Tri Budi W. Rahardjo

High Tofu Intake Is Associated with Worse Memory in Elderly Indonesian Men and Women

Background/Aims: Cell culture studies suggest that phytoestrogens, abundant in soy products such as tempe and tofu, could protect against cognitive decline. Paradoxically, the Honolulu Asia Aging Study reported an increased risk for cognitive impairment and other dementia markers with high tofu (soybean curd) intake. Methods: A cross-sectional study was carried out in 2 rural sites (Borobudur and Sumedang) and 1 urban site (Jakarta) among mainly Javanese and Sundanese elderly (n = 719, 52–98 years of age). Memory was measured using a word learning test sensitive to dementia and soy consumption was assessed using Food Frequency Questionnaire items. Results: High tofu consumption was associated with worse memory (β = –0.18, p < 0.01, 95% CI = –0.34 to –0.06), while high tempe consumption (a fermented whole soybean product) was independently related to better memory (β = 0.12, p < 0.05, 95% CI = 0.00–0.28), particularly in participants over 68 years of age. Fruit consumption also had an independent positive association. The analyses were controlled for age, sex, education, site and intake of other foods. Conclusion: The results for tofu consumption as a risk factor for low memory function may tie in with the Honolulu Asia Aging Study data. It is unclear whether these negative associations could be attributed to potential toxins or to its phytoestrogen levels. Estrogen (through which receptors phytoestrogens can exert effects) was found to increase dementia risk in women over 65 years of age. Tempe contains high levels of phytoestrogens, but (due to fermentation) also exhibits high folate levels which may exert protective effects. Future studies should validate these findings and investigate potential mechanisms.

Phytoestrogens and cognitive function: a review

Neuroprotective effects of phytoestrogen compounds (found in soy) have been demonstrated in animal research and cell culture studies. In particular, phytoestrogens have been shown to reduce Alzheimers Disease (AD) related pathology, potentially alleviating risk of AD progression. In addition to their antioxidant properties, soy products also have the ability to affect cognition via interaction with estrogen receptors. However, observational studies and randomised controlled trials in humans have resulted in inconclusive findings within this domain. There are several possible reasons for these discrepant data. Studies which report no effect of phytoestrogens on cognition have mainly been carried out in European cohorts, with an average low dietary consumption. In contrast, investigation of Asian populations, with a higher general intake of tofu (a non-fermented soy product) have shown negative associations with cognitive function in those over the age of 65. Consideration of type of soy product is important, as in the latter sample, protective effects of tempe (fermented soy) were also observed. Limited data provide evidence that effects of phytoestrogens on cognition may be modified by dosage, duration of consumption and cognitive test used. Additionally, characteristics of the study population including age, gender, ethnicity and menopausal status appear to be mediating variables. Phytoestrogen treatment interventions have also shown time-limited positive effects on cognition. These findings are consistent with estrogen treatment studies, where initial positive short-term cognitive effects may occur, which reverse with long-term continuous use in elderly women. Well controlled, large scale studies are needed to assess the effects of phytoestrogens on the aging brain and provide further understanding of this association.

Microbial biofilms on facial prostheses

The composition of microbial biofilms on silicone rubber facial prostheses was investigated and compared with the microbial flora on healthy and prosthesis-covered skin. Scanning electron microscopy showed the presence of mixed bacterial and yeast biofilms on and deterioration of the surface of the prostheses. Microbial culturing confirmed the presence of yeasts and bacteria. Microbial colonization was significantly increased on prosthesis-covered skin compared to healthy skin. Candida spp. were exclusively isolated from prosthesis-covered skin and from prostheses. Biofilms from prostheses showed the least diverse band-profile in denaturing gradient gel electrophoresis (DGGE) whereas prosthesis-covered skin showed the most diverse band-profile. Bacterial diversity exceeded yeast diversity in all samples. It is concluded that occlusion of the skin by prostheses creates a favorable niche for opportunistic pathogens such as Candida spp. and Staphylococcus aureus. Biofilms on healthy skin, skin underneath the prosthesis and on the prosthesis had a comparable composition, but the numbers present differed according to the microorganism.

