Study finds cardiorespiratory fitness contributes to successful brain aging

Left hemisphere of J. Piłsudski's brain, lateral view.

Cardiorespiratory fitness may positively impact the structure of white matter in the brains of older adults. These results suggest that exercise could be prescribed to lessen age-related declines in brain structure.

30 april 2015--The findings, which appear online in the Annals of Clinical and Translational Neurology, are the first to show a relationship between fitness and brain structure in older adults, but not younger adults.

The researchers compared younger adults (age 18-31) to older adults (age 55-82). All participants had MRIs taken of their brains and their cardiorespiratory (heart and lung) fitness was measured while they exercised on a treadmill. The researchers found cardiorespiratory fitness was positively linked to the structural integrity of white matter fiber bundles in the brain in the older adults, while no such association was observed in younger adults.

"We found that higher levels of cardiorespiratory fitness were associated with enhanced brain structure in older adults," explained corresponding author Scott Hayes, PhD, assistant professor of psychiatry at Boston University School of Medicine and the associate director of the Neuroimaging Research for Veterans Center at the VA Boston Healthcare System. "We found that physical activities that enhance cardiorespiratory fitness, such as walking, are inexpensive, accessible and could potentially improve quality of life by delaying cognitive decline and prolonging independent function," he added.

According to the researchers these results provide evidence of a positive association between fitness and brain structure in older adults. "We hope this study provides additional motivation for older adults to increase their levels of physical activity, which positively impacts health, mood, cognition and the brain." They caution that additional research is needed to track changes in fitness and brain structure over time, as well as clarify the impact of specific exercise programs (such as strength, aerobic or combined training) or dose of exercise (frequency, intensity, duration) on white matter microstructure.

Provided by Boston University Medical Center

A note of caution about health apps

There's a running joke that if you check your symptoms on the Internet, it will probably diagnose you with cancer.

29 april 2015--But there seems to be a growing trend that we are starting to rely more and more on digital technology to help us with our health. For example, WebMD last reported an average of 156 million unique users per month – a 33 per cent increase from the previous year.

Health apps (applications that offer health-related services on your mobile phone or tablet) are flooding the market. And the same goes for wearable technology, or 'wearables', like the Fitbit, JawBone and most recently the Apple Watch.

But how much can we rely on this technology? And does it actually do us any good?

Alarm bells

Some health apps have the potential to be very useful – for example to help people who live in remote areas access a GP when they can't go in person.

Similarly, given that four in 10 cancers are linked to lifestyle, apps that allow you to track and monitor your health could help you lead a healthier life, or could be used to give your GP a more rounded picture of your health.

But when health apps start claiming that they can diagnose cancer from a 'selfie', warning bells start going off.

Recently a number of smartphone apps appeared, that claimed to be able to diagnose skin cancer based on a photograph. They were advertised as a modern way to check a mole to see if it was cancerous or not.

While it could be a good idea in principle, these particular apps didn't turn out to be very accurate.

One recent study in JAMA Dermatology, which looked at various skin cancer apps, found that three out of the four apps they examined incorrectly classified at least 30 per cent of melanomas as 'unconcerning'.

The only one that was accurate wasn't a diagnostic app at all – it helped people with suspected skin cancer by sending a picture directly to a certified dermatologist.

Another study, this time published in the British Journal of Dermatology, examined 39 skin cancer-focused apps and found that none them had been validated for diagnostic accuracy or usefulness by any established research methods.

The inaccuracy and false claims didn't go unnoticed. Earlier this year the US government cracked down on two apps that were claiming to be able to diagnose skin cancer. "Truth in advertising laws apply in the mobile market place", said the US Federal Trade Commission (FTC),which issued a strong warning to app makers who claim that their product has diagnostic capabilities.

App manufacturers, the Commission said, should be able to back up their claims. Saying "consult a doctor" or "for information only" does not absolve you of responsibility.

But it's not only skin cancer apps that were dubious.

A recent study by researchers at Imperial College, London, published in the journal Breast, looked at 185 health apps that mainly focused on breast cancer information and awareness. Only 15 per cent were based on robust evidence and even fewer – 13 per cent – had medical professional input when they were designed and created.

On top of this, potential safety concerns were found in more than 15 per cent of the apps they reviewed.

Each week it seems that another app comes out claiming it can diagnose a different cancer or disease – but we need to be careful how much we trust them.

"All apps are not created equal," warns Sarah Williams, our health information manager.

"When apps claim to give you a diagnosis, be wary, and remember there's no technological replacement for seeing your GP," she advises.

No harm, no foul?

So it looks like diagnostic apps that can accurately and reliably diagnose cancer are a long way off.

But some health apps may be helpful – or at the very least not harmful.

There has been some evidence to suggest mobile weight loss programmes are just as effective as paper- or website-based ones but these studies are small.

And Williams points out that having the goals in the first place is what probably matters the most.

And wearables might be prone to many of the same issues as software.

Researchers have also tested popular fitness tracking wearables such as Fitbit and Jawbone. While these may accurately measure the various metrics they claim to, there is no evidence yet to suggest that they have any added health benefits (Although, granted, there is no evidence that they cause you any harm either).

"When it comes to improving your health it isn't getting the information that matters, it's what you do with it," said Williams.

So while they may not be harmful, they may not be not particularly useful either.

And just because you can track these metrics doesn't necessarily mean you should.

The BMJ recently interviewed two experts – with opposing views – about whether we should even be tracking this data at all.

"We shouldn't confuse more health care with better health care," said Dr Des Spence, a General Practioner in Glasgow, in a linked podcast for the journal.

And while Iltifat Husain, editor of iMedicalApps.com, was generally positive about health apps he agreed: "Most of the metrics these apps measure are pointless. They just add noise."

Dr Spence raised particular concerns about technology that claims to track things like blood pressure, body temperature, heart rate etc.

