Tuesday, August 15, 2017

Singing may be good medicine for Parkinson's patients

Singing may be good medicine for parkinson's  patients
15 aug 2017--Singing? To benefit people with Parkinson's disease? It just may help, a researcher says.
"We're not trying to make them better singers, but to help them strengthen the muscles that control swallowing and respiratory function," said Elizabeth Stegemoller, an assistant professor of kinesiology at Iowa State University.
Stegemoller holds a weekly singing therapy class for Parkinson's disease patients. At each session, participants go through a series of vocal exercises and songs.
Singing uses the same muscles as swallowing and breathing control, two functions affected by Parkinson's disease. Singing significantly improves this muscle activity, according to Stegemoller's research.
"We work on proper breath support, posture and how we use the muscles involved with the vocal cords, which requires them to intricately coordinate good, strong muscle activity," she said in a university news release.
Other benefits noted by patients, their families and caregivers include improvements in mood, stress and depression, Stegemoller said.
Her research was published in Complementary Therapies in Medicine.
Parkinson's disease is a chronic and progressive movement disorder. Nearly one million Americans live with the disease. The cause isn't known, and there is no cure at present. But there are treatment options such as medication and surgery to manage symptoms, according to the Parkinson's Disease Foundation.
Symptoms can include tremors of the hands, arms, legs, jaw and face; slowness of movement; limb rigidity; and problems with balance and coordination.

More information: The U.S. National Institute of Neurological Disorders and Stroke has more on Parkinson's disease.

Saturday, August 12, 2017

Social isolation, loneliness could be greater threat to public health than obesity, researchers say

loneliness

Loneliness and social isolation may represent a greater public health hazard than obesity, and their impact has been growing and will continue to grow, according to research presented at the 125th Annual Convention of the American Psychological Association.

12 aug 2017--"Being connected to others socially is widely considered a fundamental human need—crucial to both well-being and survival. Extreme examples show infants in custodial care who lack human contact fail to thrive and often die, and indeed, social isolation or solitary confinement has been used as a form of punishment," said Julianne Holt-Lunstad, PhD, professor of psychology at Brigham Young University. "Yet an increasing portion of the U.S. population now experiences isolation regularly."
Approximately 42.6 million adults over age 45 in the United States are estimated to be suffering from chronic loneliness, according to AARP's Loneliness Study. In addition, the most recent U.S. census data shows more than a quarter of the population lives alone, more than half of the population is unmarried and, since the previous census, marriage rates and the number of children per household have declined.
"These trends suggest that Americans are becoming less socially connected and experiencing more loneliness," said Holt-Lunstad.
To illustrate the influence of social isolation and loneliness on the risk for premature mortality, Holt-Lunstad presented data from two meta-analyses. The first involved 148 studies, representing more than 300,000 participants, and found that greater social connection is associated with a 50 percent reduced risk of early death. The second study, involving 70 studies representing more than 3.4 million individuals primarily from North America but also from Europe, Asia and Australia, examined the role that social isolation, loneliness or living alone might have on mortality. Researchers found that all three had a significant and equal effect on the risk of premature death, one that was equal to or exceeded the effect of other well-accepted risk factors such as obesity.
"There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators," said Holt-Lunstad. "With an increasing aging population, the effect on public health is only anticipated to increase. Indeed, many nations around the world now suggest we are facing a 'loneliness epidemic.' The challenge we face now is what can be done about it."
Holt-Lunstad recommended a greater priority be placed on research and resources to tackle this public health threat from the societal to the individual level. For instance, greater emphasis could be placed on social skills training for children in schools and doctors should be encouraged to include social connectedness in medical screening, she said. Additionally, people should be preparing for retirement socially as well as financially, as many social ties are related to the workplace, she noted, adding that community planners should make sure to include shared social spaces that encourage gathering and interaction, such as recreation centers and community gardens.

More information: Session 3328: "Loneliness: A Growing Public Health Threat," Plenary, Saturday, Aug. 5, 3-3:50 p.m. EDT, Room 151A, Street Level, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C.


