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Toulouse, France

Manckoundia P.,Service de Medecine Interne Geriatrie | Manckoundia P.,University of Burgundy | Lorenzini M.,Service de Medecine Interne Geriatrie | Disson-Dautriche A.,Center Regional Of Pharmacovigilance | And 6 more authors.
Archives of Gerontology and Geriatrics

Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the " Mutualité-Sociale-Agricole (MSA)" of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80-98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% β-blockers and 30% inhibitors of the renin-angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects. © 2011 Elsevier Ireland Ltd. Source

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Walking speed may be associated with the amount of amyloid buildup elderly people have in the brain, even if they don’t have symptoms of Alzheimer’s disease (AD) yet, according to a new Neurology study. “Our results suggest that taking into account physical parameters that are not conventionally looked at in AD, such as gait speed, may help optimize the early identification of individuals at risk of AD,” study author Natalia del Campo, Ph.D., of the Gerontopole and the Centre of Excellence in Neurodegeneration of Toulouse in France told Bioscience Technology. Positron emission tomography (PET) scans were taken of the 128 participants’ brains to measure the amount of amyloid plaques, the buildup of which has been associated with the development of Alzheimer’s.  The participants had an average age of 76, and did not have dementia but were at risk of developing Alzheimer’s because they had some concerns with memory. Participants also were given thinking and memory tests.  Del Campo said that a total of 46 percent of the participants had mild cognitive impairment, which can be a precursor to the dementia that occurs in Alzheimer’s.  From the PET scans, researchers found 48 percent had a level of amyloid often associated with dementia. Then walking speed was measured using the 4m walk test from the Short Physical Performance Battery, a commonly used geriatric assessment.  On average, walking speed was 3.48 feet per second.  Of the participants, only two tested out of the normal range of walking speed and were slower. Read More: Sleep Position May Impact Brain’s Ability to Clear Waste Researchers found that there was an association between slow walking speed and amyloid buildup in multiple regions of the brain, including the putamen, which relates to motor function. Researchers found that the amyloid level accounted for up to 9 percent in the difference of walking speed, after comparing how fast people walked both with and without taking into account the amount of amyloid in the brain. Del Campo told Bioscience Technology that at a group level, and after correcting for a number of factors such as age, BMI (body mass index) and a certain genotype that has been associated with the development of Alzheimer’s, that the slowest walkers had the largest amount of amyloid buildup. She added that slow walking older adults should not be concerned, as there are many other causes of slow walking.  She noted that most subjects in the study walked at a pace considered normal according to current conventions, and that the study sample is not representative of the general elderly population. Del Campo said the next steps for research “will include a study to examine the relationship between brain amyloid and gait speed over time.  This will help determine whether the accumulation of brain amyloid is associated with a progressive decline in gait speed. It will also help characterize the directionality of the relationship, and examine other potential underlying causes that contribute this relationship.  Further research is thus also needed to examine other neuropathological processes that occur in AD in addition to the deposition of amyloid, such as the accumulation of tau, which may have an impact on motor function.” The study was based on a larger trial called the Multidomain Alzheimer Preventative Trial, which was supported by the French Ministry of Health and Pierre Fabre Research Institute.

Rolland Y.,Gerontopole | Resnick B.,University of Maryland, Baltimore | Katz P.R.,University of Toronto | Little M.O.,Saint Louis University | And 34 more authors.
Journal of the American Medical Directors Association

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations. © 2014 American Medical Directors Association, Inc. Source

Salva A.,Autonomous University of Barcelona | Andrieu S.,University Paul Sabatier | Fernandez E.,Autonomous University of Barcelona | Schiffrin E.J.,Nestle | And 5 more authors.
Journal of Nutrition, Health and Aging

Objective: To assess the effectiveness of health and nutrition program (NutriAlz) versus usual care on functional level in elderly people with dementia living at home, as well as on clinical practice related to nutrition and on the caregiver's burden. Design: Cluster randomized multi-centre study with one-year follow-up. Setting: 11 Alzheimer outpatients and day care centres (Barcelona, Spain). Participants: Nine hundred and forty six home-living Alzheimer patients with identified caregiver were consecutively recruited (intervention group: 6 centres, 448 patients vs control group: 5 centres, 498 patients). Intervention: The intervention was a teaching and training intervention on health and nutrition program, NutriAlz, directed both to physician and main caregiver, as well as persons affected by Alzheimer's disease or other dementias, including a standardised protocol for feeding and nutrition. Main Outcome Measures: The main outcome measure was the reduction in the loss of autonomy (Activities of daily living (ADL/IADL) scales) assessed at 6 and 12 months. Secondary outcomes measures were Improvement in nutritional status (Mini Nutritional Assessment (MNA), BMI, and weight changes), and caregiver burden (Zarit scale). Results: The one-year assessment was completed for 293 patients (65.4%) in the intervention group and 363 patients (72.9%) in the control group (usual care). The annual rate of ADL change was -0.83 vs -0.62 (p=0.984), and the caregiver's subjective burden 0.59 vs 2.36 (p=0.681) in intervention and control group, respectively. MNA, however, showed an improvement (+0.46 vs -0.66, p=0.028), suggesting an effective nutritional behaviour. Conclusion: The NutriAlz program had no effect on functional decline in Alzheimer disease patients living at home over one year, but reduced the risk for malnutrition, as recommendations concerning diet and exercise were provided. © 2011 Serdi and Springer Verlag France. Source

Piau A.,Gerontopole | Piau A.,Toulouse University Hospital Center | Nourhashemi F.,Gerontopole | Nourhashemi F.,French Institute of Health and Medical Research | And 4 more authors.
Journal of Nutrition, Health and Aging

Alzheimer's disease (AD) is an age-related neurodegenerative disease with a global prevalence estimated at 26.55 million in 2006. During the past decades, several agents have been approved that enhance cognition of AD patients. However, the effectiveness of these treatments are limited or controversial and they do not modify disease progression. Recent advances in understanding AD pathogenesis have led to the development of numerous compounds that might modify the disease process. AD is mainly characterized neuropathologically by the presence of two kinds of protein aggregates: extracellular plaques of Abeta-peptide and intracellular neurofibrillary tangles. Abeta and tau could interfere in an original way contributing to a cascade of events leading to neuronal death and transmitter deficits. Investigation for novel therapeutic approaches targeting the presumed underlying pathogenic mechanisms is major focus of research. Antiamyloid agents targeting production, accumulation, clearance, or toxicity associated with Abeta peptide, are some approaches under investigation to limit extracellular plaques of Abeta-peptide accumulation. We can state as an example: Abeta passive and active immunization, secretases modulation, Abeta degradation enhancement, or antiaggregation and antifibrillization agents. Tau-related therapies are also under clinical investigation but few compounds are available. Another alternative approach under development is neuroprotective agents such as antioxidants, anti-inflammatory drugs, compounds acting against glutamate mediated neurotoxicity. Neurorestorative approaches through neurotrophin or cell therapy also represent a minor avenue in AD research. Finally, statins, receptor for advanced glycation end products inhibitors, thiazolidinediones, insulin, and hormonal therapies are some other ways of research for a therapeutic approach of Alzheimer's disease. Taking into account AD complexity, it becomes clear that polypharmacology with drugs targeting different sites could be the future treatment approach and a majority of the recent drugs under evaluation seems to act on multiple targets. This article exposes general classes of disease-modifying therapies under investigation. © 2011 Serdi and Springer Verlag France. Source

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