New model for predicting cardiovascular disease risk worldwide

Researchers have developed the first global model for predicting cardiovascular disease (CVD) risk. The model—developed by Harvard T.H. Chan School of Public Health, Imperial College London, and colleagues—will be of particular help to public health professionals, clinicians, and patients in developing countries for prevention of CVD.

31 mar 2015--A paper on the new CVD risk prediction method, and its application in several example countries, appears online March 26, 2015 in The Lancet Diabetes & Endocrinology.

"This new tool allows healthcare professionals around the world to make optimal clinical decisions about treatment of their patients and for health policy makers to efficiently allocate resources to CVD prevention," said Goodarz Danaei, assistant professor of global health at Harvard Chan School.

To develop the model, which will be available later this year at http://www.globorisk.org, the researchers analyzed data from more than 50,000 participants in eight existing long-term studies, which included risk factors such as blood pressure, cholesterol, diabetes, and smoking, as well as gender and age.

The researchers generated risk charts that estimated risk of fatal CVD over a span of 10 years for 11 countries in different regions of the world. The risk of fatal CVD was lowest in South Korea, Spain, Japan, and Denmark, and highest in the Czech Republic, China, Iran, and Mexico. In the former group of countries, only 5%-10% of men and women had more than a 10% risk of fatal CVD. But in China, 33% of men and 28% of women had a 10-year fatal CVD risk of 10% or higher. In Mexico the prevalence of high-risk CVD was 16% for men and 11% for women.

The researchers found that more people were at high risk of CVD in many developing countries compared with developed ones. Within developed countries, they found that the U.S. had a larger share of its population at high risk of CVD than England, Japan, South Korea, Denmark, or Spain.

The results emphasize the need to use the current momentum for universal health coverage to ensure that people at high risk of CVD in low- and middle-income countries receive the same basic treatments available to those in the high-income world, according to the authors. The U.S. results also demonstrate the urgent need for equitable access to primary health care as a tool for CVD prevention.

More information: "Globorisk - A novel risk score for predicting cardiovascular disease risk in national populations: a pooled analysis of prospective cohorts and health examination surveys," Kaveh Hajifathalian, Peter Ueda, Yuan Lu, Mark Woodward, Alireza Ahmadvand, Carlos A. Aguilar-Salinas, Fereidoun Azizi, Renata Cifkova, Mariachiara Di Cesare, Louise Eriksen, Farshad Farzadfar, Nayu Ikeda, Davood Khalili, Young-Ho Khang, Vera Lanska, Luz León-Muñoz, Dianna Magliano, Kelias P. Msyamboza, Kyungwon Oh, Fernando Rodríguez-Artalejo, Rosalba Rojaz-Martinez, Jonathan E. Shaw, Gretchen A. Stevens, Janne Tolstrup, Bin Zhou, Joshua A Salomon, Majid Ezzati, and Goodarz Danaei, Lancet Diabetes & Endocrinology, online March 26, 2015, DOI: 10.1016/S2213-8587(15)00081-9

Provided by Harvard School of Public Health

Walking after meals could save older people from a fall

Going for a walk instead of resting after eating could help to save older people from some falls caused by a sudden loss in blood pressure, according to new research.

30 mar 2015--Post-prandial hypotension is a fall in blood pressure seen within two hours of eating a meal. This health condition commonly affects older people – after a meal (usually breakfast), an older person may feel tired, dizzy or even experience a fall.

"Although this condition is common in older people, many are not aware of it," says the University of Adelaide's Professor Renuka Visvanathan, Director of the Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, and Director of Aged and Extended Care Services at The Queen Elizabeth Hospital.

"Falls among older people often result in fractures, and those who experience a fall may lose confidence as well as lose their independence. Falls can also be fatal for older people," she says.

Professor Visvanathan says researchers have been trying to better understand the reasons as to why this condition occurs, in the hopes of developing improved treatments or preventing post-prandial hypotension.

Research by University of Adelaide student Dr Shailaja Nair and University of South Australia student Ms Zoe Kopsaftis, working under the supervision of Professor Visvanathan and Dr Diana Piscitelli from the University of South Australia, has now confirmed that older people with post-prandial hypotension should be encouraged to walk intermittently at a normal pace for at least 120 minutes after a meal, as a means of reducing the fall in bloodpressure.

"This advice, coupled with other practical strategies, such as drinking a glass of water with meals, may help older people avoid the consequences of post-prandial hypotension," Professor Visvanathan says.

"Much of the research conducted to date has been undertaken in healthy older people, but this new research has involved people with a confirmed diagnosis of the condition," she says.

Provided by University of Adelaide

Ultrasound against Alzheimer's shows promise in lab animals

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

Queensland scientists have found that non-invasive ultrasound technology can be used to treat Alzheimer's disease and restore memory.

29 mar 2015--University of Queensland researchers discovered that the innovative drug-free approach breaks apart the neurotoxic amyloid plaques that result in memory loss and cognitive decline.

Welcoming the findings today at UQ's Queensland Brain Institute, Queensland Premier Annastacia Palaszczuk said they could have a wide impact for the community.

"The Government's $9 million investment into this technology was to drive discoveries into clinics, and today's announcement indicates that together with the Queensland Brain Institute, it was a worthwhile investment," Ms Palaszczuk said.

"I want my Government to encourage more of this type of innovative research.

"Our Advance Queensland initiative aims to increase research and discoveries like this and to put this state's research at the forefront internationally by supporting local researchers and helping to keep them in Queensland.

"These exciting findings will hopefully be of benefit to all Australians in the future."

QBI Founding Director Professor Perry Bartlett said the discovery – a result of 'game-changing' work performed at the Queensland Brain Institute's Clem Jones Centre for Ageing Dementia Research – was made possible through the support of the State and Federal Governments and philanthropic support led by the Clem Jones Foundation.

"The farsighted investment of government and philanthropic partners has allowed us to build the research excellence and capacity required to make major discoveries such as this," Professor Perry Bartlett said.

"I believe the work opens up an entirely novel avenue for future therapeutic treatment."

Clem Jones Centre for Ageing Dementia Research director Professor Jürgen Götz said the new treatment method could revolutionise Alzheimer's treatment by restoring memory.

