Many elderly people are receiving and using prescription medications inappropriately

A new study from Belgium indicates that the majority of community-dwelling elderly adults are taking prescription medications inappropriately. The study, which is published in the British Journal of Clinical Pharmacology, also found a link between underuse—not taking essential medications—and an increased risk of dying or needing to be hospitalized.

17 july 2016--Appropriate prescribing of medications is a major challenge in the care of elderly adults because older patients tend to be more sensitive to the effects of medications than younger patients, and they often have multiple conditions requiring numerous prescriptions that could negatively interact with each other. To examine patterns of prescription drug use in elderly adults, Maarten Wauters of Ghent University and his colleagues studied 503 community-dwelling adults aged 80 years and older for a period of 18 months.
The researchers found that more than half (58 percent) of patients were taking five or more chronic medications daily. Few patients were taking medications appropriately, with underuse occurring in 67 percent of patients and misuse occurring in 56 percent of patients (with some overlap between these groups). Just 17 percent of the population were not affected by any kind of underuse or misuse.
Over the 18-month study period, underuse was associated with 39 percent and 26 percent increased risks of mortality and hospitalization, respectively, per underused medication. Associations with misuse were unclear.
"Taking too many medications or unsafe medications are known to cause adverse health outcomes; however, we have shown that not taking essential, beneficial medications is more frequent and can be more strongly associated with negative outcomes," said Wauters. "Prescribing medications to older persons should be done after careful thought, balancing the benefits and risk of every medications at regular intervals."
Wauters noted that clinical pharmacologists can play an important role in identifying and addressing inappropriate prescribing. "Clinical pharmacologists can help prescribers to clearly assess misuse and underuse of medications in full knowledge of the patient, their comorbidities, and their medications. They can help to build electronic systems for constant monitoring of the quality of prescribing, using evidence-based criteria of potentially inappropriate prescribing."
"Prescriptions are the most common interaction many of us have with healthcare professionals, yet this research shows the underuse of prescription medicines can be harmful. Clinical pharmacology is the only medical specialty in the UK's health service focusing on the safe, effective, and economic use of medicines," said Professor Sir Munir Pirmohamed, Vice President - Clinical at the British Pharmacology Society. "Despite there being only 72 clinical pharmacology consultants in the UK, the British Pharmacological Society is leading the way in improved prescribing around the world through the delivery of the Prescribing Safety Assessment - a national prescribing assessment - and dedicated learning resources."

More information: "Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalisation in a cohort of community-dwelling oldest old." Maarten Wauters, Monique Elseviers, Bert Vaes, Jan Degryse, Olivia Dalleur, Robert Vander Stichele, Thierry Christiaens, and Majda Azermai, British Journal of Clinical Pharmacology. Published Online: July 18, 2016, DOI: 10.1111/bcp.13055


Provided by Wiley

Global study shows stroke largely preventable

Micrograph showing cortical pseudolaminar necrosis, a finding seen in strokes on medical imaging and at autopsy. H&E-LFB stain. Credit: Nephron/Wikipedia

Ten risk factors that can be modified are responsible for nine of 10 strokes worldwide, but the ranking of those factors vary regionally, says a study led by researchers of the Population Health Research Institute (PHRI) of McMaster University.

16 july 2016--Prevention of stroke is a major public health priority, but the variation by region should influence the development of strategies for reducing stroke risk, say the authors of the study published in The Lancet today.
Stroke is a leading cause of death and disability, particularly in low-income and middle-income countries. The two major types of stroke include ischaemic stroke caused by blood clots, which accounts for 85% of strokes, and haemorrhagic stroke or bleeding into the brain, which accounts for 15% of strokes.
The study led by Dr. Martin O'Donnell and Dr. Salim Yusuf of the Population Health Research Institute at McMaster and collaborators from 32 countries, builds on findings from the first phase of the INTERSTROKE study which identified ten modifiable risk factors for stroke in 6,000 participants from 22 countries. This full-scale INTERSTROKE study added 20,000 individuals from 32 countries in Europe, Asia, America, Africa and Australia, and sought to identify the main causes of stroke in diverse populations, young and old, men and women and within subtypes of stroke.
"This study has the size and scope to explore stroke risk factors in all major regions of the world and within key populations," said O'Donnell, a principal investigator for the PHRI and professor of translational medicine at HRB-Clinical Research Facility, NUI Galway.
"We have confirmed the ten modifiable risk factors associated with 90% of stroke cases in all regions, young and older and in men and women. The study also confirms that hypertension is the most important modifiable risk factor in all regions, and the key target in reducing the burden of stroke globally."
The investigators looked at the different risk factors, and determined the proportion of strokes which would be cut if the risk factor disappeared.
The number of strokes would be practically cut in half (48%) if hypertension was eliminated; trimmed by more than a third (36%) if people were physically active; and shaved by almost one fifth (19%) if they had better diets. In addition, this proportion was cut back by 12% if smoking was eliminated; 9% for cardiac (heart) causes, 4% for diabetes, 6% for alcohol intake, 6% for stress, and 27% for lipids (the study used apolipoproteins, which was found to be a better predictor of stroke than total cholesterol).
Many of these risk factors are known to also be associated with each other (such as obesity and diabetes), and when were combined together, the total for all 10 risk factors was 91%, which was similar in all regions, age groups and in men and women.
However, the importance of some risk factors appeared to vary by region. For example, the importance of hypertension ranged from practically 40% in Western Europe, North America, and Australia to 60% in Southeast Asia. The risk of alcohol was lowest in Western Europe, North America and Australia but highest in Africa and south Asia, while the potential impact of physical inactivity was highest in China.
An irregular heart rhythm, or atrial fibrillation, was significantly associated with ischaemic stroke in all regions, but was of greater importance in Western Europe, North America and Australia, than in China or South Asia.
However, when all 10 risk factors were included together, their collective importance was similar in all regions.
"Our findings will inform the development of global population-level interventions to reduce stroke, and how such programs may be tailored to individual regions," said Yusuf, a professor of medicine of McMaster's Michael G. DeGroote School of Medicine and director of the PHRI. "This includes better health education, more affordable healthy food, avoidance of tobacco and more affordable medication for hypertension and dyslipidaemia."
Along with the study, The Lancet published a related comment from New Zealand researchers Valery L. Feigin and Rita Krishnamurthi of the National Institute for Stroke and Applied Neurosciences, of Auckland's University of Technology.
They said the key messages from the study were that stroke is a highly preventable disease globally, regardless of age and sex; that the relative importance of modifiable risk factors means there should be development of regional or ethnic-specific primary prevention programs, and that additional research on stroke risk factors is needed for countries and ethnic groups not included in INTERSTROKE.
"Now is the time for governments, health organizations, and individuals to proactively reduce the global burden of stroke. Governments of all countries should develop and implement an emergency action plan for the primary prevention of stroke," they wrote.

