Disability In Adults Research Articles

Developing a battery of physical performance tests to predict functional disability in Japanese older adults: A longitudinal study from the Kasama study.

Preventing functional disability benefits the quality of life of older adults and mitigates the economic burden of an aging society. However, the most effective physical performance tests and optimal cut points for identifying older adults at risk of functional disability remain unclear, and Japan lacks physical function-based assessment tools. We aimed to identify the physical performance tests related to functional disability and to develop a predictive test battery for it. We included 975 older adults (mean 72.8 ± 5.2 years, 55.4% women) in Kasama City, Japan. Functional disability was defined as certification of care level 2 or above based on the long-term care insurance system. Cox proportional hazards analysis examined the association between physical performance tests and incident functional disability. During a mean follow-up of 8.6 years (maximum 14 years), 236 participants (24.2%) developed functional disability. After adjusting for covariates, higher performances in grip strength, single-leg balance with eyes open (SLB), timed up-and-go (TUG), five-repetition sit-to-stand (5-STS), and 5-m habitual walk were significantly associated with a lower risk of functional disability. In a stepwise model, SLB, TUG, and 5-STS were key predictors of functional disability. Receiver operating characteristic analysis determined optimal cut points of 32.6/32.7 s for SLB, 6.5/6.6 s for TUG, and 7.8/7.9 s for 5-STS. We developed a predictive battery combining these cut points (area under the curve = 0.78). The developed battery of physical performance tests predicts future functional disability and is useful for screening older adults at high risk. Geriatr Gerontol Int 2024; ••: ••-••.

Light Physical Activity Throughout the Day and Physical Function in Older Adults

Abstract Background Light physical activity (LPA) plays a crucial role in preventing muscle loss and disability in older adults. Since LPA makes up a significant portion of daily activity, understanding how the timing of LPA influences physical function is important for designing effective health interventions. Methods This cross-sectional study investigated the association between the timing of LPA and physical function among 200 older adults (mean age 76.3, 55.5% female) attending the geriatric outpatient clinic at National Taiwan University Hospital. LPA was objectively measured using wrist-worn accelerometers for seven consecutive days. Principal component analysis (PCA) was used to identify distinct patterns of LPA timing. Participants underwent assessments of grip strength, basic mobility, walking speed, and lower limb muscle strength. Multivariable linear regression models were adjusted for potential confounders, including gender, age, moderate-to-vigorous physical activity (MVPA), and accelerometer wear time. Results Our findings revealed that higher levels of LPA during the morning to noon period were positively associated with better performance across all four physical function tests. Moreover, after controlling for relevant confounders, increased LPA in the late afternoon and evening was positively associated with enhanced basic mobility, walking speed, and lower limb muscle strength. Conclusions This study highlights the importance of considering LPA timing when promoting physical function in older adults, independent of MVPA participation. Encouraging LPA, particularly during the morning to noon period, could be a valuable strategy for maintaining and improving physical capabilities in this population. These findings provide actionable insights for clinicians and health professionals when tailoring physical activity recommendations for older adults within geriatric care settings. Key messages • Morning LPA boosts physical function in seniors, enhancing grip, mobility, walking speed, and muscle strength. • Timing of light activity crucial for older adults’ physical health, with morning to noon activity showing most benefits.