"We're extremely excited by this innovation of treating Alzheimer's without using drug therapeutics," Professor Götz said.

"The ultrasound waves oscillate tremendously quickly, activating microglial cells that digest and remove the amyloid plaques that destroy brain synapses.

"The word 'breakthrough' is often mis-used, but in this case I think this really does fundamentally change our understanding of how to treat this disease, and I foresee a great future for this approach."

Alzheimer's affects more than two-thirds of dementia patients, and approximately a quarter of a million Australians.

The total number of dementia cases in Australia is expected to rise to 900,000 by 2050.

"With an ageing population placing an increasing burden on the health system, an important factor is cost, and other potential drug treatments using antibodies will be expensive," Professor Götz said.

"In contrast, this method uses relatively inexpensive ultrasound and microbubble technology which is non-invasive and appears highly effective.

The approach is able to temporarily open the blood-brain barrier, activating mechanisms that clear toxic protein clumps and restoring memory functions.

"With our approach the blood-brain barrier's opening is only temporary for a few hours, so it quickly restores its protective role," Professor Götz said.

Research has been conducted using mice with an Alzheimer's model, with the next step being to scale the research in higher animal models ahead of human clinical trials, which are at least two years away.

"This treatment restored memory function to the same level of normal healthy mice," Professor Götz said.

"We're also working on seeing whether this method clears toxic protein aggregates in neurodegenerative diseases other than Alzheimer's and whether this also restores executive functions, including decision-making and motor control."

Findings of the research, "Scanning ultrasound efficiently removes amyloid-β and restores memory in an Alzheimer's model", are published in the journal Science Translational Medicine.

More information: Scanning ultrasound removes amyloid-β and restores memory in an Alzheimer's disease mouse model, Science Translational Medicine, stm.sciencemag.org/lookup/doi/… scitranslmed.aaa2512

Provided by Queensland Brain Insitute

Researchers help create 'gold standard' method for measuring an early sign of Alzheimer's

Diagram of the brain of a person with Alzheimer's Disease. 

After six years of painstaking research, a UCLA-led team has validated the first standardized protocol for measuring one of the earliest signs of Alzheimer's disease—the atrophy of the part of the brain known as the hippocampus.

27 mar 2015--The finding marks the final step in an international consortium's successful effort to develop a unified and reliable approach to assessing signs of Alzheimer's-related neurodegeneration through structural imaging tests, a staple in the diagnosis and monitoring of the disease. The study is published in the journal Alzheimer's and Dementia.

Using brain tissue of deceased Alzheimer's disease patients, a group headed by Dr. Liana Apostolova, director of the neuroimaging laboratory at the Mary S. Easton Center for Alzheimer's Disease Research at UCLA, confirmed that the newly agreed-upon method for measuring hippocampal atrophy in structural MRI tests correlates with the pathologic changes that are known to be hallmarks of the disease—the progressive development of amyloid plaques and neurofibrillary tangles in the brain.

"This hippocampal protocol will now become the gold standard in the field, adopted by many if not all research groups across the globe in their study of Alzheimer's disease," said Apostolova, who was invited to play a key role in the consortium because of her reputation as one of the world's leading experts in hippocampal structural anatomy and atrophy. "It will serve as a powerful tool in clinical trials for measuring the efficacy of new drugs in slowing or halting disease progression."

The brain is the least accessible and most challenging organ to study in the human body; as a result, Alzheimer's disease can be diagnosed definitively only by examining brain tissue after death. In living patients, physicians diagnose Alzheimer's by evaluating other health factors, known as biomarkers, in combination with memory loss and other cognitive symptoms.

The hippocampus is a small region of the brain that is associated with memory formation, and memory loss is the earliest clinical feature of Alzheimer's disease. Its shrinkage or atrophy, as determined by a structural MRI exam, is a well-established biomarker for the disease and is commonly used in both clinical and research settings to diagnose the disease and monitor its progression.

But until now, the effectiveness of structural MRI has been limited because of the widely different approaches being used to identify the hippocampus and measure its volume—which has called into question the validity of this approach. A typical hippocampus is about 3,000 to 4,000 cubic millimeters in volume. But, Apostolova notes, two scientists analyzing the same structure can come up with a difference of as much as 2,000 cubic millimeters.

In addition, no previous study had verified whether estimates for the volume of the hippocampus using MRI corresponded to actual tissue loss.

To address these deficiencies, the European Alzheimer's Disease Consortium-Alzheimer's Disease Neuroimaging Initiative was established to develop a Harmonized Protocol for Hippocampal Segmentation, or HarP—an effort to establish a definitive method for measuring hippocampal shrinkage through structural MRI in a way that best corresponds to the Alzheimer's disease process.

Once the HarP was established, Apostolova and four other experts were invited to develop the gold standard for measuring the hippocampus to be used by anyone employing the HarP protocol. The UCLA-led team then validated the technique and ensured the changes in the hippocampus corresponded to the hallmark pathologic changes associated with Alzheimer's disease.

"The technique is meant to be used on scans of living human subjects, so it's important that we are absolutely certain that this methodology measures what it is supposed to and captures disease presence accurately," Apostolova said.

To do that, her group used a powerful 7 Tesla MRI scanner to take images of the brain specimens of 16 deceased individuals—nine who had Alzheimer's disease and seven who were cognitively normal—each for 60 hours. This provided unprecedented visualization of the hippocampal tissue, Apostolova said.

After applying the protocol to measure the hippocampal structures, the researchers analyzed the tissues for two changes that signify the disease: a buildup of amyloid tau protein and loss of neurons. The team found a significant correlation between hippocampal volume and the Alzheimer's disease indicators.

"As a result of the years of scientifically rigorous work of this consortium, hippocampal atrophy can finally be reliably and reproducibly established from structural MRI scans," Apostolova said.

Although the technique can be used immediately in research settings such as clinical trials, the next step, Apostolova noted, will be to use the standardized protocol to validate automated techniques available for measuring the hippocampus so the approach could be used more widely—including for the diagnosis of the disease in doctor's offices and other patient care settings.

Provided by University of California, Los Angeles

Study finds the role of genes is greater with living to older ages

Genes appear to play a stronger role in longevity in people living to extreme older ages, according to a study of siblings led by Boston University and Boston Medical Center (BMC) researchers.

