Current Aging Science - Volume 11, Issue 4, 2018

Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000’s, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.

Prion diseases are a group of incurable infectious terminal neurodegenerative diseases caused by the aggregated misfolded PrPsc in selected mammals including humans. The complex physical interaction between normal prion protein PrPc and infectious PrPsc causes conformational change from the α- helix structure of PrPc to the β-sheet structure of PrPsc, and this process is repeated. Increased oxidative stress is one of the factors that facilitate the conversion of PrPc to PrPsc. This overview presents evidence to show that increased oxidative stress and inflammation are involved in the progression of this disease. Evidence is given for the participation of redoxsensitive metals Cu and Fe with PrPsc inducing oxidative stress by disturbing the homeostasis of these metals. The fact that some antioxidants block the toxicity of misfolded PrPc peptide supports the role of oxidative stress in prion disease. After exogenous infection in mice, PrPsc enters the follicular dendritic cells where PrPsc replicates before neuroinvasion where they continue to replicate and cause inflammation leading to neurodegeneration. Therefore, reducing levels of oxidative stress and inflammation may decrease the rate of the progression of this disease. It may be an important order to reduce oxidative stress and inflammation at the same time. This may be achieved by increasing the levels of antioxidant enzymes by activating the Nrf2 pathway together with simultaneous administration of dietary and endogenous antioxidants. It is proposed that a mixture of micronutrients could enable these concurrent events thereby reducing the progression of human prion disease.

Background: Transcranial Doppler Ultrasonography (TCD) can be utilised to measure the tight coupling of cerebral blood flow velocity (CBFv) in response to cognitive demand by task activation, termed neurovascular coupling. Aims: To investigate the differences in neurovascular coupling between healthy older (>50 years) and younger (18-49 years) adults in response to cognitive testing. Methods: Fifty-four older (n=25) and younger (n=29) adults underwent continuous bilateral TCD, beat-to-beat blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (ETCO2; capnography) monitoring. After a 5-min baseline period, memory (M1-4: recalling three learned words, learning a name and address, recalling US presidents and UK prime ministers, and recalling the previously learned name and address) and visuospatial (V1-4: drawing a cube and infinity diagram, drawing a clock face, counting dots, and recognising obscured letters) tasks from the Addenbrooke's Cognitive Examination (ACE-III) were performed. Data are mean (standard deviation). Results: In the memory paradigms, the peak percentage change in CBFv differed significantly between younger and older groups only in the dominant hemisphere during the M1 task, (2.17 (9.16)% vs. 8.38 (9.27)%, respectively, p=0.017). In the visuospatial paradigm, there were also significant differences in peak percentage change in CBFv between younger and older groups in the V1 (5.87 (8.32)% vs. 11.89 (6.60)%, p=0.005) and V2 tasks (6.30 (8.72)% vs. 11.30 (7.77)%, p=0.032). Conclusion: Healthy older adults demonstrate augmented cerebrovascular physiology in response to cognitive challenge compared to younger adults. The impact of abnormal ageing on cerebrovascular physiology, for example, related to cognitively impaired states, requires further investigation.

Background: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. Objective: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. Method: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. Results: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. Conclusion: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks.

Background: Prodromal Neurodegenerative Disease (ND) due to tauopathies such as Alzheimer’s Disease (AD) and Synucleinopathies (SN) such as Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB) present subtly. Although ND are considered cognitive disorders, in fact ND present with behavioral and even medical symptomatology years to decades prior to the onset of cognitive changes. Recognizing prodromal ND syndromes is a public health priority because ND is common, disabling and expensive. Diagnosing prodromal ND in real world clinical settings is challenging because ND of the same pathology can present with different symptoms in different people. Individual variability in nature and variability in nurture across the life course influence how ND pathology manifests clinically. The objective of this study was to describe how non-cognitive symptoms from behavioral, medical, neurological and psychiatric domains cluster in prodromal and early stages of ND. Methods: This was an observational study of patients receiving routine clinical care for memory disorders. All patients receiving a standardized evaluation including complete neurological history and examination and standardized brief neuropsychological testing. A Principal Component Analysis (PCA) considering emotion, motor, sensory and sleep factors was performed on the entire sample of patients in order to identify co-occurring symptom clusters. All patients received a consensus diagnosis adjudicated by at least two dementia experts. Patients were grouped into Cognitively Normal, Detectable Cognitive Impairment, and Mild Cognitive Impairment categories due to AD and/or PD/LBD or NOS pathology. Symptom cluster scores were compared between clinical diagnostic groups. Results: In this study 165 patients completed baseline neuropsychological testing and reported subjective measures of non-cognitive symptoms. Four syndrome specific symptom factors emerged and eight non-specific symptom factors. Symptoms of personality changes, paranoia, hallucinations, cravings, agitation, and changes in appetite grouped together into a cluster consistent with an "SN Non-motor Phenotype". Appetite, walking, balance, hearing, increased falls, and dandruff grouped together into a cluster consistent with an "SN Motor Phenotype". The Prodromal AD phenotype included symptoms of anxiety, irritability, apathy, sleep disturbance and social isolation. The fourth factor included symptoms of increased sweating, twitching, and tremor grouped into a cluster consistent with an Autonomic phenotype. Conclusion: Non-cognitive features can be reliably measured by self-report in busy clinical settings. Such measurement can be useful in distinguishing patients with different etiologies of ND. Better characterization of unique, prodromal, non-cognitive ND trajectories could improve public health efforts to modify the course of ND for all patients at risk.

