Immunogenicity and Reactogenicity of Messenger RNA Coronavirus Disease 2019 Vaccine Booster Administered by Intradermal or Intramuscular Route in Thai Older Adults.

BACKGROUND: Intradermal (ID) vaccination may alleviate COVID-19 vaccine shortages and vaccine hesitancy. METHODS: Persons aged ≥65 years who were vaccinated with 2-dose ChAdOx1 12-24 weeks earlier were randomized to receive a booster vaccination by either ID (20 µg mRNA-1273 or 10 µg BNT162b2) or intramuscular (IM) (100 µg mRNA-1273 or 30 µg BNT162b2) route. Anti-receptor-binding domain (RBD) immunoglobulin G (IgG), neutralizing antibody (NAb), and interferon gamma (IFN-γ)-producing cells were measured at 2-4 weeks following vaccination. RESULTS: Of 210 participants enrolled, 70.5% were female and median age was 77.5 (interquartile range, 71-84) years. Following booster dose, both ID vaccinations induced 37% lower levels of anti-RBD IgG compared with IM vaccination of the same vaccine. NAb titers against ancestral and Omicron BA.1 were highest following IM mRNA-1273 (geometric mean, 1718 and 617), followed by ID mRNA-1273 (1212 and 318), IM BNT162b2 (713 and 230), and ID BNT162b2 (587 and 148), respectively. Spike-specific IFN-γ responses were similar or higher in the ID groups compared with IM groups. ID route tended to have fewer systemic adverse events (AEs), although more local AEs were reported in the ID mRNA-1273 group. CONCLUSIONS: Fractional ID vaccination induced lower humoral but comparable cellular immunity compared to IM and may be an alternative for older people. CLINICAL TRIALS REGISTRATION: TCTR20220112002.

The benefits of a novel chicken-based oral nutritional supplement for older adults: A double-blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: A considerable proportion of older adults are lactose intolerant. The aim of this study was to investigate the clinical safety, efficacy, and tolerability of a chicken-based oral nutritional supplement (ONS). METHODS AND STUDY DESIGN: Double-blind randomized controlled trial. Subjects in the intervention group received chicken-based ONS, and those in the control group received a similarly flavored oral fluid placebo. All subjects were followed-up every two months for a total of 6 months. RESULTS: Thirty-eight older adults aged ≥70 years were recruited. The mean age and BMI were 81.5±5.6 years and 19.6±2.5 kg/m2. At the end of this trial, there was no statistically significant change in sarcopenia-related variables in the intervention group. However, the higher-level physical activity (PA) group within the intervention group had a significantly improved usual gait speed (UGS) compared to the lower-level PA group (p=0.04). The adjusted mean differences in UGS between the high and low level PA groups in the intervention and placebo groups were 0.149 m/sec and 0.083 m/sec, respectively. Significant difference was observed for changes in two bone markers between the intervention and placebo groups. CONCLUSIONS: The chicken-based ONS evaluated in this study was well-tolerated. No improvement of sarcopenia-related components was shown by the study ONS. Up to nearly an 80% increase in adjusted mean difference in UGS between the high and low level PA groups was observed in the nutritional intervention group compared to the zero-protein calorie placebo group. Significant improvement in age-related bone resorption was the earliest advantage of taking our ONS.

Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic.

BACKGROUND: Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. METHODS: A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. RESULTS: The main diagnoses of dementia were Alzheimer's disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson's disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. CONCLUSIONS: Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.

Cut-off points of quadriceps strength, declines and relationships of sarcopenia-related variables among Thai community-dwelling older adults.

AIM: To define quadriceps strength cut-off points for both sexes to be used in the working diagnosis of sarcopenia in older Asian people, and to investigate the age-related declines of sarcopenia-related variables and correlations between those variables among community-dwelling older adults. METHODS: The present 3-year prospective study was a part of the Bangkok Longitudinal Study by Siriraj Hospital for Older Men and Women. Data on 2149 participants aged ≥ 60 years were included in this analysis. RESULTS: The quadriceps strength cut-off points, identified based on mobility decline over 2 years of follow up, were 18.0 kg for men and 16.0 kg for women. When these cut-off points were applied to the whole population aged ≥ 60 years (n = 950), the low quadriceps strength group had poorer results on all clinical variables when compared with the normal quadriceps strength group. Although nearly all of the sarcopenia-related variables declined over 2 years of follow up in both older men and women, more significant differences between age groups were seen in older women. Quadriceps strength had the highest degree of correlation with total lean body mass in all age groups (r = 0.550-0.584, P < 0.001), followed by the 6-min walk test in all age groups (r = 0.449-0.516, P < 0.001). CONCLUSIONS: The quadriceps strength cut-off points of 18.0 kg for older men and 16.0 kg for older women would be useful as a muscle strength measurement for use in any diagnostic algorithm; for example, sarcopenia diagnosis in older Asian people.