Impact of ayurvedic panchakarma therapy on osteoarthritis

Osteoarthritis is the leading cause of chronic pain and disability in adults, imparting a substantial economic burden on both society and individuals. This case series explored the impact of Ayurvedic Panchakarma therapy on knee osteoarthritis. Data from procedures conducted between March 2022 and January 2024 at a clinic in Maharashtra, India was collected. Patients of either gender who were clinically diagnosed with osteoarthritis grade 2 and underwent Knee Rejuvenation Therapy were included in this analysis. Follow-up was conducted after 1 month and at 90 days. Baseline data was compared with follow-up data. A total of 16 patients with mean age of 57.63 ± 10.20 years were included in the study. The Knee Injury and Osteoarthritis Outcome Score (KOOS) score (day 1: 20.31±11.18, after 1 month: 49.94±10.85, day 90: 71.31±5.89, p=0.00), pain (day 1: 25.44±14.03, after 1 month: 57.81±10.66, day 90: 80.63±5.78, p=0.00), symptoms (day 1: 30.69±14.59, after 1 month: 55.75±12.94, day 90: 83.00±6.04, p=0.00), sports (day 1: 2.81±6.84, after 1 month: 25.31±15.05, day 90: 39.69±15.76, p=0.00), function (day 1: 31.25±16.69, after 1 month: 58.94±12.34, day 90: 78.81±7.98, p=0.00), and quality of life (day 1: 14.13±14.83, after 1 month: 52.00±10.78, after 1 month: 73.50±4.50, p=0.00) increased from baseline to the 90-day follow-up. Ayurvedic treatment is effective in improving the KOOS score and reducing the severity of arthritis in diagnosed osteoarthritis patients.

Reliability and Validity of the Diagnostic Interview Trauma and Stressors- Intellectual Disability in Adults with Mild Intellectual Disabilities or Borderline Intellectual Functioning

ABSTRACT Objective To assess the reliability and construct validity of the Diagnostic Interview Trauma and Stressors- Intellectual Disability – Adult version (DITS-ID-adults) in adults with mild intellectual disabilities or borderline intellectual functioning (MID-BIF). Method The DITS-ID-adults, Brief Symptom Inventory–18 (BSI–18), and Impact of Event Scale-Intellectual Disability (IES – ID) were administered to 97 participants with MID-BIF who lived in supported housing. The Anxiety, Depression, and Mood Scale (ADESS) and Behavior Problems Inventory (BPI) were administered to their relatives. Results The interrater reliability of the DITS-ID-adults was good to excellent. The construct validity of the DITS-ID-adults was good, based on positive correlations between the BSI–18, IES-ID, ADESS and DITS-ID-adults, and mainly positive correlations between the BPI and DITS-ID-adults (r = .21 to r = .75). Reporting potentially traumatic events listed under the A criterium for PTSD was associated with fulfilling PTSD symptom criteria. In this sample, 58% were classified with post-traumatic stress disorder (PTSD) according to the DITS-ID-adults, while PTSD diagnosis on file was low (7%). Conclusion The present findings support the DITS-ID-adults as a reliable and valid basis for classifying PTSD in individuals with MID-BIF.

Relationship between locus of control and health-related quality of life in chronic stroke patients: a cross-sectional study

IntroductionStroke is a major cause of disability in adults and the elderly worldwide. Post-stroke rehabilitation success largely depends on consistent participation in treatment sessions and adherence to prescribed physical exercises; however, factors such as individual belief about their health status often affect motivation, slowing recovery. Addressing these influences is essential for improving health-related quality of life and optimizing recovery outcomes.MethodsThis study employed a cross-sectional and correlational design with convenience sampling. The aim was to explore the relationship between recovery locus of control (RLOC) and health-related quality of life (HRQoL) among chronic stroke survivors. The Recovery Locus of Control scale and the EuroQol 5D-5L scale were utilized for assessment.ResultsA total of 69 participants were included in this survey. The mean RLOC score was 34.91, with internal RLOC at 21.16 and external RLOC at 13.77 and the total EQ5D index was 0.659. Age was a significant grouping factor, with the 30–39 age group showing a significant positive relationship (r = 1.000, p = 0.002), pain and anxiety/depression (p = .045), mobility and anxiety/depression (p = .009), anxiety/depression and self-care (p = .047), IRLOC and ERLOC (p = .013).ConclusionThe study found that while respondents exhibited high RLOC scores, there was no significant relationship between RLOC scores and the EQ5D-5L index score, suggesting that other factors may play a more critical role in influencing HRQoL among chronic stroke survivors.

