This study aimed to compare postural control without or with dual task, in patients over 65 years,depending on the degree of arterial stiffness, measured using the carotid-femoral pulse. Sway path traveled and surface covered by the center of foot pressure were measured on a forceplatform in different postural conditions, i.e. eyes open, eyes closed and eyes open with a dual task, allowing to calculate the length function of surface (LFS), this ratio providing information about the precision (surface) of postural control and the effort made (length) by the participant. After an age-adjustment, LFS was higher in participants with high pulse wave velocity in different postural conditions especially dual task condition. The difficulties in maintaining the equilibrium under a dual task condition being more pronounced inpeople with increased arterial stiffness, it is necessary to avoid or to limit its aggravation to reduce the number offalls, one of the main causes of mortality in the elderly. Arterial stiffness generates vascular alterations that may cause balance disorders and falls. This study aimed to investigate the possible link between arterial stiffness and postural control under different sensorial conditions in patients over 65 years. Carotid-femoral pulse wave velocity (PWV) was measured in 47 participants aged over 65 years to evaluate their arterial stiffness (high PWV). Twenty-seven participants (mean age = 70.52 ± 4.02 years, 22 females) had a normal PWV (< 10 m s−1) and 20 participants (mean age = 75.93 ± 6.11 years; 15 females) had a high PWV (≥ 10 m s−1). Postural control was evaluated using a force platform in four postural conditions: eyes open (EO) 1, eyes closed (EC), eyes open with a dual task (DT) and eyes open again (EO2). Using sway path traveled and surface covered by the center of foot pressure, we calculate the length function of surface (LFS). This ratio provides information about the precision (surface) of postural control and the effort made (length) by the subjects. After an age-adjustment, LFS was lower in EO than in EC and DT in both groups (p ≤ 0.001). LFS was higher in participants with high PWV both in eyes open and eyes closed conditions (p < 0.05). LFS increased when PWV increased in EO (p < 0.01) and EC conditions (p < 0.001) but not when a dual task was performed. Difficulties in maintaining equilibrium under a dual-task condition are more pronounced in people with increased arterial stiffness. These data suggest that understanding of the influence of the arterial stiffness level on specific balance control parameters could contribute to propose better balance-oriented rehabilitation programs in older adults in an attempt to prevent fall.

Objectives: The longitudinal ADELAHYDE-2 study aims to identify the factors associated with cognitive impairment/decline and white matter hyperintensities burden.Methods: Longitudinal single-center study comprising two visits separated by approximately 7 years. A total of 131 patients completed the two visits. The primary outcome was global memory composite scale, while the secondary outcome was white matter hyperintensities (WMH/Fazekas scale) load.Results: Global memory at visit 2 (V2) was largely influenced by age, smoking status, glycated hemoglobin, and history of stroke already present at visit 1 (V1). These variables accounted for similar to 51% of the memory alterations at V2. WMH at V2 was likely influenced by age, left ventricular hypertrophy, diabetes mellitus, carotid intima-media thickness, and body mass index at V1. These findings accounted for similar to 37% of the WMH changes at V2. Increase in pulse wave velocity from V1 to V2 showed a trend for association with memory deterioration (adjusted estimates = 0.06; P =.067), whereas smoking and increase in systolic blood pressure (trend) were associated with an increment in WMH (adjusted estimates = 0.49; P =.047 and adjusted estimates = 0.01; P =.08, respectively). On the other hand, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and statins (trend) were likely to be protective (adjusted estimates for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers = 0.49; P =.049, and adjusted estimates for statins = -0.46; P =.055).Conclusions: Several readily identifiable factors are associated with memory deterioration and WMH, many of which are potentially modifiable. Interventions aimed to control these risk factors need to be tested prospectively in order to assess their cognitive protective value. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Objective: Previous studies have shown that Diabetes mellitus (DM) is associated with an increased risk of cognitive impairment, but little data is available on Arabic populations, inspite of their remarkably high prevalence of DM. In this study we attempt to study the effect of DM on cognitive performance in middle-aged and elderly patients. Design: Observational cross sectional study. Setting: Outpatient clinics in King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Participants: The study included 241 volunteers aged 59.6 ± 9.2 years; 171 outpatients with DM, matched with 70 controls without. Measurements: Volunteers underwent cognitive assessment using the Montreal Cognitive Assessment Test (MoCA) and the Rowland Universal Dementia Assessment Scale (RUDAS). Results: RUDAS score was poorer in diabetics (25,25 ± 2,78 vs. 26,71 ± 2,57 in controls; p<0.0001) who are more likely to have cognitive impairment 16% , than those who are not diabetics 3%; p=0.004. This association was confirmed in multivariate analyses and shown to be independent of female gender and low education level, all of which were associated with worse RUDAS cognitive score.The results were not significant when the MoCA was used, as 85 % of the cases and 78 % of the controls had abnormal results;p=0.194.Among diabetics, there was no statistically significant effect found for glycemic control or DM duration on either one of the tests.The prevalence of obesity was similar in the two groups with 63% in diabetics and 62% in controls. Conclusion: In our population with an alarming prevalence of obesity, diabetes was associated with poorer cognitive performance independent of female gender or low education level, drawing attention to this under-recognized problem of cognitive impairment that could result in significant health and social problems, particularly in areas with high diabetes prevalence. RUDAS was found to be a very reasonable and convenient test to assess cognition in our sample characterized by a low educational level.

