Effects of multidomain lifestyle intervention, omega-3 supplementation or their combination on physical activity levels in older adults: secondary analysis of the Multidomain Alzheimer Preventive Trial (MAPT) randomised controlled trial.

Background/objectives: to investigate the effects of a 3-year multidomain lifestyle intervention, omega-3 supplementation or both on physical activity (PA) in older adults with subjective memory complaints. Design/settings/subjects: the Multidomain Alzheimer Preventive Trial was a 3-year randomised controlled trial that enroled 1,680 community-dwelling adults aged 70 years or over, with subjective memory complaints. Participants were randomised to omega-3 supplementation (total daily dose of 800 mg docosahexanoic acid and up to 225 mg eicosapentanoic acid), multidomain intervention (nutritional and exercise counselling and cognitive training), omega-3 plus multidomain intervention or placebo with usual care. Methods: PA was assessed using a self-reported questionnaire. From this, global moderate-to-vigorous PA, leisure-time PA, non-leisure-time PA and light PA were measured in metabolic equivalent tasks-minutes per week (MET-min/week). Results: in the multidomain groups, participants significantly increased their moderate-to-vigorous and leisure-time PA at 6 months (≥300 MET-min/week for both in the multidomain groups; P ≤ 0.002) before returning to baseline by the end of the trial. Activity in the placebo/usual care and omega-3/usual care groups declined overtime. Between-group differences remained significant for both multidomain groups for leisure-time physical activity at 2- and 3-year follow-ups. Compared to placebo/usual care, interventions had no significant effects on non-leisure-time PA and light PA. Omega-3 supplementation alone had no effects on PA. Conclusions: a multidomain intervention focused on cognitive training, and nutritional and PA counselling increased PA in the short-term and limited its decline in the long-term among older adults with memory complaints. ClinicalTrials.gov-Registration number: NCT0067268.

A follow-up intervention in severely demented patients after discharge from a special Alzheimer acute care unit: impact on early emergency room re-hospitalization rate.

BACKGROUND: Emergency room (ER) re-hospitalizations are prevalent in severe Alzheimer's disease affected older patients. DESIGN: Quasi-experimental before and after study. SETTING: Discharge of severely demented patients from a Special Alzheimer Acute Care Unit. PARTICIPANTS: A total of 390 patients hospitalized in the unit from 2007 through 2009, with at least one of the following characteristics: severe disruptive behavioral and psychological symptoms of dementia (BPSD) (agitation, aggressiveness, and psychotic symptoms), change of living arrangement related to BPSD, exhaustion of the principal caregiver, and discharge of a subject with anosognosia living alone in the community. INTERVENTION: The intervention consisted of an individualized care plan, targeting the problems observed during the hospital stay, implemented by the means of regular telephone contacts (in the first week after discharge, before the end of the first month, and then at 3 and 6 months) between a geriatric team and the patient's caregiver. Information was gathered on functional decline, BPSD, change of living arrangement and treatment. The calls were followed by a telephone intervention providing advice, support, and information to the caregiver. When required, these calls were followed by a consultation with a physician or psychologist, or by a consultation in the patient's home. MEASUREMENTS: The primary outcome measure was the ER re-hospitalization rate, defined as occurring within 31 days of discharge. RESULTS: The early ER re-hospitalization rate was 8.39% in 2007 versus 8.02% in 2008 (p = 0.818) and 7.47% in 2009 (p = 0.563). Vocal disruptive behavior are more prevalent in re-hospitalized patients (9.64% versus 3.97%, p = 0.05) than in non re-hospitalized patients. CONCLUSION: We found a nonsignificant decrease of early ER re-hospitalization rate at 1 month after discharge. Interventions addressing severe dementia affected patients with BPSD are needed, as this is a major issue in the organization of health care systems.

Sarcopenia and cognitive impairment in elderly women: results from the EPIDOS cohort.