The dynamic effects of becoming disabled on work, wages and wellbeing in the UK from 1991 to 2018

Abstract Over recent decades it has consistently been shown that disabled adults in the UK fare worse in the labour market and have lower levels of wellbeing than non-disabled adults. However, this is in part due to the selection into dis-ability of those with existing socio-economic disadvantages. In this article, we use panel data from the combined British Household Panel Survey and Understanding Society, covering the 27 years from 1991 to 2018, to distinguish between the effect of selection, the effect of dis-ability onset and the effect of dis-ability duration on a range of labour market and wellbeing outcomes. We show that there is important selection both into dis-ability and into longer experience of dis-ability on the basis of observable characteristics. We also show the importance of controlling for time-invariant unobservable individual characteristics that similarly affect selection into dis-ability and duration of dis-ability. Even after controlling for both forms of selection, we find significant negative effects of dis-ability onset and duration, and offer policy solutions to address them.

Isoliquiritigenin alleviates cerebral ischemia-reperfusion injury by reducing oxidative stress and ameliorating mitochondrial dysfunction via activating the Nrf2 pathway

Cerebral ischemia-reperfusion injury (CIRI) refers to a secondary brain injury that occurs when blood supply is restored to ischemic brain tissue and is one of the leading causes of adult disability and mortality. Multiple pathological mechanisms are involved in the progression of CIRI, including neuronal oxidative stress and mitochondrial dysfunction. Isoliquiritigenin (ISL) has been preliminarily reported to have potential neuroprotective effects on rats subjected to cerebral ischemic insult. However, the protective mechanisms of ISL have not been elucidated. This study aims to further investigate the effects of ISL-mediated neuroprotection and elucidate the underlying molecular mechanism. The findings indicate that ISL treatment significantly alleviated middle cerebral artery occlusion (MCAO)-induced cerebral infarction, neurological deficits, histopathological damage, and neuronal apoptosis in mice. In vitro, ISL effectively mitigated the reduction of cell viability, Na+-K+-ATPase, and MnSOD activities, as well as the degree of DNA damage induced by oxygen-glucose deprivation (OGD) injury in PC12 cells. Mechanistic studies revealed that administration of ISL evidently improved redox homeostasis and restored mitochondrial function via inhibiting oxidative stress injury and ameliorating mitochondrial biogenesis, mitochondrial fusion-fission balance, and mitophagy. Moreover, ISL facilitated the dissociation of Keap1/Nrf2, enhanced the nuclear transfer of Nrf2, and promoted the binding activity of Nrf2 with ARE. Finally, ISL obviously inhibited neuronal apoptosis by activating the Nrf2 pathway and ameliorating mitochondrial dysfunction in mice. Nevertheless, Nrf2 inhibitor brusatol reversed the mitochondrial protective properties and anti-apoptotic effects of ISL both in vivo and in vitro. Overall, our findings revealed that ISL exhibited a profound neuroprotective effect on mice following CIRI insult by reducing oxidative stress and ameliorating mitochondrial dysfunction, which was closely related to the activation of the Nrf2 pathway.

Experiencing the Craft and Ethical Impact of Young Adult Disability Fiction

Scholars like Ria Cheyne and Sami Schalk have argued that the imaginative and ethical structures of fiction can, if effectively leveraged, provide readers a new orientation to, or understanding of, difference. Advancing recent work that identifies methods to assess the material reception of disability literature, the article demonstrates how general audiences perceive both the craft and ethical import of fiction. Beverly Butler’s 1962 novel Light a Single Candle is one example of young adult literature that has resonated with audiences over time. Literary disability studies and narrative theory clarify the range of storytelling techniques that make the novel compelling: Butler, a blind author herself, carefully creates distances among reader, narrator, and character only to close them; she uses the physical description of blind modality to represent social experience; and she installs characters that model different disability ethics. Systematically analyzing the novel’s online reviews, the article shows that audiences sense Butler’s storytelling techniques in ways that open up spaces for mindful reflection on the nature of impairment and the construction of disability.

Effect of oral health on functional disability and mortality in older adults in Japan: a cohort study.

