Tuesday, August 22, 2017

Clear link between heavy vitamin B intake and lung cancer

Study: Clear link between heavy vitamin B intake and lung cancer
High-dose, long-term use of vitamins B12 and B6 dramatically increase a man's risk of lung cancer, especially among those who smoke, according to a new study from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
22 aug 2017--New research suggests long-term, high-dose supplementation with vitamins B6 and B12—long touted by the vitamin industry for increasing energy and improving metabolism—is associated with a two- to four-fold increased lung cancer risk in men relative to non-users.
Risk was further elevated in male smokers taking more than 20 mg of B6 or 55 micrograms of B12 a day for 10 years. Male smokers taking B6 at this dose were three times more likely to develop lung cancer. Male smokers taking B12 at such doses were approximately four times more likely to develop the disease compared to non-users.
Epidemiologists from The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Fred Hutchinson Cancer Research Center and National Taiwan University report their findings in the Aug. 22, 2017 issue of the Journal of Clinical Oncology.
This is the first prospective, observational study to look at the effects of long-term high-dose B6/B12 supplement use and lung cancer risk. These supplements have been broadly thought to reduce cancer risk.
For this study, Theodore Brasky, PhD, of the OSUCCC - James, and colleagues analyzed data from more than 77,000 patients participants in the VITamins And Lifestyle (VITAL) cohort study, a long-term prospective observational study designed to evaluate vitamin and other mineral supplements in relation to cancer risk. All participants were aged between 50 and 76 were recruited in the state of Washington between the years 2000 and 2002. Upon enrolling in the study, participants reported information to researchers about B-vitamin usage over the past 10 years. This included dosage information—a critical but often missing detail needed for strong risk assessment and association research.
Study: Clear link between heavy vitamin B intake and lung cancer
Diana Sullivan, RN examines a patient at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. In a newly published study, researchers there discovered that men who take high-dose vitamin B6 and B12 supplements for a decade had significantly higher risks for developing lung cancer, especially if they also smoked while taking the supplements.
For this new analysis, researchers used statistical techniques to adjust for numerous factors including: personal smoking history, age, race, education, body size, alcohol consumption, personal history of cancer or chronic lung disease, family history of lung cancer and use of anti-inflammatory drugs.
"This sets all of these other influencing factors as equal, so we are left with a less confounded effect of long-term B6 and B12 super-supplementation," explains Brasky. "Our data shows that taking high doses of B6 and B12 over a very long period of time could contribute to lung cancer incidence rates in male smokers. This is certainly a concern worthy of further evaluation."
Brasky notes these findings relate to doses that are well above those from taking a multivitamin every day for 10 years.
"These are doses that can only be obtained from taking high-dose B vitamin supplements, and these supplements are many times the U.S. Recommended Dietary Allowance," he said.
Two additional studies are underway at The OSUCCC - James to further evaluate high dose, long-term B6 and B12 supplementation and lung cancer risk. One study will examine associations in post-menopausal women in order to confirm the current finding of no elevated risk in women. The second will examine B6/B12 high dose, long-term supplementation in a second large prospective study of men in an effort to determine whether the increases risk observed in the current study can be replicated.


Provided by The Ohio State University Comprehensive Cancer Center

Tuesday, August 15, 2017

Singing may be good medicine for Parkinson's patients

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

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

Saturday, August 12, 2017

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

loneliness

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

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

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


Provided by American Psychological Association

Thursday, August 10, 2017

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

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

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

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


Provided by European Society of Cardiology

Sunday, August 06, 2017

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

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

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

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

No longer frail

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

HIIT was well-tolerated

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


Provided by University at Buffalo

Saturday, August 05, 2017

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

drinking wine

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

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

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


Provided by University of California - San Diego

Thursday, August 03, 2017

Worldwide health authorities urged to rethink vitamin D guidelines

vitamin D

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

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


Provided by University of Surrey

Wednesday, August 02, 2017

Poor appetite and food intake in older adults

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

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

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


Provided by American Geriatrics Society

Tuesday, August 01, 2017

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

dementia

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

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

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


Provided by Oxford University Press

Monday, July 31, 2017

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

dementia

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

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

Sunday, July 30, 2017

Dog walking could be key to ensuring activity in later life

dog

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

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

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


Provided by University of East Anglia

Saturday, July 29, 2017


Ketamine for depression encouraging, but questions remain around long-term use

Ketamine
3-D model of Ketamine. 
A world-first systematic review into the safety of ketamine as a treatment for depression, published in the prestigious Lancet Psychiatry, shows the risks of long-term ketamine treatment remain unclear.
Led by researchers from UNSW Sydney and Black Dog Institute, the review examined all prior published studies of ketamine treatment for depression, and finds few existing studies effectively report the safety of repeated doses or sustained use.


