Wednesday, June 28, 2017

Task Force presents new ranking of colorectal cancer screening tests

In its latest recommendations, the US Multi-Society Task Force (MSTF) on Colorectal Cancer (CRC) Screening confirms that people at average risk should be screened beginning at age 50, and recommends colonoscopy and fecal immunochemical testing (FIT) as the "first tier" screening tests for this group. Screening continues to be a first line of defense against CRC, as it can detect pre-cancerous growths as well as cancer, which is highly treatable if caught early.

28 jun 2017--Overall, the incidence of colorectal cancer (CRC) in people age 50 and older is declining. However, the task force noted a rising incidence of CRC in younger Americans, for reasons that are unclear. While the relative incidence in younger people remains low, the increasing trend of young onset CRC is nevertheless a "major public health concern." In addition, the task force suggests beginning screening earlier in the African-American population, at age 45.
"Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer" was published jointly in three gastroenterology journals, GastroenterologyThe American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy (published online June 6).
Recommendations for screening are re-evaluated periodically as new evidence emerges and as shifts occur in healthcare delivery and access. The task force, made up of representatives from the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology and American Gastroenterological Association, evaluated seven different types of screening tests based on effectiveness at detecting cancer and pre-cancerous polyps.
Experts know that offering screening tests systematically to people without any symptoms is the best way to prevent colorectal cancer and to detect it at an earlier, more treatable stage. However, the large number of options available for screening, and the wide variation in effectiveness, acceptability to patients and cost, suggests that guidance is needed to facilitate discussions between physicians and patients and make the process of offering screening both feasible for physicians and easily understood and accepted by patients.
"We believe these recommendations make the presentation of screening options in the office easier for providers and patients, maximizing both effectiveness and adherence. The document also addresses important issues for organized screening programs that are sometimes used in large health plans," said lead author Douglas K. Rex, MD, FASGE, AGAF, MACG. "These recommendations are informed both by available scientific evidence, as well as practical considerations and cost data."
The document includes sections on screening tests, targets, cost and quality; practical considerations; family history as a risk factor; and age considerations. Each screening test is explained, along with advantages and disadvantages. Strength of evidence is noted in the document for various recommendations.

Screening Tests

The task force ranked tests into three "tiers" according to the strength of the recommendation for average-risk people. The task force also incorporated practical considerations, such as test availability, cost effectiveness, current usage patterns, obstacles to implementation, and the likelihood that patients will repeat the test when they should.
For any test other than colonoscopy, patients need to understand that if they have a positive result, they will need to undergo a colonoscopy to follow up on those results.
Tier 1— the cornerstone tests—are colonoscopy every 10 years or annual FIT. Colonoscopy is highly sensitive for cancer and all classes of precancerous lesions, and it is the only test that allows a patient to be diagnosed and treated in a single session. FIT is less sensitive and must be repeated every year, but it is non-invasive, lower-cost, and performs very well in preventing cancer and cancer deaths when repeated annually. For these reasons, FIT is an attractive option in large health plans with organized screening programs, which also have systems in place to ensure annual testing.

Tier 2 options include:
  • CT colonography every five years
  • FIT-fecal DNA every three years
  • Flexible sigmoidoscopy every five to 10 years
Tier 3 options include:
  • Capsule colonoscopy every five years
Available tests not recommended:
  • Septin9 (a blood-based test)
Highlights of the screening test recommendations include:
  • Colonoscopy should be performed every 10 years or a FIT administered every year as first-tier options for screening average-risk persons for colorectal neoplasia.
Physicians performing screening colonoscopy should measure quality, including the adenoma detection rate.
Physicians performing FIT need to monitor quality. The recommended quality measurements for FIT programs are detailed in a prior publication.1
Patients who refuse colonoscopy or FIT should have CT colonography every 5 years, FIT-fecal DNA every three years, or flexible sigmoidoscopy every five to 10 years .
Capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT-fecal DNA, CT colonography, and flexible sigmoidoscopy.
Septin9 is not recommended for CRC screening.

Family History

A family history of CRC in a first-degree relative (parent, sibling or child) increases a person's risk of developing this type of cancer, regardless of the age when the relative is diagnosed.
Highlights of recommendations pertaining to family history include:
People with a family history of CRC in a first-degree relative diagnosed before age 60 should undergo colonoscopy every five years, beginning at age 40 or 10 years before the age at which their relative was diagnosed, whichever comes first. The same is true for those who have a first-degree relative with a documented advanced adenoma or documented advanced serrated lesions.
People with one first-degree relative diagnosed at age 60 or older are advised to begin screening at age 40.

CRC increasingly is found in younger people

The incidence of CRC is rising in people under age 50. The reasons for this trend are not known at this time. Although the rate of CRC in this age group is still low, the increase is a "major public health concern," according to the authors.
Aggressive evaluation of patients with symptoms is recommended as an important first step, particularly for symptoms involving bleeding, which may include blood in the stool, black or tarry stool with a negative upper endoscopy, or iron deficiency anemia. If a test other than colonoscopy is used to evaluate bleeding symptoms, a diagnosis should be made, and the patient should be treated and followed until resolution of the problem.
Patients who have only non-bleeding symptoms, such as abnormal bowel habits, change in bowel habits or appearance, or abdominal pain, but who have no evidence of bleeding, are no more likely to have cancer than asymptomatic persons of similar age.

Rationale for screening earlier in African-American population

In the African-American population, there is a lower screening rate for CRC, higher incidence rates of cancer, and worse survival statistics compared with other races. The task force outlined a scientific rationale for starting screening earlier based on higher cancer incidence, as well as the younger mean age of colorectal cancer onset in this population even as they acknowledge that there are few data to show that screening before age 50 improves outcomes in this group.
For the first time, the new MSTF document suggests beginning screening at age 45 for African-American patients, though the task force noted the need for additional study of the yield of CRC screening in persons under age 50, and particularly in this population.
The task force added that recommendations to screen earlier in this group "have served an important role in stimulating discussion of and research on CRC in African Americans, increasing awareness in physicians of an important public health problem and racial disparity in health outcomes in the United States, and increasing awareness of CRC in African Americans." The group added that "provider recommendation is key," and that patient navigation services can improve compliance with colonoscopy screening.

Conclusion

In summary, the task force recommends beginning CRC screening at age 50 for average-risk patients, and considers colonoscopy and FIT to be the cornerstones of screening for these patients regardless of the healthcare setting. The authors stressed that optimal results in CRC screening depend on good technical performance and reporting of tests and ensuring that patients undergo appropriate follow-up after testing.
"Screening often originates in the doctor's office, and in that setting, colonoscopy is particularly attractive, because it needs to be performed so infrequently. However, if patients decline colonoscopy, they should be offered FIT, and if they decline FIT, a second-tier test should be offered," said Dr. Rex.
"In the doctor's office, it's also reasonable to present the pros and cons of both colonoscopy every 10 years and annual FIT to patients, so they can choose between the two tests. This approach provides a framework for screening that is simple and accommodates almost every healthcare setting," Dr. Rex continued. "These recommendations constitute a practical approach toward the ultimate goal of maximizing screening rates, while using well accepted, effective and cost-effective tests."

More information: 1. Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the U.S. Multisociety Task Force on colorectal cancer. Gastrointest Endosc 2016: 85:2-21


Provided by American Society for Gastrointestinal Endoscopy

Tuesday, June 27, 2017

Older adults who take 5+ medications walk slower than those who take fewer medications

old person

"Polypharmacy" is the term used when someone takes many (usually five or more) different medications. Experts suggest that, for most older adults, taking that many medications may not be medically necessary. Taking multiple medications also can be linked to problems such as falls, frailty, disability, and even death. 

