Alessandro Ble

Hypercortisolemic depression is associated with the metabolic syndrome in late-life

INTRODUCTION Depression has been hypothesized to be associated with metabolic abnormalities which increase the risk of cardiovascular disease (CVD) and diabetes. Such a link could be due to increased HPA-axis activity. This study investigates the cross-sectional relationship between depression, urinary cortisol and metabolic syndrome in an older population. METHODS Data are from 867 participants of the InChianti Study, aged 65 years. Depressive symptoms were assessed using the CES-D scale; cortisol levels were determined in 24-h urine samples. Metabolic syndrome was defined as three or more of the following: abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure, and high fasting glucose. RESULTS Clinically relevant depressed mood (CES-D20) was present in 20.6% of the sample, and 24.5% had the metabolic syndrome. After adjustment for sociodemographics and health indicators, depression score (per SD increase: OR=1.20, 95% CI=1.02-1.41) and urinary cortisol level (per SD increase: OR=1.23, 95% CI=1.01-1.51) were significantly associated with presence of metabolic syndrome. There was, however, a significant interaction (p=0.003) between depressed mood and urinary cortisol in the probability of having metabolic syndrome. The odds of metabolic syndrome in persons with both depressed mood and urinary cortisol excretion in the highest tertile was 1.84 (95% CI=1.02-3.34) compared to persons with neither condition. DISCUSSION This study suggests a synergistic relationship between depression, cortisol and metabolic syndrome. Hypercortisolemic depression may constitute a specific risk group for the metabolic syndrome.

Association Between Hormones and Metabolic Syndrome in Older Italian Men

OBJECTIVES: To determine whether low levels of testosterone, sex hormone binding globulin (SHBG), insulin‐like growth factor‐1 (IGF‐1), and dehydroepiandrosterone sulfate (DHEAS) and high levels of cortisol and leptin would be associated with metabolic syndrome (MS).

Genetic polymorphisms in older subjects with vascular or Alzheimer's dementia

Objectives– Paraoxonase, angiotensin‐converting enzyme (ACE), methylenetetrahydrofolate reductase (MTHFR), and apo E gene polymorphisms were evaluated in older patients with vascular dementia (VD) or late‐onset Alzheimers disease (LOAD). Material and methods– Sixty patients with VD, 45 patients with LOAD, and 54 non‐demented controls were compared. Results– No differences in the distribution of paraoxonase, ACE, and MTHFR polymorphisms were found. The overall frequency of apo E ε4 allele was “low”; ε4 allele was more frequent in LOAD (17.5%) and VD (13.3%) compared with controls (9.2%), but the difference was not statistically significant. Conclusion– Paraoxonase, ACE, and MTHFR polymorphisms were not associated with VD or LOAD; these common polymorphisms might have a marginal role in the pathogenesis of dementia in older subjects. In spite of a “low” frequency of the apo E ε4 allele in our sample, the frequency of ε4 allele was about double in LOAD compared with controls.

Body Mass Index, Body Cell Mass, and 4‐Year All‐Cause Mortality Risk in Older Nursing Home Residents

Objectives: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all‐cause mortality in a sample of older nursing home residents.

The Relationship between Heart Rate Variability and Adiposity Differs for Central and Overall Adiposity

While frank obesity is associated with reduced HRV, indicative of poorer autonomic nervous system (ANS) function, the association between body mass index (BMI) and HRV is less clear. We hypothesized that effects of adiposity on ANS are mostly mediated by visceral fat and less by subcutaneous fat; therefore, centrally distributed adipose tissue, that is, waist circumference (WC), should be more strongly associated with HRV than overall adiposity (BMI). To examine this hypothesis, we used data collected in a subset of the Baltimore Longitudinal Study of Aging to compare strength of association between HRV and WC to that of HRV and BMI. Time domain HRV variables SDNN (standard deviation of successive differences in normal-to-normal (N-N) intervals) and RMSSD (root mean square of successive differences in N-N intervals) were calculated from 24-hour Holter recordings in 159 participants (29–96 years). Increasing WC was associated with decreasing SDNN and RMSSD in younger but not older participants (P value for WC-by-age interaction = 0.003). BMI was not associated with either SDNN or RMSSD at any age. In conclusion, central adiposity may contribute to sympathetic and parasympathetic ANS declines early in life.

Much more medicine for the oldest old: trends in UK electronic clinical records

Background: the oldest old (85+) pose complex medical challenges. Both underdiagnosis and overdiagnosis are claimed in this group. Objective: to estimate diagnosis, prescribing and hospital admission prevalence from 2003/4 to 2011/12, to monitor trends in medicalisation. Design and setting: observational study of Clinical Practice Research Datalink (CPRD) electronic medical records from general practice populations (eligible; n = 27,109) with oversampling of the oldest old. Methods: we identified 18 common diseases and five geriatric syndromes (dizziness, incontinence, skin ulcers, falls and fractures) from Read codes. We counted medications prescribed ≥1 time in all quarters of studied years. Results: there were major increases in recorded prevalence of most conditions in the 85+ group, especially chronic kidney disease (stages 3–5: prevalence <1% rising to 36.4%). The proportions of the 85+ group with ≥3 conditions rose from 32.2 to 55.1% (27.1 to 35.1% in the 65–84 year group). Geriatric syndrome trends were less marked. In the 85+ age group the proportion receiving no chronically prescribed medications fell from 29.6 to 13.6%, while the proportion on ≥3 rose from 44.6 to 66.2%. The proportion of 85+ year olds with ≥1 hospital admissions per year rose from 27.6 to 35.4%. Conclusions: there has been a dramatic increase in the medicalisation of the oldest old, evident in increased diagnosis (likely partly due to better record keeping) but also increased prescribing and hospitalisation. Diagnostic trends especially for chronic kidney disease may raise concerns about overdiagnosis. These findings provide new urgency to questions about the appropriateness of multiple diagnostic labelling.

