Dear HARC Workshop Guests.
Due to the large interest in the 1 st Workshop the additional registration has been opened. Current registration does not include lunch.
This two-day event will be a perfect opportunity to meet world-class experts within the field of dementia and nutritional sciences . Lectures grouped with 4 tracks (early detection of cognitive decline, nutrition and cognitive decline pathogenesis, diet, nutrition and body composition assessment and, finally, nutritional and diet interventions for cognitive decline and other disorders) will be of a state-of-the-art type with questions and answers following each session. Moreover, there will be a possibility to present original data (posters and some oral presentations spots ) and discuss the results with scientific leaders. Hopefully, workshop will also create an occasion to refresh acquaintances and establish new ones in hope for building up an international co-operations and research projects in the future.
For more details please contact Workshop Office: firstname.lastname@example.org or email@example.com
HEALTHY AGEING RESEARCH CENTRE (HARC) WORKSHOP I
NUTRITION AND DIET FOR AGE-RELATED COGNITIVE DECLINE AND DEMENTIA
MARCH 6th-7th, 2014
Venue: Didactic Centre of the Medical University of Lodz, ul. Pomorska 251, Łódź
Workshop Coordinators: prof. Iwona Kłoszewska, prof. Tomasz Sobów
Day 1: Thursday, 6th March 2014
9:00-9:30 Opening (prof. Kłoszewska, Prof. Kowalski)
Session 1 (Early detection of cognitive decline and dementia):
9:30 - 11:30 (each presentation 25 minutes + 5 minutes for Q&A)
1. M. Tsolaki (Aristotle University of Thessaloniki, Greece): Clinical workout for the early detection of cognitive decline and dementia.
2. Ch. Bastin (University of Liège, Belgium): Neuropsychological assessment for early
3. T. Paajanen (Finnish Institute of Occupational Health, Helsinki, Finland): Neurocognition and structural MRI interactions in mild cognitive impairment and Alzheimer’s disease.
4. N. Andreasen (Karolinska Institutet, Stockholm, Sweden): PREDICTION OF ALZHEIMER PATHOLOGY BY CSF BIOMARKERS.
Coffee Break 11:30-12:00
Session 2 (Evidence for the role of nutrition and diet in the pathogenesis of cognitive decline):
12:00-14:00 (each presentation 25 minutes + 5 minutes for Q&A)
1. M.J. Dauncey (University of Cambridge, United Kingdom) Nutrition, the brain and cognitive decline: insights from epigenetics.
2. P. Mecocci (University of Peruggia, Italy): Diet and dementia with a focus on vitamins and oligoelements.
3. D. Gustafson (Suny Downstate Medical Center, New York, USA & University of Goethenburg, Sweden): Adiposity and dementia over the life course.
4. P. Barberger-Gateau (University of Bordeaux, France): Nutrition and brain aging: how can we move ahead?
Lunch break: 14:00-15:00
Session 3 (Methods of diet, nutrition and body composition assessment)
15:00-17:30 (each presentation 25 minutes + 5 minutes for Q&A)
1. S. Kłęk (Stanley Dudrick Hospital, Skawina, Poland): Nutritional assesssment and methods for clinical nutrition.
2. A. Camina Martin (University of Valladolid, Spain): The importance of the body composition analysis in the Geriatric Nutritional Assessment: the utility of bioelectrical impedance in demented patients.
3. E. Marini (University of Cagliari, Italy): Bioelectrical impedance vector analysis for the assessment of body composition in the elderly.
4. M. Mueller (University of Kiel, Germany): Assessment and definition of lean body mass deficiency in the elderly.
5. Lodz Psychiatry / Medical Psychology HARC Group Presentation: R.Magierski (Medical University of Lodz, Poland): Evaluation of the influence of metabolic processes and body composition on cognitive functions: NutrDem Project.
17:30-18:15 Poster session walk-through presentations (snacks and beverages available)
Day 2: Friday 7th March, 2014!
Session 4 (Nutritional and diet interventions for age-related cognitive decline and frailty)
1. M. Secher (University of Toulouse, France): Nutrition and Frailty: Introducing the Gerontopole Frailty Clinics.
2. D. Religa (Karolinska Institutet, Stockholm, Sweden): Better health for elderly with registry based studies in nutrition. SveDem, the Swedish Dementia Quality Registry.
