A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease

<p>Abstract</p> <p>Background</p> <p>Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance.</p> <p>Objectives</p> <p>To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD.</p> <p>Methods</p> <p>A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals.</p> <p>Results</p> <p>The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019).</p> <p>Conclusion</p> <p>Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.</p

Treino cognitivo em idosos e efeitos nas funções executivas

El envejecimiento se asocia comúnmente con el deterioro cognitivo y la pérdida de otras capacidades, lo cual conlleva la necesidad de investigar elementos que puedan contribuir a las intervenciones preventivas de rehabilitación cognitiva y que tienen como objetivo garantizar la calidad de vida de los ancianos. El objetivo de este estudio fue caracterizar ancianos que se inscribieron en esta intervención, para medir los efectos del entrenamiento cognitivo, con énfasis en las funciones ejecutivas, comparando un grupo experimental con un grupo control. Se trata de una investigación cuantitativa, con un diseño cuasi-experimental; es correlacional y comparativa, con pre y post-test e intervención. La muestra estuvo conformada por 83 ancianos, dividida en un grupo experimental (GE) (45 personas) y un grupo control (GC) (38 personas). Se utilizaron los siguientes instrumentos: entrevista neuropsicológica semiestructurada sobre características sociodemográficas; Examen Mínimo del Estado Mental (Mini Mental State o MMSE, por sus siglas en inglés); Inventario de Ansiedad Beck (BAI, por sus siglas en inglés); Escala de Depresión Geriátrica (GDS, por sus siglas en inglés); subpruebas WAIS-III: prueba de amplitud de dígitos (Digit Span), vocabulario, diseño con bloques, codificación, Secuenciación de Letras y Números (LNS por sus siglas en inglés), y la búsqueda de símbolos; Test de Trazos (TMT por sus siglas en inglés); Figuras Complejas de Rey; Paradigma de Sternberg; tareas de fluidez verbal sobre semántica (animales) y fonemas (F-A-S); Prueba de Aprendizaje Verbal-auditiva de Rey (RVLT por sus siglas en inglés); Prueba de Stroop: colores y palabras; tareas ir/no ir; y Test Wisconsin de Clasificación de Cartas (WCST por sus siglas en inglés). Los resultados de la comparación entre los grupos mostraron que hubo una diferencia significativa en cuanto al número de errores en el Paradigma de Sternberg y las categorías completas del WCST. Las comparaciones intragrupales mostraron que el GE tuvo mejores resultados después de la intervención en las siguientes pruebas: GDS, RAVLT, Figuras Complejas de Rey (memoria), prueba de amplitud de dígitos y vocabulario.O envelhecimento está comumente relacionado ao declínio cognitivo e a outras perdas de diferentes habilidades, o que aponta a necessidade de buscar elementos que possam contribuir para intervenções preventivas de reabilitação cognitiva, que tenham como objetivo assegurar uma melhor qualidade de vida do idoso. O objetivo deste estudo é caracterizar os idosos participantes, mensurar os efeitos do treino cognitivo, com ênfase nas funções executivas, comparados a um grupo controle. Trata-se de uma pesquisa do tipo quantitativa, com delineamento quase experimental, correlacional e comparativa com pré e pós-teste e de intervenção. Houve grupo controle para comparação. A mostra foi composta por 83 idosos da população geral, divididos em 45 idosos que fizeram parte do Grupo Experimental (GE) e 38 idosos participantes do Grupo Controle (GC). Instrumentos utilizados: Entrevista neuropsicológica sociodemográfica; Mini Exame do Estado Mental (MEEM); Inventário de Ansiedade de Beck (BAI); Escala de Depressão Geriátrica (GDS); Subtestes Dígitos, Vocabulário, Cubos, Código, Sequência Números e Letras (SNL); Procurar Símbolos (WAIS-III) ; Trail Makint Test (TMT); Figuras Complexas de Rey; Paradigma de Sternberg; Tarefas de fluência verbal (letras F, A, S); Rey Auditory-Verbal Learning Test (RVLT); Teste Stroop; Tarefas go-no-go e Teste Wisconsin (WCST). Os resultados mostraram na comparação entre os grupos, que houve diferença significativa quanto à variação no número de erros no Paradigma de Sternberg, Categorias Completadas do WCST e Procurar Símbolos. Nas comparações intragrupo, o Grupo Experimental melhorou significativamente os escores após a intervenção dos instrumentos GDS, RAVLT, Figuras Complexas de Rey–memória, Dígitos OD, Dígitos Total e Vocabulário.Aging is commonly associated with cognitive decline and loss of other abilities, which leads to the need for researching elements that may contribute to preventive cognitive rehabilitation interventions aiming to guarantee the elderly a good quality of life. The objective of this study is to characterize elderly who enrolled in this intervention, to measure the effects of cognitive training with emphasis on executive functions, by comparing an Experimental to a Control group. This is a quantitative research that used a quasi-experimental design; it is correlational and comparative, involving pre- and posttesting and intervention. The sample was formed by 83 elders, split into an Experimental Group (EG) (45 people) and a Control Group (GC) (38 people). The instruments used were the following: a neuropsychological semi-structured interview about sociodemographic characteristics; Mini Mental State Examination (MMSE); Beck Anxiety Inventory (BAI); Geriatric Depression Scale (GDS); WAIS-III subtests: Digit Span, Vocabulary, Block Design, Coding, Letter-Number Sequencing (LNS), and Symbol Search; Trail Making Test (TMT); Ray Complex Figures; Sternberg Paradigm; verbal fluency tasks about semantics (animals) and phonemes (F-A-S); Rey Auditory-Verbal Learning Test (RVLT); Stroop Test: colors and words; go/ no go tasks; and the Wisconsin Card Sorting Test (WCST). The results from the comparison between groups showed that there was a significant difference regarding the number of errors in the Sternberg Paradigm and Completed Categories of the WCST. Intragroup comparisons showed that the EG had better results after the intervention on the following tests: GDS, RAVLT, Rey Complex Figures (memory), Digit Span and Vocabulary

