Validation of the Mini Nutritional Assessment-Short Form in a Population of Frail Elders without Disability. Analysis of the Toulouse Frailty Platform Population in 2013.

OBJECTIVE: To assess the validity of the Mini Nutritional Assessment-Short Form (MNA-SF) in elderly patients from the Toulouse Frailty Platform. PARTICIPANTS: Overall, 267 patients aged 65 and over, without severe cognitive impairment (i.e. Mini Mental Status Examination > 20 and CDR<1), no physical disability (i.e. Activities of Daily Living ≥ 5) and no active cancer history (over the past 12 months) were included in 2013. MEASUREMENTS: Receiver operating characteristic (ROC) analyses were used to assess the predictive validity of the French version of the MNA-SF for good nutritional status (defined as a full MNA score≥24/30). Analyses were conducted in the overall sample and then in subgroups of frail and pre-frail subjects according to the frailty phenotype. Optimal cut-off points were determined to obtain the best sensitivity/specificity ratio and the highest number of correctly classified subjects. RESULTS: Among 267 patients, mean age=81.5±5.8; women=67.0%; 138 (51.7%) were frail, 98 (36.7%) were pre-frail and 31 (11.6%) were robust. Given their MNA-SF scores, 201 (75.3%) had a good nutritional status, 61 (22.8%) were at risk of malnutrition and 5 (1.9%) were malnourished. In the overall sample, but also in subgroups of pre-frail or frail elders, the areas under ROC curves were 0.954, 0.948 and 0.958 respectively. The 11 points cut-off provided the best correct classification ratio (91.4%); sensitivity=94.0%, specificity=83.3%. CONCLUSION: The MNA-SF appeared to be a validated and effective tool for malnutrition screening in frail elders. Implementing this tool in clinical routine should contribute to improving the screening of malnourished frail individuals.

MAPT STUDY: A MULTIDOMAIN APPROACH FOR PREVENTING ALZHEIMER'S DISEASE: DESIGN AND BASELINE DATA.

OBJECTIVE: The Multidomain Alzheimer Preventive Trial (MAPT study) was designed to assess the efficacy of isolated supplementation with omega-3 fatty acid, an isolated multidomain intervention (consisting of nutritional counseling, physical exercise, cognitive stimulation) or a combination of the two interventions on the change of cognitive functions in frail subjects aged 70 years and older for a period of 3 years. Ancillary neuroimaging studies were additionally implemented to evaluate the impact of interventions on cerebral metabolism (FDG PET scans) and atrophy rate (MRIs), as well as brain amyloïd deposit (AV45 PET scans). DESIGN PATIENTS: 1680 subjects (mean age: 75.3 years; female: 64.8 %), enrolled by 13 memory clinics, were randomized into one of the following four groups: omega-3 supplementation alone, multidomain intervention alone, omega-3 plus multidomain intervention, or placebo. Participants underwent cognitive, functional and biological assessments at M6, M12, M24 and M36 visits. The primary endpoint is a change of memory function at 3 years, as assessed by the Free and Cued Selective Reminding test. All participants will be followed for 2 additional years after the 3-years intervention (MAPT PLUS extension study). INTERVENTIONS: 1/Omega-3 supplementation: two soft capsules daily as a single dose, containing a total of 400 mg docosahexaenoic acid (DHA), i.e., 800 mg docosahexaenoic acid per day, for 3 years. 2/ Multidomain intervention: collective training sessions conducted in small groups (6-8 participants) in twelve 120-minute sessions over the first 2 months (two sessions a week for the first month, and one session a week the second month) then a 60-minute session per month in the following three areas: nutrition, physical activity, and cognition until the end of the 3 years. In addition to the collective sessions, individualized preventive outpatient visits exploring possible risk factors for cognitive decline are performed at baseline, M12 and M24. BASELINE POPULATION: For cognition, the mean MMSE at baseline was 28.1 (± 1.6). About 58% and 42% of participants had a CDR score equal to 0 and 0.5, respectively. Regarding mobility status, 200 (11.9%) had a 4-m gait speed lower or equal to 0.8 m/s. According to the Fried criteria, 673 (42.1%) participants were considered pre frail, and 51 (3.2%) frail. The red blood cell DHA content was 26.1 ± 8.1 µg/g. Five hundred and three participants underwent baseline MRI. AV45 PET scans were performed in 271 individuals and preliminary results showed that 38.0% had a cortical SUVR > 1.17, which gave an indication of significant brain amyloïd deposit. DISCUSSION: The MAPT trial is presently the first largest and longest multidomain preventive trial relevant to cognitive decline in older adults with subjective memory complaints. The multidomain intervention designed for the MAPT trial is likely to be easily implemented within the general population.

Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group.

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on "Cognitive Frailty" was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a "Cognitive Frailty" condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called "cognitive frailty" as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

Frailty consensus: a call to action.

Frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. 1. Physical frailty is an important medical syndrome. The group defined physical frailty as "a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death." 2. Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy. 3. Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons. 4. For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (>5%) due to chronic disease should be screened for frailty.

Dietary vitamin D intake and muscle mass in older women. Results from a cross-sectional analysis of the EPIDOS study.

