Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer's Disease-A Review
    Brink, Annelien C. van den; Brouwer-Brolsma, Elske M. ; Berendsen, Agnes A.M. ; Rest, Ondine van de - \ 2019
    Advances in Nutrition 10 (2019)6. - ISSN 2161-8313 - p. 1040 - 1065.
    Alzheimer's disease - cognition - cognitive decline - DASH - dementia - dietary components - dietary patterns - Mediterranean - MIND - nutrition

    As there is currently no cure for dementia, there is an urgent need for preventive strategies. The current review provides an overview of the existing evidence examining the associations of the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets and their dietary components with cognitive decline, dementia, and Alzheimer's disease (AD). A systematic search was conducted within Ovid Medline for studies published up to 27 March 2019 and reference lists from existing reviews and select articles were examined to supplement the electronic search results. In total, 56 articles were included. Higher adherence to the Mediterranean diet was associated with better cognitive scores in 9 of 12 cross-sectional studies, 17 of 25 longitudinal studies, and 1 of 3 trials. Higher adherence to the DASH diet was associated with better cognitive function in 1 cross-sectional study, 2 of 5 longitudinal studies, and 1 trial. Higher adherence to the MIND diet was associated with better cognitive scores in 1 cross-sectional study and 2 of 3 longitudinal studies. Evidence on the association of these dietary patterns with dementia in general was limited. However, higher adherence to the Mediterranean diet was associated with a lower risk of AD in 1 case-control study and 6 of 8 longitudinal studies. Moreover, higher adherence to the DASH or MIND diets was associated with a lower AD risk in 1 longitudinal study. With respect to the components of these dietary patterns, olive oil may be associated with less cognitive decline. In conclusion, current scientific evidence suggests that higher adherence to the Mediterranean, DASH, or MIND diets is associated with less cognitive decline and a lower risk of AD, where the strongest associations are observed for the MIND diet.

    'I want to make myself useful': The value of nature-based adult day services in urban areas for people with dementia and their family carers
    Bruin, Simone R. de; Buist, Yvette ; Hassink, Jan ; Vaandrager, Lenneke - \ 2019
    Ageing and Society (2019). - ISSN 0144-686X
    adult day services - care farm - dementia - family carers - green care - nature-based services

    Nature-based adult day services (ADSs) in urban areas are relatively new services in the Netherlands. Since knowledge about these services is still scarce, this study aimed to elucidate their value for people with dementia and their family carers in terms of health and wellbeing. We interviewed 39 people with dementia attending nature-based ADSs in urban areas and their family carers, and 17 providers of these services. Respondents indicated that nature-based ADSs in urban areas positively affected the health and wellbeing of people with dementia. According to them, these services support contact with nature and animals, activity engagement, physical activity, structure, social interactions, healthy eating, a sense of meaning in life and a focus on normal daily life. Respondents further indicated that these services stimulate respite, reassurance and maintenance of family carers' own activities and social contacts. We conclude that nature-based ADSs in urban areas have a wide range of benefits that might affect the health and wellbeing of people with dementia and their family carers. Worldwide, demand is growing for innovative practices in dementia care. It is therefore worthwhile monitoring the development of dementia care innovations, such as nature-based ADSs, and for countries to exchange lessons learned from these services.

    The MemTrax Test Compared to the Montreal Cognitive Assessment Estimation of Mild Cognitive Impairment
    Hoek, Marjanne D. Van Der; Nieuwenhuizen, Arie ; Keijer, Jaap ; Ashford, J.W. - \ 2019
    Journal of Alzheimers Disease 67 (2019)3. - ISSN 1387-2877 - p. 1045 - 1054.
    Alzheimer's disease - continuous performance task - dementia - elderly - memory - mild cognitive impairment - screening

    Cognitive impairment is a leading cause of dysfunction in the elderly. When mild cognitive impairment (MCI) occurs in elderly, it is frequently a prodromal condition to dementia. The Montreal Cognitive Assessment (MoCA) is a commonly used tool to screen for MCI. However, this test requires a face-to-face administration and is composed of an assortment of questions whose responses are added together by the rater to provide a score whose precise meaning has been controversial. This study was designed to evaluate the performance of a computerized memory test (MemTrax), which is an adaptation of a continuous recognition task, with respect to the MoCA. Two outcome measures are generated from the MemTrax test: MemTrax speed and MemTrax correct. Subjects were administered the MoCA and the MemTrax test. Based on the results of the MoCA, subjects were divided in two groups of cognitive status: normal cognition (n = 45) and MCI (n = 37). Mean MemTrax scores were significantly lower in the MCI than in the normal cognition group. All MemTrax outcome variables were positively associated with the MoCA. Two methods, computing the average MTX score and linear regression were used to estimate the cutoff values of the MemTrax test to detect MCI. These methods showed that for the outcome MemTrax speed a score below the range of 0.87 - 91 s -1 is an indication of MCI, and for the outcome MemTrax correct a score below the range of 85 - 90% is an indication for MCI.

