/L) was 79.7% in men and 65.5% in women (P < 0.001). Prevalence of low folate (defined as < 11 nmol/L) and vitamin B12 levels (defiend as < 185 pmol/L) was 70.8 % and 76.8% in men and 56.5% and 72.6% in women (P < 0.001, P = 0.036, respectively). Correlation coefficients between tHcy, folate, and vitamin B12 indicated an inverse linear correlation (r = ?0.21, P < 0.001, r = ?0.35, P < 0.001, respectively).

Conclusions

As China’s economic climate has developed, the nutritional status of elderly people in the rural parts of the country has improved in some aspects. However, the trend toward obesity will lead to a shift in the burden of obesity-related chronic diseases. In addition, rurally-located elderly people are at high risk of death that may be associated with abnormal serum cholesterol. The data also suggest that severe deficiencies in folate and vitamin B12 levels exist, as well as there being a high prevalence of hyperhomocysteinemia. Folate and vitamin B12 supplementation are necessary to prevent related diseases.     

Lower intake of vegetables and legumes associated with cognitive decline among illiterate elderly Chinese: A 3-year cohort study

Background

Despite many studies on cognitive function and its influential factors among old population, relatively little research has been designed to study the relationship between dietary intake and cognitive function in elderly.

Objective

We conducted a population-based, prospective nested case-control study to investigate the association between dietary habits and declines in cognitive function over three years among Chinese illiterate elderly.

Design and methods

This study was part of the Chinese Longitudinal Health Longevity Study (CLHLS). Six thousand nine hundred and eleven illiterate residents aged 65 or older were investigated. Socio-demographic and dietary habits data were collected at baseline. The cognitive function of illiterate elderly persons was assessed using Chinese revised Mini Mental State Examination (MMSE-r) in 2002 and 2005. Cognitive decline was defined as MMSE-r score dropped to less than 18 at follow-up among those with normal cognitive function (MMSE-r??18 at baseline). Odds ratios (OR) were calculated via logistic regression models.

Results

Five thousand six hundred and ninety one elderly were included in the current analysis. In bivariate analysis, cognitive decline was associated with gender, marital status,financial status, smoking, drinking alcohol, drinking tea, eating fruits, vegetables, legumes, fishes, meat, egg and sugar. Multivariate logistic regression analysis found that always eating vegetable (Adjusted OR: 0.66; 95% confidence intervals, CI: 0.58, 0.75), always consuming legumes (AOR:0.78; 95% CI: 0.64, 0.96) were inversely associated with cognitive decline.

Conclusions

Lower intakes of vegetables and legumes were associated with cognitive decline among illiterate elderly Chinese. Dietary factors may be important for prevention cognitive decline.     

Social contact networks for the spread of pandemic influenza in children and teenagers

Background

There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.

Methods

This cohort study collected data on family socioeconomic status, household and neighbourhood environmental conditions, child health and nutritional status, psychosocial stimulation and nursery school attendance. The effect of these on Wechsler Pre-School and Primary Scale of Intelligence scores at five years of age was investigated using a multivariable hierarchical analysis, guided by the proposed conceptual framework.

Results

Unfavourable socioeconomic conditions, poorly educated mother, absent father, poor sanitary conditions at home and in the neighbourhood and low birth weight were negatively associated with cognitive performance at five years of age, while strong positive associations were found with high levels of domestic stimulation and nursery school attendance.

Conclusion

Children's cognitive development in urban contexts in developing countries could be substantially increased by interventions promoting early psychosocial stimulation and preschool experience, together with efforts to prevent low birth weight and promote adequate nutritional status.     

The effect of antioxidant vitamins E and C on cognitive performance of the elderly with mild cognitive impairment in Isfahan,Iran: a double-blind,randomized, placebo-controlled trial

Purpose

This study was carried out to investigate the effect of vitamins E and C on cognitive performance among the elderly in Iran.

Methods

About 256 elderly with mild cognitive impairment, aged 60–75 years, received 300 mg of vitamin E plus 400 mg of vitamin C or placebo daily just for 1 year.

