Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Background: Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. Methods: We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Data analysis: Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Discussion: Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Effects of Memantine and High Dose Vitamin D on Gait in Male APP/PS1 Alzheimer's Disease Mice Following Vitamin D Deprivation.

BACKGROUND: Altered gait is a frequent feature of Alzheimer's disease (AD), as is vitamin D deficiency. Treatment with memantine and vitamin D can protect cortical axons from exposure to amyloid-ß and glutamate toxicity, suggesting this combination may mitigate altered gait in AD. OBJECTIVE: Investigate the effects of vitamin D deprivation and subsequent treatment with memantine and vitamin D enrichment on gait performance in APPswe/PS1dE9 mice. METHODS: Male APPswe/PS1dE9 mice were split into four groups (n = 14 each) at 2.5 months of age. A control group was fed a standard diet throughout while the other three groups started a vitamin D-deficient diet at month 6. One group remained on this deficient diet for the rest of the study. At month 9, the other two groups began treatment with either memantine alone or memantine combined with 10 IU/g of vitamin D. Gait was assessed using CatWalk at months 6, 9, 12, and 15. RESULTS: Vitamin D deprivation led to a 13% increase in hind stride width by month 15 (p < 0.001). Examination of the treatment groups at month 15 revealed that mice treated with memantine alone still showed an increase in hind stride width compared to controls (p < 0.01), while mice treated with memantine and vitamin D did not (p = 0.21). CONCLUSION: Vitamin D deprivation led to impaired postural control in the APPswe/PS1dE9 model. Treatment with memantine and vitamin D, but not memantine alone, prevented this impairment. Future work should explore the potential for treatments incorporating vitamin D supplementation to improve gait in people with AD.

Vitamin D Supplementation and Cognition in Adults: A Systematic Review of Randomized Controlled Trials.

BACKGROUND: The role of vitamin D supplementation in improving cognition and slowing the incidence of minor and major neurocognitive disorders is a matter of debate. To our knowledge, no systematic review of randomized controlled trials (RCTs) has examined this question in adults. OBJECTIVES: The purpose of this systematic review is to synthesize the evidence regarding the effects of vitamin D supplementation on cognitive performance and neurocognitive disorders in adults. METHODS: A systematic search of scientific articles in English or French was conducted. The MEDLINE (PubMed), EMBASE (Ovid, EMBASE), PsychINFO, and Cochrane Central databases were searched for records without any limit on publication date in May 2021. Inclusion criteria were (1) human participants, (2) RCT, (3) participant age ≥ 18, (4) vitamin D supplementation as the intervention, and (5) cognition (i.e., cognitive performance or cognitive status such as cognitively healthy or minor and major neurocognitive disorder) as the primary outcome. Two independent reviewers both assessed all eligible studies' full texts and the risk of bias arising from methodological issues using a standardized procedure. RESULTS: Of the 2137 abstracts identified, 61 (2.9%) met screening inclusion criteria. After full text examination, 41 records (67.2%) were excluded. As a result, 20 RCTs (32.8%) were included in the systematic review. The review yielded mixed findings and, thus, failed to find evidence supporting cognitive benefits from vitamin D supplementation or suggesting a causal association between vitamin D and cognitive function. Half of the RCTs reported mixed results, one quarter negative results, and the last quarter positive effects for vitamin D supplementation on cognitive performance. The variability in serum 25-dihydroxyvitamin D concentration thresholds, the cognitive tests employed, the supplementation doses, and the samples' characteristics (i.e., ethnicity or number of participants) may explain these mixed findings. CONCLUSION: This systematic review of RCTs does not support a role for vitamin D supplementation in enhancing cognition in adults.

Effect of Memantine Treatment and Combination with Vitamin D Supplementation on Body Composition in the APP/PS1 Mouse Model of Alzheimer's Disease Following Chronic Vitamin D Deficiency.