    The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome
    Dekker, Alain D. ; Sacco, Silvia ; Carfi, Angelo ; Benejam, Bessy ; Vermeiren, Yannick ; Beugelsdijk, Gonny ; Schippers, Mieke ; Hassefras, Lyanne ; Eleveld, José ; Grefelman, Sharina ; Fopma, Roelie ; Bomer-Veenboer, Monique ; Boti, Mariángeles ; Oosterling, G.D.E. ; Scholten, Esther ; Tollenaere, Marleen ; Checkley, Laura ; Strydom, André ; Goethem, Gert Van; Onder, Graziano ; Blesa, Rafael ; Eulenburg, Christine Zu; Coppus, Antonia M.W. ; Rebillat, Anne Sophie ; Fortea, Juan ; Deyn, Peter P. De - \ 2018
    Journal of Alzheimers Disease 63 (2018)2. - ISSN 1387-2877 - p. 797 - 820.
    Alzheimer's disease - behavior - BPSD - dementia - Down syndrome - neuropsychiatric symptoms - trisomy 21

    People with Down syndrome (DS) are prone to develop Alzheimer's disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n=149), with questionable dementia (DS+Q, n=65), and with diagnosed dementia (DS+AD, n=67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.

    De BPSD-DS evaluatieschaal voor dementiegerelateerde gedragsveranderingen bij mensen met downsyndroom
    Dekker, Alain D. ; Vermeiren, Yannick ; Beugelsdijk, Gonny ; Schippers, Mieke ; Hassefras, Lyanne ; Eleveld, José ; Grefelman, Sharina ; Fopma, Roelie ; Bomer-Veenboer, Monique ; Oosterling, G.D.E. ; Scholten, Esther ; Tollenaere, Marleen ; Goethem, Gert Van; Eulenburg, Christine zu; Coppus, Antonia M.W. ; Deyn, Peter P. De - \ 2018
    Tijdschrift voor Gerontologie en Geriatrie 49 (2018)5. - ISSN 0167-9228 - p. 187 - 205.
    Alzheimer’s disease - behaviour - dementia - Down syndrome - trisomy 21

    Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N = 149), with questionable dementia (DS + TD, N = 65) and with diagnosed dementia (DS + AD, N = 67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS + AD group and lowest in the DS group. Interestingly, among DS + TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study.

    A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older
    Arnoldussen, Ilse A.C. ; Sundh, Valter ; Bäckman, Kristoffer ; Kern, Silke ; Östling, Svante ; Blennow, Kaj ; Zetterberg, Henrik ; Skoog, Ingmar ; Kiliaan, Amanda J. ; Gustafson, Deborah R. - \ 2018
    Journal of Alzheimers Disease 63 (2018)4. - ISSN 1387-2877 - p. 1325 - 1335.
    Adiponectin - body mass index - dementia - elderly - leptin - waist hip ratio

    Background: Adiposity measured in mid- or late-life and estimated using anthropometric measures such as body mass index (BMI) and waist-to-hip ratio (WHR), or metabolic markers such as blood leptin and adiponectin levels, is associated with late-onset dementia risk. However, during later life, this association may reverse and aging- and dementia-related processes may differentially affect adiposity measures. Objective: We explored associations of concurrent BMI, WHR, and blood leptin and high molecular weight adiponectin levels with dementia occurrence. Methods: 924 Swedish community-dwelling elderly without dementia, aged 70 years and older, systematically-sampled by birth day and birth year population-based in the Gothenburg city region of Sweden. The Gothenburg Birth Cohort Studies are designed for evaluating risk and protective factors for dementia. All dementias diagnosed after age 70 for 10 years were identified. Multivariable logistic regression models were used to predict dementia occurrence between 2000-2005, 2005-2010, and 2000-2010 after excluding prevalent baseline (year 2000) dementias. Baseline levels of BMI, WHR, leptin, and adiponectin were used. Results: Within 5 years of baseline, low BMI (<20kg/m 2) was associated with higher odds of dementia compared to those in the healthy BMI category (≥ 20-24.9kg/m 2). Compared to the lowest quartile, leptin levels in the second quartile were associated with lower odds of dementia in women (p<0.05). Conclusion: In late-life, anthropometric and metabolic adiposity measures appear to be differentially associated with dementia risk. While BMI and leptin levels are highly positively correlated, our results show that their association with dementia at age ≥70 years, is asynchronous. These data suggest that with aging, the complexity of the adiposity exposure may increase and suggests metabolic dysregulation. Additional studies are needed to better understand this complexity.

    Dietary patterns for healthier cognitive ageing
    Berendsen, Agnes A.M. - \ 2017
    Wageningen University. Promotor(en): C.P.G.M. de Groot; E.J.M. Feskens, co-promotor(en): O. van de Rest. - Wageningen : Wageningen University - ISBN 9789463436014 - 190
    meal patterns - feeding habits - aging - cognition - health - food supplements - dementia - nutritional intervention - elderly - elderly nutrition - nutrition and health - maaltijdpatronen - voedingsgewoonten - verouderen - kenvermogen - gezondheid - voedselsupplementen - dementie - maatregel op voedingsgebied - ouderen - ouderenvoeding - voeding en gezondheid

    With ageing of our population and the accompanying increase in the number of people living with dementia, it is important to find modifiable risk factors to postpone the onset of cognitive decline. Diet has been proposed such a modifiable risk factor. To date, numerous studies have been conducted demonstrating a possible role of specific nutrients and foods in cognitive functioning. However, as people do not consume single nutrients, the research field has shifted towards studying dietary patterns in which synergistic effects of single nutrients and/or foods can be studied. The main aim of this thesis was to study the association of healthful dietary patterns with cognitive functioning. In addition, nutrient intake inadequacies were assessed and the potential to change dietary intake in older adults aged 65 years and older was studied.

