Osteoporosis linked with heart disease in older people

University of Southampton scientists have discovered a link between coronary heart disease and osteoporosis, suggesting both conditions could have similar causes.

30 jun 2015--In one of the first studies of its kind to use a special scanning technique, researchers found that people with a history of heart disease had substantially lower cortical volumetric bone mineral density in their wrist bone (the distal radius) than those without.

Using a state-of-the-art technique called 'high resolution peripheral quantitative computed tomography', researchers from Southampton's Medical Research Council (MRC) Lifecourse Epidemiology Unit were able to visualise multiple layers of the wrist bone, in much the same way a 3D printer might build up layers of an object. These cross section visuals were used to assess symptoms of osteoporosis - a condition that weakens bones, making them more vulnerable to fractures and breaks.

The technique was used on 350 men and women, aged 70 - 85, who had enrolled on the Hertfordshire Cohort Study. The findings, published today in Osteoporosis International, show that cortical volumetric bone mineral density was lower among participants with coronary heart disease (or ischaemic heart disease) such as angina, heart attack or heart failure. The effect was more prominent in women than in men.

Professor Cyrus Cooper, Director of the MRC Lifecourse Epidemiology Unit and Professor of Rheumatology at the University of Southampton, says: "This is one of the first studies to use this technology to explore bone geometry, density and microstructure in patients with heart disease. The findings highlight the need to evaluate a history of heart disease in the management of osteoporosis in older people and further research is also needed to provide a better understanding of the underlying mechanisms which explain the link between osteoporosis and heart disease."

Dr. Julien Paccou, Clinical Research Fellow at the MRC Lifecourse Epidemiology Unit, University of Southampton, added: "In essence, this work and others show that people with a history of cardiovascular disease tend to have weaker bones. There is a need to better understand this association to improve bone health."

The study Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius was funded by the Medical Research Council.

Provided by University of Southampton

Multiple pathways progressing to Alzheimer's disease

A micrograph of amyloid plaques and neurofibrillary tangles in human brain. Credit: Thomas Deerinck/National Center for Microscopy and Imaging Research at UC San Diego

The amyloid cascade hypothesis of Alzheimer's disease (AD) posits that sticky aggregations or plaques of amyloid-beta peptides accumulate over time in the brain, triggering a series of events that ultimately result in the full-blown neurodegenerative disorder. The hypothesis has been a major driver of AD research for more than 20 years.

29 jun 2015--However, in a new study published this week online in the Journal of Alzheimer's Disease, researchers at University of California, San Diego School of Medicine and Veterans Affairs San Diego Healthcare System suggest the picture is not so clear-cut, reporting that early indicators or biomarkers of AD development are not fixed in a specific sequence.

"Our current ability to identify early stages of AD is limited by the focus on amyloid accumulation and the expectation that biomarkers follow the same timeline for all individuals," said Emily C. Edmonds, PhD, a senior postdoctoral fellow in the Department of Psychiatry and first author of the study.

But, Edmonds said, "AD is complex in the sense that there may be different neurobiological pathways leading to expression of the disease. Our findings suggest that the number of abnormal biomarkers and cognitive markers an individual possesses, without regard to the temporal sequence, is most predictive of future decline."

"Preclinical AD" is a very early stage of AD prior to the appearance of diagnosable symptoms. Current National Institute of Aging-Alzheimer's Association (NIA-AA) criteria for preclinical AD describe a disease progression that begins with accumulation of amyloid-beta, leading to neurodegeneration, cognitive decline and, eventually, diagnosable AD.

In their study, researchers classified 570 cognitively normal participants in the Alzheimer's Disease Neuroimaging Initiative according to NIA-AA criteria, and then separately examined the participants based upon the presence and number of abnormal biological and cognitive markers associated with preclinical AD. They found that neurodegeneration alone was 2.5 times more common than amyloid accumulation alone at baseline measurements.

They then examined only those participants who progressed to a diagnosis of mild cognitive impairment, which is an at-risk cognitive state of AD. They found that it was most common to show neurodegeneration as the first sign of early AD, and equally common to show amyloid accumulation or subtle cognitive decline as the first sign.

Edmonds said that the findings underscore the need to improve identification of persons at risk for AD through the use of multiple, diverse assessment tools. This includes sensitive learning and memory tests capable of reliably identifying cognitive changes at the earliest stages.

"At present, it is much more common for assessment of cognition to be based on insensitive screening measures or reports of cognitive problems by patients or their family members," said Edmonds. "These blunt screening tools can be very unreliable, which might explain why cognitive decline has traditionally been viewed as occurring later in the disease process. The integration of sensitive neuropsychological measures with assessment of biomarkers of AD can enhance our ability to more accurately identify individuals who are at risk for future progression to AD."

Provided by University of California - San Diego

Weight loss plus vitamin D reduces inflammation linked to cancer, chronic disease

For the first time, researchers at Fred Hutchinson Cancer Research Center have found that weight loss, in combination with vitamin D supplementation, has a greater effect on reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases, including some cancers.

28 jun 2015--Results of the randomized, controlled clinical trial—which involved more than 200 overweight, postmenopausal women who had insufficient levels of vitamin D at the beginning of the study—are published online ahead of the July print issue ofCancer Prevention Research, a journal of the American Association for Cancer Research.

"We know from our previous studies that by losing weight, people can reduce their overall levels of inflammation, and there is some evidence suggesting that taking vitamin D supplements can have a similar effect if one has insufficient levels of the nutrient," said lead and corresponding author Catherine Duggan, Ph.D., a principal staff scientist in the Public Health Sciences Division at Fred Hutch. However, it has not been known whether combining the two—weight loss and vitamin D—would further boost this effect. "It's the first study to test whether adding vitamin D augments the considerable effect of weight loss on inflammatory biomarkers," she said.