More information: The Lancet, DOI: 10.1016/S0140-6736(16)30506-2


Provided by McMaster University

Eating more fruit and vegetables can substantially increase happiness levels

University of Warwick research indicates that eating more fruit and vegetables can substantially increase people's later happiness levels.

14 july 2016--To be published shortly in the prestigious American Journal of Public Health, the study is one of the first major scientific attempts to explore psychological well-being beyond the traditional finding that fruit and vegetables can reduce risk of cancer and heart attacks.
Happiness benefits were detected for each extra daily portion of fruit and vegetables up to 8 portions per day.
The researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and veg a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment. The well-being improvements occurred within 24 months.

Cancer

The study followed more than 12,000 randomly selected people. These subjects kept food diaries and had their psychological well-being measured. The authors found large positive psychological benefits within two years of an improved diet.
Professor Andrew Oswald said: "Eating fruit and vegetables apparently boosts our happiness far more quickly than it improves human health. People's motivation to eat healthy food is weakened by the fact that physical-health benefits, such as protecting against cancer, accrue decades later. However, well-being improvements from increased consumption of fruit and vegetables are closer to immediate."
The work is a collaboration between the University of Warwick, England and the University of Queensland, Australia. The researchers found that happiness increased incrementally for each extra daily portion of fruit and vegetables up to eight portions per day. The study involved an examination of longitudinal food diaries of 12,385 randomly sampled Australian adults over 2007, 2009, and 2013 in the Household, Income, and Labour Dynamics in Australia Survey. The authors adjusted the effects on incident changes in happiness and life satisfaction for people's changing incomes and personal circumstances.

Western diet

The study has policy implications, particularly in the developed world where the typical citizen eats an unhealthy diet. The findings could be used by health professionals to persuade people to consume more fruits and vegetables.
Dr Redzo Mujcic, research fellow at the University of Queensland, said: "Perhaps our results will be more effective than traditional messages in convincing people to have a healthy diet. There is a psychological payoff now from fruit and vegetables—not just a lower health risk decades later."
The authors found that alterations in fruit and vegetable intake were predictive of later alterations in happiness and satisfaction with life. They took into account many other influences, including changes in people's incomes and life circumstances. One part of the study examined information from the Australian Go for 2&5 Campaign. The campaign was run in some Australian states which have promoted the consumption of two portions of fruit and five portions of vegetables each day.

Antioxidants

The academics think it may be possible eventually to link this study to current research into antioxidants which suggests a connection between optimism and carotenoid in the blood. However they argue that further research is needed in this area.

More information: "Evolution of well-being and happiness after increases in the consumption of fruit and vegetables." American Journal of Public Health. ajph.aphapublications.org/doi/abs/10.2105/


Provided by University of Warwick

Setting a new standard for how we measure global health

New guidelines for tracking health trends around the world, developed by leaders from influential global health institutions, were announced last week (28 June) in London. These guidelines set a new standard of openness, transparency, and accountability in public health. And they position the field of health measurement at the forefront of science.

13 july 2016--But most importantly, they democratize research that seeks to help people live longer and healthier lives.
Some people might be questioning why they should care. The answer is as simple as it is complex: There are potential implications for their health and well-being, as well as their countries' health policiesand budgets, and, in turn, mandatory contributions to those budgets in the form of income taxes.
Countless organizations and individuals use, and in some cases, manipulate data for their advantage, whether for prestige or profit, or both. The media are replete with reports on health studies proclaiming how newly discovered drugs could lead to advances for people suffering from Alzheimer's Disease, battling cancer, or managing high blood pressure. The "right" data can lead to "breakthroughs" for pharmaceutical companies, or those researching, manufacturing, and marketing medical devices, naturopathic remedies, and other health-related products and services.
How does one determine the difference between "good science," the result of rigorous research and analysis of data that can be verified for its accuracy, and "bad science," produced from information, the authenticity of which is, at best, suspect, or, at worst, fraudulent?
One of the best ways is the publication of studies in peer-review journals. The new guidelines, known in the scientific community as Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), were published by PLOS Medicine and The Lancet. The peer-review and editorial process is designed to help ensure thorough and accurate reporting of science, and to avoid over-interpreting results and to clearly acknowledge a study's limitations. These new research and reporting guidelines comprise a useful tool toward those objectives. The 18-point checklist requires disclosure of information regarding data that informs researchers' analyses and their findings. That checklist includes:

• Defining the indicators, populations (including age, sex, and geography), and time periods for which estimates are made;
• Listing funding sources for the work to disclose potential conflicts of interest;
• Describing how data are identified and accessed;
• Providing source information, such as references to individuals, institutions, data collection methods, and timespans of data collection;
• Disclosing ways to access analytic or statistical source codes used to generate estimates; and
• Making data and analyses publicly available for other researchers.