    Chapter 2 describes nutrient intake of 245 Dutch adults aged 65-80 years. We identified the contribution of nutrient dense foods, fortified foods and dietary supplements to the total intake of micronutrients. Nutrient density of foods was evaluated using the Nutrient Rich Food score 9.3. Nutrient intake inadequacies were observed for vitamin D, vitamin B6 and selenium. Conventional foods were the main source of vitamin D, vitamin B6 and selenium intake. Foods with the highest nutrient density contributed most to total vitamin B6 intake. In order to optimize nutrient intakes of elderly, combinations of natural food sources, fortified foods and dietary supplements should be considered.

    Chapter 3 provides a systematic review of the literature on human studies up to May 2014 that examined the role of dietary patterns in relation to cognitive decline or dementia. The results demonstrate that better adherence to a Mediterranean diet was associated with less cognitive decline, dementia or Alzheimer’s Disease (AD) in four out of six cross-sectional studies, six out of 12 longitudinal studies, one trial and three meta-analyses. Other healthy dietary patterns, among which the Healthy Diet Indicator, have shown to be associated with reduced cognitive decline and/or a reduced risk of dementia in all six cross-sectional studies and six out of eight longitudinal studies. The conclusion of this literature review was that more conclusive evidence is needed to come to more targeted and detailed dietary guidelines to prevent or postpone cognitive decline.

    In chapter 4 the association between the Healthy Diet Indicator (HDI) and cognitive functioning in older adults from three different cohort studies was investigated. The cohorts included in total 21,837 subjects from Europe (SENECA and the Rotterdam Study [RS]) and the Unites States (Nurses’ Health Study [NHS]). Cognitive functioning was measured using the Mini-Mental State Examination (MMSE) in SENECA and RS, and the Telephone Interview for Cognitive Status (TICS) in NHS. In all three cohorts, the HDI was not significantly associated with cognitive decline, nor with cognitive function.

    In chapter 5 the association of long-term adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with cognitive function and decline in older American women was examined. A total of 16,144 women from the Nurses’ Health Study, aged ≥70 years, who underwent cognitive testing a total of 4 times by telephone from 1995-2001 (baseline), with multiple dietary assessments between 1984 and the first cognitive exam were studied. Greater adherence to long-term DASH score was significantly associated with better average global cognition, verbal memory and TICS score at older ages, but not with cognitive decline.

    In chapter 6, the same cohort as in chapter 5 was studied to examine the association between long-term adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and decline. Higher MIND diet scores were associated with better verbal memory at older ages, but not with cognitive decline over 6 years in global cognition, verbal memory or TICS.

    Chapter 7 provides an overview of the NU-AGE (NUtrients and AGEing) dietary intervention study. The NU-AGE study is a randomized one-year intervention in 1,250 apparently healthy, independently living European subjects aged 65 to 80 years. Subjects were randomised into either the intervention group or the control group. Participants in the intervention group received dietary advice aimed at meeting the dietary recommendations of the ageing population. At the start of this thesis, the NU-AGE study was the first dietary intervention investigating the effect of a whole diet and providing targeted dietary recommendations for optimal health and quality of life in apparently healthy European elderly.

    In chapter 8, we evaluated if the NU-AGE intervention could be effective to shift the dietary intake of apparently healthy older adults aged 65-80 years living in Italy, the UK, the Netherlands, Poland, and France towards a more healthful diet. The NU-AGE index was created to assess adherence to the NU-AGE diet. At baseline and after one-year follow-up dietary intake was assessed by means of 7-day food records. In total, 1,296 participants were randomized and 1,145 participants completed the intervention (571 in intervention group, 570 in control group). After one-year follow-up, the intervention group improved mean intake of 13 out of 16 dietary recommendations of the NU-AGE diet (p<0.05) with a significant increase of the total NU-AGE index, compared to the control group (mean change in NU-AGE index 21.3±15.9, p<0.01). The NU-AGE dietary intervention, based on dietary recommendations for older adults, may be a feasible strategy to improve dietary intake in an ageing European population.

    Chapter 9 shows the results of the NU-AGE parallel randomized dietary intervention study on cognitive functioning in the Dutch NU-AGE subpopulation, including 252 older adults aged 65-80 years (123 intervention, 129 control). The primary outcome was one-year change in global cognition and in four cognitive domains as measured through a comprehensive neuropsychological test battery. Comparing the intervention with the control group, there was no effect of the intervention on cognitive functioning.

    In chapter 10 the main findings of this thesis were summarized and a reflection on methodological aspects was given. When grading the reported associations in previous studies and studies in this thesis, it was concluded that there is probable evidence for a role of the Mediterranean diet on cognitive functioning. For the DASH and MIND diet there is a possible link with cognitive functioning; for the HDI and the NU-AGE diet there is no sufficient evidence yet to conclude that there is a relation with cognitive functioning. Not only is there a need for well-designed intervention and prospective studies, we also call for communication strategies to the general public about the consumption of healthier diets to not only impact cardiovascular but also potentially impact brain health as many individuals will face progressive cognitive decline in the near future.