27 jun 2017--Polypharmacy also is a problem for older adults due to side effects or interactions resulting from the use of different medications. Older adults may have difficulties taking the medications properly, and the medications may interfere with a person's ability to function well.
The ability to walk well is a sign of independence and good health for older adults, for example, and it may be affected by the use of multiple medications. Although healthcare providers know that some treatments can slow or hamper an older person's ability to walk, little is known about the effects of polypharmacy on walking while performing other tasks, like talking. In a new study, researchers examined how polypharmacy affected walking while talking. They published their study in the Journal of the American Geriatrics Society.
The researchers examined information from 482 people age 65 and older who were enrolled in the "Central Control of Mobility in Aging" study. That study's main purpose was to determine how changes to the brain and our central nervous system occur during aging, and how they might impact an older person's ability to walk.
Researchers confirmed the medications (prescriptions as well as herbal and other over-the-counter supplements) study participants were taking. The researchers defined "polypharmacy" as using five or more of these treatments.
Participants took detailed exams assessing physical health, mental well-being, and mobility at the start of the study and at yearly follow-up appointments. Among other evaluations, the researchers measured the participants' walking speed. None of the participants used walking aides (such as canes or walkers) or monitors. The participants were asked to walk at their normal pace on a special 20-foot long walkway, and to walk while talking. The research team also interviewed the participants to learn about their medical conditions, ability to think and make decisions, and brain function.
Among the 482 participants in the study, 34 percent used five or more medications during the study period (June 2011-February 2016); 10 percent used more than eight medications. The participants were mostly in their late 70s.
People in the polypharmacy group were more likely to have high blood pressure, congestive heart failure, diabetes, and a history of heart attacks. They were also more likely to have had a fall within the last year and were more overweight than people in the non-polypharmacy group.
After accounting for chronic health problems, a history of falls, and other issues, the people in the polypharmacy group had a slower walking speed (or gait) than the people in the non-polypharmacy group. Those who took 8 or more medications had slower walking speed when walking while talking. The researchers concluded that there was a link between polypharmacy and walking speed, and that more studies would be needed to follow-up on their findings and the effect specific medications might have on overall well-being.
The researchers also noted that at their check-ups, older adults should be asked about all the medications they take, including herbal and other over-the-counter supplements. They also suggested that healthcare professionals measure walking speed during regular check-ups.

More information: Claudene George et al, Polypharmacy and Gait Performance in Community-dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14957


Provided by American Geriatrics Society

Thursday, June 22, 2017

More frequent sexual activity can boost brain power in older adults, according to study

sex
More frequent sexual activity has been linked to improved brain function in older adults, according to a study by the universities of Coventry and Oxford.
Researchers found that people who engaged in more regular sexual activity scored higher on tests that measured their verbal fluency and their ability to visually perceive objects and the spaces between them.

22 jun 2017--The study, published today in the Journals of Gerontology, Series B: Psychological and Social Sciences, involved 73 people aged between 50 and 83.
Participants filled in a questionnaire on how often, on average, they had engaged in sexual activity over the past 12 months - whether that was never, monthly or weekly - as well as answering questions about their general health and lifestyle.
The 28 men and 45 women also took part in a standardised test, which is typically used to measure different patterns of brain function in older adults, focussing on attention, memory, fluency, language and visuospatial ability.
This included verbal fluency tests in which participants had 60 seconds to name as many animals as possible, and then to say as many words beginning with F as they could - tests which reflect higher cognitive abilities.
They also took part in tests to determine their visuospatial ability which included copying a complex design and drawing a clock face from memory.
It was these two sets of tests where participants who engaged in weekly sexual activity scored the most highly, with the verbal fluency tests showing the strongest effect.
The results suggested that frequency of sexual activity was not linked to attention, memory or language. In these tests, the participants performed just as well regardless of whether they reported weekly, monthly or no sexual activity.
This study expanded on previous research from 2016, which found that older adults who were sexually active scored higher on cognitive tests than those who were not sexually active.
But this time the research looked more specifically at the impact of the frequency of sexual activity (i.e. does it make a difference how often you engage in sexual activity) and also used a broader range of tests to investigate different areas of cognitive function.
The academics say further research could look at how biological elements, such as dopamine and oxytocin, could influence the relationship between sexual activity and brain function to give a fuller explanation of their findings.
Lead researcher Dr Hayley Wright, from Coventry University's Centre for Research in Psychology, Behaviour and Achievement, said:
"We can only speculate whether this is driven by social or physical elements - but an area we would like to research further is the biological mechanisms that may influence this.
"Every time we do another piece of research we are getting a little bit closer to understanding why this association exists at all, what the underlying mechanisms are, and whether there is a 'cause and effect' relationship between sexual activity and cognitive function in older people.
"People don't like to think that older people have sex - but we need to challenge this conception at a societal level and look at what impact sexual activity can have on those aged 50 and over, beyond the known effects on sexual health and general wellbeing."

More information: Hayley Wright et al, Frequent Sexual Activity Predicts Specific Cognitive Abilities in Older Adults, The Journals of Gerontology: Series B (2017). DOI: 10.1093/geronb/gbx065


Provided by Coventry University

Monday, June 19, 2017

Worldwide consensus on the terminology that supports research into sedentary behavior

A worldwide network of scientists examining the links between sedentary lifestyles and health problems such as obesity and cardiovascular disease today announced a new dictionary of terms to support research into sedentary behaviour.

18 jun 2017--The results of the 'terminology consensus project' led by the Children's Hospital of Eastern Ontario Research Institute's (CHEO RI) Sedentary Behaviour Research Network (SBRN) are published today in the International Journal of Behavioral Nutrition and Physical Activity in a paper co-authored by 84 scientists from 20 countries.
"This is the world's most extensive agreement to date on consensus definitions for researchers examining sedentary behaviour, an emerging global public health priority," said lead author Dr. Mark Tremblay, director of the CHEO RI's Healthy Active Living and Obesity Research Group (HALO) and a professor at the University of Ottawa. "There is an urgent need for clear, common and accepted terminology worldwide to facilitate the interpretation and comparison of research. We have made tremendous progress by defining terms such as physical inactivity, stationary behaviour, sedentary behaviour, and screen time. These terms have already been translated into several languages for rapid global uptake."
The paper, entitled "Sedentary Behaviour Research Network: Terminology Consensus Project Process and Outcome", provides refined definitions to suit all age groups, including babies, young children and people with chronic disease or mobility impairment. It also describes how bouts, breaks and interruptions should be defined and measured in the context of assessing sedentary behaviour and in relation to health outcomes.
The conceptual framework described in the paper also illustrates how both energy expenditure and posture are important components and how the terms relate to movement behaviours throughout a 24-hour period, including physical activity and sleep. Examples provided distinguish between active and passive sitting, active and passive standing, sedentary and stationary behaviour, screen time and non-screen-based sedentary time. Sedentary behaviour for a baby, for example, includes sitting in a car seat with minimal movement and, for a toddler, watching TV while sitting, reclining or lying down.
The 84 SBRN co-authors, which include researchers, trainees, graduate students, health practitioners and government employees, agree that standardization of the terminology is crucial to advancing future research, especially since this rapidly growing field of health science involves multi-disciplinary researchers, practitioners and industries.
"These consensus definitions will help scientists and practitioners navigate and understand the rapidly evolving field of sedentary behaviour research, allowing for more consistent and robust exploration of behaviours across 24 hours - sleep, sedentary behaviours and various intensities of physical activity - and may facilitate future research exploring ways to alter behaviours to improve health," Dr. Tremblay said. "Our hope is that these will reduce confusion and advance research related to sedentary behaviour and, ultimately, promote healthy active living."
Dr. Tremblay will chair a discussion of the project's findings at a workshop today at the International Society of Behavioral Nutrition and Physical Activity annual meeting in Victoria, British Columbia. Consensus definitions have been translated into French, Spanish, Portuguese, Dutch, Korean, German, Greek, Traditional Chinese, and Japanese.