3. J. Woodside (Queen’s University of Belfast, United Kingdom): Mediterranean Diet Interventions to prevent cognitive decline - opportunities and challenges.
4. T. Kostka (Medical University of Lodz, Poland): Exercise, nutrition and quality of life in the elderly.
Coffee break till 11:30
Special session: Original short communications (posters available during the conference, up to 6 chosen also for short communications)
11:30 - 13:00
Conference closing (prof. Kłoszewska)
M. Milewska (Warsaw Medical Uniwersity, Poland) Practical workshop for previously registered participants (DXA, BIA)
M. Tsolaki (3rd Department of Neurology, Aristotle University of Thessaloniki, Greece) Clinical workout for the early detection of cognitive decline and Dementia.
Cognitive Decline is a dynamic state between normal cognition and dementia, where interventions can be taken to stop or delay the progression to dementia. It is broadly of 2 types-amnestic, where memory loss is the chief concern and nonamnestic, where it is not. One variant of nonamnestic, dysexecutive, being more prevalent is sometimes known as a separate subtype by itself. Diagnosis of Cognitive Decline is mostly clinical and is aided by various scales and neuropsychological testing. By testing multiple cognitive domains and avoiding ceiling effects, MCI can be identified before age 60 years. Premorbid GCA is a risk/protective factor, but deficits after adjusting for early adult GCA suggest additional processes leading to declining trajectories. The availability of biomarkers does not replace or diminish the need for a thorough clinical evaluation. A structured clinical approach helps to define the diagnosis and collects information essential for establishing a comprehensive care plan for patients with dementia and their families. Functional imaging studies help in early detection and is superior to biomarkers or structural magnetic resonance imaging. Widespread disconnection was observed primarily in cortical hubs known to manifest early Alzheimer's disease pathology, namely precuneus, parietal lobules, supramarginal and angular gyri, and cuneus, with additional involvement of subcortical regions, sensorimotor cortex and insula. Diseases correlated with Cognitive Decline: Parkinson’s Disease, Cancer, Brain Injury, Intellectual Disability, Cerebral Vascular Disease, depression etc. Prognosis of Cognitive decline. A recent study sought to determine the stability of the clinical etiologic diagnosis over time and to identify factors associated with instability. Lower diagnostic stability was significantly associated with older age, nonwhite race, milder disease at presentation, more underlying conditions contributing to cognitive decline, lack of a consistent spouse/partner informant, and being evaluated by different clinicians on different visits. Multistate Markov modeling generally confirmed these associations.
Ch. Bastin (Cyclotron Research Center, University of Liège, Liège, Belgium). Early neuropsychological detection of Alzheimer's disease.
Considering that brain pathology due to Alzheimer’s disease starts many years before the clinical symptoms become evident, subtle cognitive changes may exist already in the predementia phase. Different approaches have been used to detect initial cognitive impairments indicative of Alzheimer’s disease. One approach is the assessment of the predictive power of neuropsychological tools in characterizing patients with stable mild cognitive impairment (MCI) versus MCI patients who subsequently develop Alzheimer’s disease. Another approach is the longitudinal evaluation of large cohorts of older adults in population-based studies. Findings from several studies suggest that a memory test that ensures deep encoding of information and assesses retrieval with free as well as cued recall is a useful tool to distinguish patients at an early stage of Alzheimer disease from MCI non-converters. Impaired semantic memory has also been proposed as a neuropsychological marker of predementia Alzheimer’s disease. Beyond the memory domain, category verbal fluency has been shown to predict progression to Alzheimer’s disease. Moreover, combining neuropsychological scores of memory and executive functions and neuroimaging data allows a better discrimination between stable MCI and converters than neuroimaging data alone. Altogether, it is possible to detect cognitive changes that are predictive of the typical form of probable Alzheimer’s disease already in the predementia stage. Such at risk people are thought to be the best target for therapeutic interventions.
T. Paajanen (Finnish Institute of Occupational Health, Helsinki, Finland & Department of Neurology, University of Eastern Finland, Kuopio, Finland) Neurocognition and structural MRI interactions in mild cognitive impairment and Alzheimer’s disease.
