Prospective associations of plasma growth differentiation factor 15 with physical performance and cognitive functions in older adults

Background Growth differentiation factor 15 (GDF15) has been associated with several age-related disorders, but its associations with functional abilities in community-dwelling older adults are not well studied. Methods The study was a secondary analysis on 1096 community-dwelling older adults (aged 69 to 94 years) recruited from the Multidomain Alzheimer’s Preventive Trial. Plasma GDF15 was measured one year after participants’ enrolment. Annual data of physical performance (grip strength and short physical performance battery [SPPB]) and global cognitive functions (mini-mental state examination [MMSE] and a composite cognitive score) were measured for four years. Adjusted mixed-effects linear models were performed for cross-sectional and longitudinal association analyses. Results A higher GDF15 was cross-sectionally associated with a weaker grip strength (β = -1.1E-03, 95%CI [-2.0E-03, -1.5E-04]), a lower SPPB score (β = -3.1E-04, 95%CI [-5.4E-04, -9.0E-05]) and worse cognitive functions (β = -2.4E-04, 95%CI [-3.3E-04, -1.6E-04] for composite cognitive score; β = -4.0E-04, 95%CI [-6.4E-04, -1.6E-04] for MMSE). Participants with higher GDF15 demonstrated greater longitudinal declines in SPPB (β = -1.0E-04, 95%CI [-1.7E-04, -2.0E-05]) and composite cognitive score (β = -2.0E-05, 95%CI [-4.0E-05, -3.6E-06]). The optimal initial GDF15 cutoff values for identifying participants with minimal clinically significant decline after one year were 2189 pg/mL for SPPB (AUC: 0.580) and 2330 pg/mL for composite cognitive score (AUC: 0.587). Conclusions Plasma GDF15 is cross-sectionally and longitudinally associated with lower-limb physical performance and global cognitive function in older adults. Circulating GDF15 alone has limited capacity of discriminating older adults who will develop clinically significant functional declines.

Does grip strength correlate with rotator cuff strength in patients with atraumatic shoulder instability?

Aim To investigate if there is a correlation between grip strength (GS) and rotator cuff (RC) strength in patients with atraumatic shoulder instability (ASI) and to compare the relationship between these two measures with that previously published for a healthy population. Moreover, to determine if testing GS could be incorporated as a surrogate clinical assessment for RC strength in these patients. Methods A total of 20 subjects with ASI were included. Out of the 20 patients, eight presented with bilateral instability, which constituted a total of 28 atraumatic unstable shoulders (N = 28). GS was measured using a Jamar hand-dynamometer. External rotation (ER) and internal rotation (IR) strength was tested in inner and outer ranges using a hand-held dynamometer (HHD). Pearson’s correlation test was computed to investigate the relationship. Multiple linear regression was conducted to predict GS based on RC strength. Results Significant and strong positive correlations were found between GS and inner-range IR (r = 0.764, P < 0.001), inner-range ER (r = 0.611, P = 0.001), outer-range IR (r = 0.817, P < 0.001), and outer-range ER (r = 0.736, P < 0.001). A significant regression equation was found (F (4, 23) = 13.254, P < 0.001), with an R2 of 0.697 indicating that RC strength explained 69.7% of the variance in GS. Conclusions The results support the hypothesis showing that GS is strongly associated with RC strength in ASI patients. The simplicity of handgrip testing allows it to be used in clinical scenarios where sophisticated assessment tools are not available. GS is a convenient means to monitor patient progress during shoulder rehabilitation programs.

Combined driving: task-specific position impacts grip strength of equestrian athletes

Background Loss of hand strength is a predictor of mortality in aging populations. Despite reliance on the hands to participate in equestrian driving activity, no existing studies focus on associations of hand strength to athletic performance. Therefore, this study 1) established baseline handgrip of equestrian combined drivers in standing and task-specific positions, 2) determined endurance of task-specific handgrip, 3) compared handgrip strength to normative data, and 4) evaluated associations of handgrip and equestrian-specific variables. Methods There were 51 combined drivers (9 males, 42 females) ages 21–78 who completed a survey, standing handgrip, and grip strength and endurance in a task-specific position. Sixty-three percent of participants were 50 years or older. The dynamometer grip bar was normalized by hand size for standing tests; to duplicate sport-specific tasks, the bar was set to the closest setting. Significances were determined at p < 0.05. Results Drivers with more than 30 years of experience demonstrated highest summed standing (73.1 ± 5.2 kg) and summed sitting (59.9 ± 6.3 kg) grip strength. Females 60-years and older had greater handgrip endurance (Χ2 = 8.323, df = 2, p = .0156) in non-dominant (left) hands. Males (60%) reported more cold weather fatigue than females. Glove wearing was associated with bilateral endurance balance; a higher proportion of endurance balance between dominant and non-dominant (49% high-high and 29% low-low; Χ2 = 11.047, df = 1, p = .0009) was realized. There were no associations of handgrip and prior injury. Conclusions Our results have implications in understanding task-specific and normative grip strengths in aging equestrian populations. Bilateral balance in handgrip strength and endurance is important particularly in maintaining strength in non-dominant hands over time. Equestrian driving sport promotes greater endurance in older females. Strength can be improved by participating in combined driving, and engagement in this sport over several years’ benefits hand strength over time. This cohort of equestrian participants provides evidence that participating in hand-specific activities promotes greater strength, which has been previously shown to improve aging outcomes.