Provided by American Psychological Association

Thursday, August 10, 2017

Pneumonia or sepsis in adults associated with increased risk of cardiovascular disease

Pneumonia or sepsis in adults that results in hospital admission is associated with a six-fold increased risk of cardiovascular disease in the first year, according to research published today in the European Journal of Preventive Cardiology. Cardiovascular risk was more than doubled in years two and three after the infection and persisted for at least five years.

10 aug 2017--"Severe infections in adulthood are associated with a contemporaneously raised risk of cardiovascular disease," said last author Professor Scott Montgomery, director of the clinical epidemiology group, Örebro University, Sweden. "Whether this raised risk persists for several years after infection is less well established."
This study examined if hospital admission for sepsis or pneumonia is associated with an increased risk of cardiovascular disease in the years following infection, and whether there is a period of particularly heightened risk.
The study included 236 739 men born between 1952 and 1956 who underwent extensive physical and psychological examinations at around age 18 years as part of compulsory military conscription assessments. The researchers obtained infection and cardiovascular disease diagnoses from a register that has recorded information on patients admitted to hospital since 1964. The men were followed from late adolescence into middle age (follow-up was completed in 2010).
The researchers analysed the associations between a first infection with sepsis or pneumonia that resulted in hospital admission with subsequent cardiovascular disease risk at pre-specified time intervals post-infection (0-1, >1-2, >2-3, >3-4, >4-5, and 5+ years after hospital admission for the infection).
During the follow-up period, a total of 46 754 men (19.7%) had a first diagnosis of cardiovascular disease. There were 9 987 hospital admissions for pneumonia or sepsis among 8 534 men who received these diagnoses.
The researchers found that infection was associated with a 6.33-fold raised risk of cardiovascular disease during the first year after the infection. In the second and third years following an infection, cardiovascular disease risk remained raised by 2.47 and 2.12 times. Risk decreased with time but was still raised for at least five years after the infection by nearly two-fold (hazard ratio 1.87).
Similar findings were observed for coronary heart disease, stroke, and fatal cardiovascular disease. The persistently raised risk could not be explained by subsequent severe infections.
"Our results indicate that the risk of cardiovascular disease, including coronary heart disease and stroke, was increased after hospital admission for sepsis or pneumonia," said lead author Dr Cecilia Bergh, an affiliated researcher at Örebro University. "The risk remained notably raised for three years after infection and was still nearly two-fold after five years."
When the researchers examined the relationship between other risk factors such as high blood pressure, overweight, obesity, poorer physical fitness, and household crowding in childhood, they found that infection was associated with the highest magnitude of cardiovascular disease risk in the first three years post-infection.
Professor Montgomery said: "Conventional cardiovascular risk factors are still important but infection may be the primary source of risk for a limited time."
The authors said the results point to a causal relationship, since cardiovascular disease risk is very high immediately after infection and reduces with time. Persistent systemic inflammation after a severe infection may play a role, as inflammation is a risk for cardiovascular disease. Most patients with sepsis or pneumonia recover but many still have high circulating inflammatory markers after the acute phase of the infection.
Professor Montgomery said: "Our findings provide another reason to protect against infection and suggest that there is a post-infection window of increased cardiovascular disease risk. We did not study any interventions that could be initiated during this period, but preventative therapies such as statins could be investigated."

More information: Bergh C, et al. Severe infections and subsequent delayed cardiovascular disease. European Journal of Preventive Cardiology. 2017. DOI: 10.1177/2047487317724009


Provided by European Society of Cardiology

Sunday, August 06, 2017

High intensity interval training can reverse frailty at advanced age, preclinical study finds

High intensity interval training can reverse frailty at advanced age, preclinical study finds

Growing older may not have to mean growing frail. A preclinical study has revealed that brief periods of intense physical activity can be safely administered at advanced age, and that this kind of activity has the potential to reverse frailty.
Published in the Journal of Gerontology A in June by University at Buffalo researchers, the study is the first to investigate whether a novel, short-session regimen of high-intensity interval training (HIIT) can be safe and effective in older populations.

