Returning killer T cells back to barracks could improve vaccines

Regulatory T cells police the immune system, making sure that killer T cells coming back from battling pathogens transition into a resting state, but still prepared to fight if the pathogen returns. The researchers say these findings are important for the development of more effective, faster-acting vaccines. Credit: Surojit Sarkar, Vandana Kalia, Yevgeniy Yuzefpolskiy

Just as militaries need to have trained, experienced soldiers ready for future wars, making sure that the immune system has enough battle-ready T cells on hand is important for fast-acting, more effective vaccines, according to Penn State researchers.

17 jun 2015--In a study of immune response in mice, the researchers found that regulatory T cells—Tregs—are critical for the immune system's ability to remember and fight off future pathogen attacks. T cells, which are specialized types of white blood cells, play important roles in the immune system and immunological memory.

"Immunological memory is the capability of your immune system to remember the diseases and pathogens it fought off in the past, and the generation of long-lived immunological memory is the basis of effective vaccination," said Surojit Sarkar, assistant professor of immunology in veterinary and biomedical sciences.

Sarkar likens the immune system, which is made up of many different cells, to an army that battles pathogens and diseases that are invading the body. Initially T cells are called up to attack the pathogens, but these cells, called naïve T cells, have no experience or immediate defenses against the invader. As the T cells increase in number and generate defenses to take on the threat, they become effector—or killer—T cells.

Once the battle is over, though, the immune system retains some killer T cells that have encountered the pathogen as memory T cells, Sarkar said.

"Once the T cells clear the pathogen, just like in warfare, you do not leave your weapons drawn, you holster them," said Sarkar. "In the case of the immune system, those charged killer T cells also downregulate their killer machinery."

The researchers found that the regulatory T cells, another type of T cell commonly known for their role in preventing the immune system from attacking the body's own cells and tissues—autoimmunity—suppressed the killer T cells through a protein on their surface—cytotoxic T-lymphocyte associated protein-4.

"I like to think of Tregs as the police of our immune system—their job is to keep other immune cells in check, said Vandana Kalia, assistant professor of immunology in veterinary and biomedical sciences, who worked with Sarkar on the study. "In the case of memory T cells, Tregs serve to keep their killer functions in check and help maintain them in a quiescent, yet ready to kill, state."

She added that the CTLA-4, expressed at high levels on Tregs, applies the brakes on these activated killer T cells to slow them down.

According to the researchers, who report their findings in today's (June 16) issue of Immunity, the study could have a far-reaching impact on immunity to a wide array of infectious diseases and even cancer vaccines and tumor immunity.

The researchers suggest that accelerating T cell memory following an immunization could lead to vaccines that become effective more quickly. For example, health care workers who are preparing to go to the field to fight an epidemic might only need to wait days, rather than weeks, for their vaccinations to become effective.

The findings could also help guide the development of future vaccines.

"What our study is doing is looking at the basic concepts of how the immune system's memory develops and such fundamental information is critical for advancing our current vaccine development efforts," said Kalia.

Although the last few decades have established the importance of immunological memory in vaccination, the basic idea has been known for centuries, said Sarkar.

"The Greek historian Thucydides observed that people who had been exposed to the plague once—and survived it—felt more comfortable helping other plague victims because they knew that they would not be attacked fatally again," said Sarkar.

Provided by Pennsylvania State University

Eating up to 100 g of chocolate daily linked to lowered heart disease and stroke risk

Chocolate. Credit: Wikimedia Commons

Eating up to 100 g of chocolate every day is linked to lowered heart disease and stroke risk, finds research published online in the journal Heart.

16 JUN 2015--There doesn't seem to be any evidence for cutting out chocolate to lower the risk of cardiovascular disease, conclude the researchers.

They base their findings on almost 21,000 adults taking part in the EPIC-Norfolk study, which is tracking the impact of diet on the long term health of 25,000 men and women in Norfolk, England, using food frequency and lifestyle questionnaires.

The researchers also carried out a systematic review of the available international published evidence on the links between chocolate and cardiovascular disease, involving almost 158,000 people—including the EPIC study participants.

The EPIC-Norfolk participants (9214 men and 11 737 women) were monitored for an average of almost 12 years, during which time 3013 (14%) people experienced either an episode of fatal or non-fatal coronary heart disease or stroke.

Around one in five (20%) participants said they did not eat any chocolate, but among the others, daily consumption averaged 7 g, with some eating up to 100 g.

Higher levels of consumption were associated with younger age and lower weight (BMI), waist: hip ratio, systolic blood pressure, inflammatory proteins, diabetes and more regular physical activity —all of which add up to a favourable cardiovascular disease risk profile.

Eating more chocolate was also associated with higher energy intake and a diet containing more fat and carbs and less protein and alcohol.

The calculations showed that compared with those who ate no chocolate higher intake was linked to an 11% lower risk of cardiovascular disease and a 25% lower risk of associated death.

It was also associated with a 9% lower risk of hospital admission or death as a result of coronary heart disease, after taking account of dietary factors.

And among the 16,000 people whose inflammatory protein (CRP) level had been measured, those eating the most chocolate seemed to have an 18% lower risk than those who ate the least.

The highest chocolate intake was similarly associated with a 23% lower risk of stroke, even after taking account of other potential risk factors.

Of nine relevant studies included in the systematic review, five studies each assessed coronary heart disease and stroke outcome, and they found a significantly lower risk of both conditions associated with regular chocolate consumption.

And it was linked to a 25% lower risk of any episode of cardiovascular disease and a 45% lower risk of associated death.

This is an observational study so no definitive conclusions about cause and effect can be drawn. And the researchers point out that food frequency questionnaires do involve a certain amount of recall bias and underestimation of items eaten.

Reverse causation—whereby those with a higher cardiovascular disease risk profile eat less chocolate and foods containing it than those who are healthier—may also help to explain the results, they say.

Nevertheless, they add: "Cumulative evidence suggests that higher chocolate intake is associated with a lower risk of future cardiovascular events."

