Omar Jaluul

Nutritional status of selenium in Alzheimer's disease patients

Studies have shown that various antioxidants are decreased in different age-related degenerative diseases and thus, oxidative stress would have a central role in the pathogenesis of many disorders that involve neuronal degeneration, including Alzheimers disease (AD). The present study aimed to assess the nutritional status of Se in AD patients and to compare with control subjects with normal cognitive function. The case-control study was carried out on a group of elderly with AD (n 28) and compared with a control group (n 29), both aged between 60 and 89 years. Se intake was evaluated by using a 3-d dietary food record. Se was evaluated in plasma, erythrocytes and nails by using the method of hydride generation atomic absorption spectroscopy. Deficient Se intake was largely observed in the AD group. AD patients showed significantly lower Se levels in plasma, erythrocytes and nails (32.59 microg/l, 43.74 microg/l and 0.302 microg/g) when compared with the control group (50.99 microg/l, 79.16 microg/l and 0.400 microg/g). The results allowed us to suggest that AD has an important relation with Se deficiency.

Influence of education and depressive symptoms on cognitive function in the elderly

OBJECTIVE The purpose of the present study was to investigate the influence that education and depression have on the performance of elderly people in neuropsychological tests. METHODS The study was conducted at the Institute of Psychiatry, University of São Paulo School of Medicine, Hospital das Clínicas. All of the individuals evaluated were aged 60 or older. The study sample consisted of 59 outpatients with depressive disorders and 51 healthy controls. We stratified the sample by level of education: low = 1-4 years of schooling; high = 5 or more years of schooling. Evaluations consisted of psychiatric assessment, cognitive assessment, laboratory tests and cerebral magnetic resonance imaging. RESULTS We found that level of education influenced all the measures of cognitive domains investigated (intellectual efficiency, processing speed, attention, executive function and memory) except the Digit Span Forward and Fuld Object Memory Evaluation (immediate and delayed recall), whereas depressive symptoms influenced some measures of memory, attention, executive function and processing speed. Although the combination of a low level of education and depression had a significant negative influence on Stroop Test part B, Trail Making Test part B and Logical Memory (immediate recall), we found no other significant effects of the interaction between level of education and depression. CONCLUSION The results of this study underscore the importance of considering the level of education in the analysis of cognitive performance in depressed elderly patients, as well as the relevance of developing new cognitive function tests in which level of education has a reduced impact on the results.

Quality of life and multimorbidity of elderly outpatients.

INTRODUCTION: Substantial medical research has established an inverse relationship between quality of life and illness. However, there exists minimal evidence for such a connection in the context of stable and controlled diseases. OBJECTIVE: We wished to correlate multimorbidity with quality of life for elderly patients who suffer from stable chronic diseases. METHODS: We used a tool to evaluate quality of life, namely World Health Organization quality of life-BRIEF, together with a scale of multimorbidity known as the Cumulative Illness Rating Scale - Geriatric Version. Furthermore, the quality of life data were correlated with scores recorded on the Cumulative Illness Rating Scale - Geriatric Version, the number of drugs used, and individual perceptions of health and age. RESULTS: We studied 104 elderly patients who suffered from chronic diseases. The patients had exhibited neither acute events nor secondary complications, their cognition was intact, and they were functionally independent. The Cumulative Illness Rating Scale - Geriatric Version showed an inverse correlation with the physical domain (p= 0.008) and a tendency toward an inverse correlation with the psychological domain (p= 0.052). Self-perception of health showed a high correlation with the physical domain (p= 0.000), psychological domain (p= 0.000) and environmental domain (p= 0.000). The number of drugs used correlated only with the physical domain (p= 0.004). Age and social domain showed a tendency toward a positive correlation (p= 0.054). DISCUSSION: We uncovered an inverse relationship between quality of life and multimorbidity in a group of patients who suffered from stable chronic diseases, with no functional limitations, pain or complications. Our data suggest that a patient’s knowledge that they have a certain clinical condition changes their subjective assessment of quality of life in the related domain. CONCLUSION: The perceived quality of life of the sample was affected by multimorbidity in the physical domain, with a tendency toward commensurate effects in the psychological domain.

Effect of temporal lobe structure volume on memory in elderly depressed patients.

OBJECTIVE To compare the volume of the hippocampus and parahippocampal gyrus in elderly individuals with and without depressive disorders, and to determine whether the volumes of these regions correlate with scores on memory tests. METHOD Clinical and demographic differences, as well as differences in regional gray matter volumes, were assessed in 48 elderly patients with depressive disorders and 31 control subjects. Brain (structural MRI) scans were processed using statistical parametric mapping and voxel-based morphometry. Cognitive tests were administered to subjects in both groups. RESULTS There were no between-group gray matter volume differences in the hippocampus or parahippocampal gyrus. In the elderly depressed group only, the volume of the left parahippocampal gyrus correlated with scores on the delayed naming portion of the visual-verbal learning test. There were also significant direct correlations in depressed subjects between the volumes of the left hippocampus, right and left parahippocampal gyrus and immediate recall scores on verbal episodic memory tests and visual learning tests. In the control group, there were direct correlations only between overall cognitive performance (as assessed with the MMSE) and the volume of right hippocampus, and between the total score on the visual-verbal learning test and the volume of the right and left parahippocampal gyrus. CONCLUSIONS These findings highlight different patterns of relationship between cognitive performance and volumes of medial temporal structures in depressed individuals and healthy elderly subjects. The direct correlation between delayed visual-verbal memory recall scores with left parahippocampal volumes specifically in elderly depressed individuals provides support to the view that depression in elderly populations may be a risk factor for dementia.

