Janina Krell-Roesch

Health and demographic surveillance sites (HDSS) provide sampling frames to conduct longitudinal studies. This review aims to provide a comprehensive characterization of HDSS in Ethiopia and assess its potential as a robust infrastructure for longitudinal studies on aging-related and other health outcomes. We searched databases including PubMed for peer-reviewed articles, HDSS reports, strategic papers, and other pertinent literature, and extracted pertinent information. Projection of adult population (aged ≥40 years) for the respective HDSS was done based on the estimated growth rate. From a total of 979 articles, 56 were included in the review. Currently, 11 HDSS are present in Ethiopia, and each has more than 9,000 households with an average household size of at least three. HDSS have unique characteristics and are designed to focus on respective geographic and demographic contexts. A total of 27 districts (1-6 districts per HDSS) and 12 sub-districts are included across all HDSS. The number of adults aged ≥40 years is projected to rise from 210, 673 in 2024 to 295,780 in 2037, indicating their potential as infrastructure to conduct studies on aging. Limited geographic coverage across regions and resource constraints are identified gaps in HDSS. Major cities, urban areas, and remote areas may lack sufficient coverage or representation. In light of the anticipated significant increase in the number of older adults in the HDSS capture sites, HDSS can serve as an infrastructure for conducting studies on aging-related and other health outcomes in Ethiopia.

Activities of daily living (ADL) are associated with declines in physical fitness and subjective health. However, it remains unclear as to whether ADL impairments are related to specific components of physical fitness and health variables. Therefore, we examined differences between community‐dwelling older persons with versus without ADL impairments with regard to various physical fitness components, physical complaints as well as subjective and objective health outcomes. Cross‐sectional study among 254 participants aged ≥ 55 years [51% female; 84 with ADL impairments; mean (SD) age 62.1 (6.6) years] enrolled in the population‐based “Gesundheit zum Mitmachen” study in Southwestern Germany. ADL, physical complaints and subjective health status were assessed using a self‐report questionnaire, physical fitness (cardiorespiratory fitness, strength, gross motor coordination, flexibility, and functional mobility) was assessed using a fitness test battery, and objective health status was derived from health exam performed by a physician. We ran analyses of covariance, adjusted for age, sex, body mass index and education. Participants with ADL impairments had statistically significantly worse subjective ( p < 0.001) and objective ( p < 0.001) health and reported more physical complaints ( p < 0.001) compared to those without ADL impairments. Regarding physical fitness, ADL‐impaired participants performed worse in 10 out of 12 variables. The findings provide additional evidence that ADL impairments are related to decreased objective and subjective health and physical fitness in older community‐dwelling adults. Future studies employing more comprehensive, preferably objective, ADL assessments and considering cognitive impairments, which may also impact ADL performance, are warranted.

Fasting is part and parcel of the practice of various religious groups. In the scientific literature, the term intermittent fasting (IF) was first reported in a 1946 paper demonstrating its association with increased longevity in rodents. Research has extended IF, particularly time-restricted eating (TRE), to Alzheimer's disease (AD), a progressive neurodegenerative disease characterized by neuritic plaques, neurofibrillary tangles, and neuronal loss. AD manifests in asymptomatic, mild cognitive impairment (MCI), and dementia phases. Delaying progression from MCI to dementia by one year could reduce dementia prevalence by millions. Currently, no pharmacological treatments can reverse or arrest MCI progression to dementia, making exploration of non-pharmacological interventions critical. TRE is a promising approach. AD brains exhibit decreased glucose uptake, while ketone utilization remains intact. Fasting for at least 8–12 h induces a cascade of molecuar events that lead to a metabolic switch from glucose to ketone utilization, providing an alternative energy source for AD brains. Preclinical studies demonstrate that TRE enhances cognitive function via hippocampal neurogenesis, autophagy, and reduced neuroinflammation. Human studies on TRE in MCI are limited but promising, often focusing on cardiometabolic outcomes, with little known about TRE targeting MCI. This review synthesizes current evidence on TRE and cognitive outcomes in humans, non-human primates, and rodents, and describes ongoing trials in MCI patients. We propose a theoretical model of direct and indirect pathways linking TRE with resistance to AD in the brain parenchyma, and identify gaps in knowledge regarding long-term cognitive effects and mechanistic pathways of TRE in MCI, urging rigorous clinical trials to establish TRE as a safe and possibly effective strategy to delay MCI progression to dementia.

