Disease In Older Adults Research Articles

Handgrip strength in older adults with chronic diseases from 27 European countries and Israel.

Understanding the association of deconditioned strength with the most prevalent chronic diseases in older adults and inferring possible interventional strategies is of utmost importance. We aimed to investigate the association between handgrip strength and chronic diseases in a large representative European population of adults over the age of 50 years. Individuals aged 50 or older residing in 27 European countries and Israel participated in this cross-sectional study. Data on prior or current chronic disease and handgrip strength were retrieved from the 7th wave of Survey of Health, Ageing and Retirement in Europe (SHARE). We tested associations using binary logistic regression adjusted for potential confounders. Based on data from 73,463 participants, the examined diseases showed a negative association with handgrip strength in the fully adjusted model. Participants from the highest tertile of handgrip strength had particularly lower odds for Parkinson ((Adjusted odds ratio (AOR) = 0.42 [95% Confidence Interval = 0.32-0.56])), stroke (AOR = 0.51 [95% Confidence Interval = 0.44-0.59], and emotional disorders ((Adjusted odds ratio (AOR) = 0.51 [95% Confidence Interval = 0.45-0.58])) compared with participants with the lowest level of handgrip strength in the fully adjusted model. There is a negative association between handgrip strength and a wide range of chronic diseases. Evaluating handgrip strength in this population may provide a valuable clinical measure and a simple preventive strategy in relation to these diseases. The present findings support the use of resistance training for the prevention of specific chronic conditions, particularly Parkinson, stroke and emotional disorders.

Genome-Wide Association Studies Identify an Association of Transferrin Binding Protein B Variation and Invasive Serogroup Y Meningococcal Disease in Older Adults.

Neisseria meningitidis serogroup Y, especially ST-23 clonal complex (Y:cc23), represents a larger proportion of invasive meningococcal disease (IMD) in older adults compared to younger individuals. This study explored the meningococcal genetic variation underlying this association. Maximum-likelihood phylogenies and the pangenome were analyzed using whole-genome sequence (WGS) data from 200 Y:cc23 isolates in the Neisseria PubMLST database. Genome-wide association studies (GWAS) were performed on WGS data from 250 Y:cc23 isolates from individuals with IMD aged ≥65 years versus < 65 years. Y:cc23 meningococcal variants did not cluster by age group or disease phenotype in phylogenetic analyses. Pangenome comparisons found no differences in presence or absence of genes in IMD isolates from the different age groups. GWAS identified differences in nucleotide polymorphisms within the transferrin-binding protein B (tbpB) gene in isolates from individuals ≥65 years of age. TbpB structure modelling suggests these may impact binding of human transferrin. These data suggest differential iron scavenging capacity amongst Y:cc23 meningococci isolated from older compared to younger patients. Iron acquisition is essential for many bacterial pathogens including the meningococcus. These polymorphisms may facilitate colonization, thereby increasing the risk of disease in vulnerable older people with altered nasopharyngeal microbiomes and nutritional status.

ODP090 Fragility Fractures and Osteoporosis Screening in Patients with Chronic Lymphocytic Leukemia