"The apps that measure your vital signs […] have no background of testing, they're completely unregulated and I'm worried about what impact this might have," he said, citing 'overdiagnosis' – diagnosing a disease or condition that wouldn't cause harm to that person in their lifetime – as a legitimate concern.

"We need to be cautious and not lunge into these things, because they have the potential for harm".

Wild Wild West

But while it may not be morally responsible for app makers to sell these apps to consumers, ultimate responsibility rests with governments, and regulations.

Unfortunately, there are no real regulations for health applications. Essentially, if you can code it, you can market it.

"It's like the wild wild west," Husain told the BMJ.

But regulations are slowly being made.

In February the US Food and Drug Administration (FDA) said it was going to start to regulate apps – but at its discretion and only apps that meet the definition of "medical device". This leaves a host of apps without regulation.

In the UK and Europe regulations are taking a similar route and only focusing on health apps and wearables that qualify as a "medical device".

As it stands those apps and wearables that qualify as a "medical device" need to prove that they work and are safe to obtain a CE mark or certificate, which allows the product to be sold and distributed in Europe.

But unlike actual medical devices, like an x-ray machine, which need to get the CE mark before they are sold, apps may go straight onto the market. Only if they are later deemed to be a "medical device" will they need to meet the standards to get the CE mark.

As for proving effectiveness the Medical and Healthcare products Regulatory Agency (MHRA) has told us that while apps and wearables do not go through clinical trials in the way medicines do, manufacturers do need to produce clinical data before they can get a CE mark.

How much clinical data they need to produce is uncertain and, as with the US, there are still many health apps that will go unregulated.

And then there's still the question of what happens when software is updated – for example, do manufacturers need to prove an update is as effective as the original?

Due to the ad hoc nature of the regulations other organisations, such as the NHS, have taken it upon themselves to help advise consumers on which apps are good. They have a library of apps that have been reviewed for relevance to people in the UK, using information from a verifiable source and complying with data protection rules. But it is by no means a comprehensive list or a gold standard quality mark.

So until there is some more robust evidence and better regulation we're saying be wary of how much you trust health apps and wearables – they might not be all they're cracked up to be.

More information: "Diagnostic Inaccuracy of Smartphone Applications for Melanoma Detection." JAMA Dermatol. 2013;149(4):422-426. DOI: 10.1001/jamadermatol.2013.2382

"Smartphone applications for melanoma detection by community, patient and generalist clinician users: a review." Br J Dermatol. 2015 Jan 20. DOI: 10.1111/bjd.13665

"Smartphone breast applications – What's the evidence?," The Breast, Volume 23, Issue 5, October 2014, Pages 683-689, ISSN 0960-9776, dx.doi.org/10.1016/j.breast.2014.07.006

Provided by Cancer Research UK

The art of maintaining cognitive health as our brains age

Brains age, just like the rest of the body, even for those don't get neurological disease, according to an Institute of Medicine report released on April 14.

28 april 2015--"Some of the changes that one observes doesn't mean that it's all over, gloom and doom," the committee's vice chair, Kristine Yaffe, MD, told the Washington Post.

While aging does more damage to some than others, most people can take steps to improve their health, according to Yaffe, the Roy and Marie Scola Endowed Chair and professor of psychiatry, neurology, and epidemiology at UCSF and chief of geriatric psychiatry and director of the Memory Disorders Clinic at the San Francisco VA Medical Center.

The committee proposed three actions to help maintain cognitive function with age: staying physically active; managing blood pressure and diabetes; and stopping smoking. Aging adults should also pay careful attention to health conditions and medications that could influence their cognitive health. 

Having an active social and intellectual life can also promote cognitive health, as can getting good sleep. Aging individuals should treat any sleep disorders that develop and be aware of the delirium that can be caused by medications and hospitalization.

The committee advised caution when evaluating claims that brain training and nutritional supplements can improve cognition.

The scientific literature has shown that older adults can get better at trained abilities, although often more slowly than younger adults, and that they can maintain these skills. But it's less clear whether these benefits transfer to real-world activities like driving or remembering an appointment.

As for nutritional supplements, the report says the medical literature does not offer convincing support that any of them can prevent cognitive decline. 

The committee urged more protections for older adults, who lose an estimated $2.9 billion a year, directly and indirectly, because of financial fraud. The report said government and the financial services industry should take steps to protectolder adults from exploitation and help preserve their independence.

More information: "Cognitive Aging: Progress in Understanding and Opportunities for Action": www.iom.edu/Reports/2015/Cognitive-Aging.aspx

Provided by University of California, San Francisco

Major pathway identified in nerve cell death offers hope for therapies

Axon degeneration (top), caused by nerve injury or disease, depletes the energy supply within axons, shutting down communication between nerve cells. Washington University scientists blocked axon degeneration by supplementing neurons with a chemical called nicotinamide riboside, which kept the axons energized and healthy (bottom). Credit: Milbrandt lab

New research highlights how nerves - whether harmed by disease or traumatic injury - start to die, a discovery that unveils novel targets for developing drugs to slow or halt peripheral neuropathies and devastating neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis (ALS).

27 april 2015--Peripheral neuropathy damages nerves in the body's extremities and can cause unrelenting pain, stinging, burning, itching and sensitivity to touch. The condition is commonly associated with diabetes or develops as a side effect of chemotherapy.

The research, by scientists at Washington University School of Medicine in St. Louis, is reported online April 23 in the journal Science.

Nerve cells talk to each other by transmitting signals along communication cables called axons. Such signals underlie vital activities, such as thinking and memory, movement and language.

As part of the study, the researchers showed they could prevent axons from dying, a finding that suggests therapies could be developed to counteract the withering away of nerve axons.