Oral health has previously shown associations with functional disability and mortality. We aimed to explore the associations of various aspects of oral health status with functional disability and mortality using survival analysis, as well as the relative magnitudes of the impact of these aspects on outcomes. We obtained data for individuals aged 75years and older in Shimane, Japan, who had at least one oral health check-up between April 1, 2016, and March 31, 2022under Japan's long-life medical care system insurance system. Those with missing data or with functional disability at baseline were excluded. 13aspects of oral health status were assessed by dentists or dental hygienists as part of the check-up (using protocols provided by the JapanDental Association and the Japanese Ministry of Health, Labour and Welfare): number of remaining teeth, subjective masticatory performance, objective masticatory performance, periodontal tissue status, functional dysphagia, tongue mobility, articulation, oral hygiene, number of decayed teeth, inadaptation of dentures of the upper jaw and lower jaw (considered separately), oral mucosal disease, and dry mouth. Multivariate Cox proportional hazards models were used to analyse the associations between each aspect of oral health and functional disability and mortality, with fully adjusted models adjusting for sex, age, BMI, medical history, or a propensity score derived from these covariates. Population-attributable fractions (PAFs) were calculated to assess the differential impacts of these oral health status aspects on outcome occurrence. Of the 24 619individuals who had an oral health check-up during the study period, 21 881individuals wereincluded in the analysis of functional disability (9175 [41·93%] men, 12 706 [58·07%] women, mean age 78·31years [SD 2·88], mean follow-up 41·43months [20·80]), and 22 747individuals in the analysis of mortality (9722 [42·74%] men, 13 025 [57·26%] women, mean age 78·34years [2·89], mean follow-up 42·63months [20·58]). All 13aspects of oral health status showed significant associations with the occurrence of mortality, while functional disabilitywas associated with 11aspects (excluding oral mucosal disease and dry mouth) in the fully adjusted model. Based on PAFs, of all oral health aspects assessed, objective masticatory performance hadthegreatestimpact on both functional disability (PAF 23·10% [95% CI 20·42-25·69] for the lowest and 10·62% [8·18-12·99] for the second-lowest quartile of performance) and mortality (16·47% [13·44-19·40] and 8·90% [5·87-11·82]). Various aspects of oral health are associated with mortality and functional disability. Maintaining good oral health in older adults might help to reduce these outcomes. None.

Effect of Multimorbidity on Old-Age Disability Among Adults Over 50 Years Old: Evidence From a Meta-Analysis.

This is a meta-analysis study to assess the relationship between multimorbidity and disability among older adults over 50 years old. Population-based studies, aged ≥50 years, assessing associations between multimorbidity (numbers and patterns) and disability in older adults, and reporting risk estimation with odds ratios (OR), were included. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 411007, and this meta-analysis was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Twelve studies were included. For the older adults with 2 chronic conditions and ≥3 chronic conditions, the ORs of disability are 2.52 (95% CI 2.30-2.76) and 3.38 (95% CI 3.05-3.75), respectively. Among three multimorbidity patterns, the combination of cardiovascular and metabolic diseases pattern (OR 8.01, 95% CI 7.60-8.44) had the highest disability incidence rate. Chronic conditions in the multimorbidity patterns of combination of cardiovascular and metabolic diseases and mental health problems have an enhancement effect (1 + 1 > 2) on old-age disability impairment, whereas those in the multimorbidity pattern of musculoskeletal disorders have a dampening effect (1 + 1 < 2). The differentiated and specific early interventions should be developed based on the different multimorbidity patterns to prevent the old-age functional decline and disability in older adults.

Association between willingness to exercise and incident disability in older adults: a prospective longitudinal cohort study.

