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Motor Function, Paratonia and Glycation Cross-Linked in Older People Hans Dretnh Motor function, paratonia UITNODIGING voor het bijwonen van de openbare verdediging van mijn proefschrift and glycation cross-linked in older people Motor function, paratonia and glycation cross-linked Motor function decline and paratonia in older people and their relation with Advanced Glycation End-Products Maandag 24 september om 12.45 in de aula van het Academiegebouw van de Rijksuniversiteit Groningen, Broerstraat 5 te Groningen Aansluitend bent u van harte welkom op de receptie ter plaatse Motor Function, Paratonia and Glycation Cross-linked in Older People Cross-linked and Glycation Paratonia Function, Motor Tevens bent u tussen 16.00 en 18.00 welkom voor een borrel in ZuidOostZorg/Sunenz, Burgemeester Wuiteweg 140, Drachten. Graag aanmelden voor de borrel via [email protected] voor 17 september. Hans Drenth [email protected] [email protected] Paranimfen: Sjoukje Drenth Fransisca Spa Contact [email protected] Hans Drenth Motor Function, Paratonia and Glycation Cross-linked in Older People Motor function decline and paratonia and their relation with Advanced Glycation End-Products Hans Drenth The work presented in this thesis was performed at the Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands, at the Research Institute SHARE of the Groningen Graduate School of Medical Sciences of the University Medical Center Groningen, University of Groningen, The Netherlands and at the Frailty in Ageing research group, Vrije Universiteit Brussel, Brussels, Belgium. The work described in this thesis was sponsored by Alzheimer Nederland (the Dutch Alzheimer Organisation) and ZuidOostZorg, organisation for Elderly Care, Drachten, the Netherlands. Cover design Henri Groenewold Printed by Gildeprint Drukkerijen ISBN 978-94-034-0798-2 (printed version) ISBN 978-94-034-0797-5 (electronic version) Acknowledgments The printing of this thesis was financially supported by - Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen - University of Groningen - Research Institute SHARE, University Medical Center Groningen - University Medical Center Groningen - Scientific College Physical Therapy (WCF) of the Royal Dutch Society for Physical Therapy (KNGF) - Alzheimer Nederland (the Dutch Alzheimer Organisation) - Doctoral School of Life Sciences and Medicine, Vrije Universiteit Brussel - Dutch Society for Geriatric Physical Therapy (NVFG) © 2018 Hans Drenth, Groningen All rights reserved. No parts of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, without the prior written permission of the copyright owner. Motor function, paratonia and glycation cross-linked in older people Motor function decline and paratonia and their relation with Advanced Glycation End-Products PhD thesis to obtain the degree of PhD of the University of Groningen on the authority of the Rector Magnificus Prof. E. Sterken and in accordance with the decision by the College of Deans and to obtain the degree of PhD of Gerontological Sciences Vrije Universiteit Brussel Double PhD degree This thesis will be defended in public on Monday 24 September 2018 at 12.45 by Johannes Christiaan Drenth born on 29 February 1968 in ‘s-Gravenhage, the Netherlands Supervisors Prof. C.P. van der Schans Prof. S.U. Zuidema Prof. I. Bautmans Co-supervisors Dr. J.S.M. Hobbelen Assessment Committee Prof. T. Hortobagyi Prof. D. Beckwée Prof. E. Boulanger Prof. O. Bruyere TABLE OF CONTENTS Chapter 1: General introduction 7 Chapter 2: The Contribution of Advanced Glycation End-Product (AGE) 19 Accumulation to the Decline in Motor Function European Review of Aging and Physical Activity 2016, Mar 4; 13:3. Chapter 3: Advanced Glycation End-Products are Associated with Physical 45 Activity and Physical Functioning in the Older Population Journals of Gerontology; Series A Biological Sciences and Medical Sciences 2018, Apr 28. Chapter 4: Advanced Glycation End-Products are Associated with the 61 Presence and Severity of Paratonia in Early Stage Alzheimer Disease JAMDA 2017, Jul 1; 18(7): 636.e7-636.e12. Chapter 5: Association between Advanced Glycation End-Products and 79 Functional Performance in Alzheimer’s Disease and Mixed Dementia International Psychogeriatrics 2017, Sep; 29 (9): 1525–1534. Chapter 6: Psychometric Properties of the MyotonPRO in People with Paratonia 95 Gerontology 2017, Dec 22. Chapter 7: Summary and General Discussion 119 Samenvatting 134 Dankwoord 138 Curriculum Vitae 140 Research Institute for Health Research SHARE 141 Chapter 1 General Introduction Chapter 1 BACKGROUND Within the aging population, motor function decline such as reduced walking abilities and