Background: Episodic memory impairment and hippocampal atrophy are both intensively studied characteristics of the Alzheimer’s Disease (AD). However, due to modern automatic magnetic resonance imaging (MRI) methods, it is also possible to investigate early neocortical changes and their relationship with cognitive performance.
Aim: To present some new results combining neurocognition and structural MRI in mild cognitive impairment (MCI) and AD.
Methods: Results from the European multi-center AddNeuroMed (ANM) study are presented together with findings from the Alzheimer’s Disease Neuroimaging Iniative (ADNI). In the ANM study we analyzed data of 301 subjects (103 AD, 22 progressive MCI, 78 stable MCI and 98 controls) that went through neuropsychological assessments and uniform MRI pipeline analysis including vertex-based cortical thickness measures of the entire cortical mantle.
Results: In the ANM we found that recently developed total scores on CERAD neuropsychological battery are sensitive in detecting progressive MCI and reflect accurately cortical thickness signature of prodromal AD. In the ADNI, researchers found cortical signatures of cognition as potential imaging markers to predict conversion from MCI to AD.
Conclusions: Studies focusing on interactions between cognition and structural MRI can be beneficial in developing more accurate methods for assessing MCI and AD.
N. Andreasen (Dep. Geriatric Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden) Prediction of Alzheimer pathology by CSF biomarkers.
Early diagnosis of Alzheimer Disease (AD) is of importance to be able to initiate symptomatic treatment with acetylcholine esterase (AChE) inhibitors, and will be of even greater significance when potential disease-arresting drugs, such as Ab vaccination regimes, reach the clinical phase. Further, cerebrospinal fluid (CSF) biomarkers may also be valuable tools to identify and monitor the biochemical effect of new candidate drugs in AD patients.
Since CSF is in direct contact with the extracellular space of the brain, biochemical changes in the brain are likely to be reflected in the CSF. Thus, CSF biomarkers have been developed that reflect the central pathogenic processes in AD, including the neuronal degeneration (total tau, T-tau), the deposition of Ab in plaques (the 42 amino acid form of Ab, Ab42), and the phosphorylation of tau with formation of tangles (phosphor-tau, P-tau).
Several hundred studies have shown that these CSF biomarkers have high diagnostic accuracy to identify AD, and to differentiate AD from normal aging and several important differential diagnoses. Recent studies also show that CSF biomarkers may help to identify mild cognitive impairment (MCI) cases that will progress to AD with dementia from those who have a benign form of MCI without progression. Further, there are a high correlation between CSF Ab42 and PET-PIB and these two markers are seen to be the earliest biomarkers becoming positive in prodromal AD today.
M. J. Dauncey (Wolfson College, University of Cambridge, UK) Nutrition, the Brain and Cognitive Decline: Insights from Epigenetic
Nutrition affects brain structure and function throughout life, with profound implications for cognitive decline and dementia. These effects are mediated by changes in expression of multiple genes, and responses to nutrition are in turn affected by individual genetic variability. An important layer of regulation is provided by the epigenome: nutrition is one of many epigenetic regulators that modify gene expression without changes in DNA sequence. Epigenetic mechanisms are central to brain development, health and disease, and enable cell-specific and age-related gene expression. They suggest key pathways by which nutrition is involved in the pathogenesis of cognitive decline: many nutrients, foods and diets have both immediate and long-term effects on the epigenome, including energy status and dietary methyl donors. Optimal brain function results from complex interactions between numerous genetic and environmental factors, including food intake, physical activity, age and stress. Future advances in nutriepigenomics should provide novel approaches to prevention of cognitive decline, and treatment of dementia and Alzheimer's disease.
Dauncey MJ (2009). New insights into nutrition and cognitive neuroscience. Proc Nutr Soc 68:408-415.
Dauncey MJ (2012). Recent advances in nutrition, genes and brain health. Proc Nutr Soc 71:581-591.
Dauncey MJ (2013). Genomic and epigenomic insights into nutrition and brain disorders. Nutrients 5:887-914.