And they point out that as milk chocolate, which is considered to be less 'healthy' than dark chocolate, was more frequently eaten by the EPIC-Norfolk participants, the beneficial health effects may extend to this type of chocolate too.

"This may indicate that not only flavonoids, but also other compounds, possibly related to milk constituents, such as calcium and fatty acids, may provide an explanation for the observed association," they suggest.

And they conclude: "There does not appear to be any evidence to say that chocolate should be avoided in those who are concerned about cardiovascular risk."

More information: Habitual chocolate consumption and risk of cardiovascular disease among healthy men and women

Provided by British Medical Journal

Elder abuse is common around the world

A new global review reveals that elder abuse—which includes psychological, physical, and sexual abuse; neglect; and financial exploitation—is common among community-dwelling older adults and is especially prevalent among minority older adults. Older adults with cognitive and physical impairments or psychosocial distress are also at increased risk of elder abuse.

16 jun 2015--In North and South American epidemiological studies, the prevalence of elder abuse ranged from about 10% among cognitively intact older adults to 47% in older adults with dementia. In Europe, the prevalence varied from 2% in Ireland to 61% in Croatia. In Asia, the highest prevalence was found among older adults in China (36%), while the lowest was reported among older adults in India (14%). In Africa, the prevalence ranged between 30% and 44%.

The findings suggest that health professionals should consider integrating routine screening of elder abuse in clinical practice, especially among high-risk populations. Specific guidance is provided in the review for healthcare professionals to manage potential elder abuse cases.

"The epidemics of elder abuse and our societal inability to sufficiently protect the most vulnerable population are only compounded by their increased risks for premature death, psychosocial distress, use of emergency departments, hospitalization, and nursing home placement," said Dr. XinQi Dong, lead author of the Journal of the American Geriatrics Society review. "Systematic, coordinated and targeted research, education, advocacy, and policy efforts are needed to protect, prevent, and serve our golden population in diverse communities."

World Elder Abuse Awareness Day is today-June 15, 2015.

More information: Journal of the American Geriatrics Society 2015. DOI: 10.1111/jgs.13454

Provided by Wiley

Chamomile tea tied to longer lives for Mexican-American women

But study did not determine how much was consumed, and only found an association, not cause-and-effect link.

15 jun 2015—Consumption of chamomile may be linked to a longer lifespan for older Mexican-American women, new research suggests.

The study, funded by the U.S. National Institutes of Health, found that among Mexican-American women who consumed chamomile, the risk of death during the study period was reduced by about 28 percent.

"Drinking chamomile tea is beneficial to the health of Mexican-American women," said the study's lead author, Bret Howrey, assistant professor of family medicine at the University of Texas Medical Branch in Galveston.

However, the study only showed evidence of a possible link between chamomile and longer lifespan. It didn't prove a cause-and-effect relationship.

And at least one nutritionist questioned the validity of the study's findings.

The herb chamomile is a mainstay of alternative medicine, and practitioners often recommend it to treat conditions like stomach problems and cramps, according to the study. But "few well-designed and controlled human studies have been conducted on the effects of herbal teas or herbal preparations," said Diane McKay, an assistant professor with the Friedman School of Nutrition Science and Policy at Tufts University, who's familiar with the study findings.

Researchers examined the findings from almost 1,700 Mexican-American people from the southwest United States. They were all 65 and older, and were tracked from 2000 to 2007. About 14 percent of the participants reported using chamomile, according to the study.

Using chamomile didn't seem to affect lifespan in men, the study found.

When researchers adjusted the statistics to account for factors such as age, smoking and chronic health conditions, they found the odds of dying during the study period were reduced by just over one-quarter in women who used chamomile.

Why might chamomile affect lifespan and health in general? It's unclear. "Our understanding of chamomile is still really in its infancy," Howrey said.

He added that the study itself has limitations: It's based entirely on research into a Mexican-American community. Only 26 percent of those in the study had a normal weight. Also, there's no information on the overall diet of the participants. Those who consumed chamomile could have healthier diets overall, although the researchers did try to take factors such as fitness and weight into account.

The study also says nothing about people who aren't Mexican-American, Howrey said. And he noted that the study doesn't eliminate the possibility that men could benefit from chamomile. The study may not have picked up a benefit for them due to lower rates of chamomile consumption (just 8 percent of men reported using it) or worse health overall, he said.

McKay called the study "deeply flawed." She said the findings don't support the idea that chamomile affects lifespan.

Among other weaknesses, she said, the study doesn't explain how participants consumed chamomile: "We can't say for sure whether these folks actually drank the same chamomile tea we find on our store shelves, or even how much they drank and how often. No information was collected on the actual form of chamomile used, i.e., whether it was tea, pill or other type of preparation, or whether it was actually consumed rather than used as a lotion or inhaled oil, for example."

Howrey acknowledged that the study says nothing about how much chamomile to take. Still, he recommends consuming chamomile, especially since it's "generally non-toxic, relatively inexpensive, and widely available."

He mentioned one caveat—some people may be allergic to chamomile, especially if they're allergic to related plants such ragweed.

Howrey said the researchers are continuing to track the older Mexican-Americans. However, "if the effects of brewed chamomile are very subtle and benefits slow to manifest," a more extensive study would be needed, he said.

The study was published recently in the journal The Gerontologist.

Patients with primary hand OA should not be prescribed hydroxychloroquine

The results of an interventional trial presented today at the European League Against Rheumatism Annual Congress (EULAR 2015) showed that use of the disease-modifying anti-rheumatic drug hydroxychloroquine for 24 weeks did not diminish mild-moderate pain from primary hand osteoarthritis (OA). Furthermore, treatment did not improve overall physical, social and emotional wellbeing. These findings suggest that hydroxychloroquine should no longer be routinely prescribed for patients with this form of arthritis.

14 jun 2015--OA is the most common type of arthritis, causing significant joint pain and disability. Population data suggest symptomatic hand OA affects around 8% of people aged 60 or over, and 26% of women and 13% of men aged 70 or over.

