Canadian Task Force on Preventive Health Care releases updated guideline
For adults aged 65 years or older living in the community, there is no benefit to screening for cognitive impairment if they are asymptomatic, according to a new Canadian guideline published in CMAJ(Canadian Medical Association Journal).
30 nov 2015--"While the task force recommends against screening older community-living adults for cognitive impairment, physicians should investigate if patients or their family members express concern about possible memory loss," states Dr. Kevin Pottie, chair of the Canadian Task Force on Preventive Health Care working group for the cognitive impairment guideline. "This recommendation is for adults without symptoms, not for people with concerns."
The recommendation updates the task force's previous recommendation that found insufficient evidence to recommend for or against screening, which was published in 2001. The current recommendation is based on a lack of evidence that screening is effective, a high rate of false-positive results for screening and the ineffectiveness of treatment for mild cognitive impairment. The task force found no clinical trials that evaluated the benefits or harms of screening for cognitive impairment, and instead looked at the effectiveness of treatment for mild cognitive impairment as indirect evidence to inform its recommendations on screening.
Cognitive impairment begins with normal age-related memory loss and may progress to mild cognitive impairment and possibly dementia. Although mild cognitive impairment is noticeable, it does not substantially affect daily living, unlike dementia. However, mild cognitive impairment can be a risk factor for later dementia, but it may not progress to that stage.
"Our assumptions were that, if clinicians are able to identify individuals with mild cognitive impairment early through screening and either slow down or stop its progression through effective treatment, the incidence of cognitive impairment (measured through cognition, function, behaviour and global status) may decline," the authors state. Key findings:
Cholinesterase inhibitors, a common treatment for Alzheimer disease, do not improve cognition in people with mild cognitive impairment.
Dietary supplements and vitamins did not improve cognitive function in people with mild cognitive impairment.
Nonpharmacologic interventions such as exercise and cognitive training may have some minor benefit, although the effect was not clinically significant.
The recommendation not to screen aligns with other national and international guidelines such as the United Kingdom's National Institute for Health and Care Excellence (NICE) 2011 guidelines and the US Preventive Services Task Force 2014 guidelines.
"The task force's findings have identified multiple opportunities for research," states Dr. Pottie. "It is clear that we need more precise screening tools and treatments, including preventive approaches that improve outcomes for people with cognitive impairment."
The guideline, as well as materials for physicians, is available at http://www.canadiantaskforce.ca.
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the task force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.
Loneliness triggers cellular changes that can cause illness, study shows
Loneliness is more than a feeling: For older adults, perceived social isolation is a major health risk that can increase the risk of premature death by 14 percent.Researchers have long known the dangers of loneliness, but the cellular mechanisms by which loneliness causes adverse health outcomes have not been well understood. Now a team of researchers, including UChicago psychologist and leading loneliness expert John Cacioppo, has released a study shedding new light on how loneliness triggers physiological responses that can ultimately make us sick.
25 nov 2015--The paper, which appears Nov. 23 in the Proceedings of the National Academy of Sciences, shows that loneliness leads to fight-or-flight stress signaling, which can ultimately affect the production of white blood cells.
Along with Cacioppo, the research team includes Steven W. Cole of UCLA and John P. Capitanio of the California National Primate Research Center at the University of California, Davis. The study examined loneliness in both humans and rhesus macaques, a highly social primate species.
Previous research from this group had identified a link between loneliness and a phenomenon they called "conserved transcriptional response to adversity" or CTRA. This response is characterized by an increased expression of genes involved in inflammation and a decreased expression of genes involved in antiviral responses. Essentially, lonely people had a less effective immune response and more inflammation than non-lonely people.
For the current study, the team examined gene expression in leukocytes, cells of the immune system that are involved in protecting the body against bacteria and viruses.
As expected, the leukocytes of lonely humans and macaques showed the effects of CTRA—an increased expression of genes involved in inflammation and a decreased expression of genes involved in antiviral responses. But the study also revealed several important new pieces of information about loneliness' effect on the body.
First, the researchers found that loneliness predicted future CTRA gene expression measured a year or more later. Interestingly, CTRA gene expression also predicted loneliness measured a year or more later. Leukocyte gene expression and loneliness appear to have a reciprocal relationship, suggesting that each can help propagate the other over time. These results were specific to loneliness and could not be explained by depression, stress or social support.
Next, the team investigated the cellular processes linking social experience to CTRA gene expression in rhesus macaque monkeys at the California National Primate Research Center, which had been behaviorally classified as high in perceived social isolation. Like the lonely humans, the "lonely like" monkeys showed higher CTRA activity. They also showed higher levels of the fight-or-flight neurotransmitter, norepinephrine.
Previous research has found that norepinephrine can stimulate blood stem cells in bone marrow to make more of a particular kind of immune cell—an immature monocyte that shows high levels of inflammatory gene expression and low levels of antiviral gene expression. Both lonely humans and "lonely like" monkeys showed higher levels of monocytes in their blood.
More detailed studies of the monkey white blood cells found that this difference stemmed from expansion of the pool of immature monocytes. In an additional study, monkeys repeatedly exposed to mildly stressful social conditions (unfamiliar cage-mates) also showed increases in immature monocyte levels. These analyses have finally identified one reason why CTRA gene expression is amplified in the white blood cell pool: increased output of immature monocytes.
Finally, the researchers determined that this monocyte-related CTRA shift had real consequences for health. In a monkey model of viral infection, the impaired antiviral gene expression in "lonely like" monkeys allowed simian immunodeficiency virus (the monkey version of HIV) to grow faster in both blood and brain.
Taken together, these findings support a mechanistic model in which loneliness results in fight-or-flight stress signaling, which increases the production of immature monocytes, leading to up-regulation of inflammatory genes and impaired anti-viral responses. The "danger signals" activated in the brain by loneliness ultimately affect the production of white blood cells. The resulting shift in monocyte output may both propagate loneliness and contribute to its associated health risks.
The team plans to continue research on how loneliness leads to poor health outcomes and how these effects can be prevented in older adults.