Abstract Chronic lymphocytic leukemia (CLL) and osteoporosis are diseases of older adults with high prevalence rates. CLL infiltrates the bone marrow, increasing bone resorption and demineralization which contribute to the pathophysiology of osteoporosis. Despite this, there are limited clinical data describing the association of CLL with osteoporosis and fracture risk. We hypothesized that osteoporosis and fragility fractures (FF) are common in patients with CLL. The Huntsman Cancer Institute (HCI) has a CLL database which includes all patients diagnosed with CLL since January 1, 2000 and received care at the HCI. Patients included were identified from the CLL database with ICD-9 and 10 codes associated with osteopenia, osteoporosis and/or presence of a FF. Of the 57 patients included, 67% were female (n=38) with a mean age of 69 ± 10 years and 93% Caucasian. 60% (n=34) had RAI stage of 0-1 with genetic changes noted as follows: Del(13q) 46% (n=26), Del(17p) 7% (n=4), Del(11q) 5% (n=3), and Trisomy 12 14% (n=8). IGVH mutation was present in 31.6% of patients (n=18). 47% (n=25) of patients were treated with chemotherapy, of which Rituximab (n=14), Bendamustine (n=7), Cyclophosphamide (n=5), and Ibrutinib (n=5) were the most frequently used. 58.5% (n=32) had a history of FF, with 84% occurring in the spine (n=27/32). Assessment for Vitamin D deficiency and hyperparathyroidism were performed in 54% (n=31) and 21% (n=12) of the cohort respectively. Even though every patient in the study either had a diagnosis of osteoporosis by ICD code or FF, only 44% (n=25) of patients had an available DXA scan for our review, and only 31% (n=18) received treatment for osteoporosis. Of those with a DXA, the worst T score was in the right femoral neck (T score -1.9, IQR -1.5 to -2.5) with 44% (n=14/32) either having T scores in the normal or osteopenic range. Interestingly, FF was associated with higher T scores in the spine (FF spine T score -1. 0±1.5 vs no FF T score -2.2±0.8, p=0. 03). Clinical factors associated with FF were male sex (83% men vs 46% women, p&amp;lt;0. 01) and positive smoking history (93% smokers vs 46% non-smokers, p&amp;lt;0. 01). Use of chemotherapy and hip T scores were not associated with FF. The data from our study suggests that patients with CLL are predisposed to axial fragility fractures despite non-osteoporotic T scores. In addition, osteoporosis screening with DXA is under-utilized in the CLL population, despite meeting age-appropriate screening guidelines. Increased awareness and screening for axial fragility fractures, especially in men and smokers, should be recommended in the long term follow up of patients with CLL. Further study is needed to understand the pathophysiology of osteoporosis and FF in patients with CLL to develop improved methods for prevention of these morbid fractures. Presentation: No date and time listed

Association of copper exposure with prevalence of chronic kidney disease in older adults

Metal exposure is suspected to be associated with the risk of chronic kidney disease (CKD). Copper (Cu) is an essential yet toxic trace element in humans. Epidemiological evidence on the association of Cu exposure with CKD remains inconsistent. This study aims to investigate the association of blood Cu and its co-exposure to other metals with CKD. A cross-sectional study was conducted among 3285 older participants in Zhejiang, China. The whole blood levels of Cu as well as other 10 metals were measured using the inductively coupled plasma mass spectrometry (ICP-MS). CKD events were defined as the presence of albuminuria or estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2. Multivariable logistic regression and linear regression models were applied to assess the association of Cu with kidney function. The Bayesian kernel machine regression (BKMR) was used to examine the association of metal interactions with CKD. In logistic models, we found a dose-dependent positive association between blood Cu and the prevalence of CKD. Compared to the lowest quartile of blood Cu, the odds ratio (OR) of CKD in the highest quartile was 1.65 (95% confidence interval, CI: 1.25, 2.17), and the β of eGFR was-1.74 (95% CI:-3.15,-0.34) after adjusting for multiple covariates. The positive linear dose-response association was found between blood Cu and the OR of CKD, and negative linear association was found between Cu and the β of eGFR. The positive association between blood Cu and CKD risk was stronger at lower level of manganese (Mn) in the BKMR model. The whole blood level of Cu was remarkably associated with the risk of CKD and showed positive dose-response relationships in the older Chinese population. The toxicity of Cu on kidney function could be antagonized by the exposure of Mn. These findings shed new light on the potential role of Cu in kidney health.

Use of the Visceral Adiposity Index as an Indicator of Chronic Kidney Disease in Older Adults: Comparison with Body Mass Index.

The visceral adiposity index (VAI) was recently introduced to quantify visceral fat accumulation and dysfunction. This cross-sectional study explored whether the VAI is associated with chronic kidney disease (CKD) in older adults and compared its utility with that of body mass index (BMI) for predicting CKD. In total, 7736 older adults (3479 men and 4257 women) aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups. Associations of the VAI and BMI with CKD were compared among the groups, and cut-off points for moderate-to-severe CKD (MSCKD) were established. While the VAI could discriminate among all of the groups, the BMI could not. The severity of CKD was more strongly associated with the VAI than BMI. The odds ratios indicated that, in the fully adjusted model, the VAI was a significant predictor of MSCKD in both men and women, while the BMI was a significant predictor only in men. For the VAI, the area under the receiver operating characteristic curve values for men and women were 0.631 (cut-off point: ≥2.993) and 0.588 (≥4.001), compared with 0.555 (≥25.335) and 0.533 (≥24.096) for BMI, respectively. Taken together, the findings suggest that the VAI is associated with CKD and represents a better indicator for the disease than BMI.