29 july 2017--Ketamine research leader UNSW Professor Colleen Loo, who is based at the Black Dog Institute, said these major gaps in the literature must be addressed before ketamine is widely adopted as a clinical treatment for depression.
"Despite growing interest in ketamine as an antidepressant, and some preliminary findings suggesting its rapid-acting efficacy, to date this has not been effectively explored over the long term and after repeated dosing," said Professor Loo, a co-author of the study.
"As ketamine treatment will likely involve multiple and repeated doses over an extended time period, it is crucial to determine whether the potential side effects outweigh the benefits to ensure it is safe for this purpose."
The review follows research revealed earlier this week, which provided preliminary evidence of promising results for ketamine delivered to elderly patients in repeated intravenous doses.
Globally, ketamine is increasingly being used off-label to treat severe and treatment-resistant depression. Also known by its party drug name 'Special K', ketamine is not approved for use in Australia, but has Therapeutic Goods Administration (TGA) approval as an anaesthetic.
Researchers in the current study trawled the literature on ketamine for depression to identify its main side effects and whether these differed between single or repeated dosing. They analysed 288 articles, of which 60 studies met the inclusion criteria, which encompassed a total of 899 patients who had received at least one dose of ketamine.
The results show that despite acute side effects commonly occurring after a single treatment of ketamine, not all studies actively monitored for or reported on them. Side effects were more likely to occur when ketamine was given intravenously, and were usually reported on immediately following a single dose.
The most common side effects reported in the literature were headache, dizziness, dissociation, elevated blood pressure and blurred vision. This is consistent with side effects reported in existing user groups - recreational drug users or those prescribed ketamine for chronic pain. However, most studies only reported on side effects in an ad-hoc way, with a lack of conclusive data available into ketamine's longer-term or cumulative effects.
"Despite low ketamine doses currently being used in depression studies, urological toxicity, liver function abnormalities, negative cognitive affects and risk of dependency may limit the safe use of ketamine as a long-term antidepressant treatment," the authors state.
Previous studies have linked longer-term ketamine use to bladder inflammation, liver damage, cognitive changes like memory loss, and craving or addiction. Very few studies have examined human ketamine dependence, with less than 15 cases described in the scientific literature over the past 20 years.
"Our study also raises questions over the risk of administering ketamine in patients with pre-existing or co-morbid medical conditions, such as those with a history of high blood pressure or heart disease," said Professor Loo.
"For instance, we know that when used to treat chronic pain, ketamine is associated with acute blood pressure changes, and experts recommend lower doses administered through slower-acting, non-intravenous means accordingly."
Future ketamine-related depression studies should focus on assessing the safety of repeated dosing regimes, consider co-morbid physical health factors, and actively assess and report on potential side effects in a systematic way, the authors recommend.
The research team are now developing a new tool to standardise future reporting on these side effects, called the Ketamine Side Effect Tool (K-SET) and Ketamine Safety Screening Tool (KSST), to address inconsistencies in the literature.
Professor Colleen Loo is also currently leading the world's largest independent trial of ketamine to treat depression, testing its effects after twice-weekly treatments over a period of four weeks amongst 200 participants.

More information: Lancet Psychiatry (2017). www.thelancet.com/journals/lan … ulltext?elsca1=tlxpr


Provided by University of New South Wale

Friday, July 28, 2017

World-first ketamine trial shows promise for geriatric depression

World-first ketamine trial shows promise for geriatric depression
Australian researchers have completed the world's first randomised control trial (RCT) assessing the efficacy and safety of ketamine as a treatment for depression in elderly patients.
The results, published in the latest American Journal of Geriatric Psychiatry, provide preliminary evidence suggesting ketamine's effectiveness as an antidepressant when delivered in repeated intravenous doses.

