Evaluation of Central Auditory Discrimination Abilities in Older Adults

The present study focuses on auditory discrimination abilities in older adults aged 65-89 years. We applied the ‘Leipzig Inventory for Patient Psychoacoustic’ (LIPP), a psychoacoustic test battery specifically designed to identify deficits in central auditory processing. These tests quantify the just noticeable differences (JND) for the three basic acoustic parameters (i.e. frequency, intensity, and signal duration). Three different test modes (monaural, dichotic signal/noise [s/n] and interaural) were used, stimulus level was 35dB sensation level. The tests are designed as three-alternative forced-choice procedure with a maximum-likelihood procedure estimating p=0,5 correct response value. These procedures have proven to be highly efficient and provide a reliable outcome. The measurements yielded significant age-dependent deteriorations in the ability to discriminate single acoustic features pointing to progressive impairments in central auditory processing. The degree of deterioration was correlated to the different acoustic features and to the test modes. Most prominent, interaural frequency and signal duration discrimination at low test frequencies was elevated which indicates a deterioration of time- and phase-dependent processing at brain stem and cortical levels. LIPP proves to be an effective tool to identify basic pathophysiological mechanisms and the source of a specific impairment in auditory processing of the elderly

Higher Lipoprotein (a) Levels Are Associated with Better Pulmonary Function in Community-Dwelling Older People - Data from the Berlin Aging Study II

Reduced pulmonary function and elevated serum cholesterol levels are recognized risk factors for cardiovascular disease. Currently, there is some controversy concerning relationships between cholesterol, LDL-cholesterol, HDL-cholesterol, serum triglycerides and lung function. However, most previous studies compared patients suffering from chronic obstructive pulmonary disease (COPD) with healthy controls, and only a small number examined this relationship in population-based cohorts. Moreover, lipoprotein a [Lp(a)], another lipid parameter independently associated with cardiovascular diseases, appears not to have been addressed at all in studies of lung function at the population level. Here, we determined relationships between lung function and several lipid parameters including Lp(a) in 606 older community-dwelling participants (55.1% women, 68±4 years old) from the Berlin Aging Study II (BASE-II). We found a significantly lower forced expiration volume in 1 second (FEV1) in men with low Lp(a) concentrations (t-test). This finding was further substantiated by linear regression models adjusting for known covariates, showing that these associations are statistically significant in both men and women. According to the highest adjusted model, men and women with Lp(a) levels below the 20th percentile had 217.3ml and 124.2ml less FEV1 and 239.0ml and 135.2ml less FVC, respectively, compared to participants with higher Lp(a) levels. The adjusted models also suggest that the known strong correlation between pro-inflammatory parameters and lung function has only a marginal impact on the Lp(a)-pulmonary function association. Our results do not support the hypothesis that higher Lp(a) levels are responsible for the increased CVD risk in people with reduced lung function, at least not in the group of community-dwelling older people studied here

New loci for body fat percentage reveal link between adiposity and cardiometabolic disease risk

To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P<5 × 10−8), of which eight were previously associated with increased overall adiposity (BMI, BF%) and four (in or near COBLL1/GRB14, IGF2BP1, PLA2G6, CRTC1) were novel associations with BF%. Seven loci showed a larger effect on BF% than on BMI, suggestive of a primary association with adiposity, while five loci showed larger effects on BMI than on BF%, suggesting association with both fat and lean mass. In particular, the loci more strongly associated with BF% showed distinct cross-phenotype association signatures with a range of cardiometabolic traits revealing new insights in the link between adiposity and disease risk

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p&nbsp;&lt;.001. Over 24&nbsp;months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10&nbsp;ml/min/1.73&nbsp;m2 decrease), that was most notable in patients with eGFR &lt;30&nbsp;ml/min/1.73&nbsp;m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90&nbsp;ml/min/1.73&nbsp;m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P &lt;.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

New loci for body fat percentage reveal link between adiposity and cardiometabolic disease risk

To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P <5 x 10(-8)), of which eight were previously associated with increased overall adiposity (BMI, BF%) and four (in or near COBLL1/GRB14, IGF2BP1, PLA2G6, CRTC1) were novel associations with BF%. Seven loci showed a larger effect on BF% than on BMI, suggestive of a primary association with adiposity, while five loci showed larger effects on BMI than on BF%, suggesting association with both fat and lean mass. In particular, the loci more strongly associated with BF% showed distinct cross-phenotype association signatures with a range of cardiometabolic traits revealing new insights in the link between adiposity and disease risk.Peer reviewe

Effects of a single lipid apheresis on cardiac microvascular function in patients with elevated lipoprotein(a) and coronary artery disease: detection by stress/rest perfusion magnetic resonance imaging