Tofu intake is associated with poor cognitive performance among community-dwelling elderly in China.

Tofu is a soy product which is commonly consumed in Asian countries, such as China and Indonesia. Several studies found negative associations of high tofu consumption with cognitive function in older Asian populations. However, the effect of tofu on cognitive function remains disputed as it was not found in Western populations. In the present study, the effect of weekly tofu intake on cognitive performance was investigated in an observational cross sectional study of 517 Chinese elderly from Shanghai. Similar to earlier studies, results showed that a higher weekly intake of tofu was associated with worse memory performance using the Hopkins Verbal Learning Test (β = -0.10, p = 0.01) after controlling for age, gender, education, being vegetarian, and weekly intake of fruit/juice, green vegetables, and orange/red vegetables. Furthermore, among older elderly (≥68 years of age), high tofu intake increased the risk of cognitive impairment indicative of dementia (OR = 1.27, 95% CI = 0.99-1.64, p = 0.04), after adjusting for all covariates. Consumption of meat and green vegetables independently also reduced risk of dementia. To conclude, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China. Similar findings were reported in Indonesia and in Japanese Americans in the US. These findings suggest that the effect of tofu on cognition in elderly should be further investigated.

The Hopkins Verbal Learning Test and Detection of MCI and Mild Dementia: A Literature Review

A decline in verbal memory is one of the primary symptoms found in amnestic Mild Cognitive Impairment (aMCI) and most types of dementia. To detect verbal memory impairment in clinical and research settings, the Hopkins Verbal Learning Test (HVLT) has been recommended. In the current paper, the utility of the HVLT for aMCI/mild dementia diagnostics, as well as its use in treatment studies is reviewed. The HVLT was considered to have good diagnostic accuracy, be well tolerated and applicable across cultures. Optimal cut-offs for MCI and mild dementia are discussed and their possible relation to demographic factors such as age, gender, ethnicity and education.

Tempereversed effects of ovariectomy on brain function in rats: Effects of age and type of soy product.

BACKGROUD The aims of this study were to analyze the differences in nutrient content and isoflavones in tempe flour and tofu flour, and to analyze the effect of tempe and tofu flour on cognitive function of female rats after ovariectomy. METHOD Seventy two (72) white female Sprague Dawley strain rats, aged 12 months were used for this study. Before the intervention 52 rats underwent ovariectomy (OVx) and they were grouped into 4 intervention groups: tempe flour (Tp), tofu flour (Tf), estradiol (E2), and casein as a control protein (Cs). The remaining 20 rats were classed as controls and had no ovariectomy (NO). Cognitive function was measured using a maze test. Oneway ANOVA with polynomial contrasts and post hoc LSD were used with a p-value<0.05 to indicate significance. RESULTS The content of nutrients (vitamin B6, vitamin B12, folic acid) and isoflavones (genistein) were all higher in tempe flour higher than in tofu flour. After 8 weeks, the Tp group had showed significantly increased cognitive function (P<0.05), while the Tf group, the E2 group and the Cs group also all had increased performance, but not significantly so (P>0.05). There was no change in scores in the NO group. CONCLUSIONS Intervention by tempe flour can increase cognitive function in female ovariectomized female rats. Further research should focus onother aspects of cognitive function and the content of amyloid plaques and neurotransmitter synthesis in the brain.

Risk Factors for Possible Dementia Using the Hopkins Verbal Learning Test and the Mini-Mental State Examination in Shanghai

Using a combination of the Hopkins Verbal Learning Test (HVLT) and the Mini-Mental State Examination (MMSE), we investigated the prevalence of possible dementia (DEM) in community-dwelling elderly in Shanghai. Subsequently, we investigated significant risk factors for DEM and generated a DEM self-checklist for early DEM detection and case management. We found that among a total of 521 participants using a HVLT cut-off score of <19 and a MMSE cut-off score of <24, a total of 69 DEM cases were identified. Risk factors, such as advanced age (≥68 years), low education (no or primary level), self-reported history of hypertension, and self-reported subjective memory complaints (SMC) were significantly predictive of DEM. The presence of ≥3 out of four of the above mentioned risk factors can effectively discriminate DEM cases from non-DEM subjects.

