Wednesday, June 29, 2016

Delirium at nursing home admission a risky sign for seniors

Delirium at nursing home admission a risky sign for seniors
Seniors with delirium who enter the nursing home after hospitalization are at greater risk than patients who make that transition without the condition, according to new research. Credit: Graphicstock
Brown University public health researchers who analyzed the medical records of more than 5.5 million seniors admitted to nursing homes between 2011 and 2014 found that approximately 240,000 had delirium. Those patients faced serious additional health risks compared to those without the condition.

29 jun 2016--"Upon admission to post-acute care, there are at least 4 percent of patients who have delirium," said Cyrus Kosar, a graduate student who led the research and presented the results June 25 at the AcademyHealth Annual Research Meeting in Boston. "We should make an effort to improve care for these specific patients since they are high risk."
The research was selected as one of the best student abstracts in AcademyHealth's Long Term Services and Supports Interest Group. The honor includes a $550 award as well as a one year AcademyHealth student membership.
Delirium is sometimes misunderstood, even among health care providers. Often observed among hospitalized patients – particularly older ones – it's an acute decline in cognitive functioning that may appear to come and go, sometimes within matters of hours. It's not chronic, which is a key distinction from dementia, a long-term, progressive, terminal degeneration of brain function.
Delirium may result from severe illnesses such as lingering infections, dehydration, sedation, or an improper blending or administration of medications.
"Delirium essentially is a good signal of a sicker patient or for a patient who is not getting the care that they need," said Kosar, who worked with Vince Mor and Kali Thomas professor and research assistant professor respectively of health services, policy and practice in the School of Public Health.
Other researchers have found that health outcomes among patients with delirium are worse while they are in the hospital than for people without delirium. In this case, Kosar and Thomas wanted to look into the impact of delirium on post-acute care outcomes, which has rarely been studied.
"There is a good chance that the patients who are admitted to post-acute care with delirium came from acute care with delirium, so we might be capturing a group of patients with unresolved delirium," Kosar said.
Kosar, Thomas and Mor performed their analysis by looking in the Minimum Data Set 3.0, a national dataset of nursing home care that recently began requiring structured assessments of delirium. To compile the records, nursing home personnel measured a variety of demographic and health characteristics in incoming patients, including delirium using the standard Confusion Assessment Method. In all, their sample included 5.58 million patients aged 65 or older admitted to nursing homes for post-acute care.
Of all the patients, more than 1.1 million had dementia, but even after a statistical accounting for that form of cognitive decline and other health problems (as well as age, gender and other factors) the patients with delirium faced greater health risks.
The mortality rate after 30 days was 16 percent among those with delirium compared to 6 percent (a statistically adjusted 2.3 times greater risk). The risk of readmission to the hospital within a month was also higher: 21 percent for seniors with delirium vs. 15 percent among those without (a 1.4 times risk). Among those delirium patients who went home after the nursing home admission, their rate of functional recovery (a decrease in dependency for daily living activities as measured by a standard scale) was lower: 49 percent vs. 60 percent (a statistically adjusted 17 percent lower chance).
The results can help nursing home care providers become aware that a significant number of their patients likely arrive with delirium and that the stakes for those patients are especially high, the researchers said. Identifying and addressing it could save lives and spare patients (and their insurers) from unnecessary readmissions to the hospital.
"I do believe there are patients we can target to address their delirium more effectively," Kosar said. "There are going to be times when we can address the issues."

Provided by Brown University

Tuesday, June 28, 2016

Antidepressant does not reduce hospitalization, death for HF patients with depression

In a study appearing in the June 28 issue of JAMA, Christiane E. Angermann, M.D., of University Hospital Wurzburg, Germany, and colleagues examined whether 24 months of treatment with the antidepressant escitalopram would improve mortality, illness, and mood in patients with chronic heart failure and depression.