BACKGROUND: common pathophysiological pathways are shared between age-related body composition changes and cognitive impairment. OBJECTIVE: evaluate whether current operative sarcopenia definitions are associated with cognition in community-dwelling older women. DESIGN: cross-sectional analyses. SUBJECTS: a total of 3,025 women aged 75 years and older. MEASUREMENTS: body composition (assessed by dual energy X-ray absorptiometry) and cognition (measured by short portable mental status questionnaire) were obtained in all participants. Multivariate logistic regression models assessed the association of six operative definitions of sarcopenia with cognitive impairment. Gait speed (GS, measured over a 6-meter track at usual pace) and handgrip strength (HG, measured by a hand-held dynamometer) were considered additional factors of interest. RESULTS: a total of 492 (16.3%) women were cognitively impaired. The prevalence of sarcopenia ranged from 3.3 to 18.8%. No sarcopenia definition was associated with cognitive impairment after controlling for potential confounders. To proof consistency, the analyses were performed using GS and HG, two well-established predictors of cognitive impairment. Low GS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.72-3.40] and low HG (OR: 1.81, 95% CI: 1.33-2.46) were associated with cognitive impairment. CONCLUSION: no significant association was evidenced between different operative sarcopenia definitions and cognitive impairment. The study suggests that the association between physical performance and cognitive impairment in not mediated by sarcopenia.

Untangling the overlap between frailty and low lean mass: Data from Toulouse frailty day hospital.

BACKGROUND: The decline in lean mass, observed in older people, has been frequently associated with frailty. This assumption has scarcely been assessed. This study explored the association between current proposed definitions of low lean mass and the Fried phenotype of frailty. METHODS: Cross-sectional study. Participants admitted to the Toulouse frailty day hospital, with an assessment of body composition, 70 years or older were included consecutively in the study. Low lean mass (LLM), was identified using five international operative definitions. To construct the definitions, muscle mass was assessed using Intelligent Dual Energy X-ray absorptiometry (I-DXA, LUNAR). Frailty was assessed using the Fried criteria. RESULTS: Data from 283 participants, mean age 82 years and 71% of women were analyzed. LLM was identified between 8.5% and 39.2% of the participants according to the different definitions. Frailty was identified in 46.6% of the sample. 9.1%-48.5% of the frail older people had LLM depending on the definition. The highest association between frailty and LLM was observed with the definition proposed by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project [adjusted Odds Ratio 2.64; 95% confidence interval 1.5-4.8]. CONCLUSION: The decline in lean mass is a component of the frailty syndrome but not universally present. Indeed, LLM and frailty were associated and partly overlapped. Future research including longitudinal studies should exploit the added value of combining LLM and frailty measures in preventing disability and other negative health outcomes.

Sarcopenia Screened by the SARC-F Questionnaire and Physical Performances of Elderly Women: A Cross-Sectional Study.

OBJECTIVES: Screening for sarcopenia in daily practice can be challenging. Our objective was to explore whether the SARC-F questionnaire is a valid screening tool for sarcopenia (defined by the Foundation for the National Institutes of Health [FNIH] criteria). Moreover, we evaluated the physical performance of older women according to the SARC-F questionnaire. DESIGN: Cross-sectional study. PARTICIPANTS: Data from the Toulouse and Lyon EPIDémiologie de l'OStéoporose study (EPIDOS) on 3025 women living in the community (mean age: 80.5 ± 3.9 years), without a previous history of hip fracture, were assessed. MEASUREMENTS: The SARC-F self-report questionnaire score ranges from 0 to 10: a score ≥4 defines sarcopenia. The FNIH criteria uses handgrip strength (GS) and appendicular lean mass (ALM; assessed by DXA) divided by body mass index (BMI) to define sarcopenia. Outcome measures were the following performance-based tests: knee-extension strength, 6-m gait speed, and a repeated chair-stand test. The associations of sarcopenia with performance-based tests was examined using bootstrap multiple linear-regression models; adjusted R2 determined the percentage variation for each outcome explained by the model. RESULTS: Prevalence of sarcopenia was 16.7% (n = 504) according to the SARC-F questionnaire and 1.8% (n = 49) using the FNIH criteria. Sensibility and specificity of the SARC-F to diagnose sarcopenia (defined by FNIH criteria) were 34% and 85%, respectively. Sarcopenic women defined by SARC-F had significantly lower physical performance than nonsarcopenic women. The SARC-F improved the ability to predict poor physical performance. CONCLUSION: The validity of the SARC-F questionnaire to screen for sarcopenia, when compared with the FNIH criteria, was limited. However, sarcopenia defined by the SARC-F questionnaire substantially improved the predictive value of clinical characteristics of patients to predict poor physical performance.

