Understanding the epidemiology of sarcopenia throughout the lifecourse

Sarcopenia is an age-related syndrome which is characterised by progressive and generalised loss of muscle mass and strength. How prevalent is sarcopenia? As there is a lack of consensus in the operational definition used to characterized the disorder, estimates vary widely in different clinical settings, and depending on the definition used.

29 jun 2017--Recent definitions have integrated information on muscle mass, strength, and physical function. A new systematic review by researchers at the MRC Lifecourse Epidemiology Unit, University of Southampton, has now evaluated the epidemiology of these three distinct physiological components.
Specifically, the review highlights the similarities and differences between the patterns of variation in muscle mass, strength and physical function in regard to age, gender, geography, time, as well as the relation to individual risk factors. The review also describes how different approaches used to measure muscle mass, strength and function contribute to varying prevalence rates.
Observations include:

• There are differences in relation to the peak level and subsequent loss rate of muscle mass, strength and function between men and women, between ethnic groups, and over time.
• The rate of decline is most rapid in regard to physical function, followed by muscle strength. The decline of muscle mass is least rapid.
• Although men have significantly higher levels of muscle mass, strength and function than women at any given age, the rate of decline for all three parameters is similar in both genders.
• The higher levels of muscle mass in some ethnicities do not translate into higher levels of muscle strength and function.
• Asian populations tend to have similar declines in muscle mass to non-Asians, but experience much more rapid deterioration in strength and function.
• Sedentary lifestyle, adiposity and multi-morbidity are environmental risk factors affecting all three components. The role of smoking and alcohol intake is less apparent than has been observed in regard to osteoporosis or cardiovascular disease.
• Nutrition has an important influence on the development of sarcopenia. Protein intake has the potential to slow the loss of muscle mass, but is not as influential in maintaining strength and function.
• Physical activity (and in particular resistance training) when performed at higher intensities, is beneficial for muscle strength and functioning.
• Trials combining protein supplementation and physical activity show promising results in reducing the decline in muscles strength and function with advancing age.

Lead author Professor Cyrus Cooper stated: "Sarcopenia contributes to the risk of physical frailty, functional impairment, poor health-related quality of life, and premature death in older people. Understanding the epidemiological characteristics of muscle mass, strength and function is an important first step in achieving consensus in the definition of sarcopenia. This will allow us to better understand its prevalence, to determine clinically relevant thresholds for diagnosis, and ultimately, to enable the development of novel preventive and therapeutic strategies."

More information: S. C. Shaw et al, Epidemiology of Sarcopenia: Determinants Throughout the Lifecourse, Calcified Tissue International (2017). DOI: 10.1007/s00223-017-0277-0


Provided by International Osteoporosis Foundation

Task Force presents new ranking of colorectal cancer screening tests

In its latest recommendations, the US Multi-Society Task Force (MSTF) on Colorectal Cancer (CRC) Screening confirms that people at average risk should be screened beginning at age 50, and recommends colonoscopy and fecal immunochemical testing (FIT) as the "first tier" screening tests for this group. Screening continues to be a first line of defense against CRC, as it can detect pre-cancerous growths as well as cancer, which is highly treatable if caught early.

28 jun 2017--Overall, the incidence of colorectal cancer (CRC) in people age 50 and older is declining. However, the task force noted a rising incidence of CRC in younger Americans, for reasons that are unclear. While the relative incidence in younger people remains low, the increasing trend of young onset CRC is nevertheless a "major public health concern." In addition, the task force suggests beginning screening earlier in the African-American population, at age 45.
"Colorectal Cancer Screening: Recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer" was published jointly in three gastroenterology journals, Gastroenterology, The American Journal of Gastroenterology and GIE: Gastrointestinal Endoscopy (published online June 6).
Recommendations for screening are re-evaluated periodically as new evidence emerges and as shifts occur in healthcare delivery and access. The task force, made up of representatives from the American Society for Gastrointestinal Endoscopy, American College of Gastroenterology and American Gastroenterological Association, evaluated seven different types of screening tests based on effectiveness at detecting cancer and pre-cancerous polyps.
Experts know that offering screening tests systematically to people without any symptoms is the best way to prevent colorectal cancer and to detect it at an earlier, more treatable stage. However, the large number of options available for screening, and the wide variation in effectiveness, acceptability to patients and cost, suggests that guidance is needed to facilitate discussions between physicians and patients and make the process of offering screening both feasible for physicians and easily understood and accepted by patients.
"We believe these recommendations make the presentation of screening options in the office easier for providers and patients, maximizing both effectiveness and adherence. The document also addresses important issues for organized screening programs that are sometimes used in large health plans," said lead author Douglas K. Rex, MD, FASGE, AGAF, MACG. "These recommendations are informed both by available scientific evidence, as well as practical considerations and cost data."
The document includes sections on screening tests, targets, cost and quality; practical considerations; family history as a risk factor; and age considerations. Each screening test is explained, along with advantages and disadvantages. Strength of evidence is noted in the document for various recommendations.