Provided by Children's Hospital of Eastern Ontario Research Institute

Saturday, June 17, 2017

Is white or whole wheat bread 'healthier?' Depends on the person

Is white or whole wheat bread 'healthier?' Depends on the person
This visual abstract shows the findings of Korem et al. who performed a crossover trial of industrial white or artisanal sourdough bread consumption and found no significant difference in clinical effects, with the gut microbiome composition remaining generally stable. They showed the glycemic response to bread type to be person specific and microbiome associated, highlighting the importance of nutrition personalization.
17 jun 2017--Despite many studies looking at which bread is the healthiest, it is still not clear what effect bread and differences among bread types have on clinically relevant parameters and on the microbiome. In the journal Cell Metabolism on June 6, Weizmann Institute researchers report the results of a comprehensive, randomized trial in 20 healthy subjects comparing differences in how processed white bread and artisanal whole wheat sourdough affect the body.
Surprisingly, the investigators found the bread itself didn't greatly affect the participants and that different people reacted differently to the bread. The research team then devised an algorithm to help predict how individuals may respond to the bread in their diets.
All of the participants in the study normally consumed about 10% of their calories from bread. Half were assigned to consume an increased amount of processed, packaged white bread for a week—around 25% of their calories—and half to consume an increased amount of whole wheat sourdough, which was baked especially for the study and delivered fresh to the participants. After a 2-week period without bread, the diets for the two groups were reversed.
Before the study and throughout the time it was ongoing, many health effects were monitored. These included wakeup glucose levels; levels of the essential minerals calcium, iron, and magnesium; fat and cholesterol levels; kidney and liver enzymes; and several markers for inflammation and tissue damage. The investigators also measured the makeup of the participants' microbiomes before, during, and after the study.
"The initial finding, and this was very much contrary to our expectation, was that there were no clinically significant differences between the effects of these two types of bread on any of the parameters that we measured," says Eran Segal, a computational biologist at the Weizmann Institute of Science and one of the study's senior authors. "We looked at a number of markers, and there was no measurable difference in the effect that this type of dietary intervention had."
Based on some of their earlier work, however, which found that different people have different glycemic responses to the same diet, the investigators suspected that something more complicated may be going on: perhaps the glycemic response of some of the people in the study was better to one type of bread, and some better to the other type. A closer look indicated that this was indeed the case. About half the people had a better response to the processed, white flour bread, and the other half had a better response to the whole wheat sourdough. The lack of differences were only seen when all findings were averaged together.
"The findings for this study are not only fascinating but potentially very important, because they point toward a new paradigm: different people react differently, even to the same foods," says Eran Elinav (@EranElinav), a researcher in the Department of Immunology at the Weizmann Institute and another of the study's senior authors. "To date, the nutritional values assigned to food have been based on minimal science, and one-size-fits-all diets have failed miserably."
He adds: "These findings could lead to a more rational approach for telling people which foods are a better fit for them, based on their microbiomes."
Avraham Levy, a professor in the Department of Plant and Environmental Sciences and another coauthor, adds a caveat to the study: "These experiments looked at everyone eating the same amounts of carbohydrates from both bread types, which means that they ate more whole wheat bread because it contains less available carbohydrates. Moreover, we know that because of its high fiber content, people generally eat less whole wheat bread. We didn't take into consideration how much you would eat based on how full you felt. So the story must go on."

More information: Cell Metabolism, Korem et al: "Bread affects clinical parameters and induces gut microbiome-associated personal glycemic responses." http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30288-7 , DOI: 10.1016/j.cmet.2017.05.002


Provided by Cell Press

Tuesday, June 13, 2017

Older adults are good Samaritans to strangers

NUS study: Older adults are good Samaritans to strangers
A study conducted by Asst Prof Yu Rongjun (right) and Dr Narun Pornpattananangkul (left) from the National University of Singapore found that older adults, compared to young adults, are more generous towards strangers.
13 jun 2017--People tend to become more generous as they age. This certainly holds true when it comes to helping strangers, according to a recent study by researchers from the National University of Singapore (NUS). Findings from the study showed that while the older adults treat their kin and friends the same as younger adults do, the elderly donate more to strangers than younger adults, even when their generosity is unlikely to be reciprocated.
"Greater generosity was observed among senior citizens possibly because as people become older, their values shift away from purely personal interests to more enduring sources of meaning found in their communities," explained Assistant Professor Yu Rongjun, who led the study. Asst Prof Yu is from the Department of Psychology at the NUS Faculty of Arts and Social Sciences, as well as the Singapore Institute for Neurotechnology at NUS.
The research results were first reported online in Journals of Gerontology: Psychological Sciences on 5 April 2017.

Generosity towards strangers is a function of age

Studies have shown that as people age, they are inclined to volunteer more frequently, are more attentive to ecological concerns, and are less interested in becoming rich. However, there is a lack of understanding of the core motive behind such altruistic behaviour. The team led by Asst Prof Yu sought to address this knowledge gap by looking at how social relationships with others influence how much older adults donate in comparison with younger adults.
The study, which was conducted from March 2016 to January 2017, involved 78 adults in Singapore. 39 of them were older adults with an average age of 70, while the other 39 were younger adults who were about 23 years old.
The NUS research team employed a framework known as social discounting to quantify generosity towards people. The framework works on the principle that people treat those they are closer with better than those whom they are more distantly acquainted, and much better than total strangers. The participants had to rate how close they were to people in their social environment, and the amount of money they would give to each respective person. Using a computational model, the NUS research team calculated the amount of money that the participants are willing to give to another person as a function of social distance.
The results revealed that both younger and older adults are equally generous to people who are close to them, such as family members or close friends. However, senior citizens are more generous to those who are more socially distant, such as total strangers, and the seniors' level of generosity does not decrease with distance as quickly as that of the younger adults. In addition, older adults are more likely to forgo their resources to strangers even when their generosity is unlikely to be reciprocated.
Dr Narun Pornpattananangkul, the first author of the research paper, said, "In psychology, the motivation to contribute to the greater good is known as an "ego-transcending" motivation. In our earlier work, we found that there is an enhancement of this motivation after people received oxytocin, a hormone related to maternal love and trust. In this study, we found a similar pattern of an ego-transcending motivation among the older adults, as if the older adults received oxytocin to boost their generosity. We speculate that age-related changes at the neurobiological level may account for this change in generosity." Dr Pornpattananangkul is a research fellow from the Department of Psychology at the NUS Faculty of Arts and Social Sciences.
Asst Prof Yu added, "Our findings shed light on the age-related changes among the elderly, and provide an understanding of why they are more inclined to lend a helping hand to strangers. Providing older adults with more opportunities to help others is not only beneficial to our society, but it might also be a boon to the well-being of older adults themselves. Future studies with direct well-being measures should further examine this hypothesis."

Future studies to examine neural mechanisms involved in decision making

To further their understanding on how decision making shifts among the elderly, Asst Prof Yu and his team at NUS are embarking on studies to examine the neural mechanisms underlying the changes in decision making by using brain-imaging technologies. Research findings from these studies have the potential to be translated into effective intervention programmes to promote healthy ageing, and may help tackle age-related conditions such as Parkinson's disease and Alzheimer's disease, which are often characterised by deficits in decision making.

More information: Narun Pornpattananangkul et al, Social Discounting in the Elderly: Senior Citizens are Good Samaritans to Strangers, The Journals of Gerontology: Series B (2017). DOI: 10.1093/geronb/gbx040


Provided by National University of Singapor

Saturday, June 10, 2017

First large-scale population analysis reinforces ketamine's reputation as antidepressant

ketamine

Better known as an anesthetic or as an illicit hallucinogenic drug, ketamine has also long been noted for alleviating depression. But ketamine has not been tested in a large clinical trial, and all evidence of its antidepressant effects has come from anecdotes and small studies of fewer than 100 patients. 

10 jun 2017--Now, in the largest study of its kind, researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego mined the FDA Adverse Effect Reporting System (FAERS) database for depression symptoms in patients taking ketamine for pain. They found that depression was reported half as often among the more than 41,000 patients who took ketamine, as compared to patients who took any other drug or drug combination for pain.
The study, published May 3 in Scientific Reports, also uncovered antidepressant effects for three other drugs typically used for other purposes—Botox, the pain reliever diclofenac and the antibiotic minocycline.
"Current FDA-approved treatments for depression fail for millions of people because they don't work or don't work fast enough," said senior author Ruben Abagyan, PhD, professor of pharmacy. "This study extends small-scale clinical evidence that ketamine can be used to alleviate depression, and provides needed solid statistical support for wider clinical applications and possibly larger scale clinical trials."
Abagyan led the study with pharmacy students Isaac Cohen and Tigran Makunts, and Rabia Atayee, PharmD, associate professor of clinical pharmacy, all at Skaggs School of Pharmacy.
The FAERS database contains more than 8 million patient records. The research team focused on patients in the database who received ketamine, narrowing their study population down to approximately 41,000. They applied a mathematical algorithm to look for statistically significant differences in reported depression symptoms for each patient.
"While most researchers and regulators monitor the FAERS database for increased incidences of symptoms in order to spot potentially harmful drug side effects, we were looking for the opposite—lack of a symptom," Cohen said.
The team found that the incidence of depression symptoms in patients who took ketamine in addition to other pain therapeutics dropped by 50 percent (with an error margin less than 2 percent) compared to the patients who took any other drug or drug combination for pain. Patients who took ketamine also less frequently reported pain and opioid-associated side effects, such as constipation, as compared to patients who received other pain medications.
According to Abagyan, it is possible that another factor common to patients taking ketamine was driving the antidepressant effect, such as the fact that ketamine also relieves pain. That's why they compared ketamine patients with patients taking other pain medications. That control group eliminated the possibility that people who take ketamine have less depression because they have less pain. Abagyan says it's still possible, though unlikely, the effect could be due to a still unidentified confounding factor.
Three other drugs with previously under-appreciated antidepressant effects also emerged from this analysis: Botox, used cosmetically to treat wrinkles and medically to treat migraines and other disorders; diclofenac, a nonsteroidal anti-inflammatory drug (NSAID); and minocycline, an antibiotic.
After the diclofenac finding, Abagyan and team went back and looked at ketamine patients who did not also take NSAIDs and compared them to patients who took any other combination of drugs for pain except NSAIDs. Depression rates in patients taking ketamine remained low.
The researchers hypothesize that the antidepressant effects of diclofenac and minocycline may be due, at least in part, to their abilities to reduce inflammation. For Botox, the potential mechanism for reducing depression is less clear. The team is now working to separate Botox's beauty effects (which could indirectly make a person feel better emotionally) and its antidepressant effects. To do this, they are first using FAERS data to determine if collagen fillers and other cosmetic treatments similarly affect depression rates.
According to the World Health Organization, more than 300 million people experience depression worldwide. If not effectively treated, depression can become a chronic disease that increases a person's risk of mortality from suicide, heart disease or other factors. Depression is currently treated with five classes of antidepressants, most commonly serotonin reuptake inhibitors.
For financial and ethical reasons, ketamine has never been tested for its safety and effectiveness in treating depression in a large-scale clinical trial, but it reportedly works much more rapidly than standard antidepressants. Ketamine is relatively inexpensive and is covered by most health insurance plans if three other antidepressants fail.
"The approach we used here could be applied to any number of other conditions, and may reveal new and important uses for thousands of already approved drugs, without large investments in additional clinical trials," Makunts said.