    Vis eten helpt mogelijk tegen dementie
    Rest, Ondine van de - \ 2016
    fish consumption - nutrition and health - nutrition research - dementia - alzheimer's disease - hereditary diseases - disease prevention

    Regelmatig vis eten helpt mogelijk dementie af te remmen bij mensen met een groot erfelijk risico op de ziekte. Het is een resultaat dat het belang van het huidige advies – één keer per week vis eten – nog eens onderstreept, schrijft Ondine van de Rest, onderzoeker bij Humane voeding, in het tijdschrift JAMA.

    Brain region-specific monoaminergic correlates of neuropsychiatric symptoms in Alzheimer's disease
    Vermeiren, Yannick ; Dam, Debby Van; Aerts, Tony ; Engelborghs, Sebastiaan ; Deyn, Peter P. De - \ 2014
    Journal of Alzheimers Disease 41 (2014)3. - ISSN 1387-2877 - p. 819 - 833.
    Alzheimer's disease - behavior - brain tissue - correlations - dementia - monoamines and metabolites - neurochemistry - neuropsychiatric symptoms

    Neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) are present during the disease course of nearly all AD patients and consist of psychosis, agitation/aggression, and depression, among others. Given their detrimental consequences regarding life expectancy, cognition, and socio-economic costs, it is essential to elucidate their neurochemical etiology to facilitate the development of novel and effective pharmacotherapeutics. This study attempted to identify brain region-specific monoaminergic correlates of NPS by measuring the levels of eight monoamines and metabolites in nine relevant postmortem brain regions of 40 behaviorally characterized AD patients, i.e., dopamine (DA), serotonin (5-HT), (nor)epinephrine and their respective metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid, 5-hydroxy-3-indoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), using RP-HPLC-ECD. Likewise, Mini-Mental State Examination (MMSE) score correlates of monoaminergic neurotransmitter alterations were calculated. As a result, MMSE scores, used as a measure of dementia severity, correlated positively with hippocampal 5-HIAA levels as well as with 5-HT levels of the superior temporal gyrus and cerebellar cortex. Furthermore, hippocampal 5-HIAA levels inversely correlated with agitation scores, whereas thalamic MHPG levels comparably did with the presence of hallucinations. Finally, in the cerebellar cortex, DOPAC/DA ratios, indicative of DA turnover, correlated with physically agitated behavior while MHPG levels correlated with affective disturbances. These findings support the assumption that specific NPS features in AD might be (in)directly related to brain region-specific monoaminergic neurotransmitter alterations. Additionally, the effect of AD pathology on neurochemical alterations in the cerebellum requires further examination due to its important but underestimated role in the neurochemical pathophysiology of NPS in AD.

    Nutrition and cognition in older adults : studies on the role of glucose, sucrose, protein, vitamin B12 and folic acid
    Zwaluw, N.L. van der - \ 2014
    Wageningen University. Promotor(en): Lisette de Groot, co-promotor(en): Ondine van de Rest; Rosalie Dhonukshe-Rutten. - Wageningen : Wageningen University - ISBN 9789462571075 - 184
    ouderenvoeding - voeding - ouderen - kenvermogen - glucose - sucrose - eiwittoevoegingen - vitamine b12 - dementie - elderly nutrition - nutrition - elderly - cognition - glucose - sucrose - protein supplements - vitamin b12 - dementia

    The age-related cognitive decline and the increase in dementia patients are large problems in societies with growing ageing populations. No cure is present for dementia, while the available medication only focuses on alleviating symptoms. It is therefore of major importance to find risk factors that can modify the development of cognitive decline and dementia. Pre-clinical and observational studies suggest a role for nutrients. Evidence derived from randomized controlled trials (RCTs) is, however, limited and equivocal with most studies showing no effect and only a few studies showing a beneficial effect of a nutritional intervention. In the current thesis, we investigated the acute and longer-term effects of different nutrients, i.e. glucose and sucrose, protein, resistance-type exercise training with or without protein, and vitamin B12 and folic acid in order to optimize and preserve cognitive functions in non-demented elderly people.

    A comprehensive literature review was performed on the acute effects of glucose and sucrose on cognitive performance (Chapter 2). Glucose is the most important fuel for the brain, and as such, manipulation of the supply of glucose may affect cognitive functions. The main conclusion of our review was that a glucose load may have a short-term beneficial effect on episodic memory. Enhancing effects on other cognitive domains were less clear, partly due to the small number of studies examining these effects. Limited research was also done on the possible effects of sucrose on cognitive functions. Therefore, we investigated the acute effects of 50 g of glucose and 100 g of sucrose on a broad spectrum of cognitive functions reflecting performance on episodic memory, working memory, attention and information processing speed, and executive functions (Chapter 3). This was done by a cross-over study in 43 elderly participants who had self-reported memory complaints. In contrast to the conclusion of our review, we did not observe an effect of glucose or sucrose on episodic memory, though we showed a beneficial effect of sucrose on attention and information processing speed.