26 mar 2015--The study, published online in the Journal of Gerontology: Biological Sciences, found that for people who live to 90 years old, the chance of their siblings also reaching age 90 is relatively small - about 1.7 times greater than for the average person born around the same time. But for people who survive to age 95, the chance of a sibling living to the same age is 3.5 times greater - and for those who live to 100, the chance of a sibling reaching the same age grows to about nine times greater.

At 105 years old, the chance that a sibling will attain the same age is 35 times greater than for people born around the same time - although the authors note that such extreme longevity among siblings is very rare.

"These much higher relative chances of survival likely reflect different and more potent genetic contributions to the rarity of survival being studied, and strongly suggest that survival to age 90 and survival to age 105 are dramatically different phenotypes or conditions, with very different underlying genetic influences," the authors conclude.

The study, led by Paola Sebastiani, PhD, professor of biostatistics at the BU School of Public Health, analyzed survival data of the families of 1,500 participants in the New England Centenarian Study, the largest study of centenarians and their family members in the world, based at BMC. Among those families, the research team looked at more than 1,900 sibling relationships that contained at least one person reaching the age of 90.

Sebastiani and co-author Thomas Perls, MD, MPH, professor of medicine at the BU School of Medicine and the centenarian study's founder and lead investigator, said the findings advance the idea that genes play "a stronger and stronger role in living to these more and more extreme ages," and that the combinations of longevity-enabling genes that help people survive to 95 years are likely different from those that help people reach the age of 105, who are about 1,000 times rarer in the population.

They said that previous studies of the determinants of survival to older ages have been clouded by researchers not being precise about what they call aging, life span, longevity, or even exceptional longevity.

"For a long time, based upon twins' studies in the 1980s and early '90s, scholars have maintained that 20 to 30 percent of longevity or even life span is due to differences in genes, and that the remainder is due to differences in environment, health-related behaviors or chance events. But the oldest twins in those studies only got to their mid- to late-80's," said Perls. "Findings from this and other studies of much older (and rarer) individuals show that genetic makeup explains an increasingly greater portion of the variation in how old people live to be, especially for ages rarer than 100 years."

Perls and Sebastiani said there is considerable inconsistency in the gerontological literature concerning definitions of aging, longevity and life span.

"The casual use of these terms leads to confusing claims regarding heredity and non-replicated genetic studies," Perls said. "Many researchers equate the term 'longevity' with 'old age,' and neither term is adequately specific."

Because genes play a much stronger differentiating role in living to 105-plus years, studies of such individuals are "much more powerful in discovering longevity-related genes than studies of people in their 90s," he said.

Sebastiani, Perls and co-authors call for investigators probing genetic influences to be precise in describing the rarity or percentile of survival that study subjects achieve.

Provided by Boston University Medical Center

Today's 75-year-olds are cognitively fitter and happier than the 75-year-olds of 20 years ago

Older adults today show higher levels of cognitive functioning and well-being than older adults of the same age 20 years ago. This has been found in a collaborative study among several research institutions in Berlin, including the Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, the Max Planck Institute for Human Development (MPIB), and the German Socio-Economic Panel (SOEP). The result will be published in the scientific journal Psychology and Aging.

25 mar 2015--For all of those who are worrying about getting old, here is some good news: Old age is getting younger. On average, today's 75-year-olds are cognitively much fitter than the 75-year-olds of 20 years ago. At the same time, the current generation of 75-year-olds also reports higher levels of well-being and greater life satisfaction. "The gains in cognitive functioning and well-being that we have measured here in Berlin are considerable and of great significance for life quality in old age," comments Ulman Lindenberger, Director of the Center for Lifespan Psychology at the Max Planck Institute for Human Development. The researchers relate the gains to sociocultural factors such as education. In their opinion, the increase in well-being is also due to better physical fitness and higher levels of independence in old age.

"However, we expect that these positive historical trends are attenuated at the end of life," adds Denis Gerstorf, Professor for Developmental Psychology at the Department of Psychology, Humboldt-Universität zu Berlin. During the final stage of life, the increase in good years of life is likely to give way to a rapid and marked drop in both cognition and well-being. Current studies by Gerstorf and colleagues examining old people's last years of life support this view.

More information: "Secular changes in late-life cognition and well-being: Towards a long bright future with a short brisk ending?" www.diw.de/documents/publikati… 97.de/diw_sp0738.pdf

Provided by Max Planck Society

The price of delirium: New study finds nearly half of patients have delirium

A new study presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that 48 percent of hip fracture patients, age 65 and older, had delirium, or acute confusion, before, during and after surgery (perioperative), resulting in significantly longer hospital stays and higher costs for care.

24 mar 2015--Approximately 300,000 Americans are hospitalized with hip fractures each year. The risk is particularly high in post-menopausal women who face an increased risk for osteoporosis, a disease that diminishes bone mass and increases fracture risk. Delirium is common among older hip fracture patients, and multiple studies have found that patients with postoperative delirium are more likely to have complications, including infections, and less likely to return to their pre-injury level of function. Delirium patients also are more frequently placed in nursing homes following surgery, and have an increased rate of mortality.

In this study, researchers at the University of Toronto sought to determine the economic implications of perioperative delirium in older orthopaedic patients by reviewing hip fracture records between January 2011 and December 2012. A total of 242 hip fracture patients with a mean age of 82 (ages 65 to 103) were studied. Demographic, clinical, surgical and adverse events data were analyzed. Perioperative delirium was assessed using the Confusion Assessment Method (CAM).The study found that 116 patients (48 percent) experienced delirium during hospital admission. The patients with delirium were significantly older (mean age 85), and were more likely to have a higher American Society of Anesthesiologists (ASA) score ("one" represents a "completely healthy fit patient," and "five," a patient not expected to live beyond 24 hours without surgery). After controlling for these differences, perioperative delirium was associated with 7.4 additional hospital days and $8,282 ($8,649 in U.S. dollars) in additional hospital costs (1.5 times the cost of patients who did not experience delirium).There were no differences in mean time between triage or admission and surgery, length of surgery, or anesthesia type between groups. A significantly greater proportion of patients who experienced perioperative delirium required long-term and/or skilled care facility admission follow their hospital stay (8 percent versus 0 percent).