BACKGROUND: Vitamin D deficiency and altered body composition are common in Alzheimer's disease (AD). Memantine with vitamin D supplementation can protect cortical axons against amyloid-ß exposure and glutamate toxicity. OBJECTIVE: To study the effects of vitamin D deprivation and subsequent treatment with memantine and vitamin D enrichment on whole-body composition using a mouse model of AD. METHODS: Male APPswe/PS1dE9 mice were divided into four groups at 2.5 months of age: the control group (n = 14) was fed a standard diet throughout; the remaining mice were started on a vitamin D-deficient diet at month 6. The vitamin D-deficient group (n = 14) remained on the vitamin D-deficient diet for the rest of the study. Of the remaining two groups, one had memantine (n = 14), while the other had both memantine and 10 IU/g vitamin D (n = 14), added to their diet at month 9. Serum 25(OH)D levels measured at months 6, 9, 12, and 15 confirmed vitamin D levels were lower in mice on vitamin D-deficient diets and higher in the vitamin D-supplemented mice. Micro-computed tomography was performed at month 15 to determine whole-body composition. RESULTS: In mice deprived of vitamin D, memantine increased bone mineral content (8.7% increase, p < 0.01) and absolute skeletal tissue mass (9.3% increase, p < 0.05) and volume (9.2% increase, p < 0.05) relative to controls. This was not observed when memantine treatment was combined with vitamin D enrichment. CONCLUSION: Combination treatment of vitamin D and memantine had no negative effects on body composition. Future studies should clarify whether vitamin D status impacts the effects of memantine treatment on bone physiology in people with AD.

Serum Vitamin D and Cingulate Cortex Thickness in Older Adults: Quantitative MRI of the Brain.

BACKGROUND: Vitamin D insufficiency is associated with brain changes, and cognitive and mobility declines in older adults. OBJECTIVE: Our objective was to investigate in older adults whether vitamin D insufficiency<50nmol/L was associated with thinner cingulate cortex, a brain area related to cognitive functions influenced by vitamin D. METHODS: Two hundred and fifteen Caucasian older community-dwellers (mean±SD, 72.1±5.5years; 40% female) received a blood test and brain MRI. The thickness of perigenual anterior cingulate cortex, midcingulate cortex and posterior cingulate cortex was measured using FreeSurfer from T1-weighted MR images. Age, gender, education, BMI, mean arterial pressure, comorbidities, use of vitamin D supplements or anti-vascular drugs, MMSE, GDS, IADL, serum calcium and vitamin B9 concentrations, creatinine clearance were used as covariables. RESULTS: Participants with vitamin D insufficiency (n=80) had thinner total cingulate thickness than the others (24.6±1.9mm versus 25.3±1.4mm, P=0.001); a significant difference found for all 3 regions. Vitamin D insufficiency was cross-sectionally associated with a decreased total cingulate thickness (ß=- 0.49, P=0.028). Serum 25OHD concentration correlated positively with the thickness of perigenual anterior (P=0.011), midcingulate (P=0.013) and posterior cingulate cortex (P=0.021). CONCLUSION: Vitamin D insufficiency was associated with thinner cingulate cortex in the studied sample of older adults. These findings provide insight into the pathophysiology of cognitive and mobility declines in older adults with vitamin D insufficiency.

Effects of Vitamin D and Calcium Fortified Yogurts on Gait, Cognitive Performances, and Serum 25-Hydroxyvitamin D Concentrations in Older Community-Dwelling Females: Results from the GAit, MEmory, Dietary and Vitamin D (GAME-D2) Randomized Controlled Trial.

BACKGROUND: Vitamin D3 fortified food may improve serum vitamin D level, suggesting that the prevention of adverse consequences of hypovitaminosis D is possible with food fortification. The aim of this randomized controlled trial (RCT) was to examine the effects of vitamin D and calcium fortified yogurt on spatiotemporal gait parameters, cognitive performance, handgrip strength, and serum 25OHD levels in healthy older females. METHODS: Forty older community-dwelling females were recruited in a single-blind, randomized, controlled, superiority clinical trial in two parallel groups (20 participants in the intervention group and 20 in the control group) with intent-to-treat. The intervention group took fortified yogurts daily (i.e., 400 UI of vitamin D3 and 800 mg calcium) for 3 months. The non-fortified yogurts contained similar proteins, carbohydrates and lipids, as well as a lower dose of calcium (300 mg) and no vitamin D3 supplementation. Spatiotemporal gait parameters (mean value and coefficient of variation) were assessed using a computerized walkway. Handgrip strength was measured with hydraulic dynamometers. Cognitive performances, including global cognitive functioning assessed with the Mini Mental Status Examination (MMSE) were recorded. All the outcomes were assessed at baseline and at the end of follow-up. The primary outcome was the coefficient of variation of stride time. RESULTS: The intervention group maintained its global cognitive performance and serum 25OHD concentrations, whereas these outcomes decreased (i.e., worst performance) in the control group. The changes in the MMSE score (p = 0.022) and serum 25OHD concentrations were different (p ≤ 0.001) with better values reported in the intervention group compared to the control group. There was no significant change in gait parameters (p ≥ 0.518) and handgrip strength (p ≥ 0.600). CONCLUSIONS: Fortified yogurts with vitamin D (i.e., 200 IU) and calcium (i.e., 400 mg) twice a day maintained global cognitive performance and vitamin D status in older females, but not gait performances, signifying that they mainly prevent hypovitaminosis D-related extra-skeletal disorders.

