Gender specific age-related changes in bone density, muscle strength and functional performance in the elderly: a-10 year prospective population-based study

Background:&nbsp;Age-related losses in bone mineral density (BMD), muscle strength, balance, and gait have been linked to&nbsp;an increased risk of falls, fractures and disability, but few prospective studies have compared the timing, rate and pattern&nbsp;of changes in each of these measures in middle-aged and older men and women. This is important so that targeted&nbsp;strategies can be developed to optimise specific musculoskeletal and functional performance measures in older adults.&nbsp;Thus, the aim of this 10-year prospective study was to: 1) characterize and compare age- and gender-specific changes in&nbsp;BMD, grip strength, balance and gait in adults aged 50 years and over, and 2) compare the relative rates of changes&nbsp;between each of these musculoskeletal and functional parameters with ageing.Methods: Men (n = 152) and women (n = 206) aged 50, 60, 70 and 80 years recruited for a population-based study had&nbsp;forearm BMD, grip strength, balance and gait velocity re-assessed after 10-years.Results: The annual loss in BMD was 0.5-0.7% greater in women compared to men aged 60 years and older&nbsp;(p &lt; 0.05- &lt; 0.001), but there were no gender differences in the rate of loss in grip strength, balance or gait. From the age&nbsp;of 50 years there was a consistent pattern of loss in grip strength, while the greatest deterioration in balance and gait&nbsp;occurred from 60 and 70 years onwards, respectively. Comparison of the changes between the different measures&nbsp;revealed that the annual loss in grip strength in men and women aged &lt;70 years was 1-3% greater than the decline in&nbsp;BMD, balance and gait velocity.Conclusion: There were no gender differences in the timing (age) and rate (magnitude) of decline in grip strength,&nbsp;balance or gait in Swedish adults aged 50 years and older, but forearm BMD decreased at a greater rate in women than&nbsp;in men. Furthermore, there was heterogeneity in the rate of loss between the different musculoskeletal and function&nbsp;parameters, especially prior to the age of 70 years, with grip strength deteriorating at a greater rate than BMD,&nbsp;balance and gait.</div

Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme.

Objective To investigate the associations of body mass index (BMI) and grip strength with objective measures of physical performance (chair rise time, walking speed and balance) including an assessment of sex differences and non-linearity. Methods Cross-sectional data from eight UK cohort studies (total N = 16 444) participating in the Healthy Ageing across the Life Course (HALCyon) research programme, ranging in age from 50 to 90+ years at the time of physical capability assessment, were used. Regression models were fitted within each study and meta-analysis methods used to pool regression coefficients across studies and to assess the extent of heterogeneity between studies. Results Higher BMI was associated with poorer performance on chair rise (N = 10 773), walking speed (N = 9 761) and standing balance (N = 13 921) tests. Higher BMI was associated with stronger grip strength in men only. Stronger grip strength was associated with better performance on all tests with a tendency for the associations to be stronger in women than men; for example, walking speed was higher by 0.43 cm/s (0.14, 0.71) more per kg in women than men. Both BMI and grip strength remained independently related with performance after mutual adjustment, but there was no evidence of effect modification. Both BMI and grip strength exhibited non-linear relations with performance; those in the lowest fifth of grip strength and highest fifth of BMI having particularly poor performance. Findings were similar when waist circumference was examined in place of BMI. Conclusion Older men and women with weak muscle strength and high BMI have considerably poorer performance than others and associations were observed even in the youngest cohort (age 53). Although causality cannot be inferred from observational cross-sectional studies, our findings suggest the likely benefit of early assessment and interventions to reduce fat mass and improve muscle strength in the prevention of future functional limitations