Current pharmacological treatment options of hand OA are limited as they have been shown to only work for short periods and are not effective for all patients. In addition, many of these treatments have side-effects which restrict their use. Hydroxychloroquine has been used successfully in the treatment of mild rheumatoid arthritis and other autoimmune diseases for many years, and was believed to be beneficial in hand OA as well.5

"The findings from our trial do not support the prescription of hydroxychloroquine for patients with mild-moderate pain from hand osteoarthritis, neither on a physical nor emotional level," said Mrs. Natalja M Basoski, lead researcher, of the Department of Rheumatology, Maasstad Ziekenhuis, Rotterdam, Netherlands. "However, further investigations will need to be performed to determine whether hydroxychloroquine relieves pain in other specific phenotypes of hand OA," she added.

Results showed that 24 weeks of treatment with hydroxychloroquine in symptomatic hand OA did not significantly reduce pain when compared to placebo. In addition, hydroxychloroquine showed no overall effect on pain, disability and joint stiffness, as measured by the Australian Canadian Hand Osteoarthritis Index (AUSCAN), and no overall change was observed in physical, social and emotional wellbeing scores, as measured by Arthritis Impact Measurement Scale 2 SF (AIMS2-SF) scales.

Two hundred and two patients aged 40 years or older with primary hand OA were recruited from rheumatology clinics from six different hospitals in the Rotterdam region, between July 2010 and December 2013. Subjects were randomly assigned to receive either oral hydroxychloroquine 400mg once a day (n=100) or placebo (n=102) for 24 weeks. Paracetamol was used as rescue medication.

The primary outcome for this trial was a decrease of hand pain in the previous 24 hours, following 24 weeks of treatment, as rated on a visual analogue scale (VAS). Secondary outcomes included VAS pain ranked at 6 and 12 weeks, change in total score of the AUSCAN Index and the AIMS2-SF at the end of the study.

Provided by European League Against Rheumatism

Study sheds light on atrial fibrillation symptoms, quality of life

Most patients with atrial fibrillation—the most common type of abnormal heart rhythm—experience multiple symptoms and decreased quality of life, according to a large, nationally representative study. The findings may lead to more targeted interventions in these patients, says a Yale researcher.

13 jun 2015--Atrial fibrillation (AF) is an irregular, rapid heart rate that affects circulation and raises the risk of stroke and death in patients. Prior to the study, research on AF symptoms and quality of life had generally been done on smaller, select patient groups, said lead author and assistant professor of medicine (cardiology) Dr. James V. Freeman. To confirm previous findings and evaluate patient outcomes in a larger population, the researchers used data on more than 10,000 patients from the Outcomes Registry for Better Informed Treatment of AF.

The researchers found that in most cases—62%—patients had symptoms (palpitations, difficulty breathing with exertion, fatigue, lightheadedness) and 17% had severe or disabling symptoms. They noted a clear correlation between the burden of the AF symptoms and patient reports of diminished quality of life.

The most novel finding was that patients with the worst symptoms were younger and generally healthier, yet more likely to be hospitalized. "That's unusual," said Freeman. "This means that by targeting interventions to control the AF rhythm and impact symptoms, we may be able to keep these patients out of the hospital and have an impact on healthcare utilization." 

The study published this week online in Circulation: Cardiovascular Quality and Outcomes.

More information: "Association Between Atrial Fibrillation Symptoms, Quality of Life, and Patient Outcomes: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)." Circ Cardiovasc Qual Outcomes. DOI: 10.1161/CIRCOUTCOMES.114.001303

Provided by Yale University

More women turning to CAM for menopause without medical guidance

The use of complementary and alternative medicine (CAM) is increasing for the treatment of menopausal symptoms but often without the guidance of a clinician. That's according to a new study reported online today inMenopause, the journal of the North American Menopause Society (NAMS). As a result, the authors suggest that healthcare providers—in particular family medicine practitioners—need to be more aware of the various CAM therapies and take a more active role in guiding patients through their options to more safely and effectively coordinate their care.

12 jun 2015--Ongoing fear of the potential risks of hormone therapy is cited as a primary reason for the growing use of CAM among menopausal women (including pre-, peri- and postmenopausal) in recent decades. CAM is a general term for healthcare practices and products not associated with the conventional medical profession. Some of the more commonly accessed CAM practitioner groups include massage therapists, naturopaths/herbalists, chiropractors/osteopaths, and acupuncturists. The more popular self-prescribed CAM supplements/activities include vitamins/minerals, yoga/meditation, herbal medicines, aromatherapy oils and/or Chinese medicines.

Although there is still ongoing debate within the medical industry regarding the proven effectiveness of CAM alternatives, the point of this study was to confirm that most adults seeking treatment for their symptoms purchase CAM products or services without the guidance of a healthcare practitioner. It is estimated that 53 percent of menopausal women use at least one type of CAM for the management of such menopause-related symptoms as hot flashes, night sweats, anxiety, depression, stiff or painful joints, back pain, headaches, tiredness, vaginal discharge, leaking urine and palpitations.

This raises major safety concerns, according to the authors, since much of the use of self-prescribed CAM products is done without a medical consultation. The greatest safety concern relates to the large percentage of menopausal womenwho typically use CAM products concurrently with conventional medicine but who may be unaware of the possible herb-drug interactions.

'There is still much to be learned in the CAM arena and women need to understand that just because something appears natural does not necessarily mean it is without risk, especially for certain populations,' says NAMS Medical Director Wulf Utian, M.D., Ph.D., D.Sc. 'In the meantime, this study does a good job of alerting clinicians to the growing interest in CAM alternatives and of the critical role of health providers in helping educate patients on the potential risks and benefits of all options.'

More information: The article, 'Longitudinal analysis of associations between women's consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010' will be published in the January 2016 print edition of Menopause.

Provided by The North American Menopause Society

Who your doctor is could dictate how you're cared for at end of life

Credit: Petr Kratochvil/public domain

New research from Brigham and Women's Hospital finds that physician characteristics are the strongest predictor of whether a patient will be referred to hospice care.