"We have uncovered new details that let us piece together a major pathway involved in axon degeneration," said senior author Jeffrey Milbrandt, MD, PhD, the James S. McDonnell Professor and head of the Department of Genetics. "This is an important step forward and helps to identify new therapeutic targets. That we were able to block axon degeneration in the lab also gives us hope that drugs could be developed to treat patients suffering from a variety of neurological conditions."

A common thread among many neurological disorders and traumatic nerve injuries is the degeneration of axons, which interrupts nerve signaling and prevents nerves from communicating with one another. Axon degeneration is thought to be an initiating event in many of these disorders. In fact, an unhealthy axon is known to trigger its own death, and researchers are keenly interested in understanding how this happens.

Working in cell cultures, fruit flies and mice, Milbrandt and co-author Aaron DiAntonio, MD, PhD, the Alan A. and Edith L. Wolff Professor of Developmental Biology, and their colleagues showed that a protein already known to be involved in axon degeneration, acts like a switch to trigger axon degeneration after an injury.

M.D./Ph.D. student Josiah Gerdts (left) and Jeffrey Milbrandt, M.D., Ph.D., head of the Department of Genetics at Washington University School of Medicine, have identified a major pathway in the death of nerve axons, which carry messages between nerve cells. The finding provides a foundation for developing treatments against neurodegenerative diseases and peripheral neuropathies. Credit: Robert Boston, Washington University

Moreover, they found that this protein, once unleashed, causes a rapid decline in the energy supply within axons. Within minutes after the protein - called SARM1 - is activated in neurons, a massive loss of nicotinamide adenine dinucleotide (NAD), a chemical central to a cell's energy production, occurs within the axon.

"When a nerve is diseased or injured, SARM1 becomes more active, initiating a series of events that quickly causes an energetic catastrophe within the axon, and the axon undergoes self-destruction," said first author Josiah Gerdts, an MD/PhD student in Milbrandt's laboratory.

Working in neurons in which SARM1 was activated, the researchers showed they could completely block axon degeneration and neuron cell death by supplementing the cells with a precursor to NAD, a chemical called nicotinamide riboside. The neurons were able to use nicotinamide riboside to keep the axons energized and healthy.

Nicotinamide riboside has been linked in animal studies to good health and longevity, but its benefits have not been shown in people. The researchers said much more research is needed to know whether the chemical could slow or halt axon degeneration in the body.

"We are encouraged by the findings and think that identifying a class of drugs that block SARM1 activity has therapeutic potential in neurological disorders," Milbrandt said. "The molecular details this pathway provides give us a number of therapeutic avenues to attack."

More information: Gerdts J, Brace EJ, Sasaki Y, DiAntonio A and Milbrandt J. SARM1 activation triggers axon degeneration locally via NAD+ destruction. Science. April 24, 2015. www.sciencemag.org/lookup/doi/… 1126/science.1258366

Provided by Washington University School of Medicine

Studies reveal severe diabetes worsens Parkinson's symptoms

A pair of studies from the Perelman School of Medicine at the University of Pennsylvania demonstrate a correlation between diabetes severity and parkinsonism, or parkinsonian tremors; and examine the caregiving differences between men and women with PD.

26 april 2015--The findings will be presented this week at the American Academy of Neurology's 67th Annual Meeting in Washington, D.C.

Diabetes Severity is Associated with Worse Parkinsonism

The study enrolled 1,100 subjects over the age of 55 without Parkinson's disease or dementia from the existing Philadelphia Healthy Bran Aging cohort at the University of Pennsylvania. At baseline testing, 34 percent of subjects were found to have diabetes. A Hemoglobin A1c glucose test was performed and a diabetes severity score created that combined the presence of retinopathy, neuropathy, nephropathy and insulin dependence.

Subjects were then assessed for parkinsonian signs and cognitive impairment. The median hemoglobin A1c was 6.6 (less than 6.5 is ideal in most cases) and the median parkinsonism score was 8.3 (anything above zero is abnormal).

Higher parkinsonian scores were associated with greater diabetes severity, older age, African-American race and a past history of arthritis. Further analysis showed diabetes severity remained significantly associated with higher parkinsonian sign scores.

"Our study was based on emerging evidence that the presence of diabetes may increase the risk of both Parkinson's disease and specific motor features in parkinsonism," said Nabila Dahodwala, MD, an assistant professor of Neurology at the Perelman School of Medicine at the University of Pennsylvania and director of the National Parkinson Foundation Center of Excellence at the Parkinson's Disease and Movement Disorders Center at Pennsylvania Hospital.

"We hypothesize that the high burden of cardiovascular risk from diabetes contributes to brain injury, which can impact cognition and parkinsonism," explains Dahodwala. Further studies are needed to show causality between diabetes and parksonism. These could indicate that aggressive management of diabetes could provide additional motor benefit.

This work was funded by the Parkinson Council, NIA K23 AG034236 and P30 AG031043 and Penn Minority Aging Research for Community Health (MARCH).

Sex Differences in Parkinson's Disease Caregiving

Researchers looked at caregiving patterns among PD patients to determine if there are sex differences in caregiver accompaniment to visits, paid caregiving and caregiving strain and found that women with PD have fewer informal caregiving resources and are more likely to use formal, paid caregiving.

"Parkinson's patients rely on formal and informal caregiver support as the disease worsens," Dahodwala said. Previous research has shown that there is a higher incidence of Parkinson's disease among men, but little is known about caregiving patterns by sex.

Dahodwala and her team collected information on each of 4,718 men and 2,788 women in the National Parkinson Foundation Parkinson's Outcomes Project's medication, disease duration as well as caregiver presence and the caregiver type, time to first paid caregiver and more.

Their analysis showed that compared with women, men were significantly more likely to have a regular care partner (88 versus 80 percent), but less likely to have a paid caregiver at baseline than women (2.2 versus 4.9 percent). In addition, women were found to have lower odds of caregiver accompaniment at baseline visit, but faster time to first paid caregiver. Caregiver strain was found to be higher among caregivers of male subjects.