Background: Age-related decrease in mitochondrial activity has been reported in several tissues. Reactive Oxygen Species (ROS) produced from defected mitochondria lead to aging and accumulate through time. However, studies about the mitochondrial DNA mutation level in blood are contradictory. Other lifestyle factors may modify the effects of age in post-mitotic tissues such as blood. The BMI represents the sum of the various lifestyle factors. Objective: We proposed that age, obesity and mtDNA deletion are three ROS producing factors, which may interact with each other and induce senescence. Methods: In a cross-sectional study, 172 male and female volunteers without known mitochondrial diseases were selected and the presence of common mitochondrial 4977bp deletion (ΔmtDNA4977) evaluated using Nested-PCR. Results: Our results showed that a high percentage of samples (54.06%) harbor common deletion in blood. Furthermore, both BMI and the ΔmtDNA4977 levels significantly decrease with age. The chronological age, BMI and ΔmtDNA4977 reciprocally affect each other. Conclusion: Our data suggest that age affects purifying selection and BMI, which may influence the relative level of the mtDNA common deletion in blood.

Background: Aging leads to changes in skeletal muscle quantity and quality and is accompanied with increase in body mass and fat mass, whereas fat-free mass either decreases or remains unchanged. The body composition of rodents has been an important factor for clinical trials in the laboratory. Glucocorticoids such as dexamethasone are widely used in clinical medicine, but may induce myopathy, characterized by muscle weakness, atrophy, and fatigue. In animals treated with glucocorticoids, a dose-dependent reduction of body weight has been observed. This weight loss is usually followed by muscle atrophy and a reduction of several muscle proteins, contributing to impaired muscle function. This study was designed to describe changes in body composition and BMC of 22-month-old rats during 10- and 20-day recovery period after 10-day dexamethasone administration. Method: Data on body mass, lean body mass, fat mass and bone mineral content of the rats were obtained with dual energy X-ray absorptiometry scan. Result: Significant reduction in body mass, lean body mass, fat mass and fast-twitch muscle mass was observed after dexamethasone treatment. Body mass, fat mass and fast-twitch muscle mass stayed decreased during 20 days after terminating the hormone administration; lean body mass reached the preadministration level after 20-day recovery period. There were no significant changes in bone mineral density during the recovery period. Dexamethasone treatment gradually reduced hindlimb grip strength that also stayed decreased during the 20-day recovery period. Conclusion: This study demonstrated that a 10-day period of overexprosure to glycocorticoids induced longlasting changes in old rats’ body composition and these values did not attain the baseline level even after 20-day recovery period.

Background: Pulse Wave Velocity (PWV) is the propagation speed of the wave-induced along the aorta and arterial tree, each time the heart beats. PWV increases with increased arterial stiffness, thus establishing it as a reliable prognostic marker for cardiovascular morbidity and mortality. On the other hand, Total Vascular Resistance (TVR) is the overall resistance offered by systemic circulation and pulmonary circulation. This resistance needs to be overcome in order to create the flow of blood through the circulatory system. The goal of this study was to investigate the influence of different cardiovascular factors on arterial stiffness and vascular resistance in CVD patient from eastern India population. Methods: Total of 782 patients with Cardiovascular Disease (CVD) like hypertension, Ischemic heart disease, Congestive cardiac failure and peripheral arterial disease were included to evaluate the cardiovascular hemodynamic and non-hemodynamic parameter by oscillometric method and investigated those factors on PWV and TVR in subjects of both sexes aged between 15 to 87 years. Results: The old age (> 55 years) was found to have greatest impact on PWV as compared with younger age group. Systolic Blood Pressure (SBP), Heart Rate (HR), augmentation pressure and Body Surface Area (BSA) had a positive association with the PWV. Augmentation Index and Body Mass Index (BMI) had a negative impact on the PWV. Conclusion: Despite the limitations, like unequal number of male and female participants, wide variation of the age of the subjects and analyzing association of many factors at a time, our large and community-based study show individual blood pressure and pulse pressure depending on complex interaction between large arteries and arterioles. This study sheds light on the relationship between proximal and distal part (PWV and TVR) of the arterial tree as well as their association with different hemodynamic and non-hemodynamic parameters.