    Protein supplementation was the next nutritional intervention that was investigated. Several amino acids are precursors for neurotransmitters, and their supply may affect the synthesis and release of these neurotransmitters, and may consequently affect cognitive performance. A 24-week randomized placebo-controlled trial was carried out in 65 frail and pre-frail elderly people (Chapter 4). The protein supplementation included twice a day 15 grams of protein in the form of a drink. Reaction time improved more in the protein group compared to the placebo group, but the scores on the cognitive domains, i.e. episodic memory, attention and working memory, information processing speed, and executive functions, or the other single test scores, did not differ between treatment groups. In addition, we investigated the effects of 24 weeks resistance-type exercise training with and without protein supplementation in pre-frail and frail elderly people (Chapter 5). Exercise training without extra protein (n=62) improved performance on the domain attention and working memory. Exercise training together with protein supplementation (n=65) improved performance on information processing speed.

    Last, the role of vitamin B12 and folate on cognitive health was investigated. Low levels of these nutrients can increase homocysteine levels, which is a suggested risk factor for cognitive decline. The effect of daily supplementation with 500 µg vitamin B12 and 400 µg folic acid was investigated in 2,919 participants for two years (Chapter 6). Global cognitive function and episodic memory were assessed in the total study population, whereas extensive neuropsychological testing was done in a subpopulation (n=856). B-vitamin supplementation did not improve cognitive domain scores. Only a small, though significant, effect was observed on global cognitive performance, measured by the Mini-Mental State Examination, but this was suggested to be due to chance. Brain MRI scans were made in a subgroup (n=218) after two years of intervention to obtain volumetric measures of grey and white matter, and total brain volume (Chapter 7). We investigated the cross-sectional associations between follow-up levels of folate, homocysteine and three vitamin B12 status biomarkers, e.g. methylmalonic acid, holotranscobalamin and serum vitamin B12, and brain volumes. Fully adjusted regression models showed a borderline significant association between plasma homocysteine and total brain volume, with a stronger association in the group that received B-vitamin supplementation. Serum B12 and holotranscobalamin were not associated with brain volumes, whereas high methylmalonic acid levels were associated with lower brain volumes in the group that received B-vitamins. In contrast, higher folate levels were associated with lower total brain volumes. In addition, when comparing the group that received two years of B-vitamin supplementation and those who did not, we observed lower brain volumes in the B-vitamin group, which might be a result of a difference in age between the two groups.

    To conclude, the nutritional intervention studies showed little evidence for a beneficial effect on cognitive performance in relatively healthy older adults. Given the large problem of dementia, research on modifiable risk factors, including nutrition, should continue, with well thought out research methods, including large and long-term observational and intervention studies with high-sensitive study populations and early biomarkers (e.g. imaging techniques) for cognitive decline in combination with neuropsychological tests. In this way, nutrition can be added to the list of lifestyle factors that can fight dementia.

    Voeding en beweging ter preventie van cognitieve achteruitgang
    Severs, A. ; Rest, O. van de; Groot, C.P.G.M. de; Loon, L.J.C. van - \ 2014
    VoedingsMagazine 27 (2014)1. - ISSN 0922-8012 - p. 18 - 20.
    ouderen - ouderenvoeding - eiwittoevoegingen - dementie - kenvermogen - lichaamsbeweging - voeding en gezondheid - voedingsstoffen - elderly - elderly nutrition - protein supplements - dementia - cognition - exercise - nutrition and health - nutrients
    Dementie wordt een steeds groter en kostbaarder probleem door de vergrijzing. Wetenschappers zijn naarstig op zoek naar mogelijkheden om het tij te keren. Zo ook dr.ir. Ondine van de Rest, onderzoeker aan Wageningen University. Haar onderzoek is gericht op de rol van voeding bij leeftijdsgerelateerde cognitieve achteruitgang. Samen met prof. dr.Lisette de Groot, hoogleraar voeding voor de oudere mens aan Wageningen Universiteit, en Prof. Dr. Luc van Loon, hoogleraar fysiologie van inspanning aan Maastricht Universiteit, voerde ze binnen het Top Instituut Food and Nutrition (TIFN) een interventiestudie uit bij ouderen naar het effect van eiwitsuppletie en beweging op de cognitie.
    Behavioral symptoms in mild cognitive impairment as compared with Alzheimer's disease and healthy older adults
    Mussele, Stefan Van Der; Bastard, Nathalie Le; Vermeiren, Yannick ; Saerens, Jos ; Somers, Nore ; Mariën, Peter ; Goeman, Johan ; Deyn, Peter P. De; Engelborghs, Sebastiaan - \ 2013
    International Journal of Geriatric Psychiatry 28 (2013)3. - ISSN 0885-6230 - p. 265 - 275.
    Alzheimer's disease - behavioral symptoms - caregiver burden - dementia - frontal lobe symptoms - mild cognitive impairment

