iSupport-Brasil: Cross-cultural adaptation of the content included in the iSupport program for caregivers of people who have dementia.

OBJECTIVE: Examine the process of culturally adapting the content of the World Health Organization iSupport program for family caregivers of people living with dementia in Brazil. METHOD: This is a multicenter and methodological study to cross-culturally adapt the iSupport program. Initially, the content of the iSupport program was translated into Brazilian Portuguese by professional translator trained in Psychology, with mastery of the original language of the content (English). Focus groups were then held with caregivers/former caregivers of people who have dementia (n = 24) and health professionals specialized in aging (n = 24). The participants had access to part of the iSupport material for analysis purposes. Semi-structured interviews were conducted between June and September 2019. All the interviews were recorded and transcribed in full for subsequent analysis. All the ethical aspects were respected. RESULTS: The translator implemented some cross-cultural adaptations, such as substituting 69 proper names used in the original version by names of different Brazilian regions. In relation to the analysis of the material and comments from the focus groups, in general, all the participants had positive opinions about the material included in iSupport. Some changes were suggested in relation to the terminology and examples given in the modules to better fit the Brazilian culture and health systems, and links to relevant pages of the local Alzheimer's association were included. All the linguistic and cultural adaptations proposed were systematically documented and duly justified in structured forms provided by the World Health Organization, which approved all of them after verification of fidelity. CONCLUSION: The product of this research is the first version of the iSupport-Brasil program and the inclusion of its content in a digital platform. For the most part, the content offered in iSupport proved to be an important online tool to provide support and diverse information to the caregivers of people who have dementia.

25-hydroxyvitamin D in older adults: Which factors really matter?

BACKGROUND AND OBJECTIVES: This study investigated the interaction between a set of factors commonly associated with vitamin D production and nutritional intake and serum 25(OH)D levels among older adults. METHODS: Cross-sectional study on 346 adults over 60 years. Serum 25(OH)D levels were measured following routine biochemical laboratory protocols. Multivariable logistic regression investigated which factors were independently associated with vitamin D deficiency. RESULTS: The prevalence of vitamin D deficiency and insufficiency was 35.3% and 44.2%, respectively. The multivariable logistic regression showed gender and BMI as independent adjustment measures for serum 25(OH)D levels; all other associations were non-significant. CONCLUSIONS: Sex and BMI prevail as principal determinants of serum 25(OH)D levels among older adults. BMI seems to have a more pronounced influence on serum 25(OH)D levels of females compared to males. Healthcare professionals should consider active screening for changes in serum 25(OH)D levels in older obese adults, especially females.

Plasma 25-hydroxyvitamin D levels, quality of life, inflammation and depression in older adults: Are they related?

BACKGROUND AND OBJECTIVES: This study aimed to determine whether there is an association between inflammation and depression taking into account the effect of several confounders, but specially plasma 25-hydroxyvitamin D (25[OH]D) levels. MATERIAL AND METHODS: A cross-sectional study was conducted on adults (n = 346) aged 60 years or older recruited from primary healthcare centres. Depression was assessed by the Geriatric Depression Scale (GDS), while plasma 25(OH)D and inflammatory cytokines were measured following routine biochemical laboratory protocols. RESULTS: Subjects were divided into two subgroups according to their depression status, and matched in their baseline conditions using random forest-based propensity scores. Both groups were rather similar in regard to most variables, apart from quality of life (p < 0.001) and plasma levels of IL-6 (p = 0.03). The overall prevalence of vitamin D deficiency was 36.3% (95% Confidence Interval [95% CI], 30.2%-42.5%), without a significant difference between depression groups (p = 0.2). A significant association was observed between GDS score and plasma IL-6 levels only among those with SF-6D score between 0.26 and 0.50 (p = 0.001). CONCLUSIONS: The association between inflammation and depression is more likely to be due to a moderation influence of quality of life rather than plasma 25(OH)D levels. However, further studies are needed to ascertain the effect of a poor quality of life leading to chronic inflammation and poor health upon longer periods of follow-up.

Associations between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity.

BACKGROUND: We investigated the association between inflammatory markers and muscle strength in older adults according to the presence or absence of obesity. Dynapenia is the age-related decline in muscle strength and results in negative outcomes to older adults. Accordingly, obesity is more prevalent throughout aging and is associated with comorbidities, such as type 2 diabetes, dyslipidemia and cardiovascular diseases. Both dynapenia and obesity are strongly linked to chronic inflammation, sharing common signaling pathways. METHODS: We recruited 247 older adults aged 60 or older and collected sociodemographic, anthropometric and metabolic data. Dynapenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Circulating inflammatory cytokines were measured in plasma using a multiplex panel kit. Anthropometric, sociodemographic, lipid profile, and fasting blood glucose were also assessed. RESULTS: Dynapenic participants were predominantly males (74.4%), had insufficiently active lifestyle and higher IL-10 plasma levels (0.95 pg/mL; 0.40-2.12). The prevalence of obesity was higher among non-dynapenic participants (45.3%; 95% CI, 37.7-53). In dynapenic older adults, obesity was predominant in males (53.6%) and subjects with normal muscle strength had higher serum levels of TNF-ß (0.63 pg/mL; 0.30-1.30) and lower hand-grip strength (24 kg; 20.00-28.00). Using a multivariate quantile regression analysis, we found a strong and negative association between IL-10 and muscle strength. CONCLUSIONS: This study can help to understand the association of inflammation, obesity and muscle strength to promote interventions in order to avoid or delay the negative outcomes associated with dynapenia and sarcopenia in older adults.