The association of frailty with chronic kidney disease in older adults using the ASPirin in reducing events in the elderly cohort.

Frailty and chronic kidney disease (CKD) both increase with age and are prevalent in older adults. However, studies in older adults examining the relationship between frailty and milder impairments of kidney function are relatively sparse. We examined the cross-sectional association of baseline estimated glomerular filtration rate (eGFR), albuminuria and CKD ([eGFR <60 ml/min/1.73 m2 ] and/or albuminuria [>3.0mg/mmol]) with prefrailty and frailty in the ASPirin in Reducing Events in the Elderly (ASPREE) trial cohort of healthy older participants. Univariate logistic regression models measured the unadjusted odds ratios (OR) and 95% confidence intervals (CI) for prevalent combined prefrailty and frailty (respectively defined as presence of 1-2 or 3+ of 5 modified fried criteria) for the association between CKD, eGFR, albuminuria and other potential risk factors. Multivariable models calculated OR for prefrailty-frailty adjusted for potential confounders and either CKD, (i) eGFR and albuminuria measured as either continuous variables; (ii) or categorical variables; (iii). Of 17 759 eligible participants, 6934 were classified as prefrail, 389 were frail. CKD, eGFR and albuminuria were all associated with combined prefrailty-frailty on univariate analysis. In the multivariable modelling, neither CKD (reduced eGFR and/or albuminuria), nor eGFR (either continuous or categorical variables) were associated with prefrailty-frailty. However, albuminuria, either as a continuous variable (OR [95% CI] 1.07 [1.04-1.10]; p < .001), or categorical variable (OR 1.21 [1.08-1.36]; p=.001) was consistently associated with prefrailty-frailty. The complex relationship between albuminuria (which may be a biomarker for vascular inflammation), ageing, progressive CKD and frailty requires further investigation.

Blood pressure variability and plasma Alzheimer’s disease biomarkers in older adults

Blood pressure variability is an emerging risk factor for Alzheimer’s disease in older adults, independent of average blood pressure levels. Growing evidence suggests increased blood pressure variability is linked to Alzheimer’s disease pathophysiology indexed by cerebrospinal fluid and positron emission tomography markers, but relationships with plasma Alzheimer’s disease markers have not been investigated. In this cross-sectional study of 54 community-dwelling older adults (aged 55–88, mean age 69.9 [8.2 SD]), elevated blood pressure variability over 5 min was associated with lower levels of plasma Aβ1–42 (standardized ß = − 0.36 [95% CI − 0.61, − 0.12]; p = 0.005; adjusted R2 = 0.28) and Aβ1–42: Aβ1–40 ratio (ß = − 0.49 [95% CI − 0.71, − 0.22]; p < 0.001; adjusted R2 = 0.28), and higher levels of total tau (ß = 0.27 [95% CI 0.01, 0.54]; p = 0.04; adjusted R2 = 0.19) and Ptau181:Aβ1–42 ratio (ß = 0.26 [95% CI 0.02, 0.51]; p = 0.04; adjusted R2 = 0.22). Findings suggest higher blood pressure variability is linked to plasma biomarkers of increased Alzheimer’s disease pathophysiology.

Middle meningeal artery embolization for treatment of chronic subdural hematoma.

Chronic subdural hematoma (cSDH) is caused by rupture of bridging intracranial veins located in the subdural space. Predominantly, cSDH is adisease of older adults and other predisposing risk factors include minor head trauma, cerebral atrophy, antiplatelet and anticoagulation therapies, arterial hypertension, cerebrovascular atherosclerosis, diabetes mellitus, cerebrospinal fluid loss, and excessive alcohol consumption. The incidence of cSDH is rising worldwide due to an aging population and the increased use of anticoagulant or antiplatelet medications. Clinical manifestations are varied, with altered mental status and focal neurologic deficits among the most common. Treatment strategies depend on the symptomatology and extent of hematoma. In general, conservative treatment is sought for patients who are asymptomatic or have only mild symptoms, whereas symptomatic patients are often treated surgically. However, the recurrence rate of cSDH may be as high as 30%. In recent years, middle meningeal artery embolization has emerged as acomplementary option to surgery aimed at decreasing the recurrence rate after excision as well as an alternative therapeutic approach to surgical therapy in certain circumstances. Embolization of the middle meningeal artery appears to be a promising treatment for patients with cSDH, both before and after surgical excision.