"Older patients are at high risk of developing delirium during hospitalization for a hip fracture, which is associated with worse outcomes," said orthopaedic surgeon and lead study author Michael G. Zywiel, MD. "Our work demonstrates that delirium also markedly increases the cost of elderly patient care while in the hospital. Given the high number of patients hospitalized every year with a hip fracture, there is a real need to develop and fund improved interventions to prevent in-hospital delirium in these patients.

"Our research suggests that reducing the rate of delirium would simultaneously increase the quality of care while decreasing costs, presenting hospitals, surgeons and other stakeholders with promising opportunities to improve the value of hip fracture care," said Dr. Zywiel.

The American Academy of Orthopaedic Surgeons' (AAOS) new clinical practice guideline, "Management of Hip Fractures in the Elderly", makes a series of recommendations to reduce delirium in older hip fracture patients. They include:

• Preoperative regional analgesia to reduce pain.
• Hip fracture surgery within 48 hours of hospital admission.
• Intensive physical therapy following hospital discharge to improve functional outcomes.
• An osteoporosis evaluation, as well as vitamin D and calcium supplements, for patients following a hip fracture.

Provided by American Academy of Orthopaedic Surgeons

Peak cognitive skills not strictly a feature of youth, study finds

New research is changing long-held ideas of how our minds age, painting a richer picture of different cognitive skills peaking across a lifetime, with at least one—vocabulary—peaking at a time when many are considering retirement.

23 mar 2015--The study, supported by results from tens of thousands of volunteers who participated in a series of online tests, also hinted that at least some cognitive skills are plastic and that their decline can be delayed by changes in education, environment, or lifestyle. Researchers' analysis of existing tests from different decades showed vocabulary skills peaking later and later in life, a trend they ascribe in part to improvements in education and the rise of white-collar jobs.

"What we're seeing is that, across adulthood, some things 'age' in the sense that processing speed does go down," said co-author Laura Germine, a research associate in Harvard's Psychology Department and a postdoctoral fellow at Harvard-affiliated Massachusetts General Hospital. "But other things are doing something very different from what is implied by the word 'aging.' They're maturing, they're getting refined over time. For the everyday person, the word 'aging' implies a breakdown of things. 'Ripening' might be better."

Germine conducted the research with Joshua Hartshorne, a postdoctoral fellow at the Massachusetts Institute of Technology. Published this month in the journal Psychological Science, it presents the results of a fine-grained analysis enabled by the many volunteers—more than 48,000—who went to www.testmybrain.org and www.gameswithwords.org and took a series of game-like tests that measured an array of cognitive skills, including brain processing speed, memory, emotional cognition, and so-called "crystalized intelligence," the application of learned knowledge such as vocabulary and arithmetic.

The results present a much more nuanced picture of changes in cognitive skills over a lifetime than that provided by current theoretical frameworks, Germine said. It has traditionally been believed that many cognitive skills peak early—late teens and 20s—and decline with age, with crystallized intelligence, thought to peak in the 40s, being the exception.

The view that there is a broad decline in most cognitive skills likely emerged due to limitations in the population that can be easily tested for studies on aging, Germine said. Because most adults are busy working and raising families, they have little time to come to a lab and participate in experiments. Instead, she said, such tests are most often taken by college students and by retirees, giving psychologists a good view of the two ends of the lifespan but much less data about what goes on in between.

"Regular old adults have been some of the hardest participants to get for this kind of research," Germine said.

The Web-based tests used by Germine and Hartshorne (who runs gameswithwords.org) are different because they can be done from any computer and take just a few minutes, making them more accessible to working adults. The trick in designing such tests, Germine said, is to make them engaging so that participants feel rewarded enough to take a second test, or to tell others.

The two began working together as Ph.D. students at Harvard after Germine published results from online testing in 2011 showing that the ability to recognize and remember faces peaks between ages 30 and 34, later than was thought. Hartshorne approached Germine because work he was doing on a different aspect of memory also showed a later peak than the accepted average.

Because Hartshorne too had gathered his data through Web-based experiments, the pair worried they were measuring some quirk of people in their late 20s and early 30s who used the Internet. So they obtained the results of older, paper-based tests of intelligence and memory, broke down the data, and reanalyzed it to see if it revealed the same unexpected peaks as the Web findings. To their relief, it did.

The pair then continued with the study released this month, which shows a series of cognitive peaks through life. Peak mental processing speed occurs, as expected, in late teens and early 20s and declines relatively rapidly afterward. But other skills peak at different times. Working memory climbs in the late 20s to early 30s, and then declines only slowly over time. Social cognition, the ability to detect others' emotions, peaks even later—in the 40s to age 50—and doesn't start to significantly decline until after 60.

"That fits with absolutely no theoretical framework that we currently have," Germine said.

Crystalized intelligence, measured as vocabulary skills, didn't have a peak. Instead, it continued to improve as respondents aged, until 65 to 70. The result was so startling, it sent Germine and Hartshorne back again to paper tests—this time the large-scale General Social Survey. Their first look at the GSS indicated that vocabulary skills peaked decades earlier than in their study, from 45 to 50. But before dismissing their own results, the researchers decided to break down the GSS by decade.

From 1974 through 1987, they found, vocabulary skills peaked in the early 40s. From 1988 through 1997, they peaked at around 50, and from 1998 to 2012, they peaked at 65, matching their data.

Germine attributed the change in vocabulary skills over time to broader changes in society, including an increased emphasis on education, both early in life and lifelong; the rise of white-collar jobs that require more reading and writing; and to a general improvement in nutrition and physical well-being, factors that support cognitive health.

Baby boomers "are the most educated generation of all generations that have ever retired," Germine said.

Though the research enriches scientific understanding of changes in cognition, in many ways it only confirms what people in their homes, schools, and workplaces already know, Germine said.

"A lot of people have this intuition that one matures as one gets older. It's not just because there's more information in the brain, there's lots of other things, too. As we get older, we get better at solving certain kinds of problems, though we may not have the quickness of our 20s. It's a rich process of change. … In a lot of ways, our results are surprising from a theoretical standpoint, but they also kind of really make sense."

