bs_bs_banner
Letters to the Editor
Lactobacillus bifidus and pathogenic Escherichia coli in geriatric patients
Dear Editor, Sporadic diarrhea caused by pathogenic Escherichia coli (E. coli) infection had been reported in Sendai, Japan, during summer in 2006 and in order to prevent epidemic infection, pathogenic E. coli of stools was examined in all inpatients of geriatric wards of Hikariga-oka Sperman Hospital, Sendai. The subjects were 58 bedridden patients who were inpatients from July to September in 2006. They suffered mainly dementia (21 male and 37 female patients, age 75 ± 13 years) and showed no symptoms of diarrhea, fever or vomiting at the time of examination of stool. Among 58 patients 16 patients took food orally and the other 42 patients took food using percutaneous endoscopic gastrostomy. Pathogenic E. coli of stools was examined by a laboratory company, Hokenkagaku Group, Sendai, Japan. Among 58 patients, pathogenic E. coli was found in 24 patients (8 male and 16 female patients, age 72 ± 15 years). Serotypes of pathogenic E. coli were O-153 (n = 11), O-25 (n = 8) and others (O-1, O-6, O-28, O-125 and O-136, n = 1 in each type), and no verotoxin were found. There was no systematic difference of the type of pathogenic E. coli among three different inpatient wards. There was no difference of infection of pathological E. coli between oral and percutaneous endoscopic gastrostomy feeding. Lactobacillus bifidus (L. bifidus) (either Lac B or Lebenin 1 g, 3 times a day) had been prescribed in 34 patients and had not been prescribed in the other 24 patients. Table 1 shows that the infection of pathogenic E. coli was significantly lower in patients taking L. bifidus irrespective of either oral or percutaneous endoscopic gastrostomy feeding (P < 0.05). There were no systematic differences of infection of pathogenic E. coli in terms of other drugs (gastrointestinal, cardiopulmonary, diabetic drugs and so on). Pathogenic E. coli is one of the agents responsible for epidemic diarrheal sickness in geriatric patients. The pathogens might be introduced by contamination from staff or new inpatients because of sporadic infection being observed at that time. In the present study, we found an unexpectedly high rate of pathogenic E. coli infection, although there were no clinical symptoms. Establishment of normal bacterial flora is important to prevent growth of potential pathogens, as well as contributing to the adequate maturation of the immune system, as imbalance in the normal microflora composition have been consistently associated with several disease consequences. Various therapeutic treatments © 2015 Japan Geriatrics Society
Table 1 coli
Lactobacillus bifidus and enteropathogenic Escherichia Enteropathogenic E. coli (−) (+)
Lactobacillus bifidus (−) Total PEG Oral (+) Total PEG Oral
24 17 7 10 5 5
23 19 4 1* 1 0
*Shows significance of enteropathogenic Escherichia coli between Lactobacillus bifidus (−) and (+) at P < 0.05 (Fisher’s exact test).
have been used, such as administration of probiotics, prebiotics or their association (symbiotics) as a new and interesting strategy to modulate intestinal microbiota.1 L. bifidus is of the major genera of bacteria that make up the colon flora in mammals, and can exert a range of beneficial health effects, including the regulation of intestinal microbial homeostasis,2 the inhibition of pathogens and harmful bacteria that colonize and/or infect the gut mucosa, and are used as probiotics.3,4 The present study suggests that L. bifidus might protect against infection of pathogenic E. coli in bedridden geriatric patients. Although we could not know whether L. bifidus would prevent diarrhea sickness or not caused by pathogenic E. coli, L. bifidus might be useful to regulate gut mucosa and prevent infection by pathogenic E. coli, as homeostasis of gut mucosa of bedridden geriatric patients might be degraded.5 Preventive procedures for patients with positive pathogenic E. coli would be required irrespective of clinical symptoms, and L. bifidus might decrease the chance of epidemic infection. The small number of patients might not be convincing, but further sporadic infections have not been observed since then and we report a preliminary study that was observed in 2006.
Disclosure statement The authors declare no conflict of interest. Youichi Kosaka, Takashi Ohrui, Akira Ohtawara, Satoshi Ishizuka, Masako Azumi, Masahiko Fujii and Hidetada Sasaki Sendai Tomizawa Hospital, Sendai, Japan doi: 10.1111/ggi.12362
| 387
bs_bs_banner
JJ de Paula et al.