To explore this question, Duggan and colleagues recruited 218 healthy, overweight older women who had lower-than-recommended levels of vitamin D (less than 32 ng/mL). The women then took part in a 12-month diet and exercise program (including 45 minutes of moderate-to-vigorous exercise five days a week). Half of the study participants were randomly selected to receive 2,000 IU of vitamin D daily for the duration of the year-long trial, and the other half received an identical-appearing placebo, or dummy vitamin. Biomarkers of inflammation were measured at the beginning and end of the study. The researchers then compared changes in these levels between the two groups.

At the end of the study, all of the participants had reduced levels of inflammation, regardless of whether they took vitamin D, "which highlights the importance of weight loss in reducing inflammation," Duggan said. However, those who saw the most significant decline in markers of inflammation were those who took vitamin D and lost 5 to 10 percent of their baseline weight. These study participants had a 37 percent reduction in a pro-inflammatory cytokine called interleukin-6, or IL-6, as compared to those in the placebo group, who saw a 17.2 percent reduction in IL-6. The researchers found similar results among women in the vitamin D group who lost more than 10 percent of their starting weight. While IL-6 has normal functions in the body, elevated levels are associated with an increased risk of developing certain cancers and diabetes and may be implicated as a cause of depression, Duggan said.

"We were quite surprised to see that vitamin D had an effect on an inflammation biomarker only among women who lost at least 5 percent of their baseline weight," Duggan said. "That suggests vitamin D can augment the effect of weight loss on inflammation."

Vitamin D is a steroid hormone that has multiple functions beyond its widely recognized role in regulating calcium levels and bone metabolism. Vitamin D receptors are found in more than 30 cell types and the research focus around this nutrient recently has shifted from bone health to vitamin D's effect on cancer, cardiovascular health and weight loss, among other health issues.

Inflammation occurs when the body is exposed to pathogens, such as bacteria or viruses, which puts the immune system in overdrive until the "attack" ceases and the inflammatory response abates. Overweight or obese people, however, exist in a state of chronic inflammation. This sustained upregulation of the inflammatory response occurs because fat tissue continually produces cytokines, molecules that are usually only present for a short time, while the body is fighting infection, for example.

"It is thought that this state of chronic inflammation is pro-tumorigenic, that is, it encourages the growth of cancer cells," she said. There is also some evidence that increased body mass "dilutes" vitamin D, possibly by sequestering it in fat tissue.

"Weight loss reduces inflammation, and thus represents another mechanism for reducing cancer risk," Duggan said. "If ensuring that vitamin D levels are replete, or at an optimum level, can decrease inflammation over and above that ofweight loss alone, that can be an important addition to the tools people can use to reduce their cancer risk."

Duggan encourages women to speak to their health care providers about measuring their levels of vitamin D to determine the most appropriate dosage.

Provided by Fred Hutchinson Cancer Research Center

When it comes to older people and sex, doctors put their heads in the sand

Then we did it in this position.

The sex lives of older people have received a lot of attention recently. From the Netflix sitcom Grace and Frankie, which stars Jane Fonda and Lily Tomlin (both in their 70s) and does not shy away from the issue of sex, tothe Channel 4 series that focused on "love and sex when we're over 60", it seems there is no escaping the message that older adults have and enjoy sex.

27 jun 2015--Indeed, five years ago the World Health Organisation declared sexual health to be important across the lifespan. And since the early 2000s governing bodies have promoted sexual activity as good for the health and well-being of older adults. The UK's largest sexual health study, the National Survey of Sexual Attitudes and Lifestyles (NATSAL), has, for the very first time in its 25-year history, included adults aged 60 and older. And the English Longitudinal Study of Ageing (ELSA) which began in 2002 has, also for the first time, included questions about sex. These studies follow the growing number of international studies that have explored the frequency of sexual activity among older adults, including, for exampleSpain, North America, Australia and Sweden.

Clearly, there has been a societal shift in attitudes towards sexuality and ageing which, in my view, is a step in the right direction. It enables us to move away from the taboo that surrounds sex after the age of 60 and the negative stereotyping of the sexuality of older adults. But, in spite of this increased recognition and visibility, there is consistent evidence that older adults tend not to seek help when they have a concern about sex and also that doctors are unlikely to ask their older patients about it.

Don't ask, don't tell

In our research we found that doctors were unlikely to be proactive when it came to the sexual needs of their older patients, leaving it instead for the patient to raise the issue. This related to a number of factors, including having limited knowledge of later-life sexuality issues, receiving "inadequate" training at medical school and thinking that sexuality and intimacy were private topics for older adults and that raising them would cause offence.

Opening up the conversation. Credit: Shutterstock

There was also evidence that doctors assumed sex was less important to older patients than it was to younger patients, which might explain why they were less likely to mention that medications could affect sexual function when the patient was older.

Similar barriers have been identified in relation to the aftercare of health conditions that are known to impact sexual function. For example, one study found that health professionals who worked in stroke care rarely raised the topic of sexual well-being with their patients. This was due to a lack of motivation on their part and difficulties with their own communication skills and confidence. Another, in the area of spinal care, found that while the majority of neurosurgeons saw discussing sexual matters with patients as part of their role, 73% reported that they didn't do this.

Expecting the patient to be the one to raise the issue of sex if she or he has a concern should be viewed alongside the research finding that older adults tend to prefer it if the health professional initiates a discussion about sex. That research also identified the reasons older adults may not ask for help; these included viewing the sexual problem as a "normal" part of getting old and thinking that the doctor would not be able to help because sex is a specialist area.