The ARIA-MASK-air® approach

Funding Information: The authors thank Ms Véronique Pretschner for submitting the paper. MASK‐air has been supported by Charité Universitätsmedizin Berlin, EU grants (EU Structural and Development Funds Languedoc Roussillon and Region PACA; POLLAR: EIT Health; Twinning: EIP on AHA; Twinning DHE: H2020; Catalyse: Horizon Europe) and educational grants from Mylan‐Viatris, ALK, GSK, Novartis, Stallergènes‐Greer and Uriach. None for the study. ® Publisher Copyright: © 2023 The Authors. Clinical and Translational Allergy published by John Wiley & Sons Ltd on behalf of European Academy of Allergy and Clinical Immunology.MASK-air®, a validated mHealth app (Medical Device regulation Class IIa) has enabled large observational implementation studies in over 58,000 people with allergic rhinitis and/or asthma. It can help to address unmet patient needs in rhinitis and asthma care. MASK-air® is a Good Practice of DG Santé on digitally-enabled, patient-centred care. It is also a candidate Good Practice of OECD (Organisation for Economic Co-operation and Development). MASK-air® data has enabled novel phenotype discovery and characterisation, as well as novel insights into the management of allergic rhinitis. MASK-air® data show that most rhinitis patients (i) are not adherent and do not follow guidelines, (ii) use as-needed treatment, (iii) do not take medication when they are well, (iv) increase their treatment based on symptoms and (v) do not use the recommended treatment. The data also show that control (symptoms, work productivity, educational performance) is not always improved by medications. A combined symptom-medication score (ARIA-EAACI-CSMS) has been validated for clinical practice and trials. The implications of the novel MASK-air® results should lead to change management in rhinitis and asthma.publishersversionpublishe

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049