11 jun 2015--Individual physicians are widely believed to influence the kind of care their patients receive at the end of life, but to date, there is little scientific evidence to support this belief. New research from Brigham and Women's Hospital (BWH) indicates that the individual physician a patient sees is the strongest known predictor of whether or not he or she will enroll in hospice care, outweighing other known drivers such as geographic location, patient age, race and comorbidities.

These findings are published in the June 2015 issue of Health Affairs.

"We found that the physician a patient sees is the single most important predictor we know of whether or not that patient enrolls in hospice care," said Ziad Obermeyer, MD, a physician researcher in the Department of Emergency Medicine at BWH, Assistant Professor of Emergency Medicine at Harvard Medical School, and lead author of the paper. "This new information provides a clear policy target for improving and advancing the quality of care for patients at the end of their lives."

Researchers used a nationally representative Medicare sample to identify people with a poor-prognosis cancer diagnosis who would have been eligible for hospice care before they died, using a palliative care screening algorithm from a large cancer center, from 2006-2011. The sample included 198,948 patients who, on average, were 78 years-old, 88 percent white and 52 percent male. The 66 percent who enrolled in hospice were more likely to be female, white and live in ZIP codes with higher median incomes, when compared to patients not enrolled in hospice.

Researchers calculated the proportion of a physician's patients that were enrolled in hospice care, as a measure of their propensity to refer their patients to hospice. After controlling for patient, hospital, and geographic factors that predict hospice enrollment, they found that patients would be 27 percent more likely to enroll in hospice if they saw a physician in the top 10 percent of hospice use, compared to a physician in the bottom 10 percent. Additionally, researchers report that large numbers of cancer patients in this cohort were seen in a relatively small group of physicians.

"Our data show that about 10 percent of physicians cared for about half of all patients. This suggests that we can target a small group of physicians with interventions geared towards physician specialty and how often their patients enroll in hospice to improve end of life care," Obermeyer said.

Researchers found that regional factors, greater comorbidity and physician specialty were all significantly associated with the likelihood of hospice enrollment, which generally increased over time. They also noted a new, albeit small effect on the likelihood of hospice enrollment: physicians associated with for profit hospitals were less likely to have patients enroll when compared to physicians affiliated with non-profit hospitals. Obermeyer suggests that further research exploring this link is warranted.

"As an emergency physician, I am often the first person to ask patients about what kind of care they want at the end of their life. In these situations, patients and their families often have only hours to make difficult and complex decisions," said Obermeyer. "As physicians, we need to have these conversations earlier. We need to know what our patients really want at the end of their lives. We need to remove the barriers to having these discussions and give our patients the care they actually want."

Provided by Brigham and Women's Hospital

Resilience to stress may be key for long-term health

Reacting positively to stressful situations may play a key role in long-term health, according to researchers.

10 jun 2015--In a study measuring adults' reactions to stress and how it affects their bodies, researchers found that adults who fail to maintain positive moods such as cheerfulness or calm when faced with the minor stressors of everyday life appear to have elevated levels of inflammation. Furthermore, women can be at heightened risk.

Inflammatory responses are part of the body's ability to protect itself via the immune system. However, chronic—long-term—inflammation can undermine health, and appears to play a role in obesity, heart disease and cancer.

These findings add to growing body of evidence regarding the health implications of affective reactivity—emotional response—to daily stressors. The researchers report their results in a recent edition of Health Psychology.

Nancy Sin, postdoctoral fellow in the Center for Healthy Aging and Department of Biobehavioral Health, Penn State and her colleagues showed that the frequency of daily stressors, in and of itself, was less consequential for inflammation than how an individual reacted to those stressors.

"A person's frequency of stress may be less related to inflammation than responses to stress," said Sin. "It is how a person reacts to stress that is important."

Sin's findings also highlight the important—but often discounted—contributions of positive affect in naturalistic stress processes.

"Positive emotions, and how they can help people in the event of stress, have really been overlooked," Sin said.

In the short-term, with illness or exercise, the body experiences a high immune response to help repair itself. However, in the long term, heightened inflammatory immune responses may not be healthy. Individuals who have trouble regulating their responses may be at risk for certain age-related conditions, such as cardiovascular disease, frailty and cognitive decline, Sin said.

"To our knowledge, this paper is the first to link biomarkers of inflammation with positive mood responses to stressors in everyday life," said Jennifer E. Graham-Engeland, associate professor of biobehavioral health, Penn State.

A cross-sectional sample of 872 adults from the National Study of Daily Experiences reported daily stressors and emotional reactions for eight consecutive days. Blood samples of participants were obtained during a separate clinic visit and assayed for inflammatory markers.

Subjects were interviewed by phone every day for eight consecutive days. They were asked to rate their positive and negative emotions, as well as whether or not they encountered stressors. This enabled researchers to evaluate a person's emotional response on days when they experience stressors, and compare it to days when they do not.

"We calculated reactivity scores to see how participants generally reacted to stressors," Sin said. "Then we used it to predict two markers of inflammation."

The researchers used several different types of stressors, among them were arguments and avoiding arguments at work, school or home; being discriminated against; a network stressor, i.e., a stressful event that happens to someone close to the subject; and other stressors.

"We examined both positive and negative affective reactions to stress and compared the effects of stress exposure with responses to stressors," Graham-Engeland said. "Little is known about the potential role of daily stress processes on inflammation. Much of the relevant past research with humans has focused on either chronic stress or acute laboratory-based stress—methods that do not fully capture how people respond to naturalistic stressors in the context of daily life."

Data came from the second wave of the Midlife in the United States Study, a national survey designed to investigate health and well-being in midlife and older adulthood. Its goal is to expand understanding of how daily mood and stressful events may relate to inflammation and health.