Relationship between muscle strength and rehospitalization in ventricular assist device patients

We examined the relationship between leg extensor muscle strength (LEMS) at discharge and rehospitalization within 1 year in patients with a newly implanted ventricular assist device (VAD). This study included 28 patients who had received a VAD at our institution between October 2013 and February 2019, all of whom had been discharged for 1 year. The patients were divided into two groups according to their LEMS at discharge (higher strength [group H] and lower strength [group L]), based on the median value of the 55.2 kg-force (kgf)/body weight (BW) equation. Exercise performance parameters (e.g., grip strength, 6-min walk distance, and peak VO2) and laboratory data concerning nutritional status were also collected. Nine patients (64.3%) in group L were rehospitalized within 1 year after discharge. The rehospitalization rate was significantly higher in group L than group H (p = 0.020). Compared with discharge, patients exhibited higher grip strength (56.3 vs. 48.6 kg/BW, respectively; p = 0.011), 6-min walk distances (588 vs. 470 m, respectively; p = 0.002), and peak VO2 (15.4 vs. 11.9 mL/min/kg, respectively; p < 0.001) at 1 year after discharge. However, the LEMS (57.4 vs. 58.0 kgf/BW, respectively; p = 0.798) did not increase after discharge in VAD patients who avoided rehospitalization. LEMS at discharge was associated with rehospitalization after VAD surgery; a high LEMS improves the likelihood of avoiding rehospitalization.

Anxiety disorders and age-related changes in physiology

Background Anxiety disorders are leading contributors to the global disease burden, highly prevalent across the lifespan and associated with substantially increased morbidity and early mortality. Aims The aim of this study was to examine age-related changes across a wide range of physiological measures in middle-aged and older adults with a lifetime history of anxiety disorders compared with healthy controls. Method The UK Biobank study recruited >500 000 adults, aged 37–73, between 2006 and 2010. We used generalised additive models to estimate non-linear associations between age and hand-grip strength, cardiovascular function, body composition, lung function and heel bone mineral density in a case group and in a control group. Results The main data-set included 332 078 adults (mean age 56.37 years; 52.65% women). In both genders, individuals with anxiety disorders had a lower hand-grip strength and lower blood pressure, whereas their pulse rate and body composition measures were higher than in the healthy control group. Case–control group differences were larger when considering individuals with chronic and/or severe anxiety disorders, and differences in body composition were modulated by depression comorbidity status. Differences in age-related physiological changes between females in the anxiety disorder case group and healthy controls were most evident for blood pressure, pulse rate and body composition, whereas this was the case in males for hand-grip strength, blood pressure and body composition. Most differences in physiological measures between the case and control groups decreased with increasing age. Conclusions Findings in individuals with a lifetime history of anxiety disorders differed from a healthy control group across multiple physiological measures, with some evidence of case–control group differences by age. The differences observed varied by chronicity/severity and depression comorbidity.

Effect of Scapular Kinesiotaping as an Adjunct to Dynamic Neuromuscular Stabilization Exercises on Upper Extremity Functions in Stroke Patients

Background and Purpose: Stroke is one of the leading causes of death and disability in India. Upper extremities get more affected in Middle cerebral artery syndrome. Stroke patients have lack of functional ability of upper extremity due to scapular malalignment resulting from paralysis of the scapular muscles. Kinesiotape helps to realign the muscles and thus it becomes easy to activate or inhibit them. We hypothesised that Dynamic Neuromuscular Stabilisation exercises along with kinesiotape could improve upper extremity function. Methodology: Ethical clearance was obtained. Informed consent was taken. 30 patients were selected according to inclusion and exclusion criteria. 15 subjects were randomly divided into experimental and control group. Subjects were given Dynamic neuromuscular stabilisation exercises for scapular strengthening. The experimental group was given Kinesiotaping to the scapula using muscle technique. Pre and post treatment assessment was done using Upper Extremity Function Index, grip strength and scapular abduction position with MB ruler. Result: The intergroup comparison revealed a highly significant difference for upper extremity function index and grip strength whereas scapular abduction was not significant. Conclusion: The Scapular Kinesiotaping as an adjunct to Dynamic Neuromuscular Stabilization Exercises is significantly effective to improve upper extremity functions and grip strength in post stroke patients. Key words: Stroke, Upper Extremity Functions, Dynamic Neuromuscular Stabilization Exercises, Scapular Kinesiotaping.

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

Background Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. Materials and methods We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Results The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. Conclusion We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. Level of evidence Therapeutic III.

The Brain-Derived Neurotrophic Factor Functional Polymorphism and Hand Grip Strength Impact the Association between Brain-Derived Neurotrophic Factor Levels and Cognition in Older Adults in the United States

Introduction Aging is associated with subtle cognitive decline in attention, memory, executive function, processing speed, and reasoning. Although lower brain-derived neurotrophic factor (BDNF) has been linked to cognitive decline among older adults, it is not known if the association differs among individuals with various BDNF Val66Met (rs6265) genotypes. In addition, it is not clear whether these associations vary by hand grip strength or physical activity (PA). Methods A total of 2904 older adults were included in this study using data from the Health and Retirement Study. Associations between serum BDNF and measures of cognitive function were evaluated using multivariable linear regression models stratified by Met allele status. PA and hand grip strength were added to the model to evaluate whether including these variables altered associations between serum BDNF and cognition. Results Mean age was 71.4 years old, and mean body mass index was 28.3 kg/m2. Serum BDNF levels were positively associated with higher total cognitive score (beta = 0.34, p = .07), mental status (beta = 0.16, p = .07), and word recall (beta = 0.22, p =.04) among Met carriers, while serum BDNF levels were negatively associated with mental status (beta = −0.09, p = .07) among non-Met carriers. Furthermore, associations changed when hand grip strength was added to the model but not when PA was added to the model. Conclusions The BDNF Val66Met variant may moderate the association between serum BDNF levels and cognitive function in older adults. Furthermore, such associations differ according to hand grip strength but not PA.