28 jun 2016--Previous meta-analysis indicates that depression prevalence in patients with heart failure is 10 percent to 40 percent, depending on disease severity. Depression has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing in parallel with depression severity. Long-term efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression, is unknown for patients with heart failure and depression.
For this study, 372 patients with chronic heart failure with reduced ejection fraction (a measure of heart function) and depression were randomly assigned to receive escitalopram or matching placebo in addition to optimal heart failure therapy. During a median participation time of 18.4 months (n = 185) for the escitalopram group and 18.7 months (n = 187) for the placebo group, the primary outcome of death or hospitalization occurred in 116 (63 percent) patients and 119 (64 percent) patients, respectively. There was no significant improvement on a measure of depression for patients in the escitalopram group.
"These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression," the authors write.

More information: JAMADOI: 10.1001/jama.2016.7207

Provided by The JAMA Network Journals

Sunday, June 26, 2016

New study helps determine which older adults might need help taking medications

As age increases, older adults can develop problems taking their medications. But until now, few studies have examined the traits that might cause elders to need help with their medications, or how widespread a problem this might be.

26 jun 2016--In a study published in the Journal of the American Geriatrics Society, researchers investigated this issue using data from the 10-year Duke EPESE study. They examined data from 4,106 African American and white older adults living in five counties in North Carolina.
The researchers asked the participants the question, "Are you able to take your medicine without help (in the right doses at the right time)?" The participants' health conditions included: poor vision, poor hearing, or having been diagnosed with stroke, diabetes, hypertension (also known as high blood pressure), heart attack, or cancer (except skin cancer).
The researchers also tested the participants' mental abilities and reviewed their medication containers to learn how many prescription and over-the-counter medications they took.
At the beginning of the study, 7.1 percent of participants needed help taking their medications. Three years later, 11 percent needed help who did not need help at the beginning of the study. Predictors of a new need for medication help were similar to those seen at the beginning of the study:
  • Being 75-years-old or older
  • Being male
  • Having memory problems
  • Having problems performing activities of daily living
The researchers reported that people aged 80 and older were 1.5 to 3 times as likely to need help with their medications than were people aged 65 to 69.
Men were 1.5 to 2 times as likely as women to need help. The odds of needing help were 3 to 5 times greater among people with memory challenges.
"Health conditions may worsen or not improve if older adults skip or don't take their medications properly," said Brenda D. Jamerson, PharmD, Center on Biobehavioral Health Disparities Research at Duke University. "Serious side effects may also occur from taking medications at the wrong time or in the wrong dose. Some older adults can put themselves at risk for experiencing problems if they don't receive the assistance they may need," added Dr. Jamerson.
The researchers noted their study helped identify which characteristics make it more likely that an older adult will need help taking his or her medication.

More information: Brenda D. Jamerson et al, A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale,Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14166

Provided by American Geriatrics Society

Saturday, June 25, 2016

Some older adults live well, despite advancing years and the burdens of chronic diseases

You might believe that older adults who deal with extensive chronic illnesses or serious diseases would be more likely to be frail and to have a poorer quality of life than healthier older adults. That may be true for some elders—but not for all. Researchers writing in the Journal of the American Geriatrics Society suggest that an undefined coping mechanism of some sort may play a role in how well older adults are able to live despite having burdensome illnesses.

25 jun 2016--The researchers examined three groups of participants enrolled in the Cardiovascular Health Study, a large research project that examined adults 65-years-old and older from four cities around the country.
Researchers assigned people to one of three groups, based on the extent of their disease and their level of vigor or frailty:
1. The expected agers (3,528 people) had higher disease but also higher frailty levels. They spent 47 percent of the remainder of their lives able and healthy.
2. The adapters (882 people) had higher disease levels as well as relatively high vigor (being active and mobile) levels. They spent 55 percent of the reminder of their lives able and healthy.
3. The prematurely frail (885 people) had lower disease levels but higher frailty levels. They spent 37 percent of their remaining lives able and healthy.
The researchers said "adapter" older adults who were more vigorous than expected, based on their disease burden, lived longer lives when compared to those who were more frail than expected based on their disease burden. These "adapters" could have unique characteristics, perhaps some undefined coping mechanism, that should be studied further, suggested the researchers.