28 july 2017--Led by a team of researchers from UNSW Sydney and Black Dog Institute, the trial tested different doses of ketamine among 16 older age participants (aged over 60 years) who had treatment-resistant depression, administered at Wesley Hospital.
"These findings take us a big step forward as we begin to fully understand the potential and limitations of ketamine's antidepressant qualities," said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
"Not only was ketamine well-tolerated by participants, with none experiencing severe or problematic side effects, but giving the treatment by a simple subcutaneous injection (a small injection under the skin) was also shown to be an acceptable method for administering the drug in a safe and effective way."
Participants received increasing doses of ketamine over a period of five weeks, with doses optimised for each individual participant using a new dose-titration approach developed by Professor Loo's Sydney research team and collaborators.
As part of the double-blind, placebo-controlled trial, an active control treatment which causes sedation similar to ketamine, was used to substitute for one of the treatment sessions. Researchers monitored for mood and other side-effects after each treatment session.
Following the RCT, participants also received 12 ketamine treatments in an open-label phase to investigate the effectiveness of multiple doses of ketamine.
By the six-month follow-up, 43% of participants (7 of 14) who completed the RCT had entered remission, with five remitting at amounts below the commonly-used dose of 0.5 mg/kg. Repeated treatments also resulted in a higher likelihood of remission or a longer time to relapse, with an overall response and remission rate of 68.8% for the patients receiving ketamine treatment.
"Elderly patients with severe depression face additional barriers when seeking treatment for the condition. Many medications may cause more side effects or have lower efficacy as the brain ages," said co-author Dr Duncan George from UNSW.
"Older people are also more likely to have co-morbidities like neurodegenerative disorders and chronic pain, which can cause further complications due to ketamine's reported side effects.
"Our results indicate a dose-titration method may be particularly useful for older patients, as the best dose was selected for each individual person to maximise ketamine's benefits while minimising its adverse side effects."
Previous studies into ketamine treatments for older people with depression – which are limited to just five case reports – show mixed success, with findings limited by small sample sizes.
More broadly, little is known about ketamine's potential side effects at different doses, which include cognitive and dissociative effects, elevated blood pressure and heart rate, liver inflammation and urinary problems.
"These results are a promising early piece of the puzzle, but the risks of ketamine use are still not wholly understood. Future studies with greater sample sizes are needed to formally assess ketamine's side effects, such as its impact on liver function," Professor Loo added.

More information: Duncan George et al. Pilot Randomized Controlled Trial of Titrated Subcutaneous Ketamine in Older Patients with Treatment-Resistant Depression, The American Journal of Geriatric Psychiatry (2017). DOI: 10.1016/j.jagp.2017.06.007


