Homocysteine, type 2 diabetes mellitus, and cognitive performance: The Maine-Syracuse Study

Type 2 diabetes mellitus and higher total plasma homocysteine concentrations are each associated with an increased incidence of cardiovascular disease and with diminished cognitive performance. Relations between homocysteine concentrations and cardiovascular disease incidence are stronger in the presence of type 2 diabetes mellitus. Therefore, we hypothesized that relations between homocysteine concentrations and cognitive performance would be stronger in the presence of type 2 diabetes. We related homocysteine concentrations and cognitive performance on the Mini-Mental State Examination in 817 dementia- and stroke-free participants of the Maine-Syracuse Study, 90 of whom were classified with type 2 diabetes mellitus. Regardless of statistical adjustment for age, sex, gender, vitamin co-factors (folate, vitamin B6, vitamin B12), cardiovascular disease risk factors, and duration and type of treatment for type 2 diabetes mellitus, statistically significant inverse associations between homocysteine concentrations and cognitive performance were observed for diabetic individuals. The weaker inverse associations between homocysteine concentrations and cognitive performance obtained for non-diabetic individuals were not robust to statistical adjustment for some covariates. Interactions between homocysteine concentrations and type 2 diabetes mellitus are observed such that associations between homocysteine and cognitive performance are stronger in the presence of diabetes

Homocysteine, Folate, and Vitamins B\u3csub\u3e6\u3c/sub\u3e and B\u3csub\u3e12\u3c/sub\u3e Blood Levels in Relation to Cognitive Performance: The Maine-Syracuse Study

Objective: Our objective was to examine associations among plasma homocysteine concentrations (tHcy), the tHcy-cofactors (folate, vitamins B6 and B12), and multiple domains of cognitive performance, with statistical adjustment for possible confounds, including cardiovascular disease risk factors (CVD-RF) and cardiovascular disease (CVD). Methods: Subjects were 812 partici- pants (58% women) of the Maine-Syracuse study who were free of dementia and stroke. Employing a cross-sectional design and multiple regression analyses, fasting concentrations of tHcy and its vitamin cofactors (folate, B6, and B12) were related to multiple domains of cognitive performance. Results: With adjustment for age, education, gender, ethnicity, and the vitamins, tHcy was inversely associated with visual-spatial organization, working memory, scanning-tracking, and abstract reasoning. The same results were found with adjustment for age, education, gender, ethnicity, CVD-RF, and CVD. Vitamin cofactors were positively related to cognitive performance, but with adjustment for CVD-RF and CVD, only vitamin B6 was related to multiple cognitive domains. Conclusions: The inverse association of tHcy with multiple domains of cognitive functioning is not necessarily dependent on vitamin levels, vitamin deficiency, prevalent CVD risk factors, and manifest CVD. Serum folate, serum B12, and plasma B6 vitamin concentrations are positively associated with cognitive performance. Investigation of other possible mechanisms (e.g., tHcy neurotoxicity) mediating tHcy associations with cognitive performance is important, as are clinical trials examining the efficacy of folate, vitamin B6, and vitamin B12 for maintenance of cognitive functioning

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

Advances in diagnosis and the treatment for upper gastro-intestinal (UGI) cancers have led to improved survival rates and, consequently, to a larger population of survivors of many types of UGI cancer [1,2]. Progress in survivorship care for UGI cancer remains poor, and many survivors experience ongoing negative physical and psychosocial impacts of treatment, which can have profound and long-term impacts on physical function and quality of life (QOL) [3,4]. At one year post-op, 40% of survivors report poor physical function, and significant reductions in walking distance, cardiorespiratory fitness and muscle strength are observed, along with a high prevalence of fatigue (41%), sarcopenia (35%) and dyspnoea (20%) [5–7]. Nutritional compromise in UGI cancer survivors is frequently reported, with eating restrictions are observed in 49% at 1 year post-surgery and malabsorption in 73% at two years post-op [6,8]. This can lead to significant reductions in fat-free body mass and skeletal muscle [8]. From a psychosocial perspective, anxiety (36%), fear of recurrence (29%) and high rates of sleep difficulties (51%) are reported. An integrated, multi-disciplinary specialist rehabilitation approach focusing on patient-centred outcomes is indicated to address the substantial, complex, multi-dimensional rehabilitation needs of UGI cancer survivors and to enable them to achieve the best possible quality of life and to reintegrate into family, social and working life [9–12]

Systematic reviews of animal studies – Report of an international symposium

Objective: The Symposium on Animal Systematic Reviews held 24 May 2022, sought to bring organisations working on animal literature searching and systematic reviews together into the same virtual space for introductions and discussion.Background: Groups working on animal research synthesis are often siloed into preclinical, veterinary, and One Health settings. This symposium sought to define commonalities and differences in methodologies, resources, and philosophies and to discuss future needs.Methods: The 3-hour virtual symposium for veterinarians, researchers, and information specialists began with introductions by panelists from organisations involved in searching the literature for animal studies and conducting systematic reviews. This was followed by a panel discussion and question and answer period.Results: Panelists identified a need to ensure planning and accurate description of primary animal studies as a precursor to quality systematic reviews. They acknowledged and discussed differences in evidence synthesis expectations and tools based on the type of review, the types of studies available on the topic, and the focus on preclinical, veterinary, or One Health topics.Conclusion: The need to increase the speed and quality of evidence reviews, and to automate updates, requires investing in the development of both skilled teams and platforms. The symposium provided a chance to identify existing resources, define challenges, and note gaps unique to systematic reviews of animal studies.Application: This symposium acts as a baseline for ongoing discussions centred on improving the culture and pipeline for evidence syntheses of animal studies that inform decision-making