Provided by Harvard University

New assessment tool helps predict risk of cognitive decline

22 mar 2015—A new assessment tool may be able to predict risk of mild cognitive impairment (MCI) in older adults, according to a study published online March 18 in Neurology.

V. Shane Pankratz, Ph.D., from the University of New Mexico Health Sciences Center in Albuquerque, and colleagues developed risk scores to predict risk of MCI. Baseline demographic and clinical variables from participants (aged 70 to 89 years at baseline in October 2004) in a longitudinal cohort were used to inform the risk models.

The researchers found that 401 of the 1,449 cognitively normal participants developed MCI (27.7 percent). An augmented model improved the C statistic of the basic model from 0.60 (0.58 for women and 0.62 for men) to 0.70 (0.69 for women and 0.71 for men). In the augmented model, the highest versus lowest sex-specific quartiles had an approximately seven-fold higher risk of developing MCI for both men and women. Inclusion of APOE ε4 carrier status significantly improved the model (P = 0.002).

"These models may be useful in identifying patients who might benefit from more expensive or invasive diagnostic testing, and can inform clinical trial design," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

More information: Abstract
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New mobile app will find dementia friendly places

A 'TripAdvisor'-style app is being launched which allows carers to locate and rate dementia-friendly places so they are better able to get out and about with their loved-ones.
Triggered by Dr Katie Brittain, a Lecturer in Social Gerontology at Newcastle University, the Dementia Friendly Places project is one of the first to use the App Movement platform to collectively develop an app that meets a community need.

21 mar 2015--'App Movement' turns computer programming on its head by allowing an idea or a 'need' to drive the development of an app rather than the other way around.  And unlike most apps which gradually gather a groundswell of support after they are launched, App Movement needs the support first in order to get the project off the ground, much like the established crowdfunding platforms, such as Kick Starter.

The 'Dementia Friendly Places' app will be used to rate cafes, restaurants, shops and other public places anywhere in the world and the things that will be rated and seen as important will be chosen by the people who support the app.

Katie said: "Much research and policy has focused on places that are indoors, for example a person's home or a care home, and yet the outdoors has huge health and social benefits to the person enjoying them. 

"So I asked the question how can we design or shape outside places, such as our cities or our neighbourhoods, to support people with dementia to continue to use and enjoy them?  The app is a really good way of gathering information from the community – asking people to feed in the breadth of knowledge and advice that is out there so that we can all share it and make use of it."

Dr Brittain was inspired to start the movement to help her 95-year old grandmother who is living with dementia. Through the app, she is hoping to create a listing of places that are 'dementia friendly', the places people with dementia and their carers enjoy to go, outside or inside. 

Her idea was an instant success with the App Movement community, and within 24 hours of the app idea submission, Dementia Friendly Places reached over 100% support from the public and was ready to enter the next phase of development.

Sandra Hastings, Director of Silverline Memories, launched The Silverline Cafe last May to coincide with Dementia Awareness Week.  The Silverline Cafe offers a weekly session for people living with Dementia and their loved ones to come along for a cuppa and a take part in a range of activities to share in.  Sandra said of the app: "This is a really positive development for people living with Dementia and will go a long way to address the issues of social isolation and isolation so commonly experienced by people living with Dementia".

Dr Lynne Corner, Director of Engagement, FMS Newcastle University and Chair, NE Dementia Action Alliance, said: "This is a fabulous idea. People with dementia can be very isolated and anxious, and lose confidence about going out. Carers especially need help to find places they can go where they know people will be understand dementia and be helpful and supportive.  

"This app will really help people living with dementia to find such places in their communities, and therefore continue to enjoy activities and interests which many of us take for granted, but which make a huge difference to our well-being and quality of life."

"There's nothing out there like this at the moment but the huge support for the Dementia Friendly Places app just shows there's a real need for it," said Katie.

"Many of us wouldn't know where to start when it comes to developing an app but that doesn't mean we don't have a good idea for one."

Provided by Newcastle University

Diet soda linked to increases in belly fat in older adults

19 mar 2015--A new study published in the Journal of the American Geriatrics Society shows that increasing diet soda intake is directly linked to greater abdominal obesity in adults 65 years of age and older. Findings raise concerns about the safety of chronic diet soda consumption, which may increase belly fat and contribute to greater risk of metabolic syndrome and cardiovascular diseases.

Metabolic syndrome—a combination of risk factors that may lead to high blood pressure, diabetes, heart disease, and stroke—is one of the results of the obesity epidemic. In fact, the World Health Organization (WHO) estimates that 1.9 billion adults were overweight (body mass index [BMI] of 25 or more) in 2014. Of this group, 600 million people fell into the obese range (BMI of 30 or more)—a figure that has more than doubled since 1980.

In an effort to combat obesity, many adults try to reduce sugar intake by turning to nonnutritive or artificial sweeteners, such as aspartame, saccharin, or sucralose. Previous research shows that in the past 30 years, artificial sweeteners and diet soda intake have increased, yet the prevalence of obesity has also seen a dramatic increase in the same time period. Many of the studies exploring diet soda consumption and cardiometabolic diseases have focused on middle-aged and younger adults.

"Our study seeks to fill the age gap by exploring the adverse health effects of diet soda intake in individuals 65 years of age and older," explains lead author Sharon Fowler, MPH, from the University of Texas Health Science Center at San Antonio. "The burden of metabolic syndrome and cardiovascular disease, along with healthcare costs, is great in the ever-increasing senior population."

The San Antonio Longitudinal Study of Aging (SALSA) enrolled 749 Mexican- and European-Americans who were aged 65 and older at the start of the study (1992-96). Diet soda intake, waist circumference, height, and weight were measured at study onset, and at three follow-ups in 2000-01, 2001-03, and 2003-04, for a total of 9.4 follow-up years. At the first follow-up there were 474 (79.1%) surviving participants; there were 413 (73.4%) at the second follow-up and 375 (71.0%) at the third follow-up.