More information: Isaac V. Cohen et al, Population scale data reveals the antidepressant effects of ketamine and other therapeutics approved for non-psychiatric indications, Scientific Reports (2017). DOI: 10.1038/s41598-017-01590-x


Provided by University of California - San Diego

Sunday, June 04, 2017

Burden of multiple chronic illness told through new chartbook

Burden of multiple chronic illness told through new chartbook
From the report 'Multiple Chronic Conditions in the United States.' 
A new publication illustrates the burden that chronic illnesses impose on American society, demonstrating through charts and graphics how 60 percent of American adults suffer from at least one chronic health condition and 42 percent have more than one.

04 jun 2017--The chartbook updates previous compendiums with more-recent information about the prevalence of multiple chronic conditions, as well as the associated health care utilization and spending.
The data confirms that the prevalence of multiple chronic conditions is highest among older adults. Women are more likely than men to have multiple chronic conditions, as many women live longer than men do.
A chronic condition is a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment.
When a patient has more than one chronic condition—such as diabetes, high blood pressure and depression—treatment can be difficult to manage, researchers say. Treatment strategies or drug regimens may be similar, but one chronic condition often is managed better than the others.
"We hope this updated chartbook helps both health professionals and the public better understand that chronic disease is a burden not only for patients, but also for the health care system overall," said Christine Buttorff, lead author of the study and an associate policy researcher at RAND, a nonprofit research organization.
The project was supported by the Partnership to Fight Chronic Disease. The report, "Multiple Chronic Conditions in the United States," is available at http://www.rand.org. Other authors of the report are Teague Ruder and Melissa Bauman.


Provided by RAND Corporation

Saturday, June 03, 2017

Frailer patients at much greater risk of institutional care and death after discharge from hospital

Independent of age, frail patients are almost twice as likely to die in the year following admission to critical care, and even more likely to need nursing home care after discharge from hospital, compared with patients who are not frail, according to new research presented at this year's Euroanaesthesia Congress in Geneva (3-5 June).

03 jun 2017--Frailty (a decline in physiological reserve and function leading to increased vulnerability to poor health outcomes) is very common, affecting up to 1 in 10 people over 70 years old. While people who are frail are not disabled, they have reduced strength and endurance and find it difficult to carry out normal daily activities. Frailty is linked to earlier death, poor function, and increased hospitalisations. However, the role of frailty in critical care outcomes is unclear.
In this study, Professor Gary Mills from the University of Sheffield, UK and colleagues looked at data over a 3-year period for 7,732 adults aged 17 to 104 years old, who had been admitted to critical care departments in two hospitals in Sheffield, UK. They measured the effect of frailty on the risk of death in the year after hospitalisation. Smaller samples of patients were also assessed for changes to residence (3,469 patients) and differences in dependency (2,387) before and after admission. Of 7,732 patients 1,726 were considered to be frail with an average age of 72.5 years, based on an assessment of their health and function in line prior to this illness episode, using the Rockwood frailty score.
Results showed that around 40% of frail patients had died within one year of admission compared to 15% of non-frail patients. Analysis of the data showed that frail patients were at almost twice the risk of dying in the year after admission to critical care compared to non-frail patients, even after accounting for important characteristics like age, the number of organs supported during care and major comorbidities like metastatic disease or kidney failure. Frail patients were also nearly 2.5 times as likely to need institutional care and became more dependent after discharge from hospital.
The authors conclude: "Our findings suggest that being frail is associated with poorer outcomes after critical illness and this could affect decision making regarding appropriate care by patients. This study should trigger further research and quality improvement efforts aimed at improving the care and outcomes of the growing population of frail patients with critical illness."


Provided by European Society of Anaesthesiology

Tuesday, May 30, 2017

World first study reveals increase in premature deaths in Australian nursing homes

The first comprehensive study of deaths in Australian nursing homes has been published today (29 May), revealing a more than 400 per cent increase in the incidence of premature and potentially preventable deaths of nursing home residents over the past decade.

30 may 2017--These deaths - from falls, choking, suicide and homicide - account for almost 3,300 deaths of nursing home residents over a 13 year period.
The study, led by Professor Joseph Ibrahim, from the Monash University Faculty of Medicine, Nursing and Health Sciences and published in the Medical Journal of Australia, used coronial data to review the deaths by external causes of all of nursing home residents between 2000 and 2013.
The study found that - of the 21,672 deaths of nursing home residents reported to the Coroners Court during the 13 year period, 3,289, or 15.2 per cent, were from external or preventable causes, almost all unintentional.
Unintentional Deaths: Four out of five of those who died from external causes died from falls (81.5 per cent) while one in 12 died of choking (7.9 per cent). Somewhat surprising was the small number who died from complications of clinical care (1.2 per cent).
Intentional Deaths: Almost one in 18 people who died from preventable causes in aged care facilities were killed, either from suicide (4.4 per cent) and resident-to-resident assault (1.0 per cent).
The study found that the 400 per cent increase over the 13 year period in the number of preventable deaths in nursing homes is in part due to better reporting. However, Professor Ibrahim cautions that this figure is probably an under estimate owing to some deaths being misclassified as "natural" due to the tendency for health professionals and society to downplay the significance of the injury-related factors tending to assume old age and any underlying illness are the explanation for deaths.
Professor Ibrahim has called for a national strategy to reduce unnecessary harm including deaths in nursing homes:
"Professionals from governments and the nursing home sector should develop strategies for preventing these deaths and establish a lead authority, responsible for reducing harm by improving practice in nursing homes," Professor Ibrahim said.
"Currently no one entity is responsible for reducing harm by improving practice."
This national study is the first in the world to look at potentially preventable deaths in nursing homes using information from medico-legal investigations.
"Improving the quality of care for nursing home residents requires a better understanding of how, why, where and when they die. The global population is ageing rapidly, and the need for aged care services is consequently increasing," Professor Ibrahim said.
"With this study we have our first real understanding of how many deaths are occurring in nursing homes that shouldn't be happening. However, there is a paucity of information about the cause and manner of premature deaths of nursing home residents from which we can review how these operations are run."
Professor Ibrahim acknowledged that the increased number of preventable deaths identified may be, in part, due to increased scrutiny of aged care facilities by the community and government.

More information: Medical Journal of Australia (2017). DOI: 10.5694/mja16.00873


Provided by Monash University

Monday, May 29, 2017

Some benefit for curcuminoids in knee osteoarthritis

Some benefit for curcuminoids in knee osteoarthritis
Curcuminoids seem beneficial for knee osteoarthritis (OA), although they are less effective for pain relief than ibuprofen, according to a review and meta-analysis published online May 4 in the International Journal of Rheumatic Diseases.

29 may 2017--Igho J. Onakpoya, M.D., from the University of Oxford in the United Kingdom, and colleagues reviewed data from randomized controlled trials that examined the effectiveness of orally-administered curcuminoids in OA in adults. Data were included from seven studies conducted in Asia, with 797 participants with primarily knee OA.
The overall risk of bias in the studies was moderate. The researchers found that curcuminoids correlated with significantly reduced knee pain (standardized mean difference, − 3.45) and improved quality of life (mean difference, −2.69) compared with placebo. Compared with ibuprofen, curcuminoids had significantly fewer effects on pain relief, knee stiffness, and physical function. Curcuminoids also correlated with significant improvements in Western Ontario and McMaster Universities Arthritis Index total scores and with significant reductions in rescue medication use. There were no serious adverse events.
"Curcuminoids may have some beneficial effects on knee pain and quality of life in patients with knee OA," the authors write. "However, they are less effective at relieving pain compared with ibuprofen."