P. Mecocci (Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy) Diet and dementia: focus on vitamins and oligoelements
Dietary factors can be central for Alzheimer’s disease (AD) prevention. Among those, vitamin E has a major role in protecting the brain from damage mediated by free radicals. Vitamin E includes four tocopherols and four tocotrienols, named α, β, γ, and δ. Most investigation of vitamin E in relation to AD has focused primarily only on α-tocopherol, with conflicting findings. However, increasing knowledge regarding the biological properties of vitamin E provides a strong rationale that other forms of vitamin E, beyond just α-tocopherol, may be important for AD prevention. We examined the relation of all plasma vitamin E forms and markers of vitamin E damage (α-tocopherylquinone, 5-nitro-γ-tocopherol) to mild cognitive impairment (MCI) and AD. In a multicentric study (AddNeuroMed) we showed that reduced plasma levels of all vitamin E forms and increased levels of their oxidative/nitrosative markers may be indicators for the development of MCI and AD. In two population-based longitudinal studies in older adults (Kungsholmen Project; CAIDE Study) we found a reduced incidence of cognitive impairment and AD in subjects with high plasma levels of different vitamin E forms. Furthermore differences have been found, among population of north and south Europe enrolled in AddNeuroMed, in vitamin E family members, suggesting the effect and importance of lipid content in diet.
Zinc (Zn), an essential component of enzymatic antioxidant defences, is another micronutrient for which there is increasing evidence of neuroprotective activity, but conclusive data are lacking. In a multicenter study in healthy older adults (ZincAge) we found that plasma Zn levels were associated with cognition and Zn supplementation was able to increase activity of Zn-dependent antioxidant enzymes.
Overall, these findings warrant further investigation of the role of vitamin E and Zn in AD, to better define preventive strategies based on dietary recommendations.
D. Gustafson (State University of New York – Downstate Medical Center, USA; also visiting appointments: University of Gothenburg, Sweden & UMS 011 Inserm Versailles Saint Quentin, France) Adiposity and dementia over the life course.
Higher levels of total and central adiposity, measured as higher body mass index (BMI, kg/m2), waist circumference or waist-to-hip ratio (WHR), have been associated with late-onset dementia. However, some epidemiologic studies do not support this association; and potential underlying biological mechanisms that provide biological plausibility are not clear in terms of providing direct links to adipose tissue. Studies linking adiposity to dementia have considered adiposity measures from mid-life and late-life. Given an evolving background trajectory of BMI that exists over the life course and the influence of dementia processes on BMI, results have been conflicting depending on when BMI is measured in relationship to clinical dementia onset. This has made interpretation of the adiposity-dementia literature difficult. This presentation will review the epidemiologic evidence for associations between adiposity and dementia, issues of timing of the adiposity measure in relation to dementia onset, and potential biological mechanisms for observed associations.
P. Barberger-Gateau (University of Bordeaux, Centre de Recherche INSERM U897, Bordeaux, France) Nutrition and brain aging: How can we move ahead?
Epidemiological studies and basic research suggest a protective effect of several classes of nutrients, especially long-chain omega-3 polyunsaturated fatty acids, antioxidants and B vitamins, against brain aging. However, most randomized controlled trials (RCT) with dietary supplements have failed to show any impact on cognitive decline so far. This presentation will analyze the reasons for such inconsistent results and suggest some avenues for future research in the field. The role of other nutrients such as vitamin D should be investigated. Furthermore, the synergistic effect of combinations of nutrients as found in a balanced diet is still poorly understood. Potential beneficiaries of a nutritional supplementation should be better targeted, according to their dietary, cognitive and maybe genetic characteristics. Additional epidemiological studies are necessary to provide relevant data that will be used to design more convincing RCTs assessing the impact of nutrition for the prevention or treatment of cognitive decline in older persons. Major challenges of RCTs with nutritional interventions include finding an optimal window of opportunity during the long process leading to dementia, defining relevant cognitive outcomes or intermediate biomarkers of disease progression, and implementing an intervention with optimal doses of supplements or dietary recommendations.