06 aug 2017--The study was conducted on two groups of a dozen mice, each 24 months old, which correlates roughly to 65 years old in human terms. All the mice had been sedentary up until that age. While cautioning that the study was done in mice, the authors state that the results could have significant application to humans.
"We know that being frail or being at risk for becoming frail puts people at increased risk of dying and comorbidity," said Bruce R. Troen, MD, senior author on the study with Kenneth L. Seldeen, PhD, who is first author.
Troen is professor and chief of the Division of Geriatrics and Palliative Medicine in the Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at UB, a geriatrician with UBMD Internal Medicine, and a physician-investigator with the Veterans Affairs Western New York Health Care System. Seldeen is research assistant professor of medicine at UB.
"These results show that it's possible that high-intensity interval training can help enhance quality of life and capacity to be healthy," Troen said.
The results were striking with mice exhibiting "dramatic" improvements in numerous measurements, including strength and physical performance.

No longer frail

One of the most significant findings was that by the end of the study, five of six mice found to be frail or pre-frail at baseline improved, and four were no longer frail.
"Those four mice who had exhibited the kinds of deficits that correlate to frailty in humans improved to a completely robust level," said Troen. "The HIIT actually reversed frailty in them."
Troen and Seldeen developed mouse equivalents for measures that assess human frailty, including ways to evaluate grip strength, endurance and gait speed, so that they could establish baseline levels and then compare those with results once the study was complete.
"Because the performance measures for the mice are directly relevant to clinical parameters, we think this program of exercise is quite applicable to humans," said Troen. "We're laying a foundation so we can do this in people and so we can understand how to tailor it to individuals so they can successfully implement this."
Similar to the way that an athletic trainer might individualize a fitness program for a client, Troen and Seldeen tailored intensity levels to each mouse.
"While the mice are genetically identical, they aren't phenotypically identical," Seldeen explained, "so we customized the exercise program to each mouse, first finding out what each one was capable of at baseline, and then increasing or decreasing the intensity depending on the performance of the mouse during the study."

HIIT was well-tolerated

The 10-minute exercise program involved a three-minute warm-up, three intervals of one minute of high intensity and one minute at lower intensity, and a final minute of higher intensity on an inclined treadmill. The exercises were done three times a week over 16 weeks. All exercises were well-tolerated by the mice.
There were dramatic improvements in grip strength, treadmill endurance and gait speed. The mice showed greater muscle mass and an increase in total mitochondria, the energy factories of cells.
"Increased mitochondrial biomass allows you to utilize oxygen more efficiency," Troen explained. "With HIIT, we saw both mitochondrial increase and an improvement in muscle quality and fiber size in these mice."
As to why HIIT results in such significant benefits to those who engage in it, Troen said that it has to do with the stress to which it subjects the body.
"Exercise stresses the system and the body can respond beneficially," he explained. "We believe that the intensity of individualized HIIT provides a more significant but manageable stress so the body responds more robustly to these short, vigorous periods of exercise.
"In other words, you get more bang for your buck."
Troen and Seldeen cautioned that anyone considering HIIT should check with their physician first.


Provided by University at Buffalo

Saturday, August 05, 2017

For white middle class, moderate drinking is linked to cognitive health in old age

drinking wine

Older adults who consume alcohol moderately on a regular basis are more likely to live to the age of 85 without dementia or other cognitive impairments than non-drinkers, according to a University of California San Diego School of Medicine-led study.
The findings are published in the August issue of the Journal of Alzheimer's Disease.