More information: Jason L. Sanders et al, Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14163

Provided by American Geriatrics Society

Friday, June 24, 2016

Diabetes raises risk of heart attack death by 50 percent

Diabetes raises risk of heart attack death by 50 percent
Having diabetes increases the risk of dying from the effects of a heart attack by around 50 per cent, a University of Leeds study has found.
Researchers in the School of Medicine tracked 700,000 people who had been admitted to hospital with a heart attack between January 2003 and June 2013.
Of these, 121,000 had diabetes.

24 jun 2016--After stripping out the effects of age,sex, any other illnesses and differences in the emergency medical treatment received, the team found stark differences in survival rates.
People with diabetes were 56 per cent more likely to have died if they had experienced a ST elevation myocardial infarction (STEMI) heart attack – in which the coronary artery is completely blocked – than those without the condition.
They were 39 per cent more likely to have died if they had a non-ST elevation myocardial infarction (NSTEMI) heart attack – in which the artery is partially blocked - than those without diabetes.
Lead researcher Dr Chris Gale, Consultant Cardiologist and Associate Professor in the School of Medicine, said: "These results provide robust evidence that diabetes is a significant long-term population burden among patients who have had a heart attack.
"Although these days people are more likely than ever to survive a heart attack, we need to place greater focus on the long-term effects of diabetes in heart attack survivors.
"The partnership between cardiologists, GPs and diabetologists needs to be strengthened and we need to make sure we are using established medications as effectively as possible among high-risk individuals."
He added that the next step in their research would be finding out exactly what it is about having diabetes that increases the risk of death following heart attack.
Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, which funded the study said: "We knew that following a heart attack, you are less likely to survive if you also have diabetes.
"However, we did not know if this observation was due to having diabetes or having other conditions which are commonly seen in people with diabetes.
"This paper is the first to conclusively show that the adverse effect on survival is linked to having diabetes, rather than other conditions people with diabetes may suffer from.
"This research highlights the need to find new ways to prevent coronary heart disease in people with diabetes and develop new treatments to improve survival after a heart attack.
"The British Heart Foundation is committed to funding research in this area.
"We are currently funding researchers in Leeds to find new ways of keeping blood vessels healthy in people with diabetes in the fight for every heartbeat."
Dr Anna Morris, Head of Research Funding at Diabetes UK, said: "While researchers tackle this issue, we know that managing diabetes effectively can reduce the risk of developing cardiovascular disease.
"This includes eating healthily, keeping active and taking medications as prescribed by your doctor.
"It's essential that people with diabetes get the support they need to do this effectively, and that we continue to fund research across the UK aimed at preventing the onset of complications in the first place."
The study is published in the Journal of Epidemiology and Community Health.

More information: O A Alabas et al. Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study, Journal of Epidemiology and Community Health (2016). DOI: 10.1136/jech-2016-207402

Provided by University of Leeds

Tuesday, June 21, 2016

Impaired decision-making may contribute to motor symptoms in Parkinson's disease

Impaired decision-making may contribute to motor symptoms in Parkinson's disease
Michele Basso. Credit: UCLA
UCLA researchers have discovered that people with Parkinson's disease have a form of impaired decision-making that may be a major contributor to the movement problems that characterize the disease. The finding suggests that the neurological factors underlying Parkinson's, which currently affects nearly 1 million people in the United States, may be more complex than commonly believed. The study also could pave the way for strategies to detect Parkinson's earlier in its course.