Findings indicate that the increase in waist circumference among diet soda drinkers, per follow-up interval, was almost triple that among non-users: 2.11 cm versus 0.77 cm, respectively. After adjustment for multiple potential confounders, interval waist circumference increases were 0.77 cm for non-users, 1.76 cm for occasional users, and 3.04 cm for daily users. This translates to waist circumference increases of 0.80 inches for non-users, 1.83 inches for occasional users, and 3.16 inches for daily users over the total 9.4-year SALSA follow-up period.

"The SALSA study shows that increasing diet soda intake was associated with escalating abdominal obesity, which may increase cardiometabolic risk in older adults," Fowler concludes. The authors recommend that older individuals who drink diet soda daily, particularly those at high cardiometabolic risk, should try to curb their consumption of artificially sweetened drinks.

More information: "Diet Soda Intake Is Associated with Long-Term Increases in Waist Circumference in a Biethnic Cohort of Older Adults: The San Antonio Longitudinal Study of Aging." Sharon P.G. Fowler, Ken Williams and Helen P. Hazuda.Journal of the American Geriatrics Society; Published Online: March 17, 2015 .DOI: 10.1111/jgs.13376)

Provided by Wiley

New MIND diet may significantly protect against Alzheimer's disease

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

18mar 2015--A new diet, appropriately known by the acronym MIND, could significantly lower a person's risk of developing Alzheimer's disease, even if the diet is not meticulously followed, according to a paper published online for subscribers in March in the journal Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Rush nutritional epidemiologist Martha Clare Morris, PhD, and colleagues developed the "Mediterranean-DASH Intervention for Neurodegenerative Delay" (MIND) diet. The study shows that the MIND diet lowered the risk of AD by as much as 53 percent in participants who adhered to the diet rigorously, and by about 35 percent in those who followed it moderately well.

"One of the more exciting things about this is that people who adhered even moderately to the MIND diet had a reduction in their risk for AD," said Morris, a Rush professor, assistant provost for Community Research, and director of Nutrition and Nutritional Epidemiology. "I think that will motivate people."

Morris and her colleagues developed the MIND diet based on information that has accrued from years' worth of past research about what foods and nutrients have good, and bad, effects on the functioning of the brain over time. This is the first study to relate the MIND diet to Alzheimer's disease.

"I was so very pleased to see the outcome we got from the new diet," she said.

The MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, both of which have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke. Some researchers have found that the two older diets provide protection against dementia as well.

In the latest study, the MIND diet was compared with the two other diets. People with high adherence to the DASH and Mediterranean diets also had reductions in AD—39 percent with the DASH diet and 54 percent with the Mediterranean diet—but got negligible benefits from moderate adherence to either of the two other diets.

The MIND diet is also easier to follow than, say, the Mediterranean diet, which calls for daily consumption of fish and 3-4 daily servings of each of fruits and vegetables, Morris said.

The MIND diet has 15 dietary components, including 10 "brain-healthy food groups"—green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine—and five unhealthy groups that comprise red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

With the MIND diet, a person who eats at least three servings of whole grains, a salad and one other vegetable every day—along with a glass of wine—snacks most days on nuts, has beans every other day or so, eats poultry and berries at least twice a week and fish at least once a week and benefit. However, he or she must limits intake of the designated unhealthy foods, especially butter (less than 1 tablespoon a day), cheese, and fried or fast food (less than a serving a week for any of the three), to have a real shot at avoiding the devastating effects of AD, according to the study.

Berries are the only fruit specifically to make the MIND diet. "Blueberries are one of the more potent foods in terms of protecting the brain," Morris said, and strawberries have also performed well in past studies of the effect of food on cognitive function.

The MIND diet was not an intervention in this study, however; researchers looked at what people were already eating. Participants earned points if they ate brain-healthy foods frequently and avoided unhealthy foods. The one exception was that participants got one point if they said olive oil was the primary oil used in their homes.

The study enlisted volunteers already participating in the ongoing Rush Memory and Aging Project (MAP), which began in 1997 among residents of Chicago-area retirement communities and senior public housing complexes. An optional "food frequency questionnaire" was added from 2004 to February 2013, and the MIND diet study looked at results for 923 volunteers. A total of 144 cases of AD developed in this cohort.

AD, which takes a devastating toll on cognitive function, is not unlike heart disease in that there appear to be "many factors that play into who gets the disease," including behavioral, environmental and genetic components, Dr. Morris said.

"With late-onset AD, with that older group of people, genetic risk factors are a small piece of the picture," she said. Past studies have yielded evidence that suggests that what we eat may play a significant role in determining who gets AD and who doesn't, Morris said.

When the researchers in the new study left out of the analyses those participants who changed their diets somewhere along the line—say, on a doctor's orders after a stroke—they found that "the association became stronger between the MIND diet and [favorable] outcomes" in terms of AD, Morris said. "That probably means that people who eat this diet consistently over the years get the best protection."

In other words, it looks like the longer a person eats the MIND diet, the less risk that person will have of developing AD, Morris said. As is the case with many health-related habits, including physical exercise, she said, "You'll be healthier if you've been doing the right thing for a long time."

Morris said, "We devised a diet and it worked in this Chicago study. The results need to be confirmed by other investigators in different populations and also through randomized trials." That is the best way to establish a cause-and-effect relationship between the MIND diet and reductions in the incidence of Alzheimer's disease, she said.

Provided by Rush University Medical Center

The 10-point guide to the integral management of menopausal health

Elsevier journal Maturitas, today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) covering the ten- point guide to the integral management of menopausal health. This has been written to mark the 10th EMAS Congress in Madrid May 20-22, 2015.

17 mar 2015--With increased longevity and more women becoming centenarians, management of the menopause and post-reproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalized. The position statement provides a short integral guide for all those involved in menopausal health.

For most women the menopause is a natural and inevitable process due to ovarian ageing which usually occurs in women in their late 40s or early 50s. However, it can be induced earlier by medical intervention such as bilateral oophorectomy or iatrogenic ablation of ovarian function by chemotherapy, radiotherapy or treatment with gonadotrophin-releasing hormone analogues. Discussions with patients about the menopause are becoming more complex because of the wide range of therapeutic options, the controversies regarding menopausal hormone therapy and the increasing use of alternative and complementary therapies.

EMAS is therefore producing a simple ten point guide to help physicians and allied health professionals from all specialties deal with menopausal and post-reproductive health. It covers diagnosis, screening for diseases in later life, treatment and follow up.