    Background Mild cognitive impairment (MCI) is a clinical concept that categorizes subjects who are in an intermediate cognitive state between normal aging and dementia. The aim of this study is to characterize behavior in MCI compared with Alzheimer's disease (AD) and healthy older patients. Design A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms of dementia and MCI was performed. The study population consisted of 270 MCI, 402 AD patients, and 108 healthy controls. Behavioral assessment was performed by means of Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale, Cohen-Mansfield Agitation Inventory, and Cornell Scale for Depression in Dementia. Results Moderate-to-severe behavioral symptoms were present in 13% of MCI patients, as compared with 39% in AD patients and 3% in controls (p < 0.001). The general severity of behavioral symptoms was intermediate between controls and AD patients. The three most frequent symptoms in MCI patients were aggressiveness (49%), affective disturbance (45%), and anxiety (38%); in AD patients, the most frequent symptoms were aggressiveness (60%), activity disturbances (54%), and psychosis (40%). The prevalence and severity of frontal lobe symptoms, aggressiveness, activity disturbances, and delusions was intermediate between normal aging and AD. In addition, the severity of physically non-aggressive and verbally agitated behavior and the severity of depressive symptoms were also intermediate. Conclusions The behavioral profile of MCI patients is characterized as an intermediate state between normal aging and AD for the prevalence and severity of certain behavioral symptoms. Follow-up is ongoing to test the hypothesis that behavioral disturbances in MCI predict progression to dementia.

    Prevalence and associated behavioral symptoms of depression in mild cognitive impairment and dementia due to Alzheimer's disease
    Mussele, Stefan Van Der; Bekelaar, Kim ; Bastard, Nathalie Le; Vermeiren, Yannick ; Saerens, Jos ; Somers, Nore ; Mariën, Peter ; Goeman, Johan ; Deyn, Peter P. De; Engelborghs, Sebastiaan - \ 2013
    International Journal of Geriatric Psychiatry 28 (2013)9. - ISSN 0885-6230 - p. 947 - 958.
    Alzheimer's disease - behavioral symptoms - Cornell Scale - dementia - depression - depressive symptoms - frontal lobe symptoms - mild cognitive impairment

    Background Mild cognitive impairment (MCI) is a clinical concept that categorizes subjects who are in an intermediate cognitive state between normal aging and dementia. The aims of this study are to determine the prevalence of significant depressive symptoms in MCI and Alzheimer's disease (AD) patients and to characterize the behavior associated with significant depressive symptoms in MCI and AD patients. Methods A cross-sectional analysis of baseline data from a prospective, longitudinal study on behavioral symptoms of dementia and MCI was performed. The study population consisted of 270 MCI and 402 AD patients. Behavioral assessment was performed by means of Middelheim Frontality Score, Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD) and Cohen-Mansfield Agitation Inventory. The presence of significant depressive symptoms was defined as a Cornell Scale for Depression in Dementia total score >7. Results The prevalence of significant depressive symptoms in AD patients (25%) was higher compared with MCI patients (16%) (p = 0.005). Patients with significant depressive symptoms showed an increased severity of frontal lobe symptoms, behavioral symptoms and agitation (Middelheim Frontality Score, Behave-AD and Cohen-Mansfield Agitation Inventory total scores; p < 0.001). Also, most of the individual frontal lobe and behavioral symptoms were more prevalent and severe, resulting in higher Behave-AD global scores. Mild cognitive impairment patients with depressive symptoms showed more severe behavioral symptoms and more severe verbally agitated behavior than AD patients without depressive symptoms (p < 0.001). Conclusions Frontal lobe and behavioral symptoms are more prevalent and severe in MCI and AD patients with significant depressive symptoms as compared with patients without depressive symptoms.

    Total antioxidant capacity of the diet and major neurologic outcomes in older adults
    Devore, E.E. ; Feskens, E.J.M. ; Ikram, M.A. ; Heijer, T. den; Vernooij, M. ; Lijn, F. van der; Hofman, A. ; Niessen, W.J. ; Breteler, M.M.B. - \ 2013
    Neurology 80 (2013)10. - ISSN 0028-3878 - p. 904 - 910.
    food-frequency questionnaire - alzheimers-disease - cardiovascular-disease - hippocampal atrophy - ischemic-stroke - rotterdam - risk - dementia - metaanalysis - association
    Objective: To evaluate total antioxidant capacity of the diet, measured by the ferric-reducing antioxidant power (FRAP) assay, in relation to risks of dementia and stroke, as well as key structural brain volumes, in the elderly. Methods: We prospectively studied 5,395 participants in the Rotterdam Study, aged 55 years and older, who were dementia free and provided dietary information at study baseline; 5,285 individuals were also stroke free at baseline, and 462 were dementia and stroke free at the time of an MRI brain scan 5 years after baseline. Dietary data were ascertained using a semiquantitative food-frequency questionnaire, and combined with food-specific FRAP measurements from published tables; this information was aggregated across the diet to obtain “dietary FRAP scores.” Multivariable-adjusted Cox proportional hazard models were used to estimate relative risks of dementia and stroke, and multivariable-adjusted linear regression was used to estimate mean differences in structural brain volumes, across tertiles of dietary FRAP scores. Results: During a median 13.8 years of follow-up, we identified approximately 600 cases each of dementia and stroke. In multivariable-adjusted models, we observed no associations between dietary FRAP scores and risk of dementia (p trend = 0.3; relative risk = 1.12, 95% confidence interval = 0.91–1.38, comparing the highest vs lowest FRAP tertiles) or risk of stroke (p trend = 0.3; relative risk = 0.91, 95% confidence interval = 0.75–1.11, comparing extreme FRAP tertiles); results were similar across subtypes of these outcomes. Dietary FRAP scores were unrelated to brain tissue volumes as well. Conclusions: Total antioxidant capacity of the diet, measured by dietary FRAP scores, does not seem to predict risks of major neurologic diseases
    Gemeenten en zorgboerderijen : een kansrijke combinatie binnen de Wmo voor mensen met dementie, mits...
    Bruin, S. ; Hop, P. ; Molema, C. ; Nowak, S. ; Baan, C. ; Oosting, S.J. - \ 2013
    Bilthoven : Rijksinstituut voor Volksgezondheid en Milieu
    zorgboerderijen - sociale zorg - langdurige zorg - sociale voorzieningen - dementie - ouderen - social care farms - social care - long term care - social services - dementia - elderly
    Boerderijen en mensen met dementie: het lijkt geen voor de hand liggende combinatie. Toch is er een aanzienlijk aantal zorgboerderijen waar mensen met dementie terecht kunnen voor dagopvang. Zorgboerderijen bieden mensen met dementie een zinvolle en prettige dagbesteding in een landelijke omgeving. Hun mantelzorgers worden daarmee tijdelijk ontlast van de zorg. Hiermee kunnen zorgboerderijen mogelijk bijdragen aan het langer thuis wonen van mensen met dementie; één van de doelstellingen van het beleid van de rijksoverheid op het gebied van de langdurige zorg.
    Eten en drinken bij dementie
    Wapenaar, J. ; Groot, C.P.G.M. de - \ 2013
    Amsterdam : Reed Business Education - ISBN 9789035235397 - 88
    dementie - humane voeding - voeding - voeding en gezondheid - gezondheidszorg - ouderen - dementia - human feeding - nutrition - nutrition and health - health care - elderly
    Voor veel mensen met dementie is eten en drinken moeilijk. Goede zorg bij eten en drinken is essentieel om mensen met dementie zo gezond mogelijk te houden en hun kwaliteit van leven hoog te houden. Verzorgenden, verpleegkundigen en voedingsassistenten krijgen met dit boek praktische handvatten om hun cliënten te kunnen ondersteunen. Ze leren met dit boek hoe ze kunnen helpen bij het eten en drinken en hoe ze het thema eten en drinken kunnen gebruiken om de kwaliteit van leven van mensen met dementie te verbeteren.
    Homocysteine, progression of ventricular enlargement, and cognitive decline. The Second Manifestations of ARTerial disease-Magnetic Resonance Study
    Jochemsen, H.M. ; Kloppenborg, R.P. ; Groot, C.P.G.M. de; Kampman, E. ; Mali, W.P. ; Graaf, Y. van der; Geerlings, M.I. - \ 2013
    Alzheimer's & Dementia 9 (2013)3. - ISSN 1552-5260 - p. 302 - 309.
    brain atrophy - plasma homocysteine - risk-factor - folic-acid - probabilistic segmentation - elderly individuals - smart-mr - dementia - impairment - lesions
    Background Homocysteine may be a modifiable risk factor for cognitive decline and brain atrophy, particularly in older persons. We examined whether homocysteine increased the risk for cognitive decline and brain atrophy, and evaluated the modifying effect of age. Methods Within the Second Manifestations of ARTerial disease-Magnetic Resonance study—a prospective cohort study among patients with atherosclerotic disease—longitudinal analyses were performed in 663 patients (mean age: 57 ± 9 years; follow-up: 3.9 ± 0.4 years). At baseline and follow-up, brain segmentation on magnetic resonance imaging was used to quantify relative (%) cortical, ventricular, and global brain volumes, and z-scores of memory and executive functioning were calculated. Linear regression analysis was used to estimate associations of homocysteine (per standard deviation increase) and hyperhomocysteinemia (HHCY) with brain volumes, memory, and executive functioning at follow-up, adjusted for baseline brain volume, memory, and executive functioning, respectively, and age, sex, and vascular risk factors. Furthermore, interaction terms between homocysteine and age (continuous) were added. Results Significant interactions were observed between total plasma homocysteine (tHcy) and age with cortical, ventricular, and global brain volume (for all three measures: P <.05), and between HHCY and age with executive functioning (P = .04), and results were stratified by age. In patients aged =65 years, increasing tHcy level and HHCY were significantly associated with progression of ventricular enlargement (B = 0.07%, 95% confidence interval [CI]: 0.01% to 0.13% and B = 0.16%, 95% CI: 0.01% to 0.31%, respectively) and with a decline in executive function (B = -0.29, 95% CI: -0.54 to -0.04 and B = -0.84, 95% CI: -1.37 to -0.32, respectively). Conclusion Elevated tHcy was related to progression of ventricular enlargement and increased the risk for a decline in executive functioning in older persons
    Thuis op de zorgboerderij : handreiking kleinschalig wonen voor ouderen met dementie
    Roest, A.E. ; Oltmer, K. ; Driest, P. ; Jans, A. - \ 2010
    [S.l.] : Taskforce Multifunctionele Landbouw
    welzijnsvoorzieningen - gezondheidszorg - ouderen - dementie - zorgboerderijen - multifunctionele landbouw - welfare services - health care - elderly - dementia - social care farms - multifunctional agriculture
    Nederland telt momenteel rond de 1.000 zorgboerderijen. Zorgboerderijen verlenen zorg aan mensen met een verstandelijke of lichamelijke beperking, jongeren met ontwikkelingsproblemen, mensen met verslavings- of GGZ-achtergrond en/of mensen met burn-out. Rond de 150 zorgboerderijen richten zich op ouderen met dementie. Deze doelgroep zal in de komende decennia het sterkst in omvang toenemen en daarmee ook de kansen voor de zorgboerderijen op een zorgvraag met een redelijk zekere financiering. De zorgboerderijen gericht op ouderen met dementie bieden vooral dagbesteding. Slechts een handjevol zorgboerderijen biedt intensievere vormen van zorg en ondersteuning, waaronder woonvoorzieningen, aan ouderen die een grote zorgbehoefte hebben en niet meer zelfstandig kunnen wonen. De meeste van deze ouderen hebben een vorm van dementie
    Apolipoprotein E Genotype Modifies the Association between Midlife Lung Function and Cognitive Function in Old Age
    Giltay, E.J. ; Nissinen, A. ; Giampaoli, S. ; Kromhout, D. - \ 2009
    Dementia and Geriatric Cognitive Disorders 28 (2009)5. - ISSN 1420-8008 - p. 433 - 441.
    alzheimers-disease - pulmonary-function - risk-factors - atherosclerosis risk - respiratory-function - life expectancy - apoe epsilon-4 - birth cohort - dementia - health
    Background/Aims: Because poor lung function may be a risk factor for cognitive decline, we aimed to test the association of respiratory function with cognitive function and dementia later in life, as well as potential effect modification by APOE 4 carrier status. Methods: In a prospective population-based cohort study, forced vital capacity and forced expiratory flow were measured around 1965 in 857 men aged 45-64 years (394 from Finland, 208 from The Netherlands, and 255 from Italy). The Mini-Mental State Examination scores around 1990, 1995 and 2000 were analyzed using multilevel regression models and the Clinical Dementia Rating score around 1990 using multinomial logistic regression analyses. Results: Midlife lung function was positively associated with cognitive function in old age in APOE 4 non-carriers, but not in carriers (p <0.05 for interaction). In Finland and Italy, 18.6% had questionable to mild dementia and 2.8% moderate to severe dementia after 25 years of follow-up. Dementia was inversely related to midlife lung function in APOE 4 non-carriers, but not in carriers (p <0.05 for interaction). Conclusions: Small lung volumes were prospectively associated with an increased risk for poor cognitive function and dementia in non-carriers of the APOE 4 gene.
    Sowing in the autumn season : exploring benefits of green care farms for dementia patients
    Bruin, S.R. de - \ 2009
    Wageningen University. Promotor(en): Akke van der Zijpp, co-promotor(en): J.M.G.A. Schols; Simon Oosting; M.J. Enders-Slegers. - [S.l. : S.n. - ISBN 9789085855095 - 196
    dementie - oudere patiënten - patiëntenzorg - dagopvang - gezondheid - menselijke activiteit - voedselopname - zorgboerderijen - multifunctionele landbouw - welzijn - dementia - elderly patients - patient care - day care - health - human activity - food intake - social care farms - multifunctional agriculture - well-being
    In the Netherlands an increasing number of farms combine agricultural production with care services for people with care needs. It is generally believed that these green care farms (GCFs) have beneficial effects on the health status of a diversity of target groups. At present, empirical studies testing this hypothesis are scarce. The main objective of the studies described in this thesis was to gain insight into the potential benefits of day care at GCFs for community‐dwelling older dementia patients. Day care at GCFs was therefore compared with day care at regular day care facilities (RDCFs). In view of the differences between both day care types regarding the day care setting and day care program it was hypothesized that they would differ in their effects on the health status of dementia patients. In two cross‐sectional studies it was tested to what extent the day program of dementia patients at GCFs differed from those at RDCFs. It appeared that at GCFs, dementia patients were (physically) more active, participated in more diverse activities, were more outdoors, and had more opportunities to perform activities in smaller groups than those at RDCFs. It was tested whether these differences resulted into different effects for five domains of health: dietary intake, cognition, emotional well‐being, behaviour, and functional performance. In a comparative cross‐sectional study dietary intake of dementia patients attending day care at GCFs or RDCFs was recorded both at home and during their time at the day care facility. The study showed that dementia patients attending day care at GCFs had significantly higher intakes of energy, carbohydrate, and fluid than their counterparts attending day care at RDCFs. In a cohort study, rates of change during 1 year in cognitive functioning, emotional well‐being, behavioural symptoms, and functional performance were compared between dementia patients attending day care at GCFs and RDCFs. Functioning in these domains remained rather stable and no differences were observed between subjects from GCFs and RDCFs. In the cohort study, also caregiver burden of family caregivers of these dementia patients was assessed. Caregivers’ quality of life, emotional distress, and feelings of competence remained rather stable in family caregivers of dementia patients from both day care settings. In conclusion, the present work has shown that GCFs exceeded RDCFs in offering older dementia patients a diverse day program and in stimulating their dietary intake. The latter may result into a better preserved nutritional status in dementia patients attending day care at GCFs than in those attending day care at RDCFs. GCFs and RDCFs were equally effective in preventing significant decrease of cognitive functioning, emotional well‐being, and functional performance and in preventing significant increase of the number of behavioural symptoms. Both day care types further prevented significant increase of caregiver burden. Day care at GCFs is a new and valuable addition to the present care modalities for community‐dwelling older dementia patients and their caregivers
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