Some medical journals will require authors to use these guidelines to help ensure their data and analyses are appropriately documented. The guidelines also will provide insights into the validity or "weight" of evidence used in analyses. This will increase much-needed transparency in the scientific community, and, by example, potentially raise expectations for transparency and better reporting in all population health studies, regardless of the publication in which they appear.
The working group that created the guidelines included representatives from: PLOS Medicine, the Lancet, the World Health Organization, the London School of Hygiene and Tropical Medicine, the Harvard and Johns Hopkins Schools of Public Health, the University of Oxford, the University of Ottawa, and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle.
The more than 1,700 collaborators from over 120 countries who contribute to the Global Burden of Diseases, Injuries, and Risk Factors enterprise – the largest and most comprehensive effort to date to measure epidemiological levels and trends worldwide – will adhere to GATHER guidelines with each update of the study. Their compliance, and that of other health researchers throughout the world, will lead to more accurate analyses and more informed public health policies. Through better measurement, we will build better health evidence. Better evidence will enable the emergence of new ideas, new best practices, and, ultimately, improvement in the lives of people worldwide.

More information: Gretchen A. Stevens et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement, PLOS Medicine (2016). DOI: 10.1371/journal.pmed.1002056

This story is republished courtesy of PLOS Blogs: blogs.plos.org.

Provided by Public Library of Science

'Big Data' study discovers earliest sign of Alzheimer's development

Credit: McGill University

Scientists at the Montreal Neurological Institute and Hospital have used a powerful tool to better understand the progression of late-onset Alzheimer's disease (LOAD), identifying its first physiological signs.

12 july 2016--Led by Dr. Alan Evans, a professor of neurology, neurosurgery and biomedical engineering at the Neuro, the researchers analyzed more than 7,700 brain images from 1,171 people in various stages of Alzheimer's progression using a variety of techniques including magnetic resonance imaging (MRI) and positron emission tomography (PET). Blood and cerebrospinal fluid were also analyzed, as well as the subjects' level of cognition.
The researchers found that, contrary to previous understanding, the first physiological sign of Alzheimer's disease is a decrease in blood flow in the brain. An increase in amyloid protein was considered to be the first detectable sign of Alzheimer's. While amyloid certainly plays a role, this study finds that changes in blood flow are the earliest known warning sign of Alzheimer's. The study also found that changes in cognition begin earlier in the progression than previously believed.
Late-onset Alzheimer's disease is an incredibly complex disease but an equally important one to understand. It is not caused by any one neurological mechanism but is a result of several associated mechanisms in the brain. LOAD is the most common cause of human dementia and an understanding of the interactions between its various mechanisms is important to develop treatments.
Previous research on the many mechanisms that make up LOAD has been limited in scope and did not provide a complete picture of this complex disease. This study, published in the journal Nature Communications on June 21, factored in the pattern of amyloid concentration, glucose metabolism, cerebral blood flow, functional activity and brain atrophy in 78 regions of the brain, covering all grey matter.
"The lack of an integrative understanding of LOAD pathology, its multifactorial mechanisms, is a crucial obstacle for the development of effective, disease-modifying therapeutic agents," says Yasser Iturria Medina, a post-doctoral fellow at the MNI and the paper's first author.
The trajectory of each biological factor was recorded using data from each patient taken over a 30-year period. This process was then repeated 500 times to improve robustness of estimations and stability of the results.
Compiling and analyzing the data took thousands of compute hours to complete, and could not have been possible without sophisticated software and terabytes of hard drive space. Such a data-driven approach to neurology is becoming increasingly important, according to Evans.
"We have many ways to capture data about the brain, but what are you supposed to do with all this data?" he says. "Increasingly, neurology is limited by the ability to take all this information together and make sense of it. This creates complex mathematical and statistical challenges but that's where the future of clinical research in the brain lies."
This research also underlines the importance of data sharing across institutions, known as the Open Science model. Patient data for the study came from the Alzheimer's Disease Neuroimaging Initiative (ADNI), a partnership of more than 30 institutions across Canada and the United States. The knowledge that this study has added to our understanding of LOAD would still be undiscovered had it not been for data sharing. Evans points out that his is just one of hundreds of scientific papers to come from the ADNI dataset.
"That by itself is justification for ADNI and data sharing," he says. "What goes around comes around. We benefit from the data put in by others, and we contribute our own data."
While this study is one of the most thorough ever published on the subject of Alzheimer's disease progression, Evans says he would like to go further, to not only record but determine the causes of each mechanism, which could be the key to unlocking better treatments. It is something that is limited only by how much computer power Big Data can provide.
"This is a computational, mathematical challenge that goes beyond anything we've done so far," says Evans. "Our goal is to go to a high-level, causal modeling of the interactions amongst all of the factors of disease, but you need huge computational power to do that. It's our job to be ready with the software, the algorithms, and the data while we wait for the hardware to appear."
"We still need more data-driven integrative studies, capable of considering all possible biological factors involved, as well as of clarifying the direct interactions among these factors," says Medina. "Without that, we cannot dream of effective treatments. We would continue to work in the dark."