Study connects mitochondria to psychological stress response and species resilience
Mitochondria. Credit: Wikipedia commons24 nov 2015—Mitochondria are symbiotic organelles that reside in most of the body's cells and power cellular functions. They contain their own DNA, called mtDNA, and they produce adenosine triphosphate (ATP), which transports energy within cells. Mitochondria have a number of additional biological functions, and there is evidence that the mitochondrion influences an organism's integrated response to psychological stress.
Though no rigorous studies have previously examined whether mitochondria modulate an organism's psychological stress response, there are three reasons for the hypothesis that they do: First, requirements for ATP must be increased to face stress-induced cellular perturbations. Second, mitochondria generate reactive metabolic intermediates and reactive oxygen species (ROSs) during electron flow, which leads to oxidative stress in the absence of sufficient antioxidants. The generation of these constituents is a signal of adaptation, altering gene expression, which means that the stress-induced epigenetic changes observed in the hippocampus could be a result of mitochondrial activity. And third, stress-induced physiological responses like insulin resistance, inflammation and others can be triggered by mitochondrial dysfunction alone. So mitochondria are a likely hub of stress response and modulation.
Based on this evidence, a group of researchers from the University of Pennsylvania and Rockefeller University hypothesized that abnormal mitochondrial functions would have different modulation effects on an organism's multi-systemic response to psychological stress. They designed a study of this response in mice, and have published their results in the Proceedings of the National Academy of Sciences.
The researchers generated mice with ubiquitously expressed mutations in mtDNA genes that decrease the activity of respiratory chain complexes; they also studied mice with genetic deletions in nDNA that impair the transport of ATP from the mitochondrion to the cytoplasm, and that regulate the intramitochondrial redox balance. They studied the impact of these genetic manipulations on physical parameters linked to the restraint of stress.
The authors write, "All investigated neuroendocrine, metabolic, inflammatory, and transcriptional responses were perturbed by at least one of the mitochondrial defects. Notably, each mitochondrial defect produced a unique stress-response signature. Collectively, our results therefore establish that mitochondria impact the nature and magnitude of physiological and molecular responses to a controlled psychological stressor."
In order to be successfully adaptive, organisms mount integrated stress responses across multiple organ systems. The ability to mount appropriate responses to psychological stress is critical for survival, and is thus considered a driver of species evolution. Maladaptive stress response in humans results in chronic stress characterized by specific symptoms, and which ultimately contributes to disease.
"Stressful experiences, on their own, do not cause damage or disease," the authors write. "Rather, it is the organism's responses to stress that have the potential to result in physiological dysregulation and dysfunction, culminating in allostatic load and disease. Our study demonstrates how mitochondria can shape the major stress-response pathways, thereby recalibrating the multisystemic response to psychological stress."
The authors note further that based on this model, it seems that mitochondria lie at the interface of genetic and environmental factors that shape an organism's evolution. They suggest that future research targeting mitochondria can contribute to biological resilience, psychological health, and response to environmental stressors.
More information: Mitochondrial functions modulate neuroendocrine, metabolic, inflammatory, and transcriptional responses to acute psychological stress. PNAS 2015 ; published ahead of print November 16, 2015, DOI: 10.1073/pnas.1515733112
Abstract The experience of psychological stress triggers neuroendocrine, inflammatory, metabolic, and transcriptional perturbations that ultimately predispose to disease. However, the subcellular determinants of this integrated, multisystemic stress response have not been defined. Central to stress adaptation is cellular energetics, involving mitochondrial energy production and oxidative stress. We therefore hypothesized that abnormal mitochondrial functions would differentially modulate the organism's multisystemic response to psychological stress. By mutating or deleting mitochondrial genes encoded in the mtDNA [NADH dehydrogenase 6 (ND6) and cytochrome c oxidase subunit I (COI)] or nuclear DNA [adenine nucleotide translocator 1 (ANT1) and nicotinamide nucleotide transhydrogenase (NNT)], we selectively impaired mitochondrial respiratory chain function, energy exchange, and mitochondrial redox balance in mice. The resulting impact on physiological reactivity and recovery from restraint stress were then characterized. We show that mitochondrial dysfunctions altered the hypothalamic–pituitary–adrenal axis, sympathetic adrenal–medullary activation and catecholamine levels, the inflammatory cytokine IL-6, circulating metabolites, and hippocampal gene expression responses to stress. Each mitochondrial defect generated a distinct whole-body stress-response signature. These results demonstrate the role of mitochondrial energetics and redox balance as modulators of key pathophysiological perturbations previously linked to disease. This work establishes mitochondria as stress-response modulators, with implications for understanding the mechanisms of stress pathophysiology and mitochondrial diseases.
Monday, November 23, 2015
The search for happiness: Using MRI to find where happiness happens
Kyoto University scientists have used MRI brain scans to find the location of happiness. Japanese researchers have mapped out using MRI where happiness emerges in the brain. The study, published in Scientific Reports, paves the way for measuring happiness objectively—and also provides insights on a neurologically based way of being happy.
23 nov 2015--Exercising, meditating, scouring self-help books... we go out of our way to be happy, but do we really know what happiness is?
Wataru Sato and his team at Kyoto University have found an answer from a neurological perspective. Overall happiness, according to their study, is a combination of happy emotions and satisfaction of life coming together in the precuneus, a region in the medial parietal lobe that becomes active when experiencing consciousness.
People feel emotions in different ways; for instance, some people feel happiness more intensely than others when they receive compliments. Psychologists have found that emotional factors like these and satisfaction of life together constitutes the subjective experience of being "happy". The neural mechanism behind how happiness emerges, however, remained unclear. Understanding that mechanism, according to Sato, will be a huge asset for quantifying levels of happiness objectively.
Sato and his team scanned the brains of research participants with MRI. The participants then took a survey that asked how happy they are generally, how intensely they feel emotions, and how satisfied they are with their lives.
Their analysis revealed that those who scored higher on the happiness surveys had more grey matter mass in the precuneus. In other words, people who feel happiness more intensely, feel sadness less intensely, and are more able to find meaning in life have a larger precuneus.