Review of Evidence for the Usage of Antioxidants for Eye Aging.

Oxidative stress is one of the common factors leading to age-related eye diseases in older adults. Factors such as high oxygen consumption, high concentration of polyunsaturated fatty acids, and cumulative exposure to high-energy visible light in the eyes, lead to excessive generation of reactive oxygen species, hence triggering apoptosis of ocular cells and giving rise to ophthalmic diseases. Dietary supplements such as carotenoids, anthocyanins, and vitamins have antioxidant properties which may be of benefit in retaining better vision or reversing vision impairment; thus, studies have been conducted to understand the role of dietary supplements in the treatment or prevention of ophthalmic diseases. While high concentration of carotenoids such as lutein and zeaxanthin decrease the risk of developing age-related macular disease, anthocyanins and vitamins play a role in the treatment and prevention of other ophthalmic diseases: saffron extract reduced intraocular pressure in glaucoma patients; bilberry extract prevented impairments in lenses and retina, as well as alleviate symptoms of dry eye disease; high concentration of beta-carotene may reduce the risk of developing cataract. Further studies with clinical measurements are required to investigate the effectiveness of antioxidants on visual function and ophthalmic diseases.

MM-192 Young Patients With Multiple Myeloma Diagnosed Before 50 Years of Age: Single-Center Experience

Multiple myeloma is a disease of older adults, and there are conflicting data about the presentation, treatment, and prognosis in younger age groups. The present study is designed to analyze the clinical and hematological profile and outcomes in young adults with multiple myeloma. The study is a retrospective analysis of individual patients' data. All consecutive patients with multiple myeloma aged 50 years or younger and treated in our institution between September 2007 and December 2020 were reviewed. Data were collected from patients' electronic medical records. A total of 175 patients were reviewed, 115 (65.7%) were male, 47 (26.8%) were smokers, and the median age was 45 (range: 24-50). At diagnosis, 73.1% of the patients presented at International Staging System (ISS) stage I-II, lytic bone lesions presented in 81.7% of the cohort, and anemia presented in 46.9%. The median M component is 3.20, 28 had no serum M component, and 74 had no serum or urine M protein. IgG Kappa 73 (41.7) and Free Kappa 40 (22.8) represent the majority of the protein isotype. The median bone marrow involvement is 60%, 14.3% (25/175) did cytogenic testing, and the most common abnormality is 4:14. VTD is the most commonly used induction regimen, 109 (62%) underwent ASCT, and 42 had relapse. The outcome is as follows: CR, 56 (32); DP, 26 (14.8); PR, 43 (24.6); SD, 5 (2.8); VGPR, 35 (20); <PR, 8 (4.6). After a median follow-up of 73 months, 61.1% of patients were still alive. Ninety-four patients of the population (53.7%) had experienced disease progression or/and death, and 62.3% of patients underwent autologous stem cell transplantation with a median overall survival (OS) of 118 months versus 24 months for those who did not. The OS for patients with ASCT was 75.2% versus 37.9% for those without (P<0.0001). There is a need for more research focusing on multiple myeloma in young patients regarding epidemiological landscape, disease biology, and clinical management.

CT-511 Clinical Characteristics and Response Outcomes in Older Multiple Myeloma Patients Who Received Idecabtagene Vicleucel: A Single Center Study