To investigate whether the willingness to exercise (WTE) and exercise habits affect the incidence of disability among older adults. This study included 8,354 individuals (72.5 ± 6.2years, 55.9% female). The participants were divided into three categories based on their WTE: unwillingness to exercise, willingness to exercise (but without exercise habits), and exercise habits. The incidence of disability was prospectively determined within 24months of the follow-up. Cox regression analysis was used to examine the relationship between WTE and the incidence of disability. Overall, 600 (7.2%), 4,703 (56.3%), and 3,051 (36.5%) participants were classified as unwillingness to exercise, willingness to exercise, and exercise habits, respectively. Compared with the unwillingness to exercise group, the willingness to exercise group (hazard ratio [HR] 0.71, 95%Confidence Interval [CI] 0.52-0.96) and the exercise habits group (HR 0.65, 95%CI 0.46-0.92) had a lower risk of disability incidence. These results suggest that WTE reduces the risk of disability in older adults. Therefore, the importance of increasing WTE to prevent the occurrence of disabilities is clear. Our results suggest that even though physical activity declines with age, it is important to have the desire to exercise and develop exercise habits.

Multidimensional Poverty and Disability of Older Adults in China: Will Long-Term Care Insurance Make a Difference?

Multidimensional Poverty and Disability of Older Adults in China: Will Long-Term Care Insurance Make a Difference?

Interaction between tea consumption and genes on activities of daily living disability in older adults.

The effects of tea consumption on delaying aging and the onset of age-related disabilities have been reported; however, it is unclear whether these benefits are impacted by genes. This study aimed to examine the associations between tea consumption and activities of daily living (ADL) and explore the role of genetic factors. Data from 46,487 older adults aged 64-105 who participated in at least one data wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2002, 2005, 2008, 2011, 2014, and 2018 were analyzed. Genetic data were produced using the Affymetrix Axiom™myDesign™ (384-format) Human Genotyping Array. The generalized estimation equation and multiple logistic regression models were constructed to examine the effects of tea consumption, polygenic risk score, and their interactions on ADL. Tea consumption was related to reduced ADL decline-the effect was statistically significant among men but not women. A significant interaction between tea consumption and polygenic risk score (PRS) was observed. Tea consumption was associated with a decreased risk of ADL disability only among individuals with a low PRS. These findings indicate that tea consumption plays a role in preventing disability in older adults with low polygenic risk.

Exosomes-Shuttled lncRNA SNHG7 by Bone Marrow Mesenchymal Stem Cells Alleviates Osteoarthritis Through Targeting miR-485-5p/FSP1 Axis-Mediated Chondrocytes Ferroptosis and Inflammation.

Osteoarthritis (OA), a degenerative joint disorder, is a major reason of disability in adults. Accumulating evidences have proved that bone marrow mesenchymal stem cells (BMSCs)-carried exosomes play a significant therapeutic effect on OA. However, the precise regulatory network remains unknown. OA and normal cartilage samples were acquired from patients, and chondrocytes were exposed to IL-1β to conduct a cellular OA model. Exosomes prepared from BMSCs were identified using nanoparticle tracking analysis (NTA) and transmission electron microscopy (TEM). Cell viability was determined with CCK-8 assay. Inflammatory injury was assessed by LDH and inflammatory factors (TNF-α and IL-6) using corresponding ELISA kits, respectively. Ferroptosis was evaluated by GSH, MDA and iron levels using corresponding kits, and ROS level with DCFH-DA. The expressions of genes/proteins were determined with RT-qPCR/western bolt. RNA immunoprecipitation and luciferase activity assay were conducted for testing the interactions of small nucleolar RNA host gene 7 (SNHG7)/ferroptosis suppressor protein 1 (FSP1) and miR-485-5p. The expressions of SNHG7 and FSP1 were both reduced in IL-1β-induced chondrocytes and OA cartilage tissues, and there was a positive correlation between them in clinical level. Moreover, SNHG7 was enriched in BMSCs-derived exosomes (BMSCs-Exos) and could be internalized by chondrocytes. Functional analysis illustrated that BMSCs-Exos administration repressed inflammatory injury, oxidative stress and ferroptosis in IL-1β-induced chondrocytes, while these changes were reinforced when SNHG7 was overexpressed in BMSCs-Exos. Notably, FSP1 silencing in chondrocytes abolished the beneficial effects mediated by exosomal SNHG7. Exosomal SNHG7 released from BMSCs inhibited inflammation and ferroptosis in IL-1β-induced chondrocytes through miR-485-5p/FSP1 axis. This work suggested that BMSCs-derived exosomal SNHG7 would be a prospective target for OA treatment.