21 jun 2016--Publishing in the June 16 issue of the journal Current Biology, the UCLA-led team found that, compared to healthy individuals, people with early-stage Parkinson's have difficulty with perceptual decision-making only when the sensory information before them is weak enough that they must draw on prior experiences. When the sensory information is strong, individuals with Parkinson's are able to make decisions as well as people who are healthy.
The finding may help explain a well-known phenomenon associated with Parkinson's, called paradoxical movement, in which people with the disease - often even while medicated with dopamine therapy - have difficulty initiating walking. Typically, these people have a shuffling gait, along with stooped posture. But when the same people are assisted by strong sensory information, such as horizontal lines drawn on the floor for them to step over, their walking and gait are significantly improved.
"This tells us that the problem for people with Parkinson's disease is not walking per se, but rather in generating the walking pattern without the assistance of sensory information," said study senior author Michele Basso, a professor in UCLA's Semel Institute for Neuroscience and Human Behavior and the department of neurobiology in the David Geffen School of Medicine at UCLA and director of the Fuster Laboratory of Cognitive Neuroscience in the Semel Institute. "The patients with Parkinson's disease in our study were impaired only when they had to rely on memory information to guide their actions. We believe this fundamental problem of decision-making in the absence of sufficient sensory information may be what is underlying some of the movement disorder symptoms."
In making perceptual decisions, people integrate memory information with the sensory information before them. For example, when people are contemplating crossing a street when a car is headed their way from a distance, they use past experience to help determine whether they have sufficient time to proceed safely. Sometimes the current information is so clear that relying on prior experiences is not necessary, but when that current information is ambiguous, it becomes more important to draw on memories.
Building on nearly two decades' worth of findings by Basso and other researchers on the neurophysiological underpinnings of decision-making in monkeys, the UCLA team conducted decision-making experiments with a dozen early-stage Parkinson's disease patients and a comparison group of healthy individuals. The task involved making decisions about visual information that was more or less ambiguous, requiring the participants to draw on memories of similar previous experiences. In those cases, the patients with Parkinson's disease had trouble integrating the information from memory and making a decision, even when verbally instructed by the research team.
The discovery by the UCLA team adds to a growing body of evidence that is beginning to redefine how researchers view Parkinson's. The disease has no cure, although medication or surgery can relieve symptoms to a certain extent.
"Parkinson's disease has long been seen as purely a motor problem, limited mostly to a section of the brain called the basal ganglia and a neurotransmitter called dopamine that is not produced at sufficient levels," Basso said.
But she noted that the patients in the UCLA study were in the early stages of the disease and on medication to normalize dopamine production. Moreover, preliminary results from Basso's group show that the decision-making impairment related to memory seems unaffected by medication in early-stage patients with Parkinson's disease.
"The field is realizing that Parkinson's disease is a multisystem disease that probably involves many brain areas and neurotransmitter systems," Basso said. "Our finding suggests that the dysfunction we uncovered may actually be unrelated to dopamine. New efforts by us and others are geared at finding out which other brain areas and neurotransmitters are involved, and how."
Given that all of the patients in the UCLA study were in the early stage of the disease but still showed the decision-making dysfunction, Basso and her colleagues also hope to build on the discovery to identify a biological marker for early-stage Parkinson's disease. Detecting and treating the disease earlier would be an important strategy, given that by the time patients begin to express motor symptoms, a significant amount of damage has already been done to the brain.
The next steps for the UCLA team are to perform imaging experiments in both healthy people and patients with Parkinson's disease to determine the neurological factors involved in the decision-making dysfunction.

More information: Current

Provided by University of California, Los Angeles

Sunday, June 19, 2016

Judgment, memory better for older adults with optimistic outlook

Judgment, memory better for older adults with optimistic outlook
When older adults feel optimistic about their future, they are less likely to experience decreases in memory, problem solving and judgment, according to new research conducted at the University of Michigan.

19 jun 2016--Optimism has been linked to positive health behaviors, such as exercising and eating healthier diets, and lower risk for a variety of health conditions, including stroke and heart attacks.
This is believed to be the first study to look at the relationship between optimism and cognitive health in adults ages 65 and older. The researchers used data from the Health and Retirement Study, a national survey funded by the National Institute on Aging and conducted at U-M's Institute for Social Research.
During a four-year period, about 500 of the study's more than 4,600 participants developed cognitive impairment, a condition in which individuals experience decreased memory and/or have difficulty solving problems and making sound decisions. However, study participants who reported high levels of optimism had decreased risk of cognitive impairment, researchers said.
The findings are important given that the number of people living with cognitive impairment and dementia is projected to surge from 5.1 million in 2015 to 13.8 million by 2050. In addition, the costs of dementia are projected to catapult from 226 million in 2015 to 1.1 trillion in 2050.
"We felt like this was an important topic to investigate and to our knowledge, it's the first study to examine the link between optimism and cognitive impairment in older adults," said lead author Katerina Gawronski, a U-M graduate now at the University of Pennsylvania. "We found that optimism was indeed associated with better cognitive health over time."
Gawronski and Eric Kim of Harvard University conducted the research as students at U-M.
They say that randomized controlled trial studies have shown that optimism can be modified using fairly simple paper and pencil exercises. For example, writing about one's "best possible self" has been shown to increase optimism.
"Therefore, optimism may be a novel and promising target for prevention and intervention strategies aimed at improving cognitive health," Kim said.
The findings appear in the online issue of Psychosomatic Medicine.