References 1 Arribas B, Rodrguez-Cabezas ME, Comalada M et al. Evaluation of the preventative effects exerted by Lactobacillus fermentum in an experimental model of septic shock induced in mice. Br J Nutr 2009; 101: 51–58. 2 Amdekar S, Singh V, Dwivedi L et al. Antiinflammatory, antimicrobial and immunomodulatory properties of Lactobacillus casei against enteropathogenic E. coli. Webmed Cent Microbiol 2010; 1 (10): WMC00873.
3 Guarmer F, Malagelada JR. Gut flora in health and disease. Lancet 2003; 361: 512–519. 4 Mogadhamm MZ, Sattari M, Mobarez AM, Doctorzahed F. Inhibitory effect of yogurt Lactobacillibacteriocins on verotoxins production and enterohemorrhagic Eshcherichia coli O157:H7. Pak J Biol Sci 2006; 9: 2112–2116. 5 Takahashi M, Shirai S, Sawayama C et al. Constipation and aspiration pneumonia. Geriatr Gerontol Int 2012; 12: 570– 571.
Transcultural issues on the assessment of executive functions and processing speed in older adults with low formal education: Usefulness of The Five Digits Test in the assessment of dementia Dear Editor, The assessment of older adults with low formal education and cognitive complaints is still a challenge in clinical gerontology.1 Although, in developed countries, the clinicians have a wide selection of cognitive tests for the patient’s assessment, much of these traditional tests demand a set of abilities that much of the older adults in developing countries is still lacking.2 For example, a classical measure of processing speed and executive functions is the Stroop Color-Word Test, which requires the subject to name the color of dots, then name the color of neutral words and finally name the color in which color names are printed.3 The test is feasible for the assessment of older adults in developed countries and is used in large normative studies.4,5 However, in countries where the elderly population has low formal education, the Stroop Color-Word Test usually does not work, as the reading routines (necessary for the interference effect) are not fully efficient. An alternative in these cases is the use of “mini-verbal tests”: cognitive assessment tools developed to be less influenced by cultural particularities, language and formal education.6 A mini-verbal version of the Stroop Color-Word Test is the Five Digits Test (FDT).7 FDT investigates the interference effect by using two automatic attentional process trials: reading numbers (e.g. 2-2-2, “two”) and counting small quantities (e.g. ***, “three”); and two controlled attentional process trials: choosing to count how many numbers are in each incongruent stimuli (e.g. 2-2-2-2, “four”), and shifting between the reading and counting routines. In the present Letter to the Editor, we aim to show the appli388 |
doi: 10.1111/ggi.12364
cability and clinical value of the assessment of dementia in older adults with advanced age (76.4 ± 7.5 years) and low formal education (5.3 ± 4.0 years). We studied 80 older adults from a memory clinic in Brazil, divided into two groups: controls (n = 40) and mild dementia (n = 40), matched by age, education and sex. We carried out the diagnoses by multidisciplinary assessment as reported in a previous article.8 The participants performed the FDT (not used for participants’ diagnosis) and other cognitive measures. Receiver operating characteristic curve analysis assessed FDT accuracy on the participant’s diagnoses, and assessed the FDT correlations with other cognitive measures of executive functions (Digit Span8), processing speed (Digit-Symbol Coding and Symbol Search8) and instrumental activities of daily living.9 Table 1 shows the group comparisons and test correlations. We found a moderate accuracy of several FDT measures in these participants, with a significant area under the curve ranging from 0.70 (choosing time) to 0.78 (shifting errors). Correlations between the FDT times and the other measures ranged from −0.28 (shifting × Digit Span) to −0.78 (choosing × Symbol Search), suggesting construct validity. We have also found moderate associations between the FDT times with performance on activities of daily living, evidence of ecological validity. The present results show the feasibility of a “miniverbal” version of the classic Stroop Color-Word Test for the assessment of executive functions and processing speed in older adults with low formal education. We believe that the development of mini-verbal tests is of utmost importance, as most of the dementia cases are found in developing countries.10 © 2015 Japan Geriatrics Society
