Development of dementia in older adults : the body-mind connection

Over the past years, two major lines have emerged in the field of dementia research that are focused on: (1) The accurate and early prediction of dementia, and (2) The identification of modifiable factors for dementia prevention. This thesis has contributed to both. We explored the role played by the body-mind connection in cognitive aging by investigating whether motor functioning is a predictor of dementia and if different co-occurring diseases (i.e., multimorbidity [MM] patterns) are risk factors for dementia. We carried out four longitudinal studies, two for each research line, using 12 years of data from SNAC-K, a population-based study involving 3363 older adults, clinically assessed at regular intervals. Study I. Participants with both cognitive and motor dysfunctions demonstrated the highest hazard of developing dementia. After gait speed was added to cognitive assessment, the area under the curve (AUC) increased from 0.69 to 0.83 among the oldest participants. This increase was driven by a reduction in the proportion of false negatives, while the number of false positives (high specificity) remained low. Adding gait speed did not improve the predictive power of the cognitive battery in identifying dementia among younger-old adults. Study II. Individuals with concurrent cognitive and motor decline presented with a mixed and more rapidly evolving brain pathology on magnetic resonance imaging, affecting both gray and white matter. Adults experiencing only cognitive decline had a steeper hippocampal volume loss, whereas those exhibiting only motor decline displayed greater white matter hyperintensity burden. Study III. Individuals belonging to the neuropsychiatric, cardiovascular, and sensory impairment/cancer MM-patterns had the highest hazards of dementia, among those with MM. Inflammation (high C-reactive protein levels) increased dementia hazard within these three patterns, whereas being an APOE ε4-carrier heightened dementia hazard for neuropsychiatric and cardiovascular MM-patterns. Study IV. Exposure to air particulate matter ≤ 2.5μm [PM2.5] was found to increase dementia hazard by up to 50%. The presence of heart diseases (heart failure and ischemic heart disease) further amplified the risk, whereas stroke mediated up to 50% of the PM2.5-dementia association. Conclusions. The findings from these four studies underline the relevance of the body-mind connection in dementia development. An easy-to-obtain motor marker (gait speed) improved the ability of the cognitive test to detect future dementia. This could be explained by the mixed brain pathology, which we found to develop in individuals with fast and concomitant cognitive and motor decline. Specific MM-patterns seemed to increase dementia risk, an effect that was further accentuated by the presence of inflammation and genetic predisposition. Finally, cardiovascular diseases could be important in explaining the relation between PM2.5 and dementia risk. Further exploring the relation between body- and mind- related conditions could be essential in identifying at-risk populations and biomarkers for incipient dementia, and thus, in advancing our understanding of dementia in older adults

Modern sedimentary facies in a progradational barrier-spit system, Goro lagoon, Po delta, Italy

Barriers and spits connected to fluvial sedimentary sources represent environments which tend to evolve rapidly and experience sudden transformations, mainly driven by changes in sediment supply and path. As a consequence, the variability of facies is significant even within small sedimentary records. The 7 km long barrier-spit system facing the Goro Lagoon, and fed by the mouth of the Po di Goro, is a typical example of an accretionary coastal morphotype, suitable to describe adjacent nearshore depositional environments and their stratigraphic signatures, variability, and relationships. Thirteen short cores of sediment were sampled in order to represent the variable depositional subenvironments from the shoreface (prodelta-delta front) to the back barrier, crossing the active barrier-spit and the ancient spit arms and relative swales. The description of the modern sedimentary records, improved upon using core X-rays, has been coupled with information on the morphological changes which occurred during the period of maximum spit development (1955\u20132000), based on available aerial photos and a cartographic/topographic dataset. The results obtained allow for the description and interpretation of the depositional environments changing at the human-scale. Sediments of the upper shoreface are quite uniform, composed by evenly laminated sands; the transition between delta front and prodelta at a depth of 6m is marked by the alternation of sand and mud beds. These reflect the periodic changes in sediment supply by the river, as well as storm events. The most recent spit branch and the relative back barrier-swale environment are the results of the rapid progradation of the spit system, which implies phases of rapid longshore growth, hooked spit development, cannibalization, overwash, and breaching. Morphodynamic changes have resulted in an overlap of short sedimentary records where stratigraphic signatures are linked either to phases of sediment transport and selection by waves and tidal currents (cross-bedding, foreset, and planar laminated sands, shell imbrication, massive beds) or to phases of sedimentary stasis when biological activity is predominant (algal mat and bioturbation). Human signature is also well marked inside the stratigraphic record. Clam harvesting is carried out within the lagoon, causing the physical disturbance and winnowing of the superficial sediment, thus inducing the local formation of graded beds and shell rehash