S. Kłęk (Stanley Dudrick Memorial Hospital, Skawina, Poland) Nutritional assesssment and methods for clinical nutrition
Disease-related malnutrition (DRM), which can be both cause and consequence of acute or chronic illness, is a critical public health concern worldwide. It is caused primarily by poor nutrient intake, and metabolic dysregulation stemming from acute or chronic inflammation, but it can also be an effect of disease and/or its treatment. Patients in hospital and in the community often fail to meet their daily requirements for energy, protein and micronutrients, which leads to the latter and increases morbidity, mortality, hospital readmissions and length of hospital stay.It has been demonstrated that malnutrition occurs in 20-60% of hospitalized patients, and may deteriorate during the hospital stay, but also is frequent among outpatients (7-16%). The screening for malnutrition is of utmost importance, and must be performed with adequate methods, suitable for age, stage of disease and other parameters.
The enteral nutrition (EN) is a method of choice for nutritional support, hence it should be always considered as the first step, whenever the latter is necessary. The beneficial effect of EN was demonstrated in many clinical studies. EN can be performed either orally or via tube.
A.Camina Martin (Dept. Nutrition and Food Science, Medicine Faculty, University of Valladolid) The importance of the body composition analysis in the Geriatric Nutritional Assessment: the utility of bioelectrical impedance in demented patients.
In clinical practice, geriatric nutritional assessment usually includes nutritional screening, a simple anthropometric assessment, measurement of various biochemical parameters, such as serum-albumin, and sometimes (but not always) body composition analysis. However, it should be noted that there is a high prevalence of undiagnosed subclinical malnutrition in patients with dementia. Several factors have contributed to this situation. Among them, probably the most notable is the method used to assess the body composition. In this regard, for the analysis of body composition in clinical practice, techniques are needed which are non-invasive, affordable, safe and simple, requiring the minimum possible collaboration by the elderly patient. Consequently, both the BMI and the waist circumference (WC) have been widely employed as indicators of adiposity (overall and central adiposity, respectively), but currently there is no consensus on the cut-off points for the elderly, and changes in body composition (especially muscle mass depletion) are often masked by normal values of both the BMI and the WC. Nevertheless, bioelectrical impedance analysis (BIA) is a simple, cost-effective and precise method for BC analysis to determine body fluid volume and fat-free mass (FFM) in healthy subjects and stable elderly patients when using the specific equations developed and validated in this population. The main disadvantage of BIA is that it is highly sensitive to sudden changes in body water content (dehydration or liquid retention), and these can lead to substantial errors in body compartment estimates. However, using BIA vector analysis (BIVA) estimation errors can be minimised, since there is no need for the subject to be normally hydrated nor does it require the use of predictive models.
E. Marini (University of Cagliari, Italy) Bioelectrical impedance vector analysis for the assessment of body composition in the elderly
The presentation will be focused on bioimpedance vectorial techniques (BIVA), with an updated analysis of their efficacy for assessing body composition in the elderly.
BIVA differs from traditional bioimpedance procedure (BIA) in that it analyzes the bioelectrical values standardized for body height - directly, and thus avoids the potential error deriving from adopting BIA equations, which can lead to unreliable results in elderly individuals.
The classic BIVA approach has been validated for the assessment of nutritional and hydration status, but has proved weak in evaluating body composition.
Specific BIVA (BIVA sp.) is a recently proposed variant of classic BIVA that adjusts bioelectrical values for body geometry (height and cross-sectional area), besides just body height. Specific BIVA has been validated for the evaluation of the proportion of fat mass (FM%) in samples of healthy elderly Italians and adult U.S. Americans, and has proved capable of distinguishing sarcopenic individuals from sarcopenic-obese individuals. The specific reference values for healthy Italian elderly people have been recently published.
During the conference, a newly implemented specific BIVA software, a new 3D optical technique for the measure of body measures, and an application of BIVA sp. in patients with Alzheimers disease will be discussed.
M.J. Mueller (Institute of Human Nutrition, Christian-Albrechts-University, Kiel, Germany) Assessment and definition of lean body mass deficiency in the elderly.