Provided by University of Michigan

Saturday, June 18, 2016

Physical activity in dementia

Physical activity in dementia
This figure shows the amount of time each group spent physically active over a 24 hour period. The healthy control group engages in the largest amount of activity, with the institutionalized dementia group engaging in significantly less. 
It has been recognised for over 60 years that regular physical activity provides health benefits. Our bodies are designed to be stimulated by physical exertion. Fitness is associated with lower all-cause mortality, along with improved sleep, quality of life, social life and reduced stress. On the other hand, physical inactivity predicts obesity, diabetes, cardiovascular disease, mental health issues, reduced quality of life and overall mortality. The evidence is clear: we need to get moving.

18 jun 2016--In addition to health outcomes, cognition and physical activity are intrinsically linked. This is increasingly true within the senior population. More physically active older adults show less cognitive decline than those who are not active. Older adults participating in physical activity programs often demonstrate improvements in their cognitive abilities – particularly with attention and executive function. In frailer older adults with many health problems, physical activity interventions facilitate better cognition, physical capacity and quality of life. Regular physical activity has also been associated with reduced risk of cognitive decline and development of dementia. Many hypotheses have been postulated regarding the role of physical activity in staving off cognitive impairment. It may protect cardiovascular changes in the brain by maintaining cerebral blood flow, facilitate the growth of new neurons or relieve stress and therefore improve cognitive function.
But what does physical activity look like in the cognitively impaired population – specifically within dementia? A recent study in PLOS ONE aimed to quantify and characterize physical activity in dementia patients objectively. While previous studies report that dementia patients are less physically active than older adults without cognitive impairment, the majority of these findings come from self-reported measures. These are often not as reliable or accurate as they are subjective, and may be impacted by memory recall problems. Van Alphen and colleagues chose to use the Actiwatch, a wrist-worn accelerometer, to collect objective data on the frequency, duration and intensity of daily physical activity in dementia patients. One hundred and twenty dementia patients were included in the study, recruited from 13 nursing homes and four day-care centers, along with 26 older adult controls. All participants were required to wear the Actiwatch for at least six days, 24 hours a day.
The researchers were interested in the differences in physical activity levels between community-dwelling dementia patients and institutionalized patients. To this end, daily physical activity levels were significantly different between institutionalized patients and community-dwelling patients and controls, with institutionalized patients engaging in physical activity 23.5% less than community-dwelling patients and 40% less than controls. This is important to note as infrastructures and activities could be implemented in care homes to encourage physical activity.
Physical activity in dementia
This figure demonstrates the amount of time the different groups spend sedentary compared to other levels of physical intensity. The first bars (0-99) represent sedentary time, while the rest of the bars show a gradual climb in activity intensity. 
Additionally, institutionalized patients spent 72% of their day in a sedentary state; 9.3% more than community-dwelling patients and 19% more than controls. These results remain significant after controlling for age, cognitive abilities and use of walking aids. While there were no significant differences in amount of physical activity between Alzheimer's disease patients and non-Alzheimer's disease patients (encompassing dementia with Lewy bodies, Parkinson's disease with dementia, vascular dementia and frontotemporal dementia), Alzheimer's disease patients did spend significantly less time (6.9%) in a sedentary state. Van Alphen and colleagues concluded that both institutionalized and community-dwelling dementia patients remained sedentary for the majority of the day and performed lower intensity activities than that of controls.
But why is it important to know about physical activity levels in dementia? The dangers of physical inactivity were highlighted earlier; for dementia patients, the ability to carry out everyday activities may be compromised, along with reduced quality of life and further cognitive decline. Studies have demonstrated that encouraging active participation in functional tasks – such as dressing and washing – and attending dance or exercise classes – can improve physical capacity and reduce fall risk in moderate-to-severe dementia. Bi-weekly exercise programs are associated with slower rates of cognitive and functional decline in dementia. Individuals with mild cognitive impairment – a pre-dementia stage – undergoing an aerobic fitness intervention demonstrate significant improvements in cognition, particularly executive function. Encouraging physical activity in this population holds a range of benefits – from improved mood, function, cognition and fitness to reduced stress and improved quality of life for their caregiver.
There is still much work to be done. Studies need to recruit larger samples of patients with non-Alzheimer's disease dementias to assess the differences across dementia subtypes. Type of activity should be examined; most accelerometers can provide data about frequency and duration of movement but fail to automatically specify what activities are being undertaken. Individual differences in activity type may predict different health outcomes. As Van Alphen and colleagues reported, dementia groups are more likely to engage in low-intensity activities such as walking or household chores. These activities are beneficial for cardiorespiratory capacity and body composition, and exercise interventions could be tailored to suit this preference. The effects of vigorous – such as sprinting or spinning – and low-intensity activities should also be compared. This is an area ripe for investigation and may be beneficial for the development of physical interventions.
Increasing physical activity levels is a global challenge and one that is continuously being addressed. The World Health Organization (WHO) recommends 30 minutes of moderate-to- vigorous exercise a day, which can be achieved by walking, gym classes and activities, sports or physical hobbies such as gardening. Governments develop policies, guidelines and initiatives to encourage people to participate in physical exercises, such as Let's Move. National campaigns – such as This Girl Can – promote a sense of unity in keeping active. Free exercise programs – such as Shape Up New York – allow people to engage in a range of fitness classes, from aerobics to Zumba. These all endorse the message to get up, get going and get active! Still 20% of individuals older than 15 years do not meet these physical activity guidelines. Therefore, I believe our approach to the promotion and facilitation of physical activity needs to change. Most people associate the prescription of getting active with problems like obesity and heart disease. More education on how active individuals incur health benefits beyond physical health is also needed.
Exercise is often portrayed as inaccessible without expensive gym facilities and a grueling experience for those who do take part – think of all those films depicting the embarrassment of being picked last in gym class. Facilities allowing engagement in moderate-intensity exercise – such as walking, cycling and running – should be built; fun and simple ways to get involved should be endorsed. Physical activity is an inexpensive, easily-accessible approach to improve health and overall well-being – and we should be taking full advantage of that.