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluates the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. Primary outcomes were fall incidence and fall risk (assessed using Berg Balance Scale [BBS] and Timed Up and Go [TUG]); fear of falling was a secondary outcome. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1, 190.81) = 8.25, p = 0.005, d = 0.22), while group × time changes in TUG performance, fear of falling, and fall incidence were nonsignificant. These findings demonstrate the feasibility of a staff-mediated mHealth approach to fall prevention in NH residents, showing significant improvements in BBS scores as one functional indicator of fall risk, while TUG, fall incidence and fear of falling showed no change.

Engagement in physical and cognitive activities is associated with a decreased risk of mild cognitive impairment (MCI) and dementia, but the association with Alzheimer disease (AD) neuroimaging biomarkers is less clear. We thus examined associations of physical and cognitive activities with longitudinal trajectories of AD neuroimaging biomarkers among older adults free of dementia. We conducted a longitudinal study within the population-based Mayo Clinic Study of Aging (mean follow-up durations 1.3-3.4 years). Participants were aged 50 years or older and were cognitively unimpaired or had MCI at baseline. Engagement in physical and cognitive activities during 12 months before baseline was assessed through questionnaires. Participants underwent AD neuroimaging biomarker assessments at 1 or more time points. We ran linear mixed-effect models to examine associations between physical and cognitive activity composite scores and trajectories of individual yearly change in amyloid deposition (Pittsburgh compound B [PiB]-PET centiloid), tau burden (tau-PET standardized uptake value ratio [SUVR]), and regional glucose hypometabolism (fluorodeoxyglucose [FDG]-PET SUVR), adjusted for age, sex, APOE ɛ4 carrier status, and medical comorbidity. We included 1,176 participants (47% female; mean [SD] age, 68.7 [9.6] years) for PiB-PET trajectories, 399 participants (49% female; mean [SD] age, 71.9 [11.0] years) for tau-PET trajectories, and 983 participants (46% female; mean [SD] age, 67.9 [9.2] years) for FDG-PET trajectories. PiB-PET and tau-PET measures increased during follow-up (3.4 [SD 4.0] and 1.3 [SD 2.1] years, respectively), whereas FDG-PET values decreased over 2.9 (SD 3.5) years of follow-up. Participants with higher total physical activity (interaction estimate 0.0017; 95% CI 0.0003-0.0031; p = 0.021) and higher moderate-to-vigorous physical activity (interaction estimate 0.0015; 95% CI 0.0001-0.0029; p = 0.040) had a less pronounced decrease in FDG-PET over time. Participants with higher cognitive activity experienced a less pronounced increase in PiB-PET (interaction estimate -0.2253; 95% CI -0.4437 to -0.0070; p = 0.043) and a smaller decrease in FDG-PET (interaction estimate 0.0015; 95% CI 0.0001-0.0028; p = 0.038) over time. Physical activity was associated with less synaptic dysfunction and cognitive activity with less synaptic dysfunction and lower amyloid burden over time, albeit effect sizes were small. Further research is needed to validate findings and clarify causal inference between physical and cognitive activities and AD neuroimaging biomarkers.