Gene promoter polymorphism of RUNX2 and risk of osteoporosis in postmenopausal Indonesian women

Objectives: Osteoporosis is a metabolic bone disease of reduced bone mass density (BMD) and elevated risk of fracture due to an imbalance in bone formation and resorption. The risk and incidence of osteoporosis increase towards advanced age, particularly in postmenopausal women, and the risk is known to be affected by the variation in the expression of the associated regulatory genes. This work aimed to clarify the impact of variation in RUNX2 (runt domain transcription factor 2), which is an osteoblast-specific transcription factor that normally stimulates bone formation and osteoblast differentiation, regarding single-nucleotide polymorphism within RUNX2 promoter (P1) and risk of osteoporosis in postmenopausal Indonesian women. Methods: Using DNA sampling from blood, the variation at the single-nucleotide polymorphism (-330, G→T, rs59983488) at the RUNX2 P1 promoter was investigated using polymerase chain reaction–restriction fragment length polymorphism for 180 consenting postmenopausal Indonesian women. The subjects were examined for bone mass density and classification to normal and those with osteopenia or osteoporosis by T-scoring with dual-energy X-ray absorptiometry. Chi-square testing and logistic regression were mainly used for statistical assessment. Results: The results showed a general trend with increased risk of osteoporosis associated with the genotype TT (mutant type) and the corresponding T allele of the tested polymorphism of RUNX2 promoter P1. The trend was, however, not significant in multivariate testing adjusted for age and time after menopause. Conclusion: To confirm the potential risk with TT genotype would require testing of a much larger sample of subjects. As the tested single-nucleotide polymorphism only represents one of the relevant candidate locations of RUNX2, the results are taken nevertheless to suggest an impact by overall RUNX2 variation in the risk of osteoporosis in Indonesian postmenopausal women.

A cross-sectional study of physical activity and health-related quality of life in an elderly Indonesian cohort

Introduction: Improving health-related quality of life (QoL) may have far-reaching clinical implications, and previous studies have shown associations between participation in physical activity and higher QoL. However, it is unclear which types of physical activity are particularly beneficial and how much of this relationship is explained by instrumental activities of daily living (IADL) following physical activity. Method: This observational study measured frequency of participation in several different physical activities and IADL scores in a large elderly, community-dwelling sample. Hierarchical regression analyses were used to assess relationships between these variables and self-rated QoL using the Medical Outcome Survey SF-36 questionnaire. Findings: Participation in walking was found to be associated with higher QoL ratings in older men and women. IADL scores were correlated with QoL ratings but only partially mediated the association between walking and QoL. Participation in other types of physical activity was not significantly associated with QoL ratings. Conclusion: Walking may be recommended alongside treatment for illness or disability due to its potential benefits to QoL and treatment outcomes. Further research should investigate the role of physical fitness in this relationship, to determine whether these findings can be replicated in different populations.

The Hopkins Verbal Learning Test: an in-depth analysis of recall patterns

ABSTRACT One of the earliest signs of dementia is memory issues and verbal word lists, such as the Hopkins Verbal Learning Test (HVLT), are successfully used for screening. To gain insight in how memory is affected in dementia, and to further improve the efficacy of the HVLT, in-depth analysis of the recall patterns of dementia cases and controls was conducted. Dementia cases and controls were matched for factors that can affect performance, such as age, gender and education level. Word frequency, syllable length, and orthographic neighbourhood size did not differ in the Indonesian version of the HVLT, nor did these characteristics affect recall. However dementia cases showed consistent and poor recall across the three trials; with the worst recall for the “human shelter” category and best recall for the “animals” category. Dementia cases also showed impaired accessibility of all categories with reduced subsequent recall from accessed categories and reduced primacy and recency levels. Finally, dementia cases exhibited lower levels of re-remembering and recalling new words, and higher levels of immediate forgetting and never recalling words. It was concluded that utilising the extra information provided by the in-depth analyses of the recall patterns could be beneficial to improve dementia screening.