05 aug 2017--Previous studies have found a correlation between moderate alcohol intake and longevity. "This study is unique because we considered men and women's cognitive health at late age and found that alcohol consumption is not only associated with reduced mortality, but with greater chances of remaining cognitively healthy into older age," said senior author Linda McEvoy, PhD, an associate professor at UC San Diego School of Medicine.
In particular, the researchers found that among men and women 85 and older, individuals who consumed "moderate to heavy" amounts of alcohol five to seven days a week were twice as likely to be cognitively healthy than non-drinkers. Cognitive health was assessed every four years over the course of the 29-year study, using a standard dementia screening test known as the Mini Mental State Examination.
Drinking was categorized as moderate, heavy or excessive using gender and age-specific guidelines established by the National Institute on Alcohol Abuse and Alcoholism. By its definition, moderate drinking involves consuming up to one alcoholic beverage a day for adult women of any age and men aged 65 and older; and up to two drinks a day for adult men under age 65. Heavy drinking is defined as up to three alcoholic beverages per day for women of any adult age and men 65 and older; and four drinks a day for adult men under 65. Drinking more than these amounts is categorized as excessive.
"It is important to point out that there were very few individuals in our study who drank to excess, so our study does not show how excessive or binge-type drinking may affect longevity and cognitive health in aging," McEvoy said. Long-term excessive alcohol intake is known to cause alcohol-related dementia.
The researchers said the study does not suggest drinking is responsible for increased longevity and cognitive health. Alcohol consumption, particularly of wine, is associated with higher incomes and education levels, which in turn are associated with lower rates of smoking, lower rates of mental illness and better access to health care.
The UC San Diego School of Medicine research team adjusted the statistical analyses to remove confounding variables, such as smoking or obesity, but noted the study is based only on statistical relationships between different demographic factors, behaviors and health outcomes. There remain on-going debates about whether and how alcohol impacts lifespan or potentially protects against cognitive impairments with age.
One of the study's advantages, however, is that the data derive from a relatively homogenous population in a geographically well-defined area. All of the 1,344 older adults (728 women; 616 men) who participated in the study are from Rancho Bernardo, a white-collar, middle-to-upper-middle-class suburb in San Diego County. More than 99 percent of the study participants, tracked from 1984 to 2013, are Caucasian with at least some college education.
"This study shows that moderate drinking may be part of a healthy lifestyle to maintain cognitive fitness in aging," said lead author Erin Richard, a graduate student in the Joint San Diego State University/UC San Diego Doctoral Program in Public Health. "However, it is not a recommendation for everyone to drink. Some people have health problems that are made worse by alcohol, and others cannot limit their drinking to only a glass or two per day. For these people, drinking can have negative consequences."

More information: Erin L. Richard et al, Alcohol Intake and Cognitively Healthy Longevity in Community-Dwelling Adults: The Rancho Bernardo Study, Journal of Alzheimer's Disease (2017). DOI: 10.3233/JAD-161153


Provided by University of California - San Diego

Thursday, August 03, 2017

Worldwide health authorities urged to rethink vitamin D guidelines

vitamin D

Worldwide health authorities are being urged to rethink official guidance around vitamin D following the publication of a ground breaking study from the University of Surrey, which dispels the myth that vitamin D2 and D3 have the same nutritional value.