"Over history, many eminent scholars like Aristotle have contemplated what happiness is," lead author Wataru Sato said. "I'm very happy that we now know more about what it means to be happy."
So how does that help us? Sato is hopeful about the implications this has for happiness training.
"Several studies have shown that meditation increases grey matter mass in the precuneus. This new insight on where happiness happens in the brain will be useful for developing happiness programs based on scientific research," he said.
Arash Panahifar, a post-doctoral fellow at the University of Saskatchewan, Department of Anatomy and Cell Biology, has helped develop unique imaging techniques to identify the early signs of osteoarthritis.20 nov 2015--Arthritis is the leading cause of long-term disability in Canada, with osteoarthritis being the most common form of the disease. It is estimated that 14.2 per cent of Canadians suffer from osteoarthritis.
"Currently, we do not manage this disease well at all," said Arash Panahifar, a post-doctoral fellow at the University of Saskatchewan, Department of Anatomy and Cell Biology. "Unfortunately, the best we can do for these patients is to treat the symptoms with pain killers and watch as the entire cartilage thickness is degraded and the joint cannot function any longer."
At times, the joints can be replaced through surgery, but the goal is prevention.
"A major problem with osteoarthritis is its late diagnosis, when the disease is so advanced that we can't do anything to stop it."
Panahifar, along with Canadian Light Source, University of Alberta, and U of S scientists, are trying to diagnose osteoarthritis at its earliest stages using unique three-dimensional synchrotron imaging techniques on the CLS biomedical imaging and therapy beamline (BMIT).
He said that while there are some two-dimensional techniques that can also detect the osteoarthritis markers in bone, to fully understand the mechanisms of the disease, we need to map the bone and changes in its structure using a 3D map on BMIT.
To better understand the cause(s) of osteoarthritis, Panahifar and colleagues used a "tracer" of strontium to label early changes that were happening in the knee joints that were developing osteoarthritis. When they looked at bone in the stunning details available from BMIT, the healthy subjects looked very different to those with osteoarthritis. The tracer was distributed uniformly in honey-comb like structure of healthy bone, while unhealthy subjects showed pathological changes occurring in the bone microstructure. The unhealthy bones showed the tracer in the areas directly beneath the cartilage as well as at bone margins (bone spurs), marking active bone turnover in those regions as the disease was progressing.
Figure: 3D images collected at the CLS showing distribution of strontium tracer (light blue) in the bone particularly at the marginal osteophytes (bone spurs) and the subchondral bone. The image at the right shows some microscopic features of an osteoarthritic bone namely osteophyte formation (white arrows) and destruction of the articular cartilage in the operated side of the femoral condyle (star) where underlying bone is exposed. The associated area showed a significant accumulation of the tracer in the respective 3D distribution map of strontium.Those bone spurs grow rapidly and eventually limit the normal movement of the joint, leading to disability and pain.
Panahifar thinks the techniques he has helped develop can help pharmaceutical companies to design effective drugs for the treatment of osteoarthritis. "This technique can also be used for research into other bone diseases, like bone cancersand metastasis," he said.
"I would like to make a difference in the way bone diseases are diagnosed and treated, and to develop methods for novel therapeutic approaches, potentially at the Canadian Light Source."
More information: Arash Panahifar et al. 3-D localization of non-radioactive strontium in osteoarthritic bone: Role in the dynamic labeling of bone pathological changes, Journal of Orthopaedic Research (2015). DOI: 10.1002/jor.22937
Provided by Canadian Light Source
Thursday, November 19, 2015
Journal Maturitas publishes position statement on testosterone replacement therapy in the aging male
Journal Maturitas today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) covering testosterone replacement therapy in the aging male.
19 nov 2015--Late-onset hypogonadism (LOH) represents a common clinical entity in older men. It is characterized by the presence of symptoms (most usually of a sexual nature, such as decreased libido, decreased spontaneous erections and erectile dysfunction) in combination with low serum testosterone concentrations. Whether testosterone replacement therapy (TRT) should be offered to those individuals is still under extensive debate because of the uncertainties regarding risk of cardiovascular disease and prostate cancer. The position statement provides a practical guide to the use of testosterone replacement in older men.
The overall conclusion is that a general policy around offering TRT to all aging men with low testosterone concentrations is not recommended. It is always advisable to encourage older men with LOH to undertake lifestyle modifications, including weight loss, increasing exercise, stopping smoking and reducing alcohol intake before considering starting TRT. The assessment procedure should include individual evaluation of co-morbidities and careful risk versus benefit estimation; TRT should be very carefully weighed up in testosterone deficient older men with or without pre-existing heart disease, until evidence from large randomized prospective trials regarding cardiovascular safety becomes available.
Older men should be able to discuss testosterone replacement therapy with their health professional so that shared and informed decisions can be made.
More information: Manuel Neves-e-Castro et al. EMAS position statement: The ten point guide to the integral management of menopausal health, Maturitas (2015). DOI: 10.1016/j.maturitas.2015.02.003
Provided by Elsevier
Wednesday, November 18, 2015
Alzheimer's patients' health care costs higher already before diagnosis
Diagram of the brain of a person with Alzheimer's Disease. The health care costs of patients diagnosed with Alzheimer's disease (AD) start to increase already one year before the diagnosis, shows a new study from the University of Eastern Finland.
18 nov 2015--The differences in the health care costs between AD patients and non-AD patients were the greatest during six months following the diagnosis, with AD patients having 5,088 euros higher health care costs per person-year. After the first six months, the differences evened out. Two years after the diagnosis, the health care costs of AD patients stabilised at a level two times higher than that of non-AD patients.
The majority of the health care costs of AD patients, i.e. 78-84 per cent, were caused by hospital care and only a fraction by drug therapy. Anti-dementia drugs initiated after the diagnosis explained the majority of the drug costs. Five years prior to the diagnosis, Alzheimer's patients had on average 1.4 hospital days more per person-year than non-AD patients, whereas two years after the diagnosis they had as many as 14.2 hospital days more.
The study used data from the Finnish Medication Use and Alzheimer's Disease Study, Medalz, and analysed the hospital care and drugs costs of 70,718 Finnish AD patients living in their own home and the hospital care and drug costs of as many non-AD patients from five years before until two years after the diagnosis.
