Innovative biomarkers for predicting type 2 diabetes mellitus:relevance to dietary management of frailty in older adults

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a “healthy” diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Designing an adaptive salutogenic care environment

Humans are profoundly affected by the surroundings which they inhabit. Environmental psychologists have produced numerous credible theories describing optimal human environments, based on the concept of congruence or “fit” (1, 2). Lack of person/environment fit can lead to stress-related illness and lack of psychosocial well-being (3). Conversely, appropriately designed environments can promote wellness (4) or “salutogenesis” (5). Increasingly, research in the area of Evidence-Based Design, largely concentrated in the area of healthcare architecture, has tended to bear out these theories (6). Patients and long-term care residents, because of injury, illness or physical/ cognitive impairment, are less likely to be able to intervene to modify their immediate environment, unless this is designed specifically to facilitate their particular needs. In the context of care settings, detailed design of personal space therefore takes on enormous significance. MyRoom conceptualises a personalisable room, utilising sensoring and networked computing to enable the environment to respond directly and continuously to the occupant. Bio-signals collected and relayed to the system will actuate application(s) intended to positively influence user well-being. Drawing on the evidence base in relation to therapeutic design interventions (7), real-time changes in ambient lighting, colour, image, etc. respond continuously to the user’s physiological state, optimising congruence. Based on research evidence, consideration is also given to development of an application which uses natural images (8). It is envisaged that actuation will require machine-learning based on interpretation of data gathered by sensors; sensoring arrangements may vary depending on context and end-user. Such interventions aim to reduce inappropriate stress/ provide stimulation, supporting both instrumental and cognitive tasks.

Institucionalização do Défice

Esta investigação objetiva rastrear cognitivamente as pessoas idosas que se encontram sob resposta social, Centro de Dia e Lar de Idosos, no concelho de Miranda do Corvo e utiliza como instrumentos de rastreio o Mini Mental State Examination (MMSE) e o Montreal Cognitive Assessment (MoCA). Concomitantemente esta investigação propõe-se relacionar três itens do domínio da linguagem, propostos por nós, com as habilitações. A população que frequenta as instituições investigadas, 224 pessoas com idades 65 anos, apresenta as seguintes características sociodemográficas: 179 mulheres (79,9%), média de idades de 83,76 anos ( = ±7,29) sendo que 93 (41,5%) não possuem qualquer grau de escolaridade. A avaliação efetuada, durante o período de 19 de Dezembro de 2011 a 7 de Maio de 2012, evidencia que as pessoas que frequentam/residem estas/nestas respostas sociais apresentam elevados níveis de défice cognitivo quando comparadas com a população inquirida no “Estudo do Perfil do Envelhecimento da População Portuguesa” (2010). A diferença mostrou ser estatisticamente significativa independentemente de se utilizarem as referências para cortes etários de 65, de 65-74 ou de 75 anos de idade. Segundo os resultados obtidos através da administração do MMSE verificamos que dos 144 inquiridos 55 (38,2%) têm défice cognitivo. Se acrescentarmos a estes inquiridos os restantes utentes/clientes com diagnóstico de demência reportado nos processos individuais e confirmado através de sintomatologia tanto por nós como pela equipa técnica dos equipamentos esta percentagem sobe para 135 pessoas, ou seja, 135 (60,3%) das pessoas nestas respostas sociais. Na avaliação efetuada através do MoCA verificamos que 140 (97,2%) dos idosos têm défice cognitivo. Se acrescentarmos a estes inquiridos os restantes utentes/clientes com diagnóstico de demência esta percentagem sobe para 220 pessoas, ou seja, 98,2% das pessoas nestas respostas sociais. Os resultados obtidos, independentemente da magnitude da diferença avaliativa nos dois instrumentos utilizados, facto que consideramos não ser alheio às características sociodemográficas da coorte geracional que frequenta este tipo de respostas, atestam a prevalência do défice cognitivo nas instituições que acolhem pessoas idosas. Assim, propomos que as respostas sociais implementem programas de estimulação cognitiva para a conservação e melhoria das capacidades cognitivas dos idosos. / This investigation aims to track cognitively older people who are under social response, Day Centre and Home for the Aged, in the municipality of Miranda do Corvo and used as screening tools for the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Concomitantly this research proposes three items relate domain language, proposed by us, with qualifications. The people who attend the institutions surveyed, 224 people aged ≥ 65 years, presents the following sociodemographic characteristics: 179 women (79.9%), mean age of 83.76 years (σ = ± 7.29) being 93 (41.5%) do not have any schooling. The assessment carried out during the period from 19 December 2011 to May 7 2012, shows that people who attend / they reside / these social responses show high levels of cognitive impairment when compared with the population surveyed in the "Study Profile Aging of the Population Portuguese "(2010). The difference proved to be statistically significant regardless of whether the reference to use of cuts age ≥ 65, ≥ 75 or 65-74 years old. According to the results obtained by administering the MMSE found that 55 of the 144 respondents (38.2%) had cognitive impairment. If we add to these the remaining respondents users / clients with dementia reported in individual cases and confirmed by symptoms both by us and by the technical team of equipment that percentage goes up to 135 persons, ie, 135 (60.3%) of people in these social responses. In the evaluation conducted by MoCA found that 140 (97.2%) of the elderly have cognitive impairment. If we add to these the remaining respondents users / clients diagnosed with dementia this percentage rises to 220 people, or 98.2% of the people in these social responses. The results, regardless of the magnitude of the difference in the two evaluative instruments used, that we consider not to be oblivious to the sociodemographic characteristics of the generational cohort that attends this type of answers, attest to the prevalence of cognitive impairment in institutions for elderly people. Thus, we propose that the answers implement social cognitive stimulation programs for the conservation and improvement of cognitive abilities of the elderly.