More information: Y. Iturria-Medina et al. Early role of vascular dysregulation on late-onset Alzheimer's disease based on multifactorial data-driven analysis, Nature 

Communications (2016). DOI: 10.1038/ncomms11934

Provided by McGill University

Living longer associated with living healthier, study of centenarians finds

Credit: Peter Griffin/public domain

Research has shown that the human lifespan has the potential to be extended. But would this merely mean people living longer in poor health? The upbeat findings from a new study in the Journal of the American Geriatrics Society indicate that those extra years could well be healthy ones. In a study of nearly 3,000 people, the onset of illness came decades later in life for centenarians than for their younger counterparts.

09 july 2016--"Most people struggle with an ever-increasing burden of disease and disability as they age," said study leader Nir Barzilai, M.D., professor of medicine and of genetics at Albert Einstein College of Medicine, director of Einstein's Institute for Aging Research, and attending physician at Montefiore Health System. "But we found that those who live exceptionally long lives have the additional benefit of shorter periods of illness – sometimes just weeks or months – before death."
The researchers looked at the health status of centenarians and near-centenarians enrolled in two ongoing studies: the Longevity Genes Project (LGP) and the New England Centenarian Study (NECS). Since 1998, Dr. Barzilai and colleagues have conducted the LGP, which recruits healthy, independently living Ashkenazi Jewish people 95 and older from the northeastern United States. For comparison, the LGP includes a group of Ashkenazi Jewish individuals who do not have a parental history of longevity. The NECS began in 1994 as a study of all centenarians living in eight towns near Boston and was later expanded to include participants from North America generally as well as England, Ireland, Australia and New Zealand. The NECS comparison group consisted of people aged 58 to 95.
This study compared (1) the health status of 483 long-lived LGP participants with 696 LGP comparison individuals 60-94 years old, and (2) the health status of 1,498 long-lived NECS participants with 302 NECS comparison subjects aged 58-95. For both sets of comparisons, the researchers looked at the ages at which individuals developed five major age-related health problems: cancer, cardiovascular disease, hypertension, osteoporosis and stroke. Analysis revealed a consistent pattern of delayed onset of illness in the LGP and NECS centenarian groups compared to their respective comparison groups.
For example, for the long-lived NECS individuals, cancer didn't afflict 20 percent of men until age 97 and women until 99. In contrast, 20 percent of NECS comparison participants had developed cancer by age 67 in men and 74 in women. Results were similar for the LGP: for the long-lived LGP participants, the age at which 20 percent had developed cancer was delayed to 96 for both sexes. But cancer had affected 20 percent of LGP control-group males by age 78 and control-group females by 74.
Despite their genetic, social and cultural differences, the long-lived LGP and NECS participants proved markedly similar with respect to major illness: Compared to younger comparison groups, their onset of major age-related disease was delayed, with serious illness essentially compressed into a few years very late in life. The findings suggest that discoveries made in one group of centenarians can be generalized to diverse populations. And they contradict the notion that the older people get, the sicker they become and the greater the cost of taking care of them.
The study is titled "Compression of Morbidity Is Observed Across Diverse Cohorts with Exceptional Longevity."


Provided by Albert Einstein College of Medicine

Combination therapy best combats heart disease

Combination pills could be the future of heart disease treatment.

Using combination drugs or 'polypills', may hold the key to reducing heart disease in Western Australia.
This is the finding of Curtin University researchers who took part in the global Heart Outcomes Prevention Evaluation-3, or 'HOPE-3' study, which involved more than 12,000 participants in 21 countries.

08 july 2016--The study targeted people at a moderate risk of cardiovascular disease, and investigated what impact a combination of inexpensive drugs might have on reducing the risk of heart attack and stroke.
"More than a decade ago, researchers from the UK put forward a proposal that if we had a combination pill, which included cholesterol lowering and blood pressure lowering medications, that a significant improvement may result," says Curtin University's Professor Christopher Reid.
"They estimated around an 80 per cent reduction in heart attacks and strokes. Over the last decade there's been a number of studies that have looked at this concept of a polypill or a combined approach to cardiovascular prevention.
"We provided study participants with anti-hypertensives alone to lower blood pressure, statins alone to lower cholesterol, a combination of the two, and lastly placebos which provided no treatment at all," Prof Reid says.
"Most importantly, we saw a near 40 per cent reduction in heart attacks and strokes in the groups that were receiving combinations, lipid lowering and cholesterol lowering therapies."
"It's really painting a picture that combination therapy may well be one of the best ways in which we can reduce the burden of cardiovascular disease."
Researchers found that anti-hypertensives alone were effective for lowering blood pressure among participants with significantly elevated blood pressures. But those with normal blood pressures, anti-hypertensives had no major impact on heart attacks and strokes.
With cholesterol lowering therapy, overall the test group showed a 25 to 30 per cent reduction in heart attack and stroke rate after the five-year follow-up period.
"What the Hope-3 study did in quite a clever design was randomise participants to receive either blood pressure lowering or lipid lowering or the combination treatments in comparison to placebo treatments in each of those three study groups," Prof Reid says.
He says people at moderate-risk could still fall victim to heart attack and stroke, and says further research is needed into the effectiveness of 'polypills'.
"Hope-3 is a very important part of piecing together the puzzle, and clearly our results demonstrate that in a moderate risk group, the combination of lipid lowering and blood pressure lowering is very effective in reducing heart attacks and strokes."