Prescription of Antithrombotic Therapy in Older Patients Hospitalized for Transient Ischemic Attack and Ischemic Stroke: The GIFA Study

Background and Purpose— Antithrombotic therapy has been demonstrated as an effective tool for secondary ischemic stroke prevention. Nevertheless, scant data are available on actual prescription of this therapy in clinical practice. Methods— A total of 17 337 patients admitted to geriatric and internal medicine wards participating in the study in the 1993 to 1998 survey period were analyzed. Patients with coded diagnoses of ischemic stroke and transient ischemic attack (TIA) were selected. Data recorded included demographic and clinical characteristics and medication prescription during hospital stay and at discharge. Logistic regression analyses were used to identify conditions associated with the prescription of antiplatelet or anticoagulant drugs. Results— Among 946 patients with diagnosis of stroke or TIA (mean age 78 years), >40% was discharged without antithrombotic prescription. Conditions that made the prescription more unlikely were diagnosis of stroke (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.44 to 0.86), presence of anemia (OR: 0.70; 95% CI: 0.49 to 0.98), severe disability (OR: 0.48; 95% CI: 0.30 to 0.75), and cognitive impairment (OR: 0.58; 95% CI: 0.43 to 0.75). There was an independent and additive association of physical and cognitive status with antithrombotic therapy prescription. Conclusions— A high rate of patients affected by stroke or TIA are discharged from the hospital without antithrombotic therapy. The most important correlates of the likelihood of not receiving an antithrombotic medication were cognitive and functional status.

Lipoprotein profile in older patients with vascular dementia and Alzheimer's disease

BackgroundSome alterations of the lipoprotein profile have been associated with cerebrovascular disease. Recently, it has been suggested that cerebrovascular disease might play a role in the pathogenesis of both vascular dementia (VD) and Alzheimers disease (AD). Nevertheless, the possible association of dyslipidemias with VD or AD is still a controversial issue.MethodsWe investigated the lipoprotein profile in 100 older patients with vascular dementia (VD; n°: 60) or Late Onset Alzheimers Disease (LOAD; n°: 40). The patients were compared with 54 community dwelling non-demented older controls.ResultsAfter adjustment for functional status, blood sedimentation rate, and serum albumin levels, no differences in lipoprotein profile emerged between the three groups, with the exception of HDL-C that was lower in VD compared with controls. Low HDL-C (< 45 mg/dL) was associated with VD (O.R.: 6.52, C.I. 95%: 1.42–30.70 vs controls, and 4.31, C.I. 95%: 0.93–19.82 vs LOAD), after multivariate adjustment. No differences in plasma lipid levels emerged between the three groups after stratification for apo E4 genotype.ConclusionsIn this cross-sectional study low HDL-C levels are associated with VD, but not with LOAD, in a sample of older subjects.

High-Density Lipoprotein Cholesterol and Objective Measures of Lower Extremity Performance in Older Nondisabled Persons: The InChianti Study

OBJECTIVES: To evaluate the independent association between high‐density lipoprotein cholesterol (HDL‐C) levels and objective measures of lower extremity performance.

Omega-6 and omega-3 fatty acids predict accelerated decline of peripheral nerve function in older persons

Pre‐clinical studies suggest that both omega‐6 and omega‐3 fatty acids have beneficial effects on peripheral nerve function. Rats feed a diet rich in polyunsaturated fatty acids (PUFAs) showed modification of phospholipid fatty acid composition in nerve membranes and improvement of sciatic nerve conduction velocity (NCV). We tested the hypothesis that baseline plasma omega‐6 and omega‐3 fatty acids levels predict accelerated decline of peripheral nerve function. Changes between baseline and the 3‐year follow‐up in peripheral nerve function was assessed by standard surface ENG of the right peroneal nerve in 384 male and 443 female participants of the InCHIANTI study (age range: 24–97 years). Plasma concentrations of selected fatty acids assessed at baseline by gas chromatography. Independent of confounders, plasma omega‐6 fatty acids and linoleic acid were significantly correlated with peroneal NCV at enrollment. Lower plasma PUFA, omega‐6 fatty acids, linoleic acid, ratio omega‐6/omega‐3, arachidonic acid and docosahexanoic acid levels were significantly predicted a steeper decline in nerve function parameters over the 3‐year follow‐up. Low plasma omega‐6 and omega‐3 fatty acids levels were associated with accelerated decline of peripheral nerve function with aging.