Le processus incapacitant au cours du vieillissement : rôle de l’exercice/activité physique

Le vieillissement est un phénomène d’importance croissante dans les sociétés actuelles. Bien que le rôle exercé par la pratique d’exercice/activité physique sur le maintien d’une capacité physique fonctionnelle optimale durant le vieillissement soit bien établi, l’inactivité physique est encore un comportement largement présent chez les personnes âgées, ce qui facilite le développement du processus incapacitant. Le but de cette revue de synthèse est d’exposer la chaîne de déclins physiologiques et fonctionnels au cours du vieillissement. Cette étude vise aussi à élucider le rôle exercé par la pratique d’exercice/activité physique afin d’empêcher ou retarder le début de tels déclins, et de renverser ou diminuer leur impact négatif sur des individus qui vieillissent. Ce travail explore l’influence des principales composantes du processus incapacitant (fragilité, limitation physique fonctionnelle, dépendance), et de la pratique d’exercice/activité physique sur la capacité physique fonctionnelle. Concernant le rapport « exercice/activité physique – processus incapacitant », certaines incohérences apparaissent parmi les études, ce qui réduit la possibilité de comparaison entre elles, et limite les conclusions. La définition du concept de fragilité, ainsi que la façon de mesurer les variables exercice/activité physique et fragilité constituent une des principales incohérences parmi ces études. Malgré cela, il ressort de ces études que la pratique régulière d’exercice/activité physique réduit des déclins liés à l’âge, tant sur le plan physiologique que sur celui de la capacité physique fonctionnelle. La pratique régulière d’exercice/activité physique contribue ainsi au maintien de l’indépendance des personnes âgées, à travers une minimisation des effets négatifs du processus incapacitant.Aging is a phenomenon of increased importance in contemporaneous societies. Although it is well established that physical exercise/activity contributes to maintain functional fitness at optimal levels, physical inactivity is a largely prevalent behaviour among elderly people, thus facilitating the disablement process. The purpose of this review is to study physiological and functional declines during aging. This article also tries to clarify the role played by physical exercise/activity in avoiding or delaying those declines, and in reverting or diminishing their negative impacts on older adults’ health. The influences of both disablement process main components (frailty, disability, and dependence) and of physical exercise/activity on functional fitness are examined. Concerning the relationships between physical exercise/activity and disablement process, some inconsistencies arise among articles, making difficult to compare them and to draw conclusions. The definitions of frailty, as well as the ways to measure physical exercise/activity, constitute the main inconsistencies among studies. However, most of the researches show that a regular practice of physical exercise/activity decreases the age-related declines in both physiological status and functional fitness. Then, exercising regularly can contribute to maintain independence in older adults by reducing the negative effects of the disablement process

Lack of energy is associated with malnutrition in nursing home residents: Results from the INCUR study

Background: Lack of energy is a symptom frequently complained by older people, leading to the inability to continue functioning at the expected level of activity. This study aimed to investigate whether nutritional status was associated with lack of energy in nursing home (NH) residents. Methods: This was a cross-sectional study. A total of 570 NH residents (72.1% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents study cohort were included in the study. Lack of energy was measured by the question “Did you feel full of energy during the past week?” from the geriatric depression scale. Nutritional status was evaluated according to Mini Nutritional Assessment Short-Form (MNA-SF). Unadjusted and adjusted logistic regression models were performed to test the association of nutritional status with lack of energy. Results: The mean age of participants was 86.5 (SD 7.5) years. A total of 246 NH residents (43.2%) reported a lack of energy. Overall, 71 (12.5%) residents were malnourished and 323 (56.7%) residents were at risk of malnutrition. Malnutrition was significantly associated with lack of energy (OR = 3.42, 95% CI = 1.92–6.08, P < 0.001), even after adjustment for potential confounders (OR = 2.41, 95% CI = 1.29–4.52, P = 0.006). Among the single items of the MNA-SF, decrease in food intake, low mobility, and psychological stress or acute disease were individually associated with lack of energy, independently of potential confounders (OR = 1.85, 95% CI = 1.24–2.77, P = 0.003; OR = 1.43, 95% CI = 1.10–1.86, P = 0.008; OR = 1.48, 95% CI = 1.19–1.84, P < 0.001; for each point respectively). Conclusions: Lack of energy and malnutrition were closely associated. The reporting of lack of energy should lead to a comprehensive assessment of the aging individual (as happening for malnutrition) in order to preventively/promptly act on potentially reversible causes

Effect of a 1-Year Nutritional Blend Supplementation on Plasma p-tau181 and GFAP Levels among Community-Dwelling Older Adults: A Secondary Analysis of the Nolan Trial

BACKGROUND: Observational studies and some randomized controlled trials have suggested that nutritional supplementation could be a possible intervention pathway to prevent cognitive decline and Alzheimer's disease (AD). As measuring amyloid-β and tau pathophysiology by positron emission tomography (PET) or cerebrospinal fluid (CSF) analyses may be perceived as complex, plasma versions of such biomarkers have emerged as more accessible alternatives with comparable capacity of predicting cognitive impairment. OBJECTIVES: This study aimed to evaluate the effect of a 1-year intervention with a nutritional blend on plasma p-tau181 and glial fibrillary acidic protein (GFAP) levels in community-dwelling older adults. Effects were further assessed in exploratory analyses within sub-cohorts stratified according to p-tau status (with the third tertile considered as high: ≥15.1 pg/ mL) and to apolipoprotein E (APOE) ε4 allele status. METHODS: A total of 289 participants ≥70 years (56.4% female, mean age 78.1 years, SD=4.7) of the randomized, double-blind, multicenter, placebo-controlled Nolan trial had their plasma p-tau181 assessed, and daily took either a nutritional blend (composed of thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid, cobalamin, vitamin E, vitamin C, vitamin D, choline, selenium, citrulline, eicosapentaenoic acid - EPA, and docosahexaenoic acid - DHA) or placebo for 1 year. RESULTS: After 1-year, both groups presented a significant increase in plasma p-tau181 and GFAP values, with no effect of the intervention (p-tau181 between-group difference: 0.27pg/mL, 95%CI: -0.95, 1.48; p=0.665; GFAP between-group difference: -3.28 pg/mL, 95%CI: -17.25, 10.69; p=0.644). P-tau-and APOE ε4-stratified analyses provided similar findings. CONCLUSIONS: In community-dwelling older adults, we observed an increase in plasma p-tau181 and GFAP levels that was not different between the supplementation groups after one year