Indicators of oral nutritional supplements prescription in nursing home residents: A cross-sectional study.

BACKGROUND & AIMS: Identifying factors associated with oral nutritional supplement (ONS) prescription in nursing homes (NH) may help to treat malnutrition in this very old and vulnerable population. OBJECTIVES: The aim of the study was to investigate if resident-related and NH-related characteristics were associated with ONS prescription. DESIGN: Cross-sectional study using medical and demographic data from 6275 NH residents and data on the structure and organization (e.g., presence of a dietitian, organization of the meal) of 175 NHs in southwestern France. The main outcome measure was ONS prescription (dichotomous variable: yes/no). RESULTS: ONS were prescribed for 7.8% (n = 489) of NH residents. In a multivariate binary logistic regression, resident-related factors associated with the prescription of ONS were age, clinical markers of undernutrition (body mass index and weight loss), disability in activities of daily living, pain, pressure sores, and hospitalization in the last 12 months. NH-related factors associated with ONS prescription were: presence of a dietitian (Odds Ratio (OR): 1.46, 95% Confidence Interval: 1.18-1.88), NH coordinating physician with specific training in geriatrics (OR: 2.58, 95% CI: 1.48-4.49), organization of evening snack (OR: 1.63, 95% CI: 1.28-2.07), number of general practitioners per NH bed (OR: 0.49, 95% CI: 0.38-0.64 intermediate tertile; OR:0.77, 95% CI:0.59-1.06 highest tertile. Reference category: lowest tertile) and number of drug prescriptions (OR: 0.97, 95% CI: 0.94-0.99). CONCLUSIONS: Both resident's characteristics and NH characteristics were associated with ONS prescription independently of each other. Our results showed that NH organizational aspects are associated with ONS prescribing, suggesting that modifiable aspects may contribute to achieve optimal nutritional status in the NH setting.

Impact of a therapeutic educational program on quality of life in Alzheimer's disease: results of a pilot study.

BACKGROUND: Therapeutic patient education is expanding in the field of Alzheimer's disease (AD). OBJECTIVE: To evaluate the impact of a therapeutic educational program, on AD-affected patients and their caregivers, living in the community, on the patient's quality of life. METHODS: Non experimental before and after study. Patient/caregiver dyads were recruited in the geriatric department of the Toulouse University Hospital. The intervention consisted of an educational program, designed for both patients and caregivers. It included two individual sessions (at baseline (M0) and two months later (M2)) and four group sessions for caregivers only, one per week between M0 and M2. The primary outcome was the patient's quality of life at two months, hetero-evaluated by the caregiver. We compared the QoL-AD score between M0 and M2 with a paired Student's test. The secondary outcomes were patient's autonomy (activities of daily living) and caregiver's burden (Zarit Burden interview). RESULTS: 29 patient/caregiver dyads were recruited. The QoL-AD score was 24.6 ± 5.1 at M0 versus 27.2 ± 6.0 at M2 (p = 0.038). This difference is statistically significant. There was no difference in the secondary outcomes. CONCLUSION: This study revealed a significant positive impact of a therapeutic educational program on patients' quality of life. Our results led us to design a randomized controlled trial called the THERAD study (THERapeutic education in Alzheimer's disease). It started in January 2013, and the results will be available in 2015. If the efficacy of this approach is proven, it will be important to implement educational programs in the care plan of these patients.

Searching for a relevant definition of sarcopenia: results from the cross-sectional EPIDOS study.