Other reasons included internalised ageism, evidenced by older adults reporting concern about what the health professional would think when they knew that they were sexually active "at their age". A fear of being judged negatively for having an interest in sex forms a clear barrier – and other researchers have identified that the perceived attitude of the doctor can influence whether or not older adults seek help. For example, a study of middle aged and older women with diabetes also found that characteristics of the doctors, including their attitude towards sex and ageing, influenced whether or not the women were willing to discuss sexual matters with them.

Unmet need

If doctors leave it to older adults to ask about their sexual concerns, and older adults leave it to their doctors to raise the issue, then a clear unmet need exists. This impasse has implications for the sexual well-being of older adults, particularly as many studies – including NATSAL and ELSA – report that sexual problems are more likely to occur the older a person gets. For some older adults, sexual problems can be a cause for concern.

It is imperative to address this issue, as a growing number of industrialised countries have an increasing older population. And those born in the 1950s and subsequent decades, will have specific expectations about health care and are thusless likely than previous generations to keep quiet about their sexual health needs as they become older themselves.

Source: The Conversation

Three-five cups of coffee per day may reduce CVD mortality risk by up to 21 percent, report says

Credit: George Hodan/public domain

Drinking 3-5 cups of coffee per day could cut an individual's cardiovascular disease (CVD) mortality risk by up to 21%, according to research highlighted in a EuroPRevent session report published by the Institute for Scientific Information on Coffee (ISIC), a not-for-profit organisation devoted to the study and disclosure of science related to coffee and health1.

27 jun 2015--The finding is significant given that coronary heart disease and stroke remain the primary cause of death across Europe, responsible for 51% of all deaths in women and 42% of all deaths in men.2 Over four million people die from CVD annually in Europe and overall, CVD is estimated to cost the EU economy €196 billion every year.3

The ISIC session report highlights the research presented at a Satellite Symposium held during the European Association for Cardiovascular Prevention & Rehabilitation's 2015 congress in Lisbon, Portugal, on the subject of 'Coffee and CVD Mortality'. Leading researchers in this field presented on the role of lifestyle factors in CVD mortality risk reduction, the epidemiological evidence on coffee and CVD mortality, and the conclusions from meta-analyses on coffee and CVD mortality.

Key highlights:

• The lowest CVD mortality risk is seen at an intake of approximately 3 cups of coffee per day, with a percentage risk reduction of up to 21%.1
• Two 2014 meta-analyses suggest an association between coffee consumption and CVD risk, proposing a 'U-shaped' pattern whereby optimal protective effects were achieved with 3-5 cups of coffee per day.3,4
• Drinking 3-4 cups of coffee per day is associated with an approximate 25% lower risk of developing type 2 diabetes compared to consuming none or less than 2 cups per day.5 People with diabetes typically have a higher CVD mortality risk, therefore this association may be linked to a decreased CVD risk.6
• In males, a combination of 5 healthy behaviours (a healthy diet, moderate alcohol consumption (10 to 30 g/ day), no smoking, being physically active and having no abdominal adiposity) could prevent 79% of myocardial infarction events.7
• Half of CVD cases in women could be avoided by modifying lifestyle choices, as approximately 73% of CHD cases and 46% of clinical CVD are attributable to an unhealthy lifestyle.8

The report concludes that recent research supports the view that moderate coffee consumption at approximately 3 - 5 cups per day may have a protective effect against CVD mortality risk. The mechanisms of action behind the associations are unclear, however areas of interest for future research include the anti-inflammatory and antioxidant properties of coffee, and the known association between coffee consumption and type 2 diabetes risk reduction as CVD mortality is typically higher in this group. It is important to note that results differ between varying populations; it is suggested that 2 cups of coffee per day may offer the greatest protection in a Japanese population, whilst 3 cups may provide the greatest protection in UK and US populations.

Prof. Doutor António Vaz Carneiro of the Faculdade de Medicine da Universidade de Lisboa commented: "It is important to acknowledge factors which might have a protective effect against CVD mortality. Moderate coffee consumption could play a significant role in reducing CVD mortality risk which would impact health outcomes and healthcare spending across Europe."

The session report details the key scientific research presented by Assoc. Prof. Esther Lopez-Garcia, Prof. Alicja Wolk, and Prof. Carlo La Vecchia during a session titled: Coffee and CVD Mortality Risk, which took place on 14th May in Lisbon, Portugal.

More information: References:

1. Crippa A. et al. (2014) Coffee consumption and mortality from all causes, cardiovascular disease, and cancer: a dose-response meta-analysis. Am J Epidemiol. 180(8):763-75

2. Nichols M. et al. (2014) Cardiovascular disease in Europe 2014: epidemiological update. European Heart Journal. 35(42):2950-9

3. European Heart Network, 'European Cardiovascular Disease Statistics 2012' Available at: www.ehnheart.org/ cvd-statistics.html

4. Ding M. et al (2014) Long-term coffee consumption and risk of cardiovascular disease: a systematic review and a dose-response meta-analysis of prospective cohort studies. Circulation. 129(6):643-59

5. Huxley R. et al. (2009) Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus. Archives of Internal Medicine. 169:2053-2063

6. Huxley R. et al. (2009) Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis. Arch Intern Med. 169(22):2053-63

7. Akesson A. et al. (2014) Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men - A Population-Based Prospective Cohort Study. J Am Coll Cardiol. 64(13):1299-1306

8. Chomistek A.K. et al. (2015) Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. J Am Coll Cardiol. 65(1):43-51

Provided by Institute for Scientific Information on Coffee

Disconnect between doctors and patients on use of email and Facebook

A large number of patients use online communication tools such as email and Facebook to engage with their physicians, despite recommendations from some hospitals and professional organizations that clinicians limit email contact with patients and avoid "friending" patients on social media, new research suggests.