Multiple myeloma (MM) is a disease of older adults with a median age of 69y at the time of diagnosis. Older patients remain at higher risk for poor outcomes due to physical and physiological decline with aging. To study clinical characteristics and outcomes in older MM patients who received CAR-T therapy. Charts were reviewed retrospectively for older (≥65y) MM patients who received ide-cel between 8/30/2021-05/31/2022. Descriptive statistics were used to analyze clinical characteristics such as age, polypharmacy, comorbidities, history of fall, peripheral neuropathy (active or history), and organ dysfunction (active or history; cardiac, pulmonary, neuro, and/or renal) at infusion. Response outcomes were evaluated using IMWG criteria with the best overall response rate (ORR) recorded and compared to KarMMa study results for older patients (≥65y, n=45) (Munshi et al., NEJM 2021; 384:705-716). In 16 patients (median: 70y, range: 65-83y) (75% ineligible for KarMMa trial), the prevalence of polypharmacy (5+ drugs), excessive polypharmacy (10+ drugs), 4+ comorbidities, history of falls, neuropathy, and organ dysfunction was 94%, 56%, 81%, 37%, 62%, and 50% respectively. Ten patients with ≥30 days of follow up were analyzed for response outcomes. With a median follow up duration of 3.2 months, best ORR was 70% (3 sCR, 1 CR, 2 VGPR, 1 PR, 3 SD/MR), which was comparable to KarMMa study results (ORR > 50%, 95% CI). CRS was grade 1-2 and no major adverse events observed. In a subgroup analysis of eight patients (>70y old), the prevalence of the above characteristics was 100%, 87%, 87%, 37%, 62%, and 62% respectively. For six patients with a median follow up of 4.2 months, best ORR was 100% (2 sCR, 1 CR, 2 VGPR, 1 PR), which was better than KarMMa study results (ORR > 50%, 95% CI). In this small group of older patients, the prevalence of polypharmacy, comorbidities, history of falls, and peripheral neuropathy were higher compared to published reports for general and/or oncology older population. Robust responses and no major toxicities were observed in all patients, especially septua & octogenarians, despite their physical and physiological limitations.

Piloting of the virtual telecare technology ‘Addison Care’ to promote self-management in persons with chronic diseases in a community setting: protocol for a mixed-methods user experience, user engagement and usability pilot study

IntroductionChronic diseases in older adults are one of the major epidemiological challenges of current times and leading cause of disability, poor quality of life, high healthcare costs and death. Self-management...

Aging and Psychological Well-Being: The Possible Role of Inhibition Skills.

(1) Background: Psychological well-being (PWB) is a multidimensional construct which is a key protective factor against chronic diseases in older adults. Numerous psychological and cognitive factors can influence older people’s PWB. However, while most studies have explored the effect of general cognition, only a few investigated the role of specific cognitive functions such as the efficiency of executive functions. Thus, the present study aimed to directly explore the relationships between PWB, age, and the core executive functions (namely working memory, flexibility, and inhibition). (2) Methods: A sample of 51 healthy older adults (age range: 60–88) were enrolled and tested both for PWB (by Ryff’s psychological well-being scale) and the core executive functions (by the Digit span backward, the Trail Making Test, and the Stroop test). (3) Results: Age and inhibitory skills are negatively correlated to the personal growth subscale of the PWB scale. Moreover, a hierarchical regression analysis showed that inhibition, but not working memory and flexibility, predicted the sense of continued growth and development (personal growth) of older adults, even after controlling for age and educational levels. Limitations and implications for future research and prevention interventions are discussed.

Association Serum Lipid Levels with Periodontal Disease in Korean Adults Over the Age of 50: The Korea National Health and Nutrition Examination Survey, 2016-2018

PURPOSE: Although the prevalence of periodontal disease in adults over the age of 50 is rapidly increasing, the association between serum lipid levels and periodontal disease in Korean adults over the age of 50 still remains to investigate. Thus, the aim was to determine the effect of serum lipid levels on periodontal disease in older adults over the age of 50 using data from the seventh Korea National Health and Nutrition Examination Survey.METHODS: The study used the data of 809 adults aged ≥50 years targeted in the 7th Korea National Health and Nutrition Examination Survey, 2016-2018. Levels of total cholesterol, triglyceride, high density- lipoprotein (HDL-cholesterol), and low density-lipoprotein (LDL-cholesterol) and periodontal conditions were measured. Complex-sample chi square test and linear regression were used to analyze the relationship serum lipid levels with periodontal disease.RESULTS: The results of chi square tests showed that the prevalence of periodontal disease among the elderly ≥50 years were statistically significant differences according to gender, age, education level, marital status, and smoking status. After adjusting for all confounding factors, HDL-cholesterol alleviated periodontal disease, while LDL-cholesterol exacerbates periodontal disease. However, total cholesterol and triglycerides were not connected with periodontal disease.CONCLUSIONS: Therefore, controlling HDL and LDL cholesterol levels through physical exercise could be a preventative measure for periodontal disease.

Cognition impairment and risk of subclinical cardiovascular disease in older adults: The atherosclerosis risk in communities study.