BACKGROUND: The diversity of definitions proposed for sarcopenia has been rarely tested in the same population, and so far, their clinical utilities for predicting physical difficulties could not be clearly understood. Our objective is to report the prevalence of sarcopenia and the characteristics of sarcopenic community-dwelling older women according to the different definitions of sarcopenia currently proposed. We also assessed these definitions for their incremental predictive value over currently standard predictors for some self-reported difficulties in physical function and knee extension strength. METHODS: Cross-sectional analysis included data from 3025 non-disabled women aged 75 years or older without previous history of hip fracture from the inclusion visit of the EPIDémiologie de l'OStéoporose study. A total body composition evaluation was available for 2725 women. Sarcopenia was defined using six different definitions of sarcopenia based on different muscle mass, gait speed, and grip strength cut-offs. Self-reported difficulties in physical function and knee extension strength were collected. Logistic regression and multiple linear regression models were built for each physical dysfunction, and the predictive capacity of sarcopenia (one model for each definition) was studied using the C-statistic, the net reclassification index, or adjusted R(2). RESULTS: The estimated prevalence of sarcopenia ranged from 3.3-20.0%. Only 85 participants (3.1%) were identified having sarcopenia according to all definitions. All definitions were, to some degree, associated with self-reported difficulties in physical function and knee extension strength, but none improved the predictive ability of the self-reported difficulties in physical function. Conversely, all definitions accounted for a small but significant amount of explained variation for predicting knee extension strength. CONCLUSIONS: Prevalence of sarcopenia varies widely depending on the definition adopted. Based on this research, the current definitions for sarcopenia does not substantially increment the predictive value of clinical characteristics of patients to predict self-reported physical difficulties and knee extension strength.

Association of a 7-year percent change in fat mass and muscle mass with subsequent cognitive dysfunction: the EPIDOS-Toulouse cohort.

BACKGROUND: Cognitive dysfunction and changes in body composition share common pathophysiological pathways. The aim of the present paper was to evaluate whether changes in appendicular muscle mass (AMM) and fat mass (FM) are associated factors with an increased risk of cognitive dysfunction in community-dwelling older women. METHODS: A nested case-control study was performed in 181 women aged 75 years and older from a subsample of the Epidemiologie de l'Osteoporose participants from Toulouse. Body composition parameters at inclusion and 7 years later (assessed by dual energy X-ray absorptiometry), and the presence of cognitive dysfunction (dementia and mild cognitive impairment) at 7 years of follow-up, assured by two memory experts based on best clinical practice and validated criteria, were obtained. Multivariate logistic regression models assessed the association of percent change in AMM and FM with risk of cognitive dysfunction. RESULTS: At 7 years of follow-up, 15 participants suffered from dementia, 6 suffered from mild cognitive impairment, and 160 were cognitively normal. Neither body composition changes nor gait speed was found to be statistically associated with cognitive dysfunction after controlling for potential confounders. Only age, over 85 years, was associated with an increased risk of subsequent cognitive impairment (odds ratio 3.10; 95 % confidence interval 1.07-8.87). CONCLUSIONS: No significant association could be evidenced between changes in body composition and cognitive dysfunction. Due to the small sample size, statistical power could be an issue. The study could also suggest the possibility that the risk of cognitive dysfunction is not mediated by changes in body composition.

Treatment strategies for sarcopenia and frailty.

Sarcopenia is the key feature of frailty in older people and a major determinant of adverse health outcomes such as functional limitations and disability. Resistance training and adequate protein and energy intake are the key strategies for the management of sarcopenia. Management of weight loss and resistance training are the most relevant protective countermeasures to slow down the decline of muscle mass and muscle strength. The quality of amino acids in the diet is an important factor for stimulating protein synthesis. Vitamin D deficiency should be treated, and new pharmacologic approaches for sarcopenia are currently assessed.

Clinical trials on sarcopenia: methodological issues regarding phase 3 trials.

Phase 3 trials estimate the effectiveness of an intervention to prevent, delay the onset of, or treat sarcopenia. Participants should have sarcopenia or present a sarcopenia risk profile. Control group should be characterized by the best standard of clinical care. This article further develops issues on sarcopenia definition, target population, primary and secondary end points, duration of the trials, muscle mass assessment, strength and physical performance assessment, and control of possible confounders. The challenges to conduct phase 3 trials in the elderly should not offset the opportunities for the development of new strategies to counteract sarcopenia and prevent late-life disability.