More information: Helena J. M. van Alphen et al. Older Adults with Dementia Are Sedentary for Most of the Day, PLOS ONE (2016). DOI: 10.1371/journal.pone.0152457

Helena J. M. van Alphen et al. Older Adults with Dementia Are Sedentary for Most of the Day, PLOS ONE (2016). DOI: 10.1371/journal.pone.0152457

Renée F. A. G. de Bruijn et al. The association between physical activity and dementia in an elderly population: the Rotterdam Study, European Journal of Epidemiology (2013). DOI: 10.1007/s10654-013-9773-3

Samuel C. Dumith et al. Worldwide prevalence of physical inactivity and its association with human development index in 76 countries, Preventive Medicine (2011). DOI: 10.1016/j.ypmed.2011.02.017
Laura D. Baker et al. Effects of Aerobic Exercise on Mild Cognitive Impairment, Archives of Neurology (2010). DOI: 10.1001/archneurol.2009.307

Nicola T. Lautenschlager et al. Physical Activity and Mild Cognitive Impairment and Alzheimer's Disease, Current Neurology and Neuroscience Reports (2010). DOI: 10.1007/s11910-010-0121-7

E. Galik et al. Optimizing Function and Physical Activity Among Nursing Home Residents With Dementia: Testing the Impact of Function-Focused Care, The Gerontologist (2013). DOI: 10.1093/geront/gnt108

Physical activity for improving cognition in older people with mild cognitive impairment DOI: 10.1002/14651858.CD008198

The Role Of Physical Activity On The Prevention Of Cognitive Impairment.