decline in activities of daily living are commonly observed 1–4. Most human physiologic systems decline during aging, independent of substantial disease effects, at an average linear loss rate of 0.34-1.28% per year between the ages of 30 and 70 years 5. Impaired motor function is a prominent characteristic of physical frailty and is associated with a wide range of adverse health consequences such as falls, disability, death, hospitalization, and institutionalization 6,7. Different mechanisms contribute to the age-related decline in motor function. One of these mechanisms that might be a factor in this decline are advanced glycation end-products (AGEs) which have been proposed as contributing to the age-related decline of the functioning of cells and tissues in normal aging. A specific age-related disease such as dementia is frequently accompanied by motor function decline which varies between the different dementia types8,9 . This decline in motor function precedes cognitive decline and progresses gradually over years3 . In early dementia stages, intentional movements become unstructured and clumsy followed by a decline in walking abilities indicated by the shortening of step length, diminished walking velocity, and unsteadiness 10–13. In the later stages, the patient becomes wheelchair bound or even bedridden due to paratonia, a specific manifestation of impaired motor function in people experiencing dementia14 . Paratonia was already being described beginning in 1828 15, but it was not until 2006 that a consensus definition of it was established16 . Despite this, paratonia is still fairly unknown, and the pathogenesis of paratonia is not well understood. It has been shown that patients in early stage dementia with diabetes mellitus (DM) have a significantly higher risk for the development of paratonia compared to those with dementia but without DM 17. Both Alzheimer’s disease (AD)18,19 and DM 20,21 are related to higher concentrations of AGEs, suggesting that AGEs could possibly be involved in the development of paratonia. MOTOR FUNCTION Motor function is defined as any movement or activity that uses motor neurons. Different motor activities derive from the coordinated activity of distributed motor networks within the central nervous system (CNS), extending via the peripheral nervous system to the musculoskeletal structures for generating movement 22. Motor impairment can be the result of damage to motor-related brain regions, and the location of the damage within CNS structures may lead to different presentations of motor function decline 3. Furthermore, motor function decline can also be caused by peripheral changes in the nervous system or skeletal muscles. Loss of skeletal muscle mass and muscle weakness is an important contributor to a decline in motor function and functional performance 23. Besides muscle 8 General introduction atrophy from either disease or disuse, it has been suggested that loss of muscle contractile properties may possibly be due to biomechanical changes in the connective tissues 1 surrounding the muscle fibres (endomysium, perimysium, and epimysium) 23. Age-related intermolecular cross-linking processes in a muscle’s connective tissue leads to changes in its mechanical properties, causing loss of elasticity and increasing tissue stiffness 24. PARATONIA Paratonia is a distinctive form of hypertonia/movement stiffness that is observed in individuals experiencing dementia and has an estimated prevalence of 10% in the early stages and up to 90-100% with later stages of dementia 14,17. The severity of paratonia increases with the progression of the dementia and is associated with a further loss of functional mobility, severe contractures (see Figure 1), and pain.16 Due to paratonia, daily care, especially washing and dressing, becomes uncomfortable and painful. Severe paratonia, therefore, results in a substantial increase of the caretaker’s burden and a decrease of the quality of life in the advanced stages of dementia14 . However, in the early stages, paratonia already has a negative and significant impact on functional mobility, and this decline has been identified as a significant risk factor for falls for those with dementia 17,25. Figure 1. Characteristic flexion posture in patient with more severe paratonia. Photo by José Verheijden. Definition of paratonia In 2006, the following operational definition of paratonia was established through an International Delphi procedure with known experts in the field 16. 9 Chapter 1 “Paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of the dementing illness, meaning that active assistance (or “mitgehen”) is more common early
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