Ein erhöhter Lp(a)-Spiegel gilt als unabhängiger Risikofaktor für die Entwicklung einer frühzeitigen Arteriosklerose. Zudem konnte ein negativer Einfluss auf das endotheliale System nachgewiesen werden. Die einzige effektive Therapie zur Absenkung erhöhter Lp(a)-Spiegel besteht in der Lipidapherese. Nur wenige Studien lieferten bislang Hinweise darauf, dass vergleichbar mit der Cholesterinabsenkung die Entfernung von Lp(a) aus dem Plasma mittels Lipidapherese die koronare Vasomotion verbessert. Unklar blieb auch, in welchem Zeitraum sich diese Veränderungen entwickeln. Die durchgeführte Studie wurde daher mit dem Ziel angelegt, die These einer Verbesserung der koronaren Vasomotion nach einmaliger Lipidapherese zu überprüfen und durch kurzzeitiges Follow-up an verschiedenen Messpunkten nach Lipidapherese im Verlauf zu beurteilen. Hierfür wurde die kardiale Magnetresonanztomographie als nicht-invasives und nebenwirkungsarmes diagnostisches Verfahren mit einer hohen räumlichen und zeitlichen Auflösung gewählt. Das eingeschlossene Kollektiv bestand aus 25 Patienten mit Hyperlipoproteinämie(a) und KHK, die randomisiert einer Untersuchungs- oder Kontrollgruppe zugeordnet wurden. Die Effekte einer einmaligen Lipidfiltration, bezogen auf die Parameter des Lipidstoffwechsels und der Hämorrheologie, wurden laborchemisch vor und direkt nach der Lipidfiltration sowie nach 24 h und 96 h dokumentiert. Ferner erfolgte in einem 24- bzw. 96-stündigen Intervall nach der Lipidfiltration mittels MR-First Pass- Perfusionsmessung die Beurteilung der myokardialen Durchblutung. Alle Messungen wurden unter Ruhe- sowie Adenosinstress durchgeführt. Dabei erfolgte eine separate Auswertung der Perfusion für das subendokardiale und subepikardiale Myokard. Die im Rahmen der Lipidfiltration erzielten Veränderungen der Lipidwerte und rheologischen Parameter zeigten eine hohe Korrelation mit den in anderen Studien erhobenen Daten. Ferner wurde eine tendenzielle Verbesserung der linksventrikulären Funktion beobachtet. Bei der Messung der endo- und epikardialen Perfusionsparameter zeigten sich die Effekte der Lipidfiltration unter Ruhe bzw. Stress jeweils in derjenigen Myokardschicht verstärkt, die einen physiologischen Perfusionsvorteil hat. Als Maß für die relative vasodilatatorische Kapazität des Myokards wurden die differenziellen Veränderungen in Subendo- und Subepikard unter Ruhe bzw. Adenosinstress zudem in einem integrativen Parameter, der sog. EER-Stress/EER- Ruhe zusammengefasst. Bereits durch eine einmalige Lipidfiltration kam es nach 24 Stunden zu einer relativen Zunahme der endokardialen Perfusion in Ruhe sowie einer Zunahme der epikardialen Perfusion unter Stress, was sich in einer signifikanten Abnahme der EER-Stress/EER-Ruhe zeigte. Die vorgelegte Studie lieferte erstmalig Hinweise darauf, dass es bei Patienten mit Hyperlipoproteinämie(a) und KHK durch die Lipidapherese zu einer Verbesserung der mikrovaskulären Funktion kommt.Elevated lipoprotein(a) (Lp(a)) is an emerging, independent risk factor for atherosclerotic disease. Patients frequently present with premature and rapidly progressing coronary artery disease. Lp(a) impairs coronary endothelial function and appears to be a predictor of adverse outcome. Unfortunately, conservative therapy remains unsatisfactory, but significant reduction of Lp(a) plasma concentration can be achieved using lipid-apheresis. This intensive treatment strategy is not covered by standard health insurance in Germany. The additional costs would have to be justified by improvements in measurable end points. Cardiac magnetic resonance imaging (CMR) is emerging as a state of the art tool to monitor subtle changes in microvascular perfusion. The purpose of this prospective, controlled and randomized study was to provide evidence that a single lipid-apheresis attenuates myocardial microvascular dysfunction in coronary artery disease patients with strongly elevated lipoprotein(a). A total of n = 25 patients were included and randomized into a treatment-group or a control-group. On day 1 all patients underwent baseline fasting blood sampling immediately before baseline CMR. After CMR the treatment-group underwent lipid-apheresis on the same day. At 24 hours both groups underwent repeat blood sampling and CMR with identical parameters. At 96 hours blood-samples were drawn in the treatment-group and this group underwent a final CMR exam. The transmyocardial perfusion gradient (i.e. endo-epi-ratio, EER) was determined and a comprehensive parameter of resting and adenosinstress perfusion was derived (EER stress/rest). While hematocrite remained unchanged, apheresis reduced lipoproteins and rheological parameters significantly. Left ventricular ejection fraction transiently improved after lipid-apheresis, emphasizing the close relation between microvascular function, myocardial perfusion and contraction. Lipid-apheresis also had subtle, opposing effects on subendo- and subepicardial perfusion: adenosin-mediated vasodilation now caused the expected benefit of subepicardial perfusion whereas the relative subendokardial perfusion advantage was reinforced at rest. Lipid-apheresis significantly reduced EER stress/rest. Although the exact physiological mechanisms remain unresolved, the observed treatment-related effects may be interpreted as functional improvement and as a “trend towards normalizsation” of myocardial microvascular function. Cardiac magnetic resonance imaging has high sensitivity to detect subtle treatment-related changes in regional myocardial perfusion in patients with elevated lipoprotein(a) and coronary artery disease undergoing lipid-apheresis