Background: Previous studies on the relationship between prediabetes, HbA1c and cognitive trajectories show mixed results. Therefore, we investigated the association of prediabetes, diabetes and HbA1c with change in global and domain‐specific cognitive scores in cognitively unimpaired (CU) adults, as well as the potential effect modification by sex or age. Methods: This longitudinal study included 4236 CU persons aged ≥ 50 years from the population‐based Mayo Clinic Study of Aging. We ran linear mixed‐effect models with baseline prediabetes, diabetes and HbA1c predicting longitudinal global and domain‐specific (i.e., memory, language, attention/executive function, and visuospatial skills) cognitive z‐scores and raw scores. Models were adjusted for age, sex, education, medical comorbidity, repeated cognitive testing, and ApoEɛ4. We additionally ran models with sex and age interactions. Results: Compared to normoglycemic individuals, individuals with prediabetes and diabetes showed poorer performance on cognitive tests, i.e., TMT‐B, category fluency, and block design subtest over time. Additionally, the presence of prediabetes, diabetes, longer diabetes duration and higher HbA1c were associated with faster global and domain‐specific cognitive decline over a median follow‐up of 6.4 years (range 1–19). Three‐way interactions showed that the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than in men. Age did not modify the effect of diabetes or higher HbA1c on cognition. Conclusions: The results suggest that prediabetes and diabetes significantly shorten the timeframe before a potentially clinically noticeable change in global and domain‐specific cognition is reached. Thus, lifestyle modification to reverse prediabetes and prevent diabetes could potentially reduce the rate of cognitive decline in aging populations. The findings differed by sex (i.e., the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than men).

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluated the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Primary outcomes were fall incidence and fall risk (Berg Balance Scale [BBS], Timed Up and Go [TUG]); fear of falling was secondary. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1,190.81) = 8.25, p = .005), while changes in TUG performance, fear of falling, and fall incidence were nonsignificant. The intervention improved balance, a key component of fall risk, but did not reduce fall frequency within the study period. These findings demonstrate the feasibility and short-term functional benefits of a staff-mediated mHealth approach to fall prevention in NH residents.

Background: The literature on dyslipidemia and cognitive trajectories among cognitively unimpaired (CU) persons remains inconclusive. Objective: To investigate the association between baseline dyslipidemia and change in global and domain specific (i.e., memory, language, attention/executive function, and visuospatial skills) cognition in a population-based setting and whether the association differs by sex, age, or APOE ɛ4 carrier status. Methods: We conducted a longitudinal study derived from the Mayo Clinic Study of Aging, involving 4236 CU persons aged ≥ 50 years. We ran linear mixed-effect models to examine baseline dyslipidemia in predicting longitudinal cognitive global and domain-specific z-scores adjusted for age, sex, education, medical comorbidity, repeated cognitive testing, and APOE ɛ4. We examined interactions among dyslipidemia, years since baseline, and separately by sex, age, and APOE ɛ4 carrier status. Results: Over a median follow-up period of 6.4 years, CU individuals with dyslipidemia showed faster decline in z-scores of all domains, i.e., memory, language, attention/executive function, visuospatial and global cognition relative to CU individuals without dyslipidemia. Three-way interactions showed that dyslipidemia's effect on decline in z-scores of global cognition, attention and visuospatial skills was less pronounced in males than females. Higher age increased dyslipidemia's effect on decline in z-scores of attention but not global cognition or any other domain. APOE ɛ4 carrier status did not modify the effect of dyslipidemia on cognitive z-scores. Conclusions: Dyslipidemia was associated with faster global and domain-specific cognitive decline over time in older community-dwelling individuals who were cognitively unimpaired at baseline. The effect of dyslipidemia on cognitive trajectories may be sex-influenced.

Regular engagement in physical activity is recognized as an effective prevention strategy for both cognitive and physical decline. We developed MyEveryCise, an exercise program that uses an activity of daily living as a cue to encourage regular physical exercise. This exploratory study assessed the effectiveness of MyEveryCise in increasing the persistence in light exercise in twenty persons with low physical activity in a one-month intervention. Using the physical activity questionnaire, we observed a significant increase in the frequency and duration of light physical exercise after the intervention, suggesting that MyEveryCise is a useful method to maintain a daily exercise routine.