Copyright of Geriatrics & Gerontology International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editor
Lactobacillus bifidus and pathogenic Escherichia coli in geriatric patients
Dear Editor, Sporadic diarrhea caused by pathogenic Escherichia coli (E. coli) infection had been reported in Sendai, Japan, during summer in 2006 and in order to prevent epidemic infection, pathogenic E. coli of stools was examined in all inpatients of geriatric wards of Hikariga-oka Sperman Hospital, Sendai. The subjects were 58 bedridden patients who were inpatients from July to September in 2006. They suffered mainly dementia (21 male and 37 female patients, age 75 ± 13 years) and showed no symptoms of diarrhea, fever or vomiting at the time of examination of stool. Among 58 patients 16 patients took food orally and the other 42 patients took food using percutaneous endoscopic gastrostomy. Pathogenic E. coli of stools was examined by a laboratory company, Hokenkagaku Group, Sendai, Japan. Among 58 patients, pathogenic E. coli was found in 24 patients (8 male and 16 female patients, age 72 ± 15 years). Serotypes of pathogenic E. coli were O-153 (n = 11), O-25 (n = 8) and others (O-1, O-6, O-28, O-125 and O-136, n = 1 in each type), and no verotoxin were found. There was no systematic difference of the type of pathogenic E. coli among three different inpatient wards. There was no difference of infection of pathological E. coli between oral and percutaneous endoscopic gastrostomy feeding. Lactobacillus bifidus (L. bifidus) (either Lac B or Lebenin 1 g, 3 times a day) had been prescribed in 34 patients and had not been prescribed in the other 24 patients. Table 1 shows that the infection of pathogenic E. coli was significantly lower in patients taking L. bifidus irrespective of either oral or percutaneous endoscopic gastrostomy feeding (P < 0.05). There were no systematic differences of infection of pathogenic E. coli in terms of other drugs (gastrointestinal, cardiopulmonary, diabetic drugs and so on). Pathogenic E. coli is one of the agents responsible for epidemic diarrheal sickness in geriatric patients. The pathogens might be introduced by contamination from staff or new inpatients because of sporadic infection being observed at that time. In the present study, we found an unexpectedly high rate of pathogenic E. coli infection, although there were no clinical symptoms. Establishment of normal bacterial flora is important to prevent growth of potential pathogens, as well as contributing to the adequate maturation of the immune system, as imbalance in the normal microflora composition have been consistently associated with several disease consequences. Various therapeutic treatments © 2015 Japan Geriatrics Society
Table 1 coli
Lactobacillus bifidus and enteropathogenic Escherichia Enteropathogenic E. coli (−) (+)
Lactobacillus bifidus (−) Total PEG Oral (+) Total PEG Oral
24 17 7 10 5 5
23 19 4 1* 1 0
*Shows significance of enteropathogenic Escherichia coli between Lactobacillus bifidus (−) and (+) at P < 0.05 (Fisher’s exact test).
have been used, such as administration of probiotics, prebiotics or their association (symbiotics) as a new and interesting strategy to modulate intestinal microbiota.1 L. bifidus is of the major genera of bacteria that make up the colon flora in mammals, and can exert a range of beneficial health effects, including the regulation of intestinal microbial homeostasis,2 the inhibition of pathogens and harmful bacteria that colonize and/or infect the gut mucosa, and are used as probiotics.3,4 The present study suggests that L. bifidus might protect against infection of pathogenic E. coli in bedridden geriatric patients. Although we could not know whether L. bifidus would prevent diarrhea sickness or not caused by pathogenic E. coli, L. bifidus might be useful to regulate gut mucosa and prevent infection by pathogenic E. coli, as homeostasis of gut mucosa of bedridden geriatric patients might be degraded.5 Preventive procedures for patients with positive pathogenic E. coli would be required irrespective of clinical symptoms, and L. bifidus might decrease the chance of epidemic infection. The small number of patients might not be convincing, but further sporadic infections have not been observed since then and we report a preliminary study that was observed in 2006.
Disclosure statement The authors declare no conflict of interest. Youichi Kosaka, Takashi Ohrui, Akira Ohtawara, Satoshi Ishizuka, Masako Azumi, Masahiko Fujii and Hidetada Sasaki Sendai Tomizawa Hospital, Sendai, Japan doi: 10.1111/ggi.12362
| 387
bs_bs_banner
JJ de Paula et al.