Background

Demographic characteristics, anthropometric variables food consumption, cognitive function by Mini-Mental State Examination (MMSE), and some of the oxidative stress biomarkers were examined.

Results

Antioxidant supplementation reduced malondialdehyde level (P < 0.001) and raised total antioxidant capacity (P < 0.001) and glutathione (P < 0.01). The serum 8-hydroxydeoxyguanosine remained unchanged (P < 0.4). After adjusting for the covariates effects, MMSE scores following 6- (25.88 ± 0.17) and 12-month antioxidant supplementation (26.8 ± 0.17) did not differ from control group (25.86 ± 0.18 and 26.59 ± 0.18, respectively).

Conclusion

Despite significant improvement in most of the oxidative stress biomarkers, antioxidants’ supplementation was not observed to enhance cognitive performance. A large number of kinetic and/or dynamic factors could be suspected.     

Body mass index, life-style, and healthy status in free living elderly people in menorca island

Objectives

To assess the BMI, life-style, and healthy status, and explore relationships between these parameters, among Menorca??s free living elderly people.

Methods

A cross-sectional survey carried out in Menorca Island in 2009. A random sample (n=450) of the elderly population (??65 years) was interviewed. Anthropometric measurements and a general questionnaire incorporating questions related to socio-demographic and life-style factors and health status were used.

Results

Approximately five per cent of elders were underweight and 60% overweight or obese. Underweight were positively and overweight and obesity negatively affected by age. The prevalence of central obesity, according to the WC cut-off points, was 66.8% in men and 85.1% in women. Low education, socioeconomic status and physical activity were risk factors for malnutrition and overweight/obesity. A possible cognitive impairment was found among elderly persons with BMI<22 kg/m². A J-shaped association between BMI and hypertension, hypercholesterolemia, heart failure and other CV diseases, a U-shaped relation between BMI and diabetes mellitus, arthritis, and chronic bronchitis, and an inverted J-shape between BMI and gastric ulcer, osteoporosis &; bone fractures, cancer, and prostatitis (in men) were found.

Conclusions

Both low and high BMI are associated with a wide range of prevalent conditions and diseases in Menorca elderly men and women.     

Predictors of refusal to participate: a longitudinal health survey of the elderly in Australia

Background

The loss of participants in longitudinal studies due to non-contact, refusal or death can introduce bias into the results of such studies. The study described here examines reasons for refusal over three waves of a survey of persons aged ≥ 70 years.

Methods

In a longitudinal study involving three waves, participants were compared to those who refused to participate but allowed an informant to be interviewed and to those who refused any participation.

Results

At Wave 1 both groups of Wave 2 non-participants had reported lower occupational status and fewer years of education, had achieved lower verbal IQ scores and cognitive performance scores and experienced some distress from the interview. Those with an informant interview only were in poorer physical health than those who participated and those who refused. Depression and anxiety symptoms were not associated with non-participation. Multivariate analyses found that verbal IQ and cognitive impairment predicted refusal. Results were very similar for refusers at both Waves 2 and 3.

Conclusions

Longitudinal studies of the elderly may over estimate cognitive performance because of the greater refusal rate of those with poorer performance. However, there is no evidence of bias with respect to anxiety or depression.     

Relation between caffeine and behavioral symptoms in elderly patients with dementia: An observational study

Objectives

Caffeine is known to improve concentration and reduce fatigue in healthy adults, but high doses may induce anxiety and agitation. Because the effects of caffeine in elderly people with dementia are unknown, this study explores the relation between caffeine and behavioral symptoms in a group of elderly patients with dementia.

Design

An observational pilot study.

Setting

A dementia special care unit of a Dutch nursing home.

Participants

A total of 29 elderly patients with dementia.

Measurements

Behavioral symptoms were measured with the NPI-NH, and sleep and caffeine consumption were measured using questionnaires.