Vascular aging is accompanied by gradual remodeling affecting both arterial and cardiac structure and mechanical properties. Hypertension is suggested to exert pro-inflammatory actions enhancing arterial stiffness.

Short leukocyte telomere length (LTL) is associated with atherosclerosis in adults and diminished survival in the elderly. The prevailing view is that LTL is associated with accelerated aging since it serves as a biomarker of the cumulative burden of inflammation and oxidative stress during adult life. LTL dynamics are defined by LTL at birth, which is highly variable, and its age-dependent attrition thereafter, which is rapid during the first 20 years of life. We examined whether age-dependent LTL attrition during old age can substantially affect individuals’ LTL ranking (e.g., longer or shorter LTL) in relation to their peers and which clinical, lifestyle or genetic factors can predict it. We measured LTL by Telomeric Restriction Fragment Southern Blot (TRF) in samples donated 8 years apart on average by 76 participants of the ADELAHYDE study. Participants were men and women aged 60 to 85 years with a history of hypertension at the inclusion. We observed a mean LTL attrition of 27 bp per year which is consistent with previous data on telomere attrition in adults. No clinical, lifestyle or genetic factors seem to exert significant effect or can predict LTL attrition in elderly people. We observed a close relationship (r=0.88, figure left panel) between baseline and follow-up LTL values. Ranking individuals by quintiles revealed that 98.6% showed no rank change (59.7%) or one quintile change (38.9%) over time (figure right panel). We conclude that in elderly people, LTL is virtually anchored to a given rank with the passage of time. Accordingly, the links of LTL with atherosclerosis and longevity appear to be established early in life. It is therefore unlikely that lifestyle and its modification during old age exert a major impact on LTL ranking.

Objective: Short leukocyte telomere length (LTL) is associated with atherosclerosis in adults and diminished survival in the elderly. The prevailing view is that LTL is associated with accelerated aging since it serves as a biomarker of the cumulative burden of inflammation and oxidative stress during adult life. However LTL dynamics are mainly defined by LTL at birth, which is highly variable, and its age-dependent attrition thereafter, which is rapid during the first 20 years of life. We examined whether age-dependent LTL attrition during old age can substantially affect individuals’ LTL ranking (e.g., longer or shorter LTL) in relation to their peers and which clinical (presence or absence of atheroma) or lifestyle (BMI and smoking) factors can predict it. Design and method: We measured LTL by Telomeric Restriction Fragment Southern Blot (TRF) in samples donated 8 years apart on average by 76 participants of the ADELAHYDE study. Participants were men and women aged 60 to 85 years with a history of hypertension at the inclusion. Results: We observed a mean LTL attrition of 27 bp per year which is consistent with previous data on telomere attrition in adults. No clinical or lifestyle risk factors seem to exert significant effect or can predict LTL attrition in elderly people. We observed a close relationship (r = 0.88) between baseline and follow-up LTL values. Ranking individuals by deciles revealed that 87.5% showed no rank change (38.9%) or only one decile change (48.6%) over time. We observed relationships between baseline values of LTL and BMI as well as between LTL and carotid atheroma. No such relationship was observed between LTL and smoking status. Conclusions: We conclude that in elderly people, LTL ranking changes very little over time. Accordingly, the links of LTL with atherosclerosis and longevity appear to be established early in life. It is therefore unlikely that lifestyle and its modification during old age exert a major impact on telomere length.