Data of AD diagnoses was obtained from the Finnish Social Insurance Institution's Reimbursement Register, data on hospital days from the Finnish Hospital Discharge Register, and data on medication from the Finnish Social Insurance Institution's Prescription Register. The costs of drug therapy were analysed as overall costs, and the costs of hospital days were calculated according to the Finnish health care system's unit costs, which also include the patient's payment contribution.
More information: Hospital care and drug costs from 5 years before until 2 years after the diagnosis of Alzheimer's disease in a Finnish nationwide cohort. Heidi Taipale, Maija Purhonen, Anna-Maija Tolppanen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen. Scandinavian Journal of Public Health, published online 9.11.2015. sjp.sagepub.com/content/early/2015/11/04/1403494815614705.abstract
Provided by University of Eastern Finland
Tuesday, November 17, 2015
Intervention cuts potentially inappropriate meds in seniors
17 nov 2015—An intervention (Optimizing Prescribing for Older People in Primary Care [OPTI-SCRIPT]) can reduce potentially inappropriate prescribing (PIP) in older patients, according to a study published in the November/December issue of the Annals of Family Medicine.
Barbara Clyne, Ph.D., from the Royal College of Surgeons in Dublin, and colleagues conducted a cluster-randomized controlled trial among 21 general practitioner practices and 190 patients with PIP. Participants in intervention practices received a complex, multifaceted intervention, including academic detailing; review of medicines, with web-based pharmaceutical treatment algorithms providing alternative treatment options; and tailored information leaflets. Control practices delivered usual care and received PIP feedback at the patient level.
The researchers found that patients in the intervention group had significantly lower odds of having PIP than patients in the control group at intervention completion (adjusted odds ratio, 0.32; P = 0.02). The mean number of PIP drugs was 0.70 and 1.18 in the intervention and control groups, respectively (P = 0.02). At intervention completion, the intervention group was less likely to have PIP drugs than the control group, but the difference was not significant (incidence rate ratio, 0.71; 95 percent confidence interval, 0.50 to 1.02; P = 0.49). The intervention effectively reduced proton pump inhibitor prescribing (adjusted odds ratio, 0.30; P = 0.04).
"The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP," the authors write.
Barriers to health care increase disease, death risk for rural elderly
A new study of adults ages 85 or older has found that rural residents have significantly higher levels of chronic disease, take more medications, and die several years earlier than their urban counterparts. The findings were just published in The Journal of Rural Health by researchers from Oregon State University and the Oregon Health & Science University.
15 nov 2015--The research confirms some of the special challenges facing older populations in rural or remote areas, who often have less access to physicians, long distances to travel for care, sometimes a lower socioeconomic and educational level, and other issues. It also reflects health problems that might have been reduced if they were treated earlier or more aggressively, researchers say.
Data from several different study groups found that rural residents measured significantly higher on the Modified Cumulative Illness Rating Scale, with about an 18 percent higher disease burden.
"It's been known for some time that health care is harder to access in rural areas, and this helps us better understand the extent of the problem," said Leah Goeres, a postdoctoral scholar who led the research at the Oregon State University/Oregon Health & Science University College of Pharmacy.
"Many physicians do the best they can in rural areas given the challenges they face," Goeres said. "But there are fewer physicians, fewer specialists, a higher caseload. Doctors have less support staff and patients have less public transportation. A patient sometimes might need to wait months to see a doctor, and have to drive significant distances. Adverse effects can increase from taking multiple medications.
"These are real barriers to choice and access, and they affect the quality of care that's available."
Also worth noting, Goeres said, is that especially in very old populations, illness can lead to more illness and quickly spiral out of control. A patient in an urban setting might receive prompt treatment for a mild ulcer, whereas the same person in a rural setting might have to wait while the condition worsens and may even lead to cancer.
"It's of particular concern that rural older adults start with more disease burden, which significantly increased over the next five years, but the average number of medications they used decreased over the same time period," said David Lee, an assistant professor in the OSU College of Pharmacy who oversaw the research.
"This may be due to difficulty accessing health care, leading to more disease burden over time, yet less use of medications," Lee said. "The opposite trends are seen in urban older adults."
This research was done in Oregon with three cohorts of older adults, one rural and two urban, and 296 people altogether. It was supported by the Oregon Alzheimer's Disease Tax Checkoff Fund and the National Institutes of Health.
The findings of the new study include:
The rural population of Oregon contains a greater proportion of older adults than the urban population.
The use of many medications can be especially risky for people in their 80s and 90s, leading to a concern called "polypharmacy" when a person takes five or more medications.
Rural participants were found to use an average of 5.5 medications, compared to 3.7 for urban participants.
At baseline measurements, valuable medications to aid bone mineralization were often used less in rural populations, but pain-killing opioids were used more often.
Medication use for high blood pressure went up significantly over time for rural populations, but not urban ones, in which their use had already been higher.
The rate of disease accumulation was significant in the rural cohort, and negligible in their urban counterparts.
The median survival time of the rural cohort was 3.5 years, compared to 7.1 years for the urban older adults.
Risk factors of chronic diseases were low education, poor socioeconomic status, a history of chronic disease, being female, and older age. These factors are associated with a typical rural population.
Living with someone, and/or having a large social network are protective factors against chronic disease, and may be more common in an urban or suburban population.
Both urban and rural residents used a large number of over-the-counter agents, including vitamins, minerals and herbal supplements.
Increased access to health care, health education, increased supervision from clinicians, and better management of both prescription and over-the-counter medications could all be of value in helping rural residents to live longer and healthier livers, the researchers said in their conclusion.
Provided by Oregon State University
Saturday, November 14, 2015
Not so happy old age?
Credit: Peter Griffin/public domainThe notion that older people are happier than younger people is being challenged following a recent study led by a University of Bradford lecturer.
14 nov 2015--In fact it suggests that people get more depressed from age 65 onwards.
The study, led by psychology lecturer Dr Helena Chui and recently published in the international journal Psychology and Aging, builds on a 15-year project observing over 2,000 older Australians living in the Adelaide area.
