Psychosocial stress and inflammation driving tryptophan breakdown in children and adolescents : a cross-sectional analysis of two cohorts

Background: Tryptophan breakdown is an important mechanism in several diseases e.g. inflammation and stress induced inflammation have been associated with the development of depression via enhanced tryptophan breakdown. Depression is a major public health problem which commonly starts during adolescence, thus identifying underlying mechanisms during early life is crucial in prevention. The aim of this work was to verify whether independent and interacting associations of psychosocial stress and inflammation on tryptophan breakdown already exist in children and adolescents as a vulnerable age group. Methods: Two cross-sectional population-based samples of children/adolescents (8-18 y) were available: 315 from the European HELENA study and 164 from the Belgian ChiBS study. In fasting serum samples, tryptophan, kynurenine, kynurenic acid, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, soluble vascular adhesion molecule 1 (sVCAM1) and soluble intercellular adhesion molecule 1 (sICAM1) were measured. Psychological stress was measured by stress reports (subjective) and cortisol (objective - awakening salivary cortisol or hair cortisol). Linear regressions with stress or inflammation as predictor were adjusted for age, sex, body mass index, puberty, socio-economic status and country. Results: In both cohorts, inflammation as measured by higher levels of CRP, sVCAM1 and sICAM1 was associated with kynurenine/tryptophan ratio and thus enhanced tryptophan breakdown (beta: 0.145-0.429). Psychological stress was only associated with tryptophan breakdown in the presence of higher inflammatory levels (TNF-alpha in both populations). Conclusions: Inflammatory levels were replicable key in enhancing tryptophan breakdown along the kynurenine pathway, even at young age and in a non-clinical sample. The stress-inflammation interaction indicated that only the stress exposures inducing higher inflammatory levels (or in an already existing inflammatory status) were associated with more tryptophan breakdown. This data further contributes to our understanding of pathways to disease development, and may help identifying those more likely to develop stress or inflammation-related illnesses

Standardization and diagnostic utility of the frontal assessment battery for healthy people and patients with dementia in the Chilean population

Background: The Frontal Assessment Battery (FAB) is a screening test that measures executive functions. Although this instrument has been validated in several countries, its diagnostic utility in a Chilean population has not been studied yet. Objectives: (1) To adapt FAB in a Chilean population; (2) To study the psychometric properties of the FAB in a Chilean population; (3) to assess the sociodemographic influence in the performance of the FAB in a sample of healthy controls, and (4) to develop normative data for this last group. Methods: A healthy control (n = 344) and a group of patients with dementia (n = 156) were assessed with the Chilean version of FAB. Results: FAB showed good internal consistency (Cronbach's alpha = 0.79) and acceptable validity based on the relationship with other variables. Factor analysis showed the unidimensionality of the instrument. Significant differences were found in the total FAB value between the healthy control and dementia groups. With the matched sample, the established cut-off point was 13.5, showing a sensitivity of 80.8% and a specificity of 90.4%. Regression analysis showed that education and age significantly predicted FAB performance in the healthy group. Finally, normative data are provided. Conclusions: The present study has shown that FAB is a useful tool to discriminate between healthy people and people with dementia. However, further studies are needed to explore the capacity of the instrument to characterize the dysexecutive syndrome in people with dementia in the Chilean population

The power of knowledge about dementia in Latin America across health professionals working on aging.

IntroductionExpert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies' accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known.MethodsWe investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location.ResultsExperts specified low public policy knowledge (X2  = 41.27, P < .001), high levels of stigma (X2  = 2636.37, P < .001), almost absent BI knowledge (X2  = 56.58, P < .001), and needs for regional diagnostic manuals (X2  = 2893.63, df = 3, P < .001) and data-sharing platforms (X2 = 1267.5, df = 3, P < .001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts.DiscussionOur findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs' dementia knowledge

The power of knowledge about dementia in Latin America across health professionals working on aging