"We hope that this study spurs some of the key stakeholders in PD to develop policies that ensure adequate support for women with the disease. Our analysis shows there is a real need for it," Dahodwala said.

More information: "Diabetes severity is associated with worse Parkinsonism." (P4.148). www.neurology.org/content/84/1… plement/P4.148.short

"Sex Differences in Parkinson's Disease Caregiving." (S48.003). www.neurology.org/content/84/1… /S48.003.short?rss=1

Provided by University of Pennsylvania School of Medicine

Long-term exposure to air pollution may pose risk to brain structure, cognitive functions

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

Air pollution, even at moderate levels, has long been recognized as a factor in raising the risk of stroke. A new study led by scientists from Beth Israel Deaconess Medical Center and Boston University School of Medicine suggests that long-term exposure can cause damage to brain structures and impair cognitive function in middle-aged and older adults.

25 april 2015--Writing in the May 2015 issue of Stroke, researchers who studied more than 900 participants of the Framingham Heart Study found evidence of smaller brain structure and of covert brain infarcts, a type of "silent" ischemic stroke resulting from a blockage in the blood vessels supplying the brain.

The study evaluated how far participants lived from major roadways and used satellite imagery to assess prolonged exposure to ambient fine particulate matter, particles with a diameter of 2.5 millionth of a meter, referred to as PM2.5.

These particles come from a variety of sources, including power plants, factories, trucks and automobiles and the burning of wood. They can travel deeply into the lungs and have been associated in other studies with increased numbers of hospital admissions for cardiovascular events such as heart attacks and strokes.

"This is one of the first studies to look at the relationship between ambient air pollution and brain structure," says Elissa Wilker, ScD, a researcher in the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center. "Our findings suggest that air pollution is associated with insidious effects on structural brain aging, even in dementia- and stroke-free individuals."

Study participants were at least 60 years old and were free of dementia and stroke. The evaluation included total cerebral brain volume, a marker of age-associated brain atrophy; hippocampal volume, which reflect changes in the area of the brain that controls memory; white matter hyperintensity volume, which can be used as a measure of pathology and aging; and covert brain infarcts.

The study found that an increase of only?2µg per cubic meter in PM2.5, a range commonly observed across metropolitan regions in New England and New York, was associated with being more likely to have covert brain infarcts and smaller cerebral brain volume, equivalent to approximately one year of brain aging.

"These results are an important step in helping us learn what is going on in the brain," Wilker says. "The mechanisms through which air pollution may affect brain aging remain unclear, but systemic inflammation resulting from the deposit of fine particles in the lungs is likely important."

"This study shows that for a 2 microgram per cubic meter of air (μg/m3) increase in PM2.5, a range commonly observed across major US cities, on average participants who lived in more polluted areas had the brain volume of someone a year older than participants who lived in less polluted areas. They also had a 46 percent higher risk of silent strokes on MRI," said Sudha Seshadri, MD, a Professor of Neurology at Boston University School of Medicine and Senior Investigator, the Framingham Study.

"This is concerning since we know that silent strokes increase the risk of overt strokes and of developing dementia, walking problems and depression. We now plan to look at more the impact of air pollution over a longer period, its effect on more sensitive MRI measures, on brain shrinkage over time, and other risks including of stroke and dementia."

Provided by Beth Israel Deaconess Medical Center

Cancer diagnoses will rise as population ages

Cancer is a leading cause of death in Virginia and researchers at the University of Virginia's Weldon Cooper Center for Public Service project that the rate of growth in new cancer cases will far outpace the growth of the population in the next 25 years, due to the overall aging of the population.

24 april 2015--The greatest number of new cancer diagnoses is projected in the major metropolitan areas, where most Virginians live. But rural localities with a larger share of older residents will experience the highest local cancer burden by having a higher proportion of their populations diagnosed with cancer over the next three decades.

This finding and others related to cancer projections across Virginia are detailed in a Census Brief released today, the sixth in a series of short publications depicting trends in census and other data of interest to the commonwealth.

"Age is an established factor in cancer," said Shonel Sen, a research and policy analyst at the Cooper Center's Demographics Research Group who worked on the projections. "Nearly 80 percent of cancers occur among the population ages 55 and over. As Virginia's population grows bigger and, more importantly, older, we anticipate cancer cases to be on the rise."

Using carefully developed population projections for the commonwealth and its localities, and known rates of cancer diagnosis by age from the Virginia Cancer Registry, the Demographics Research Group prepared projections for the number of new cases of breast (in females), prostate (in males) and lung cancers, as well as a combined category called "all cancers" for each decade through 2040.

"We developed these projections to complement the leading work underway at the University of Virginia Cancer Center in cancer control and population health statistics," said Qian Cai, director of the Demographics Research Group. "Employing our knowledge about Virginia demographics and expertise in population estimates and projections, we are able to develop credible forecasts of cancer incidence at state and regional levels."

Pending funding, the Demographics Research Group will develop additional projections for Virginia of incidence of other cancer types, and of deaths from cancer over the three decades in this report. In addition, three-decade projections of cancer incidence and deaths for the nation overall and for the 50 states can be developed, if funding is available.

"We believe that these projections will be helpful to health care providers, insurance companies and state and local governments, as well as informing the citizens of the commonwealth about this disease that impacts the lives of so many individuals and their families," Cai said. "Data such as this for cancer, and for other diseases, are valuable in anticipating demand for services."

More information: The Census Brief, data tables, and other resources are available here: www.coopercenter.org/demograph… projections-virginia Meredith Gunter

Provided by University of Virginia

Using smartphones to avoid spatial disorientation of elderly

Researchers from UPM have used new technologies of mobile network operators to locate and send alerts when an elderly person with mild cognitive impairment (MCI) suffers from episodes of spatial disorientation.

