Vascular Brain Disease in Geriatric Neuropsychiatry

Vascular brain diseases are a significant cause of dementia, and their presence, alone or associated with degenerative conditions, increases the risk of conversion to progressive cognitive decline. Neuropsychiatric manifestations vary according to the affected brain territory and disrupted neuronal circuits. In the current chapter, epidemiological prevalence, the harmonization of the diagnostic criteria of vascular subtypes, and the impact of age and socio-demographic aspects are critically reviewed. Another explored topic refers to the diagnostic and therapeutic approach. Structural imaging, including magnetic resonance (MRI) and computer tomography (CT), and a thorough neuropsychological and clinical exam, may help establish the differential diagnosis and substantially impact clinical evolution. Treatment involves various strategies, including controlling cardiovascular and metabolic risk factors, such as hypertension, atrial fibrillation, cardiopathies, and adopting a healthy lifestyle. Treatment relies on preventive and health promotion strategies related to the timely control of vascular risk factors and symptomatic approaches. The use of acetylcholinesterase inhibitors aims at stabilizing symptoms and is recommended in all stages of dementia.

O-159 Prediction of weight loss and drop-out in a lifestyle intervention in women with pcos: A randomized controlled trial

Study question Which patient related determinants contribute to a ≥ 5% weight loss and drop-out? Summary answer Participating in the lifestyle treatment and a worse body image at baseline were significantly associated with ≥5% weight loss. What is known already In general, three-component interventions including diet, exercise, and cognitive behavioral therapy have shown to be effective at the long-term to achieve weight loss. In a lifestyle program for infertile women, higher external eating behavior scores and not receiving previous support by a dietician were associated with weight loss. In a short term lifestyle program for women with PCOS, weight loss was associated with better quality of life scores and attendance of study appointments. Little has been published about the potential role of PCOS characteristics, psychological and behavioral variables on the ability to achieve weight loss in this group of women. Study design, size, duration The present study is a longitudinal RCT to study the effectiveness of a three component 1-year cognitive-behavioural lifestyle intervention on weight loss in overweight/obese women with PCOS. A total of 183 participants were randomly assigned to three groups: 1) CBT provided by the multidisciplinary team or; 2) CBT provided by the multidisciplinary team and Short Message Service (SMS) or; 3) usual care: women are encouraged to lose weight through publicly available services (control group). Participants/materials, setting, methods Women with menstrual cycle disorders are systematically screened using a standardised protocol. Data of 183 women diagnosed with PCOS according to the Rotterdam criteria, a Body Mass Index above 25 kg/m² were included. All variables were measured at start and at three, six, nine and twelve months. Main results and the role of chance The multivariable mixed-effect logistic regression model showed that participation in the lifestyle treatment (HR 2.3, P = 0.012) and a worse body image (FNAE) (HR 0.95, P = 0.023) at baseline were significantly associated with ≥5% weight loss. Drop-out was predicted by participation in the lifestyle treatment (OR 0.2 P = 0.003), additional short message service (OR 3.7, P = 0.008), smoking (OR 0.3, P = 0.22), drinking alcohol (OR 2.4, P = 0.04), higher levels of androstenedione (OR 1.2, P = 0.047). Also, women who achieved spontaneous pregnancies were more likely to drop-out (OR 0.09, P = 0.002). Limitations, reasons for caution A limitation of our study is the high discontinuation rate we observed especially after 3 months of the intervention. Therefore a statistical method was chosen that included all available data even if participants dropped out during the study period. Wider implications of the findings A three-component lifestyle intervention program for obese women with PCOS is effective for weight loss. The group of women with a more negative body image should receive additional treatment before entering such a lifestyle intervention to achieve better results. Trial registration number Registered at the Netherlands National Trial Register with number NTR2450 on August 2nd, 2010.

