Evolution and treatment of vitamin B12 deficiency as a risk factor for (cognitive and functional) neurodegenerative diseases in institutionalized elderly = Evolución y tratamiento de la deficiencia de vitamina B12 como factor de riesgo de enfermedades neurodegenerativas (cognitivas y funcionales) en las personas mayores institucionalizadas.

Prevalence of vitamin B12 deficiency is very common in elderly people and can reach values as high as 40.5% of the population. It can be the result of the interaction among several factors. Vitamin B12 deficiencies have been associated with neurological, cognitive deterioration, haematological abnormalities and cardiovascular diseases that have an important influence on the health of the elderly and their quality of life. It is necessary to approach the problems arisen from the lack of data relative to them. The main objective of this thesis was to analyse the evolution of vitamin B12 status and related parameters, lipid and haematological profiles and their relationship to health risk factors, and to functional and cognitive status over one year and to determine the effect of an oral supplementation of 500 μg of cyanocobalamin for a short period of 28 days. An additional objective was to analyze the possible effects of medicine intakes on vitamin B status. Three studies were performed: a) a one year longitudinal follow-up with four measure points; b) an intervention study providing an oral liquid supplement of 500 μg of cyanocobalamin for a 28 days period; and c) analysis of the possible effect of medication intake on vitamin B status using the ATC classification of medicines. The participants for these studies were recruited from nursing homes for the elderly in the Region of Madrid. Sixty elders (mean age 84 _ 7y, 19 men and 41 women) were recruited for Study I and 64 elders (mean age 82 _ 7y, 24 men and 40 women) for Study II. For Study III, baseline data from the initially recruited participants of the first two studies were used. An informed consent was obtained from all participants or their mentors. The studies were approved by the Ethical Committee of the University of Granada. Blood samples were obtained at each examination date and were analyzed for serum cobalamin, holoTC, serum and RBC folate and total homocysteine according to laboratory standard procedures. The haematological parameters analyzed were haematocrit, haemoglobin and MCV. For the lipid profile TG, total cholesterol, LDL- and HDLcholesterol were analyzed. Anthropometric measures (BMI, skinfolds [triceps and subscapular], waist girth and waist to hip ratio), functional tests (hand grip, arm and leg strength tests, static balance) and MMSE were obtained or administered by trained personal. The vitamin B12 supplement of Study II was administered with breakfast and the medication intake was taken from the residents’ anamnesis. Data were analyzed by parametric and non-parametric statistics depending on the obtained data. Comparisons were done using the appropriate ANOVAs or non-parametric tests. Pearsons’ partial correlations with the variable “time” as control were used to define the association of the analyzed parameters. XIII The results showed that: A) Over one year, in relationship to vitamin B status, serum cobalamin decreased, serum folate and mean corpuscular volumen increased significantly and total homocysteine concentrations were stable. Regarding blood lipid profile, triglycerides increased and HDL-cholesterol decreased significantly. Regarding selected anthropometric measurements, waist circumference increased significantly. No significant changes were observed for the rest of parameters. B) Prevalence of hyperhomocysteinemia was high in the elderly studied, ranging from 60% to 90 % over the year depending on the cut-off used for the classification. LDL-cholesterol values were high, especially among women, and showed a tendency to increase over the year. Results of the balance test showed a deficiency and a tendency to decrease; this indicates that the population studied is at high risk for falls. Lower extremity muscular function was deficient and showed a tendency to decrease. A highly significant relationship was observed between the skinfold of the triceps and blood lipid profile. C) Low cobalamin concentrations correlated significantly with low MMSE scores in the elderly studied. No correlations were observed between vitamin B12 status and functional parameters. D) Regarding vitamin B12 status, holo-transcobalamin seems to be more sensitive for diagnosis; 5-10% of the elderly had a deficiency using serum cobalamin as a criterion, and 45-52% had a deficiency when using serum holotranscobalamin as a criterion. E) 500 μg of cyanocobalamin administered orally during 28 days significantly improved vitamin B12 status and significantly decreased total homocysteine concentrations in institutionalized elderly. No effect of the intervention was observed on functional and cognitive parameters. F) The relative change (%) of improvement of vitamin B12 status was higher when using serum holo-transcobalamin as a criterion than serum cobalamin. G) Antiaenemic drug intake normalized cobalamin, urologic drugs and corticosteroids serum folate, and psychoanaleptics holo-transcobalamin levels. Drugs treating pulmonary obstruction increased total homocysteine concentration significantly. H) The daily mean drug intake was 5.1. Fiftynine percent of the elderly took medication belonging to 5 or more different ATC groups. The most prevalent were psycholeptic (53%), antiacid (53%) and antithrombotic (47%) drugs.

Comparaciones entre el factor "G" de Cattell y algunas pruebas de condición física en mis alumnos de 5º de EGB

Una de las cuestiones que más me ha interesado durante el tiempo que he estado cursando estudios en el Instituto Nacional de Educación Física de Madrid, y posteriormente en mi actividad educativa, es la posible relación entre la condición, la capacidad o el rendimiento físico o deportivo y la capacidad del rendimiento intelectual, así como las matizaciones posibles dentro de este amplísimo y complejo tema. Muchas veces he tenido que escuchar de compañeros en las tareas educativas, afirmaciones rotundas sin ninguna base científica acerca de la relación positiva o negativa, aunque casi siempre negativa, entre la capacidad física e intelectual, muy a menudo hechos en base a un sujeto que suspende prácticamente todas sus asignaturas y sin embargo obtiene sobresaliente en su calificación de Educación Física. No siendo este un caso muy frecuente, a estos educadores no se les ha ocurrido pensar en que la causa de esa diferencia tan destacada en el nivel de calificaciones, pueda ser la motivación y no la capacidad, tampoco piensan aun en el caso de que lo que hiciese la diferencia fuese una cuestión de capacidades, el que se produzca en algún caso aislado no implica ni que tenga que ocurrir siempre ni que a nivel general exista una relación negativa. La observación directa de los niños componentes de los equipos de baloncesto del colegio en el que imparto mis clases, me ha hecho ver que la mayor parte de ellos obtienen buenos rendimientos académicos, pocos mediocres, y muy pocos realmente bajos. Estos niños han sido seleccionados para formar parte de los equipos fundamentalmente por su buena condición física, lo cual podría hacer pensar en una posible relación, aunque no necesaria, entre condición física y rendimiento académico. Sin embargo gran cantidad de factores aparte de la inteligencia pueden influir en el mencionado rendimiento. Llegando el momento de plantear la realización de mi trabajo fin de carrera, en gran parte mediatizado por todo lo expuesto anteriormente, decidí centrarlo en la posible relación entre los diversos factores de la condición física, ésta misma y la inteligencia general. Teniendo en cuenta que estos son los factores más primarios y por consiguiente los que menos se van a ver influenciados por otros.