Sarcopenia and impairment in cognitive and&nbsp;physical performance

Magdalena I Tolea,1 James E Galvin1&ndash;3 1Alzheimer&rsquo;s Disease Center, Department of Neurology, 2Department of Psychiatry, 3Department of Population Health, New York University School of Medicine, New&nbsp;York, NY, USA Background: Whether older adults with sarcopenia who underperform controls on tests of physical performance and cognition also have a higher likelihood of combined cognitive-physical impairment is not clear. We assessed the impact of sarcopenia on impairment in both aspects of functionality and the relative contribution of its components, muscle mass and strength.Methods: Two hundred and twenty-three community-dwelling adults aged 40 years and older (mean age =68.1&plusmn;10.6 years; 65% female) were recruited and underwent physical functionality, anthropometry, and cognitive testing. Participants with low muscle mass were categorized as pre-sarcopenic; those with low muscle mass and muscle strength as sarcopenic; those with higher muscle mass and low muscle strength only were categorized as non-sarcopenic and were compared on risk of cognitive impairment (Montreal Cognitive Assessment &lt;26; Ascertaining Dementia 8 &ge;2), physical impairment (Mini Physical Performance Test &lt;12), both, or neither by ordinal logistic regression. Results: Compared to controls, those with sarcopenia were six times more likely to have combined cognitive impairment/physical impairment with a fully adjusted model showing a three-fold increased odds ratio. The results were consistent across different measures of global cognition (odds ratio =3.46, 95% confidence interval =1.07&ndash;11.45 for the Montreal Cognitive Assessment; odds ratio =3.61, 95% confidence interval =1.11&ndash;11.72 for Ascertaining Dementia 8). Pre-sarcopenic participants were not different from controls. The effect of sarcopenia on cognition is related to low muscle strength rather than low muscle mass. Conclusion: Individuals with sarcopenia are not only more likely to have single but also to have dual impairment in cognitive and physical function. Interventions designed to prevent sarcopenia and improve muscle strength may help reduce the burden of cognitive and physical impairments of functionality in community-dwelling seniors. Keywords: cross-sectional, muscle strength, muscle mass, physical impairment, cognitive impairment, older adult

Sarcopenic obesity and cognitive performance

Magdalena I Tolea,1 Stephanie Chrisphonte,1 James E Galvin1,2 1Charles E. Schmidt College of Medicine, Department of Integrated Medical Sciences, Comprehensive Center for Brain Health, Florida Atlantic University, Boca Raton, FL, USA; 2Christine E. Lynn College of Nursing, Louis and Anne Green Memory and Wellness Center, Florida Atlantic University, Boca Raton, FL, USA Background: Sarcopenia and obesity both negatively impact health including cognitive function. Their coexistence, however, can pose an even higher threat likely surpassing their individual effects. We assessed the relationship of sarcopenic obesity with performance on global- and subdomain-specific tests of cognition. Patients and methods: The study was a cross-sectional analysis of data from a series of community-based aging and memory studies. The sample consisted of a total of 353 participants with an average age of 69 years with a clinic visit and valid cognitive (eg, Montreal Cognitive Assessment, animal naming), functional (eg, grip strength, chair stands), and body composition (eg, muscle mass, body mass index, percent body fat) measurements. Results: Sarcopenic obesity was associated with the lowest performance on global cognition (Est.Definition1=&minus;2.85&plusmn;1.38, p=0.039), followed by sarcopenia (Est.Definition1=&minus;1.88&plusmn;0.79, p=0.017) and obesity (Est.Definition1=&minus;1.10&plusmn;0.81, p=0.175) adjusted for sociodemographic factors. The latter, however, did not differ significantly from the comparison group consisting of older adults with neither sarcopenia nor obesity. Subdomain-specific analyses revealed executive function (Est.Definition1=&minus;1.22&plusmn;0.46 for sarcopenic obesity; Est.Definition1=&minus;0.76&plusmn;0.26 for sarcopenia; Est.Definition1=&minus;0.52&plusmn;0.27 for obesity all at p0.05) and orientation (Est.Definition1=0.59&plusmn;0.26 for sarcopenic obesity; Est.Definition1=&minus;0.36&plusmn;0.15 for sarcopenia; Est.Definition1=&minus;0.29&plusmn;0.15 all but obesity significant at p&lt;0.05) as the individual cognitive skills likely to be impacted. Potential age-specific and depression effects are discussed. Conclusion: Sarcopenia alone and in combination with sarcopenic obesity can be used in clinical practice as indicators of probable cognitive impairment. At-risk older adults may benefit from programs addressing loss of cognitive function by maintaining/improving strength and preventing obesity. Keywords: sarcopenia, obesity, sarcopenic obesity, cognition, cross-sectional studie