Defining sarcopenia depends on an accurate assessment of skeletal muscle mass. DXA and whole body MRI (Magnetic Resonance Imaging) technologies can be used for precise assessments of so called appendicular lean body mass (i.e. lean body mass of arms and legs by DXA) and total body skeletal muscle mass (by whole body MRI scans). Recently, suitable reference population DXA data bases have been published which can be used to calculate age- and sex-specific percentiles where values <P10 may be considered as sarcopenia. In elderly males and females, there is no consensus whether the respective age-specific P10 or P5 values or the respective values of younger adults should be used as a reference. When compared to DXA data, there are also MRI-derived whole body muscle mass reference data obtained in smaller population groups. When compared with DXA, whole body MRI data are more accurate. Up to now neither DXA- nor MRI-derived cut off reference values have been related to muscle function and/or health risks. More recently the relationships between skeletal muscle mass and either fat mass, visceral adipose tissue (VAT) or bone mass came into the focus of discussion. This relates to the concept of functional body composition focusing on inflammation (which is related to the relation between skeletal muscle mass and fat mass or VAT) and/or osteoporosis and frailty (which is associated to the relation between skeletal muscle and bone mass). It is likely that future definitions of sarcopenia will include not only cut offs of muscle mass but also their associations with fat and bone masses and, thus, muscle and bone function and health risks.
R. Magierski (Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Poland) Evaluation of the influence of metabolic processes and body composition on cognitive functions: NutrDem Project.
Significant changes in body composition that have important health related effects may occur in the old age patients. Nutritional status, including body mass, hydratation and both micro- and macroelements are known factors related strongly to elderly health status. Cross-sectional studies have showed that demented older people have a lower body mass index (BMI) compared with cognitively intact older people. Moreover, in the demented cases both low weight and obesity have been associated with deterioration of functioning, poor quality of life and risk of numerous pathologies, including cognitive decline.
We assumed that nutritional status may serve as a proxy measure of well-being and quality of life of the demented elderly and be used as an end-point in the novel research projects.
The aim of the DemNutr Project held in our department is to determine the effect of dietary patterns, nutritional status, body composition (with an evaluation of visceral fat) and basic regulatory mechanisms of metabolism in elderly patients on cognitive functions and the risk of cognitive impairment.
Our first hypothesis is that the dietary patterns and diets used and the nutritional status has impact on cognitive performance and may be a risk factor for cognitive impairment. Secondly, it was assumed that the assessment of body composition, especially the measurement of visceral fat, may help in assessing the risk of cognitive impairment. Finally, it was assumed that the change in the nutritional status and a change in body composition may indicate a dysregulation of the fundamental mechanisms that regulate metabolism and may be a harbinger of dementia.
In order to verify our hypotheses, the use of number of specialized clinical and laboratory tests is planned. Type of dietary patterns and eating habits, risk of malnutrition, body composition and nutritional status will be evaluated. We decided to analyze body composition with different methods, including BIA and DXA in the group of demented elderly. Both techniques have been found to be more reliable as compared to standard methods in several clinical contexts. Quantitative measurements of neuropeptides that regulate energy homeostasis at the central and peripheral level will be done. Numerous biochemical blood parameters will be measured. Clinical tests comprising a psychiatric examination, an assessment of cognitive functions with computer battery, level of functioning and quality of life will be conducted.
M. Secher (University of Toulouse, France) Nutrition and Frailty: Introducing the Gerontopole Frailty Clinics.
The frailty syndrome: Frailty is a clinical state of vulnerability characterized by weakness and decreased physiologic reserve and it is a risk factor for adverse health outcomes including falls, dementia, institutionalization, functional decline and mortality. Frail older adults are less able to adapt to stressors such as acute illness or trauma. Although there is no consensual definition, Fried and col. have proposed clinical characteristics to differentiate “frail”, “pre-frail” and “robust” persons.
Association between nutrition and frailty: Poor nutrition has been identified as an influencing factor on the development of frailty. Three treatments appeared to be effective in decreasing the incidence and/or prevalence of frailty: Calorie and protein supplementation, Vitamin-D supplementation and Exercise. Interventional studies suggest that multi-domain approach (nutrition supplementation in combination with physical and cognitive exercise) can modify frailty risk
The “Gérontopôle” Frailty Clinic: In response to the French government’s policy, a Platform for Evaluation of Frailty and Prevention of Disability was established in 2011 at the “Gérontopôle” of Toulouse. Persons over 65-years-old are screened by general practitioners and are invited to undergo a multidisciplinary evaluation to identify potential risk factors for disability. Frail persons are then proposed for multidisciplinary interventions tailored to their needs.
