Véronique Provencher

COGNITIVE FRAILTY: RATIONAL AND DEFINITION FROM AN (I.A.N.A./I.A.G.G.) INTERNATIONAL CONSENSUS GROUP

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on “Cognitive Frailty” was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a “Cognitive Frailty” condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called “cognitive frailty” as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

Do 6-y changes in eating behaviors predict changes in body weight? Results from the Québec Family Study

OBJECTIVE: This study was performed to examine changes in eating behaviors as assessed by the three-factor eating questionnaire (TFEQ) and to quantify the potential associations between these eating behaviors and body weight changes in a 6-follow-up study.DESIGN AND SUBJECTS: Prospective study performed in men and women who were tested twice (Visit 1=1989–1995 and Visit 2=6 y later) in the Québec Family Study (QFS).RESULTS: Women were more restrained and less hungry than men. To reduce food intake, women relied more on strategic dieting behavior and avoided more fattening food. However, they had higher emotional and situational susceptibility to eat than men. Significant decreases in the disinhibition score were noted over time in women (P<0.01), which resulted from a decrease in habitual susceptibility behavior to increase food intake. In men, we observed an increase in the avoidance of fattening food (P<0.05). In both genders, we found that the 6-y change in restraint behavior was negatively correlated with body weight changes (P<0.05). In women, a high restraint behavior seems to promote weight gain, whereas in men, it is associated with the opposite trend.CONCLUSION: These results suggest that variables reflecting some eating behaviors are associated with body weight changes in a free-living context. However, these behaviors are expressed differently between men and women. These behaviors should be considered in clinical interventions for individuals seeking a better body weight control.

Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention

BACKGROUND Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches. OBJECTIVE To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention. DESIGN Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006. PARTICIPANTS/SETTING Premenopausal overweight/obese women (n=144; mean age of 42.3+/-5.6 years), recruited from free-living, general community. INTERVENTION Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48). MAIN OUTCOME MEASURES Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost > or =1.2 k cal x kg(-1) x 15 minutes(-1) [> or =4.8 metabolic equivalents]). STATISTICAL ANALYSES PERFORMED Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design. RESULTS Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (-0.9+/-0.2 and -1.3+/-0.5, respectively) and the social support group (-0.4+/- 0.2 and -1.4+/-0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5+/-0.2 in HAES group vs 2.7 +/- 0.2 in social support group; susceptibility to hunger: 4.2+/-0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3+/-0.2 for situational susceptibility to disinhibition and 5.9+/-0.5 for susceptibility to hunger). CONCLUSIONS These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.

Short-term effects of a "Health-At-Every-Size" approach on eating behaviors and appetite ratings.

Objective: To assess the effects of a “Health‐At‐Every‐Size” (HAES) intervention on eating behaviors and appetite ratings in 144 premenopausal overweight women.

Psychobiological impact of a progressive weight loss program in obese men

Psychobiological effects associated with a progressive body weight loss may help to improve the understanding of psychological barriers to weight loss. We hypothesized that a moderate body weight loss (about 10% of initial body weight) is accompanied with some negative psychological impact. Four questionnaires [SF-36 Health Survey, Three-Factor Eating Questionnaire (TFEQ), Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI)] were administered at each phase of a body weight loss program that consisted of a supervised diet and exercise clinical intervention to 11 obese men (mean BMI = 33.4 kg/m(2), mean age = 38 yr). The three phases investigated were: 1) at the beginning of the intervention (baseline); 2) after 5 +/- 1 kg body weight loss (Phase 1); and 3) after 10 +/- 1 kg body weight loss (Phase 2). Using the SF-36 Health Survey, physical and mental health were shown to be significantly improved at Phase 1 (p < 0.05). The TFEQ showed that cognitive dietary restraint increased (p < 0.001), and both disinhibition (p < 0.05) and susceptibility to hunger (p < 0.05) were significantly reduced at both Phase 1 and 2 compared to baseline. Depression as measured by the BDI significantly increased at Phase 2 (p < 0.05) compared to baseline and Phase 1. However, the mean BDI scores observed remained below the cut-off point for likely clinical significance. Finally, the PSQI showed that sleep quality was significantly improved at Phase 1 compared to baseline (p < 0.01). Altogether, these results suggest that a substantial improvement in the psychobiological profile occurs with a 5-kg weight loss (Phase 1) but that with additional weight loss (Phase 2) a small, but significant increase in depression occurred and seems to be associated with the increase in rigid restraint of eating. However, prospective studies with a larger sample are needed to confirm and deepen these results.

Personality traits in overweight and obese women: Associations with BMI and eating behaviors

This study aimed at assessing the extent to which personality traits are related to BMI and eating behaviors in overweight and obese women (N=154; mean body mass index (BMI) of 30.5+/-3.0 kg/m(2)). The NEO Five-Factor Inventory was used to capture the five dimensions of personality (neuroticism, extraversion, openness to experience, agreeableness and conscientiousness). Anthropometric measurements (weight, height and BMI) were performed and eating behaviors (cognitive dietary restraint, disinhibition and susceptibility to hunger) were measured by the Three-Factor Eating Questionnaire. Regressional analyses showed that only conscientiousness was positively related to BMI. A higher level of neuroticism was identified as a significant predictor of higher scores for cognitive dietary restraint, disinhibition and susceptibility to hunger. Conscientiousness was also found to be a positive determinant of cognitive dietary restraint and a higher level of agreeableness predicted a lower score of susceptibility to hunger. Results also underline the presence of other psychological factors, i.e. dysphoria and body esteem, involved in the associations between personality traits and some eating behaviours. These findings suggest that particular dimensions of personality may contribute, either directly or through their association with other psychological factors, to a better understanding of weight and eating behaviors in overweight and obese women.