26 jun 2015--The findings from Johns Hopkins Bloomberg School of Public Health researchers suggest a disconnect between what patients expect and what physicians—concerned about confidentiality and being overwhelmed in off-hours—are willing to do when it comes to online dialogue.

The study is published online June 24 in the Journal of General Internal Medicine.

"The medical establishment needs to figure out how best to incorporate this reality into their practice while properly ensuring security safeguards," says study leader Joy Lee, Ph.D., M.S., a post-doctoral fellow in the Department of Health Policy and Management at the Bloomberg School. "This is an area where there is significant patient interest, but institutions and health care providers haven't caught up."

For the study, the researchers used an online survey delivered to a random sample of 2,252 CVS retail pharmacy customers between May and June 2013. Patients were asked about their interest in using these online communication tools—as well as their physician's website—to fill their prescriptions, track their health progress and access their own health information. Researchers found that 37 percent of patients had used personal email to contact their doctors or hospital within the past six months and 18 percent reported using Facebook for the same purpose.

The findings related to Facebook are particularly interesting, Lee and her co-authors note, because "most institutions actively discourage social media contact with individual patients." Nevertheless, the researchers predict that the percentage of patients using Facebook as a means of contacting their doctors "might grow as the average age of Facebook users rises and familiarity with Facebook grows." The team cites earlier studies from 2009, 2011 and 2012 indicating that a significant number of patients are interested in using the social media platform as a means of contacting their health care providers.

In addition to gauging overall interest in these services, the researchers identified several demographic factors related to patients' use of online communication tools. Patients between the ages of 25 and 44 were most likely to use email or Facebook to contact their doctors, with 49 percent of patients surveyed in that age group indicating that they had used these tools for this purpose within the past six months. By contrast, 34 percent of patients aged 45-64 and 26 percent of patients aged 65 or older reported the same.

Additionally, survey respondents indicated significant desire to use these online communication tools for filling prescriptions: 46 percent of patients reported being interested in doing so via email while an additional 7 percent claimed that they were already doing so.

The new study did not include the opinions of health care providers.

The American College of Physicians and the Federation of State Medical Boards advises that physicians strictly limit how they communicate with patients via email, keep professional and personal online personas separate and not "friend" or contact patients through sites like Facebook and Twitter.

More information: "Patient Use of Email, Facebook, and Physicians' Websites to Communicate with Physicians: A National Online Survey of Retail Pharmacy Users" Journal of General Internal Medicine, 2015.

Provided by Johns Hopkins University Bloomberg School of Public Health

Experts propose new policies in advance of White House Conference on Aging

The 2015 White House Conference on Aging (WHCoA), slated for July 13 in Washington, DC, is focused on four priority areas: retirement security, healthy aging, long-term services and supports, and elder justice. In response, The Gerontological Society of America has produced a special issue of Public Policy & Aging Report (Volume 25, Number 2), wherein the nation's foremost experts on these topics make policy recommendations to improve the lives of all Americans as they age. The publication was supported by AARP.

25 jun 2015--The WHCoA has been held once every decade since the 1960s and offers a unique opportunity to shape the national landscape for aging-related policies. Writing in the new issue's opening editorial, PP&AR editor Robert B. Hudson, PhD, said that the rights, roles, and needs of older Americans will hold center stage at this year's event.

"It is important that such deliberations take place because the demographics and economics of aging continue to shift in important ways," Hudson stated. "Long gone—thanks largely to public policy—are days when elders were singularly poor and frail. Yet, a new series of pressures associated with extended lives, income differentials, and living environments will mark aging in the years ahead."

Multiple policy proposals for each of the WHCoA's four topics are included. For elder justice, they include calls for a public awareness campaign, elder mistreatment education, the creation of an elder abuse prevention database, and mobilizing advocates toward empowering older people around the prevalence and danger of elder abuse.

On the subject of long-term services and supports, the authors advocate increasing services availability, providing enhanced caregiver support and training, improving technology-enabled care, expanding efforts to measure both services quality and client outcomes , addressing the needs of the direct-care workforce, and devising a public-private solution to the endemic financing problems impeding the delivery of needed care.

With regard to retirement security, the experts say that eligibility periods for the Supplemental Nutrition Assistance Program (SNAP) should be extended, and Social Security Administration and Centers for Medicare and Medicaid Services data should be used to alert elders to their SNAP eligibility. Others argue that Social Security should be strengthened and benefits increased.

To promote healthy aging, the articles cover several initiatives. One proposes that Americans adopt major changes in lifestyle and a focus on prevention, while embracing technological advances, workplace redesign and, more broadly, a paradigm shift stressing both individual responsibility and population-wide strategies. Another piece demonstrates the value of age-friendly communities, which have been shown to address the problems of isolation, economic insecurity, and lack of mobility.

The latest issue of PP&AR is part of a larger effort GSA is undertaking to help ensure the 2015 WHCoA is a success. On June 25, GSA will host a webinar titled "New Visions for Long-Term Services and Supports: The Aging Network & the White House Conference on Aging," with WHCoA Executive Director Nora Super, MPA, among the speakers. She previously participated in a WHCoA listening session at GSA's most recent Annual Scientific Meeting in Washington, DC.