Provided by Pennsylvania State University

Cloud-based neuroimaging analysis could aid Alzheimer's diagnosis

These images were generated through the CapAIBL CSIRO Biomedical Imaging Group. Credit: CSIRO Biomedical Group

Alzheimer's disease remains a chronic, incurable neurodegenerative disease and a worldwide health concern. Equally as important as developing comprehensive diagnostic tests is finding a means of normalizing all the ensuing data—and that technology has arrived, say researchers at the 2015 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

09 jun 2015--The novel cloud-based software analyzes imaging data from a method of molecular imaging called positron emission tomography (PET). Different from X-ray and CT scanners, PET allows the visualization of physiological functions, including processes taking place in vital brain anatomy. Nuclear medicine physicians use PET to highlight abnormal patterns of proteins strongly linked to the development of Alzheimer's. These naturally occurring proteins include beta-amyloid, associated with the build-up of plaques, and tau, linked to neurotoxic tangles in the brain. A range of PET and magnetic resonance imaging (MRI) tracers are used to find these and other signs of neurodegenerative disease. However, clinical evaluation can vary due to differences in imaging protocols and discrepancies in visual interpretation, which proves challenging for even the most highly trained specialist.

Scientists and programmers have created a cloud-based imaging software that quantifies and compares PET data in a standardized format. Within a couple of hours, this web-based computing platform can analyze and report on data obtained from a range of PET imaging techniques. If implemented, this software could revolutionize the standard of care for patients and families awaiting a difficult diagnosis.

"This program could allow health professionals to provide earlier and more accurate diagnoses with more confidence, which could lead to earlier and more appropriate treatment for neurodegenerative disease," said Victor Villemagne, MD, a leading molecular imaging researcher at Austin Health, Heidelberg in Victoria, Australia. "The reporting could also be used to make diagnostic information more accessible to patients and their caregivers."

For this study, researchers involved in the Australian Imaging, Biomarker and Lifestyle (AIBL) Flagship Study applied the program, called Computational Analysis of PET (CapAIBL) to imaging data from 454 participants scanned using both MRI and PET. The latter was performed with one of six injectable imaging agents that combine a small amount of radioactive material with a molecular compound that binds with amyloid in the brain. The research showed that CapAIBL was able to quantify PET data accurately without the use of additional MRI scans and with consistent results using all of the assessed imaging agents.

"This innovative program uses a process called 'machine learning' to compare patients' scans with a range of normal and abnormal scans previously processed using MRI to find the closest match and then uses this information to analyze the information with no need for a new MRI," said Villemagne. "Much like a blood test, the results are presented as a number along a range from normal to abnormal and also mapped using a visual representation of patients' brains."

The study included a number of PET imaging techniques using agents that bind to amyloid deposits in the brain: 381 PET scans using the imaging agent carbon-11 Pittsburgh compound B (C-11 PiB); 180 scans using fluoride-18 (F-18) flutemetamol; 171 scans using F-18 florbetapir; 148 scans using F-18 florbetaben; 47 scans using F-18 NAV4694; and 34 scans using F-18 fluorodeoxyglucose (FDG), a common radiotracer that gauges cellular metabolism by mimicking glucose as a source of fuel inside the cells. The next phase of research is set to include PET data using tau imaging agents, which could provide additional information about disease progression, either alone or in conjunction with amyloid imaging.

An estimated 47.5 million people have been diagnosed with dementia worldwide, with 7.7 million new cases reported annually. Alzheimer's disease accounts for as much as 70 percent of these cases, according to 2015 World Health Organization (WHO) statistics.

More information: Scientific Paper 149: "Computational Analysis of PET by AIBL (CapAIBL): A cloud-based processing pipeline for the quantification of PET images"

Provided by Society of Nuclear Medicine

Aging couples connected in sickness and health

As the world's population of older adults increases, so do conversations around successful aging—including seniors' physical, mental and social well-being.

08 jun 2015--A variety of factors can impact aging adults' quality of life. Two big ones, according to new research from the University of Arizona, are the health and cognitive functioning of a person's spouse.

Analyzing data from more than 8,000 married couples—with an average age in the early 60s—researchers found that the physical health and cognitive functioning of a person's spouse can significantly affect a person's own quality of life.

The findings have implications for how to most effectively address quality-of-life issues in people's later years.

"When we think about quality of life for older adults, and improving quality of life, it seems like targeting the individual is only part of the story, and our findings suggests that for older adults, a larger part of individual well-being is defined by our partner's health and cognitive functioning as well," said UA psychologist David Sbarra, a co-author of the paper, which will be published in Psychology and Aging, a journal of the American Psychological Association.

The population of Americans age 65 years or older is expected to double during the next 25 years to about 72 million, as baby boomers age and people live longer. By 2030, older adults will account for roughly 20 percent of the U.S. population and health-care spending will increase by 25 percent, largely because of the aging population, according to the Centers for Disease Control and Prevention.

"As we build public health interventions for our aging population when it comes to quality of life, we need to take a more dyadic approach, looking at both partners," said Sbarra, an associate professor in the UA Department of Psychology with joint appointments in Family Studies and Human Development (link sends e-mail) and the Evelyn F McKnight Brain Institute.

The study was based on analysis of data from the Survey of Health, Aging and Retirement in Europe, or SHARE study, of adults age 50 and older. The data was collected at three intervals over a six-year period, between 2004-2005 and 2010-2011.

UA researchers considered survey respondents' self-reports of physical health and quality of life, as well as their scores on cognition tests measuring verbal fluency, word recall and delayed word recall. The UA study looked at health and cognition across a normal spectrum, rather than focusing on clinical cognitive disorders or chronic illnesses.

The findings support existing research on the interdependence of older married couples, and they extend that research by identifying cognition and physical health as two specifically important factors that influence spouses' quality of life.

Kyle Bourassa, a UA doctoral student in clinical psychology and the paper's lead author, said husbands' and wives' quality of life appears to be equally impacted by their spouse's physical health, with no differences across gender lines. In other words, a wife's physical health impacts her husband's quality of life as much as a husband's physical health affects his wife's quality of life.

"If you have people whose physical health is low—maybe they're suffering from an illness or unable to walk—those kind of physical health issues not only impact the individual but the person they're married to as well," Bourassa said. "Their husband or wife is the one who may have to adjust and help with their partner's new lifestyle."

