Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.
Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France; UPS/Inserm UMR1027, University of Toulouse III, Toulouse, France.
Exp Gerontol. 2019 Nov;127:110716. doi: 10.1016/j.exger.2019.110716. Epub 2019 Sep 4.
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).
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.
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 μM/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.
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.
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.
世界卫生组织（WHO）最近提出了一种以功能而非疾病为基础的创新护理模式，该模式基于内在能力（IC）的概念。
本研究旨在分析低水平炎症（LGI）（慢性升高的 C 反应蛋白 - CRP）和高同型半胱氨酸血症（HHcy）是否与非痴呆、社区居住的认知障碍高危老年人的 IC 域（运动能力、认知能力、心理和活力）以及 5 年随访期间的综合 IC Z 评分的变化相关。
本观察性研究纳入了 1516 名≥70 岁的志愿者（64.5%为女性，平均年龄 75.4 岁，标准差为 4.5），他们来自干预性研究多领域阿尔茨海默病预防试验（MAPT）。测量了血浆 CRP（基线时、6 个月和 12 个月时）和同型半胱氨酸（基线时）浓度。LGI 定义为基线至 12 个月期间连续 2 次 CRP 读数≥3 至 10mg/L；HHcy 定义为同型半胱氨酸>15µM/L。IC 域的操作性定义如下：心理。使用老年抑郁量表（GDS）评估抑郁症状；运动能力。通过简短体能测试电池（SPPB）进行评估；认知功能。通过四个测试的 Z 分数组合进行检查；活力。基于握力。将结果组合成一个综合的 IC Z 评分。
5 年后，无炎症和 LGI 组的 IC Z 评分下降，但 LGI 组的下降更为明显（未调整的平均组间差异：0.09，95%CI：0.01 至 0.16；p=0.032）。HHcy 患者的 IC Z 评分也随时间下降。合并条件导致更为明显的下降，即使在调整了潜在混杂因素后也是如此。
在 5 年随访后，LGI 和 HHcy 均与老年人的综合 IC 水平下降有关。识别与 IC 密切相关的生物标志物，可能有助于制定预防与年龄相关的功能下降和依赖护理相关的发病率和减缓其进展的策略。
