Associations of C-reactive protein and homocysteine concentrations with the impairment of intrinsic capacity domains over a 5-year follow-up among community-dwelling older adults at risk of cognitive decline (MAPT Study)
Associations of C-reactive protein and homocysteine concentrations with the impairment of intrinsic capacity domains over a 5-year follow-up among community-dwelling older adults at risk of cognitive decline (MAPT Study)
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DOI：
10.1016/j.exger.2019.110716
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发表时间：
2019-11-01
影响因子：
3.9
通讯作者：
Coley, Nicola
中科院分区：
文献类型：
--
作者：
Giudici, Kelly Virecoulon;Barreto, Philipe de Souto;Coley, Nicola
背景资料：世界卫生组织（WHO）最近提出了一种基于内在能力（IC）的创新护理模式，该模式侧重于功能而非基于疾病的视角。目的：本研究旨在分析低度炎症（LGI）C-反应蛋白（CRP）和高同型半胱氨酸血症（HHcy）与IC结构域的变化相关（活动性、认知、心理和活力）和综合IC Z-评分在非痴呆、社区居住的有认知能力下降风险的老年人中进行5年随访。设计：这项观察性研究包括1516名≥ 70岁的受试者（64.5%女性，平均年龄75.4岁，SD = 4.5），来自干预性研究多领域阿尔茨海默病预防试验（MAPT）的志愿者。测量血浆CRP（基线、6个月和12个月）和同型半胱氨酸（基线）浓度。LGI定义为在基线和12个月之间有≥ 2个连续CRP读数> 3至10 mg/L，HHcy定义为同型半胱氨酸> 15 μ M/L。IC领域的操作如下：心理。老年抑郁量表（GDS）评估的抑郁症状;活动性。通过短期体能测验（SPPB）进行评估;认知功能。通过结合四项测试的Z分数进行检查;活力。根据握力判断。结果：5年后，无炎症和LGI组的IC Z评分下降，但LGI组的IC Z评分下降更为明显（未校正的平均组间差异：0.09，95%CI：0.01至0.16; p = 0.032）。患有HHcy的参与者也表现出IC Z评分随时间推移而降低。合并条件下提供了更明显的下降，即使调整潜在的confersider.Conclusion：LGI和HHcy都与损害的综合IC水平在老年人5年后随访。识别与IC密切相关的生物标志物可能有助于制定旨在预防发病率和减缓年龄相关功能衰退和护理依赖性演变的策略。
Background: The World Health Organization (WHO) recently proposed an innovative model of care focusing on functional rather than disease-based perspectives, based on a construct of intrinsic capacity (IC).Objective: This study aimed to analyze if low-grade inflammation (LGI) (chronically raised C-reactive protein - CRP) and hyperhomocysteinemia (HHcy) were associated with variation in IC domains (mobility, cognition, psychological and vitality) and in a combined IC Z-score over a 5-year follow-up among non-demented, community-dwelling older adults at risk of cognitive decline.Design: This observational study included 1516 subjects >= 70 years (64.5% female, mean age 75.4 years, SD = 4.5), volunteers from the interventional study Multidomain Alzheimer Preventive Trial (MAPT). Plasma CRP (at baseline, 6 and 12 months) and homocysteine (at baseline) concentrations were measured. LGI was defined as having >= 2 consecutively CRP readings > 3 to 10 mg/L between baseline and 12 months, and HHcy was defined as homocysteine > 15 mu M/L. IC domains were operationalized as follows: Psychological. Depressive symptoms evaluated by the Geriatric Depression Scale (GDS); Mobility. Assessed by the Short Physical Performance Battery (SPPB); Cognitive function. Examined by a Z-score combining four tests; Vitality. Based on hand grip strength. Outcomes were combined into a composite IC Z-score.Results: IC Z-score decreased among groups with no inflammation and LGI after 5 years, but this decrease was more pronounced among the LGI group (unadjusted mean group difference: 0.09, 95%CI: 0.01 to 0.16; p = 0.032). Participants with HHcy also presented IC Z-score decreases over time. Combined conditions provided more pronounced declines, even after adjusting for potential confounders.Conclusion: LGI and HHcy were both related with impairment on the combined IC levels among older adults after a 5-year follow-up. Identifying biomarkers that strongly associate with IC may help to settle strategies aiming to prevent the incidence and slow down the evolution of age-related functional decline and care dependency.