More information: Abstract

Saturday, May 27, 2017

Strategies needed to prevent malnutrition in older people

Strategies needed to prevent malnutrition in older people
A pilot study led by Associate Professor Carol Wham, is the first in a series to investigate the prevalence of malnutrition risk in older people across three settings in Auckland.
New research from Massey University shows concerning levels of malnutrition among older people living independently in the community or newly admitted to hospital or a residential care facility.
Associate Professor Carol Wham led the study, investigating the prevalence of malnutrition risk in older people across three accommodation settings. The study was conducted within the Waitemata District Health Board region in Auckland, including North Shore City, Waitakere City and the Rodney District, in 2014.

27 may 2017--Of the 167 participants, 23 per cent were malnourished, and 35 per cent were at high risk of malnutrition. Those recently admitted to residential care had a higher prevalence of malnourishment – 47 per cent, compared to 23 per cent in hospital, and two per cent living in the community.
The pilot study, a first of its kind in New Zealand, is the first in a series to screen for risk of malnutrition in community and early admission to hospital and residential care. The research is currently being followed up, using a larger group of 250 people in each of the three settings. Researchers are now analysing these results.
Dr Wham says older people are known to be at disproportionate risk of malnutrition, with health conditions both contributing to having an inadequate food and nutrition intake and occurring as a consequence of inadequate intake. "Maintaining good nutritional status is important for remaining independent, yet far too often key aspects of food provision for older people are disregarded or taken for granted, especially among those with health disparities."
She says elimination of particular foods or food groups from the diet, due to chewing and swallowing difficulties, aggravates the risk of malnutrition. "Reduced food intake can contribute to dysphagia [difficulty swallowing], and can compromise the integrity of the swallow, which initiates a vicious cycle further decreasing food intake and further exacerbating poor swallowing function."
The risk of malnutrition is a burden on older people and health-care facilities, Dr Wham says. "In community-living older New Zealanders, high malnutrition risk has been shown to impact health-related quality of life. It's associated with higher infection rates, loss of muscle mass, strength and function, longer length of hospital stays, as well as increasing morbidity and mortality."
This study highlights the need for mandatory screening for malnutrition risk in all settings, Dr Wham says.
"We discovered marked differences in nutritional risk and the prevalence of dysphagia between older adults living in the three different social settings. Independently living older adults demonstrated the best nutritional profiles with nutrition risk and prevalence of dysphagia significantly lower than those recently admitted to hospital or residential care facilities. We expected these results. However, this data revealed the stark delineation between well older adults, and those experiencing a slide in their health status and profile.
"Malnutrition and swallowing difficulties significantly affect quality of life and are costly to individuals, families and the community. Simple intervention measures to manage under-nutrition, can make a substantial difference. However, given the differences we have identified between each setting, a more targeted approach should be used to identify the optimum nutrition intervention for each setting," Dr Wham says.
She would like to see awareness around malnutrition in older people, given a higher profile. "This issue should not be considered a 'normal' part of ageing. It needs to be higher up the political agenda," Dr Wham says.

More information: Carol Wham et al. Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand, Australasian Journal on Ageing (2017). DOI: 10.1111/ajag.12410


Provided by Massey University

Friday, May 26, 2017

US deaths from Alzheimer's soar 55 percent since 1999

Alzheimer's disease

Deaths from Alzheimer's in America have soared 55 percent since 1999, as the burden of this fatal form of dementia grows and the population ages, a federal health report said Thursday.

26 may 2017--The study in the US Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report spanned 1999 to 2014.
Experts say the data shows more caregivers are needed, along with more resources to help people suffering from Alzheimer's disease, the sixth leading cause of death in the United States.
"Millions of Americans and their family members are profoundly affected by Alzheimer's disease," said CDC Acting Director Anne Schuchat.
"As the number of older Americans with Alzheimer's disease rises, more family members are taking on the emotionally and physically challenging role of caregiver than ever before. These families need and deserve our support."
The study also found an increasing number of Alzheimer's deaths occurring at home, rising from 14 percent to 25 percent in the same period.
Most Alzheimer's deaths—54 percent—still occur in a nursing home or long-term care facility.
There is no cure for Alzheimer's disease, the most common form of dementia.
Alzheimer's accounted for 3.6 percent of all US deaths in 2014.
Alzheimer's is a growing problem as people live longer, and medical advances make them less likely to die from other diseases.
"Age is the greatest risk factor for Alzheimer's disease," said the CDC report.
"Most adults with the disease are 65 years or older."
More than five million people in the United States are living with Alzheimer's, and that number could balloon to 16 million by 2050, according to the Alzheimer's Association.

Wednesday, May 24, 2017

Antibiotic therapy for nearly 1 in 4 adults with pneumonia does not work

Antibiotic therapy for nearly 1 in 4 adults with pneumonia does not work
Antibiotic treatment ineffective for one in four adults with pneumonia. Credit: ATS
Approximately one in four (22.1 percent) adults prescribed an antibiotic in an outpatient setting (such as a doctor's office) for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference.

24 may 2017--"Pneumonia is the leading cause of death from infectious disease in the United States, so it is concerning that we found nearly one in four patients with community-acquired pneumonia required additional antibiotic therapy, subsequent hospitalization or emergency room evaluation," said lead author James A. McKinnell, MD, an LA BioMed (Los Angeles, CA) lead researcher and infectious disease specialist. "The additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile ("C diff") infection, which is difficult to treat and may be life-threatening, especially for older adults."
Dr. McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.
The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia. The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription. The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics—such as older age, or having certain other diseases in addition to pneumonia—had higher rates of drug failure. After adjusting for patient characteristics, the failure rates by class of antibiotic were: beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).
"Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure," said Dr. McKinnell. "Our data provide numerous insights into characteristics of patients who are at higher risk of complications and clinical failure. Perhaps the most striking example is the association between age and hospitalization: Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy."
Dr. McKinnell also stated that his study found substantial regional variations in treatment outcomes, which are not addressed in a specific way in the community-acquired pneumonia guidelines. In addition, the study showed that thousands of patients who suffer from other conditions - such as chronic obstructive pulmonary disease, cancer or diabetes - were not treated with combination antibiotic therapy or respiratory fluoroquinolone, as the guidelines recommend.
"While certain aspects of the guidelines need to be updated, some prescribers also have room for improvement and should implement the current guidelines," he concluded.

More information: Abstract 8450: Clinical Predictors of Antibiotic Failure in Adult Outpatients with Community-Acquired Pneumonia


Provided by American Thoracic Society

Sunday, May 21, 2017

Resilience study examines how people with disabilities live successfully in rural areas

Resilience study examines how people with disabilities live successfully in rural areas
Living in a small town can be challenging for anyone. For people with disabilities, rural areas can create even more serious barriers to accomplishing the things they want to do.
However, with the help of a trait known as resilience, many people with disabilities who live in rural areas have achieved a good quality of life and are able to participate in their communities.