Provided by University of New South Wales

Thursday, July 27, 2017

New global aging index gauges health and wellbeing of aging populations

New global aging index gauges health and wellbeing of aging populations
The five countries in the index coping best with their aging populations are: Norway, Sweden, the United States, the Netherlands and Japan. Credit: John A. Hartford Foundation Index of Societal Aging
27 july 2017--Researchers from Columbia University's Mailman School of Public Health and University of Southern California Schaeffer Center for Health Policy & Economics, with the support of The John A. Hartford Foundation, have developed a new barometer that estimates how countries are adapting to the dramatic increases in the number and proportion of older persons. The Index is composed of specific measures across five social and economic Indicators that reflect the status and wellbeing of older persons in a country and which can be followed over time and used to compare across nations.
"Now that previously unimagined numbers of older persons are living longer it is critical that we shift from our prior sole focus on the characteristics of individuals and their immediate environments to one that includes a strategy for the entire society to successfully adapt to an aging population" said John Rowe, MD, Julius B. Richmond Professor of Health Policy and Aging, Health Policy and Management at the Mailman School of Public Health, who led the interdisciplinary team of researchers.
Developed for 30 countries at the outset, the Index can track national sources of data for countries with aged populations including the United States and Western Europe. A sample analysis of the data shows that the five countries in the index coping best with their aging populations are: Norway, Sweden, the United States, the Netherlands and Japan. (See chart)
"Interestingly, the Index demonstrates that the United States - despite general problems with inequity and social cohesion - has done well in keeping older Americans financially secure, productive, and engaged," noted Dana Goldman, PhD, Distinguished Professor and Leonard D. Schaeffer Director's Chair at the USC Schaeffer Center for Health Policy & Economics.
The John A. Hartford Index of Societal Aging's five indicators provide new context for measuring the health of aging populations including an evidence-based metric to assess effectiveness over time and across many countries. Earlier indexes either made comparisons for a select group of industrialized nations only, sometimes excluding the U.S., were heavily weighted on economic metrics, such as late life labor force participation, did not fully capture inequalities within the advanced developed aging societies or did not measure many other characteristics of an aging society.
"The Index provides an accurate look at how well societies are adapting to this aging challenge," said Goldman. "Utilizing reliable and sensitive economic and social indicators that are widely available, the tool allows countries to take a broader view of both current conditions and likely future demographic realities."
New global aging index gauges health and wellbeing of aging populations
Elements of the index. Credit: John A. Hartford Index of Societal Aging
Elements of The Hartford Index
  • Productivity and Engagement - Measures connectedness within and outside the workforce.
  • Well-being - Measures the state of being healthy.
  • Equity—Measures gaps in well-being and economic security between the haves and have-nots.
  • Cohesion - Measures across generations and social connectedness
  • Security—Measures support for retirement and physical safety.
"Failure to adapt to aging is a risky strategy for a country," noted Rowe. "If we neglect to develop and implement effective policies we will be left with a society rife with intergenerational tensions, characterized by enormous gaps between the haves and the have-nots, and unable to provide needed goods and services for any of its members—especially a progressively older and more dependent population. The good news is this gloomy scenario is avoidable."
In addition to Drs. Rowe and Goldman, the Index was presented at the conference by Cynthia Chen, a postdoctoral fellow at the USC Schaeffer Center who worked on the project. Other members of the MacArthur Research Network on an Aging Society served as advisors to the project.*


Provided by Columbia University's Mailman School of Public Health

Wednesday, July 26, 2017

Using money to buy time linked to increased happiness

happiness

New research is challenging the age-old adage that money can't buy happiness.
The study, led by researchers at the University of British Columbia and Harvard Business School, suggests that using money to buy free time— such as paying to delegate household chores like cleaning and cooking— is linked to greater life satisfaction.

26 july 2017--"People who hire a housecleaner or pay the kid next door to mow the lawn might feel like they're being lazy," said study lead author Ashley Whillans, assistant professor at Harvard Business School who carried out the research as a PhD candidate in the UBC department of psychology. "But our results suggest that buying time has similar benefits for happiness as having more money."
The researchers surveyed more than 6,000 adults in the United States, Denmark, Canada and the Netherlands. Respondents were asked if and how much they spent each month to buy themselves free time. They also rated their life satisfaction, and answered questions about feelings of time stress.
Respondents who spent money on time saving purchases reported greater life satisfaction. The effect held up even after controlling for income.
"The benefits of buying time aren't just for wealthy people," said UBC psychology professor and the study's senior author Elizabeth Dunn. "We thought the effects might only hold up for people with quite a bit of disposable income, but to our surprise, we found the same effects across the income spectrum."
To test whether buying time actually causes greater happiness, the researchers also conducted a field experiment. Sixty adults were randomly assigned to spend $40 on a time saving purchase on one weekend, and $40 on a material purchase on another weekend. The results revealed that people felt happier when they spent money on a time saving purchase than on a material purchase.
Despite the benefits, the researchers were surprised to discover how few people choose to spend their money on time saving purchases in daily life. Even in a sample of 850 millionaires who were surveyed, almost half reported spending no money outsourcing disliked tasks. A survey of 98 working adults asking how they would spend a windfall of $40 also revealed that only two per cent would use it in a way that saved them time.
"Although buying time can serve as a buffer against the time pressures of daily life, few people are doing it even when they can afford it," said Dunn. "Lots of research has shown that people benefit from buying their way into pleasant experiences, but our research suggests people should also consider buying their way out of unpleasant experiences."
The study was published today in Proceedings of the National Academy of Sciences.

More information: Ashley V. Whillans el al., "Buying time promotes happiness," PNAS (2017). www.pnas.org/cgi/doi/10.1073/pnas.1706541114


Provided by University of British Columbia

Tuesday, July 25, 2017

Study finds day-to-day experiences affect awareness of aging, mood

Study finds day-to-day experiences affect awareness of aging, mood

A study of older adults finds an individual's awareness of aging is not as static as previously thought, and that day-to-day experiences and one's attitude toward aging can affect an individual's awareness of age-related change (AARC) - and how that awareness affects one's mood.