References 1 Arribas B, Rodrguez-Cabezas ME, Comalada M et al. Evaluation of the preventative effects exerted by Lactobacillus fermentum in an experimental model of septic shock induced in mice. Br J Nutr 2009; 101: 51–58. 2 Amdekar S, Singh V, Dwivedi L et al. Antiinflammatory, antimicrobial and immunomodulatory properties of Lactobacillus casei against enteropathogenic E. coli. Webmed Cent Microbiol 2010; 1 (10): WMC00873.
3 Guarmer F, Malagelada JR. Gut flora in health and disease. Lancet 2003; 361: 512–519. 4 Mogadhamm MZ, Sattari M, Mobarez AM, Doctorzahed F. Inhibitory effect of yogurt Lactobacillibacteriocins on verotoxins production and enterohemorrhagic Eshcherichia coli O157:H7. Pak J Biol Sci 2006; 9: 2112–2116. 5 Takahashi M, Shirai S, Sawayama C et al. Constipation and aspiration pneumonia. Geriatr Gerontol Int 2012; 12: 570– 571.
Transcultural issues on the assessment of executive functions and processing speed in older adults with low formal education: Usefulness of The Five Digits Test in the assessment of dementia Dear Editor, The assessment of older adults with low formal education and cognitive complaints is still a challenge in clinical gerontology.1 Although, in developed countries, the clinicians have a wide selection of cognitive tests for the patient’s assessment, much of these traditional tests demand a set of abilities that much of the older adults in developing countries is still lacking.2 For example, a classical measure of processing speed and executive functions is the Stroop Color-Word Test, which requires the subject to name the color of dots, then name the color of neutral words and finally name the color in which color names are printed.3 The test is feasible for the assessment of older adults in developed countries and is used in large normative studies.4,5 However, in countries where the elderly population has low formal education, the Stroop Color-Word Test usually does not work, as the reading routines (necessary for the interference effect) are not fully efficient. An alternative in these cases is the use of “mini-verbal tests”: cognitive assessment tools developed to be less influenced by cultural particularities, language and formal education.6 A mini-verbal version of the Stroop Color-Word Test is the Five Digits Test (FDT).7 FDT investigates the interference effect by using two automatic attentional process trials: reading numbers (e.g. 2-2-2, “two”) and counting small quantities (e.g. ***, “three”); and two controlled attentional process trials: choosing to count how many numbers are in each incongruent stimuli (e.g. 2-2-2-2, “four”), and shifting between the reading and counting routines. In the present Letter to the Editor, we aim to show the appli388 |
doi: 10.1111/ggi.12364
cability and clinical value of the assessment of dementia in older adults with advanced age (76.4 ± 7.5 years) and low formal education (5.3 ± 4.0 years). We studied 80 older adults from a memory clinic in Brazil, divided into two groups: controls (n = 40) and mild dementia (n = 40), matched by age, education and sex. We carried out the diagnoses by multidisciplinary assessment as reported in a previous article.8 The participants performed the FDT (not used for participants’ diagnosis) and other cognitive measures. Receiver operating characteristic curve analysis assessed FDT accuracy on the participant’s diagnoses, and assessed the FDT correlations with other cognitive measures of executive functions (Digit Span8), processing speed (Digit-Symbol Coding and Symbol Search8) and instrumental activities of daily living.9 Table 1 shows the group comparisons and test correlations. We found a moderate accuracy of several FDT measures in these participants, with a significant area under the curve ranging from 0.70 (choosing time) to 0.78 (shifting errors). Correlations between the FDT times and the other measures ranged from −0.28 (shifting × Digit Span) to −0.78 (choosing × Symbol Search), suggesting construct validity. We have also found moderate associations between the FDT times with performance on activities of daily living, evidence of ecological validity. The present results show the feasibility of a “miniverbal” version of the classic Stroop Color-Word Test for the assessment of executive functions and processing speed in older adults with low formal education. We believe that the development of mini-verbal tests is of utmost importance, as most of the dementia cases are found in developing countries.10 © 2015 Japan Geriatrics Society
Copyright of Geriatrics & Gerontology International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