03 aug 2017--In the first ever study of its kind, using low doses of vitamin D in fortified food, researchers from the University of Surrey investigated which of the two types of vitamin D, D2 or D3, was more effective in raising levels of this vital nutrient in the body. Vitamin D3 is derived from animal products, while D2 is plant-based.
Researchers examined the vitamin D levels of 335 South Asian and white European women over two consecutive winter periods, a time when the nutrient is known to be lacking in the body. The women were split into five groups, with each group receiving either a placebo, a juice containing vitamin D2 or D3 and a biscuit with D2 or D3.
They found that vitamin D3 was twice as effective in raising levels of the vitamin in the body than its counterpart D2. Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75 per cent and 74 per cent respectively compared to those who were given D2 through the same methods. Those given D2 saw an increase of 33 per cent and 34 per cent over the course of the 12-week intervention.
The research also found that nutrient levels of both vitamin D2 and D3 rose as a result of both food and acidic beverages such as juice, which were found to be equally as effective.
Those who received the placebo experienced a 25 per cent reduction in the vitamin over the same period.
Current guidance given by a number of Government bodies around the world including the US National Institute of Health, state that the two forms of vitamin D are equivalent and can be used to equal effect.
Latest figures from Public Health England has found that more than 1 in 5 people in the UK have low levels of vitamin D and has increased the recommended intake of the vitamin to 10 micrograms per day, throughout the year, for everyone in the general population aged 4 years and older. Daily consumption of products containing vitamin D3 but not vitamin D2 will enable the population to meet this target helping to avoid the health implications such as osteoporosis, rickets and increased risk of cardio vascular disease which are associated with insufficient levels of vitamin D in the body.
This finding not only has implications for the health sector but also for the retail market. In recent years many retailers have added vitamin D2 to their products in the belief that it will help a person fulfil their daily intake. This study has proven that D3 is the most effective form of increasing vitamin D levels in the body.
Lead author Dr Laura Tripkovic from the University of Surrey, said: "The importance of vitamin D in our bodies is not to be underestimated, but living in the UK it is very difficult to get sufficient levels of it from its natural source, the sun, so we know it has to be supplemented through our diet.
"However, our findings show that vitamin D3 is twice as effective as D2 in raising vitamin D levels in the body, which turns current thinking about the two types of vitamin D on its head. Those who consume D3 through fish, eggs or vitamin D3 containing supplements are twice as more likely to raise their vitamin D status than when consuming vitamin D2 rich foods such as mushrooms, vitamin D2 fortified bread or vitamin D2 containing supplements, helping to improve their long term health."
Professor Susan Lanham-New, Head of the Department of Nutritional Sciences at the University of Surrey and who was Principal Investigator of the BBSRC DRINC funded trial said: "This is a very exciting discovery which will revolutionise how the healthand retail sector views vitamin D.
"Vitamin D deficiency is a serious matter, but this will help people make a more informed choice about what they can eat or drink to raise their levels through their diet."


Provided by University of Surrey

Wednesday, August 02, 2017

Poor appetite and food intake in older adults

Having a poor appetite is a serious health concern for older adults. It can lead to inadequate nutrition, which can shorten your life or reduce your quality of life. Between 11 percent and 15 percent of older adults who live independently are estimated to have poor appetites.

02 aug 2017--Strategies to improve our appetites as we age include reducing portion size, increasing meal frequency, and using flavor enhancers. Until recently, however, these options have not proven to improve food intake or quality of life for older people. That's part of the reason why a team of researchers designed a study to examine the differences in food intake among older adults with varied appetite levels. Their study was published in the Journal of the American Geriatrics Society.
The researchers looked at data from 2,597 people between the ages of 70 and 79. Nearly 22 percent of the people in the study described their appetite as "poor." The researchers interviewed the participants using a 108-item survey to estimate how much food they ate.
The researchers discovered that older adults with poor appetites ate much less protein and dietary fiber. They also ate fewer solid foods, protein-rich foods, whole grains, fruits, and vegetables. However, people with poor appetite did eat/drink more dairy foods, fats, oils, sweets, and sodas compared to older adults who reported having very good appetites.
"The results of this study show several differences in food consumption among older, independent adults with various appetite levels," wrote the researchers in their study. The team concluded that identifying the specific food preferences of older adults with poor appetites could be helpful for learning how to help improve their appetite and the quality of their diets.

More information: Barbara S. van der Meij et al, Poor Appetite and Dietary Intake in Community-Dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15017


Provided by American Geriatrics Society

Tuesday, August 01, 2017

Research finds increased risk of dementia in patients who experience delirium after surgery

dementia

Delirium is common in elderly hospitalized patients, affecting an estimated 14 - 56% of patients. It frequently manifests as a sudden change in behavior, with patients suffering acute confusion, inattention, disorganized thinking and fluctuating mental status.