Decreased risk of falls in patients attending music sessions on an acute geriatric ward: results from a retrospective cohort study.

BACKGROUND: Music has been shown to improve health and quality of life. It was suggested that music may also have an impact on gait stability and fall risk. Yet, few studies have exploited music in the hospital setting, and even less so in the geriatric population. Our objective was to examine the influence of music listening on the risk of falls by comparing the Morse Fall Scale score in patients admitted to a Geriatric Assessment Unit (GAU) who attended music listening sessions and in patients who did not attend music sessions. METHODS: This was a retrospective cohort study (mean follow-up 13.3 ± 6.8 days) which took place in a GAU, St. Mary's Hospital Center, Montreal. A total of 152 charts of participants, with a mean age of 85.7 ± 6.4 years and 88.2% female were reviewed and included. There were 61 participants exposed to the music listening sessions group and 91 in the non-exposed group matched for age, sex, cause and season of admission, and living situation. One-hour music sessions were provided to the patients by volunteer musicians. The Morse Fall Scale score upon admission and discharge as well as its variation (change from before to after exposure) were used as outcomes. Age, sex, living situation, reason for admission, season of admission, Mini Mental Status Examination score, number of therapeutic classes taken daily upon admission, use of psychoactive drugs upon admission and length of stay were used as covariates. RESULTS: The Morse Fall Scale score decreased significantly in the exposed group compared to the non-exposed group (p = 0.025) and represented a small to medium-sized effect, d = 0.395. The multiple linear regression model showed a significant association between the decrease of the Morse Fall Scale score and music exposure (B = - 17.1, p = 0.043). CONCLUSION: Participating in music listening sessions was associated with a decreased risk of falls in patients admitted to a GAU. Further controlled research is necessary to confirm these findings and to determine the mechanisms by which music listening impacts fall risk. TRIAL REGISTRATION: Clinical trial registry: ClinicalTrials.gov . Registration number: NCT03348657 (November 17th, 2017). Retrospectively registered.

Medical cannabis use in older patients: Update on medical knowledge.

BACKGROUND: There is increasing scientific data suggesting that cannabis is beneficial for a large range of medical conditions. Physicians need up-to-date medical knowledge (i.e., indications, dose and safety properties) before prescribing cannabis for older patients, who are, a priori, more prone to its adverse effects than younger patients. A mini-review was conducted to examine the evidence on medical cannabis use in older patients. METHODS: An English and French systematic Medline (PubMed) search, from January 1, 2001 to October 15, 2018, was conducted using the MeSH terms "Cannabis"[Mesh] OR "Marijuana Abuse"[Mesh] OR "Medical Marijuana"[Mesh] OR "Marijuana Smoking"[Mesh] combined with the MeSH terms ("Aged"[Mesh]) OR "Aged, 80 and over"[Mesh]. A total of 451 abstracts were identified and full relevant articles were retrieved and analysed. RESULTS: Even with a growing body of data showing positive effects of medical cannabis use, mixed results have been reported. Most clinical studies have had small samples and there are few randomized controlled trials. This lack of evidence on the positive clinical effects of medical cannabis use is especially marked for older patients, few of whom have been examined. CONCLUSIONS: There is a lack of consistent data on the clinical effects of medical cannabis use in older patients to guide cannabis prescription for this group of patients.

Body position and motor imagery strategy effects on imagining gait in healthy adults: Results from a cross-sectional study.