21 may 2017--"Some people do well in life because they face few obstacles to meeting their goals: they are healthy, they have parents who are well-educated and have the resources to provide their children with a good education, and they have the support they need," said Jean Ann Summers, research director at the University of Kansas Research and Training Center on Independent Living, or RTC/IL.
The resilience study – which is still ongoing – didn't focus on this group of people, though.
"Other people do well in life despite the obstacles that they face," Summers said. "They may have grown up poor, they may have a disability, they may live in a community where few jobs or other opportunities are available. And yet they thrive. They are able to achieve their goals and have a satisfying life in the community in spite of the odds that are against them. We say those people are 'resilient.'"
Summers and her collaborators Dot Nary, assistant research professor at the RTC/IL, and Heather Lassmann, graduate research assistant, set out to identify what Summers calls "the secrets of success" that resilient people with disabilities employ to successfully live in rural communities. Their work is part of larger project based at the University of Montana Research and Training Center on the Ecology of Rural Disability.
"The study is important because if we can find out what people who are naturally resilient do, we can design a program to teach others how to be resilient," Nary said.
According to Summers, the thought process behind the study is much different than the approach medical or health care practitioners consider when trying to support people with disabilities or chronic illnesses.
"For example, in the medical model we would approach 'fixing' a broken leg by putting a cast on the leg," Summers said. "But a resilience model would focus on what it takes to make that leg grow strong, with the right nutrition and exercise, to prevent further breakage of those bones in the future."
The study applied this model in two phases. First, researchers conducted two focus groups of people living in rural communities who were nominated by staff at centers for independent living as people who display resilience.
"In the focus groups, we asked the participants to talk about the supports that were helpful to them in enabling them to participate fully in the community," Nary said. "We also asked them to talk about any attitudes or philosophy that helped them succeed in reaching their goals."
The researchers used what they learned in the focus groups to identify a series of supports, both formal and informal, along with coping skills like advocacy and strategies like humor or focusing on others that contribute to a person being resilient. They illustrated these findings in a tree-shaped graphic, which identifies the roots and branches that contribute to resilience.
In the second phase of the study, now ongoing, the researchers partnered with their colleagues at the University of Montana, who had conducted a large-scale national survey of people in rural communities. Using that survey data, they identified a new group of people with disabilities who they defined as resilient for two reasons: they had more than two risk factors, that is obstacles to success, and their survey responses indicated they were successfully participating in their communities.
Summers and Nary are now interviewing these individuals by phone to get a deeper understanding of what contributes to resilience.
"We are hearing things that are similar to what we heard in the focus groups," Summers said, "but we're also looking at other personal or environmental factors that contribute positively. For example, a particular city may offer unique environmental or social features that make participation easy for people with disabilities."
She expects the final report to be completed this fall.


Provided by University of Kansas

Saturday, May 20, 2017

Can omega-3 help prevent Alzheimer's disease? Brain SPECT imaging shows possible link


Can omega-3 help prevent Alzheimer's disease? Brain SPECT imaging shows possible link
An example of the Omega-3 Index, the method utilized in this study for measuring omega-3 fatty acid levels in red blood cell membranes in the study. Credit: William S. Harris, PHD
The incidence of Alzheimer's disease (AD) is expected to triple in the coming decades and no cure has been found. Recently, interest in dietary approaches for prevention of cognitive decline has increased. In particular, the omega-3 fatty acids have shown anti-amyloid, anti-tau and anti-inflammatory actions in the brains of animals. In a new article published in the Journal of Alzheimer's Disease, researchers have found that for patients with high omega-3 levels, blood flow in specific areas of the brain is increased.

20 may 2017--"This study is a major advance in demonstrating the value of nutritional intervention for brain health by using the latest brain imaging," commented George Perry, PhD, Dean and Professor of Biology, The University of Texas at San Antonio, and Editor-in-Chief of the Journal of Alzheimer's Disease.
Single photon emission computed tomography, or SPECT, can measure blood perfusion in the brain. Images acquired from subjects performing various cognitive tasks will show higher blood flow in specific brain regions. When these images were compared to the Omega-3 Index, a measure of the blood concentration of two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), investigators found a statistically significant correlation between higher blood flow and higher Omega-3 Index. In addition, they evaluated the neuropsychological functions of the subjects and found that omega-3 levels also correlated with various psychological feelings using a standardized test battery (WebNeuro).
This study drew from a random sample of 166 participants from a psychiatric referral clinic for which Omega-3 Index results were available. The participants were categorized into two groups of higher EPA+DHA concentrations (>50th percentile) and lower concentrations (<50th 128="" and="" brain="" brains="" completed="" computerized="" conducted="" each="" neurocognitive="" of="" on="" p="" participant="" percentile="" quantitative="" regions="" spect="" status.="" testing="" their="" was="">Results indicated statistically significant relationships between the Omega-3 index, regional perfusion on brain SPECT in areas involved with memory, and neurocognitive testing.
Overall, the study showed positive relationships between omega-3 EPA+DHA status, brain perfusion, and cognition. Lead author Daniel G. Amen, MD, of the Amen Clinics Inc., Costa Mesa, CA, adds, "This is very important research because it shows a correlation between lower omega-3 fatty acid levels and reduced brain blood flow to regions important for learning, memory, depression and dementia."
Co-author William S. Harris, PhD, University of South Dakota School of Medicine. Vermillion, SD, lends this perspective, "Although we have considerable evidence that omega-3 levels are associated with better cardiovascular health, the role of the 'fish oil' fatty acids in mental health and brain physiology is just beginning to be explored. This study opens the door to the possibility that relatively simple dietary changes could favorably impact cognitive function."

More information: Journal of Alzheimer's Disease (2017). DOI: 10.3233/JAD-17028

Provided by IOS Press

Friday, May 19, 2017

Studies link healthy brain aging to omega-3 and omega-6 fatty acids in the blood

Studies link healthy brain aging to omega-3 and omega-6 fatty acids in the blood
New studies link specific nutrients to the structure and function of brain regions that are particularly sensitive to aging and neurodegenerative disease. 
19 may 2017--Two new studies link patterns of polyunsaturated fatty acids in the blood to the integrity of brain structures and cognitive abilities that are known to decline early in aging.
The studies add to the evidence that dietary intake of omega-3 and omega-6 fatty acids can promote healthy aging, the researchers said. Further research is needed to test this hypothesis, they said.
The brain is a collection of interconnected parts, each of which ages at its own pace. Some brain structures, and the abilities they promote, start to deteriorate before others, said University of Illinois M.D./Ph.D student Marta Zamroziewicz, who led the new research with psychology professor Aron Barbey.
"We studied a primary network of the brain—the frontoparietal network - that plays an important role in fluid intelligence and also declines early, even in healthy aging," Zamroziewicz said. Fluid intelligence describes the ability to solve problems one has never encountered before.
"In a separate study, we examined the white matter structure of the fornix, a group of nerve fibers at the center of the brain that is important for memory," she said.
Previous research has shown that the fornix is one of the first brain regions to be compromised in Alzheimer's disease.
In both studies, the researchers looked for patterns of polyunsaturated fatty acids in the blood of adults ages 65 to 75. They analyzed the relationship between these nutrient patterns and subjects' brain structure and performance on cognitive tests. This research differs from other such studies, which tend to focus on only one or two polyunsaturated fatty acids, Zamroziewicz said.
"Most of the research that looks at these fats in health and healthy aging focuses on the omega-3 fatty acids DHA and EPA, but those come from fish and fish oil, and most people in the Western Hemisphere don't eat enough of those to really see the benefits," she said. Other fatty acids, like alpha-linolenic acid and stearidonic acid, are precursors of EPA and DHA in the body. Those fats can be derived from land-based foods such as nuts, seeds and oils.
"A central goal of research in nutritional cognitive neuroscience is to understand how these nutrients affect brain health," Zamroziewicz said. "Some of these nutrients are thought to be more beneficial than others."
In a study reported in the journal Nutritional Neuroscience, the researchers looked for relationships between several omega-3 fatty acids in the blood, the relative size of structures in the frontal and parietal cortices of the brain, and performance on tests of fluid intelligence in healthy elderly adults.
The team found correlations between blood levels of three omega-3 fatty acids—ALA, stearidonic acid and ecosatrienoic acid—and fluid intelligence in these adults. Further analyses revealed that the size of the left frontoparietal cortex played a mediating role in this relationship. People with higher blood levels of these three nutrients tended to have larger left frontoparietal cortices, and the size of the frontoparietal cortex predicted the subjects' performance on tests of fluid intelligence.
"A lot of research tells us that people need to be eating fish and fish oil to get neuroprotective effects from these particular fats, but this new finding suggests that even the fats that we get from nuts, seeds and oils can also make a difference in the brain," Zamroziewicz said.
In the second study, the team found that the size of the fornix was associated with a balance of omega-3 and omega-6 fatty acids in the blood, and that a more robust fornix coincided with memory preservation in older adults. Again, the researchers saw that brain structure played a mediating role between the abundance and balance of nutrients in the blood and cognition (in this case, memory). The findings are reported in the journal Aging & Disease.
"These findings have important implications for the Western diet, which tends to be misbalanced with high amounts of omega-6 fatty acids and low amounts of omega-3 fatty acids," Zamroziewicz said.
"These two studies highlight the importance of investigating the effects of groups of nutrients together, rather than focusing on one at a time," Barbey said. "They suggest that different patterns of polyunsaturated fats promote specific aspects of cognition by strengthening the underlying neural circuits that are vulnerable to disease and age-related decline."