Das Altern am eigenen Körper erfahren: Der Gero-Parcours

Der Gero-Parcours ist ein erfahrungsbasierter Stationenlauf, der entwickelt wurde, um das Altern am eigenen Körper wahrzunehmen. Aufgeteilt in fünf Themen mit insgesamt 19 Stationen, bietet der Parcours realitätsbezogene Erfahrungen zu Mobilitäts- und Sinneseinschränkungen im Alter sowie einen Einblick in inhaltlich mit der Gerostomatologie zusammenhängende Fächer wie Pflege, Ethik, Rehabilitation und klinische Ernährung. Themen mit Bezug zum älteren Menschen in der zahnmedizinischen Praxis werden anhand von Alltagssituationen aufgegriffen und mit Hilfe von Simulationen und praktischen Übungen aus der Perspektive der Senioren beleuchtet. Die unterschiedliche Kombinierbarkeit der verschiedenen Stationen des Gero-Parcours ermöglicht es, ihn individuell anzupassen und als halbtägige Aus- oder Fortbildung anzubieten. Mit dem Lehrformat wurden bereits Zahnärzte, Zahntechniker und Dentalhygienikerinnen geschult, um ihnen einen Einblick davon zu vermitteln, wie es um das Befinden älterer Menschen bestellt ist und vor welchen Herausforderungen diese stehen

Mundgesundheit und Pneumonie : der Mund als Keimreservoir für Pneumonie bei pflegebedürftigen Senioren

Mit dem Begriff Pneumonie wird eine Gruppe von Entzündungen des Lungenparenchyms zusammengefasst, die u. a. von Bakterien und Viren ausgelöst werden können. Bei betagten Menschen und Personen mit geschwächtem Immunsystem können Pneumonien zu lebensbedrohlichen Zuständen führen. In Pflegeheimen gehören Pneumonien mit einer Prävalenz von 13 bis 48 % zu den häufigsten Infektionskrankheiten und weisen zudem eine hohe Mortalitätsrate auf. Zahlreiche epidemiologische Studien untersuchen den Einfluss möglicher Risikofaktoren auf die Entstehung nosokomialer Pneumonien. Bei Personen, die in Krankenhäusern oder Pflegeheimen leben, wird ein direkter Zusammenhang zwischen oraler Plaque und dem Risiko für Pneumonien gesehen. Orale Biofilme scheinen als Infektionsreservoir für lungenpathogene Keime zu dienen, welche via Aspiration in den unteren Respirationstrakt gelangen. In Querschnittsstudien wurde bei Patienten mit schlechter Mundhygiene ein signifikant erhöhtes relatives Risiko für Pneumonien gefunden. Ergebnisse aus Interventionsstudien bestätigen diesen Zusammenhang. Eine bessere Mundhygiene durch intensive professionelle Reinigung oder chemische Plaquekontrolle führte zu einer Absenkung der Inzidenz von Pneumonien. Der Beitrag soll dem Leser einen Überblick über die aktuelle Literatur und die wissenschaftliche Evidenz zu dem Thema geben und damit den Stellenwert verdeutlichen, den die Mundhygiene in der Prävention allgemeinmedizinischer Krankheitsbilder des Alters haben kann. Weiterhin besteht das Ziel des Artikels darin, den Verantwortlichen in ambulanten und stationären Pflegeeinrichtungen die Notwendigkeit einer strukturierten zahnmedizinischen Betreuung näher zu bringen