Public&ndash;private partnerships improve health outcomes in individuals with early stage Alzheimer&rsquo;s disease

James E Galvin,1 Magdalena I Tolea,1 Nika George,2 Cheryl Wingbermuehle31Alzheimer Disease Center, Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, NY, USA; 2Clinical Psychology Program, University of&nbsp;Missouri &ndash; St Louis, 3Alzheimer&rsquo;s Association, St Louis Chapter, St Louis, MO, USAPurpose: In a collaborative effort between the Missouri Department of Health, Area Agencies on Aging (AAA), Alzheimer Association, and academic researchers, we tested whether early dementia detection and comprehensive care consultations would improve health outcomes in care receivers (CRs) and their family caregivers (FCGs), therefore addressing an important public health concern.Participants and methods: A total of&nbsp;244&nbsp;community-dwelling older adults screened for early-stage dementia by the AAA field staff were referred to the Alzheimer Association and participated in Project Learn MORE (Missouri Outreach and Referral Expanded) (PLM) &ndash; a&nbsp;2-year, nonrandomized multisite intervention consisting of comprehensive care consultations to improve coping skills. PLM participants were compared against&nbsp;96&nbsp;controls receiving the Alzheimer Association&rsquo;s &ldquo;usual services&rdquo; between January&nbsp;2011&nbsp;and December&nbsp;2012. We examined CR and FCG outcomes, including burden, care confidence, and mood, as effects of PLM, on delaying transitions in level of care.Results: CRs showed improved knowledge (P=0.002) and reduced depression (P=0.007), while FCGs demonstrated improved knowledge (P=0.003) and ability to identify sources of support for the CR (P=0.032) and for themselves (P=0.043). However, FCGs were more burdened after PLM (P=0.02), due to increased awareness of Alzheimer&rsquo;s disease. PLM delayed transitions in care (odds ratio [OR]&nbsp;3.32,&nbsp;95% confidence level [CI]:&nbsp;1.25&ndash;8.83) with the number needed to treat =6.82.Conclusion: PLM was successful in improving detection of incident cases of dementia in the community and in connecting patients and their families with needed services. Our &shy;findings support the use of state agencies and community service partners to detect dementia. Early implementation of psychosocial interventions could have significant impact in improving patient- and family-centered outcomes, potentially providing a cost-efficient alternative to pharmacotherapy.Keywords: dementia screening, AD8, social support, caregiver burden, transition in car

Symptoms of anxiety or depression and risk of fracture in older people: the Hertfordshire Cohort Study

SummaryThe aim of this study was to examine the prospective association between symptoms of anxiety and depression and risk of fracture in older people. Results showed that men, but not women, with probable anxiety at baseline had an increased risk of fracture.IntroductionThe use of psychotropic drugs has been linked with an increased risk of fracture in older people, but there are indications that the conditions for which these drugs were prescribed may themselves influence fracture risk. The aim of this study was to investigate the relation between symptoms of anxiety and depression and risk of fracture in older people. The study design is a prospective cohort study.MethodsOne thousand eighty-seven men and 1,050 women aged 59–73 years completed the Hospital Anxiety and Depression Scale (HADS). Data on incident fracture during an average follow-up period of 5.6 years were collected through interview and a postal questionnaire.ResultsCompared to men with no or few symptoms of anxiety (score ?7 on the HADS anxiety subscale), men with probable anxiety (score ?11) had an increased risk of fracture: After adjustment for age and potential confounding factors, the odds ratio (OR) (95 % confidence interval) was 4.03 (1.55, 10.5). There were no associations between levels of anxiety and fracture risk in women. Few men or women had probable depression at baseline (score ?11 on the HADS depression subscale). Amongst men with possible depression (score 8–10), there was an increased risk of fracture that was of borderline significance: multivariate-adjusted OR 3.57 (0.99, 12.9). There was no association between possible depression and fracture risk in women.ConclusionsHigh levels of anxiety in older men may increase their risk of fracture. Future research needs to replicate this finding in other populations and investigate the underlying mechanisms