Effects of exercise referral schemes enhanced with behavioural self-management strategies on functional capacity and self-reported disability in community-dwelling older adults. Secondary results from the SITLESS multi-country, three-armed randomized controlled trial.

Exercise referral schemes (ERS) are an effective strategy for increasing physical activity (PA) in older adults. Behavioural self-management strategies (SMS) may augment the maintenance of PA and associated benefits in this population, resulting in preservation of the functional capacity and prevention of disability over the long-term. The primary aim was to investigate the long-term (22-months) effects of ERS enhanced with SMS on functional capacity assessed by the Short Physical Performance Battery (SPPB) compared to ERS (primary comparison) and a control condition (CTRL).Secondarily, between-group effects after 4 and 16months on the SPPB and self-reported disability outcomes were investigated. 1360 physically inactive community-dwelling older adults ≥65years from four European countries were randomized into (i) 16weeks ERS enhanced with SMS (ERS-SMS), (ii) ERS alone and (iii) CTRL. In addition to SPPB, self-reported function and disability were assessed by the short-form late life function and disability index and with a six-item activity of daily living questionnaire. No long-term effects were found for the SPPB-score in ERS-SMS vs ERS (0.21 point, 95% CI [-0.04, 0.46]). Significant group × time effects were observed for the SPPB-score after 4months in favour of ERS-SMS over CTRL (0.51 point, 95% CI [0.29, 0.73]) and ERS (0.46 point, 95% CI [0.24, 0.68]). The study did demonstrate differences, in favour of ERS + SMS, but on SPPB these were small, and not sustained over time. The additional effect of SMS was inconsistent and uncertain.

Investigating the synergistic neuromodulation effect of bilateral rTMS and VR brain-computer interfaces training in chronic stroke patients

Objective.Stroke is a major cause of adult disability worldwide, resulting in motor impairments. To regain motor function, patients undergo rehabilitation, typically involving repetitive movement training. For those who lack volitional movement, novel technology-based approaches have emerged that directly involve the central nervous system, through neuromodulation techniques such as transcranial magnetic stimulation (TMS), and closed-loop neurofeedback like brain-computer interfaces (BCIs). This, can be augmented through proprioceptive feedback delivered many times by embodied virtual reality (VR). Nonetheless, despite a growing body of research demonstrating the individual efficacy of each technique, there is limited information on their combined effects.Approach.In this study, we analyzed the Electroencephalographic (EEG) signals acquired from 10 patients with more than 4 months since stroke during a longitudinal intervention with repetitive TMS followed by VR-BCI training. From the EEG, the event related desynchronization (ERD) and individual alpha frequency (IAF) were extracted, evaluated over time and correlated with clinical outcome.Main results.Every patient's clinical outcome improved after treatment, and ERD magnitude increased during simultaneous rTMS and VR-BCI. Additionally, IAF values showed a significant correlation with clinical outcome, nonetheless, no relationship was found between differences in ERD pre- post- intervention with the clinical improvement.Significance.This study furnishes empirical evidence supporting the efficacy of the joint action of rTMS and VR-BCI in enhancing patient recovery. It also suggests a relationship between IAF and rehabilitation outcomes, that could potentially serve as a retrievable biomarker for stroke recovery.