Can We Distinguish Age-Related Frailty from Frailty Related to Diseases? Data from the MAPT Study

Abstract Background No study has tried to distinguish subjects that become frail due to diseases (frailty related to diseases) or in the absence of specific medical events; in this latter case, it is possible that aging process would act as the main frailty driver (age-related frailty). Objectives To classify subjects according to the origin of physical frailty: age-related frailty, frailty related to diseases, frailty of uncertain origin, and to compare their clinical characteristics. Materials and methods We performed a secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT), including 195 subjects ≥70 years non-frail at baseline who became frail during a 5-year follow-up (mean age 77.8 years ± 4.7; 70% female). Physical frailty was defined as presenting ≥3 of the 5 Fried criteria: weight loss, exhaustion, weakness, slowness, low physical activity. Clinical files were independently reviewed by two different clinicians using a standardized assessment method in order to classify subjects as: "age-related frailty", "frailty related to diseases" or "frailty of uncertain origin". Inconsistencies among the two raters and cases of uncertain frailty were further assessed by two other experienced clinicians. Results From the 195 included subjects, 82 (42%) were classified as age-related frailty, 53 (27%) as frailty related to diseases, and 60 (31%) as frailty of uncertain origin. Patients who became frail due to diseases did not differ from the others groups in terms of functional, cognitive, psychological status and age at baseline, however they presented a higher burden of comorbidity as measured by the Cumulative Illness Rating Scale (CIRS) (8.20 ± 2.69; vs 6.22 ± 2.02 frailty of uncertain origin; vs. 3.25 ± 1.65 age-related frailty). Time to incident frailty (23.4 months ± 12.1 vs. 39.2 ± 19.3 months) and time spent in a pre-frailty condition (17.1 ± 11.4 vs 26.6 ± 16.6 months) were shorter in the group of frailty related to diseases compared to age-related frailty. Orthopedic diseases (n=14, 26%) were the most common pathologies leading to frailty related to diseases, followed by cardiovascular diseases (n=9, 17%) and neurological diseases (n = 8, 15%). Conclusion People classified as age-related frailty and frailty related to diseases presented different frailty-associated indicators. Future research should target the underlying biological cascades leading to these two frailty classifications, since they could ask for distinct strategies of prevention and management

On Schrödinger’s Cat and Evaluation of Trials Disrupted by the Covid19 Pandemic: A Critical Appraisal

From the beginning of 2020, the world has been fighting the SARS-Cov-2 outbreak. The life of each one of us has profoundly hanged. Unavoidably, our clinical routine has drastically modified in its priorities and methodologies (1). The COVID-19 pandemic has also raised significant issues in the field of research. The investigators’ responsibility has increased with the need to thoughtfully weigh the risk-benefit ratio for each protocol in an emergency and evolving scenario (2)

β-cyclodextrin/isopentyl caffeate inclusion complex: synthesis, characterization and antileishmanial activity

Isopentyl caffeate (ICaf) is a bioactive ester widely distributed in nature. Our patented work has shown promising results of this molecule against Leishmania. However, ICaf shows poor solubility, which limits its usage in clinical settings. In this work, we have proposed the development of an inclusion complex of ICaf in -cyclodextrin (-CD), with the aim to improve the drug solubility, and thus, its bioavailability. The inclusion complex (ICaf:-CD) was developed applying three distinct methods, i.e., physical mixture (PM), kneading (KN) or co-evaporation (CO) in different molar proportions (0.25:1, 1:1 and 2:1). Characterization of the complexes was carried out by thermal analysis, Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM) and molecular docking. The ICaf:-CD complex in a molar ratio of 1:1 obtained by CO showed the best complexation and, therefore, was selected for further analysis. Solubility assay showed a marked improvement in the ICaf:-CD (CO, 1:1) solubility profile when compared to the pure ICaf compound. Cell proliferation assay using ICaf:-CD complex showed an IC50 of 3.8 and 2.7 µg/mL against L. amazonesis and L. chagasi promastigotes, respectively. These results demonstrate the great potential of the inclusion complex to improve the treatment options for visceral and cutaneous leishmaniases.This research was funded by Banco do Nordeste (grant FUNDECI/2016.0015), Coordenação Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) and Fundação de Ámparo à Pesquisa do Estado de Sergipe (FAPITEC) (PROCESSO: 88887.159533/2017-00 extração, encapsulação e caracterização de bioativos para o interesse biotecnologico). Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq 301964/2019-0 Chamada 06/2019, and Chamada CNPq nº 01/2019) and from the Portuguese Science and Technology Foundation (FCT) project UIDB/04469/2020 (strategic fund).info:eu-repo/semantics/publishedVersio