23 april 2015--Biomedical Engineering and Telemedicine group of Universidad Politécnica de Madrid (UPM) has developed a location-awareness service using smartphones in order to detect episodes of spatial disorientation that are frequently suffered by elderly people with mild cognitive impairment. The detection of disorientation and loss analyzes information such as proximity to home or place of interest, if the user is with a relative or riding public transportation and accounts for certain time intervals. When disorientation occurs, the service puts the elderly person in touch with his nearest contact (family, a health worker or a friend) to verify if he requires help.

Due to population aging, a big societal challenge is maintaining the quality of life and autonomy of the elderly, as certain cognitive aspects can deteriorate, such as executive functions, verbal attention, visual memory and spatial navigation. This deterioration is known as mild cognitive impairment-MCI, and up to the 60% of cases include episodes of spatial disorientation that appear even in zones where the elderly person carries out daily tasks such as doing the shopping, going to the health centre or visiting someone. The person goes missing and starts to wander, causing not only stress or anxiety, but also dangerous situations (falls, accidents, etc.). Disorientation of elderly also means a source of concern for their caregivers (family, friends).

This study, conducted by GBT group at UPM, establishes safety areas for each user around a series of geographical locations called hotspots. These locations can be their home or other familiar places. These zones distinguish potentially unfamiliar areas where a situation of spatial disorientation could occur. By using the location information service, a lost person is put in contact with his relatives via smartphone.

The location service uses a new technology of intelligent communication networks called IP Multimedia Subsystem (IMS). IMS networks provide basic services that can be reused by any installed application on a smartphone. The basic presence service sends dynamic user information such as location to other users or systems subscribed to the service. The presence service can store static information through the profile of each registered user.

This study is another example of how information and communications technology (ICT) are becoming essential tools for supporting elderly people. Smartphones and their integrated sensors are a rich source of user data and its context.

The location information is an essential part of the user context in order to provide applications based on geographical location. The location service will allow people with MCI to live with more independence, preserving their autonomy and self-esteem. The service will also allow caregivers to manage situations of spatial disorientation and reducing stress and anxiety.

More information: "Design and Technical Evaluation of an Enhanced Location-Awareness Service Enabler for Spatial Disorientation Management of Elderly With Mild Cognitive Impairment". IEEE Journal of Biomedical and Health Informatics 19 (1): 37-43. DOI: 10.1109/JBHI.2014.2327638

Provided by Universidad Politécnica de Madrid

Age, creatinine, ejection fraction predict post-MI survival

22 april 2015—A simple age, creatinine, and ejection fraction (ACEF) score can predict one-year mortality risk in myocardial infarction 30-day survivors who underwent percutaneous coronary intervention, according to a study published in the May 1 issue of The American Journal of Cardiology.

Jang Hoon Lee, M.D., from Kyungpook National University Hospital in Daegu, South Korea, and colleagues examined whether the ACEF score could predict one-year mortality for 12,000 post-myocardial infarction 30-day survivors who underwent percutaneous coronary intervention. Twelve risk factors were selected and ranked based on their area under the curve (AUC) value.

The researchers found that the best AUC value was indicated by age, ejection fraction, and serum creatinine levels. Nonsurvivors had a significantly higher ACEF score (1.95 ± 0.82 versus 1.28 ± 0.5); the ACEF score independently predicted one-year mortality (adjusted hazard ratio, 2.26). A prediction model including 12 risk factors had the best accuracy (AUC, 0.8), but this was not significantly different from the ACEF score (AUC, 0.79). For the ACEF_LOW, ACEF_MID, and ACEF_HIGH groups, the adjusted hazard ratios for one-year mortality were 1 (reference), 3.11, and 10.38, respectively.

"The ACEF score may be a novel valid model to stratify the one-year mortality risk in 30-day survivors who underwent percutaneous coronary intervention after myocardial infarction," the authors write.

More information: Abstract
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Is the amyloid hypothesis the right path to find a treatment for Alzheimer's disease?

There is both risk and reward in focusing Alzheimer's disease research on inhibiting amyloid production, according to a new article in Future Science OA. The article reviews the significant body of research proposing that the accumulation of beta amyloid in the brain is the Alzheimer's disease trigger that must be inhibited. Future Science OA is an online, open access, peer-reviewed title from Future Science Group.

21 april 2015--Alzheimer's disease is the most common form of dementia in the elderly, affecting more than 36 million people worldwide, and no drugs have yet been proven to halt the progression of this degenerative disease. Significant research has focused on a theory known as the Amyloid Hypothesis, which suggests that the accumulation of a small protein fragment called beta amyloid or Aβ within brain tissue is the event which triggers Alzheimer's disease. Aβ is a derivative of the longer Amyloid Precursor Protein (APP). The article reviews research efforts that have attempted to inhibit the generation of Aβ by modulating the proteins (called secretases) that cut the APP into Aβ. The article reviews both the successes and failures of Aβ clinical trials, and the risks and rewards of continuing to pursue this line of research.

"This review outlines the role of the proteolytic secretases to produce beta amyloid peptide as part of the "Amyloid Hypothesis" of Alzheimer's disease," said the authors, of the Institute of Cardiovascular and Medical Sciences, University of Glasgow. "We examine the current status of the secretases as therapeutic targets in AD and speculate as to the viability of the AD hypothesis as a whole in light of recent findings."

"With the many failures we have seen in drugs targeting APP processing and the continued socioeconomic burden of Alzheimer's Disease, it is excellent to see such a comprehensive review covering research in the area and discussing potential ways forward," said Francesca Lake, Managing Editor.

Click here to read the complete article in Future Science OA. Additional articles and content from this online, open access, peer-reviewed title from Future Science Group is also available. The journal's broad coverage includes all areas of biotechnology and medicine, as well as topics in biological, life and physical sciences that are of relevance to human health.