25 july 2017--"People tend to have an overall attitude toward aging, good or bad, but we wanted to know whether their awareness of their own aging - or AARC - fluctuated over time in response to their everyday experiences," says Shevaun Neupert, an associate professor of psychology at North Carolina State University and lead author of a paper on the study.
For the study, researchers enrolled 116 participants between the ages of 60 and 90. Each participant took a survey to establish baseline attitudes toward aging. For the following eight days, participants kept a log of daily stressors (such as having an argument), completed a daily evaluation of age-related experiences (such as "I am becoming wiser" or "I am more slow in my thinking"), and reported on their affect, or mood.
"We found that people's AARC, as reflected in their daily evaluations, varied significantly from day to day," says Jennifer Bellingtier, a recent Ph.D. graduate from NC State and co-author of the paper. "We also found that people whose baseline attitudes toward aging were positive also tended to report more positive affect, or better moods."
"People with positive attitudes toward aging were also less likely to report 'losses,' or negative experiences, in their daily aging evaluations," Neupert says.
"However, when people with positive attitudes did report losses, it had a much more significant impact on their affect that day," Neupert says. "In other words, negative aging experiences had a bigger adverse impact on mood for people who normally had a positive attitude about aging."
The study expands on previous work that found having a positive attitude about aging makes older adults more resilient when faced with stressful situations.
The paper, "Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect," is published in the journal The Gerontologist.

More information: Shevaun D. Neupert et al, Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect, The Gerontologist (2017). DOI: 10.1093/geront/gnx055


Provided by North Carolina State University

Monday, July 24, 2017

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

old people
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.
24 july 2017--Now, research from the University of Michigan School of Public Health shows that people of fairly normal weight who never smoked and drank only in moderation have a life expectancy at age 50 that is seven years longer than the average American. They also are able to delay disability up to six years.

Current life expectancy in the United States is about 78 years for men and 82 years for women but for the low-risk group the ages are 85 and 89, respectively.
"It's important to convince people to improve these behaviors in order, not only to live a longer life, but live a long life free of disability," said Neil Mehta, assistant professor of health management and policy at the U-M School of Public Health. "However, from a societal perspective, caring for individuals with disability is very costly and our study shows that risky behaviors are significantly increasing the burden of early disability."
While previous research has focused on life expectancy impacts from the individual behaviors, the study, released today by Health Affairs, is believed to be the first to show the effect of all three factors combined.
Of course, Mehta said, people who have avoided these unhealthy behaviors are not the norm.
"Eighty percent of Americans in their 50s either have smoked or been obese. That's huge," he said. "Our study speaks to the importance of prevention at whatever level that can occur in community health or in public policy."
The study used data from U-M's Health and Retirement Study of Americans age 50 and older that began in 1992. The research sample in 1998 included nearly 15,000 respondents ages 50–74.
The researchers defined the low-risk category as those who never smoked, drank moderately (at the top end, fewer than 14 drinks per week for men and fewer than 7 drinks per week for women) and had a body mass index that was less than the classification for obese (30+)—in other words, those who would be considered normal and overweight (18.5-29.9 BMI).
Although the study did not set out to look at what happens when people change one or more of the behaviors, the team found that non-obese people who had quit smoking for 10 years prior to the study and who drank moderately had overall and disability-free life expectancies that were only one year shorter than non-obese people who had never smoked and were moderate drinkers.
"There is some evidence that you can still do a lot to improve your health, even if you have these risk factors at some point. We've done a great job with smoking cessation but it's not clear where we're going with obesity," Mehta said, adding that current budget proposals in Washington put federal funds targeted at reducing obesity and other prevention measures in jeopardy.

More information: Neil Mehta et al. The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed, Health Affairs (2017). DOI: 10.1377/hlthaff.2016.1569


Provided by University of Michigan

Sunday, July 23, 2017

Self-perceptions of aging

Self-perceptions of aging

In the 1960s, the Beatles sang about wondering whether their true love would still love them as they grew older—after they've lost their hair and are no more adventurous than wanting to knit a sweater.
A group of four studies led by University of Michigan researchers has found that however the hero of the Beatles song turns out, his health—and his wife's health—may be dictated by their perceptions of their own aging.