Knockout of neutrophil cytosolic factor 1 ameliorates neuroinflammation and motor deficit after traumatic brain injury

Traumatic brain injury (TBI) is a predominant cause of long-term disability in adults, yet the molecular mechanisms underpinning the neuropathological processes associated with it remain inadequately understood. Neutrophil cytosolic factor 1 (NCF1, also known as p47phox) is one of the cytosolic components of NADPH oxidase NOX2. In this study, we observed a reduction in the volume of TBI-induced brain lesions in NCF1-knockout mice compared to controls. Correspondingly, the neuronal loss induced by TBI was mitigated in the NCF1-knockout mice. Behavioral analysis also demonstrated that the motor coordination deficit following TBI was mitigated by the depletion of NCF1. Mechanistically, our findings revealed that NCF1 deficiency attenuated TBI-induced inflammatory responses by inhibiting the release of proinflammatory factors and reducing neutrophil infiltration into the brain parenchyma. Additionally, our results indicated that NCF1 deficiency significantly decreased the levels of reactive oxygen species in neutrophils. Taken together, our findings indicate that NCF1 plays a crucial role in the regulation of brain injury and secondary inflammation post-TBI.

Sarcopenia and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Narrative Review

The primary objective of modern medicine is to extend human life expectancy. Currently, the majority of hospital patients across various clinical settings are elderly or advanced-age individuals, often with multiple comorbidities and age-related alterations in peripheral tissues. One such alteration is sarcopenia, a progressive decline in muscle mass, strength, and function, which significantly increases the risk of disability and mortality in older adults. Sarcopenia is associated with numerous adverse outcomes, and its underlying mechanisms are the subject of ongoing research. This narrative review discusses the epidemiology, pathophysiology, and diagnostic criteria for sarcopenia. It also examines the connections between sarcopenia and metabolic dysfunction-associated steatotic liver disease (MASLD), highlighting potential treatment approaches for the coexistence of these two pathologies.

Association between frailty and activities of daily living disability in older adults residing in a high-altitude Peruvian Andean community: the Aunqui-Andes study

BackgroundThe prevalence of frailty and activities of daily living (ADL) disability may be higher in high-altitude Andean regions, due to chronic hypoxia, malnutrition, and physical challenges. and their association is relevant. This study aimed to evaluate the association between frailty and ADL disability among older adults residing in the Totos district in Peru during the year 2022.MethodsA cross-sectional study was conducted in Totos district (mean altitude: 3286 m above sea level), located in Ayacucho, Peru, during 2022. A complete census was employed including residents aged 60 and above. The exposure variable was frailty, defined by fulfilling 3 or more criteria of the Fried phenotype. The outcome variable was ADL disability, defined as a score below 95 on the Barthel index. Generalized linear models with a Poisson family, logarithmic link function, and robust variances were employed to estimate crude prevalence ratios and adjusted prevalence ratios (aPRs), along with their corresponding 95% confidence intervals (CIs).ResultsWe evaluated 272 older adults with a mean age of 74 years, of whom 59.9% were female, 62.1% were cohabiting or married and 83.1% had not completed primary education. We found that 19.5% were frail, while 51.1% had ADL disability. In the adjusted regression model, we found frailty increased the prevalence of ADL disability (aPR = 1.77; 95%CI: 1.44–2.16; p < 0.001).ConclusionFrailty was associated with an increased prevalence of ADL disability. These findings could contribute to establishing government intervention plans to manage disability and frailty within the high-risk group comprising older adults living at high altitudes.

Immunoglobulin G and Complement as Major Players in the Neurodegeneration of Multiple Sclerosis.

Multiple Sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease of the central nervous system (CNS) and is termed as one of the most common causes of neurological disability in young adults. Axonal loss and neuronal cell damage are the primary causes of disease progression and disability. Yet, little is known about the mechanism of neurodegeneration in the disease, a limitation that impairs the development of more effective treatments for progressive MS. MS is characterized by the presence of oligoclonal bands and raised levels of immunoglobulins in the CNS. The role of complement in the demyelinating process has been detected in both experimental animal models of MS and within the CNS of affected MS patients. Furthermore, both IgG antibodies and complement activation can be detected in the demyelinating plaques and cortical gray matter lesions. We propose here that both immunoglobulins and complement play an active role in the neurodegenerative process of MS. We hypothesize that the increased CNS IgG antibodies form IgG aggregates and bind complement C1q with high affinity, activating the classical complement pathway. This results in neuronal cell damage, which leads to neurodegeneration and demyelination in MS.