Measuring gait speed to better identify prodromal dementia

Abstract Slow gait speed has been shown to predict incident dementia and cognitive decline in older individuals. We aimed to summarize the evidence concerning the association of slow gait speed with cognitive decline and dementia, and discuss the possible shared pathways leading to cognitive and motor impairments, under the unifying hypothesis that body and mind are intimately connected. This is a scoping review supported by a systematic search of the literature, performed on PubMed and Web of Science. Longitudinal studies providing information on the role of gait speed in the prediction of cognitive decline and dementia in cognitively intact people and in those with initial cognitive impairment were eligible. Of 39 studies selected, including overall 57,456 participants, 33 reported a significant association between gait speed and cognitive outcomes, including dementia. Neurodegenerative pathology and cerebrovascular burden may damage cerebral areas involved in both cognitive functions and motor control. At the same time, systemic conditions, characterized by higher cardiorespiratory, and metabolic and inflammatory burden, can affect a number of organs and systems involved in motor functions, including the brain, having ultimately an impact on cognition. The interplay of body and mind seems relevant during the development of cognitive decline and dementia. The measurement of gait speed may improve the detection of prodromal dementia and cognitive impairment in individuals with and without initial cognitive deficits. The potential applicability of such a measure in both clinical and research settings points at the importance of expanding our knowledge about the common underlying mechanisms of cognitive and motor decline

The interplay between acute bacterial skin and skin structure infections and depression: a vicious circle of major clinical importance.

Purpose of review Previous studies suggest an association between depression and increased risk of various type of infections, including acute bacterial skin and skin structure infections (ABSSSI). Here, we review the latest advancement in our understanding of immunity in patients with depression and its relevance to disease management and diagnosis, with a special focus on patients suffering from ABSSSI. Recent findings Recent studies have highlighted the role of hypothalamic-pituitary-adrenal axis, neuro-endocrine stress signaling pathways and behavioral attitudes (substance abuse and homelessness) in the pathogenesis of infections in depressed patients. Furthermore, acute bacterial infections, in turn, have emerged as a possible risk for depression development because of different mechanisms including antibiotic-driven changes in the microbiota. Summary Recent evidences have emphasized the threat that comanagement of depression and infection pose to infectious disease physician and psychiatrist. Depressed patients with ABSSSI must be closely monitored for drug side-effects, drug-drug interactions, toxicity, and adequate compliance. New management strategies including new long-acting antibiotics (e.g., dalbavancin) are welcome

Multimorbidity burden and dementia risk in older adults : The role of inflammation and genetics

Funding: Swedish National study on Aging and Care; Ministry of Health and Social Affairs; Swedish Research Council, Grant/Award Number: 2016-00981; Swedish Research Council for Health,Working Life andWelfare, Grant/Award Number: 2017-01764; Italian Ministry of Health, Grant/Award Number: PE-2016-02364885We investigate dementia risk in older adults with different disease patterns and explore the role of inflammation and apolipoprotein E (APOE) genotype. A total of 2,478 dementia-free participants with two or more chronic diseases (ie, multimorbidity) part of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were grouped according to their multimorbidity patterns and followed to detect clinical dementia. The potential modifier effect of C-reactive protein (CRP) and apolipoprotein E (APOE) genotype was tested through stratified analyses. People with neuropsychiatric, cardiovascular, and sensory impairment/cancer multimorbidity had increased hazards for dementia compared to the unspecific (Hazard ration (HR) 1.66, 95% confidence interval [CI] 1.13-2.42; 1.61, 95% CI 1.17-2.29; 1.32, 95% CI 1.10-1.71, respectively). Despite the lack of statistically significant interaction, high CRP increased dementia risk within these patterns, and being APOE ε4 carriers heightened dementia risk for neuropsychiatric and cardiovascular multimorbidity. Individuals with neuropsychiatric, cardiovascular, and sensory impairment/cancer patterns are at increased risk for dementia and APOE ε4, and inflammation may further increase the risk. Identifying such high-risk groups might allow tailored interventions for dementia prevention