23 july 2017--"Beliefs about one's own aging are shared within couples, and these beliefs are predictive of future health above and beyond individual beliefs," said Shannon Mejia, a postdoctoral fellow at U-M's Institute for Social Research. "Husbands' and wives' individual experiences of physical activity and disease burden are important for their current shared beliefs and future functional health."
That is, couples who tend to view their aging negatively tend to become less healthy and less mobile than couples who view their aging positively. In addition, husbands' disease burden shape their attitudes toward both their own aging and their wives' aging. Mejia and colleagues surmise that the husbands' limitations stemming from disease negatively affect the wives' health because of the increased burden of caregiving.
Jennifer Sun, an M.D./Ph.D. candidate at the U-M Medical School who conducted the research as a psychology doctoral candidate, found that a person's self-perception of aging affects whether he or she accesses health care in a timely fashion. She found that the more negatively a person viewed his or her aging, the more likely he or she was to delay seeking health care and the more barriers he or she saw for seeking care.
This association between negative self-perceptions of aging and health care delay persisted even after Sun controlled for problems that can delay health care, such as low socioeconomic status, lack of health insurance and multiple chronic health conditions.
"While many studies have focused on financial and structural barriers to care, it is also important to consider how psychosocial, emotional and cognitive factors are affecting the decisions of older adults to delay medical care," Sun said.
A third study authored by U-M doctoral candidate Hannah Giasson found that people who experience age discrimination feel less positive about their own aging.
A fourth study found that as people aged, their explicit bias toward older people—or how they would talk out loud about how they felt toward fellow older adults—improved as they aged. But their implicit bias—how they felt internally about fellow older adults—became more negative as they aged. Giasson and William Chopik, a Michigan State University researcher, led this study.
The papers are published today in a special supplement to the August issue of The Gerontologist.
"We're interested in the way people interpret their own lives," said Jacqui Smith, the principal investigator of a project on well-being in midlife and old age and second author on some of the published papers.
"We know that the images in the world and age stereotypes play a role in how people perceive their own aging. But subtle experiences of discrimination in interactions with strangers and sometimes with your own kids or partner—that is feedback that people take to heart and either rebel against it or begin to believe it."
The AARP supported the publishing of the supplement ahead of the annual meeting of the International Association of Gerontology and Geriatrics.
"Wherever these negative perceptions come from, the damage can be profound—for individuals, communities and larger populations," said AARP CEO Jo Ann Jenkins. "We need to change the conversation about age and aging in this country. It's not about being 'polite.' It's a necessity."


Provided by University of Michigan

Thursday, July 20, 2017

AARP, GSA focus on effects of negative attitudes on aging

The ways in which negative attitudes about aging can affect people's health and quality of life are the focus of 12 peer-reviewed research papers in a new AARP-sponsored supplement issue of The Gerontologist—the respected research and analysis journal published by The Gerontological Society of America (GSA) since 1961.

20 july 2017--"Attitudes and stereotypes about aging haven't changed or have gotten worse. And many ideas about aging and solutions available to us as we age, as portrayed in the media or even in conversations among families and friends, are negative and out of date," said AARP Director of Thought Leadership-Health Erwin Tan, MD.
While the papers examine a diverse range of aging-related subjects and research considerations, a common theme is the prevalence of negative associations about aging and their impact, ranging from memory performance to use of health care. The research explores cultural, geographic, community, and family influences that may play a role in shaping an individual's attitude on aging.
"Wherever these negative perceptions come from, the damage can be profound—for individuals, communities, and larger populations," said AARP CEO Jo Ann Jenkins, whose book "Disrupt Aging" examines how aging is represented in society. "We need to change the conversation about age and aging in this country. This is not about being 'polite,' it's a necessity. "
In addition to elevating a collection of timely and insightful research, the August supplement to the The Gerontologist has a broader goal, according to Jenkins.
"We seek to enlist the aid of gerontologists in helping to change the conversation about what it means to grow older," Jenkins said. "Additionally, we want to remind gerontologists of the critical role they play, not just in academia, but in people's real lives. We are all aging, every day so there is no more mainstream topic than aging."