GSA also is a founding member of the Leadership Council of Aging Organizations, which together with AARP held a series of five WHCoA regional forums designed to gain input on the key issues from older Americans, their families, caregivers, and authorities in the field of aging. In April, another GSA journal, The Gerontologist, dedicated an issue (Volume 55, Number 2) to the four themed topics of the WHCoA.

"GSA always has had a special relationship with the WHCoA," said GSA's director of public policy, Greg O'Neill, PhD. "I view the articles in this issue of PP&AR as continuing our long tradition of providing the WHCoA with thought leadership that supports our common missions to develop effective policies that will benefit our aging society in the years ahead."

Provided by The Gerontological Society of America

What is the role of the gut microbiome in developing Parkinson's disease?

Flow chart illustrating reported effects between urate, smoking, coffee, and different physiological domains with possible relevance for PD risk. Furthermore, it is shown which of these factors are also related to changes in gut microbiota providing ground for interactions. However, at present direct evidence for such interactions is missing and information is derived from in vitro as well as in vivo studies on humans and animal models. Credit: Journal of Parkinson's Disease

In recent years, an important Parkinson's disease (PD) research focus has been on gut-related pathology, pathophysiology, and symptoms. Gastrointestinal dysfunction, in particular constipation, affects up to 80% of PD patients and idiopathic constipation is one of the strongest risk-factors for PD. Lifestyle factors such as smoking and coffee consumption, as well as blood urate levels, have been associated with a decreased PD risk. These factors may also be influenced by the bacteria living in the human gut mediating the effects of various chemicals and nutrients on disease processes. In a contribution in the current issue of the Journal of Parkinson's Disease, researchers review some of the latest studies linking gut microbiota to PD.

24 jun 2015--"Considering the gastrointestinal involvement in PD, it was recently speculated, that the associations between smoking, coffee, and PD risk could be mediated by gut microbiota," explained lead investigator Filip Scheperjans, MD, PhD, of the Department of Neurology, Helsinki University Hospital. "Through a comprehensive review of the medical literature, we looked at the possible mediatory role of gut microbiota, taking into account recent findings on microbiome composition in PD and their relevance to gut inflammation and permeability, as well as extending the scope of the investigation to include urate."

While it is known that a history of smoking reduces the risk of PD by about 36%-50% and coffee consumption reduces risk by about 33%, the underlying mechanisms are unclear. At the same time, the concentrations of different microbiota are altered in PD patients, where for example, Prevotellaceae bacteria are found in reduced levels.

The literature review indicated that smoking affects gut microbiome composition and this seems to be associated with improved barrier function and anti-inflammatory effects in the colonic mucosa. It remains to be established whether these simultaneous changes are causally related to each other and eventually to PD. "Also a possible reverse effect of gut microbiota on smoking propensity and its relevance for PD is an interesting field for future studies," added Dr. Scheperjans.

In the case of coffee consumption, most of the direct effects on the GI tract are related to gut motility, such as gastro-esophageal reflux, gallbladder contraction, and increasing colonic motor activity. The authors reviewed studies relating gut motility to microbiota compositions and suggest that there might be complex relationships between coffee, microbiome concentrations, and the altered gut motility found in PD patients.

They also note a few studies concerning urate metabolism related to microbiome concentrations in PD patients. While the evidence is as yet scarce, they suggest that further studies could be valuable.

Intriguing associations have been reported based on which microbiota could indeed play a role at the interface between environmental and lifestyle factors and PD. The most promising domains seem to be related to gut barrier function, inflammation, oxidative stress, gut motility, and metabolism. "By studying these we may gain more insight into the hugely complex network of microbiome-host-interactions underlying the observed associations," concluded Dr. Scheperjans. "Considering the well-established gastrointestinal abnormalities in PD and the vast interactions of gut microbiota with the human host, it seems mandatory to explore whether gut microbiota are involved in this devastating disorder."

More information: "Linking Smoking, Coffee, Urate, and Parkinson's Disease - A Role for Gut Microbiota?" by Filip Scheperjans, Eero Pekkonen, Seppo Kaakkola, and Petri Auvinen (DOI: 10.3233/JPD-150557), Journal of Parkinson's Disease, Volume 5, Issue 2 (2015)

Provided by IOS Press

More women are reaching 100 but centenarian men are healthier

Credit: Marina Guimarães CC-BY-SA-2.0

New research conducted by a team at King's College London has found an increasing trend in the number of people in the UK reaching age 100 over the past two decades. The study also found that, whilst women were far more likely to reach 100 than men, males tended to be healthier and had fewer diagnosed chronic illnesses compared to women.

23 jun 2015--The study, published today in the Journal of the American Geriatrics Society, used electronic health records to examine some of the main age-related chronic illnesses, including diabetes, stroke, arthritis and cancer, as well as old age related problems including falls, fractures, dementia and hearing/visual impairments among 11,084 centenarians.

Findings suggested a 50 per cent increase in the number of females reaching the age of 100 years between 1990 and 2013 and that women were four times more likely to reach age 100 than men. There was also a 30 per cent increase in the number of males reaching 100 during the same period.

Whilst far less men reached the age of 100, those that did tended to be healthier, with females more likely to experience multiple chronic illnesses and disabilities such as fractures, incontinence and hearing/visual deterioration than men.

Less life-threatening conditions such as arthritis and other musculoskeletal diseases were also shown to be more prevalent than the more serious illnesses such as diabetes and cancer across both men and women in the sample.

The increase in the overall number of centenarians and conditions associated with reaching this age suggest that the utilisation of health care services by the elderly may increase substantially and could also have an impact on the associated health care costs.

However, further research is needed to understand why some people reach extreme old age without severe health problems and others do not. This could help to improve care, develop health services and improve quality of life for older generations in the future.