01 aug 2017--Pre-existing cognitive impairment or dementia in patients undergoing surgery are widely recognized as risk factors for postoperative delirium, increasing its likelihood and severity.
However, little previous research has focused on whether delirium itself portends or even accelerates a decline into dementia in patients who showed no previous signs of cognitive impairment.
Research published today in the British Journal of Anaesthesia focuses on patients over the age of 65 who were assessed as cognitively normal prior to surgery. This study, led by Professor Juraj Sprung of the Mayo Clinic in Minnesota, finds those who developed postoperative delirium were three times more likely to suffer permanent cognitive impairment or dementia.
Over a ten year period, patients over the age of 65 enrolled at the Mayo Clinic Study of Ageing in Olmsted County Minnesota who were exposed to general anesthesia were included in an investigation involving over two 2000 patients. Their cognitive status was evaluated in regular 15 month periods before and after surgery by neuropsychologic testing and clinical assessment. Out of 2014 patients, 1667 were deemed to be cognitively normal before surgery. Of the 1152 patients who returned for follow-up cognitive evaluation, 109 (9.5%) had developed mild cognitive impairment (pre-dementia) or dementia, and those who had suffered postoperative delirium were three times more likely to be subsequently diagnosed with permanent cognitive decline or dementia. This research is the first to focus on the association between delirium and long-term cognitive decline in patients with normal mental capacity before surgery.
While previous studies have highlighted cognitive decline in the elderly following postoperative delirium, no others have involved such a detailed neuro-cognitive assessment identifying those with normal pre-operative cognitive abilities who go on to develop dementia. In conclusion, researchers believe that postoperative delirium could be a warning sign of future permanent cognitive impairment (dementia) in patients who at the time of surgery were still just above the threshold for registering cognitive decline. Alternatively, postoperative delirium could itself produce injury, which per se accelerates the trajectory of decline into dementia.
"Our research shows that delirium after surgery is not only distressing for patients and their families, but also may be a warning that patients could later develop dementia, said Sprung. "We don't yet know whether taking steps to prevent postoperative delirium could also help prevent dementia - but we need to find out."
British Journal of Anaesthesia Editor-in-Chief Professor Hugh Hemmings said: "This important research identifies a significant risk factor for developing dementia postoperatively, and highlights the need for more research in preventing, identifying and treating postoperative delirium."

More information: J. Sprung et al, Postoperative delirium in elderly patients is associated with subsequent cognitive impairment, BJA: British Journal of Anaesthesia (2017). DOI: 10.1093/bja/aex130


Provided by Oxford University Press

Monday, July 31, 2017

Is it Alzheimer's or another dementia form? Why doctors need to distinguish

dementia

Alzheimer's disease now affects an estimated 5.5 million Americans, and after decades of feverish work, researchers have so far failed to find a treatment that halts or reverses the inexorable loss of memory, function and thinking ability that characterize this feared illness.