Glutathione Peroxidase 1 Pro198Leu Polymorphism in Brazilian Alzheimer's Disease Patients: Relations to the Enzyme Activity and to Selenium Status

Background/Aims: Oxidative stress plays a central role in Alzheimer’s disease (AD). Pro198Leu cytosolic glutathione peroxidase (GPx1) polymorphism seems to be associated with a lower activity of this enzyme, but there are no studies with AD patients. Thus, the aim was to determine the frequency of the GPx1 Pro198Leu polymorphism in AD patients and to verify its relation to glutathione peroxidase (GPx) activity and selenium (Se) status. Methods: The study was carried out in a group of AD elderly (n = 28) compared to a control group (n = 29). Blood Se concentrations were measured through hydride generation atomic absorption spectroscopy. GPx activity was determined using a commercial kit, and the polymorphism using amplified DNA sequencing. Results: The distribution of genotypes was not different between groups. The variant allele frequency was 0.179 (AD group) and 0.207 (control group). Although no differences regarding GPx activity were found between individuals with different genotypes, lower blood Se levels were found in Pro/Pro AD patients compared to Pro/Pro control subjects, which was not found in the Pro/Leu groups. Moreover, the association between the erythrocyte Se concentration and GPx activity was affected by the Pro198Leu genotype. Conclusions: Results indicate that this polymorphism had apparently affected Se status in AD patients and that more studies in this field are necessary.

THE SHORT-TERM MEMORY BINDING TEST DIFFERENTIATES ELDERLY WITH SUBJECTIVE COGNITIVE DECLINE FROM HEALTHY CONTROLS IN A BRAZILIAN COHORT

Swing Time (s) 0.022524 0.008446 0.013697 Stance Time (s) 0.02011 0.003952 0.01898 Double Support Time (s) 0.137795 0.012415 0.074738 Stride Time (s) 0.011896 0.003264 0.009942 Step Time (s) 0.013079 0.003247 0.010186 Cadence (steps/min) 0.01376 0.003583 0.010019 Swing Period (%) 0.299833 0.103909 0.128888 Stance Period (%) 0.299833 0.103909 0.128888 Double Support Period (%) 0.248642 0.073979 0.190587 0 Gait Speed (m/s) 0.016868 0.002813 0.002633 1 CVof Swing Time (%) 0.213179 0.222785 0.011888 2 CVof Stance Time (%) 0.515457 0.072578 0.092257 3 CVof Double Support Time (%) 0.763278 0.100174 0.949687 Adalberto Studart Neto, Natalia Cristina Moraes, Mario Amore Cecchini, Sr., Jacy Bezerra Parmera, Raphael Ribeiro Spera, Omar Jaluul, Monica Sanches Yassuda, Mario Alfredo Parra, Sonia Maria Dozzi Brucki, Ricardo Nitrini, Medical School of University of S~ao Paulo, S~ao Paulo, Brazil; University of Sao Paulo, School of Medicine, Sao Paulo, Brazil; University of S~ao Paulo, S~ao Paulo, Brazil; University Heriot-Watt, Edinburgh, United Kingdom. Contact e-mail: adalbertostudartneto@gmail.com

Oral infections, comorbidities and sensory evidences in elderly: Cross-sectional study

BACKGROUND Oral infections affect the general health and overlap with chronic diseases due to infectious-immune mechanisms. On the other side, sensory abnormalities may be symptoms of this association. OBJECTIVE To evaluate the prevalence of oral infections, comorbidities, health parameters and sensory abnormalities in elderly patients. METHODS Thirty (30) elderly with mean age 70.4 yo, distributed according to ages were evaluated with a protocol that included demographics, comorbidities, medications, laboratory tests, blood pressure, heart rate, mini-mental state examination, clinical oral evaluation and systematized sensory testing (gustative, olfactory, thermal, mechanical and pain thresholds). Data were tabled and statistically analyzed. RESULTS Twenty-three (76.6%) subjects had chronic diseases that increased according to the age. Seventeen (56.7%) elderly were having medication. Mean probing pocket depth was 1.90mm±0.39mm, mean clinical attachment level was 0.76mm±0.54mm and mean gingival bleeding index was 29.10%±29.05%. All periodontal indexes increased with age (p <0.05) and were associated with comorbidities and use of medication. Patients with chronic diseases had more numbness and pricking sensations (p=0.031; p=0.000). Main sensory findings were: abnormal gustative and vibratory thresholds, which were associated with hematological parameters (blood count, cholesterol levels and glycaemia). Periodontal parameters were associated with facial cold threshold (p=0.000). CONCLUSION This study showed an association between systemic diseases, periodontal indexes and sensory thresholds. Sensory findings were associated with blood parameters and are potential tools for periodical health evaluation. Inflammatory or neural mechanisms need further investigation.

Can cognitive deficits predict remission in late life depression disorder

participants were prevented from viewing the start point from any point by carefully chosen locations. The angle deviation from the correct response at each point was recorded and analyzed. Results:The angle deviation showed difference among three groups at point 3 (p1⁄40.017), point 4 (p1⁄40.000) and point 5 (p1⁄40.000). Post hoc analysis showed that the performance of PI differentiates AD from non-AD at point 4 and point 5. It also showed that the angle deviations at point 4 are correlated with all components of the QuENA, namely landmark agnosia, egocentric disorientation, heading disorientation and inattention, while that at point 5 with components of landmark agnosia and heading disorientation. No correlation was found between the perfusion deficit and angle deviation at any point. Conclusions: The relationship between the brain dysfunction and the performance of PI is more complex as previously thought. More in-depth design and careful interpretation are in need to develop a new tool for helping diagnosis of the MCI and monitoring the progress of AD.