BACKGROUND: Assessment of changes in higher levels of gait control with aging is important to better understand age-related gait instability, with the perspective to improve the screening of individuals at risk for falls. The comparison between actual Timed Up and Go test (aTUG) and its imagined version (iTUG) is a simple clinical way to assess age-related changes in gait control. The modulations of iTUG performances by body positions and motor imagery (MI) strategies with normal aging have not been evaluated yet. This study aims 1) to compare the aTUG time with the iTUG time under different body positions (i.e., sitting, standing or supine) in healthy young and middle age, and older adults, and 2) to examine the associations of body positions and MI strategies (i.e., egocentric versus allocentric) with the time needed to complete the iTUG and the delta TUG time (i.e., relative difference between aTUG and iTUG) while taking into consideration clinical characteristics of participants. METHODS: A total of 60 healthy individuals (30 young and middle age participants 26.6±7.4 years, and 30 old participants 75.0±4.4 years) were recruited in this cross-sectional study. The iTUG was performed while sitting, standing and in supine position. Times of the aTUG, the iTUG under the three body positions, the TUG delta time and the strategies of MI (i.e., ego representation, defined as representation of the location of objects in space relative to the body axes of the self, versus allocentric representation defined as encoding information about body movement with respect to other object, the location of body being defined relative to the location of other objects) were used as outcomes. Age, sex, height, weight, number of drugs taken daily, level of physical activity and prevalence of closed eyes while performing iTUG were recorded. RESULTS: The aTUG time is significantly greater than iTUG while sitting and standing (P<0.001), except when older participants are standing. A significant difference is reported between iTUG while sitting or standing and iTUG while supine (P≤0.002), higher time being reported in supine position. The multiple linear regressions confirm that the supine position is associated with significant increased iTUG (P≤0.04) and decreased TUG delta time (P≤0.010), regardless of the adjustment. Older participants use the allocentric MI while imagining TUG more frequently than young and middle age participants, regardless of body positions (P≤0.001). Allocentric MI strategy is associated with a significant decrease in iTUG (P = 0.037) only while adjusting for age. A significant increase of iTUG time is associated with age (P≤0.026). CONCLUSIONS: Supine position while imagining TUG represents a more accurate position of actual performance of TUG. Age has a limited effect on iTUG performance but is associated with a change in MI from ego to allocentric representation that decreases the iTUG performances, and thus increases the discrepancy with aTUG.

Vitamin D and Subjective Memory Complaint in Community-Dwelling Older Adults.

BACKGROUND: Older adults with hypovitaminosis D report more often subjective cognitive complaints, especially with regards to memory. This raises prospects that vitamin D may improve older adults' subjective experience of memory disorders. OBJECTIVE: To determine among older community-dwellers whether higher serum 25- hydroxyvitamin D (25OHD) concentrations were associated with fewer memory complaints, while considering different subtypes of memory complaints. METHOD: One hundred eighty Caucasian community-dwellers with memory complaint and no dementia (mean±standard deviation, 71.1±3.4years; 33.3%female) from the French 'EVATEM study' were included in this analysis. Subjective memory complaints regarding memory lapses, problems learning new information, problems finding words, problems calculating and problems concentrating were assessed using a standardized questionnaire. Participants were categorized according to the highest tertile of serum 25OHD (i.e., ≥68nmol/L). Age, gender, body mass index, morbidities burden, use of vitamin D supplements, cognitive performance, mood, serum concentrations of calcium, parathyroid hormone and vitamin B12, creatinine clearance, and season of evaluation were used as potential confounders. RESULTS: Compared to participants with 25OHD<68nmol/L (n=121), those with 25OHD≥68nmol/L had less often problems learning new information (P=0.027). There were no between-group differences for the other memory complaints. The highest 25OHD tertile was cross-sectionally associated with fewer problems learning new information (odds ratio (OR)=0.48, P=0.029), even after adjustment for potential confounders (OR=0.32, P=0.039). CONCLUSION: Higher vitamin D status was associated with reduced problems memorizing new information in older community-dwellers. This novel finding provides a scientific base for vitamin D replacement trials attempting to improve older patients' subjective experience of cognitive decline.

Geriatric Assessment Can Predict Outcomes of Endoscopic Surgery for Benign Prostatic Hyperplasia in Elderly Patients.