Provided by The Gerontological Society of America

Monday, July 17, 2017

Elderly yoginis have greater cortical thickness

Elderly yoginis have greater cortical thickness
Yoga practitioners showed greater cortical thickness in a cluster in the left prefrontal cortex.
17 july 2017--Scientists in Brazil have imaged elderly female yoga practitioners' brains and found they have greater cortical thickness in the left prefrontal cortex, in brain areas associated with cognitive functions like attention and memory. The results suggest that yoga could be a way to protect against cognitive decline in old age.

As we age, the structure and functionality of our brains change and this often leads to cognitive decline, including impaired attention or memory. One such change in the brain involves the cerebral cortex becoming thinner, which scientists have shown is correlated with cognitive decline. So, how can we slow or reverse these changes?
You might think medication would be required, but surprisingly, the answer could lie in contemplative practices like yoga. Yoga practitioners consciously maintain postures, and perform breathing exercises and meditation.
"In the same way as muscles, the brain develops through training," explains Elisa Kozasa of Hospital Israelita Albert Einstein in São Paulo, Brazil, a researcher involved in the study, which was recently published in Frontiers in Aging Neuroscience. "Like any contemplative practice, yoga has a cognitive component in which attention and concentration are important."
Previous studies have suggested that yoga can have greater health benefits than similar aerobic exercises, and yoga practitioners have shown improved awareness, attention and memory. Older adults with mild cognitive impairment have also shown improvements after a short yoga training program.
yoga
Credit: CC0 Public Domain
But can practicing yoga over several years significantly shape your brain and if so, could it offset some of the changes that happen in the aging brain? The research team wanted to see if elderly long-term yoga practitioners had any differences in terms of brain structure compared with healthy elderly people who had never practiced yoga.
They recruited 21 female yoga practitioners (also known as yoginis) who had practiced yoga at least twice a week for a minimum of 8 years, although the group had an average of nearly 15 years of yoga practice. The researchers compared the yoginis with another group of 21 healthy women, who had never practiced yoga, meditation or any other contemplative practices, but who were well-matched to the yoginis in terms of their age (all the participants were 60 or over) and levels of physical activity. For more consistent results, the researchers only recruited women, and the participants completed surveys to see if there were any other factors at work that could affect brain structure, such as depression or level of formal education.
The researchers scanned the participants' brains using magnetic resonance imaging to see if there were any differences in brain structure. "We found greater thickness in the left prefrontal cortex in the yoginis, in brain regions associated with cognitive functions such as attention and memory," says Rui Afonso, another researcher involved in the study. As the groups were well-matched in terms of other factors that can change brain structure, such as education and levels of depression, yoga practice appears to underlie the yoginis' different brain structure.
The results suggest that practicing yoga in the long-term can change the structure of your brain and could protect against cognitive decline in old age. However, the team plan to carry out more studies to see if these brain changes result in enhanced cognitive performance in elderly yoginis.
Another possibility is that people with these brain features are more likely to be attracted to yoga. "We have compared experienced yoginis with non-practitioners, so we do not know if the yoginis already had these differences before they started yoga," explains Afonso. "This can only be confirmed by studying people for a few years from the time they start yoga."

More information: Rui F. Afonso et al, Greater Cortical Thickness in Elderly Female Yoga Practitioners—A Cross-Sectional Study, Frontiers in Aging Neuroscience (2017). DOI: 10.3389/fnagi.2017.00201