This article first appeared on ScienceNetwork Western Australia a science news website based at Scitech.

Provided by Science Network WA

Pill organizers could cause adverse effects among elderly

Older people who switch to using pill organisers could experience adverse effects and even hospitalisation - according to research from the University of East Anglia.
New research published today reveals that people who switch from usual medication packaging to a pill organiser are more likely to become unwell than those not using them.

07 july 2016--The research team say that patients should consult their GP or pharmacist before switching to a pill organiser.
Lead researcher Dr Debi Bhattacharya, from UEA's School of Pharmacy, said: "A lot of people use pill organisers to help them take the right medication at the right time of the day."
"We found that on average, when patients who had previously taken their medication sporadically were switched to a pill organiser, they took all of their medication and became unwell, whilst those who remained on usual medication packaging did not have any adverse effects.
"The fact that using a pill organiser could cause patients to experience adverse effects from their medication sounds rather counterintuitive."
"It is likely that because the patients had been taking their medication sporadically, they weren't getting the expected health improvements. The doctor may therefore have increased the dose of the medication to try to get the desired effect."
"When these patients were switched to a pill organiser and suddenly started taking more of their prescribed medication than previously, they experienced normal side effects of the medication."
The research team studied people aged over 75 from six medical practices who were prescribed three or more types of medical tablets.
Over a third of the 288 people surveyed were found to be already using a pill organiser of some kind and nearly a quarter showed signs of not taking their medication as prescribed on purpose.
Of the remaining patients, nearly half were not taking their medication as prescribed by mistake.
These 80 patients, who did not already use a pill organiser and who were unintentionally not taking their medication as prescribed, were chosen to take part in the trial. Some patients were excluded - for example those with a life expectancy of less than 12 months or with severe mental health problems.
A total of 29 participants were eligible to take part in the trial. They were monitored for eight weeks - with half continuing to take their medication direct from the packet, and half switching to a pill organiser.
Of those using a pill organiser, five adverse events were recorded, compared with none in the usual packaging group. The adverse effects comprised three falls, one hypoglycaemic episode (low blood glucose) and one temporary incapacitation (patient felt unwell; was unable to get out of the bath for 12 hours until rescued).
Dr Bhattacharya said: "The results of this trial are encouraging as they suggest that pill organisers do help patients to take their medication as prescribed. However, when switching from usual packaging to a pill organiser, we recommend that patients speak to their GP or pharmacist to check that the doses of their medication are appropriate.
"People who are already using a pill organiser without any ill effects should not stop using it as they do seem to help some patients take their medication as prescribed. It's the switching stage which appears to be the danger."
'The feasibility of determining the effectiveness and cost-effectiveness of medication organisation devices compared with usual care for older people in a community setting: systematic review, stakeholder focus groups and feasibility randomised controlled trial' is published by the Health Technology Assessment (HTA) on July 6, 2016.


Provided by University of East Anglia

Nutritional drink can help to conserve memory in case of prodromal Alzheimer's disease

Professor Tobias Hartmann, Saarland University. Credit: Saarland University

The study did not find a significant benefit in broad cognitive function (the study primary endpoint). Cognitive decline over the study period was less than originally expected when it was designed ten years ago, so differences found between the two groups were too small to be statistically significant. Project coordinator Professor Tobias Hartmann, Saarland University Germany, explained that this is the most likely reason the primary endpoint was not met.

01 july 2016--Professor Hilkka Soininen, Professor in Neurology MD, PhD from the University of Eastern Finland, who headed the clinical trial as part of the LipiDiDiet project, said: "Today's results are extremely valuable as they bring us closer to understanding the impact of nutritional interventions on prodromal AD which we are now better at diagnosing but unable to treat due to a lack of approved pharmaceutical options.
The LipiDiDiet study illustrates that this nutritional intervention can help to conserve brain tissue and also memory and patients' ability to perform everyday tasks—possibly the most troubling aspects of the disease. We look forward to the results of subsequent analyses and the six year extension study which will provide further insights".
The clinical trial, headed by Professor Hilkka Soininen is part of a large EC project (LipiDiDiet) to explore the therapeutic and preventative impact of nutrition on neuronal and cognitive performance in ageing, AD and vascular dementia. LipiDiDiet is funded by the seventh Framework Programme (FP7) of the European Commission (EC) and coordinated by Professor Hartmann, Saarland University in Germany.
Fortasyn Connect was selected by a consortium of leading researchers from 19 European institutes, for this 24-month, randomised, controlled, double-blind, multicentre study involving 311 patients - on the basis of its results in a previous EU project (LipiDiet).
Nearly 47 million people have Alzheimer's or a related dementia for which there is currently no cure.2 This number is expected to double every 20 years, reaching 74.7 million in 2030 and 131.5 million in 2050.2