More information: Marta K. Zamroziewicz et al, Determinants of fluid intelligence in healthy aging: Omega-3 polyunsaturated fatty acid status and frontoparietal cortex structure, Nutritional Neuroscience (2017). DOI: 10.1080/1028415X.2017.1324357


Provided by University of Illinois at Urbana-Champaign

Monday, May 15, 2017

Volunteering can reduce dementia risk in seniors, study finds


Volunteering can reduce dementia risk in seniors, study finds
Yannick Griep, assistant professor in the University of Calgary's Department of Psychology, led a five-year study that shows regular volunteering reduces the chance of dementia in seniors.
15 may 2017--Seniors now have a greater incentive than ever for doing volunteer work in their retirement years, in light of a new study that shows volunteering can substantially reduce the development of dementia.
The study, led by University of Calgary psychology professor Yannick Griep and published in the medical journal PLOS One, tracks 1,001 Swedish citizens, all of whom retired in 2010, over a five-year period, monitoring them for the development of cognitive problems.
These retirees are divided into three groups based on their engagement in volunteer work. One group is made up of individuals who consistently volunteered in their respective communities for at least one hour per week. The second group consists of those who sporadically engaged in volunteering. In the third group are retired workers who never engaged in volunteering.
The cognitive health of those individuals is assessed at regular intervals (in 2010, 2012 and 2014) by means of questionnaires as well as the monitoring of physician diagnoses, including the use of anti-dementia medication. The questionnaires touch on such factors as memory and the ability to concentrate and make clear decisions, among other cognitive issues.

Regular volunteer work provides cognitive health benefits

"We found that the people who did volunteer work for at least one hour a week on a regular basis were 2.44 times less likely to develop dementia than the seniors who didn't volunteer," says Griep.
Volunteer work in the study is defined as an activity done out of free will for no monetary compensation. Moreover, Griep clarifies that "the activity has to benefit others who are not your core family; for example, helping out a church, a school, a library a homeless shelter or some sort of charity organization."
Interestingly, Griep and his co-researchers found that the middle group—those retirees who only volunteered sporadically—did not receive any benefits to their cognitive health. "We discovered that for this group there are no differences than with the group that never volunteered," he says.
Griep can only speculate why there are no cognitive health benefits for the sporadic volunteer camp but he believes it's because they don't receive "the latent benefits of work," as do the regular volunteers. "Work has many benefits beyond just a paycheque," he says.
"It brings a structure to the day, like when we need to be up at seven and at the office for 8:30. It offers social contact with people outside of our family. It brings us the social status we get with a job title. It makes us feel like we're making a meaningful contribution to society. And there's a physical aspect as well, even if it's just walking from your house to the spot where you do your volunteer work.

Researchers strongly recommend retirees volunteer at least once a week

"If you volunteer regularly, it starts to feel like a regular job and you get these benefits of work," Griep explains. The underlying assumption, he says, is that those in the regular volunteering camp stay sharper cognitively because they are continuing to engage their minds in these key ways.
Based on the findings, Griep and his team strongly recommend that retired seniors do volunteer work at least once a week.
"This is an important issue," says Griep. "As a senior, your risk of dementia goes up substantially every year. Anything you can do that's low cost and easy to implement that will reduce the likelihood of developing dementia is invaluable. It's not only beneficial for the health-care system but also for those individuals who might develop dementia, as well as the family members who wind up caring for them."

More information: Yannick Griep et al. Can volunteering in later life reduce the risk of dementia? A 5-year longitudinal study among volunteering and non-volunteering retired seniors, PLOS ONE (2017). DOI: 10.1371/journal.pone.0173885


Provided by University of Calgary

Friday, May 12, 2017

Prediction of conversion to Alzheimer's disease with longitudinal measures and time-to-event data

Predicting the timing of Alzheimer's disease (AD) conversion for individuals with mild cognitive impairment (MCI) can be significantly improved by incorporating longitudinal change information of clinical and neuroimaging markers, in addition to baseline characteristics, according to projections made by investigators from The University of Texas Health Science Center at Houston.

 12 may 2017--In an article published in Journal of Alzheimer's Disease, the research team describes how their novel statistical models found that longitudinal measurements of ADAS-Cog was the strongest predictor for AD progression and the predictive utility was consistently significant with progression of disease.
"The growing public health threat posed by Alzheimer's disease has raised urgency to discover and assess prognostic markers for the early detection of the disease," says Sheng Luo, PhD, senior author of the report. "We assessed the comparative predictive utility of thirty-three longitudinal markers in determining the risk of AD conversion at future time points among individuals with MCI. We found that longitudinal measurements of common cognitive and functional tools can provide more accurate prediction regarding AD conversion than volumetric MRI markers for MCI patients, and markers would show different predictive values at different times in disease progression."
The data used for this study was from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. It was very well suited for the tasks because of its large samples, long follow-up period, breadth of cognitive markers and biomarkers, and prospective nature. "We simultaneously modeled time-to-dementia as well as longitudinal change in the neuropsychological, neuroimaging, and functional/behavioral variables, using joint modelling for longitudinal and survival data. These longitudinal measures may be highly associated with time-to-dementia, and therefore statistical methods that can model both the longitudinal and the time-to-event components jointly are becoming increasingly essential in most observational studies and clinical trials of neurodegenerative disorders such as AD," remarked Dr. Luo.
"The main contribution of the study," according to the lead author Li, "is that it's the first attempt to comprehensively evaluate the comparative predictive ability of longitudinal markers, both clinical and biological, for timing of AD conversion under the joint model framework. We demonstrated that the imaging and other technology-intensive markers are less powerful than cognitive and functional assessments in the prediction of AD conversion. We expect the markers identified as strong predictors in this study along with the joint modeling approach can serve as a useful tool for continuous monitoring of AD progression and treatment effect in the clinical practice."


Provided by IOS Press

Thursday, May 11, 2017

Personalized music may help nursing home residents with dementia

Personalized music may help nursing home residents with dementia
A new study suggests that personalized music has important psychiatric benefits for people with dementia living in nursing homes. 
11 may 2017--Across the country, nursing home employees and families are trying personalized music playlists to help seniors cope with the disorienting, anxious experience of living with Alzheimer's disease and related dementias. Now they can look to the results of the first national study to compare key outcomes in homes that implemented an individualized music program called MUSIC & MEMORY with similar homes that did not adopt the program.
The Brown University evaluation found that after homes adopted the program, residents with dementia became significantly more likely to discontinue antipsychotic and antianxiety medications and significantly less likely to engage in disruptive behaviors, compared to those residing in homes used for comparison. But the study of more than 25,000 residents in 196 nursing homes did not identify a significant improvement in mood.
"This is promising," said co-lead author Rosa Baier, an associate professor of practice at the Brown University School of Public Health. "It's a first step to understanding that there may be improvements that can be attributed to this intervention."
Baier noted that many gerontology experts and advocates for patients have called for ways to reduce the use of antipsychotic and antianxiety medications through a national campaign led by Medicare.
"Providers are looking for non-pharmacologic interventions to address dementia behaviors," she said. "This adds to the evidence base that can help improve patient care for these residents."
The study's findings also reinforce personal reports among caregivers and family members, including those presented in the documentary "Alive Inside," suggesting that personalized music helps patients even when their dementia is highly advanced, said co-lead author Kali Thomas, an assistant professor of health services, policy and practice at Brown. Thomas, who directed the study's evaluation, said her family tried a custom playlist with an uncle with dementia and saw him appear more at ease after listening to his favorite music, including from artists Merle Haggard and Johnny Cash.
"When we put the earphones on him, his breathing relaxed and his grimaced face relaxed," Thomas said.

Measures of music

To better understand how widespread such effects may be and how they might become clinically meaningful, Thomas, Baier and their co-authors designed the new evaluation, published in the American Journal of Geriatric Psychiatry, to test the program's effects with greater national breadth and statistical rigor than previous study designs. The work was part of the mission of Brown's Center for Long-Term Care Quality and Innovation, which tests interventions to improve post-acute and long-term care that appear promising, but haven't yet been rigorously evaluated, said Baier, the center's associate director.
To make their comparison, the team identified 98 nursing homes that had received formal training in the MUSIC & MEMORY program during 2013 and then assembled a list of similar nursing homes—accounting for Medicare quality rating, geography, the age mix of residents and other factors—that did not implement the program. The researchers included in the study all residents in each kind of home who had dementia and cognitive impairment, but who were not receiving hospice care and were not comatose. In all, 12,905 such residents lived in program homes, while 12,811 residents lived in non-program homes.
Using federal Medicare and nursing home data, the researchers then compared the before-2013-and-after changes among residents in each group on four metrics: ending antipsychotic medication, ending antianxiety medication, reductions in disruptive behavior and improvement in mood. While there were no significant differences in mood, here's what they found otherwise:
Antipsychotics: The rate of discontinuing these medications rose to 20.1 percent of program home residents after implementation in 2013 compared to 17.6 percent in a similar period before. By comparison, in non-program homes, the rate stayed flat: 15.2 discontinued after 2013 while 15.9 percent discontinued before.
Antianxiety: The discontinuation rate rose to 24.4 percent after MUSIC & MEMORY implementation in program homes, compared to 23.5 percent before, but in non-program homes the rate fell to 20.0 percent after 2013 compared to 24.8 percent before.
Behavior improvement: The rate of reduction in behavior problems increased to 56.5 percent in program homes from 50.9 percent before the program. In non-program homes the rate stayed flat at 55.9 percent after and 55.8 before.
Behavioral improvements not only help the individual patients, Thomas said, but also enhance quality of life for the residents around them and the morale of nursing home staff.
"Research suggests there is a relationship between nursing staff turnover and residents' behaviors," Thomas said.