Previous studies have shown an increase in depressive symptoms with age but only until the age of 85. This is the first study to examine the issue beyond that age.
Both men and women taking part in the study reported increasingly more depressive symptoms as they aged, with women initially starting with more depressive symptoms than men. However, men showed a faster rate of increase in symptoms so that the difference in the genders was reversed at around the age of 80.
Key factors in these increases include levels of physical impairment, the onset of medical conditions, particularly chronic ones, and the approach of death. Half of those in the study suffered with arthritis and both men and women with the chronic condition reported more depressive symptoms than those without.
Dr Chui said: "These findings are very significant and have implications for how we deal with old age. It's the first study to tell us depressive symptoms continue to increase throughout old age. We are in a period of unprecedented success in terms of people living longer than ever and in greater numbers and we should be celebrating this but it seems that we are finding it hard to cope.
"It seems that we need to look carefully at the provision of adequate services to match these needs, particularly in the area of mental health support and pain management. Social policies and ageing-friendly support structures, such as the provision of public transport and access to health care services are needed to target the 'oldest-old' adults as a whole."
Common antibiotics increase risk of cardiac arrhythmias, cardiac death
Macrolides—a group of commonly used antibiotics for bacterial infections like pneumonia, bronchitis, and some sexually transmitted diseases—are associated with a small but statistically significant increased risk of sudden cardiac death, according to a meta-analysis of 33 studies involving more than 20 million patients published today in the Journal of the American College of Cardiology
12 nov 2015--Researchers from China analyzed data from studies conducted between 1966 and 2015, comparing patients treated with macrolides to similar patients treated with other antibiotics or with no antibiotic therapy.
The researchers found an average of 80 cases of ventricular tachyarrhythmias—rapid heartbeat that can lead to sudden cardiac death—per million treatment courses in patients who were not taking macrolides. The current use of macrolides accounted for an additional 118 ventricular tachyarrhythmias or related sudden cardiac deaths per million treatment courses; 36 additional sudden cardiac deaths from causes other than ventricular tachyarrhythmia; and 38 additional cardiovascular deaths per million treatment courses.
Past use of macrolides and use of other antibiotics were not associated with increased cardiovascular risk in the study. In addition, the use of macrolides was not associated with increased all-cause death, possibly because of the relatively small effect and an increased risk of cardiac death might be partly offset by the survival benefit of anti-infection by macrolides.
"The absolute risks of sudden cardiac death and cardiac death are small, so it should likely have limited effect on prescribing practice," said Su-Hua Wu, M.D., Ph.D., of the Department of Cardiology at the First Affiliated Hospital at Sun Yat-Sen University in Guangzhou, China, and one of the study authors. "However, given that macrolides are one of the most commonly used antibiotic groups and millions of patients are prescribed these drugs annually, the total number of sudden cardiac deaths or ventricular tachyarrhythmias and cardiac deaths may not be negligible."
In an accompanying editorial, Sami Viskin, M.D., of the Tel Aviv Medical Center and Sackler School of Medicine at Tel Aviv University in Tel Aviv, Israel, put the numbers into perspective saying that the data shows that 1-in-8,500 patients treated with a macrolide antibiotic could develop a serious arrhythmic event, and 1-in-30,000 patients treated might die from the treatment.
Researchers separately examined commonly used macrolides azithromycin, clarithromycin, and erythromycin. In this analysis, researchers found all were associated with increased risk of sudden cardiac death or ventricular tachyarrhythmias; and azithromycin and clarithromycin were associated with increased risk of cardiovascular death, but only clarithromycin was associated with increased risk of all-cause mortality. "The heart safety of each macrolide needs to be better understood to help guide clinical treatment decisions," Wu said.
Study limitations include limited data on macrolide doses in observational studies, the lack of individual participant data and the retrospective nature of all meta-analyses. The study authors said large randomized controlled trials are needed to confirm these findings.
In the editorial, Viskin said macrolides are the first-line agents for a variety of illnesses and he noted methods for mitigating the risk while calling for "a consensus paper on how to deal with these hot potatoes."
"Today, when antimicrobial resistance represents a major threat to global health and new treatment options are frighteningly few, losing an entire class of antibiotics would represent a major setback in the fight against infections. Furthermore, it takes years to fully understand the consequences of a drug's disappearance."
Provided by American College of Cardiology
Wednesday, November 11, 2015
ACR: resistance training program beneficial in hand osteoarthritis
A progressive resistance strength training program can improve some aspects of hand osteoarthritis (OA), such as pain, function, and treatment satisfaction, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 6 to 11 in San Francisco.
11 nov 2015--Michele Nery, P.T., from the Universidade Federal de São Paulo in Brazil, and colleagues examined the effectiveness of progressive resistance training on pain, function, and strength in 60 hand OA patients (aged over 55 years). Participants who met eligibility criteria were randomized into an exercise group (EG) and a control group. Before randomization, both groups performed a session regarding joint protection and energy conservation. A progressive resistance strength training program for intrinsic muscles of the hand was performed in the EG for 12 weeks.
The researchers found that except for key pinch strength for the non-dominant hand and palmar pinch strength for both hands, the groups were homogenous at baseline. There was a statistically significant difference between the groups in the Australian/Canadian Hand Osteoarthritis Index, the Cochin Hand Functional Scale for hand function, and for treatment satisfaction with a Likert scale, with better results seen for the EG.
"We believe this can be an option for the treatment of hand OA patients, and they should talk to their physicians about it," Nery said in a statement.
Energy drink increases blood pressure, norepinephrine levels
Anna Svatikova, M.D., Ph.D., of the Mayo Clinic, Rochester, Minn., and colleagues randomly assigned 25 healthy volunteers (age 18 years or older) to consume a can (480 mL; 16 fl. oz.) of a commercially available energy drink (Rockstar; Rockstar Inc) and placebo drink within 5 minutes, in random order on 2 separate days, maximum 2 weeks apart. The placebo drink, selected to match the nutritional constituents of the energy drink, was similar in taste, texture, and color but lacked caffeine and other stimulants of the energy drink (240 mg of caffeine, 2,000 mg of taurine, and extracts of guarana seed, ginseng root, and milk thistle). This JAMA study is being released to coincide with its presentation at the American Heart Association's Scientific Sessions 2015.