Ojectives: Surgical management of benign prostatic hyperplasia (BPH) in elderly patients is associated with higher morbidity and mortality rate. This raises the question of benefice and risk balance. We conducted a prospective observational study to evaluate the results of endoscopic surgery for BPH in elderly patients, according to geriatric assessment. PATIENTS AND METHODS: We included prospectively 60 patients older than 75 years, with an indwelling catheter for acute or chronic retention, who were candidates to endoscopic surgery for BPH. Patients underwent the brief geriatric assessment (BGA) and the comprehensive geriatric assessment (CGA) to classify them into three groups: "vigorous," "vulnerable," and "sick." Success was defined by the bladder catheter withdrawal after surgery. RESULTS: After geriatric assessment, 33 patients were classified in the "vigorous" group (55%), 25 in the "vulnerable" group (42%), and 2 in the "sick" group (3%). The success rate immediately after surgery was 85% and 41% in the "vigorous patient" group and the "vulnerable and sick" patient group, respectively (p < 0.05). The success rate at 3 months after surgery was 94% and 55% (p < 0.05). The morbidity was higher for the "vulnerable and sick" group (44%) compared with the "vigorous" group (15%) (p < 0.05). The BGA also allowed predicting a higher risk of failure in patients with a score ≥3 immediately after surgery (odds ratio 5.9, confidence interval [95% CI] 1.61, 29.9) and 3 months after surgery (odds ratio 6.9, 95% CI 1.31, 70.8). CONCLUSION: Geriatric assessment can predict the outcome of endoscopic surgery for BPH for patients in retention older than 75 years. "Vulnerable and sick" patients had a higher risk to keep their indwelling catheter after the surgery compared with "vigorous" patients. The complication rate is also higher. The BGA can although predict a poor result of surgery when its score is equal or above 3/6.

Brain Activity during Mental Imagery of Gait Versus Gait-Like Plantar Stimulation: A Novel Combined Functional MRI Paradigm to Better Understand Cerebral Gait Control.

Human locomotion is a complex sensorimotor behavior whose central control remains difficult to explore using neuroimaging method due to technical constraints, notably the impossibility to walk with a scanner on the head and/or to walk for real inside current scanners. The aim of this functional Magnetic Resonance Imaging (fMRI) study was to analyze interactions between two paradigms to investigate the brain gait control network: (1) mental imagery of gait, and (2) passive mechanical stimulation of the plantar surface of the foot with the Korvit boots. The Korvit stimulator was used through two different modes, namely an organized ("gait like") sequence and a destructured (chaotic) pattern. Eighteen right-handed young healthy volunteers were recruited (mean age, 27 ± 4.7 years). Mental imagery activated a broad neuronal network including the supplementary motor area-proper (SMA-proper), pre-SMA, the dorsal premotor cortex, ventrolateral prefrontal cortex, anterior insula, and precuneus/superior parietal areas. The mechanical plantar stimulation activated the primary sensorimotor cortex and secondary somatosensory cortex bilaterally. The paradigms generated statistically common areas of activity, notably bilateral SMA-proper and right pre-SMA, highlighting the potential key role of SMA in gait control. There was no difference between the organized and chaotic Korvit sequences, highlighting the difficulty of developing a walking-specific plantar stimulation paradigm. In conclusion, this combined-fMRI paradigm combining mental imagery and gait-like plantar stimulation provides complementary information regarding gait-related brain activity and appears useful for the assessment of high-level gait control.

Vitamin D and cognition in older adults: international consensus guidelines.

Hypovitaminosis D, a common condition in older adults, is associated with brain changes and dementia. Given the fast growing contribution of literature in this research field, clear guidance is needed for clinicians and researchers. International experts met at the invitational summit on "Vitamin D and cognition in older adults" in Boston, MA, July 2013. Based upon literature and expert opinion, the task force focused on key questions on the role of vitamin D in Alzheimer disease and related disorders. Each question was discussed and voted using a Delphi-like approach. Experts reached agreement that hypovitaminosis D increases the risk of cognitive decline and dementia in older adults, may alter the clinical presentation as a consequence of related comorbidities, but should not be used thus far as a diagnostic or prognostic biomarker of Alzheimer disease due to lack of specificity and insufficient evidence. Hypovitaminosis D should be screened in this population because of its high prevalence and supplemented, if necessary, but this advice was not specific to cognition. The task force agreed on 5 overarching principles related to vitamin D and cognition in older adults.

Anti-Dementia Drugs, Gait Performance and Mental Imagery of Gait: A Non-Randomized Open-Label Trial.