A sexualidade nos idosos. Contributo para a avaliação das atitudes face à sexualidade nos idosos e a sua relação com a religião e nível cognitivo

O presente estudo teve como objectivo principal conhecer melhor aspectos relacionados com a sexualidade na 3ª idade. A escala utilizada foi construída por nós, tornando-se num elemento chave para esta pesquisa. A escala de atitudes face à sexualidade no idoso foi relacionada com algumas características sociodemográficas: género, idade, estado civil, escolaridade e religião. Da análise realizada ressaltam evidências de uma atitude conservadora face às questões da sexualidade na 3ª idade. Através de uma amostra de 120 idosos com idades compreendidas entre os 60 e os 97 anos de idade, constatámos que os homens e as mulheres distinguem-se significativamente no que respeita às atitudes face à sexualidade, exibindo os homens uma atitude global mais positiva e liberal (M = 25.82). Os resultados evidenciaram um efeito significativo da variável escolaridade sobre o nível cognitivo, revelando que quanto maior a escolaridade do idoso na nossa amostra, maior é o nível cognitivo. Relativamente ao estado civil, os casados revelaram uma atitude global mais positiva perante a sua sexualidade (M = 31.98) comparativamente aos viúvos (M = 27.26) e aos divorciados (M = 23.67). A religião apenas se mostrou associada com a escala de atitudes face ao cristianismo, evidenciando aqueles que são praticantes, uma atitude mais positiva em relação ao cristianismo. Na nossa amostra, também podémos constatar que quanto maior é o nível cognitivo, mais positiva é a atitude face à sexualidade. Com base nos pontos de corte do MMSE verificou-se que 75% dos idosos da nossa amostra não apresentava qualquer défice cognitivo. Comparados os grupos, sem e com défice cognitivo, constatou-se que o grupo de idosos sem défice cognitivo exibe uma atitude mais positiva face à sexualidade que o grupo com défice cognitivo. Pretendemos que de alguma forma este estudo contribua para dar a conhecer as atitudes dos idosos face à sua sexualidade bem como esperamos que os nossos resultados permitam uma reflexão sobre possíveis estratégias de intervenção no sentido de promover uma sexualidade bem vivida por esta faixa etária. / The present study aimed to better understand the main aspects related to sexuality in the 3rd age. The scale used was built by us, becoming a key element in this research. The scale of attitudes towards sexuality in the elderly was related to sociodemographic characteristics: gender, age, marital status, education and religion. From the analysis point out evidence of a conservative approach in relation to issues of sexuality in the 3rd age. Using a sample of 120 elderly aged 60 and 97 years old, found that men and women differ significantly with regard to attitudes towards sexuality, men showing a more positive overall attitude and liberal (M = 25.82). The results showed a significant effect on the education variable cognitive level, revealing that the higher the education of the elderly in our sample, the higher the cognitive level. With regard to marital status, married people showed a more positive overall attitude towards their sexuality (M = 31.98) compared to widowed (M = 27.26) and divorced (M = 23.67). The only religion was associated with the scale of attitudes to Christianity, showing those who are practitioners, a more positive attitude toward Christianity. In our sample, we can also see that the higher the cognitive level, the more positive attitude towards sexuality. Based on the MMSE cutoffs found that 75% of older people in our sample did not show any cognitive deficit. Comparing the groups with and without cognitive impairment, it was found that the group of elderly people without cognitive impairment display a more positive attitude towards sexuality that the group with cognitive impairment. We intend that somehow this study contributes to publicize the attitudes of the elderly compared to their sexuality and we expect our results allow a discussion on possible intervention strategies to promote a sexuality lived well by this age group.