08 nov 2015--Energy drink consumption has been associated with serious cardiovascular events, possibly related to caffeine and other stimulants. The researchers examined the effect of energy drink consumption on hemodynamic changes, such as blood pressure and heart rate. Participants were fasting and abstained from caffeine and alcohol 24 hours prior to each study day. Serum levels of caffeine, plasma glucose, and norepinephrine (noradrenaline) were measured and blood pressure and heart rate were obtained at baseline and 30 minutes after drink ingestion.
Caffeine levels remained unchanged after the placebo drink, but increased significantly after energy drink consumption. Consumption of the energy drink elicited a 6.2 percent increase in systolic blood pressure; diastolic blood pressure increased by 6.8 percent; average blood pressure increased after consumption of the energy drink by 6.4 percent. There was no significant difference in heart rate increase between the 2 groups. The average norepinephrine level increased from 150 pg/mL to 250 pg/mL after consumption of the energy drink and from 140 pg/mL to 179 pg/mL after placebo (change rate: 74 percent vs 31 percent, respectively).
"These acute hemodynamic and adrenergic changes may predispose to increased cardiovascular risk," the authors write. "Further research in larger studies is needed to assess whether the observed acute changes are likely to increase cardiovascular risk."
What sex is safe for heart patients: A new approach using the KiTOMI model
Heart Disease Patients: Decision-Tree to Sexual Activity. Credit: Canadian Journal of CardiologyChanges in sexual satisfaction and decreases in sexual activity are often reported by heart patients. Both patients and partners may have misconceptions about the perceived dangers of sexual activities and commonly restrict their activities. However, in a new study in the Canadian Journal of Cardiology, researchers provide a comprehensive and updated review of the relevant literature and offer evidence- and expert-based practical recommendations regarding sexual activity in heart patients.
07 nov 2015--"Our extensive literature review enabled us to dismiss several myths regarding the advisability of sexual activity in heart patients," commented lead author Ricardo Stein, MD, DSc, of the Cardiology Division of the Federal University of Rio Grande do Sul, Brazil. "Overall, the risk of death during sex is very low for most clinically stable heart patients, and interestingly, even much lower for the women."
Sexual activity, particularly coitus, is a major aspect of health-related quality of life and is often considered the most pleasant and rewarding form of exercise performed. Sexual activity is typically well-tolerated by most clinically stable heart patients, who are typically advised to participate in exercise programs as part of their recovery plan. Occurrence of sudden cardiac death is very rare, corresponding to less than 2% of all exercise-related deaths.
Counseling regarding how to gradually resume habitual sexual activity is critical for patients who have experienced a cardiac event or undergone a cardiac procedure. Sexual activity encompasses several behaviors such as kissing (Ki), touching (T), oral (O), masturbation (M) and vaginal/anal intercourse (I). The authors propose the acronym KiTOMI to represent these behaviors.
"Our KiTOMI model will allow healthcare professionals to provide very simple and objective advice to their patients," explained lead investigator Claudio Gil S. Araújo, MD, PhD, of the Heart Institute Edson Saad, Federal University of Rio de Janeiro, and the Exercise Medicine Clinic - CLINIMEX. "In almost every case some type of sexual activity would be permitted. For patients whose condition is more debilitated, KiT would be the best initial option, progressively advancing to KiTOM until all KiTOMI activities are allowed."
Sexual Activity vs Walking: Comparing Efforts. Credit: Canadian Journal of CardiologyCo-investigator, Aline Sardinha, PhD, also of the Federal University of Rio de Janeiro, noted that "Cardiac anxiety, the fear of cardiac-related stimuli and sensations, which are perceived as negative or dangerous, is common in heart patients and surely interfere with the resumption of a normal and regular sexual life." The authors emphasize the importance of sexual counseling to provide reassurance and reliable information for patients and their partners, including the proper use of medications to treat erectile dysfunction.
Recommendations resulting from this study are summarized in the following Decision Tree, which evaluates the patient's heart condition according to widely-accepted definitions, places the patient in one of three risk groups, and defines the advisable sexual activities for each group.
Putting these recommendations into perspective, the researchers equated various sexual activities with walking at different speeds, noting for example that orgasm is equivalent to a brisk walk across a street.
"Professional sexual activity advice should be offered similar to advice regarding the return to work and enrollment in an exercise program," emphasized Dr. Araújo. "KiT activities should be a component of positive sexual behavior toward a healthier sexual life and should be recommended for virtually all heart patients regardless of sexual orientation. Often considered 'taboo,' an objective discussion of sexual behavior in heart disease has often been put aside. Healthcare providers must break this vicious cycle." More information: Ricardo Stein et al. Sexual Activity and Heart Patients: A Contemporary Perspective, Canadian Journal of Cardiology (2015). DOI: 10.1016/j.cjca.2015.10.010
Provided by Elsevier
Thursday, November 05, 2015
Brain training improves memory and performance of everyday tasks in older people
Screenshot from Brain Training demo gamePlaying online games that challenge reasoning and memory skills – brain training - could have significant benefits for older people in their day to day lives, according to a new study published today (3 Nov) in JAMDA.
05 nov 2015--Researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London have shown that an online brain training package can not only improve memory and reasoning skills - but also how well older people carry out everyday tasks such as navigating public transport, shopping, cooking and managing personal finances.
Previous research has shown some promise for brain training in improving memory, although these small-scale studies have been inconclusive. This new research, which is funded by Alzheimer's Society, is the largest randomised control trial to date of an online brain training package. Involving almost 7,000 adults aged over 50, it is also the first to evaluate the impact of computerised brain training on how well people can perform their daily activities.