With regard to cognition, wives' cognitive functioning appears to have as much of an effect of husbands' quality of life as husbands' own cognitive abilities. Wives' quality of life was not as strongly affected by their husbands' cognition, but there was a measurable impact, Bourassa said.

Finally, changes in participants' self-reported overall quality of life at the three intervals in the SHARE survey varied similarly between husbands and wives, suggesting that change in one spouse's life quality over time parallels change in the other's.

As adults age, changes in physical health can be a natural part of the process, as can cognitive decline, which can range from normal change in cognition to the onset of disorders such as dementia or Alzheimer's disease. As this change can vary dramatically between different people, it makes sense to look at both physical health and cognition as they relate to quality of life for both partners, Bourassa said. Additional research is needed to determine how changes in these two areas can change quality of life over time, he said.

"The population of aging adults is going up drastically, and as we have more and more people who are living longer and longer it's really important to understand successful aging," said Bourassa, whose co-authors on the paper included Sbarra and UA psychology doctoral students Molly Memel and Cindy Woolverton.

Said Bourassa: "You could extend these findings to think about interventions targeting cognition and physical health to improve quality of life not only for the individual, but also for their partner."

Provided by University of Arizona

Strokes steal eight years' worth of brain function, new study suggests

The new study shows that having a stroke robbed older adults of about eight years' worth of brain function. Credit: University of Michigan

Having a stroke ages a person's brain function by almost eight years, new research finds - robbing them of memory and thinking speed as measured on cognitive tests.

07 JUN 2015--In both black and white patients, having had a stroke meant that their score on a 27-item test of memory and thinking speed had dropped as much as it would have if they had aged 7.9 years overnight.

For the study, data from more than 4,900 black and white seniors over the age of 65 was analyzed by a team from the University of Michigan U-M Medical School and School of Public Health and the VA Center for Clinical Management Research. The results will be published in the July issue of Stroke.

Researchers married two sources of information for their analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in a large, national study of older Americans, and Medicare data from the same individuals.

They zeroed in on the 7.5 percent of black study participants, and the 6.7 percent of white participants, who had no recent history of stroke, dementia or other cognitive issues, but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.

By measuring participants' changes in cognitive test scores over time from 1998 to 2012, the researchers could see that both blacks and whites did significantly worse on the test after their stroke than they had before.

Although the size of the effect was the same among blacks and whites, past research has shown that the rates of cognitive problems in older blacks are generally twice that of non-Hispanic whites. So the new results mean that stroke doesn't account for the mysterious differences in memory and cognition that grow along racial lines as people age.

The researchers say the findings underscore the importance of stroke prevention.

"As we search for the key drivers of the known disparities in cognitive decline between blacks and whites, we focus here on the role of 'health shocks' such as stroke," says lead author and U-M Medical School assistant professor Deborah Levine, M.D., MPH. "Although we found that stroke does not explain the difference, these results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline."

Other research on disparities in cognitive decline has focused on racial differences in socioeconomic status, education, and vascular risk factors such as diabetes, high blood pressure and smoking that can all contribute to stroke risk. These factors may explain some but not all of the racial differences in cognitive decline.

Levine and her colleagues note that certain factors - such as how many years a person has vascular risk factors, and the quality of his or her education, as well as genetic and biological factors - might play a role in racial differences in long-term cognitive performance.

But one thing is clear: strokes have serious consequences for brain function. On average, they rob the brain of eight years of cognitive health. Therefore, people of all racial and ethnic backgrounds can benefit from taking steps to reduce their risk of a stroke. That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age.

More information: Stroke, DOI: 10.1161/STROKEAHA.114.008156

Provided by University of Michigan Health System

Study shows benefits of multi-tasking on exercise

Credit: Peter Griffin/Public Domain

Who says you can't do two things at once and do them both well? A new University of Florida study challenges the notion that multi-tasking causes one or both activities to suffer. In a study of older adults who completed cognitive tasks while cycling on a stationary bike, UF researchers found that participants' cycling speed improved while multi-tasking with no cost to their cognitive performance.

06 jun 2015--Results of the study, which was supported by a grant from the National Institute on Aging, were published May 13 in the journal PLOS ONE.

The discovery was a surprise finding for investigators Lori Altmann, an associate professor of speech, language and hearing sciences at the College of Public Health and Health Professions, and Chris Hass, an associate professor of applied physiology and kinesiology in the College of Health and Human Performance. They originally set out to determine the degree to which dual task performance suffers in patients with Parkinson's disease. To do this, the researchers had a group of patients with Parkinson's and a group of healthy older adults complete a series of increasingly difficult cognitive tests while cycling.

"Every dual-task study that I'm aware of shows when people are doing two things at once they get worse," Altmann said. "Everybody has experienced walking somewhere in a hurry when the person in front of them pulls out a phone, and that person just slows to a crawl. Frankly, that's what we were expecting."

Participants' cycling speed was about 25 percent faster while doing the easiest cognitive tasks but became slower as the cognitive tasks became more difficult. Yet, the hardest tasks only brought participants back to the speeds at which they were cycling before beginning the cognitive tasks. The findings suggest that combining the easier cognitive tasks with physical activity may be a way to get people to exercise more vigorously. The researchers plan to make this a topic for future research.

"As participants were doing the easy tasks, they were really going to town on the bikes, and they didn't even realize it," Altmann said. "It was as if the cognitive tasks took their minds off the fact that they were pedaling."

During the study, 28 participants with Parkinson's disease and 20 healthy older adults completed 12 cognitive tasks while sitting in a quiet room and again while cycling. Tasks ranged in difficulty from saying the word 'go' when a blue star was shown on a projection screen to repeating increasingly long lists of numbers in reverse order of presentation. A video motion capture system recorded participants' cycling speed.

Their cycling speed was faster while performing the cognitive tasks, with the most improvement during the six easiest cognitive tasks. Cognitive performance while cycling was similar to baseline across all tasks.