OBJECTIVES: Vitamin D intake may prevent physical performance decline through prevention of muscle mass loss. Our objective was to determine whether low dietary intakes were associated with low muscle mass (MM). DESIGN AND PARTICIPANTS: Cross-sectional analysis of 1989 community-dwelling women (mean age 80.5±3.8years) from the EPIDémiologie de l'OStéoporose (EPIDOS) study were assessed at baseline. MEASUREMENTS: Low intakes of vitamin D (<70µg/week) were estimated from the weekly dietary vitamin D intakes (self-administered food frequency questionnaire). Low MM was defined according to the appendicular skeletal muscle mass index assessed using Dual Energy X-ray Absorptiometry, divided by square height of less than 5.45 kg/m2. Usual gait speed defined physical performance. Age, sun exposure, co-morbidities, education level, living arrangements, recreational physical activity, dietary protein and calcium intakes, bone mineral density, handgrip strength, and body mass index were considered as potential confounders. Multivariate logistic regression analyses assessed the association between low vitamin D intakes and low MM. RESULTS: Two-hundred and nine (10.5%) women with low MM were compared to 1,780 women with normal MM. In final model, obesity/overweight (Adjusted Odds Ratios, aOR=0.09; 95%CI [0.05-0.17]), malnutrition (aOR=3.90; 95%CI [2.74-5.54]) and low handgrip strength (aOR=2.33; 95%CI [1.44-3.77]; p<0.001) were statistically associated with a low MM status. CONCLUSION: No association with low MM has been reported regarding low dietary intakes of vitamin D.

Frailty Detection with the Gérontopôle Frailty Screening Tool (GFST).

Frailty is commonly regarded as a pre-disability condition of older persons. Its importance in the elderly should be more carefully taken into account in the clinical practice. To implement interventions aimed at preventing disability in frail older adults, screening tools for the early detection of this syndrome are needed. In this context, the Gérontopôle Frailty Screening Tool (GFST) has been recently proposed as an instrument for assisting general practitioners in the detection of non-disabled frail older adults. In the present paper, we briefly discuss about the difficulties of translating knowledge from the frailty research field to the clinical practice. Such difficulties are illustrated by presenting the evolution of the GFST over time. The use of frailty screening tools, such as the GFST, in the clinical practice is necessary to support the identification of older persons at risk of adverse events and promote the implementation of individualized strategies against disability.

Recruitment strategies for preventive trials. The MAPT study (MultiDomain Alzheimer Preventive Trial).

1680 participants were randomized over the recruitment period in MAPT study. A total of 1290 participants were recruited in the 7 University Hospital centers, and 390 participants in the 6 memory clinics around Toulouse Gerontopole / Alzheimer Disease research clinical center. The first randomization was on May 30, 2008, and the targeted number of randomized participants was reached on February 24, 2011; 2595 subjects were finally screened, of which 1680 fulfilled the eligibility criteria which represents 64.8%. Approximately, one quarter of screened people refused to participate after the detailed presentation of the study and 4.3% were still interested in participating but missed for unknown reasons the baseline visit even after repeated contacts. Of the 1810 subjects who signed the consent for participating to the study at the baseline visit, 130 (7.1%) were excluded because one of the eligibility criteria was not satisfied. Interestingly, the higher percentage of randomizations compared to screened participants is the personal contact source; almost 85 % of screened participants entered in the study. In an equivalent way, Medias and conferences are efficient recruiting sources to enrol volunteers in the study. Unexpectedly, only about 60% of screened participants from the hospital and GP sources were randomized and 33.2% from health care services. Almost a quarter of the randomized participants come from the hospital outpatients clinics and approximately 20% from public conferences. A total of 1128 contacts yielded to 556 screened volunteers and 345 randomized participants in the coordinating center of Toulouse. Thus, 30 % of contacts were recruited.

Gender Specific Associations between Frailty and Body Composition.

BACKGROUND: Frailty is a widespread geriatric syndrome, but its relationship with body composition is largely unknown. OBJECTIVES: Assess the relationship between body composition and frailty in older persons. DESIGN, PARTICIPANTS AND SETTING: Cross-sectional data analyses in 120 community-dwelling older persons (50 men, 70 women, mean age 78.5 ± 6 yr). MEASUREMENTS: Frailty was measured according to Fried's criteria and calculated as a score, and also a binary variable. Anthropometric measures were obtained (height, weight), and body composition (total lean body mass, appendicular skeletal muscle mass (ASM), total fat mass, and percentage fat), assessed by dual energy x-ray absorptiometry. Multiple regression and logistic regression analyses stratified by gender were conducted. RESULTS: Frailty, as a binary measure, was more prevalent in women than men (67.1% vs 46% p=0.04). Prevalence of low muscle mass (ASM/ht2) was higher in men than in women (40.0% vs 32.9%, p=0.04). Using gender-specific percentage fat cut-scores (27% men, 38% women, respectively) obesity was more prevalent in women than men (58.6% vs 34%, respectively, p=0.01). Multiple regression models showed age as an independent associated factor of frailty in men (ß 0.310, p=0.009) and women (ß .581 p<0.001). ASM/ht2 was a significant associated factor in men (ß -0.517, p<0.001) and trended towards significance in women (ß -0.188, p=0.06). Percentage fat was a significant associated factor in women only (ß 0.234, p=0.02). Logistic regression with frailty as a binary dependent variable yielded similar results. CONCLUSION: In this sample of older adults, the significant associated factor of frailty in men was ASM/ht2, whereas it was percentage fat in women. These associations were independent of age. With increasing longevity and the high prevalence of sarcopenia and obesity in older populations, these findings have public health implications. Larger sample and specifically designed studies are needed in order to confirm and extend these findings.

Frailty and Cognition.

Frailty is a common, heterogeneous, geriatric syndrome associated with adverse health events. Over the last years, a growing debate has emerged concerning the inclusion of cognitive impairment in the definition of frailty. In fact, cognitive impairment has been increasingly recognized as a potential contributor to the clinical vulnerability of older persons. This review presents key studies describing the interrelationships between cognition and frailty; in particular we examine the clinical relevance of cognitive impairment in the determination of the frailty syndrome.