Study details

The trial was the first to investigate the impact of Fortasyn Connect on patients with prodromal AD who were randomised to receive either Fortasyn Connect or an iso-caloric control drink once daily.
The primary outcome parameter was selected to assess the effect on cognitive function (a broad measure of thinking) during 24 months intake of Fortasyn Connect compared with a control product. This was a cognitive composite score consisting of the CERAD 10-word immediate recall, delayed recall and recognition, category fluency and letter digit substitution test.
Secondary outcome parameters were brain volumes (total hippocampal, whole-brain & ventricular volumes), the Clinical Dementia Rating Sum of Boxes (CDR-SB), Neuropsychological Test Battery composite scores: episodic memory, executive function/working memory composite and a complete composite score consisting of 16 subtests, progression to (AD) dementia, blood and CSF biomarkers, tolerance and safety.
No significant difference was observed for the cognitive composite score. Predefined analyses showed significant differences between active and control study groups for hippocampal and whole-brain atrophy, and favourable effects for CDR Sum of Boxes and episodic memory (both were most pronounced in patients with high baseline cognition with regular intake). Analyses are ongoing for progression to (AD) dementia and blood and CSF biomarkers.
Tobias Hartmann, the project's coordinator, said "We have known for a while that diet can reduce the risk of developing dementia. Indeed, certain nutrients have been found to have a neuroprotective effect on the brain. However translating this into an effective intervention hasn't been easy because single nutrients simply aren't powerful enough to fight a disease like Alzheimer's alone. Today's clinical trial results have shown that the key is combining certain nutrients, in order to increase their effect.
This is exciting because it shows that in the absence of effective drug options, we really have found something that can help slow down some of the most distressing symptoms in prodromal AD; especially in those who started the intervention early. Indeed those patients who have lost the least cognitive function, have the most to gain".


Provided by Saarland University

Delirium at nursing home admission a risky sign for seniors

Seniors with delirium who enter the nursing home after hospitalization are at greater risk than patients who make that transition without the condition, according to new research. Credit: Graphicstock

Brown University public health researchers who analyzed the medical records of more than 5.5 million seniors admitted to nursing homes between 2011 and 2014 found that approximately 240,000 had delirium. Those patients faced serious additional health risks compared to those without the condition.

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


Provided by Brown University

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

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

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

More information: JAMA, DOI: 10.1001/jama.2016.7207


Provided by The JAMA Network Journals

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

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

26 jun 2016--In a study published in the Journal of the American Geriatrics Society, researchers investigated this issue using data from the 10-year Duke EPESE study. They examined data from 4,106 African American and white older adults living in five counties in North Carolina.
The researchers asked the participants the question, "Are you able to take your medicine without help (in the right doses at the right time)?" The participants' health conditions included: poor vision, poor hearing, or having been diagnosed with stroke, diabetes, hypertension (also known as high blood pressure), heart attack, or cancer (except skin cancer).
The researchers also tested the participants' mental abilities and reviewed their medication containers to learn how many prescription and over-the-counter medications they took.
At the beginning of the study, 7.1 percent of participants needed help taking their medications. Three years later, 11 percent needed help who did not need help at the beginning of the study. Predictors of a new need for medication help were similar to those seen at the beginning of the study:

• Being 75-years-old or older
• Being male
• Having memory problems
• Having problems performing activities of daily living

The researchers reported that people aged 80 and older were 1.5 to 3 times as likely to need help with their medications than were people aged 65 to 69.
Men were 1.5 to 2 times as likely as women to need help. The odds of needing help were 3 to 5 times greater among people with memory challenges.
"Health conditions may worsen or not improve if older adults skip or don't take their medications properly," said Brenda D. Jamerson, PharmD, Center on Biobehavioral Health Disparities Research at Duke University. "Serious side effects may also occur from taking medications at the wrong time or in the wrong dose. Some older adults can put themselves at risk for experiencing problems if they don't receive the assistance they may need," added Dr. Jamerson.
The researchers noted their study helped identify which characteristics make it more likely that an older adult will need help taking his or her medication.

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


Provided by American Geriatrics Society

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

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

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

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


Provided by American Geriatrics Society

Diabetes raises risk of heart attack death by 50 percent

Having diabetes increases the risk of dying from the effects of a heart attack by around 50 per cent, a University of Leeds study has found.

Researchers in the School of Medicine tracked 700,000 people who had been admitted to hospital with a heart attack between January 2003 and June 2013.
Of these, 121,000 had diabetes.

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

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


Provided by University of Leeds

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

Michele Basso. Credit: UCLA

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

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

More information: Current Biology, www.cell.com/current-biology/fulltext/S0960-9822(16)30534-6


Provided by University of California, Los Angeles

Judgment, memory better for older adults with optimistic outlook

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

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


Provided by University of Michigan

Physical activity in dementia

This figure shows the amount of time each group spent physically active over a 24 hour period. The healthy control group engages in the largest amount of activity, with the institutionalized dementia group engaging in significantly less. 

It has been recognised for over 60 years that regular physical activity provides health benefits. Our bodies are designed to be stimulated by physical exertion. Fitness is associated with lower all-cause mortality, along with improved sleep, quality of life, social life and reduced stress. On the other hand, physical inactivity predicts obesity, diabetes, cardiovascular disease, mental health issues, reduced quality of life and overall mortality. The evidence is clear: we need to get moving.