Louis Bherer et al. A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults, Journal of Aging Research (2013). DOI: 10.1155/2013/657508

Pedro C Hallal et al. Physical activity: more of the same is not enough, The Lancet (2012). DOI: 10.1016/S0140-6736(12)61027-7

Pamela Das et al. Rethinking our approach to physical activity, The Lancet (2012). DOI: 10.1016/S0140-6736(12)61024-1

Wednesday, June 15, 2016

SNMMI Image of the Year: Novel PET imaging shows tau buildup link to neurodegeneration

SNMMI Image of the Year: Novel PET imaging shows tau buildup link to neurodegeneration
The right lateral surface of projected z-score images, reflecting deviation from healthy controls; Yellow/red: higher uptake, blue: lower uptake as compared to controls 
Positron emission tomography (PET) with three different radiotracers can now measure amyloid plaques, tau tangles and metabolic activity in the brains of living Alzheimer's patients. This multimodal study shows significant correlation between increased tau and decreased metabolic activity in the brain—a clear sign of neurodegeneration—reveal researchers at the 2016 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

15 jun 2016--Each year, SNMMI chooses an image that exemplifies the most promising advances in the field of nuclear medicine and molecular imaging. The state-of-the-art technologies captured in these images demonstrate the capacity to improve patient care by detecting disease, aiding diagnosis, improving clinical confidence and providing a means of selecting appropriate treatments. This year, the SNMMI Image of the Year was chosen from more than 2200 abstracts submitted to the meeting and voted on by reviewers and the society leadership.
The 2016 SNMMI Image of the Year goes to a German team of researchers from the University Hospital of Cologne; the Jülich Research Center; and the German Center for Neurodegenerative Diseases. Measuring tau deposits using the novel radiotracer F-18-AV-1451 (F-18-T807), in conjunction with C-11-PiB to measure amyloid plaques and F-18-FDG to measure regional neurodegeneration, offers new insight into the neurodegenerative characteristics of Alzheimer's disease and shows that tau pathology may be an instrumental target for disease-modifying strategies.
"It is a big honor for us to receive this prestigious award. It represents a great reward for the entire team and will strongly motivate our group," said Alexander Drzezga, MD, of the Department of Nuclear Medicine at the University Hospital of Cologne in Cologne, Germany. "I am convinced that it will encourage particularly the young investigators involved in this project to continue with this type of research in the future. I would like to thank all the members of our team who contributed to this work. The study represents the result of an interdisciplinary effort, involving several clinical departments and scientists from different research centers. Also, I would like to thank all the subjects who participated in the study."
"We still do not understand fully how these abnormal amyloid and tau protein depositions affect brain functions and cause dementia," stated Satoshi Minoshima, MD, PhD, chair of the SNMMI Scientific Program Committee. "This Image of the Year study begins to address that fundamental question and leads to the next investigational study to determine the relative contributions of tau and amyloid pathology to neuronal dysfunction. In the United States, the Centers for Medicare and Medicaid Services are funding amyloid PET studies to demonstrate PET's potential clinical value. The Image of the Year study adds a new dimension to the role of PET in aiding the diagnosis and treatment of patients with dementia. It is a very exciting time for the field of molecular imaging."
More than 46 million people are currently living with Alzheimer's across the world, and that number is expected to rise steeply to 131.5 million by 2050. The global economic cost of the disease is expected to approach $1 trillion in the same period, according to the newest data from Alzheimer's Disease International.

More information: Scientific Paper 124: "Differential contributions of Amyloid and Tau burden to Neuro-degeneration in Alzheimer's Disease: A multimodal in vivo PET study." G. Bischof,  J. Hammes, T. van Eimeren, and A. Drzezga, Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital of Cologne, Germany, and B. Neumaier, Institute of Radiochemistry and Experimental Molecular Imaging, University of Cologne, Germany. The study has been performed in close cooperation with the Departments of Neurology and Psychiatry, University of Cologne, Germany, the Research Center Jülich, Germany, and the German Center for Neurodegenerative Diseases. Presented at SNMMI's 63rd Annual Meeting, June 11–15, 2016, San Diego, Calif.