D. Religa (Karolinska Institutet, Stockholm, Sweden) Better health for elderly with registry based studies in nutrition. SveDem, the Swedish Dementia Quality Registry
Registry based studies are a good tool to study the clinical reality of groups, such as elderly, who seldom participate in randomized trials. In Sweden there are almost a 100 registries such us the SeniorAlert general registry for elderly, RiksSvikt for heart failure and many others. The Swedish dementia register (SveDem) is a Swedish quality register for dementia disorders and is unique because it covers a large population of patients with wide range of dementia diagnoses. It is well known that weight loss is common in patients with dementia. We have therefore studied the BMI of 22 197 patients with early dementia with mean age of 79, 4 (SD 8) and mean MMSE 21(SD 5) using SveDem 2007-2013. Data from SveDem show a mean value of body mass index (BMI) of 24,8 (SD 4,4) kg/m2 indicating normal weight, but almost 30 percent of the participants in the registry had a BMI <22, a BMI that can signify nutritional problems among the elderly. This shows that it is important to calculate the BMI of patients with dementia early in the disease and follow BMI over time. One major problem with registry based studies is missing data. BMI is easy to calculate from weight and length, but it is often neglected and in our cohort of the 36 433 patients, missing data on BMI is almost 40%. Changes over time in BMI can be followed in SveDem, allowing the analysis of various interventions to prevent or slow weight loss in this large group of dementia patients. However, an effort should be made to minimize missing values.
J.V. Woodside (Queen’s University Belfast, UK) Mediterranean Diet interventions to prevent cognitive decline - opportunities and challenges.
Cognitive decline has a profound impact on the health and quality of life of older people and their caregivers. Exploring mechanisms to delay cognitive decline has become an urgent economic priority given the projected changes in population demographics. Systematic reviews and meta-analyses of observational studies suggest that adherence to a Mediterranean Diet (MD) is associated with reduced cognitive decline, but such an observation needs to be tested in randomised controlled trials.
It has been suggested that MCI may be the optimum stage at which to intervene with preventive therapies. However, little is known about attitudes to lifestyle behaviours such as diet and PA physical activity in people with MCI and whether there are specific factors that need to be considered when designing lifestyle behaviour change interventions in this group. We have conducted qualitative research with MCI patients and their caregivers to explore their attitudes to diet and making lifestyle changes. We also explored the attitudes of health professionals regarding the nature of the lifestyle advice currently given to MCI patients. The information provided informed the design and development of educational material to encourage MD adherence in MCI patients, which was then pilot tested in order to explore the format, acceptability and potential usefulness in helping to promote behaviour change in this patient group.
T. Kostka (Department of Geriatrics, Medical University of Lodz, Poland) Exercise, nutrition and quality of life in the elderly
The prevalence of overweight and obesity is increasing in elderly subjects. On the other hand, malnutrition concerns a great deal of subjects above the age of 65 years, especially in hospitalised and institutionalised older adults. Both trends have many adverse medical and economic consequences - correlate with the incidence of acute diseases and increased mortality. Therefore, it is necessary to systematically assess the nutritional state of the elderly. Among different methods and tools that may be used to assess nutritional state, one of the most popular tools used is the Mini Nutritional Assessment (MNA). Recently, health-related quality of life (HRQL), rather than mortality and morbidity, has emerged as the key goal for health promotion in the elderly. A sedentary lifestyle on one hand may enhance nutritional risk in the elderly, and on the other hand is considered to be an important contributor to the increasing prevalence of obesity. Advantageous influence of physical activity (PA) on HRQL in older subjects has also been evidenced. In the current study we review the literature data and present the results of the cross-sectional random survey carried out in central Poland. Data was consecutively collected during several research and educational projects coordinated by the Department of Geriatrics and Healthy Ageing Research Centre of the Medical University of Lodz. Respondents were community-dwelling individuals over 65 years of age living either in urban or in rural areas, and older subjects living in institutions. Though political and social transition in Central and Eastern Europe has been generally associated with an increased life expectancy, a significant East-West health gap is still apparent. This difference is also visible in the present study, with higher rates of malnutrition and being at risk as compared to Western populations, especially for rural and institutional environments.