The reasons for participants' multi-tasking success most likely include multiple factors, the researchers say, but they hypothesize that one explanation could be the cognitive arousal that happens when people anticipate completing a difficult cognitive task. Similarly, exercise increases arousal in regions of the brain that control movement. Arousal increases the release of neurotransmitters that improve speed and efficiency of the brain, particularly the frontal lobes, thus improving performance in motor and cognitive tasks.

"What arousal does is give you more attention to focus on a task," Altmann said. "When the tasks were really easy, we saw the effect of that attention as people cycled very fast. As the cognitive tasks got harder, they started impinging on the amount of attention available to perform both tasks, so participants didn't cycle quite so fast."

Study participants with Parkinson's disease cycled slower overall and didn't speed up as much as the healthy older adults. That could be because arousal that stems from cognitive and physical exercise is dependent on dopamine and other neurotransmitters, which are impaired in people with Parkinson's.

Altmann and Hass are currently studying whether multi-tasking benefits will extend to other types of exercise, including use of an elliptical trainer. They hope to eventually examine whether pairing mental tasks with exercise can lead to both cognitive and fitness improvements in older adults.

More information: PLOS ONE, journals.plos.org/plosone/arti… journal.pone.0125470

Provided by University of Florida

New tool predicts your risk of death

Credit: Peter Griffin/public domain

Researchers from Uppsala University have studied the risk of dying over the next five years. They have developed a unique health-risk calculator by using one of the world's largest study material, UK Biobank, containing data from nearly half a million people. The results are expected to have large areas of application both in the clinical setting, public health policy and in research.

05 jun 2015--'We show that, using a few simple questions, one can predict the risk of dying within five years with greater reliability than in any other way we know today. We think our study and the associated risk calculator will become an important tool for a wide range of researchers, but also for doctors, decision-makers and the public,' says Erik Ingelsson, a professor at Uppsala University who headed the study that has now been published in The Lancet.

UK Biobank contains data on as many as 655 variables, collected from around half a million British people aged 40–70. Studies of the associations between one or a few risk factors and future mortality risk have been carried out previously in smaller studies, but none has been based on such extensive data material. Erik Ingelsson and his colleague Andrea Ganna at Karolinska Institute made a series of interesting discoveries:

1. The variables with the best capacity to predict the risk of dying were, surprisingly enough, not primarily biological measured values but self-rated factors, like self-reported health status or walking speed. The risk of dying in the next five years was, for example, 3.7 times higher for subjects with low than with normal walking speed; and the risk of dying was clearly elevated for those who did not possess a car, which is interpreted as being due to socioeconomic causes.
2. The variables that best predicted risk were not the same in men and women, and the reliability of the prediction was generally greater for men.
3. When healthy individuals only were studied, smoking was found to be the strongest predictor of death within five years.
4. The risk of dying from external causes, such as suicide or accidents (data on causes of death were also collected), was best predicted by means of socioeconomic and psychological factors.
5. Prediction was generally less reliable for older than for younger people.

The researchers proceeded by using a computer algorithm to pick out the combination of questionnaire items with the highest accuracy. The outcome was 13 questions for men and 11 for women, and on the basis of the replies to these questions a person's 'Ubble age' can be calculated. If this is lower than the actual age, it means that the person's risk of dying is lower than the average for people of the same sex and age, and vice versa. The researchers have been working with web technicians and designers to develop a simple, user-friendly tool for visualizing all results, and enabling five-year mortality risk and Ubble age to be calculated.

'We see a large number of people who may find this useful. Researchers can use it to arrive at hypotheses for follow-up studies, doctors for identifying high-risk patients, decision-makers for making the right health investments, and the public for learning more about health,' says the other author of the study, Andrea Ganna.

The authors emphasises, however, that the study shows only statistical associations, and underlines the fact that this is not a matter of whether the different variables cause death. One should also be careful to avoid drawing sweeping conclusions about individuals, since what the results show is average risk and prediction results like these are never deterministic. But the large scale of the study is important not least in the light of all the alarming reports about health risks based on studies of associations, which are usually too small to yield reliable information.

This tool can no doubt be useful for journalists in assessing the news value of a new piece of research, since it enables them to compare the results with a large set of data material. The hope is that small studies will thus be discarded from the news flow, instead of unnecessarily causing concern.

More information: Test yourself with the Ubble (UK Longevity Explorer) health tool: www.ubble.co.uk

Provided by Uppsala University

One's ability to identify different smells may impact longevity

In a recent study of older adults, those with a reduced ability to identify certain odors had an increased risk of dying during an average follow-up of 4 years. The mortality rate was 45% in participants with the lowest scores on a 40-item smell test, compared with 18% of participants with the highest scores.

04 jun 2015--The study included 1169 Medicare beneficiaries who scratched and sniffed individuals odorant strips and chose the best answer from 4 items listed as multiple-choice.

"The increased risk of death increased progressively with worse performance in the smell identification test and was highest in those with the worst smelling ability, even after adjusting for medical burden and dementia," said Dr. Davangere Devanand, lead author of the Annals of Neurology study. "This was a study of older adults—the question that remains is whether young to middle-aged adults with impaired smell identification ability are at high risk as they grow older."

More information: Annals of Neurology, DOI: 10.1002/ana.24447

Provided by Wiley

Researchers develop palliative care app to help GPs

The palliAGED app is availabled on iTunes, the Windows Phone Story and Google Play.

A new, free smartphone app is giving GPs access to specialist medical advice to care for older palliative patients at home or in residential care across Australia.

03 jun 2015--The Decision Assist Program app, called palliAGED, helps GPs to plan and provide palliative care by informing clinical processes and prescribing support for common symptoms that patients experience in the terminal phase.

The app, which was launched last week (and featured on ABC News on Sunday evening), was designed and developed following a review of available digital resources for palliative and aged care, which revealed limited existing tools to support GPs in providing care to patients nearing the end of their life.

Chief Investigator of the Decision Assist Program, Associate Professor of Palliative and Supportive Services at Flinders University, Jennifer Tieman, said the app brings together a unique set of resources and information accessible to GPs across Australia, including those in rural and remote areas.