Effects of Glucagon-Like-Peptide-1 Analogue Treatment in Genetic Obesity

Introduction: Obesity is highly prevalent, comes with serious health burden and is difficult to treat. In a minority, there is a genetic cause for the obesity. In these patients, therapy-resistant obesity is often observed despite intensive lifestyle treatment. Moreover, it is still unclear whether bariatric surgery is less successful in genetic obesity. Liraglutide is a Glucagon-Like-Peptide-1 (GLP-1) receptor agonist or GLP-1 analogue, showing positive effects on metabolic parameters, satiety and weight loss in lifestyle-induced obesity. We present our experiences of GLP-1 analogue treatment in patients with genetic obesity disorders. Methods: Adults with overweight or severe obesity and a molecularly proven genetic cause were treated with liraglutide 3,0 mg daily, in addition to ongoing intensive supportive lifestyle treatment. Anthropometrics, metabolic parameters, resting energy expenditure (REE), side effects, and subjectively reported satiety and quality of life were assessed. Results: Two patients with a heterozygous pathogenic melanocortin 4 recepter variant and two patients with 16p11.2 deletion syndrome, ranging in age between 21 and 32 years and in BMI between 28.1 and 55.7 kg/m2 at baseline, were treated. At end of follow-up, ranging between 33 weeks and 12 years, a mean change in BMI and waist circumference was observed of -5.7 ± 3.8 kg/m2 and -15.2 ± 21.1 cm, respectively. All patients reported better quality of life, three of them also reported improved satiety. Moreover, improvement of metabolic parameters was seen. No clear effect on REE was observed. Two patients experienced mild side effects, e.g. nausea and stomach pain, for a brief period. Conclusion: We here show beneficial effects of GLP-1 analogues on weight, metabolic parameters, and quality of life in four patients with genetic obesity. Satiety improved in three of the four patients. All patient achieved at least the clinically relevant 5–10% weight loss. Our findings suggest that GLP-1 analogue treatment might be an effective treatment option, in addition to a healthy lifestyle, for patients with genetic obesity.

Changes in Thyroid and Glycemic Status and Food Intake in Children with Excess Weight Who Were Submitted for a Multi-Component School Intervention for 16 Months

We investigated if children with excess weight who submitted to two types of intervention at school for 16 months showed improvements in thyroid and glycemic function and food intake. Children (8–11 years) with a body mass index-for-age (BMI/A) of ≥1 Z score were divided into two groups: Treatment 1 (n = 73) involved motivation to adopt healthier lifestyle; Treatment 2 (n = 103) involved performing weekly nutritional education, motivational, and physical activities at school. A semi-quantitative food frequency questionnaire was used. The delta BMI/A were similar after 16 months; Treatment 1 showed higher decrease in thyroid-stimulating hormone (TSH; median (range)): −0.45 (−3.19 to 2.17) and 0.06 (−4.57 to 1.63) mIU/L, p = 0.001), FreeT3 (−0.46 (−2.92 to 1.54) and −0.15 (−2.46 to 1.38) pmol/L, p = 0.038), and FreeT4 −1.41 (−6.18 to 3.47) and −0.90 (−4.89 to 2.96) pmol/L, p = 0.018), followed by decrease in energy intake (7304 (6806 to 7840) and 8267 (7739 to 8832) kJ, Ptreatment = 0.439, Ptime <0.001, interaction group–time p < 0.001), macronutrients and sugar. A positive correlation between FreeT3 and BMI/A, and a negative correlation with FreeT4 and insulin were found at baseline (r 0.212, p < 0.01; r −0.155, p < 0.01, respectively) and follow-up (r 0.222, p < 0.01; r −0.221, p < 0.01). The decrease in overall diet and particularly sugar intake was accompanied by a greater reduction in TSH and FreeT3 in Treatment 1, demonstrating the impact of dietary intake on thyroid function.

Impact of Intensive Lifestyle Treatment (Diet Plus Exercise) on Endothelial and Vascular Function, Arterial Stiffness and Blood Pressure in Stage 1 Hypertension: Results of the HINTreat Randomized Controlled Trial

Lifestyle modification is an important component of essential hypertension (EH) therapy. The aim of the Hypertension Intensive Nutrition Treatment (HINTreat) parallel, randomized controlled trial was to examine the effect of a 6-month intensive lifestyle treatment (ILT) (diet plus exercise with monthly visits) compared to the usual care. A total of 76 adults with stage 1 EH were randomized (38 in each group). Dietary analysis, anthropometry, physical activity, biochemical and urine profile, blood pressure (BP), asymmetric dimethylarginine (ADMA), central hemodynamics, β-stiffness index and carotid intima media-thickness were evaluated. The dietary inflammatory index (DII) was calculated for each participant from the intake of 29 nutrients/food components. At the end of the trial, participants in the ILT group reduced their 24h urinary Na excretion (p ≤ 0.001), daytime systolic BP (p ≤ 0.048) and mean carotid β-stiffness index (p ≤ 0.005) and ameliorated their lipidemic profile compared to the standard care. Univariate analysis for the total sample showed a strong association between DII and ADMA levels (β = 0.089, p ≤ 0.01). ILT is effective in improving the inflammatory components of the diet and selected cardiometabolic parameters, including arterial stiffness.