The brain training package comprised three reasoning tasks, such as balancing weights on a see-saw, and three problem-solving tasks, such as putting numbered tiles in numerical order. Study participants (initially recruited from the general population through a partnership between the BBC, Alzheimer's Society and the Medical Research Council) were encouraged to play the game for 10 minutes at a time, as often as they wished. Before starting the study and again after six weeks, three months and six months, the participants completed a series of cognitive tests, including measures of grammatical reasoning and memory. Those over 60 were also assessed on a test of daily living (e.g. using the telephone, navigating public transport and doing the shopping).
After six months, brain training led to significant improvements in scores on the test of daily living in people over 60, and significant improvement in reasoning and verbal learning in those over 50 compared to those who didn't play the reasoning and problem solving games. Playing the brain training games five times per week was most effective in bringing about these improvements.
While some decline in memory and thinking skills is a normal part of healthy ageing, more severe impairments can be a precursor to dementia, a condition characterised by the progressive loss of ability and function. Previous research has shown that people who have complex occupations or engage in cognitively stimulating activities such as crosswords, puzzles and learning new skills throughout life tend to have lower rates of dementia.
This new study could have important implications for preserving cognitive function in older adults and might offer an effective, easily accessible intervention to help people reduce their risk of cognitive decline later in life.
Dr Anne Corbett from the Wolfson Centre for Age-Related Diseases at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, said: "The impact of a brain training package such as this one could be extremely significant for older adults who are looking for a way to proactively maintain their cognitive health as they age. The online package could be accessible to large numbers of people, which could also have considerable benefits for public health across the UK.
"Our research adds to growing evidence that lifestyle interventions may provide a more realistic opportunity to maintain cognitive function, and potentially reduce the risk of cognitive decline later in life, particularly in the absence of any drug treatments to prevent dementia."
Dr Doug Brown, Director of Research and Development at Alzheimer's Society said: "Online brain training is rapidly growing into a multi-million pound industry and studies like this are vital to help us understand what these games can and cannot do. While this study wasn't long enough to test whether the brain training package can prevent cognitive decline or dementia, we're excited to see that it can have a positive impact on how well older people perform essential everyday tasks.
"With a rapidly ageing population, evidence that this type of brain training has a tangible, real-life benefit on cognitive function is truly significant. As government and society explore ways to enable people to live independently as they get older, this study has important implications for policy makers and public health professionals.
"Finding ways to help people maintain good brain health and avoid dementia is a key focus for the Society's research programme and we're delighted to be funding the next stage of this research. We need as many people over 50 to sign up to help us test the effect of brain training over a longer time period."
Dr Corbett added: "Today we're launching a new open trial to see how well older people engage with the brain training package over the long-term. We want to investigatehow genetics might affect performance to allow us to better understand how brain training could be used to maintain cognition or even reduce the risk of cognitive decline and dementia." Details on the study
Performance on daily tasks was measured using the self-reported Instrumental Activities of Daily Living scale which asks participants to rate their current functional ability on a range of tasks. The tasks include: ability to use a telephone, shopping, food preparation, housekeeping, laundry, transportation, medications and handling finances. Changes in cognitive performance were measured using a range of tests. Reasoning was measured using the Baddeley Grammatical Reasoning test that involves determining the accuracy of a series of grammatical statements about a picture. Verbal learning was measured using the Hopkin's Verbal Learning Test which involves learning and recalling sets of words over timed trials.
Participants over 60 who completed the reasoning and problem solving training package saw a 15% increase on the self-reported Instrumental Activities of Daily Living scale after six months compared to a control group who spent a similar amount of time performing online tasks that did not relate to reasoning or problem solving.
Participants over 50 who completed the reasoning and problem solving training package saw a 30% increase on reasoning scores and a 19% increase in verbal learning scores compared to the control group after six months. More information: Corbett, A et al (2015) 'The Effect of an Online Cognitive Training Package in Healthy Older Adults: An Online Randomized Controlled Trial' JAMDA
Try out the brain training for yourself, with the demo game, available at www.alzheimers.org.uk/braintraining
People over 50 and living in the UK can take part in the new brain training study by registering online at www.protectstudy.org.uk/
Provided by King's College London
Wednesday, November 04, 2015
Scientists say Alzheimer's is probably a collection of diseases that should be classified and treated separately
Deciphering the mechanism that underlies the development of Alzheimer's disease in certain families but not in others, researchers at the Hebrew University of Jerusalem's Faculty of Medicine have proposed that the malady is actually a collection of diseases that probably should be treated with a variety of different approaches.
04 nov 2015--Neurodegenerative diseases are incurable and debilitating conditions that result in degeneration or death of cells in the nervous system. Conditions such as prion disorders (the most famous of which is "Mad Cow Disease"), Alzheimer's Disease and Parkinson's Disease share two key features: they emerge as a result of aberrant protein folding and aggregation, and their onset is late in life. These maladies emerge either sporadically or as familial, mutation-linked illnesses (certain prion disease can be also infectious).
Most sporadic cases are diagnosed during the patient's seventh decade of life or later, while familial cases typically manifest during the fifth or sixth decade. Despite their relative rareness, mutation-linked cases are very important, as they provide hints that can help decipher the mechanisms that underlie the development of the disease.
The late onset feature typical to distinct neurodegenerative diseases, and the common temporal emergence patterns of these maladies, raise key questions: first, why do individuals who carry disease-linked mutation show no clinical signs until their fifth or sixth decade of life? In addition, why do apparently distinct disorders share a common temporal emergence pattern?
One possible explanation is that as people age, the efficiency of the mechanisms that protect younger people from the toxic aggregation of proteins declines, thus exposing them to disease. Indeed, previous studies clearly indicate that the aging process plays key roles in enabling neurodegenerative disorders to onset late in life.
These finding raised the question of what mechanisms are negatively regulated by aging, allowing the emergence of neurodegeneration in the elderly.
Since neurodegenerative disorders stem from aberrant protein folding, an international research team, led by Prof. Ehud Cohen and Dr. Tziona Ben-Gedalya at The Institute for Medical Research Israel – Canada (IMRIC) in the Hebrew University's Faculty of Medicine, postulated that an aging-associated decline in the activity of proteins that assist other proteins to fold properly, may be one mechanism that exposes the elderly to neurodegeneration.