18 jun 2016--In addition to health outcomes, cognition and physical activity are intrinsically linked. This is increasingly true within the senior population. More physically active older adults show less cognitive decline than those who are not active. Older adults participating in physical activity programs often demonstrate improvements in their cognitive abilities – particularly with attention and executive function. In frailer older adults with many health problems, physical activity interventions facilitate better cognition, physical capacity and quality of life. Regular physical activity has also been associated with reduced risk of cognitive decline and development of dementia. Many hypotheses have been postulated regarding the role of physical activity in staving off cognitive impairment. It may protect cardiovascular changes in the brain by maintaining cerebral blood flow, facilitate the growth of new neurons or relieve stress and therefore improve cognitive function.
But what does physical activity look like in the cognitively impaired population – specifically within dementia? A recent study in PLOS ONE aimed to quantify and characterize physical activity in dementia patients objectively. While previous studies report that dementia patients are less physically active than older adults without cognitive impairment, the majority of these findings come from self-reported measures. These are often not as reliable or accurate as they are subjective, and may be impacted by memory recall problems. Van Alphen and colleagues chose to use the Actiwatch, a wrist-worn accelerometer, to collect objective data on the frequency, duration and intensity of daily physical activity in dementia patients. One hundred and twenty dementia patients were included in the study, recruited from 13 nursing homes and four day-care centers, along with 26 older adult controls. All participants were required to wear the Actiwatch for at least six days, 24 hours a day.
The researchers were interested in the differences in physical activity levels between community-dwelling dementia patients and institutionalized patients. To this end, daily physical activity levels were significantly different between institutionalized patients and community-dwelling patients and controls, with institutionalized patients engaging in physical activity 23.5% less than community-dwelling patients and 40% less than controls. This is important to note as infrastructures and activities could be implemented in care homes to encourage physical activity.

This figure demonstrates the amount of time the different groups spend sedentary compared to other levels of physical intensity. The first bars (0-99) represent sedentary time, while the rest of the bars show a gradual climb in activity intensity. 

Additionally, institutionalized patients spent 72% of their day in a sedentary state; 9.3% more than community-dwelling patients and 19% more than controls. These results remain significant after controlling for age, cognitive abilities and use of walking aids. While there were no significant differences in amount of physical activity between Alzheimer's disease patients and non-Alzheimer's disease patients (encompassing dementia with Lewy bodies, Parkinson's disease with dementia, vascular dementia and frontotemporal dementia), Alzheimer's disease patients did spend significantly less time (6.9%) in a sedentary state. Van Alphen and colleagues concluded that both institutionalized and community-dwelling dementia patients remained sedentary for the majority of the day and performed lower intensity activities than that of controls.
But why is it important to know about physical activity levels in dementia? The dangers of physical inactivity were highlighted earlier; for dementia patients, the ability to carry out everyday activities may be compromised, along with reduced quality of life and further cognitive decline. Studies have demonstrated that encouraging active participation in functional tasks – such as dressing and washing – and attending dance or exercise classes – can improve physical capacity and reduce fall risk in moderate-to-severe dementia. Bi-weekly exercise programs are associated with slower rates of cognitive and functional decline in dementia. Individuals with mild cognitive impairment – a pre-dementia stage – undergoing an aerobic fitness intervention demonstrate significant improvements in cognition, particularly executive function. Encouraging physical activity in this population holds a range of benefits – from improved mood, function, cognition and fitness to reduced stress and improved quality of life for their caregiver.
There is still much work to be done. Studies need to recruit larger samples of patients with non-Alzheimer's disease dementias to assess the differences across dementia subtypes. Type of activity should be examined; most accelerometers can provide data about frequency and duration of movement but fail to automatically specify what activities are being undertaken. Individual differences in activity type may predict different health outcomes. As Van Alphen and colleagues reported, dementia groups are more likely to engage in low-intensity activities such as walking or household chores. These activities are beneficial for cardiorespiratory capacity and body composition, and exercise interventions could be tailored to suit this preference. The effects of vigorous – such as sprinting or spinning – and low-intensity activities should also be compared. This is an area ripe for investigation and may be beneficial for the development of physical interventions.
Increasing physical activity levels is a global challenge and one that is continuously being addressed. The World Health Organization (WHO) recommends 30 minutes of moderate-to- vigorous exercise a day, which can be achieved by walking, gym classes and activities, sports or physical hobbies such as gardening. Governments develop policies, guidelines and initiatives to encourage people to participate in physical exercises, such as Let's Move. National campaigns – such as This Girl Can – promote a sense of unity in keeping active. Free exercise programs – such as Shape Up New York – allow people to engage in a range of fitness classes, from aerobics to Zumba. These all endorse the message to get up, get going and get active! Still 20% of individuals older than 15 years do not meet these physical activity guidelines. Therefore, I believe our approach to the promotion and facilitation of physical activity needs to change. Most people associate the prescription of getting active with problems like obesity and heart disease. More education on how active individuals incur health benefits beyond physical health is also needed.
Exercise is often portrayed as inaccessible without expensive gym facilities and a grueling experience for those who do take part – think of all those films depicting the embarrassment of being picked last in gym class. Facilities allowing engagement in moderate-intensity exercise – such as walking, cycling and running – should be built; fun and simple ways to get involved should be endorsed. Physical activity is an inexpensive, easily-accessible approach to improve health and overall well-being – and we should be taking full advantage of that.