It must be remembered that women have individual needs and the approach needs to be personalized.

These and other recommendations presented in EMAS' position statement are published in the article: "EMAS Position statement: the ten point guide to the integral management of menopausal health" (doi:10.1016/j.maturitas.2015.02.003) inMaturitas published by Elsevier.

Provided by Elsevier

Healthy eating, exercise, and brain-training

A comprehensive programme providing older people at risk of dementia with healthy eating guidance, exercise, brain training, and management of metabolic and vascular risk factors appears to slow down cognitive decline, according to the first ever randomised controlled trial of its kind, published in The Lancet.

16 mar 2015--In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, researchers led by Professor Miia Kivipelto from the Karolinska Institutet in Stockholm, Sweden, National Institute for Health and Welfare in Helsinki, and University of Eastern Finland, assessed the effects on brain function of a comprehensive intervention aimed at addressing some of the most important risk factors for age-related dementia, such as high body-mass index and heart health.

1260 people from across Finland, aged 60-77 years, were included in the study, with half randomly allocated to the intervention group, and half allocated to a control group, who received regular health advice only. All of the study participants were deemed to be at risk of dementia, based on standardised test scores.

The intensive intervention consisted of regular meetings over two years with physicians, nurses, and other health professionals, with participants given comprehensive advice on maintaining a healthy diet, exercise programmes including both muscle and cardiovascular training, brain training exercises, and management of metabolic and vascular risk factors through regular blood tests, and other means.

After two years, study participants' mental function was scored using a standard test, the Neuropsychological Test Battery (NTB), where a higher score corresponds to better mental functioning. Overall test scores in the intervention group were 25% higher than in the control group. For some parts of the test, the difference between groups was even more striking—for executive functioning (the brain's ability to organise and regulate thought processes) scores were 83% higher in theintervention group, and processing speed was 150% higher. Based on a pre-specified analysis, the intervention appeared to have no effect on patients' memory. However, based on post-hoc analyses, there was a difference in memory scores between the intervention and control groups.

According to Professor Kivipelto, "Much previous research has shown that there are links between cognitive decline in older people and factors such as diet, heart health, and fitness. However, our study is the first large randomised controlled trial to show that an intensive programme aimed at addressing these risk factors might be able to prevent cognitive decline in elderly people who are at risk of dementia."

The study participants will now be followed for at least seven years to determine whether the diminished cognitive decline seen in this trial is followed by reduced levels of dementia and Alzheimer's diagnoses. The researchers will also be investigating possible mechanisms whereby the intervention might affect brain function.

More information: The Lancet, www.thelancet.com/journals/lan… (15)60461-5/abstract

Provided by Lancet

'Perfect storm' of stress, depression may raise risk of death, heart attack for heart patients

The combination of stress and heavy depression can significantly increase heart patient's risk of death or heart attack, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

15 mar 2015--The study examined the effect of high stress levels and high depressive symptoms among nearly 5,000 heart patients. Researchers concluded that risk is amplified when both conditions are present, thus validating the concept of a "psychosocial perfect storm."

"The increase in risk accompanying high stress and high depressive symptoms was robust and consistent across demographics, medical history, medication use and health risk behaviors," said Carmela Alcántara, Ph.D., lead author of the study and associate research scientist at Columbia University Medical Center for Behavioral Cardiovascular Health in New York.

Study participants included 4,487 coronary heart disease patients, 45 years and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

During in-home examinations and self-administered questionnaires from 2003-07, participants were asked how often during the past week they felt depressed, lonely or sad, or had crying spells. To determine stress levels, participants were asked how often during the past month they felt they were unable to control important things in their lives, felt overwhelmed, felt confidence in their ability to handle personal problems and felt things were going their way.

About 6 percent reported both high stress and high depression.

During an average six-year follow-up, 1,337 deaths or heart attacks occurred. Short-term risk of death or heart attack increased 48 percent for those in the high stress-high depressive symptoms group compared with those in the low stress-low depressive symptoms group.

The elevated risk was most strongly associated with death rather than heart attack; additional result suggest the deaths may have been cardiovascular-related, but more research is needed, researchers said. The risk was significant only during the first two-and-half years from the initial home visit, and wasn't significant for those experiencing either high stress or high depressive symptoms alone, but not both at the same time.

Study findings may challenge traditional research paradigms that only focus on depression and its impact on patients with heart disease, Alcántara said. Behavioral interventions also should be considered to help heart disease patients manage both stress and depression better.

Provided by American Heart Association

Exercise may help keep seniors moving longer despite old age brain decline

Credit: Peter Griffin/public domain

13 mar 2015--Older people who are physically active may be protecting themselves from the effects of small areas of brain damage that can affect their movement abilities, according to a new study published in the March 11, 2015, online issue of Neurology, the medical journal of the American Academy of Neurology.

Many older people have small areas of damage in their brains seen on magnetic resonance imaging (MRI) as white matter hyperintensities. Higher levels of this damage have been linked to more problems with movement, such as difficulty walking. But this new study found that people who were the most physically active did not have a drop-off in their movement abilities, even when they had high levels of brain damage.

"These results underscore the importance of efforts to encourage a more active lifestyle in older people to prevent movement problems, which is a major public health challenge," said study author Debra A. Fleischman, PhD, of Rush University Medical Center in Chicago. "Physical activity may create a 'reserve' that protects motor abilities against the effects of age-related brain damage."

The study involved 167 people with an average age of 80. The participants wore movement monitors on their wrists for up to 11 days to measure both exercise and non-exercise activity. They also took 11 tests of their movement abilities. MRI scans were used to determine the volume of white matter hyperintensities in the brain.

Compared to those at the 50th percent in activity level measured using the movement monitors, those in the top 10 percent had activity equal to walking at 2.5 mph for an additional 1.5 hours each day.

For the people in the top 10 percent, having greater amounts of brain damage did not change their scores on the movement tests. But for those at the 50th percent activity level, having greater amounts of brain damage was associated with significantly lower scores on the movement tests. For all the participants, the average score on the movement tests was 1.04. For people at the 50th percent activity level, scores ranged from 1.16 for those with the lowest amount of brain damage to 0.9 for those with the highest amount of brain damage. The detrimental effect was even stronger for those with the lowest levels of physical activity.