BACKGROUND: Few studies have examined the effect of anti-dementia drugs (i.e., acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists) on gait performance. Past studies have focused on the stride time (i.e., gait cycle duration) but not on the mental imagery of gait. OBJECTIVES: To compare mental imagery of gait and spatiotemporal gait parameters in patients with dementia [i.e., Alzheimer's disease (AD) and non-AD] before and after the use of anti-dementia drugs (i.e., acetylcholinesterase inhibitors and memantine) and in controls (i.e., patients with dementia who did not take anti-dementia drugs). METHODS: A total of 112 patients (mean age 82.5 ± 4.2 years, 68.8 % female) with mild-to-moderate AD and non-AD dementia were included in this non-randomized open-label trial (n = 56 in the Intervention group, and n = 56 in the Control group matched for age, sex, and stage and type of dementia) nested in a cohort study (mean follow-up 238.5 ± 79.8 days). Mental imagery of gait was assessed with the actual and imagined Timed Up and Go tests (aTUG and iTUG) and the difference between aTUG and iTUG (i.e., delta-TUG). Spatiotemporal gait parameters were measured with the GAITRite(®) system during normal walking. RESULTS: Participants in the Intervention group had a longer iTUG time (p < 0.001) and a lower delta-TUG value (p = 0.001) at the follow-up compared with those in the Control group. There was a significant increase in iTUG (p = 0.001) and decrease in delta-TUG (p < 0.001) from baseline to the follow-up only in the Intervention group. Multiple linear regression showed that the use of anti-dementia drugs was associated with a longer iTUG time and a lower delta-TUG value (best performance, p < 0.002). CONCLUSIONS: Our findings showed an improvement in mental imagery of gait with the use of anti-dementia drugs, but no changes in actual gait performance. TRIAL REGISTRATION: NCT01315704.

Brain volume changes in gait control in patients with mild cognitive impairment compared to cognitively healthy individuals; GAIT study results.

BACKGROUND: Differences in brain structures involved in gait control between normal and pathological aging are still matter of debate. This study aims to compare the regional and global brain volume patterns associated with gait performances assessed with Timed Up and Go test (TUG) between cognitively healthy individuals (CHI) and patients with mild cognitive impairment (MCI). MATERIAL AND METHODS: A total of 171 (80 CHI, 25 with amnestic MCI [a-MCI] and 66 with non-amnestic MCI [na-MCI]) participants (70.2±4.0years; 37% female) consecutively realized (rTUG) and imagined (iTUG) the TUG. rTUG measures the time needed to rise from a chair, walk 3m, turn around and return to a seated position and iTUG represents the validated imagined version of the TUG. Global and regional brain volumes were quantified from three-dimensional T1-weighted MRI using a semi-automated software. RESULTS: Linear regression models show that increased rTUG (i.e. worse performance) was associated with lower total white matter, total gray matter, left and right hippocampal volume in patients with na-MCI (P<0.045), and with lower right hippocampal volume in CHI (P=0.013). Increased iTUG was associated with lower gray matter and left premotor cortex volumes in patients with na-MCI (P<0.05). CONCLUSIONS: The findings showed different patterns of brain volume reduction associated with increased rTUG and iTUG between CHI and MCI patients, except for the right hippocampal volume which was smaller in both groups.

Derivation and validation of a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D.