Nisha Hazra, lead author of the study from the Department of Primary Care and Public Health Sciences at King's College London said: 'We found a surprising number of 100 year-olds who had no major illnesses. However, as the number of people living to 100 continues to increase, it's very important to understand the evolving health care needs of the oldest old.

'This will help to accurately project health care costs associated with the ageing population. Future research should focus on understanding these implications to help develop healthcare services.'

More information: "Differences in Health at Age 100 According to Sex: Population-Based Cohort Study of Centenarians Using Electronic Health Records." Journal of the American Geriatrics Society on Monday 22 June 2015

Provided by King's College London

Genetically predicted higher BP linked to antihypertensive use, lower Alzheimer's risk

Genetic variants that predict higher systolic blood pressure (SBP) are associated with a higher probability of taking antihypertensive medication and with decreased risk of Alzheimer disease (AD), according to a study published this week in PLOS Medicine. The study, conducted by Robert Scott of the MRC Epidemiology Unit, University of Cambridge, UK, Soren Ostergaard, (Aarhus University Hospital, Risskov, Denmark) and Shubhabrata Mukherjee (University of Washington, Seattle, USA) and colleagues suggests that either higher blood pressure, or anti-hypertensive therapy, may play a protective role against the development of AD.

22 jun 2015--Epidemiological studies have identified several potential risk factors for AD, but the causative nature of these associations has not been established. Without knowledge of cause, it is unclear whether health interventions upon these risk factors can alter the risk of AD. Scott and colleagues used a "Mendelian randomization" technique to test whether certain modifiable risk factors, including blood pressure, smoking, and cholesterol levels, might play a causative role in the development of AD. In Mendelian randomization, causality is inferred from associations between genetic variants linked to a risk factor, and the outcome of interest. The use of gene variants, which are inherited randomly and fixed throughout life, mitigates the risk that an identified association is mediated by a third, confounding factor related to genetic history or lifestyle.

These findings suggest that higher blood pressure (odds ratio (OR) per-SD (15.4 mmHg) of SBP [95% CI]: 0.75[0.62-0.91]; p=3.4x10-3) is associated with lower AD risk, which may be related to the effect of greater exposure to anti-hypertensive medication. Like all Mendelian randomization studies, the reliability of these results depends on the ability of the genetic variants used in the analyses to predict blood pressure, and the assumption that these genetic variants do not affect other risk factors. Moreover, as the study included an exclusively European population, the causal association may not be valid for non-European ethnic groups. Given that hypertension is a risk factor for cardiovascular disease, the researchers do not advocate raising blood pressure as a measure to prevent AD. "However," the authors state, "since there is a strong association between higher SBP gene scores and exposure to antihypertensive treatments, there is a need to evaluate the possible protective role of some of these substances against AD, independent of their effects on blood pressure."

More information: Østergaard SD, Mukherjee S, Sharp SJ, Proitsi P, Lotta LA, Day F, et al. (2015) Associations between Potentially Modifiable Risk Factors and Alzheimer Disease: A Mendelian Randomization Study. PLoS Med 12(6): e1001841. DOI: 10.1371/journal.pmed.1001841

Provided by Public Library of Science

Researchers discover the anatomic reasons for the persistence of musical memory in alzheimer patients

The region for musical memory (top: red, otherwise surrounded by a white border) compared with other regions of the brain of an Alzheimer's patient: areas with maximum neuronal loss (2nd row from above), decrease in metabolism (3rd row from above.) And amyloid protein aggregations (bottom row) are red, areas with minimal changes are shown in purple (in the left and right column, the left brain is shown from different perspectives, respectively). Credit: MPI f. Human Cognitive and Brain Sciences

21 jun 2015--In comparison to other memory functions, long-term musical memory in Alzheimer patients often remains intact and functional for a surprisingly long time. However, until now, the underlying causes of this phenomenon have remained in the dark. In a recent study, scientists from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, the University of Amsterdam and INSERM Caen have pinpointed the location of musical memory for the first time and shown that this area of the brain remains largely intact despite progressive degeneration of the brain in Alzheimer patients.

Surprisingly, Alzheimer's often spares long-term musical memory. In practice, carers and therapists take advantage of this phenomenon to stimulate their patients with music. It is often possible for music to reactivate memories, emotions and impressions. In some cases, patients are able to sing lyrics of songs even when speaking has become almost impossible for them.

However, this phenomenon has remained scientifically unexplained. "This is the first neuroscientific study to provide an anatomic explanation for the persistence of musical memory," says Jörn-Henrik Jacobsen, scientist at the Max Planck Institute in Leipzig and the University of Amsterdam.

To shed light on the matter, the researchers first located the seat of long-term musical memory in the brain with the help of functional ultra-high-field magnetic resonance imaging. For this purpose, they ran a behavioural experiment using a set of song stimuli taken from the top 10 pop hit charts in Germany between 1977 and 2007, children's songs, oldies and well-known classical pieces. The aim was to identify melodies that the study participants were familiar with. "An individual's musical experience and musical memories are largely shaped by social and cultural circumstances. It was therefore important to avoid a subjective choice of songs and to have a group selection instead," Jacobsen explains. The chosen musical excerpts were combined with totally unknown but characteristically similar pieces of music in groups of three.

While being monitored by MRI, the subjects listened to groups of three musical samples consisting of a long-known song, a song they had just heard and a completely unknown melody. The data were then analyzed with the help of statistical pattern-recognition methods. The scientists were able to conclude from the various active brain areas which of the three categories (long-known, recently heard, unknown) the study participants had just heard. They identified a region in the supplementary motor cerebral cortex that is responsible for long-term musical memory – an area that is involved in movement. "Our study shows that the temporal lobes are not essential for musical memory, as had previously been suspected, but rather areas associated with complex motor functions," Jacobsen explains.