More information: MacLeod R, Hillert E, Cameron R, and Baillie G. The Role and Therapeutic Targeting of α-, β- and γ-secretase in Alzheimer's Disease. Future Sci. OA FSO11. DOI: 10.4155/FSO.15.9  (2015).

Provided by Future Science Group

8 nutrients to protect the aging brain

20 april 2015--Brain health is the second most important component in maintaining a healthy lifestyle according to a 2014 AARP study. As people age they can experience a range of cognitive issues from decreased critical thinking to dementia and Alzheimer's disease. In the March issue of Food Technology published by the Institute of Food Technologists (IFT), contributing editor Linda Milo Ohr writes about eight nutrients that may help keep your brain in good shape.

1. Cocoa Flavanols: Cocoa flavanols have been linked to improved circulation and heart health, and preliminary research shows a possible connection to memory improvement as well. A study showed cocoa flavanols may improve the function of a specific part of the brain called the dentate gyrus, which is associated with age-related memory (Brickman, 2014).
2. Omega-3 Fatty Acids: Omega-3 fatty acids have long been shown to contribute to good heart health are now playing a role in cognitive health as well. A study on mice found that omega-3 polyunsaturated fatty acid supplementation appeared to result in better object recognition memory, spatial and localizatory memory (memories that can be consciously recalled such as facts and knowledge), and adverse response retention (Cutuli, 2014). Foods rich in omega-3s include salmon, flaxseed oil, and chia seeds.
3. Phosphatidylserine and Phosphatidic Acid: Two pilot studies showed that a combination of phosphatidylserine and phosphatidic acid can help benefit memory, mood, and cognitive function in the elderly (Lonza, 2014).
4. Walnuts: A diet supplemented with walnuts may have a beneficial effect in reducing the risk, delaying the onset, or slowing the progression of Alzheimer's disease in mice (Muthaiyah, 2014).
5. Citicoline: Citicoline is a natural substance found in the body's cells and helps in the development of brain tissue, which helps regulate memory and cognitive function, enhances communication between neurons, and protects neural structures from free radical damage. Clinical trials have shown citicoline supplements may help maintain normal cognitive function with aging and protect the brain from free radical damage. (Kyowa Hakko USA).
6. Choline: Choline, which is associated with liver health and women's health, also helps with the communication systems for cells within the brain and the rest of the body. Choline may also support the brain during aging and help prevent changes in brain chemistry that result in cognitive decline and failure. A major source of choline in the diet are eggs.
7. Magnesium: Magnesium supplements are often recommended for those who experienced serious concussions. Magnesium-rich foods include avocado, soy beans, bananas and dark chocolate.
8. Blueberries: Blueberries are known to have antioxidant and anti-inflammatory activity because they boast a high concentration of anthocyanins, a flavonoid that enhances the health-promoting quality of foods. Moderate blueberry consumption could offer neurocognitive benefits such as increased neural signaling in the brain centers.

Turning back the clock on Parkinson's

David Higgins was diagnosed with Parkinson's disease years after his initial symptoms appeared. Credit: Ryan Parks/UC San Diego Health Sciences

18 april 2015--Like many young people, David Higgins was initially in denial about the possibility of having a serious, lifelong disease.

"My friends would say, 'You walk funny," and I'd say, 'I have a stiff back,'' recalled Higgins, now 57. "Parkinson's was the last thing on my mind," he said, or on the mind of his doctor at the time, who had him tested for cardiovascular disease, brain cancer and stroke.

"There was a lot of rationalizing and denial on my part," said Higgins even though his mother, maternal grandmother and an uncle all died of Parkinson's disease, a group of progressive motor system disorders that affect as many as 1 million Americans.

Eventually, after several years, Higgins' worsening condition was impossible to ignore. "I went out for a run one day and it felt like I was moving through mud. I knew I had to do something."

That something was a life-changing consultation with Dr. Irene Litvan, the Tasch Endowed Professor in Parkinson's Disease Research and director of the Movement Disorder Center at UC San Diego Health System.

"Dr. Litvan diagnosed me in 2.5 seconds," Higgins said. "At the exact precise moment she said 'You have Parkinson's,' there was relief. Adversity is less troubling than ambiguity."

That moment occurred on Dec. 5, 2011.

Higgins was Litvan's first patient on her first day of clinical work at UC San Diego.

Center for Excellence

Since then, under her leadership, the Movement Disorder Center has grown and blossomed. In February, the center's outstanding track record in comprehensive patient care, research and education was formally recognized by other leaders in the field through its designation as a Center for Excellence by the National Parkinson Foundation.

There are only 25 Centers of Excellence for Parkinson's in the United States; 16 internationally.

Peter Schmidt, vice president of research and professional programs at the Parkinson Foundation, characterized the designation as reflecting a shared vision "for the integrated research and care enterprise, where patient-focused clinicians deliver the latest care and newest therapies."

"Their clinic benefits from research into novel approaches that advance our knowledge and their research agenda reflects the priorities of patients and families," he said.

Higgins puts it this way: "I know good people attract good people. The Center of Excellence will bring in smarter and better researchers to whom I will have access. I know I will have immediate, early access to any innovations that come about, and I have Dr. Litvan to filter out which new treatments are most substantiated and relevant to me. It means I get the best care possible."

Target: early diagnosis

Parkinson's disease—the disease that actor Michael J. Fox has—is a chronic, progressive neurological disorder, characterized by tell-tale tremors, stiffness and other declines in motor control. Loss of motor function is caused by degeneration of neurons that produce the chemical messenger dopamine. Classic Parkinson's disease symptoms usually begin when 50 to 80 percent of these dopamine neurons have died.

The Holy Grail of many progressive, currently incurable, diseases—including Parkinson's—is to be able to diagnose the disease in its earliest stages and halt its progression before damage has been done. Among the more intriguing discoveries made about Parkinson's in recent years is that some of its earliest signs may be unrelated to declines in motor skills. Loss of smell, constipation, depression and dream-enacting behaviors, for example, often precede more identifiable Parkinson's symptoms.