Qualidade Subjetiva do Sono, Sintomas Depressivos e Sentimentos de Solidão em Idosos Institucionalizados e Não Institucionalizados

Parece existir uma associação entre solidão e uma pobre qualidade subjetiva do sono. Em reforço desta ideia, alguns estudos mostraram que os sentimentos de solidão se associam a uma menor satisfação do sono, mesmo que a sua duração não esteja diminuída. Outros mostraram que a solidão se associa a sintomas depressivos. Sabe-se que na institucionalização são frequentes os problemas de sono, depressão e solidão. No entanto, falta saber o que se passa nas respostas sociais portuguesas. Assim foram os nossos principais objetivos descrever a qualidade subjetiva do sono e analisar a intensidade dos sintomas depressivos e dos sintomas de solidão em idosos institucionalizados, comparar com uma subamostra de idosos não institucionalizados e analisar a relação entre estas variáveis nas duas subamostras. Cento e quarenta idosos, com 70 institucionalizados e 70 não institucionalizados foram emparelhados por idade, sexo, escolaridade, estado civil e sem défice cognitivo. A média de idades foi de 76,58 (DP = 6,10), sendo 104 mulheres e 36 homens. Como instrumentos para a análise utilizámos um Questionário Sociodemográfico, o Questionário sobre o Sono na Terceira Idade, o Inventário de Depressão Geriátrica e a Escala de Solidão da Universidade da Califórnia, Los Angeles. Verificou-se que os idosos institucionalizados apresentavam mais sentimentos de solidão do que os não institucionalizados. Contudo, não se verificaram diferenças entre as duas subamostras em relação aos sintomas depressivos e à qualidade subjetiva do sono. Através de uma análise correlacional verificou-se nas duas subamostras que quanto pior a qualidade subjetiva do sono mais sintomas depressivos se observavam e quanto mais sintomas depressivos, mais sentimentos de solidão. Concluímos que não houve diferenças na qualidade subjetiva do sono pelo tipo de resposta social ainda que haja mais sintomas depressivos e sintomas de solidão nos idosos institucionalizados. Não encontrámos também relação entre o sono e a solidão nos idosos institucionalizados. / There seems to be an association between loneliness and poor subjective sleep quality. In support of this idea, some studies have shown that feelings of loneliness are associated with less satisfaction sleep, even if your life is not diminished. Others have shown that loneliness is associated with depressive symptoms. It is known that in the institutionalization are frequent problems with sleeping, depression and loneliness. However, lack know what is happening in the Portuguese social responses. So were our main objectives describe the subjective quality of sleep and analyze the intensity of depressive symptoms and loneliness symptoms in institutionalized elderly, compared with a non-institutionalized elderly subsample and analyze the relationship between these variables in both subsamples. One hundred and forty older adults, with 70 institutionalized and 70 non-institutionalized were matched by age, sex, education, marital status and without cognitive impairment. The average age was 76.58 (SD = 6.10), including 104 women and 36 men. As tools for the analysis we used a sociodemographic questionnaire, the Questionnaire About Sleep in the Older Adults, Geriatric Depression Inventory and the Loneliness Scale of the University of California, Los Angeles. It was found that the institutionalized older adults had more feelings of loneliness than noninstitutionalized. However, there were no differences between the two subsamples in relation to depressive symptoms and subjective sleep quality. Through a correlational analysis it was found in the two subsamples that the worse the subjective sleep quality more depressive symptoms were observed and the more depressive symptoms, more feelings of loneliness. We concluded that there no differences in subjective sleep quality by the type of social response even though there are more depressive symptoms and symptoms of loneliness in the elderly. Also we did not find relationship between sleep and loneliness in the elderly.