In a second step, the scientists compared the areas responsible for musical memory in the healthy group with anatomic findings from a study with Alzheimer patients. In the process, they considered three important features of the disease: loss of neurons, reduced metabolism and deposition of amyloid protein in the affected brain areas.

They found that the brain area that had been identified as the seat of long-term musical memory does in fact lose fewer neurons than the rest of the brain. Also, metabolism in this area does not decline as much. The extent of amyloid deposits is similar to that in other areas of the brain but does not lead to the deficits otherwise associated with advanced stages of the disease. The brain areas responsible for long-term musical memory are therefore often affected least by neuron loss and typical metabolic disorders in Alzheimer patients.

The results of the study indicate that long-term musical memory is better preserved in Alzheimer patients than short-term memory, autobiographical long-term memory and speech. It can therefore remain largely intact even in advanced stages of the disease. "Our findings also lend support to a theory previously proposed in connection with other studies that found stronger network connections between the anterior gyrus cinguli and other nodes in Alzheimer patients. This suggests that this area of the brain also provides specific compensatory functions as the disease progresses," Jacobsen says, in explanation of the results' importance.

The scientists hope their investigations will give fresh impetus to research into the poorly understood mechanisms of long-term musical memory in Alzheimer patients. "In future, a sound understanding of the complex relationships could lead to a real therapeutic benefit of music in patient care," Jacobsen believes.

More information: "Why musical memory can be preserved in advanced Alzheimer's disease." DOI: dx.doi.org/10.1093/brain/awv135

Provided by Max Planck Society

Diet that mimics fasting appears to slow aging

A diagram of the fasting mimicking diet (FMD) protocol developed by the scientists, which retains the health benefits of prolonged fasting. In mice, FMD improved metabolism and cognitive function, decreased bone loss and cancer incidence, and extended longevity. In humans, three monthly cycles of a 5-day FMD reduced multiple risk factors of aging. Credit: Valter Longo/Cell Metabolism 2015

Want to lose abdominal fat, get smarter and live longer? New research led by USC's Valter Longo shows that periodically adopting a diet that mimics the effects of fasting may yield a wide range of health benefits.

20 jun 2015--In a new study, Longo and his colleagues show that cycles of a four-day low-calorie diet that mimics fasting (FMD) cut visceral belly fat and elevated the number of progenitor and stem cells in several organs of old mice—including the brain, where it boosted neural regeneration and improved learning and memory.

The mouse tests were part of a three-tiered study on periodic fasting's effects—testing yeast, mice and humans—set to be published by Cell Metabolism on June 18.

Mice, which have relatively short life spans, provided details about fasting's lifelong effects. Yeast, which are simpler organisms, allowed Longo to uncover the biological mechanisms that fasting triggers at a cellular level. And a pilot study in humans found evidence that the mouse and yeast studies were applicable to humans.

Bimonthly cycles that lasted four days of an FMD which started at middle age extended life span, reduced the incidence of cancer, boosted the immune system, reduced inflammatory diseases, slowed bone mineral density loss and improved the cognitive abilities of older mice tracked in the study. The total monthly calorie intake was the same for the FMD and control diet groups, indicating that the effects were not the result of an overall dietary restriction.

In a pilot human trial, three cycles of a similar diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer with no major adverse side effects, according to Longo.

'Strict fasting is hard for people to stick to, and it can also be dangerous, so we developed a complex diet that triggers the same effects in the body,' said Longo, Edna M. Jones professor of biogerontology at the USC Davis School of Gerontology and director of the USC Longevity Institute. Longo has a joint appointment at the USC Dornsife College of Letters, Arts and Sciences. 'I've personally tried both, and the fasting mimicking diet is a lot easier and also a lot safer.'

The diet slashed the individual's caloric intake down to 34 to 54 percent of normal, with a specific composition of proteins, carbohydrates, fats and micronutrients. It decreased amounts of the hormone IGF-I, which is required during development to grow, but it is a promoter of aging and has been linked to cancer susceptibility. It also increased the amount of the hormone IGFBP-, and reduced biomarkers/risk factors linked to diabetes and cardiovascular disease, including glucose, trunk fat and C-reactive protein without negatively affecting muscle and bone mass.

Longo has previously shown how fasting can help starve out cancer cells while protecting immune and other cells from chemotherapy toxicity.

'It's about reprogramming the body so it enters a slower aging mode, but also rejuvenating it through stem cell-based regeneration,' Longo said. 'It's not a typical diet because it isn't something you need to stay on.'

For 25 days a month, study participants went back to their regular eating habits—good or bad—once they finished the treatment. They were not asked to change their diet and still saw positive changes.

Longo believes that for most normal people, the FMD can be done every three to six months, depending on the abdominal circumference and health status. For obese subjects or those with elevated disease risk factors, the FMD could be recommended by the physician as often as once every two weeks. His group is testing its effect in a randomized clinical trial, which will be completed soon, with more than 70 subjects.

'If the results remain as positive as the current ones, I believe this FMD will represent the first safe and effective intervention to promote positive changes associated with longevity and health span, which can be recommended by a physician,' Longo said. 'We will soon meet with FDA officers to pursue several FDA claims for disease prevention and treatment.'

Despite its positive effects, Longo cautioned against water-only fasting and warned even about attempting the fasting mimicking diet without first consulting a doctor and seeking their supervision throughout the process.