Objective: Several studies have highlighted a link between vascular alterations and cognitive decline. The PARTAGE study showed that arterial stiffness as evaluated by carotid-femoral pulse wave velocity (cfPWV) was associated with a more pronounced cognitive decline over a 1-year period in very old frail institutionalized subjects. The aim of the present analysis was to assess the role of hemodynamic parameters such as blood pressure (BP), heart rate (HR), cfPWV and central/peripheral Pulse Pressure Amplification (PPA) on cognitive decline over a period of 2 years in very old frail subjects. Design and method: 682 subjects from the PARTAGE study cohort, aged >80 years (mean age at inclusion: 87.5 ± 5 y) and living in French and Italian nursing homes, were analyzed. MMSE score was assessed at baseline (BL) and at the end of the first and second year of follow-up (2y-FU). Subjects with a decrease in MMSE of >=3 points between BL and 2y-FU were considered as “decliners”. cfPWV and PPA at baseline were assessed with an arterial tonometer. Results: After adjustment for baseline MMSE, HR, BMI, age, education level and ADL, cfPWV was higher and PPA lower in “decliners” compared to “non-decliners, while BP did not differ between the 2 groups. Logistic multivariate analysis also revealed that high cfPWV, low PPA, high HR and low ADL were all determinants of MMSE decline. (Figure: Analysis of baseline factors associated with “decliners” status using multiple logistic regression model). Figure. No caption available. Conclusions: This 2-year longitudinal study in very old institutionalized individuals shows that arterial stiffness and high heart rate enabled to identify subjects at higher risk of cognitive decline, while blood pressure alone did not appear to have a significant predictive value. These findings highlight the contribution of vascular determinants in cognitive decline even in this very old population.

Objectives Several studies have highlighted a link between vascular alterations and cognitive decline. The PARTAGE study showed that arterial stiffness as evaluated by carotid-femoral pulse wave velocity (cfPWV) was associated with a more pronounced cognitive decline over a 1-year period in very old frail institutionalized individuals. The aim of the present analysis was to assess the role of hemodynamic parameters, such as blood pressure (BP), heart rate (HR), cfPWV, and central/peripheral pulse pressure amplification (PPA) on cognitive decline over 2 years in very old frail individuals. Methods A total of 682 individuals from the PARTAGE study cohort, aged older than 80 years (mean age at inclusion: 87.5 ± 5.0 years) and living in French and Italian nursing homes, were analyzed. Mini-Mental State Examination (MMSE) score was assessed at baseline (BL) and at the end of the first and second year of follow-up (2y-FU). Those with a decrease in MMSE of 3 or more points between BL and 2y-FU were considered as "decliners." The cfPWV and PPA at baseline were assessed with an arterial tonometer. Results After adjustment for baseline MMSE, HR, body mass index, age, education level, and activities of daily living (ADLs), cfPWV was higher and PPA lower in "decliners" compared with "nondecliners," whereas BP did not differ between the 2 groups. Logistic multivariate analysis also revealed that high cfPWV, low PPA, high HR, and low ADLs were all determinants of MMSE decline. Conclusion This 2-year longitudinal study in very old institutionalized individuals shows that arterial stiffness and high HR enabled us to identify subjects at higher risk of cognitive decline, whereas BP alone did not appear to have a significant predictive value. These findings highlight the contribution of vascular determinants in cognitive decline even in this very old population.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