Qualidade subjetiva do sono, sintomas depressivos, sentimentos de solidão e institucionalização em pessoas idosas

RESUMO Objetivos: A presente investigação teve como principais objetivos descrever a qualidade subjetiva do sono e as perturbações do sono e analisar a intensidade dos sintomas depressivos e dos sentimentos de solidão em idosos institucionalizados; comparar estes dados com um grupo de idosos não institucionalizados e analisar a relação entre estas variáveis nos dois grupos. Métodos: Este estudo insere-se no Projeto Trajetórias do Envelhecimento de Idosos em Resposta Social de onde foi retirada uma amostra de cento e quarenta idosos sem défice cognitivo, com 70 institucionalizados e 70 não institucionalizados emparelhados por idade, sexo, escolaridade e estado civil. A média de idades foi de 76,58 (DP = 6,10), incluindo 104 mulheres e 36 homens. Como instrumentos foram utilizados um Questionário Sociodemográfico, o Questionário sobre o Sono na Terceira Idade, a Escala Geriátrica de depressão e a Escala de Solidão da Universidade da Califórnia, Los Angeles. Resultados: Verificou-se que os idosos institucionalizados apresentavam mais sentimentos de solidão do que os não institucionalizados. Contudo, não se verificaram diferenças entre os dois grupos em relação aos sintomas depressivos, qualidade subjetiva do sono ou perturbações do sono, com algumas exceções: os idosos residentes na comunidade mostraram ter a perceção de demorar mais tempo a adormecer, de acordar mais cedo e de ter mais pesadelos. Através de uma análise correlacional verificou-se, na amostra global, que quanto pior a qualidade subjetiva do sono mais sintomas depressivos se observavam e quanto mais sintomas depressivos, mais sentimentos de solidão, não havendo, contudo, relação entre o sono e a solidão. Conclusões: Concluímos que a situação de institucionalização se acompanha de mais sentimentos de solidão, mas não de sintomas depressivos ou de pior qualidade de sono. Por esse motivo, sugere-se que se desenvolvam programas de intervenção dirigidos à solidão em idosos institucionalizados. ABSTRACT Aims: The main objectives of this investigation were to describe the subjective quality of sleep and sleep disorders and analyze the intensity of depressive and loneliness symptoms in institutionalized elderly people; compare these data against a non-institutionalized elderly people subsample and analyze the relationship between these variables in both subsamples. Method: This study is part of Trajectories of Elderly Aging in Social Response Project from which a sample of one hundred and forty elderly people with no cognitive impairment was taken, with 70 institutionalized and 70 non-institutionalized matched by age, sex, education, and marital status. The average age was 76.58 (SD = 6.10), including 104 women and 36 men. The tools used for this analysis were a sociodemographic questionnaire, the Questionnaire About Sleep in the Older Adults, Geriatric Depression Scale, and the Loneliness Scale of the University of California, Los Angeles. Results: The study confirmed that institutionalized elderly people had more feelings of loneliness than those non-institutionalized. However, there were no differences between the two subsamples regarding depressive symptoms and subjective sleep quality or sleep disturbances, with some exceptions: Elderly people living in the community showed to have the perception of taking more time to fall asleep, waking up earlier, and having more nightmares. Through a correlational analysis it was found, in both subsamples, that the worse the subjective sleep quality the more depressive symptoms were observed; and the more depressive symptoms, the more feelings of loneliness, despite of not existing a relation between sleep and loneliness. Conclusions: We concluded that institutionalization is linked to more feelings of loneliness but not to depressive symptoms nor to worse quality of sleep. For this reason, it is suggested that intervention programs are developed with a focus on elderly institutionalized populations.