To identify such mechanisms, they searched for similar mutational patterns in different proteins that are linked to the development of distinct neurodegenerative disorders. Their research showed that the development of Alzheimer's disease in certain families, and of a familial prion disorder in other families, originate from very similar mutational patterns.
Based on this discovery, they identified that the malfunction of the protein "cyclophilin B," which helps nascent proteins to attain their proper spatial structures, is responsible for the manifestation of both maladies. They also comprehensively characterized the mechanism that underlies the development of Alzheimer's disease in individuals who carry these mutations, and found that it has no relevance to the emergence of the disease in patients who carry other Alzheimer's-linked mutations.
According to Dr. Ehud Cohen: "This study provides important new insights: first, it shows that the development of distinct neurodegenerative disorders stems from a similar mechanism. More importantly, it indicates that Alzheimer's disease can emanate from more than one mechanism, suggesting that it is actually a collection of diseases that should be classified."
The new insights derived from this study may reinforce the efforts to develop novel therapies to the different subtypes of Alzheimer's disease, providing new hope to those who suffer from this incurable disorder and to their families.
Dr. Ehud Cohen added: "Our study proposes that the failure to develop efficient Alzheimer's therapy emanates from the pooling, in clinical experiments, of patients who suffer from distinct disorders that eventually lead to Alzheimer's symptoms. Therefore it is essential to carefully characterize and classify the mechanisms that underlie Alzheimer's disease, in order to allow for the development of novel therapies that can be prescribed to the individual patient according to their relevant disease subtype."
More information: T. Ben-Gedalya et al. Alzheimer's disease-causing proline substitutions lead to presenilin 1 aggregation and malfunction, The EMBO Journal (2015). DOI: 10.15252/embj.201592042
Provided by Hebrew University of Jerusalem
Tuesday, November 03, 2015
Vitamin D pill a day may improve exercise performance and lower risk of heart disease
Taking vitamin D supplements can improve exercise performance and lower the risk of heart disease, according to the findings of a preliminary study presented today at the Society for Endocrinology annual conference in Edinburgh.
03 nov 2015--Vitamin D, which is both a vitamin and a hormone, helps control levels of calcium and phosphate in the blood and is essential for the formation of bones and teeth. Sources of Vitamin D include oily fish and eggs, but it can be difficult to get enough through diet alone. Most people generate vitamin D by exposing their skin to ultraviolet B rays in sunlight.
Previous studies suggest that vitamin D can block the action of enzyme 11-βHSD1, which is needed to make the "stress hormone" cortisol. High levels of cortisol may raise blood pressure by restricting arteries, narrowing blood vessels and stimulating the kidneys to retain water. As Vitamin D may reduce circulating levels of cortisol, it could theoretically improve exercise performance and lower cardiovascular risk factors.
In this study, researchers from Queen Margaret University in Edinburgh gave 13 healthy adults matched by age and weight 50μg of vitamin D per day or a placebo over a period of two weeks.
Adults supplementing with vitamin D had lower blood pressure compared to those given a placebo, as well as having lower levels of the stress hormone cortisol in their urine. A fitness test found that the group taking vitamin D could cycle 6.5km in 20 minutes, compared to just 5km at the start of the experiment. Despite cycling 30% further in the same time, the group taking vitamin D supplements also showed lower signs of physical exertion.
Around ten million people in England may have low vitamin D levels. On average, one in ten adults has low levels of vitamin D in summer, compared to two in five in winter. Because people with darker skin are less efficient at using sunlight to make vitamin D, up to three out of four adults with dark skin are deficient in winter.
"Our pilot study suggests that taking vitamin D supplements can improve fitness levels and lower cardiovascular risk factors such as blood pressure", said Dr Raquel Revuelta Iniesta, co-author of the study. "Our next step is to perform a larger clinical trial for a longer period of time in both healthy individuals and large groups of athletes such as cyclists or long-distance runners".
"Vitamin D deficiency is a silent syndrome linked to insulin resistance, diabetes, rheumatoid arthritis, and a higher risk for certain cancers", said lead author of the study Dr Emad Al-Dujaili. "Our study adds to the body of evidence showing the importance of tackling this widespread problem".
Provided by Society for Endocrinology
Monday, November 02, 2015
Underlying processes of working memory are more complex than previously thought
The hippocampus is a region of the brain largely responsible for memory formation.
02 nov 2015--In order to retain a piece of information for a short time, working memory is required. The underlying processes are considerably more complex than hitherto assumed, as researchers from the Ruhr-Universität Bochum and Bonn University report in the journal Cell Reports. Two brain states must alternate rhythmically in order for a piece of information to be successfully maintained.
Working memory: maintaining new information for a short time
When we want to remember a new piece of information for a short time, for example a phone number, working memory is called upon. Different brain regions are involved in this process, including the hippocampus, which is known for its crucial role in long-term memory. The team headed by Prof Dr Nikolai Axmacher from the Institute of Cognitive Neuroscience in Bochum and Marcin Leszczynski, researcher in Bochum and at the Department of Epileptology at Bonn University, studied rhythmic activity patterns in the hippocampus while the subjects memorised sequences of numbers or faces.
Two activity states at semi-second intervals
To this end, the team worked with epilepsy patients who had electrodes implanted into the hippocampus for the purpose of surgical planning. Those electrodes enabled the researchers to measure the activity of the region embedded deeply in the brain. While the patients memorised sequences of faces or numbers, the researchers observed two activity states in the hippocampus, which alternated twice per second: an excited and a less excited state.
If the rhythmic pattern did not occur in the hippocampus, the patients tended to make mistakes during the task. Based on the activity patterns, the researchers were also able to estimate how many numbers or faces the test subjects could reliably memorise. "The results show that the brain performs highly complex processes even during seemingly simple tasks," says Prof Nikolai Axmacher. "Our subjective feeling if something is simple or complex is not a reliable marker for how the brain actually solves a task."
More information: M. Leszczyński, J. Fell, N. Axmacher (2015): Rhythmic working memory activation in the human hippocampus, Cell Reports, DOI: 10.1016/j.celrep.2015.09.081