Eating behaviours, dietary profile and body composition according to dieting history in men and women of the Québec Family Study

The purpose of the present cross-sectional study was to compare eating behaviours (cognitive dietary restraint, disinhibition and susceptibility to hunger), dietary profile and physiological variables according to the practice of dieting: current dieting; history of dieting in the 10-year period that preceded the study; no dieting during the same period. Dieting history, anthropometric markers of adiposity, RMR, dietary profile (3 d food record) and eating behaviours (three-factor eating questionnaire) were determined in a sample of 244 men and 352 women. A greater proportion of women (31.8 %) than men (16.8 %) reported that they had been on a diet over the past 10 years (P=0.0001). In both genders, current and past dieters had a higher BMI (P<0.05) than non-dieters and current dieters had lower reported energy intakes than past dieters and non-dieters (only in women) (P<0.05). Current and past dieters also had higher scores for all eating behaviours and their subscales (P<0.05; except for susceptibility to hunger in men) compared with non-dieters (adjusted for age, reported energy intake, percentage of dietary fat, BMI and RMR). Moreover, for each dieting-history category, women had significantly higher scores for cognitive dietary restraint than men (P<0.05). In conclusion, the present study showed that current and past dieters had higher scores for cognitive dietary restraint and disinhibition compared with non-dieters. As disinhibition has previously been associated with a greater risk of subsequent weight gain, interventions aimed at preventing an increase in disinhibition may be promising for long-term weight maintenance.

Challenges and strategies pertaining to recruitment and retention of frail elderly in research studies: A systematic review

INTRODUCTION Recruitment and retention of frail elderly in research studies can be difficult. OBJECTIVE To identify challenges and strategies pertaining to recruitment and retention of frail elderly in research studies. METHODS A systematic review was conducted. Four databases (MEDLINE, CINAHL, AgeLine, Embase) were searched from January 1992 to December 2012. Empirical studies were included if they explored barriers to or strategies for recruitment or retention of adults aged 60-plus who were identified as frail, vulnerable or housebound. Two researchers independently determined the eligibility of each abstract reviewed and assessed the level of evidence presented. Data concerning challenges encountered (type and impact) and strategies used (type and impact) were abstracted. RESULTS Of 916 articles identified in the searches, 15 met the inclusion criteria. The level of evidence of the studies retained varied from poor to good. Lack of perceived benefit, distrust of research staff, poor health and mobility problems were identified as common challenges. The most frequently reported strategies used were to establish a partnership with staff that participants knew and trusted, and be flexible about the time and place of the study. However, few studies performed analyses to compare the impact of specific challenges and strategies on refusal or drop-out rates. CONCLUSIONS This review highlights the need to improve knowledge about the impact of barriers and strategies on recruitment and retention of frail older adults. This knowledge will help to develop innovative and cost-effective ways to increase and maintain participation, which may improve the generalizability of research findings to this population.

New learning in dementia : Transfer and spontaneous use of learning in everyday life functioning. Two case studies

The purpose of these two case studies was to explore the effectiveness of learning methods in dementia when applied in real-life settings and the integration of new skills in daily life functioning. The first participant, DD, learned to look at a calendar with the spaced retrieval method to answer his repeated questions about the current date and calls made to family. Progressive cuing was used by his wife to increase spontaneous use of the calendar, but DD had difficulty integrating the calendar into his routine. The second patient, MD, relearned a leisure activity (listening to music on a cassette radio) and how to participate in a social activity (saying the rosary in a group) with a combination of learning methods. Transfer of these skills in similar contexts was difficult for MD. She never integrated the cassette radio into her daily life routine but she went regularly to the rosary activity, which was cued by an alarm clock. In sum, the learning methods used were very effective with these patients but transfer and spontaneous use were difficult. Since these aspects are essential to rehabilitation, they should be further explored in order to increase the effectiveness of cognitive interventions.

Errorless-Based Techniques Can Improve Route Finding in Early Alzheimer's Disease: A Case Study

Topographical disorientation is a common and early manifestation of dementia of Alzheimer type, which threatens independence in activities of daily living. Errorless-based techniques appear to be effective in helping patients with amnesia to learn routes, but little is known about their effectiveness in early dementia of Alzheimer type. A 77-year-old woman with dementia of Alzheimer type had difficulty in finding her way around her seniors residence, which reduced her social activities. This study used an ABA design (A is the baseline and B is the intervention) with multiple baselines across routes for going to the rosary (target), laundry, and game rooms (controls). The errorless-based technique intervention was applied to 2 of the 3 routes. Analyses showed significant improvement only for the routes learned with errorless-based techniques. Following the study, the participant increased her topographical knowledge of her surroundings. Route learning interventions based on errorless-based techniques appear to be a promising approach for improving the independence in early dementia of Alzheimer type.