Memória e envelhecimento: Qual o real impacto da idade?

RESUMO Objetivos. O défice mnésico é uma das alterações cognitivas que mais afeta as pessoas idosas. A idade é considerada um dos fatores de relevo nas alterações de memória, inclusivamente pelas próprias pessoas idosas. A investigação tem mostrado que existem outros fatores além da idade que afetam a memória das pessoas idosas. Contudo, fica por esclarecer qual o real papel da idade sobre a memória quando é controlada a influência de outras variáveis. Assim, o presente estudo pretende analisar o impacto da idade no funcionamento mnésico de pessoas idosas e verificar se, ao controlar o papel de outras variáveis (sexo, escolaridade, profissão, situação civil, situação residencial e situação clínica), esse potencial impacto se mantém. Métodos. A amostra global foi constituída por 1126 participantes (283 homens e 843 mulheres; 226 residentes na comunidade e 900 em resposta social dirigida à população idosa) com idades compreendidas entre os 60 e os 100 anos. A avaliação foi realizada com recurso aos itens do Mini-Mental State Examination (memória de trabalho), o fator do Montreal Cognitive Assessment (memória declarativa verbal) e Figura Complexa de ReyOsterrieth (memória visuoespacial). Resultados. Globalmente, a idade, escolaridade, profissão, situação civil, residencial e clínica influenciaram a memória de forma diferenciada consoante o tipo de memória. As análises de regressão hierárquica mostraram que a idade é um fator preditivo em todos os tipos de memória. Emergiram ainda outros fatores preditivos com coeficientes de regressão superiores à idade conforme o tipo de memória (exceto na memória de trabalho). Conclusões. A idade, a escolaridade e a profissão influenciam a memória, assim como os fatores que potencialmente estimulam cognitiva e socialmente (como ter um companheiro e residir na comunidade). Os resultados apontam para a importância de intervir em pessoas em respostas sociais, mais idosas, sem companheiro, com baixa escolaridade e profissão manual. ABSTRACT Goals. Memory impairment is one of the types of cognitive impairment that most affects the elderly. Age is considered one of the major factors in memory impairment, including by the elderly themselves. Research has shown that there are other factors affecting memory of elderly persons. It remains, however, unclear what is the real impact of age in memory when controlling the influence of other variables. Thus, this study aims to analyze the impact of age on memory functioning of elderly persons and check if the potential impact remains when controlling the role of other variables (sex, education, profession, marital status, residential status, and clinical situation). Methods. The global sample comprised 1126 subjects (283 men and 843 women, 226 residents in the community and 900 institutionalized elderly) aged from 60 to 100 years. The assessment included items from the MiniMental State Examination (working memory), the Montreal Cognitive Assessment factor (verbal declarative memory), and Rey-Osterrieth Complex Figure (visuospatial memory). Results. Overall, age, education, profession, marital, residential, and clinical condition have differently influenced memory, depending on the type of memory. The hierarchical regression analysis showed that age is a predictive factor in all types of memory. However, other predictors have emerged with higher regression coefficients compared to age, according to the type of memory (except in working memory). Conclusions. Age, education and profession influence memory, as well as factors that potentially stimulate cognitively and socially (like having a partner and living in the community). The results indicate the importance of intervening, especially among institutionalized elderly, older, unmarried, with low education, and manual profession.