Health expectancies in the older Thai population.

This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005-2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.

Caregiver burden and needs of dementia caregivers in Thailand: a cross-sectional study.

OBJECTIVE: To identify the burdens of Thai dementia caregivers and to determine the services that could support them in this function. MATERIAL AND METHOD: The authors surveyed 88 dementia caregivers attending "Caregiver Day". The questionnaire contained Caregiver Burden Inventory. The answers range from "not at all descriptive" (zero) to "very descriptive" (4). The authors also explored baseline characteristics of caregivers and care recipients as well as caregiver's needs of a supporting system. RESULTS: There was an 82% response rate. Responses in time-dependence burden distributed almost equally in the five possible scales. In developmental and physical burden, caregivers rate scores mainly from 0-2. The scores in social and emotional burden ranged mainly between 0-1. Dependency in basic activities of daily living correlated with higher caregiver burden (odd ratio 7.48, 95% confidence interval 1.42-39.53, p = 0.02), while sex and kinship did not. The top three caregiver's needs were 1) caregiver education and training, 2) telephone line provided for caregiver consultation and 3) special system in a hospital provided for dementia patients to have rapid access to see a doctor. CONCLUSION: Caring for dementia patients can lead to high caregiver burden, particularly those caring for dependent patients. Physical and developmental burdens are affected more than social and emotional burdens. Culture, relationship quality and resources (coping, outlook on life and social support) might be contributing factors of this difference.

Digit span and verbal fluency tests in patients with mild cognitive impairment and normal subjects in Thai-community.

BACKGROUND: Far too little attention has been paid to the difference of Digit Span test and category verbal fluency test (CVFT) between normal and mild cognitive impairment (MCI) subjects. OBJECTIVE: To investigate the difference of Digit Span test and CVFT between normal subjects and patients with MCI and study the influence of age, gender, and education on the task performance. MATERIAL AND METHOD: The authors collected data of 77 participants diagnosed with amnestic MCI (from 517 participants screened) and 30 normal subjects aged 50 or over enrolled from communities in Bangkok. The Digit Span test and CVFT (semantic fluency and Controlled word association test for letter fluency) were used to evaluate the subjects. RESULTS: MCI patients had significantly lower digit span score, in both Digits Forward and Digits Backward, poorer performance on semantic fluency for animals and fruits and letter fluency test. The logistic regression model of MCI diagnosis showed that only Digits Backward score was a predictor of MCI diagnosis (OR 0.643 for each increment of 1 digit, p = 0.009, 95% confidence interval 0.462-0.896). The cut-off point of Digit Backward score was 4 and yielded sensitivity of 77% and specificity of 57%. Females had lower scores than males in every test except semantic fluency for fruits. The digit span and semantic fluency scores decreased as age increased but letter fluency increased correspondently with age. The digit span and CVFT scores increased in parallel with the increase of education. CONCLUSION: MCI patients had poorer performance on the Digit Span and CVFT tests than normal age and education matched subjects. Digits Backward test can predict the MCI diagnosis. Age, gender and education have an impact on the performance of the tests.

Quality of life of the community-based patients with mild cognitive impairment.

AIM: To determine quality of life (QOL) in patients with mild cognitive impairment (MCI) compared to normal subjects and to investigate the impact of demographic factors on QOL. METHODS: There were 122 participants aged 50 and over, diagnosed with MCI (n = 85) or normal (n = 37) recruited from a community-based setting in Bangkok. The Thai version of the World Health Organization Quality of Life (WHOQOL-BREF-THAI) was used to assess the QOL in the subjects. RESULTS: The MCI patients had significantly lower psychological QOL compared to normal subjects. The MCI patients with low education had poorer total QOL scores, and patients with poor financial status had poorer psychological QOL scores and total QOL scores. The MCI patients who lived alone had poorer social relationship QOL. There were correlations between the Thai version of Geriatric Depression Scale (TGDS) and physical QOL, TGDS and psychological QOL, and TGDS and total QOL scores. The depression subscale of the Neuropsychiatric Inventory had negative correlation with physical and psychological QOL. CONCLUSION: The MCI patients had poorer psychological QOL than normal subjects. Low education, poor financial status, living alone and depressive symptoms had an influence on the quality of life.