Provided by Frontiers

Saturday, July 15, 2017

Surgery for early prostate cancer may not save lives

Surgery for early prostate cancer may not save lives
Gerald L. Andriole, M.D., (right) director of Washington University's Division of Urologic Surgery, performs surgery on a patient with prostate cancer. New research provides further evidence that surgery is unnecessary for early-stage prostate cancer, although some men whose disease is further along may benefit.
15 july 2017--A major 20-year study provides further evidence that prostate cancer surgery offers negligible benefits to many men with early-stage disease. In such men, who account for most cases of newly diagnosed prostate cancer, surgery did not prolong life and often caused serious complications such as infection, urinary incontinence and erectile dysfunction.
The study, by a national research team including Washington University School of Medicine in St. Louis, was led by the Minneapolis Veterans Administration Health Care System. It is published July 13 in The New England Journal of Medicine.
In men with early prostate cancer, the study compared surgery with observation. With the latter, men only were treated if they developed bothersome symptoms, such as urinary difficulty or bone pain. Such symptoms may indicate progression of the cancer. Many men in the observation group received no treatment at all because early-stage prostate cancer often grows slowly and rarely causes symptoms.
"The findings will go a long way in helping to improve prostate cancer care," said co-author Gerald L. Andriole, MD, director of Washington University's Division of Urologic Surgery. "About 70 percent of patients newly diagnosed with prostate cancer cases are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors. As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary. We hope the findings will steer doctors away from recommending surgery or radiation to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it's necessary."
The American Cancer Society ranks prostate cancer as the second most common cancer in men and the third-leading cause of cancer deaths among men, after lung and colorectal cancer. In 2017, about 161,360 men will be diagnosed with prostate cancer, and 26,730 will die from it.
The study, known as the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, is one of the largest and longest involving cancer patients. It got underway in 1994 just as the prostate-specific antigen blood test for prostate cancer became routine. With many more men diagnosed with prostate cancer, the standard treatment for all prostate cancers became surgery or radiation, with the thinking that removing or irradiating the tumor would increase survival. But over the next decade, reports of treatment-related complications raised concerns, as did data indicating that most early-stage cancers grew so slowly they were unlikely to cause health problems.
To evaluate any potential benefits of surgery, the researchers randomly assigned 731 men in the U.S. with localized prostate cancer to receive either surgery or observation at one of 44 Department of Veteran Affairs Health Care Centers or eight academic medical centers, including Washington University. The average age of men in the study was 67 at the time of enrollment.
Of the men who had prostate cancer surgery, 223 (61 percent) died of other causes after up to 20 years of follow-up, compared with 245 men (66 percent) in the observation group - a difference that is not statistically different. Further, 27 (7 percent) men in the surgery group died of prostate cancer, compared with 42 men (11 percent) in the observation group, but that difference also is not statistically significant.
However, the data show that surgery may have a mortality benefit in some men, particularly those with a long life expectancy and intermediate-risk prostate cancer. (Such men generally have PSA scores of 10-20 ng/ml and a Gleason score of seven. The latter score signifies tumor aggressiveness.)
"It would be a disservice to dismiss surgery as a viable option for patients with intermediate-risk prostate cancer," said Andriole, the School of Medicine's Robert K. Royce Distinguished Professor of Urologic Surgery. He treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. "For these patients, and for some men with high-risk prostate cancer, surgery is often beneficial, as are other other treatments such as radiation."
Technology has advanced since the study began, allowing physicians to more accurately classify tumors and avoid overtreating patients who have prostate cancer.
Of the 364 men treated with surgery, 53 (15 percent) suffered from erectile dysfunction, and 63 (17 percent) reported having incontinence. Another 45 developed other complications.
"The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often," said senior author Timothy Wilt, MD, a physician-researcher with the Center for Chronic Disease Outcomes Research at the Minneapolis VA Health Care System and a professor of medicine at the University of Minnesota. "Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer."

More information: New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1615869


Provided by Washington University in St. Louis

Wednesday, July 12, 2017

Cognitive function up with adherence to mediterranean diet

Cognitive function up with adherence to mediterranean diet
12 july 2017--For older adults, greater adherence to the Mediterranean diet (MedDiet) and the Mediterranean-DASH diet Intervention for Neurodegeneration Delay (MIND) is associated with improved cognitive function, according to a study published online recently in the Journal of the American Geriatrics Society.
Claire T. McEvoy, Ph.D., from the University of California in San Francisco, and colleagues conducted a cross-sectional study involving 5,907 community-dwelling older adults to examine adherence to dietary patterns. Diet scores were generated for the MedDiet and the MIND diet using food frequency questionnaires. A composite test score of global cognitive function was used to measure cognitive performance.
The researchers found that in fully adjusted models, participants with mid and high MedDiet scores were less likely to have poor cognitive performance than those with low scores (odds ratios, 0.85 [95 percent confidence interval, 0.71 to 1.02; P = 0.08] and 0.65 [95 percent confidence interval, 0.52 to 0.81; P < 0.001]). Similar results were seen for the MIND diet. In each dietary pattern, higher scores were independently correlated with significantly better cognitive function (P < 0.001) in a dose-response pattern (Ptrend < 0.001).
"Clinical trials are required to elucidate the role of dietary patterns in cognitive aging," the authors write.
One author disclosed financial ties to Takeda Pharmaceuticals.

More information: Abstract
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