Free and cued selective reminding test predicts progression to Alzheimer's disease in people with mild cognitive impairment

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PRNP P39L variant is a rare cause of frontotemporal dementia in Iialian population

The missense P39L variant in the prion protein gene (PRNP) has recently been associated with frontotemporal dementia (FTD). Here, we analyzed the presence of the P39L variant in 761 patients with FTD and 719 controls and found a single carrier among patients. The patient was a 67-year-old male, with a positive family history for dementia, who developed apathy, short term memory deficit, and postural instability at 66. Clinical and instrumental workup excluded prion disease. At MRI, bilateral frontal lobe atrophy was present. A diagnosis of FTD was made, with a mainly apathetic phenotype. The PRNP P39L mutation may be an extremely rare cause of FTD (0.13%)

Improvement in muscular strength and aerobic capacities in elderly people occurs independently of physical training type or exercise model

OBJECTIVES: Progressive decline of physiological processes with aging is normal. Aging is also associated with decreased functional capacity and onset of many diseases. This study evaluated the changes in physical fitness (PF), body composition (BC), and lipid profile (LP) in elderly men completing different training protocols. METHODS: Fifty-five men (age 60-80 years) were randomized into the following groups: without training, aerobic training on dry land, combined training on dry land, and combined training in water. Training was conducted for 8 weeks, and PF, LP, and BC were assessed at the beginning and end of the intervention. RESULTS: Significant improvements were observed in all parameters; however, combined programs on land or in water were more effective at improving strength and aerobic fitness. Combined exercise produced greater effects on BC and LP and some muscle fitness parameters; however, improvements in muscular and aerobic capacities occurred independently of exercise type or model. CONCLUSION: These results indicate that the effects of training occur regardless of training type or model, and are directly associated with training periodization, adherence, and regularit

Physical activity and exercise in dementia : an umbrella review of intervention and observational studies

Background: Dementia is a common condition in older people. Among the potential risk factors, increasing attention has been focused on sedentary behaviour. However, synthesizing literature exploring whether physical activity/exercise can affect health outcomes in people with dementia or with mild cognitive impairment (MCI) is still limited. Therefore, the aim of this umbrella review, promoted by the European Geriatric Medicine Society (EuGMS), is to understand the importance of physical activity/exercise for improving cognitive and non-cognitive outcomes in people with dementia/MCI. Methods: Umbrella review of systematic reviews (SR) (with or without meta-analyses) of randomized controlled trials (RCTs) and observational (prospective and case-control in people with MCI) studies based on a systematic literature search in several databases. The certainty of evidence of statistically significant outcomes attributable to physical activity/exercise interventions was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Among 1,160 articles initially evaluated, 27 systematic reviews (4 without meta-analysis) for a total of 28,205 participants with dementia/MCI were included. No observational study on physical activity/exercise in MCI for preventing dementia was included. In SRs with MAs, physical activity/exercise was effective in improving global cognition in Alzheimer’s disease and in all types of dementia (very low/low certainty of evidence). Moreover, physical activity/ exercise significantly improved global cognition, attention, executive function, and memory in MCI, with a certainty of evidence varying from low to moderate. Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls and neuropsychiatric symptoms. SRs, without meta-analysis, corroborated these results. Conclusions: Supported by very low to moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and non-cognitive outcomes in people with dementia and MCI, but RCTs, with low risk of bias/confounding, are still needed to confirm these findings