La supplémentation nutritionnelle dans la prévention et le traitement des troubles cognitifs associés à la maladie d’Alzheimer

Cette recension systématique analyse 19 essais cliniques randomisés contre placebo qui mesurent l’effet de suppléments d’oméga-3, de vitamines B (B6, B9 et B12), ou de vitamines antioxydantes (C et E), sur le fonctionnement cognitif d’aînés avec ou sans trouble cognitif. Les bases de données consultées pour la recherche des articles sont Cochrane Library, Current Contents, EBSCO, EMBASE, MEDLINE et PsycNet. Les mots clés utilisés sont «alzheimer’s disease», or «mild cognitive impairment», or «cognitive decline»; and «dietary supplements» or «vitamin C», or «vitamin E», or «alpha-tocopherol», or «vitamin B», or «cobalamin», or «folic acid», or «omega 3», or «fatty acids»; and «prevention», or «treatment». La recherche inclut les articles publiés en anglais et en français, de 1999 à juin 2014. Les différents suppléments à l’étude sont bien tolérés et sécuritaires. Des résultats significatifs sont enregistrés sur des mesures cognitives suite à la supplémentation en oméga-3, et en vitamines B, chez des participants sans trouble cognitif ou avec un diagnostic de trouble cognitif léger. Chez les participants atteints de la maladie d’Alzheimer, des résultats significatifs sont surtout enregistrés sur des mesures fonctionnelles, de symptômes psychologiques et comportementaux, ou de qualité de vie, suite à l’administration d’un supplément nutritionnel. La présence d’une hétérogénéité importante dans la méthodologie des essais cliniques limite toutefois les conclusions quant à la pertinence clinique de ces traitements. L’établissement de lignes directrices suite à un consensus d’experts s’avère nécessaire afin d’uniformiser la recherche sur cette nouvelle piste d’intervention dans la prévention et le traitement de la maladie d’Alzheimer.

The role of cellular prion protein in Alzheimer’s disease

Alzheimer’s disease (AD) is the most prevalent age-related neurodegenerative disease that leads to cognitive impairment and dementia. The major defined pathological hallmark of AD is the accumulation of amyloid beta (Aβ), a neurotoxic peptide, derived from beta and gamma-secretase cleavage of the amyloid precursor protein (APP). It has been described that cellular prion protein (PrPC) plays a role in the pathogenesis of Alzheimer disease. Although, the role of PrPC is still unclear, previous studies showed contradictious results. To elucidate this issue, the main objective of the present study is to investigate the influence of a knockout of the PRNP gene in 5XFAD mice, 5xFAD mice exhibited 5 mutations related to familial Alzheimer disease. These mice show an Aβ1-42 accumulation and an increased neuronal loss during aging. To create a bi-transgenic 5xFAD mice were crossed with Prnp0/0 Zurich 1 mice (prion protein knockout mice). We subjected two transgenic mice (5xFAD and Prnp0/05xFAD) at different ages (3, 9 and 12 months of age) to a battery of task to evaluate cognitive and motoric deficits and a biochemical analysis (ELISA, western blot and immunohistochemistry) to investigate the regulation and potential involvement of downstream signaling proteins in the Aβ induced toxicity process dependent of the PrPC concentration. The study revealed that the deficits induced by Aβ mediated toxicity appeared earlier in 5xFAD mice (9 months of age) than in Prnp0/05xFAD (12 months of age). Investigating the amount of amyloid beta in 5xFAD mice we observed a PrPC dependent regulation in 9 month-old animals of Aβ1−40 but not of the toxic form Aβ1−42. We did not found in Prnp0/05xFAD mice the up-regulation of P-Fyn, Fyn or Cav-1 as we found in 5xFAD mice. This suggests an important role of PrPC in Alzheimer’s disease as a promoter of toxic effect of Aβ oligomers. Our results may suggest the loss of PrPC delays the toxicity of amyloid beta. In conclusion, our data support a role of PrPC as a mediator of Aβ toxicity in AD by promoting early onset of disease.