OBJECTIVES: Hypovitaminosis D is highly prevalent among seniors. Although evidence is insufficient to recommend routine vitamin D screening in seniors, universal vitamin D supplementation is not desirable either. To rationalize vitamin D determination, our objective was to elaborate and test a clinical diagnostic tool for the identification of seniors with hypovitaminosis D without using a blood test. DESIGN: Derivation of a clinical diagnostic tool using artificial neural networks (multilayer perceptron; MLP) in randomized training subgroup of Prévention des Chutes, Réseau 4' cohort, and validation in randomized testing subgroup. SETTING: Health Examination Centers of health insurance, Lyon, France. PARTICIPANTS: A total of 1924 community-dwellers aged ≥ 65 years without vitamin D supplements, consecutively recruited between 2009 and 2012. MEASUREMENTS: Hypovitaminosis D defined as serum 25-hydroxyvitamin (25OHD) concentration ≤ 75 nmol/L, ≤ 50 nmol/L, or ≤ 25 nmol/L. A set of clinical variables (age, gender, living alone, individual deprivation, body mass index, undernutrition, polymorbidity, number of drugs used daily, psychoactive drugs, biphosphonates, strontium, calcium supplements, falls, fear of falling, vertebral fractures, Timed Up and Go, walking aids, lower-limb proprioception, handgrip strength, visual acuity, wearing glasses, cognitive disorders, sad mood) were recorded. Several MLPs, based on varying amounts of variables according to their relative importance, were tested consecutively. RESULTS: A total of 1729 participants (89.9%) had 25OHD ≤ 75 nmol/L, 1288 (66.9%) had 25OHD ≤ 50 nmol/L, and 525 (27.2%) had 25OHD ≤ 25 nmol/L. MLP using 16 clinical variables was able to diagnose hypovitaminosis D ≤ 75 nmol/L with accuracy = 96.3%, area under curve (AUC) = 0.938, and κ = 79.3 indicating almost perfect agreement. It was also able to diagnose hypovitaminosis D ≤ 50 nmol/L with accuracy = 81.5, AUC = 0.867, and κ = 57.8 (moderate agreement); and hypovitaminosis D ≤ 25 nmol/L with accuracy = 82.5, AUC = 0.385, and κ = 55.0 (moderate agreement). CONCLUSIONS: We elaborated an algorithm able to identify, from 16 clinical variables, seniors with hypovitaminosis D.

Biology of subjective cognitive complaint amongst geriatric patients: vitamin D involvement.

BACKGROUND: Insufficiency in vitamin D, a neurosteroid hormone, is associated with cognitive decline in older adults. The impact on the subjective perception of cognitive decline has not yet been examined. The objective of this cross-sectional hospital-based study was to determine whether vitamin D insufficiency was associated with subjective cognitive complaint amongst geriatric patients. METHODS: Ninety-nine consecutive Caucasian in- and outpatients recruited in the 'Cognition and LIPophilic vitamins' (CLIP) study, who had no advanced cognitive disorders (i.e., Mini-Mental State Examination score≥20) and who took no vitamin D supplements, were categorized into 2 groups based on vitamin D insufficiency (i.e., serum 25-hydroxyvitamin D≥75 nmol/L). Subjective cognitive complaint was examined using the Memory Complaint Questionnaire (MAC-Q; score 0-30, best). MAC-Q score<15 out of 30 defined severe cognitive complaint. Age, gender, body mass index, education level, comorbidity burden, functional autonomy, mood, and serum concentrations of parathyroid hormone, calcium, thyroid-stimulating hormone and vitamin B12, and estimated glomerular filtration rate were used as potential confounders. RESULTS: Compared to participants with serum 25OHD>75 nmol/L, those with vitamin D insufficiency (n=89) had a lower mean MAC-Q score (14.9±2.9 versus 17.1±1.6, P=0.02) and more often a MAC-Q score<15 (52.8% versus 10.0%, P=0.01). Vitamin D insufficiency was inversely associated with the MAC-Q score (adjusted ß=-2.84, P=0.03), and positively associated with severe cognitive complaint (adjusted OR=10.07, P=0.03). CONCLUSION: Vitamin D insufficiency was associated with subjective cognitive complaint in the studied cohort of geriatric patients.

Vitamin D-related changes in intracranial volume in older adults: a quantitative neuroimaging study.

OBJECTIVES: Vitamin D is involved in skeletal and brain health. Recently, serum 25-hydroxyvitamin D (25OHD) concentration was found to be inversely correlated with intracranial volume in younger adults. Since hypovitaminosis D is most common in older adults, our objective was to determine whether this inverse correlation between 25OHD concentration and intracranial volume also occurred in older adults. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: One hundred and ten Caucasian older community-dwellers (mean, 71.7±5.7 years; 45.5% female) received a blood test and an MRI of the brain at the same period. The intracranial volume and the subvolumes of cerebrospinal fluid, total brain, infratentorial brain, supratentorial brain, total white matter, total gray matter, cortical gray matter and subcortical gray matter were measured using FreeSurfer volumetry on T1-weighted images. Vitamin D insufficiency was defined as serum 25OHD<50nmol/L. Age, gender, body mass index, education level, use of vitamin D supplements, season of evaluation, serum concentrations of calcium and thyroid stimulating hormone were used as covariables in the analysis. RESULTS: We found that participants with vitamin D insufficiency (n=41) had greater intracranial volume than those without (1555.0±1379.2cm(3) versus 1488.0±167.4cm(3), P=0.033). Serum 25OHD concentration was cross-sectionally associated with decreased intracranial volume in mm(3) (unadjusted ß=-1194.4, P=0.028), even after adjustment for covariables (adjusted ß=-994.3, P=0.048). We found an inverse correlation of serum 25OHD with intracranial volume (r=-0.21, P=0.028) and the volume of white matter (r=-0.20, P=0.033). The other subvolumes did not correlate with serum 25OHD concentration. CONCLUSIONS: Serum 25OHD concentration was independently and inversely associated with intracranial volume in older adults.