31 july 2017--But researchers have been quite successful at devising ways to diagnose Alzheimer's earlier and earlier. And that capability has emerged alongside evidence of a tantalizing possibility: that if you can catch the disease early enough - ideally when symptoms of confusion or memory loss are just emerging, or before - some therapies already in hand might essentially halt its progress.
For anyone who detects some mental slippage and wonders, "Is it Alzheimer's?" the current state of dementia research raises a very real, and very wrenching, dilemma: If I can know, do I want to know?
That is, if it's Alzheimer's disease, would I do anything differently? Would there be some benefit in knowing for my loved ones, for myself?
Doctors and insurers, including the federal government, which administers Medicare, are asking some variants of the same questions: If an effective test, which costs between $3,000 and $5,000 a shot, can diagnose dementia early, and distinguish Alzheimer's from other forms of dementia, should it be recommended to patients with cognitive concerns and routinely covered by their insurance? Would it make patients' lives better, or lower the cost of their care?
Newly unveiled research results are bringing some clarity to such deliberations. And other new research, published Wednesday in the journal Neurology, proposes a new diagnostic tool that may be able to detect Alzheimer's, and distinguish it from another form of dementia, more simply and cheaply than does the best test now available.
At the Alzheimer's Association International Conference in London last week, researchers reported their preliminary findings from a trial that is testing the impact of diagnostic testing for Alzheimer's disease on nearly 19,000 Medicare beneficiaries.
All of these study participants - largely people in their 70s, all with a diagnosis of either "mild cognitive impairment" or atypical dementia - are living with the unconfirmed suspicion that they have Alzheimer's. The study is underwritten by the Centers for Medicare & Medicaid Services and the Alzheimer's Association. It set out to find out whether knowing - getting the costly test that would offer either confirmation or reprieve - would change the way that patients with cognitive troubles are treated, or the way that they plan their lives.
The preliminary results suggested it did. After getting the results of a PET brain scan to detect and measure amyloid deposits, which are the key hallmark of Alzheimer's disease, roughly two-thirds of the subjects saw their medication regimens changed or were counseled differently by their doctors about what to expect.
That new information may have guided family caregivers in planning their own futures, or prodded patients to make financial decisions and power-of-attorney assignments sooner. Some who learned that they did not have Alzheimer's discontinued medications that can have unpleasant side effects. Others learned they do have Alzheimer's and decided to enroll in clinical trials that will test new drugs.
A second study presented in London analyzed data from several studies, and found that in a large population of research participants with cognitive concerns, brain amyloid PET scans led to a change in diagnosis in approximately 20 percent of cases.
"People should know what's coming," said Dr. Maria Carrillo, chief science officer for the Alzheimer's Association. The Centers for Medicare & Medicaid Services has given amyloid scans a provisional approval, meaning they do not routinely pay for them. The results may guide the agency to rethink its position, she added.
The PET scan bore bad news for Ken Lehmann, who enrolled last year in the IDEAS trial, short for Imaging Dementia - Evidence for Amyloid Scanning. After his long, slow decline that has flummoxed doctors, Lehmann's brain scan clearly showed he has Alzheimer's disease.
The certainty that has brought has been a long time coming. When Lehmann began withdrawing from friends, forgetting to pay bills and having trouble following conversations, he was just 58. Now, he's 80.
Ken had always been considered a "Renaissance man" - a furniture company executive who rebuilt Porsches, played basketball and loved to entertain friends, said his wife, Mary Margaret Lehmann. But as years passed, his judgment seemed off. He would lose track of points he was making, and sometimes of where he was at.
It would take the loss of their home and a business bankruptcy for the Lehmanns to demand answers to what was going on. In 2009, they moved from Sacramento, Calif., to Edina, Minn., to live with a daughter. And there, at last, they found a neurologist who, despite initial skepticism ("but he presents so well!" the doctor proclaimed), diagnosed dementia.
For the Lehmanns and many patients and families like them - as well as for neurologists - that diagnosis is often just the beginning of a deeper mystery.
Alzheimer's disease is the most feared and most common form of dementia, accounting for between 60 percent and 80 percent of all dementia cases diagnosed. But at least seven other forms of dementia, and dementia linked to the movement disorder Parkinson's disease, can cause loss of memory, reasoning, judgment and the ability to speak, comprehend and care for oneself.
To the estimated 16 million Americans living with some form of cognitive impairment, telling the difference could make a significant difference. Dementia forms with different origins progress differently (or sometimes not at all). They respond best to different medications, and will come to require different levels of care and treatment. Some (though not Alzheimer's) can even be reversed with treatment.
Being able to distinguish which form of dementia a patient has should help doctors and caregivers to make better choices.
But it's a question that until recently could be answered only after death. At that point, a post-mortem examination of the brain could be done to look for the built-up clumps and tangles of beta-amyloid proteins, the overall shrinkage, and the loss of neurons in the brain's hippocampus that are, collectively, the hallmarks of Alzheimer's.
No more. Improved medical imaging technologies developed over the last decade have made it possible to peer inside the brain of a living patient, detect and measure the accumulation of beta-amyloid, and make a definitive diagnosis.
In 2012, the Food and Drug Administration took a first step in making such imaging possible, giving its blessing to the imaging agent florbetapir F18, which binds to amyloid aggregates in the brain and allows a PET scan to be used to make the diagnosis. In 2013, two new imaging agents won FDA approval, and new imaging agents and techniques promise ever more precise means to visualize and diagnose Alzheimer's in the brain.
On Wednesday, research published in the journal Neurology suggested that transcranial magnetic stimulation, a technique that can selectively turn up or down activity in different parts of the brain, could prove useful in distinguishing between Alzheimer's disease from frontotemporal dementia.
In many ways, Ken Lehmann's symptoms fit neatly into a diagnosis of frontotemporal dementia. A form of cognitive impairment that typically becomes evident earlier than most cases of Alzheimer's, FTD often affects judgment, personality and verbal communication. This form of dementia progresses as inexorably as does Alzheimer's. But its typical course differs slightly.
As an enrollee in the IDEAS trial, Lehmann was prepared to learn what it was he had.
"I had come to the conclusion they just don't know," said Lehmann, now 80, from his home in Minnesota. "In seven years, my journey of decline has been very miniscule, and they don't know why."
It turns out, he added, "I have all the biomarkers of Alzheimer's disease."
Once he and his wife learned that, they stepped up their preparations for further decline. And they redoubled their efforts to do things that bring joy, and that may slow Ken's decline as well.
They follow a diet rich in fatty fish, healthful fats and fruits and vegetables, and Ken does woodworking. He also sings in a Minneapolis chorus, Giving Voice, with other dementia patients. He has regained a long-lost ability to read music.
"Just not knowing is very disconcerting," says Mary Margaret, who is her husband's principal caregiver. "I don't know what the timeline is, but I now know what the needs are, in terms of financial and legal needs and end-of-life issues. Those all need to be planned for ahead of time, and now we have all of that in place. To me, that's a safety net."