Introduction: Expert knowledge is critical to fight dementia in inequitable regions like Latin American and Caribbean countries (LACs). However, the opinions of aging experts on public policies’ accessibility and transmission, stigma, diagnostic manuals, data-sharing platforms, and use of behavioral insights (BIs) are not well known. Methods: We investigated opinions among health professionals working on aging in LACs (N = 3365) with regression models including expertise-related information (public policies, BI), individual differences (work, age, academic degree), and location. Results: Experts specified low public policy knowledge (X2 = 41.27, P <.001), high levels of stigma (X2 = 2636.37, P <.001), almost absent BI knowledge (X2 = 56.58, P <.001), and needs for regional diagnostic manuals (X2 = 2893.63, df = 3, P <.001) and data-sharing platforms (X2 = 1267.5, df = 3, P <.001). Lack of dementia knowledge was modulated by different factors. An implemented BI-based treatment for a proposed prevention program improved perception across experts. Discussion: Our findings help to prioritize future potential actions of governmental agencies and non-governmental organizations (NGOs) to improve LACs’ dementia knowledge.Fil: Ibañez, Agustin Mariano. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés; Argentina. Universidad Autónoma del Caribe; Colombia. University of California; Estados Unidos. Universidad Adolfo Ibañez; ChileFil: Flichtentrei, Daniel. Intramed; ArgentinaFil: Hesse Rizzi, Eugenia Fátima. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés; ArgentinaFil: Dottori, Martin. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de San Andrés; ArgentinaFil: Tomio, Ailin. Universidad de San Andrés; ArgentinaFil: Slachevsky, Andrea. Universidad del Desarrollo; Chile. Universidad de Chile. Facultad de Medicina; ChileFil: Serrano, Cecilia Mariela. Dr. Cesar Milstein Hospital; ArgentinaFil: Gonzalez Billaut, Christian. Universidad de Chile. Facultad de Medicina; ChileFil: Custodio, Nilton. Instituto Nacional de Salud del Perú; PerúFil: Miranda, Claudia. Universidad Andrés Bello; Chile. Instituto Milenio para la Investigación de la Depresión; ChileFil: Bustin, Julian. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Instituto de Neurología Cognitiva. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Fundación Favaloro. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt; ArgentinaFil: Cetckovitch, Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Instituto de Neurología Cognitiva. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Fundación Favaloro. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt; ArgentinaFil: Torrente, Fernando Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Instituto de Neurología Cognitiva. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt | Fundación Favaloro. Instituto de Neurociencia Cognitiva y Traslacional. Fundación Ineco Rosario Sede del Incyt; ArgentinaFil: Olavarria, Loreto. Universidad de Chile. Facultad de Medicina; ChileFil: León, Tomas. Universidad de Chile. Facultad de Medicina; ChileFil: Beber, Barbara Costa. Universidade Federal de Ciências da Saúde de Porto Alegre; BrasilFil: Bruki, Sonia. Universidade de Sao Paulo; BrasilFil: Suemoto, Claudia K.. Universidade de Sao Paulo; BrasilFil: Nitrini, Ricardo. Universidade de Sao Paulo; BrasilFil: Miller, Bruce L.. University of California; Estados UnidosFil: Yokoyama, Jennifer S.. University of California; Estados Unido

Impact of Social Isolation on People with Dementia and Their Family Caregivers

Background: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. Objective: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. Methods: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. Results: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. Conclusion: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.Fil: Azevedo, Lílian Viana dos Santos. Universidade Federal de Minas Gerais; BrasilFil: Calandri, Ismael Luis. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Slachevsky, Andrea. Universidad de Chile; Chile. Centro de Gerociencia, Salud Mental y Metabolismo; Chile. Universidad del Desarrollo; ChileFil: Graviotto, Héctor Gastón. Unidad Asistencial "Dr. César Milstein"; ArgentinaFil: Santos Vieira, Maria Carolina. Universidade Federal de Minas Gerais; Brasil. Rede Mater Dei de Saúde; BrasilFil: Bezerra de Andrade, Caíssa. Universidade Federal de Minas Gerais; BrasilFil: Peredo Rossetti, Adriana. Universidade Federal de Minas Gerais; Brasil. Rede Mater Dei de Saúde; BrasilFil: Barroso Generoso, Alana. Universidade Federal de Minas Gerais; Brasil. Rede Mater Dei de Saúde; BrasilFil: Carvalho Carmona, Karoline. Universidade Federal de Minas Gerais; BrasilFil: Cardoso Pinto, Ludmilla Aparecida. Universidad de Chile. Facultad de Medicina.; ChileFil: Sorbara, Marcos. Unidad Asistencial "Dr. César Milstein"; ArgentinaFil: Pinto, Alejandra. Universidad de Chile. Facultad de Medicina.; ChileFil: Guajardo, Tania. Universidad de Chile. Facultad de Medicina.; ChileFil: Olavarria, Loreto. Universidad de Chile. Facultad de Medicina.; ChileFil: Thumala, Daniela. Universidad de Chile. Facultad de Medicina.; Chile. Centro de Gerociencia, Salud Mental y Metabolismo; ChileFil: Crivelli, Lucía. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Vivas, Ludmila. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Allegri, Ricardo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Tonidandel Barbosa, Maira. Universidad de Chile; Chile. Universidade Federal de Minas Gerais; BrasilFil: Serrano, Cecilia Mariela. Unidad Asistencial "Dr. César Milstein"; ArgentinaFil: Miranda Castillo, Claudia. Universidad Andrés Bello; Chile. Instituto Milenio para la Investigación de la Depresión; ChileFil: Caramelli, Paulo. Universidade Federal de Minas Gerais; Brasi