BackgroundClinical cardiovascular disease (CVD) and cognition impairment are common and often coexist in aging populations, and CVD is associated with greater cognition impairment risk; however, the association between cognition impairment and CVD risk is inconsistent. It is unknown if pathways that contribute to CVD are caused by impaired cognition. We hypothesized that cognition impairment would be associated with greater subclinical CVD including subclinical myocardial damage [assessed by high-sensitivity cardiac troponin T (hs-cTnT)] and cardiac strain or dysfunction [assessed by N-terminal pro-B-type natriuretic peptide (NT-proBNP)].MethodsThis analysis included Atherosclerosis Risk in Communities Study (ARIC) participants who underwent global cognition z-score tests between 1991 and 1993. Cardiac biomarkers were measured from stored plasma samples collected between 1996 and 1999. Logistic regression models were used to determine the association of cognitive function with subclinical CVD risk.ResultsThere were 558/9216 (6.1%) and 447/9097 (5.0%) participants with incident elevated hs-CTnT (≥14 ng/L) and NT-proBNP (≥300 pg/mL) levels, respectively. Comparing the lowest and highest quartiles of global cognition z-scores, a higher incidence of elevated hs-CTnT [odds ratio (OR) = 1.511, 95% confidence interval (CI): 1.093–2.088, P = 0.013] and NT-proBNP (OR = 1.929, 95% CI: 1.350–2.755, P < 0.001) were observed, respectively. In structural equation modeling, the indirect effect of global cognition z-score on major adverse cardiac events was 42.1% (P < 0.05).ConclusionImpairments in baseline cognitive function were associated with subclinical myocardial damage or wall strain. Although future studies are warranted to investigate the pathophysiological mechanisms behind these associations, our study suggests common pathways between cognitive and cardiac dysfunction.

The clinical correlation between Alzheimer's disease and epilepsy.

Alzheimer's disease and epilepsy are common nervous system diseases in older adults, and their incidence rates tend to increase with age. Patients with mild cognitive impairment and Alzheimer's disease are more prone to have seizures. In patients older than 65 years, neurodegenerative conditions accounted for ~10% of all late-onset epilepsy cases, most of which are Alzheimer's disease. Epilepsy and seizure can occur in the early and late stages of Alzheimer's disease, leading to functional deterioration and behavioral alterations. Seizures promote amyloid-β and tau deposits, leading to neurodegenerative processes. Thus, there is a bi-directional association between Alzheimer's disease and epilepsy. Epilepsy is a risk factor for Alzheimer's disease and, in turn, Alzheimer's disease is an independent risk factor for developing epilepsy in old age. Many studies have evaluated the shared pathogenesis and clinical relevance of Alzheimer's disease and epilepsy. In this review, we discuss the clinical associations between Alzheimer's disease and epilepsy, including their incidence, clinical features, and electroencephalogram abnormalities. Clinical studies of the two disorders in recent years are summarized, and new antiepileptic drugs used for treating Alzheimer's disease are reviewed.

Infectious diseases and cognition: do we have to worry?

ObjectivesAge-related physiological changes, particularly immune system decline, may contribute to greater vulnerability to infectious diseases in older individuals. A growing body of evidence shows that both, acute, and chronic infections may be accompanied by cognitive disturbances as part of their manifestations. Given the importance of cognition in aging trajectories, the objective of this article was to review current knowledge on cognitive outcomes of infectious diseases in older adults, and to emphasize the importance of considering cognition as a domain of interest in its own rights in these diseases.MethodsA MEDLINE/PubMed database search was conducted to identify articles reporting cognitive impairment associated with various severe acute infections and specific chronic infectious conditions such as human immune deficiency virus, the herpes virus family, hepatitis C virus, Lyme borreliosis, Helicobacter pylori, periodontitis, and emerging pathogens like SARS-CoV-2, as well as potentially preventive strategies like vaccination.Results/ ConclusionsTaken together, the studies examined in the present review emphasize that numerous acute and chronic infectious diseases share mechanisms that, when added to specific risk factors frequently found in older persons, contribute to considerably increase the risk of cognitive outcomes such as cognitive decline and dementia. This review may help to appreciate the role that infectious diseases play in cognitive trajectories and thus promote further investigation on the topic.