Provided by Society of Nuclear Medicine

Sunday, June 05, 2016

New model of Alzheimer's patient emotions can help guide health care

New model of Alzheimer's patient emotions can help guide health care
The Socio-Emotional Adaptation Model created by Emory researchers shows combinations of positive and negative contextual domains.  Credit: Emory University
A recent study published in The Gerontologist says understanding the emotional reactions of individuals diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) will provide health care professionals with important information needed to develop suitable treatments.

05 jun 2016--Emory researchers developed a model, the Socio-Emotional Adaptation Theory, based on emotional reactions of individuals diagnosed with MCI and AD, which shows combinations of complex interactions and accompanying emotions. The model consists of four positive and negative contextual domains, including relationship with informal support partner (spouse or loved one), relationship with formal support partner (clinicians), locus of control, and coping mechanisms. By looking at areas of overlap, based on positive or negative contexts, researchers suggest it is possible to better understand the root cause of the emotions.
"If we can look at a person's connection with those around them along with emotions they experience, which are complex and do not present linearly, then clinicians will be better able to provide treatment, particularly for patients in later stages of AD who have difficulty explaining their emotional needs," says Sean N. Halpin, MA, lead author of the study and manager of research projects in geriatrics in the Emory University School of Medicine.
Halpin notes this is an initial effort to develop a cohesive model of the emotional changes experienced by patients with MCI/AD and to encourage health care practitioners to engage these patients as active partners in the process of fully understanding their disease.

More information: Sean N. Halpin et al. Socio-Emotional Adaptation Theory: Charting the Emotional Process of Alzheimer's Disease, The Gerontologist (2016). DOI: 10.1093/geront/gnw046

Provided by Emory University

Thursday, June 02, 2016

Dietary fiber intake tied to successful aging, research reveals

mediterranean diet
Credit: Wikipedia.
Most people know that a diet high in fiber helps to keep us "regular." Now Australian researchers have uncovered a surprising benefit of this often-undervalued dietary component.

02 jun 2016--A new paper published in The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences by scientists from The Westmead Institute for Medical Research—reports that eating the right amount of fiber from breads, cereals, and fruits can help us avoid disease and disability into old age.
Using data compiled from the Blue Mountains Eye Study, a benchmark population-based study that examined a cohort of more than 1,600 adults aged 50 years and older for long-term sensory loss risk factors and systemic diseases, the researchers explored the relationship between carbohydrate nutrition and healthy aging.
They found that out of all the factors they examined—which included a person's total carbohydrate intake, total fiber intake, glycemic index, glycemic load, and sugar intake—it was the fiber that made the biggest difference to what the researchers termed "successful aging."
Successful aging was defined as including an absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases including cancer, coronary artery disease, and stroke.
According to lead author of the paper, Associate Professor Bamini Gopinath, PhD, from the Institute's Centre for Vision Research, the study is the first to look at the relationship between carbohydrate intake and healthy aging, and the results were significant enough to warrant further investigation.
"Out of all the variables that we looked at, fiber intake—which is a type of carbohydrate that the body can't digest—had the strongest influence," she said. "Essentially, we found that those who had the highest intake of fiber or total fiber actually had an almost 80 percent greater likelihood of living a long and healthy life over a 10-year follow-up. That is, they were less likely to suffer from hypertension, diabetes, dementia, depression, and functional disability."
While it might have been expected that the level of sugar intake would make the biggest impact on successful aging, Gopinath pointed out that the particular group they examined were older adults whose intake of carbonated and sugary drinks was quite low.
Although it is too early to use the study results as a basis for dietary advice, Gopinath said the research has opened up a new avenue for exploration.
"There are a lot of other large cohort studies that could pursue this further and see if they can find similar associations. And it would also be interesting to tease out the mechanisms that are actually linking these variables," she said.
This study backs up similar recent findings by the researchers, which highlight the importance of the overall diet and healthy aging.
In another study published last year in The Journals of Gerontology, Westmead Institute researchers found that, in general, adults who closely adhered to recommended national dietary guidelines reached old age with an absence of chronic diseases and disability, and had good functional and mental health status.

Provided by The Gerontological Society of America