'Not everyone is healthy enough to fast for five days, and the health consequences can be severe for a few who do it improperly,' he said. 'Water-only fasting should only be done in a specialized clinic. Also, certain types of very low calorie diets, and particularly those with high protein content, can increase the incidence of gallstones in women at risk'.

'In contrast,' he added, 'the fasting mimicking diet tested in the trial can be done anywhere under the supervision of a physician and carefully following the guidelines established in the clinical trials.'

Longo also cautioned that diabetic subjects should not undergo either fasting or fasting mimicking diets while receiving insulin, metformin or similar drugs. He also said that subjects with body mass index less than 18 should not undergo the FMD diet.

For the study, Longo collaborated with researchers and clinicians from USC as well as from Texas, Italy and England. The study was funded by the National Institute on Aging.

More information: Cell Metabolism, Brandhorst and Choi et al. 'A periodic diet that mimics fasting promotes multi-system regeneration, enhanced cognitive performance, and healthspan.'

Provided by University of Southern California

Community acquired pneumonia increases long-term morbidity and mortality

Having had community-acquired pneumonia (CAP) greatly increases the risk of long-term morbidity and mortality compared to the general population who have never had CAP, according to a new study from researchers in Canada, the longest and largest outcomes study of patients with CAP reported to date.

19 jun 2015--"Although the short-term adverse health consequences of CAP are well known, the long-term effects of the disease are less clear," said Dean T. Eurich, PhD, MSc, BSP, of the University of Alberta in Edmonton, Alberta, Canada. "In our large population-based study of more than 6,000 adults with CAP and almost 30,000 matched controls, we found that CAP patients have high rates of long-term morbidity and mortality compared to those who have never had CAP, irrespective of their age."

The study was published online ahead of print publication in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

During a median of 9.8 years of follow-up, 2,858 CAP patients died, an absolute risk difference of 30 excess deaths per 1000 patient years of follow-up and a greater that 50% relative increased rate of mortality among CAP patients. Although CAP patients under 25 years of age had the lowest absolute risk difference for mortality, and those over 80 years had the highest absolute risk difference, young CAP adults in fact had the worst relative outcomes of all patients with over a 2-fold increased rate of mortality relative to controls.

The mortality rate was significantly elevated among CAP patients even after including the 406patients who died within 30 days of the index event and excluding an additional 248 patients who died within 90 days of admission.

In addition to this increased mortality risk, the absolute rates of all-cause hospitalization, emergency department visits, and CAP-related hospital visits, were all significantly higher in CAP patients compared to controls. "Indeed CAP is still considered 'the old man's friend' because of the almost assured high mortality; however our results lend strong support to the alternate proposition that CAP ought to also be considered the young adult's adversary," said Dr. Eurich.

"Future research may help explain the factors underling these increased long-term risks in CAP patients and inform a treatment approach in these patients," said Dr. Eurich."Some of these adverse events may be preventable and our results suggest that we have likely underestimated the cost effectiveness, the impact and importance of immunizations that prevent pneumonia."

More information: The study is available at www.atsjournals.org/doi/abs/10… -0140OC#.VXmxsPlVhHw

Provided by American Thoracic Society

Physicians should help families with decisions about end-of-life care

About 20 percent of Americans spend time in an intensive care unit around the time of their death, and most deaths follow a decision to limit life-sustaining therapies.

18 jun 2015--Physicians have a responsibility to provide recommendations to families of dying patients, a Loyola University Medical Center critical care physician writes in the journal Chest.

"A physician has a responsibility to present surrogates with the plan of care he or she believes to be in the best application of a patient's authentic values and interests to a specific clinical situation," Paul Hutchison, MD, writes.

Taking the opposite side is Robert Veatch, PhD, of Georgetown University's Kennedy Institute of Ethics. Dr. Veatch writes physicians "have no basis for recommending treatment goals and, even if they did, they would tend to distort the decision-maker's perspective."

Family members or other surrogate decision makers often have no experience in making end-of-life decisions for another person, and they struggle in this role. Making a decision without a recommendation may be overwhelming, Dr. Hutchison writes.

"When the patient's prognosis is uncertain and the treatments are potentially burdensome, surrogates often look to the physician for assistance with the treatment-limitation decisions."

After asking the surrogate about the patient's values, the physician is equipped to offer a recommendation, provided the recommendation reflects the patent's known values and not the physician's personal, political or spiritual beliefs; acknowledges the uncertainty of the prognosis; and is subject to further consideration and discussion with the surrogate. "The recommended plan is never the final word without the surrogate's assent."

Dr. Hutchison explores the physician's role in two common scenarios:

The surrogate asks the physician for a recommendation. Such a request "is an expression of his trust in the physician who has a reciprocal duty to provide guidance and support," Dr. Hutchison writes. "Failure to accept this role amounts to abandonment and requires the surrogate to bear the entire burden of the decision."

The surrogate requests aggressive therapies for a dying patient. Dr. Hutchison explains that treatments should be pursued only if they can provide benefit to the patient. "While physicians should not be individual arbiters of resource allocation at the bedside, medical resources are not infinite, and most would agree that they need to be used responsibly," Dr. Hutchison writes.

Dr. Hutchison notes we do not allow permit physicians to make end-of-life decisions without exploring a surrogate's preferences for treatments. Similarly, it would be odd for family members, who have no medical background or training, to make decisions without a physician's input.

"No matter what the content of the recommendation, however, it must always be offered with humility and with openness to contrasting perspectives," Dr. Hutchison writes. "After all, the physician and surrogate are on the same team and with the same ultimate goal: respect for the interests and dignity of the critically ill patient."

Provided by Loyola University Health System

Returning killer T cells back to barracks could improve vaccines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Provided by Pennsylvania State University