Dietary patterns, foods, and food groups : relation to late-life cognitive disorders

The limited efficacy of disease-modifying therapeutic strategies for mild cognitive impairment (MCI) and Alzheimer\u2019s dementia (AD) underscores the need for preventive measures to reduce the burden of late-life cognitive impairment. The aim of the present review article was to investigate the relationship among dietary patterns, foods, and food groups and late-life cognitive disorders considering the results of observational studies published in the last three years (2014-2016). In the last decade, the association between diet and cognitive function or dementia has been largely investigated. However, more recently, the National Institute on Aging-Alzheimer\u2019s Association guidelines for AD and cognitive decline due to AD pathology introduced some evidence suggesting a direct relation between diet and changes in the brain structure and activity. Several studies focused on the role of the dietary patterns on late-life cognition, with accumulating evidence that combinations of foods and nutrients into certain patterns may act synergistically to provide stronger health effects than those conferred by their individual dietary components. In particular, higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline, although the Mediterranean diet (MeDi) combines several foods, micronutrients, and macronutrients already separately proposed as potential protective factors against dementia and MCI. Moreover, also other emerging healthy dietary patterns such as the Dietary Approach to Stop Hypertension (DASH) and the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diets were associated with slower rates of cognitive decline and significant reduction in AD rate. Furthermore, some foods or food groups traditionally considered harmful such as eggs and red meat have been partially rehabilitated, while there is still a negative correlation of cognitive functions with added sugars and trans fatty acids, nutrients also increasing the cardiovascular risk. This would suggest a genesis for the same damage for aging brain

Dietary intervention and prevention of cognitive-related outcomes in healthy older adults without cognitive dysfunction

In the last decade, the association between diet and cognitive function/dementia has been largely investigated in observational studies, while there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we reviewed RCTs published in the last three years (2014-2016) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged over 60 years using different levels of investigation (i.e., dietary pattern changes/ medical food/nutraceutical supplementation/multidomain approach and dietary macro-and micronutrient approaches). From the included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. Moreover, there was high evidence that protein supplementation improved specific cognitive domains. For fatty acid supplementation, mainly long-chain polyunsaturated fatty acids, there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains, MRI findings, and/or cognitive-related biomarkers also in selected subgroups of older subjects although some results were conflicting. Moreover, there was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and/or MRI findings. Finally, there was only low evidence suggesting efficacy of intervention with homocysteine-related vitamins in improving cognitive functions, dementia incidence, or cognitive-related biomarkers in cognitively healthy older subjects

Nutritional interventions in patients with Alzheimer’s disease and other late-life cognitive disorders

Given the impact of nutrition on neuroprotection largely investigated in observational studies, in the present article, we reviewed evidence from randomized clinical trials (RCTs) published in the last three years (2014-2016) exploring nutritional intervention efficacy in slowing cognitive impairment progression and achieving cognitive-related outcomes in patients aged 60 years and older with mild cognitive impairment (MCI), preclinical Alzheimer\u2019s disease (AD), prodromal AD, AD, unspecified dementia, and vascular dementia using different levels of investigation (i.e., medical food/nutraceutical supplementation/multidomain approach and dietary food/macro-and micronutrient approaches). From the reviewed RCTs, there was emerging evidence that nutritional intervention through medical food/nutraceutical supplementation (Fortasyn Connect\uae and another similar nutraceutical formulation) and multidomain approach improved magnetic resonance imaging findings and other cognitive-related biomarkers, but without clear effect on cognition in mild AD and MCI. Moreover, there was some evidence of a positive effect of antioxidant-rich foods (nuts) in improving specific cognitive domains and cognitive-related outcomes in MCI and mild-to-moderate dementia, but only in small samples. There was also convincing evidence for fatty acid supplementation, mainly n-3 polyunsaturated fatty acids (PUFAs), in improving specific cognitive domains and/or cognitive-related biomarkers in MCI and AD. Furthermore, antioxidant vitamin and trace element supplementations improved only cognitive-related outcomes and biomarkers, without effect on cognitive function in AD and MCI patients. Finally, high-dose B vitamin supplementation in AD and MCI patients improved cognitive outcomes but only in the subjects with a high baseline plasma n-3 PUFA, while folic acid supplementation had positive impact on specific cognitive domains

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

The turbulent structure of the flow field generated by a hydrofoil in stalling condition beneath a water-air interface

In this paper, measurements beneath the interface of the flow past a hydrofoil in water during stalling conditions are used to characterise the flow field and to extract and to analyse the small eddies using an original algorithm based on the wavelet transform. The detected eddies are analysed to evaluate their spatial distribution and their intensity separating the wake of the foil-related from the wake of the breaker-related eddies. The wake of the foil-related eddies have an almost symmetric distribution of circulation with slight dominance of counter-clockwise (CCW) eddies, while the breaker-related eddies have an asymmetric distribution of circulation, and clockwise (CW) eddies are dominant. The joint probability density function (PDF) of the turbulent kinetic energy (TKE) and the Reynolds shear stress is computed by referring to the time-averaged values in the area occupied by the eddies. A similar PDF computed using the instantaneous values during eddies presence shows values of TKE and Reynolds shear stress roughly twice the average values, i.e., eddies can be associated to larger fluctuations of the flow field respect to the time average flow field. However, on average, the Reynolds shear stress during eddy presence is less than the Reynolds shear stress of the time-averaged flow at the same location. The sign of the Reynolds shear stress is systematically opposite to the time-averaged value in quadrants Q2– Q4 for CW eddies and in quadrants Q1–Q3 for CCW eddies. Therefore, in the presence of eddies there is a counter-flux of momentum. The conditional analysis of the terms of the TKE balance indicates that, in the wake of the foil and during the presence of eddies, the production is 15% stronger than the timeaveraged production at the same location occupied by the eddies. Beneath the free surface the production is 30% weaker than the time average. A similar analysis for the advection indicates that, in the wake of the foil, the advection in the presence of eddies is an order of magnitude greater (in absolute value) than the advection due to the time-averaged flow at the same location. Additionally, beneath the free surface, the advection in the presence of eddies is much greater than the average. A similar behaviour can be observed for the transport term due to turbulence. Therefore, in the presence of eddies, production plus advection plus transport is enhanced with respect to the average flow and is increased approximately by 40% in the wake of the foil and 20% beneath the free surface

Effect of relaxation on the physical symptoms in women with multiple sclerosis

Background and Objective: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease, leading to progressive disability, reduces daily activity and function and emerges with a wide range of physical symptoms. This study was done to determine the effect of relaxation on the physical symptoms in women with Multiple Sclerosis. Methods: In this clinical trial study, 50 patients with MS were randomly divided into relaxation and control groups. In the interventional group, Jacobson and Benson method was performed for 4 weeks, twice a week for 40 minutes and patients in the control group were received only care and routine medical treatment. Data was collected via fatigue severity scale (FSS), numerical rating scale (NRS) before, immediately after and two months after intervention. Results: The mean severity of fatigue score, before, immediately and two months after the intervention were not the same and time trends was effective on severity of fatigue score (P<0.05). The mean of fatigue score were significantly reduced in intervention group (immediately and two months after intervention) in compared to pre-intervention. The mean severity of pain score ,before, immediately and two months after the intervention were not the same and time trends was effective on mean severity of pain score (P<0.05). The mean intensity of pain score over time in the relaxation group non-significantly reduced in compared to the control group. Conclusion: Relaxation technique is effective as a low-cost, safe and easy method to reduce fatigue and pain in patients with MS