Quedas em idosos numa unidade de longa duração e manutenção

Introdução: as quedas são um importante problema na saúde nos idosos, apresentando os idosos institucionalizados um risco específico, determinado pela mudança de ambiente, diminuição da atividade física e alterações na independência funcional. Objetivo: estimar a prevalência e avaliar o risco de quedas nos idosos institucionalizados na ULDM – Sta Maria Maior de Miranda do Douro no período compreendido entre 02/12/2008 e 31/08/2014. Conhecer quais as estratégias de prevenção implementadas para evitar a recorrência de quedas nos idosos com histórico de quedas. Metodologia: Estudo descritivo e analítico de caráter retrospetivo, sobre uma amostra constituída por utentes com idade igual ou superior a 65 anos, internados numa Unidade de Longa Duração e Manutenção, no período compreendido entre 02/12/2008 e 31/08/2014 (N=158). Resultados: A prevalência de quedas foi de 14%. As quedas tiveram como principais fatores de risco a idade avançada, a presença de doenças crónicas, a mobilidade reduzida, défice cognitivo e polimedicação. O quarto e o WC foram os espaços físicos onde ocorreram com mais frequência. As principais causas foram, por esta ordem, a perda de apoio, episódio de desorientação/agitação e a perda de consciência. A maior parte das quedas não tiveram consequências físicas para o idoso ou limitaram-se a lesões traumáticas. As medidas de prevenção mais frequentemente aplicadas foram as medidas de apoio e a contenção física. Conclusão: nos resultados obtidos verifica-se uma prevalência de quedas muito superior quando comparada com outros estudos nesta área. Os dados apontam à necessidade de implementação de políticas institucionais de prevenção de quedas.

Hyperprolinemia as a clue in the diagnosis of a patient with a psychiatric disorder

Background: Over the last few years, microdeletions of the 22q11.2 region responsible for DiGeorge syndrome, or velocardiofacial syndrome, have been increasingly related to neuropsychiatric disorders including schizophrenia and bipolar disorders. These signs seem to be related to certain genes located in the hemideleted region as the proline dehydrogenase (PRODH) and the catecholo-methyltransferase (COMT) genes. The PRODH or proline oxidase deficiency is responsible for hyperprolinemia type 1 (HPI) also causing psychiatric manifestations. Case Report: We describe a 17 year old boy with previous mild psychomotor and speech delay, mild cognitive impairment, and obsessive behaviours who started his adolescent psychiatric care presenting irritablemood and aggressive behaviour with schizophrenia symptoms that scored a “severely ill” level PANSS assessment. Symptoms got worse when he was treated with valproic acid and plasma aminoacids showing increase in alanine and proline, suggested a mitochondrial involvement of the proline metabolic pathway. Results: Mild dysmorphia suggested a possible 22q11.2 deletion genetically confirmed involving both the PRODH and COMT regions. HPI that can present with psychiatric features is however a recessive disorder and therefore the symptoms could not be solely explained by this genetic deletion. Additional investigations also showed disclosed a p.L289m (c.1865 T > A) mutation in the PRODH gene. Discussion: We believe that the association of this mutation together with the 22q11.2 deletion would lead to a decrease of functional protein. Although it may be difficult to diagnosis chromosomal abnormalities in patients with no clear malformations and mild dysmorphic features as in this patient we emphasize need to investigate the aetiology in patients with psychiatric symptoms, especially if they have other systemic manifestations such as developmental delay or psychotic symptoms, as it may be important in the management of the patients.

Alzheimer’s electroencephalogram event scalp and source localization

Alzheimer’s disease is the most common cause of dementia which causes a progressive and irreversible impairment of several cognitive functions. The aging population has been increasing significantly in recent decades and this disease affects mainly the elderly. Its diagnostic accuracy is relatively low and there is not a biomarker able to detect AD without invasive tests. Despite the progress in better understanding the disease there remains no prospect of cure at least in the near future. The electroencephalogram (EEG) test is a widely available technology in clinical settings. It may help diagnosis of brain disorders, once it can be used in patients who have cognitive impairment involving a general decrease in overall brain function or in patients with a located deficit. This study is a new approach to improve the scalp localization and the detection of brain anomalies (EEG temporal events) sources associated with AD by using the EEG.