"The Decision Assist Program has highlighted the importance of ensuring our health professionals are well trained and have access to specialist medical advice in the area of palliative care," said Associate Professor Tieman.

"The app is just one of a suite of free resources for GPs on palliative care and advance care planning that have developed by Decision Assist," she said.

Assistant Director of Metro South Palliative Care Service, Dr Greg Parker, said the new smartphone app provided many benefits for doctors.

"GPs who are called upon to treat elderly patients in a residential care or at home setting may have limited experience providing palliative care," Dr Parker said.

"The app provides information that will help them manage and care for their patients in the final stages of their life," he said.

The palliAGED app can be downloaded at the following stores:

• Google Play
• Windows phone store
• Apple iTunes

Provided by Flinders University

Does aging affect decision making?

Aging is associated with significant decline in cognitive functions. But does this translate into poorer decision making? Psychologists from the University of Basel and the Max Planck Institute for Human Development report that in simple decision situations, older adults perform just as well as younger adults. However, according to their study published in the academic journal Cognition, aging may affect decision performance in more complex decision situations.

02 jun 105--Important decisions in politics and economics are often made by older people: According to Forbes magazine, the average age of the world's most powerful people in 2013 was 61 years. As populations across the globe age, the selection of older individuals into such powerful roles may even be further intensified.

Aging is associated with a significant decline in so-called fluid cognitive abilities, for example, the ability to store information in memory or to quickly solve cognitive problems. Fluid cognitive abilities may play a role particularly in "decisions from experience", that is, when the potential consequences of available options is not conveniently summarized but has to be acquired through information search (exploration) and learning. Thus, how do older in comparison to younger adults fare when making decisions from experience?

Choosing between lotteries

Psychologists from the University of Basel and the Max Planck Institute for Human Development in Berlin conducted three studies in which younger (average age: 24 years) and older adults (71 years) repeatedly made decisions from experience- either on a computer in the lab (study 1) or on an iPad at home (study 2).

In each lottery, participants had the choice between two options, which were presented as two unlabeled boxes on the screen. Before making a consequential decision, participants could sample the possible gains and losses of each option by clicking onto the two boxes, as often as they liked. They were thus able to learn which option was better, promising the higher gain or the smaller loss in the long run. Surprisingly, older adults put the same amount of effort into exploring the options and chose the advantageous options as often as younger adults.

"Simple but successful" learning strategies

The psychologists then analyzed participants' learning processes using computer simulations and found a possible explanation for their results: "Younger as well as older adults are using relatively simple but successful learning strategies", explains first-author Dr. Renato Frey. These strategies remain relatively unaffected by reduced fluid cognitive abilities. Only in a third study where participants no longer had to choose between two but four or up to eight options, did the researchers observe a decline in decision-making performance by older adults. Overall, the results suggest that simple strategies can be useful to aging decision makers even though such strategies may not fully compensate for age-related cognitive decline in very complex decision situations.

More information: Frey, R., Mata, R., & Hertwig, R. (2015). The role of cognitive abilities in decisions from experience: Age differences emerge as a function of choice set size. Cognition, 142, 60-80. DOI: 10.1016/j.cognition.2015.05.004

Provided by University of Basel

Altered pain processing in patients with cognitive impairment

People with dementia and other forms of cognitive impairment (CI) have altered responses to pain, with many conditions associated with increased pain sensitivity, concludes a research review in Pain, the official publication of the International Association for the Study of Pain.

01 jun 2015--The available evidence questions the previous notion that people with CI have reduced pain sensitivity to pain. Rather, "It appears that those with widespread brain atrophy or neural degeneration...all show increased pain responses and/or greater pain sensitivity," write Ruth Defrin, PhD, of University of Tel Aviv, Israel, and colleagues.

Differences in Pain Sensitivity with Cognitive Impairment

Dr. Defrin and colleagues analyzed previous studies on pain responses in cognitively impaired patients. The topic is an important one, as many patients with CI—which can result from a wide range of neurological and neurodegenerative diseases, or even normal aging—have "sustained and complex healthcare needs" involving pain.

"However, individuals with CI can have difficulty communicating the features of their pain to others, which in turn presents a significant challenge for effective diagnosis and treatment of their pain," the researchers write. Because of those communication issues, it has even been suggested that cognitively impaired people have reduced pain sensitivity. Dr. Defrin and coauthors believe that understanding the experience and responses to pain in people with CI is "an imperative ethical goal."

Evidence suggests that even normal, healthy aging may be associated with increased vulnerability to pain, as well as slightly reduced cognitive performance. These changes may set up a "vicious circle," with pain leading to a decline in cognitive function and vice versa.

Most studies suggest that the experience of pain is elevated in patients with mild to moderate Alzheimer's disease. Pain sensitivity in late Alzheimer's disease is unclear; Dr. Defrin and colleagues emphasize the need for multi-method approaches to assessing pain in this group of patients.

The effects of other types of neurodegenerative impairment on pain processing appear variable. Pain responses seem to be decreased in patients with frontotemporal dementia (Pick's disease) and Huntington's disease, but increased in those with Parkinson's disease. Effects on pain sensitivity may vary even for diseases affecting similar areas of the brain.

Various developmental disabilities—such as autism, cerebral palsy, and intellectual disability—are also associated with increased pain sensitivity. As in other groups of patients with communication difficulties, alternative ways of assessing pain are needed.

Pain processing also appears to be affected in patients with various types of brain damage, such as stroke and traumatic brain injury. Recent studies have demonstrated brain responses to pain stimuli even in severely brain-damaged patientsin a vegetative state.

Within the limitations of the studies performed to date, the analysis suggests that pain processing is frequently altered in cognitively impaired individuals, often with increased sensitivity to painful stimuli. Dr. Defrin and colleagues hope their review will increase awareness of possible changes in pain perception and processing and promote better approaches to pain management in people living with CI.

More information: "Experimental pain processing in individuals with cognitive impairment: Current state of the science." DOI: 10.1097/j.pain.0000000000000195

Provided by Wolters Kluwer Health