"The definition of Parkinson's disease is presently being refined," said Litvan, who is a member of the International Parkinson and Movement Disorder Task Force working on this re-definition. "One of the advantages of being treated at a Center of Excellence such as ours is that the professionals who evaluate patients also participate in research and are up-to-date on the latest diagnostic methods, technology and treatment options for Parkinson's disease and related disorders.

New developments

UC San Diego is one of only a few centers in the nation conducting research on a PET scan that detects deposits of a protein called tau that aggregates in the brain of patients with a related Parkinsonian disorder called progressive supranuclear palsy (PSP). "The PET scan may allow us to make an accurate diagnosis of this disorder in vivo," Litvan said. "This could help us properly manage the person's condition and identify people who would be most likely to benefit from investigational therapies."

There is also a growing interest in identifying biomarkers in blood that could inexpensively and non-invasively diagnose different neurodegenerative disorders at their most incipient stages.

Another promising development is evidence suggesting that Parkinson's may spread from one neuron to its neighbors by aggregations of a protein called alpha-synuclein. If this is the case, capturing and removing the aggregations before they affect neighboring cells might slow or halt the progression of the disease. "I am very excited about this area of research," Litvan said.

Litvan is also involved in a phase 3, double-blind placebo-controlled study of a calcium channel blocker use to treat high blood pressure. In animal studies, the drug, called isradapine, blocks specific calcium channels that increase before dopamine-producing neurons die. "We hope what is observed in animals will also occur in humans," she said.

Since 2011, Higgins has gone on medications and embraced a physical therapy regime at the Movement Disorder Center that has virtually erased any outward signs of illness. He has also become a full-time patient advocate for Parkinson's and was recently in Washington, D.C. lobbying officials to appropriate more funding for Parkinson's disease research.

"People see me and they ask why I am here," he said. "They can't tell I have Parkinson's. I am here because I believe that institutions like UC San Diego and science in general are our hope for new therapies and cures."

Provided by University of California - San Diego

Are populations aging more slowly than we think?

Faster increases in life expectancy do not necessarily produce faster population aging, according to new research published in the journal PLOS ONE. This counterintuitive finding was the result of applying new measures of aging developed at IIASA to future population projections for Europe up to the year 2050.

16 april 2015--"Age can be measured as the time already lived or it can be adjusted taking into account the time left to live. If you don't consider people old just because they reached age 65 but instead take into account how long they have left to live, then the faster the increase in life expectancy, the less aging is actually going on." says IIASA World Population Program Deputy Director, Sergei Scherbov, who led the study in collaboration with IIASA and Stony Brook University researcher Warren Sanderson.

Traditional measures of age simply categorize people as "old" at a specific age, often 65. But previous research by Scherbov, Sanderson, and colleagues has shown that the traditional definition puts many people in the category of "old" who have characteristics of much younger people.

"What we think of as old has changed over time, and it will need to continue changing in the future as people live longer, healthier lives," says Scherbov. "Someone who is 60 years old today, I would argue is middle aged. 200 years ago, a 60-year-old would be a very old person."

Sanderson explains, "The onset of old age is important because it is often used as an indicator of increased disability and dependence, and decreased labor force participation. Adjusting what we consider to be the onset of old age when we study different countries and time periods is crucial both for the scientific understanding of population aging for the formulation of policies consistent with our current demographic situation."

In the new study the researchers compared the proportion of the population that was categorized as "old" using the conventional measure that assumes that people become "old" at age 65 and the proportion based on their new measure of age, which incorporates changes in life expectancy.

The study looked at three scenarios for future population aging in Europe, using three different rates of increase for life expectancy, from no increase to an increase of about 1.4 years per decade, the level projected by the Wittgenstein Center's European Demographic Datasheet. The results show that, as expected, faster increase in life expectancy lead to faster population aging when people are categorized as "old" at age 65 regardless of time or place, but, surprisingly, that they lead to slower population aging when the new measures of age are used.

Provided by International Institute for Applied Systems Analysis

The brain's aging and a new report urges ways to stay sharp

Credit: Wikimedia Commons

15 april 2015--The brain ages just like the rest of a body, says a new report that urges seniors to take steps to keep sharp.

The prestigious Institute of Medicine examined what scientists know about "cognitive aging," changes in mental functioning as we get older.

This isn't a disease like Alzheimer's but a natural process—and it's not always bad. Wisdom can indeed increase with age, and years of experience can prove invaluable, stressed Dr. Dan Blazer, an emeritus professor of psychiatry at Duke University who chaired the IOM committee.

"The brain ages in all of us. But there's wide variability in the way the brain ages," Blazer said.

Staying cognitively sharp is one of the biggest concerns of seniors, with good reason. Tuesday's report warns that even subtle slowdowns can affect daily life, making seniors more vulnerable to financial scams, driving problems or other difficulties in a technology-driven world.

Indeed, while some people will experience little if any cognitive change, many older adults process information more slowly, and have more difficulty multitasking than when they were younger, the report found. What's called working memory—the brain's short-term storage—often declines with age but typically long-term memory remains intact even if it takes longer to recall someone's name.

That kind of change may not be obvious until, say, someone is faced with a complex financial decision or forced to make a transaction quickly and has trouble, Blazer said. Older adults are losing nearly $3 billion a year, directly and indirectly, to financial fraud, the report noted.

What's the difference between normal aging and cognitive decline?

"There's no clear line that we can draw here," Blazer cautioned.

Someone experiencing memory difficulty needs to be checked by a doctor, said IOM panelist Dr. Jason Karlawish of the University of Pennsylvania. With Alzheimer's, nerve cells in the brain die. With normal cognitive aging, neurons don't die—they just don't work as well, he explained.

The best advice for staying sharp as you get older: Be physically active. The sooner you start the better, but it's never too late, Blazer said.