The results remained the same after researchers adjusted for other factors that could affect the relationship, such as body mass index (BMI), depression and vascular disease.

Fleischman noted that the study does not determine whether physical activity causes people to preserve their movement abilities; it only shows the association.

Provided by American Academy of Neurology

GPS technology provides peace of mind for families coping with dementia

Allison Warman wears a GPS device that tracks her movements to help her from getting lost during her regular walks through her Calgary neighbourhood. Warman is a participant in the Locator Device Project, a partnership between the U of A and AHS, that uses GPS technology to help families affected by dementia. Credit: Lyle Aspinall

13 mar 2015--It was a phone call that changed everything. Two years ago, while Allison Warman was driving from Edmonton to her house in Calgary, she became confused and disoriented to the point that she couldn't remember the way home.

She pulled over at the halfway point, in Red Deer, and called her husband Tim, who dropped everything to pick her up. It was the first warning sign something was wrong cognitively, a diagnosis that was later confirmed as dementia.

At just 53 years old, Allison—an active, vibrant mother of three and accomplished costume designer whose creations have been worn by figure skating champions Kurt Browning and  Kristi Yamaguchi, and the Alberta Ballet—is increasingly housebound, unable to work, drive or even read anything longer than a headline.

"It's been devastating to watch this happen to such an energetic and talented and creative person—she's always been an active person, doing things for people she loves—to have all that taken away from you is brutal," Tim says.

Not everything has been taken. Walking remains one of Allison's true passions, keeping her body and mind refreshed. But the risk of wandering or getting lost is a real concern for people with dementia.

Locator device project

Fortunately for Allison, Tim and the couple's teenaged children, she can continue going on her daily outings without fear, thanks to SafeTracks GPS technology in a phone-like device she wears around her neck. The device, and others like it worn in a shoe or as a watch, provide real-time location information viewable on Google Maps and can send text messages or emails to family if Allison veers outside a designated safe zone.

The device was given to Allison when she joined the Locator Device Project, a 12-month trial to evaluate GPS technology in preventing people with cognitive impairments from getting lost or wandering. The project is a partnership between the University of Alberta's Faculty of Rehabilitation Medicine and Alberta Health Services, with 40 participants from Calgary and Grande Prairie.

Allison Warman with a sample of her figure skating costume designs. Credit: Lyle Aspinall

"The technology provides peace of mind for families," says Lili Liu, lead researcher, professor and chair of the Department of Occupational Therapy. "Even if there is an accident or an incident, knowing that their loved one has a GPS device helps family members feel more at peace."

More than 40,000 Albertans have dementia of some form, and about three out of every five seniors with dementia living in the community experience wandering. The number of Alberta seniors with dementia is expected to exceed 100,000 by 2038.

"We have a responsibility to provide Albertans who are at risk with supports that will enable them to enjoy their independence without coming to harm," says Don Juzwishin, director of health technology assessment and innovation for AHS. "And we believe the locator project, which uses sophisticated GPS technology, will also support family caregivers and emergency responders to assist dementia clients who have wandered or become lost."

Liu's team, which includes several graduate students based in the Department of Occupational Therapy's satellite site in Calgary, has visited the homes of families participating in the project, answering questions and offering support. The data they're collecting are still being analyzed, but could be used to inform technology options for home-care clients and families.

To her knowledge, this is the first study of its kind in Canada, says Liu, and one she wants to eventually expand to a national level.

For the Warman family, participating in the study and using the technology has afforded Allison a precious sense of dignity.

"The best thing that has happened to her is being able to go out on her own and still be safe," says Tim, who believes the technology could benefit other individuals and families coping with dementia. "It contributes to her emotional well-being, just knowing that she is safe. It's empowering. It's just a wonderful thing."

Provided by University of Alberta

Healthy eating, exercise, and brain-training

A comprehensive programme providing older people at risk of dementia with healthy eating guidance, exercise, brain training, and management of metabolic and vascular risk factors appears to slow down cognitive decline, according to the first ever randomised controlled trial of its kind, published in The Lancet.

12 mar 2015--In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, researchers led by Professor Miia Kivipelto from the Karolinska Institutet in Stockholm, Sweden, National Institute for Health and Welfare in Helsinki, and University of Eastern Finland, assessed the effects on brain function of a comprehensive intervention aimed at addressing some of the most important risk factors for age-related dementia, such as high body-mass index and heart health.

1260 people from across Finland, aged 60-77 years, were included in the study, with half randomly allocated to the intervention group, and half allocated to a control group, who received regular health advice only. All of the study participants were deemed to be at risk of dementia, based on standardised test scores.

The intensive intervention consisted of regular meetings over two years with physicians, nurses, and other health professionals, with participants given comprehensive advice on maintaining a healthy diet, exercise programmes including both muscle and cardiovascular training, brain training exercises, and management of metabolic and vascular risk factors through regular blood tests, and other means.

After two years, study participants' mental function was scored using a standard test, the Neuropsychological Test Battery (NTB), where a higher score corresponds to better mental functioning. Overall test scores in the intervention group were 25% higher than in the control group. For some parts of the test, the difference between groups was even more striking—for executive functioning (the brain's ability to organise and regulate thought processes) scores were 83% higher in theintervention group, and processing speed was 150% higher. Based on a pre-specified analysis, the intervention appeared to have no effect on patients' memory. However, based on post-hoc analyses, there was a difference in memory scores between the intervention and control groups.

According to Professor Kivipelto, "Much previous research has shown that there are links between cognitive decline in older people and factors such as diet, heart health, and fitness. However, our study is the first large randomised controlled trial to show that an intensive programme aimed at addressing these risk factors might be able to prevent cognitive decline in elderly people who are at risk of dementia."

The study participants will now be followed for at least seven years to determine whether the diminished cognitive decline seen in this trial is followed by reduced levels of dementia and Alzheimer's diagnoses. The researchers will also be investigating possible mechanisms whereby the intervention might affect brain function.

More information: The Lancet, www.thelancet.com/journals/lan… (15)60461-5/abstract

Provided by Lancet