ADAM10 plasma levels predict worsening in cognition of older adults: a 3-year follow-up study.

BACKGROUND: Blood-based biomarkers for Alzheimer's disease (AD) are highly needed in clinic practice. So far, the gold standards for AD diagnosis are brain neuroimaging and beta-amyloid peptide, total tau, and phosphorylated tau in cerebrospinal fluid (CSF); however, they are not attractive for large-scale screening. Blood-based biomarkers allow an initial large-scale screening of patients under suspicion that could later be tested for the already established CSF biomarkers. To this regard, in this study, we evaluated whether plasma ADAM10 levels would be predictors of declines in cognition in community-dwelling older adults after a 3-year period follow-up. METHODS: This was a 3-year longitudinal cohort study that included 219 community-dwelling older adults. Sociodemographic, clinical, lifestyle, depressive symptoms (GDS), and cognitive data (Mini-Mental State Examination, MMSE; Clock Drawing test, CDT) were gathered. The measurement of ADAM10 plasma levels was performed using a sandwich ELISA kit. Bivariate comparisons between groups were performed using Wilcoxon-Mann-Whitney for continuous data and Pearson's chi-square tests with Yates continuity correction for categorical data. Longitudinal analyzes of changes in the MMSE scores were performed using linear mixed-effects modeling. RESULTS: Baseline MMSE scores and ADAM10 levels were significantly associated with MMSE scores on the follow-up assessment. When analyzing the interaction with time, normal MMSE scores and the ADAM10 plasma levels at baseline presented a significant and independent negative association with MMSE score values on the follow-up assessment. The analyses also showed that the predictive effect of ADAM10 plasma levels on decreasing MMSE scores on follow-up seems to be more pronounced in participants with normal MMSE, when compared with those with altered MMSE scores at baseline. CONCLUSIONS: Considering that ADAM10 increase in plasma is detected as soon as in mild cognitive impairment (MCI) patients, the results presented here may support the complementary clinical use of this biomarker, in addition to the classical AD biomarkers. Taken together, these results provide the first direct evidence that changes in ADAM10 plasma levels are predictors of cognitive worsening in older adults. Moreover, this work can shed light on the study of blood biomarkers for AD and contribute to the advancement of the area.

Higher levels of tumor necrosis factor ß are associated with frailty in socially vulnerable community-dwelling older adults.

BACKGROUND: The complex physiology underpinning the frailty syndrome is responsible for the absence of robust biomarkers that can be used for screening, diagnostic and/or prognostic purposes and has made clinical implementation difficult. Considering socially vulnerable populations, who have poor health status and increased morbidity and mortality, this scenario is even more complex. However, to the best of our knowledge, there are no studies available to investigate frailty biomarkers in socially vulnerable populations. Thus, the aim of this cross-sectional study was to identify potential blood-based biomarkers of frailty in a socially vulnerable population. METHODS: A sample consisting of 347 community-dwelling older people living in a context of high social vulnerability was divided into non-frail (robust), pre-frail and frail groups, according to modified Fried frailty phenotype criteria. Blood samples were collected and analyzed for basic metabolic parameters and for inflammatory cytokines. RESULTS: Levels of Interleukin-1α (IL-1α) and Tumor Necrosis Factor α (TNF-α) were significantly higher in pre-frail subjects, compared to non-frail ones. Tumor Necrosis Factor ß (TNF-ß) levels presented higher values in the frail compared to non-frail individuals. Interleukin-6 (IL-6) levels in pre-frail and frail subjects were significantly higher compared to the levels of non-frail subjects. Using an ordinal regression analysis, we observed that socially vulnerable older people at higher risk of developing frailty were subjects above 80 years old (OR: 2.5; 95% CI: 1.1-5.6) and who presented higher levels of TNF-ß (≥0.81 pg/mL, OR: 2.53; 95% CI: 1.3-4.9). CONCLUSION: As vulnerable populations continue to age, it is imperative to have a greater understanding of the frailty condition, identifying novel potential blood-based biomarkers. The results presented here could help to implement preventive healthcare strategies by evaluating frailty and at the same time measuring a set of inflammatory biomarkers, paying special attention to TNF-ß plasmatic levels.