The prevailing view in telomere epidemiology is that leukocyte telomere length (LTL) is associated with atherosclerosis since it serves as a biomarker of inflammation and oxidative stress during adult life. Our recent results however, indicate that telomere length (TL) is mainly determined at birth and childhood. Since short telomeres antecede atherosclerosis, we hypothesize that TL is not just a marker, but a determinant of arterial aging. This hypothesis cannot be tested by measurements of LTL alone, LTL reflecting TL at birth and its age-dependent attrition. We propose a model that examines different elements of TL dynamics in different tissues: leukocytes, skeletal muscle, adipose tissue and skin in patients with or without atherosclerosis. The method for TL measurement in epidemiologic studies is Telomeric Restriction Fragment Southern Blot (TRF). It requires high quality telomeric DNA therefore DNA extraction step is very important. Telomeric DNA is sensible to degradation and variations in extraction protocol can result in differences in TRF measurement. There are several DNA extraction protocols according to origin of extracted tissue. Since extraction method can influence TL and we want to compare TL between tissues, we have to choose one protocol giving high quality DNA with the 4 tissues. Three protocols were tested: phenol/chloroform/ isoamyl alcohol extraction, Miller salting out procedure and Qiagen Puregene kit. Two type of tissue grinding were also tested: automatic bead grinder and manual grinding in liquid nitrogen. Concentrations of DNA obtained were quantified by spectrophotometry at 260 nm, contaminations with proteins and solvents by 260/280 and 260/230 ratios. DNA were checked for integrity on agarose gel and TL measured by TRF method.Quality of DNA obtained with different protocols and TRF measurement make us choose phenol extraction and nitrogen grinding despite their drawbacks, time consumption for nitrogen grinding and toxicity for phenol.

Les nouvelles technologies sont de plus en plus presentes dans le quotidien et commencent a integrer le milieu medical, pour les professionnels de sante mais egalement pour les patients. Des connaissances considerables ont d'ailleurs ete acquises dans ce domaine et notamment en lien avec l'utilisation des tests neuropsychologiques. Cependant, un besoin subsiste dans le developpement de ces outils neuropsychologiques fournissant une analyse en temps reel des fonctions cognitives chez la personne âgee. Bien qu'a ce jour aucune etude n'ait fait rapport d'une utilisation de l'eye-tracker comme outil d'aide a l'interpretation dans la pratique neuropsychologique, cette methode nous a semble etre un choix judicieux pour le developpement des outils psychometriques de nouvelle generation en Geriatrie. On notera que l'analyse des mouvements oculaires par l'eye-tracker est une methode non invasive et validee comme aide diagnostique dans differentes maladies neurodegeneratives comme la maladie d'Alzheimer, la maladie de Parkinson, la demence a corps de Lewy et meme dans des maladies neuro-developpementales ou psychiatriques (autisme, schizophrenie). L'objectif principal de notre protocole est d'evaluer si l'utilisation d'une methode informatisee de suivi du regard (l'eye-tracking) est, a la fois, pertinente, efficace et fiable pour la passation des tests neuropsychologiques a visee diagnostique dans une population de sujets âges. Des etudes exploratoires vont nous permettre de verifier la validite et l'applicabilite de notre protocole et d'analyser les correlations entre les performances de nos sujets et d'autres tests neuropsychologiques standardises.

Polypharmacy is an important concern for patient safety and has been associated with increased adverse drug reactions, hospitalization and mortality in the elderly.

Background 18F-FDG PET can be used to aid in the diagnosis of Alzheimer’s disease (AD) and clarify the diagnosis and prognosis of patients with mild cognitive impairment (MCI). Purpose To compare the results of a quantitative analysis of FDG-PET brain images to a standard visual analysis (SVA) with regards to the detection of MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints. Material and Methods FDG-PET brain was performed in 71 patients (mean age, 76.4 ± 5.1 years; women, 53.5%). Images were analyzed for the presence of an MCI-like hypometabolic pattern using an SVA by 2 physicians and a voxel-based statistical procedure (statistical parametric mapping [SPM]) that compared each patient’s images to normal reference samples from 19 elderly individuals obtained using the same PET camera. The reliability of these analyses was evaluated according to neuropsychological assessment results, including the Grober & Buschke Free and Cued Selective Reminding Test, and a combined analysis by a neuropsychologist. Results An MCI-like hypometabolic pattern was documented in 5 patients (7%) by SVA and 7 patients (10%) by SPM analysis; however, only 2 of these patients were selected by both methods. The group characteristics of the 7 patients identified by the quantitative method were consistent with the MCI pattern, which included a higher rate of abnormal GB-FCSRT in Free Recall (57% vs. 9%, p < 0.05) or in Total Recall (29% vs. 8%, p < 0.05) when compared with other patients. In contrast, the group identified by SVA did not exhibit these characteristics. Conclusion A combined visual and quantitative analysis improves the diagnostic accuracy to detect an MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints.