Association between Advanced Glycation End products

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1 Association between Advanced Glycation End products
and Paratonia in Alzheimer's Disease Hans Drenth(a,b), Sytse U. Zuidema(c), Wim P. Krijnen(a), Ivan Bautmans(d), Cees van der Schans(a,e), Hans Hobbelen(a) Lectoraat Healthy Ageing, Allied Healthcare & Nursing, Hanzehogeschool, postbus 3109, 9701 DC Groningen Zuid Oost Zorg, Burg. Wuiteweg 140, 9203 KP Drachten Huisartsgeneeskunde & Ouderengeneeskunde, RU Groningen, UMC Groningen, Postbus 196, 9700 AD Groningen Frailty in Ageing onderzoeksgroep & Gerontologie, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090, Brussel, België. Revalidatiegeneeskunde, RU Groningen, UMC Groningen, Postbus , 9700 RB Groningen INTRODUCTION Physical activity has been proven to be effective in improving and sustaining physical and cognitive performance in dementia Physiological pathways of effect are unclear Paratonia = a distinctive form of hypertonia in dementia patients, associated with a loss in physical performance, severe contractures and pain The pathogenesis of paratonia is not well understood and no effective physiotherapeutic interventions are available Advanced glycation end products (AGE’s) may partly be responsible for the development of paratonia AGE’s = non-enzymatic condensation of a reducing sugar with an amino group, cross linking and non crosslinking effects Regular physical activity has shown to correlate with reduced glycation and AGE formation. If the hypothesis of an association between AGE’s and paratonia is true this can lead to an explanation of the positive effects of physical activity and new possibilities to prevent or postpone paratonia can be explored. AIM METHOD OUTCOME MEASURES Paratonia Assessment Instrument (PAI) Modified Ashworth Scale (MAS) Timed Up and Go (TUG) AGE reader Investigate the association between AGE’s and Paratonia presence and severity Functional mobility Longitudinal, one year follow-up cohort study 3 assessments Community dwelling early stage Alzheimer disease (AD) patients (N=144) RESULTS Presence of paratonia OR= 3.47, 95%CI: Paratonia severity β= 0.17, 95%CI: Functional mobility β= 3.57, 95%CI: DISCUSSION CONCLUSION Participants with a higher level of AGE’s are 3.47 times more likely to have paratonia and with every unit of AGE reader increase, the MAS increases with .17 Paratonia could be the result of peripheral biomechanical changes reducing elasticity and increasing stiffness induced by AGE’s Association of AGE levels with decline in functional mobility is consistent with studies describing the effect of AGE’s on the decline in motor function AGE levels are significantly associated with paratonia and with decline in functional mobility in patients with early stage AD This study offers a new perspective on paratonia Future research is necessary into Physical therapeutic interventions such as physical activity programs and dietary advice, possible in combination with pharmacologic strategies to reduce or postpone the development of paratonia and maintain functional mobility in dementia