Results

A significant relation was found between the total amount of caffeine consumed during the day and apathy [Kendall’s tau (KT) ?0.287 p=0.03], and the number of times that participants got up at night (KT 0.462; p <0.01). The amount of caffeine consumed after 6 p.m. was also significantly related to the number of times participants got up at night (KT 0.436; p <0.01). Multilevel analysis showed caffeine to be negatively correlated with aberrant motor behavior [b=?0.47 (0.22), Wald (461)=?2.12, p=0.03] and apathy [b=?0.88 (0.45), Wald (461)= ?1.96, p=0.05], and showed a significant relation between caffeine consumption after 6 p.m. and the number of times participants got up at night [b=0.48 (0.22), Wald (461)= 2.20, p=0.03].

Conclusion

This study established an association between caffeine consumption and behavioral symptoms in elderly patients with moderately severe dementia. Therefore, adjusting caffeine consumption could be part of an interdisciplinary approach to behavioral symptoms, particularly when aberrant motor behavior, apathy or sleeping difficulties are involved. These results indicate that further research on the effects of caffeine on behavioral symptoms in dementia is warranted.     

Tea drinking and cognitive function in oldest-old Chinese

Objective

We examined the longitudinal association between tea drinking frequency and cognitive function in a large sample of oldest-old Chinese.

Design

population-based longitudinal cohort study.

Setting

The Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Participants

7139 participants aged 80 to 115 (mean age 91.4 years) who provided complete data at baseline (year 1998).

Measurements

Current frequency of tea drinking and past frequency at age 60 were ascertained at baseline, and baseline and follow-up cognitive assessments were performed in the years 1998 (n=7139), 2000 (n=4081), 2002 (n=2288) and 2005 (n=913) respectively. Verbal fluency test was used as measure of cognitive function.

Results

Tea drinking was associated at baseline with higher mean (SD) verbal fluency scores: daily=10.7 (6.6), occasional=9.2 (5.8), non-drinker=9.0 (5.5). In linear mixed effects model that adjusted for age, gender, years of schooling, physical exercise and activities score, the regression coefficient for daily drinking (at age 60) and occasional drinking was 0.72 (P<0.0001) and 0.41(P=0.01) respectively. Tea drinkers had higher verbal fluency scores throughout the follow-up period but concurrently had a steeper slope of cognitive decline as compared with non-drinkers (coefficient for the interaction term Time*Daily drinking= ?0.12, P=0.02; ??Time?? was defined as the time interval from baseline to follow-up assessments in years). Similar results were found for current tea drinking status at study baseline year (1998) as predictor variable.

Conclusion

Regular tea drinking is associated with better cognitive function in oldest-old Chinese.     

Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O

Purpose

To validate the ICECAP-O capability measure in psycho-geriatric elderly in nursing homes, we compared the capability scores of restrained and unrestrained clients. Both nursing staff and family were used as proxies for assessing clients?? capabilities.

Method

For 122 psycho-geriatric elderly, a total of 96 nursing professionals and 68 family members completed a proxy questionnaire. We investigated the convergent and discriminant validity of the ICECAP-O and measures of care dependency, health-related quality of life, and overall quality of life. We also directly compared ICECAP-O scores of the 56 clients for whom both nursing staff and family members had completed the questionnaire.

Results

Convergent validity between ICECAP-O and care dependency, health-related, and overall quality of life measures could be established, as well as discriminant validity for the restrained and unrestrained groups. Nursing and family proxy ICECAP-O tariffs were not significantly correlated.

Discussion

ICECAP-O measures a more general concept than health-related quality of life and can differentiate between restrained and non-restrained psycho-geriatric clients. Since nurses seem to be able to assess the current quality of life of clients using the ICECAP-O more precisely than the family proxies, for now the use of nursing proxies is recommended in a nursing home setting.     

Intra-erythrocyte magnesium levels and their clinical implications in geriatric outpatients

Objectives

Magnesium deficiency has been implicated as a factor in numerous chronic diseases and previous studies suggest a greater prevalence of occult magnesium deficiency among older adults. Serum is the choice for the assessment of most analyses used in clinical medicine, although serum magnesium concentrations have been shown to be poor predictors of intracellular magnesium concentration. The aim of this study was to compare intracellular and extracellular magnesium concentrations in geriatric outpatients. Moreover, we examined whether a significant correlation between magnesium parameters and clinical outcome existed.