Artificial neural network and falls in community-dwellers: a new approach to identify the risk of recurrent falling?

BACKGROUND: Identification of the risk of recurrent falls is complex in older adults. The aim of this study was to examine the efficiency of 3 artificial neural networks (ANNs: multilayer perceptron [MLP], modified MLP, and neuroevolution of augmenting topologies [NEAT]) for the classification of recurrent fallers and nonrecurrent fallers using a set of clinical characteristics corresponding to risk factors of falls measured among community-dwelling older adults. METHODS: Based on a cross-sectional design, 3289 community-dwelling volunteers aged 65 and older were recruited. Age, gender, body mass index (BMI), number of drugs daily taken, use of psychoactive drugs, diphosphonate, calcium, vitamin D supplements and walking aid, fear of falling, distance vision score, Timed Up and Go (TUG) score, lower-limb proprioception, handgrip strength, depressive symptoms, cognitive disorders, and history of falls were recorded. Participants were separated into 2 groups based on the number of falls that occurred over the past year: 0 or 1 fall and 2 or more falls. In addition, total population was separated into training and testing subgroups for ANN analysis. RESULTS: Among 3289 participants, 18.9% (n = 622) were recurrent fallers. NEAT, using 15 clinical characteristics (ie, use of walking aid, fear of falling, use of calcium, depression, use of vitamin D supplements, female, cognitive disorders, BMI <21 kg/m(2), number of drugs daily taken >4, vision score <8, use of psychoactive drugs, lower-limb proprioception score ≤5, TUG score >9 seconds, handgrip strength score ≤29 (N), and age ≥75 years), showed the best efficiency for identification of recurrent fallers, sensitivity (80.42%), specificity (92.54%), positive predictive value (84.38), negative predictive value (90.34), accuracy (88.39), and Cohen κ (0.74), compared with MLP and modified MLP. CONCLUSIONS: NEAT, using a set of 15 clinical characteristics, was an efficient ANN for the identification of recurrent fallers in older community-dwellers.

Motor imagery of gait: a new way to detect mild cognitive impairment?

OBJECTIVES: 1) To measure and compare the time required to perform (pTUG) and the time required to imagine (iTUG) the Timed Up & Go (TUG), and the time difference between these two tasks (i.e., TUG delta time) in older adults with cognitive decline (i.e., mild cognitive impairment (MCI) and mild-to-moderate Alzheimer disease and related disorders (ADRD)) and in cognitively healthy individuals (CHI); and 2) to examine any association between the TUG delta time and a cognitive status. METHODS: Sixty-six participants (24 CHI, 23 individuals with MCI, and 19 individuals with ADRD) were recruited in this cross-sectional study. The mean and standard deviation of the pTUG and iTUG completion times and the TUG delta time, as well as age, gender, and Mini-Mental State Examination (MMSE) scores were used as outcomes. Participants were separated into three groups based on the tertilization of TUG delta time: lowest (<13.6%; n = 22; best performance), intermediate (13.6-52.2%; n = 22), and highest tertile (>52.2%; n = 22, worst performance). RESULTS: Fewer CHI were in the group exhibiting the highest tertile of TUG delta time compared to individuals with lowest and intermediate TUG delta times (p = 0.013). Being in the highest tertile of the TUG delta time was associated with cognitive decline in the unadjusted model (p = 0.012 for MCI, and p = 0.021 for mild-to-moderate ADRD). In the multivariate models, this association remained significant only for individuals with MCI (p = 0.019 while adjusting for age and gender; p = 0.047 while adjusting for age, gender, and MMSE score; p = 0.012 for the stepwise backward model). CONCLUSIONS: Our results provide the first evidence that motor imagery of gait may be used as a biomarker of MCI in older adults.