The next step

Thomas and Baier acknowledged key limitations in their study. Because they did not track everything each nursing home might be doing to achieve these care improvements, they can't be sure that all the improvements resulted from MUSIC & MEMORY specifically.
On the other hand, because the team didn't know which or how many program home residents actually received the intervention, they had to assume that every eligible resident did. Since it might be that only a fraction of residents on average actually received the interventions in program homes, the results of the study might be understated because they are "diluted" by people who were assumed to receive the intervention but did not.
"In other words, the program may have an even greater impact than reported," Baier said.
To improve their evaluation, Baier, Thomas and their colleagues plan to conduct a second study in which they will randomize some homes to implement the program and some comparison homes to continue without it. By randomizing and collecting data about how the program is implemented, they'll be able to account for the current limitations. They have applied for funding to proceed.

More information: Kali S. Thomas et al, Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia, The American Journal of Geriatric Psychiatry (2017). DOI: 10.1016/j.jagp.2017.04.008


Provided by Brown University

Wednesday, May 10, 2017

Lower incidence of chronic illness for centenarians

Lower incidence of chronic illness for centenarians
10 may 2017—Among elderly veterans, the incidence of chronic illness is lower for centenarians than octogenarians and nonagenarians, according to a study published online April 19 in the Journal of the American Geriatrics Society.

Raya Elfadel Kheirbek, M.D., M.P.H., from the Washington D.C. Veterans Affairs Medical Center, and colleagues conducted a retrospective study involving community-dwelling veterans born between 1910 and 1915 who survived to at least age 80 (31,121 octogenarians, 52,420 nonagenarians, and 3,351 centenarians). The authors examined the cumulative incidence of chronic conditions according to age group.
The researchers found that octogenarians had higher incidence rates of chronic illnesses than centenarians did (atrial fibrillation, 15 versus 0.6 percent; heart failure, 19.3 versus 0.4 percent; chronic obstructive pulmonary disease, 17.9 versus 0.6. percent; hypertension, 29.6 versus 3 percent; end-stage renal disease, 7.2 versus 0.1 percent; malignancy, 14.1 versus 0.6 percent; diabetes mellitus, 11.1 versus 0.4 percent; and stroke, 4.6 versus 0.4 percent). Nonagenarians also had higher incidence rates of chronic illnesses than did centenarians (atrial fibrillation, 13.2 versus 3.5 percent; heart failure, 15.8 versus 3.3 percent; chronic obstructive pulmonary disease, 11.8 versus 3.5 percent; hypertension, 27.2 versus 12.8 percent; end-stage renal disease, 11.9 versus 4.5 percent; malignancy, 8.6 versus 2.3 percent; diabetes mellitus, 7.5 versus 2.2 percent; and stroke, 3.5 versus 1.3 percent).
"Centenarians had a lower incidence of chronic illness than those in their 80s and 90s, demonstrating similar compression of morbidity and extension of health span observed in other studies," the authors write.

More information: Abstract
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Monday, May 08, 2017

'Silent seizures' discovered in patients with Alzheimer's disease


'Silent seizures' discovered in patients with Alzheimer's disease
On the left is Dr. Alica Goldman and on the right is Dr. Jeffrey Noebels. 
Deep in the brains of two patients with Alzheimer's disease, the main memory structure, the hippocampus, displays episodic seizure-like electrical activity. These non-convulsive hippocampal seizures are the first signs of 'silent' brain electrical network dysfunction described in patients with Alzheimer's disease. 

08 may 2017--The discovery, published in the journal Nature Medicine, provides a better understanding of the condition and can potentially lead to new treatments for this devastating disease affecting more than 5 million people in the U.S.
"About 10 years ago, we were surprised to find 'silent seizures' in mouse models of Alzheimer's disease," said co-senior author Dr. Jeffrey L. Noebels, professor of neurology, neuroscience, and molecular & human genetics, and director of the Blue Bird Circle Developmental Neurogenetics Laboratory at Baylor College of Medicine. "When we measured the animal's brain electrical activity, we detected abnormal electrical discharges in the brain with a seizure-like pattern. The mice, however, did not present with convulsions. These 'clinically silent seizures' in the deep regions of the brain, we speculated, could lead to problems of memory."
It's been reported that in a group of patients with Alzheimer's disease, those that have a history of the disease in their families, convulsive seizures are common, especially in advanced cases. However, for most patients with Alzheimer's the condition does not run in the family. In this group of patients, which are said to present with the sporadic form of the disease, convulsive seizures are typically absent. "For this reason, measuring the brain's electrical activity with an electroencephalogram or EEG test is not required for diagnosis and rarely performed," Noebels said.
Even if the test was performed, previous studies in the epilepsy field had shown that seizures deep in the brain, such as the hippocampal region, cannot be detected with routine scalp EEG recordings. Detecting such brain activity requires placing electrodes deep in the brain.

From mouse model to patients

"My colleagues and I have been interested for years in determining whether 'silent seizures' are present in the hippocampus of patients with Alzheimer's disease," Noebels said. "We were able to answer this question when my colleague and senior co-author Dr. Andrew Cole, director of Massachusetts General Hospital Epilepsy Service and professor of neurology at Harvard Medical School, told me that he had two candidates for the procedure."
Cole and Dr. Alice Lam, first-author of the study and a fellow at Massachusetts General Hospital Epilepsy Service, led the team that performed the test in the patients. They used a minimally invasive recording technique involving fine wires inserted through a small natural opening in the skull. This allowed the researchers to monitor this deep region continuously for several days. Simultaneously, the researchers recorded scalp EEG readings.
In the two patients, who had been diagnosed with Alzheimer's disease and had no previous history of epilepsy or behaviorally obvious seizures, the hippocampal recordings showed clear clinically silent seizures. At the same time, the EEG recordings that had been taken simultaneously showed no abnormal brain activity, confirming that EEG tests do not register changes in deep brain activity.
"What was fascinating was that this activity was present at night when the patients were sleeping, a time thought to be critical for the consolidation of recent memories, a trait that is most impaired in early Alzheimer's disease," Noebels said.
"Based on our observations, we are particularly intrigued by the possibility that 'silent seizure' activity per se could contribute to or accelerate the degenerative process underlying Alzheimer's disease," Cole said.
In addition, Noebels and his Baylor colleague, Dr. Alica Goldman, co-author and associate professor of neurology and neurophysiology, performed genetic analysis on the patients' samples.
"We determined that these two patients did not have a gene known to cause epilepsy. So Alica and I, who have been studying epilepsy genes for a long time, sequenced the patients' samples for the three genes known to be linked to Alzheimer's disease," Noebels said. "It turned out that the patients didn't have those either; they present with the sporadic form of the disease."
"It is very exciting that we were able to move from an observation in genetically engineered mouse models of Alzheimer's to a demonstration of the same phenomenon in patients with verified Alzheimer's disease," said Cole. "This is a critical step toward a better understanding of network dysfunction in the disease and opens the window to novel therapeutic approaches for this common condition."
"From a physician's perspective, I think this work opened my eyes toward the need to look deeper into our patients' condition in order to improve the quality of their lives as well as that of their caregivers," Goldman said. "I think this work offers an opportunity for new investigations that could be relevant for moving forward the clinical practice of Alzheimer's disease."

The need for future studies

"This work with two patients proves the concept that 'silent seizures' can occur in patients with Alzheimer's disease," Noebels said.
"Next, we need to determine whether this finding is common in Alzheimer's disease, present in other types of progressive degenerative neurocognitive diseases, and when in the course of the disease it occurs," Cole said.

More information: Silent hippocampal seizures and spikes identified by foramen ovale electrodes in Alzheimer's disease, Nature Medicine (2017). nature.com/articles/doi:10.1038/nm.4330


Provided by Baylor College of Medicine