Sunday, July 30, 2017

Dog walking could be key to ensuring activity in later life

dog

A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.
Published in the Journal of Epidemiology and Community Health, the study used data from the EPIC Norfolk cohort study, which is tracking the health and wellbeing of thousands of residents of the English county of Norfolk.

30 july 2017--The researchers from the University of East Anglia (UEA) and Centre for Diet and Activity Research (CEDAR) at the University of Cambridge found that owning or walking a dog was one of the most effective ways to beat the usual decline in later-life activity, even combatting the effects of bad weather.
Dog owners were sedentary for 30 minutes less per day, on average.
More than 3000 older-adults participating in the study were asked if they owned a dog and if they walked one. They also wore an accelerometer, a small electronic device that constantly measured their physical activity level over a seven-day period.
As bad weather and short days are known to be one of the biggest barriers to staying active outdoors, the researchers linked this data to the weather conditions experienced and sunrise and sunset times on each day of the study.
Lead author of the paper, Dr Yu-Tzu Wu, said "We know that physical activity levels decline as we age, but we're less sure about the most effective things we can do to help people maintain their activity as they get older.
"We found that dog walkers were much more physically active and spent less time sitting overall. We expected this, but when we looked at how the amount of physical activity participants undertook each day varied by weather conditions, we were really surprised at the size of the differences between those who walked dogs and the rest of the study participants."
The team found that on shorter days and those that were colder and wetter, all participants tended to be less physically active and spent more time sitting. Yet dog walkers were much less impacted by these poor conditions.
Project lead Prof Andy Jones said: "We were amazed to find that dog walkers were on average more physically active and spent less time sitting on the coldest, wettest, and darkest days than non-dog owners were on long, sunny, and warm summer days. The size of the difference we observed between these groups was much larger than we typically find for interventions such as group physical activity sessions that are often used to help people remain active."
The researchers caution against recommending everyone owns a dog, as not everyone is able to look after a pet, but they suggest these findings point to new directions for programmes to support activity.
Prof Jones said: "Physical activity interventions typically try and support people to be active by focussing on the benefits to themselves, but dog walking is also driven by the needs of the animal. Being driven by something other than our own needs might be a really potent motivator and we need to find ways of tapping into it when designing exercise interventions in the future."
'Dog ownership supports the maintenance of physical activity during poor weather in older English adults: cross-sectional results from the EPIC Norfolk cohort' is published in the Journal of Epidemiology and Community Health.

More information: Dog ownership supports the maintenance of physical activity during poor weather in older English adults: cross-sectional results from the EPIC Norfolk cohort, Journal of Epidemiology & Community Healthjech.bmj.com/lookup/doi/10.1136/jech-2017-208987


Provided by University of East Anglia