The IOM also recommended:

—Control high blood pressure and diabetes, and don't smoke. Those are key risks for heart disease, and what's bad for your heart is bad for your brain.

—Some medications commonly taken by seniors—including certain anxiety or sleep drugs, antihistamines, bladder drugs and older antidepressants—can fog the brain, so ask about yours.

—Keep socially and intellectually active.

—Get enough sleep.

—Be careful of products that claim to improve cognitive functioning. There's no evidence that vitamins and dietary supplements like ginkgo biloba help, Blazer said. And the jury's still out on whether computer-based brain-training games do any good, he said.

The IOM also urged more research into normal cognitive aging, which has been left somewhat behind the study of diseases like Alzheimer's, and more education of doctors about their patients' risks. For example, hospitalized seniors are at increased risk for delirium—sudden confusion and agitation—that can cause lingering cognitive decline after they go home, but there are ways to prevent it.

The IOM also said government agencies and communities should consider cognitive aging as they set policies and programs. It cited a California law to protect older adults who are signing up for reverse mortgages, and a Michigan plan to improve older driver safety through such steps as adjusting traffic lights to counter glare.

Tango dancing benefits Parkinson's patients

Dancing the Argentine tango could have potential benefits for people at certain stages in the development of Parkinson's disease (PD), according to findings in a new study by researchers at the Montreal Neurological Institute and Hospital -The Neuro, McGill University and the Research Institute of the McGill University Health Centre. The study looked at changes in patients' motor abilities following a 12-week tango course, and is also the first study to assess the effect that tango has on non-motor symptoms.

14 april 2015--The study looked at whether a social and physical activity linked to music, such as tango, could have possible therapeutic value for PD patients who characteristically suffer from motor dysfunctions—-tremor, rigidity, gait dysfunction—-as well as from non-motor symptoms, such as depression, fatigue and cognitive degeneration. Forty men and women with idiopathic Parkinson's disease participated in the study, which involved studio classes with two professional dance teachers. Patients were from the Movement Disorders Clinics of the McGill University Health Centre.

"There's accumulating evidence that habitual physical activity is associated with a lower risk of developing PD, which suggests a potential slowing of PD progression," says Dr. Silvia Rios Romenets, lead researcher in the study with a special interest in Parkinson's disease and dance therapy. Dr. Rios Romenets is a clinical research fellow at the Movement Disorders Clinics at The Neuro and Montreal General Hospital. "In the study, we found the tango was helpful in significantly improving balance and functional mobility, and seemed to encourage patients to appreciate their general course of therapy. We also found modest benefits in terms of patients' cognitive functions and in reducing fatigue. No significant changes were detected in overall motor functions."

Argentine tango may be particularly helpful for improving balance and functional mobility in patients with PD. Tango requires specific steps that involve rhythmically walking forward and backward. This may be particularly helpful for walking difficulties especially for freezing of gait and to prevent backward falls. In addition, tango requires working memory, control of attention, and multitasking to incorporate newly learned and previously learned dance elements, to stay in rhythm with the music, and maneuver around others on the dance floor.

Many PD patients find traditional exercise programs unappealing. Over half of PD patients fail to get their recommended daily dose of physical activity. There is however, a connection between music and the dopamine systems in the brain - which are pivotal for establishing and maintaining behavior. So, combining music with exercise in dance such as the tango, can increase accessibility, enjoyability, and motivation, as well as improving mood and stimulating cognition. Also, the social interaction and social support involved in tango have positive results on mood and compliance.

More information: Tango for treatment of motor and non-motor manifestations in Parkinson's disease: A randomized control study, DOI: 10.1016/j.ctim.2015.01.015

Provided by McGill University

Study finds that too much sodium is a worldwide killer

Salt accounts for more than 1.6 million cardiovascular-related deaths each year. Credit: Juliette Borda

Americans are not alone in their taste for salty foods. Whether the salt comes from French fries or miso soup, people all over the world are getting more than the current recommendations. And according to an analysis of global sodium intake published in the New England Journal of Medicine, that overabundance of salt accounts for more than 1.6 million cardiovascular-related deaths each year.

13 april 2015--The researchers looked at existing data on sodium intake in 187 countries representing nearly three-quarters of the world's adult population. Separately, they determined the effects of sodium on blood pressure and of blood pressure on cardiovascular diseases—including heart disease and stroke—by analyzing more than 100 previous clinical trials.

These findings were combined with current rates of cardiovascular disease around the world to estimate the number of cardiovascular deaths attributable to taking in more than 2,000 mg of sodium per day, the World Health Organization's recommended amount.

In 2010, the average global sodium consumption was nearly double that recommendation—3,950 mg—the researchers found. In fact, all regions of the world were above recommended levels, with averages ranging from 2,180 mg per day in sub-Saharan Africa to 5,510 mg per day in Central Asia.

"These 1.65 million deaths represent nearly one in 10 of all deaths from cardiovascular causes worldwide. No world region and few countries were spared," says Dariush Mozaffarian, dean of the Friedman School, who led the research while at the Harvard School of Public Health and is first author on the paper. Some of the highest rates were in East Asia and Southeast Asia, where excess salt consumption accounted for more than 20 percent of cardiovascular deaths in people under age 70, the study found.

In the United States, the researchers found that nearly 58,000 cardiovascular deaths each year could be attributed to daily sodium consumption greater than 2,000 mg. Average U.S. sodium intake was 3,600 mg per day, 80 percent higher than the WHO's recommendation and 57 percent higher than the 2,300 mg recommended by the Dietary Guidelines for Americans.

"These new findings inform the need for strong policies to reduce dietary sodium in the United States and across the world," says Mozaffarian, who chairs the Global Burden of Diseases, Nutrition and Chronic Disease Expert Group, an international team of more than 100 scientists studying the effects of nutrition on health that contributed to the research.

Provided by Tufts University