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

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

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

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

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

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

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

The Role Of Physical Activity On The Prevention Of Cognitive Impairment. www.ncbi.nlm.nih.gov/pmc/articles/PMC4811348/

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

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

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

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

The right lateral surface of projected z-score images, reflecting deviation from healthy controls; Yellow/red: higher uptake, blue: lower uptake as compared to controls 

Positron emission tomography (PET) with three different radiotracers can now measure amyloid plaques, tau tangles and metabolic activity in the brains of living Alzheimer's patients. This multimodal study shows significant correlation between increased tau and decreased metabolic activity in the brain—a clear sign of neurodegeneration—reveal researchers at the 2016 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

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

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


Provided by Society of Nuclear Medicine

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

The Socio-Emotional Adaptation Model created by Emory researchers shows combinations of positive and negative contextual domains.  Credit: Emory University

A recent study published in The Gerontologist says understanding the emotional reactions of individuals diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) will provide health care professionals with important information needed to develop suitable treatments.

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

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


Provided by Emory University

Dietary fiber intake tied to successful aging, research reveals

Credit: Wikipedia.

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

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


Provided by The Gerontological Society of America

New procedure uses the heart rate to estimate the life expectancy of infarct patients

After five years, persons with only minor arrhythmia (red graph) were five times more at risk of dying than people with higher breathing-related fluctuations. Credit: JACC

The heart rate may be an indicator of a person's life expectancy. A research team at the Technical University of Munich (TUM) has to this end analyzed an effect which at first seems paradoxical: Minor irregularities in the heartbeat are indicative of a healthy body. A clinical study confirmed a strong correlation between this phenomenon and the survival prospects of heart attack patients. The new methods of measurement may soon be applied in medical practice.

29 may 2016--A healthy person's heart will beat slightly faster upon inhalation and slow down again upon exhalation. The reason for this is that inhaling dampens an effect that will normally regulate the heart rate down to the at rest rate of approximately 60 beats per minute. This phenomenon is called respiratory sinus arrhythmia, which may be translated as a "breathing-induced irregularity in the sinus node, the bundle of nerve fibers controlling the heart beat".
The phenomenon has been known since the 19th century. A body weakened by a heart attack will show a clearly smaller difference between heart rates during the exhaling and inhaling cycles. Therefore, several attempts at using arrhythmia characteristics to draw conclusions about the life expectancy of patients were made in the past. Thus far, however, the data taken on its own yielded no conclusions as to the life expectancy of a patient. This, however, is precisely what the scientists working with Prof. Georg Schmidt, head of the Biosignal Processing team at the University Hospital Klinikum rechts der Isar, have now achieved.

Breathing cycle and heart rate: The decisive moment

Whilst in the majority of earlier studies the full breathing cycle was correlated to the heart rate, the TUM team now focused on exhaling and specifically on the moment when the heart rate would normally be reduced again. "With our approach, you might say we are surgically selecting the moment when the decisive events take place," says Georg Schmidt. In the analysis of the heart rate data, an algorithm Schmidt and his team proposed in an article published in theLancet in 2006 has proven useful. The method renders the respiratory sinus arrhythmia measurable by - to put it simply - extracting other sources of heart rhythm variation from the data collected over a certain period. The algorithm calculates an average from the data, which may then be graphed.
"Our method produces a far more specific picture of the functional condition of the body," says Dr. Daniel Sinnecker, primary author of the study. "There is no other method as yet to isolate the vagal function as specifically as this."The vagal function, i.e. the activity of the vagus nerve, is responsible, among other, for reducing the heart rate of healthy persons as described above. Although the vagus nerve affects many other bodily processes, its activity is not directly measurable.

More than 900 patients examined

Within the framework of the study, published in the Journal of the American College of Cardiology, breathing cycles and heart beat rhythms of close on 950 heart attack patients were measured shortly after a heart attack. The data was analyzed to find respiratory sinus arrhythmia. The test persons were re-examined every six months over a five-year period. The result: Heart attack patients with less pronounced arrhythmia had a higher risk of dying within the period of observation. Examined persons with only minor arrhythmia were five times more at risk of dying over the five-year period than people with higher breathing-related fluctuations.
Two further clinical studies are currently under way with TUM participation, examining the respiratory sinus arrhythmia in different groups of persons. One of the studies (EU-Cert-ICD) examines different treatment strategies in people with pacemakers, whilst the other (INVADE) monitors elderly people with and without heart disease. Schmidt and his team are confident that the results of these studies will confirm that their method, taken on its own, will be a reliable indicator of risk.

Everyday application imminent

The developers are confident that the new method may soon be widely deployed. "We are quite close to everyday application since, by and large, the development of the method is complete," says Georg Schmidt. The technical hurdles are few: Since it is no longer necessary these days to measure breathing rate in addition to heart beat, a modern ECG unit would basically suffice. "Even the general practitioner could therefore within ten minutes record sinus arrhythmic activity."
The method may be fruitfully applied in more than 80 percent of the cases, says Schmidt. Irrespective whether the examined patients had recently suffered a heart attack, it could be used in combination with other indicators to assess the health risk. Hidden risks may in this way be detected in some persons and possibly mitigated with an implantable defibrillator, for instance. "In addition to that, the cost of treatments could be reduced by avoiding unnecessary procedures," says Georg Schmidt.
A next step might be to apply this method to examine the efficacy of different strategies for treatment. Should a patient's characteristics improve in the course of treatment, it is likely that the applied therapy was appropriate.

More information: Daniel Sinnecker et al. Expiration-Triggered Sinus Arrhythmia Predicts Outcome in Survivors of Acute Myocardial Infarction, Journal of the American College of Cardiology (2016). DOI: 10.1016/j.jacc.2016.03.484


Provided by Technical University Munich