Design

Cross-sectional study.

Setting

Geriatric medicine outpatient clinic of a university hospital.

Participants

A total of 246 patients with a mean age of 71.9±5.7 years were involved.

Measurements

Intra-erythrocyte magnesium levels were analyzed with atomic absorption spectrophotometry.

Results

Serum magnesium levels were within normal range in all patients, whereas intra-erythrocyte magnesium measurements were low in 57% of the patients. Increase in serum levels were together with just only a slightly increase in intra-erythrocyte measurements and the relationship was very weak. Intra-erythrocyte Mg levels were not significantly correlated with many laboratory or clinical parameters.

Conclusion

Our results confirm that intra-erythrocyte Mg does not correlate with serum levels and clinical parameters in geriatric outpatients, but further studies are needed to define the correlation.     

Analyses of laboratory data and establishment of reference values and intervals for healthy elderly people

Objective

Protein-energy malnutrition is a common disorder in the elderly. Although serum albumin is commonly used as a nutritional marker, data is lacking on serum albumin levels in the elderly. The purpose of this study was to determine whether serum albumin levels decrease with advancing age and to establish reference value and interval of laboratory data for elderly people (75 years and over).

Participants

Blood samples from 13821 healthy people, 42064 outpatients, and 15959 inpatients were collected during 2008. Blood from 127 of our nutrition support team (NST) patients was also collected during August 2006 and May 2009, and analyzed.

Measurements

Serum albumin, hemoglobin, total cholesterol levels and lymphocyte count were determined. We analyzed the change in each parameter in accordance with age, compared the data for elderly people with younger people, and established new reference values. Clinical outcomes were examined depending on the improved reference values.

Results

Albumin was lower in older persons than in younger persons. The estimated reference value and interval were 42 (48–36) g/l in older persons and was much lower in NST patients. Hemoglobin was decreased while cholesterol and lymphocyte count were not changed in older persons: all were markedly decreased in NST patients. Terms of hospital stay were significantly longer and mortality rates were significantly higher in older persons, comparing from above to below using a new reference value of albumin (36 g/l).

Conclusions

The serum albumin level decreases with advancing age, but it was maintained to some extent in healthy older people. Serum albumin levels related to the clinical outcome. Hemoglobin and cholesterol levels and lymphocyte count were all lower in NST patients. These measurements may be valuable markers of nutritional status and can help in guiding the need for nutritional support.     

Different components of nutritional status in older inpatients with cognitive impairment

Objectives

To evaluate different components of nutritional status in older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCI).

Design

Cross-sectional study.

Setting and participants

560 elderly subjects aged ?? 65 years consecutively admitted to an acute Geriatric Unit of Apulia region of southern Italy.

Measurements

A standardized comprehensive geriatric assessment was used to evaluate medical, cognitive, affective and social aspects. Nutritional status was assessed using the mini nutritional assessment (MNA). The cognitive function was categorized into three levels ?? MCI, dementia or normal cognition (NoCI) ?? according to the neuropsychological test score.

Results

Subjects with cognitive decline had significantly lower frequency of well-nourished (MCI=10%, dementia=8%, NoCI=22%, p<0.05) and higher frequency of malnourished (MCI=47%, dementia=62%, NoCI=19%, p<0.001) than patients with normal cognition. Similarly, MNA total score, MNA-3 and MNA-4 subscores were significantly lower in patients with MCI and dementia than patients with normal cognition (p<0.001).

Conclusions

These results suggest that cognitive decline may be associated with malnutrition in this sample of hospitalized older patients. Dietary habits (MNA-3) and subjective assessment of self-perceived quality of health and nutrition (MNA-4) are particularly poor also in patients with MCI and could be. very important variables to be considered in the multidimensional evaluation of subjects with cognitive impairment.