Upper airway gene expression shows a more robust adaptive immune response to SARS-CoV-2 in children

Unlike other respiratory viruses, SARS-CoV-2 disproportionately causes severe disease in older adults whereas disease burden in children is lower. To investigate whether differences in the upper airway immune response may contribute to this disparity, we compare nasopharyngeal gene expression in 83 children (<19-years-old; 38 with SARS-CoV-2, 11 with other respiratory viruses, 34 with no virus) and 154 older adults (>40-years-old; 45 with SARS-CoV-2, 28 with other respiratory viruses, 81 with no virus). Expression of interferon-stimulated genes is robustly activated in both children and adults with SARS-CoV-2 infection compared to the respective non-viral groups, with only subtle distinctions. Children, however, demonstrate markedly greater upregulation of pathways related to B cell and T cell activation and proinflammatory cytokine signaling, including response to TNF and production of IFNγ, IL-2 and IL-4. Cell type deconvolution confirms greater recruitment of B cells, and to a lesser degree macrophages, to the upper airway of children. Only children exhibit a decrease in proportions of ciliated cells, among the primary targets of SARS-CoV-2, upon infection. These findings demonstrate that children elicit a more robust innate and especially adaptive immune response to SARS-CoV-2 in the upper airway that likely contributes to their protection from severe disease in the lower airway.

Depressive Symptoms Have Distinct Relationships With Neuroimaging Biomarkers Across the Alzheimer's Clinical Continuum.

BackgroundDepressive and anxiety symptoms are frequent in Alzheimer’s disease and associated with increased risk of developing Alzheimer’s disease in older adults. We sought to examine their relationships to Alzheimer’s disease biomarkers across the preclinical and clinical stages of the disease.MethodFifty-six healthy controls, 35 patients with subjective cognitive decline and 56 amyloid-positive cognitively impaired patients on the Alzheimer’s continuum completed depression and anxiety questionnaires, neuropsychological tests and neuroimaging assessments. We performed multiple regressions in each group separately to assess within group associations of depressive and anxiety symptoms with either cognition (global cognition and episodic memory) or neuroimaging data (gray matter volume, glucose metabolism and amyloid load).ResultsDepressive symptoms, but not anxiety, were higher in patients with subjective cognitive decline and cognitively impaired patients on the Alzheimer’s continuum compared to healthy controls. Greater depressive symptoms were associated with higher amyloid load in subjective cognitive decline patients, while they were related to higher cognition and glucose metabolism, and to better awareness of cognitive difficulties, in cognitively impaired patients on the Alzheimer’s continuum. In contrast, anxiety symptoms were not associated with brain integrity in any group.ConclusionThese data show that more depressive symptoms are associated with greater Alzheimer’s disease biomarkers in subjective cognitive decline patients, while they reflect better cognitive deficit awareness in cognitively impaired patients on the Alzheimer’s continuum. Our findings highlight the relevance of assessing and treating depressive symptoms in the preclinical stages of Alzheimer’s disease.

Polymyalgia Rheumatica.

Polymyalgia rheumatica (PMR) is among the most common inflammatory rheumatic diseases in older adults. Presumed risk factors include female sex, previous infections, and genetic factors. No epidemiological data on PMR in Germany have been available until now. This review is based on publications retrieved by a selective literature search in PubMed. Moreover, the administrative incidence and prevalence of PMR in the years 2011-2019 was determined from data of the AOK Baden-Württemberg statutory health insurance carrier for insurees aged 40 and older. In addition, we quantified the number of consultations with physicians involved in the diagnosis. The annual age- and sex-standardized incidence and prevalence of PMR from 2011 to 2019 were 18.6/100 000 persons and 138.8/100 000 persons, respectively. The incidence was higher in women than in men (21.8/100 000 vs. 12.8/100 000 persons per year). 60% of the cases were diagnosed in primary care practices. The treatment of PMR with orally administered glucocorticoids usually results in a treatment response within a few days to weeks. Approximately 43% of patients experience recurrent symptoms within a year, requiring adjustment of the glucocorticoid dose. For older patients with impaired physical ability, additional non-pharmacological treatment with exercise programs plays an important role. PMR usually takes an uncomplicated course under treatment and can be managed in primary care, but these patients are often multimorbid and require frequent follow-up. Along with research on the etiology of the disease, further studies are needed to identify the risk factors for a chronic course and to evaluate the potential effects of non-pharmacological measures.