Screening Tests

The task force ranked tests into three "tiers" according to the strength of the recommendation for average-risk people. The task force also incorporated practical considerations, such as test availability, cost effectiveness, current usage patterns, obstacles to implementation, and the likelihood that patients will repeat the test when they should.
For any test other than colonoscopy, patients need to understand that if they have a positive result, they will need to undergo a colonoscopy to follow up on those results.
Tier 1— the cornerstone tests—are colonoscopy every 10 years or annual FIT. Colonoscopy is highly sensitive for cancer and all classes of precancerous lesions, and it is the only test that allows a patient to be diagnosed and treated in a single session. FIT is less sensitive and must be repeated every year, but it is non-invasive, lower-cost, and performs very well in preventing cancer and cancer deaths when repeated annually. For these reasons, FIT is an attractive option in large health plans with organized screening programs, which also have systems in place to ensure annual testing.

Tier 2 options include:

• CT colonography every five years
• FIT-fecal DNA every three years
• Flexible sigmoidoscopy every five to 10 years

Tier 3 options include:

• Capsule colonoscopy every five years

Available tests not recommended:

• Septin9 (a blood-based test)

Highlights of the screening test recommendations include:

• Colonoscopy should be performed every 10 years or a FIT administered every year as first-tier options for screening average-risk persons for colorectal neoplasia.

Physicians performing screening colonoscopy should measure quality, including the adenoma detection rate.
Physicians performing FIT need to monitor quality. The recommended quality measurements for FIT programs are detailed in a prior publication.1
Patients who refuse colonoscopy or FIT should have CT colonography every 5 years, FIT-fecal DNA every three years, or flexible sigmoidoscopy every five to 10 years .
Capsule colonoscopy (if available) is an appropriate screening test when patients decline colonoscopy, FIT, FIT-fecal DNA, CT colonography, and flexible sigmoidoscopy.
Septin9 is not recommended for CRC screening.

Family History

A family history of CRC in a first-degree relative (parent, sibling or child) increases a person's risk of developing this type of cancer, regardless of the age when the relative is diagnosed.
Highlights of recommendations pertaining to family history include:
People with a family history of CRC in a first-degree relative diagnosed before age 60 should undergo colonoscopy every five years, beginning at age 40 or 10 years before the age at which their relative was diagnosed, whichever comes first. The same is true for those who have a first-degree relative with a documented advanced adenoma or documented advanced serrated lesions.
People with one first-degree relative diagnosed at age 60 or older are advised to begin screening at age 40.

CRC increasingly is found in younger people

The incidence of CRC is rising in people under age 50. The reasons for this trend are not known at this time. Although the rate of CRC in this age group is still low, the increase is a "major public health concern," according to the authors.
Aggressive evaluation of patients with symptoms is recommended as an important first step, particularly for symptoms involving bleeding, which may include blood in the stool, black or tarry stool with a negative upper endoscopy, or iron deficiency anemia. If a test other than colonoscopy is used to evaluate bleeding symptoms, a diagnosis should be made, and the patient should be treated and followed until resolution of the problem.
Patients who have only non-bleeding symptoms, such as abnormal bowel habits, change in bowel habits or appearance, or abdominal pain, but who have no evidence of bleeding, are no more likely to have cancer than asymptomatic persons of similar age.

Rationale for screening earlier in African-American population

In the African-American population, there is a lower screening rate for CRC, higher incidence rates of cancer, and worse survival statistics compared with other races. The task force outlined a scientific rationale for starting screening earlier based on higher cancer incidence, as well as the younger mean age of colorectal cancer onset in this population even as they acknowledge that there are few data to show that screening before age 50 improves outcomes in this group.
For the first time, the new MSTF document suggests beginning screening at age 45 for African-American patients, though the task force noted the need for additional study of the yield of CRC screening in persons under age 50, and particularly in this population.
The task force added that recommendations to screen earlier in this group "have served an important role in stimulating discussion of and research on CRC in African Americans, increasing awareness in physicians of an important public health problem and racial disparity in health outcomes in the United States, and increasing awareness of CRC in African Americans." The group added that "provider recommendation is key," and that patient navigation services can improve compliance with colonoscopy screening.

Conclusion

In summary, the task force recommends beginning CRC screening at age 50 for average-risk patients, and considers colonoscopy and FIT to be the cornerstones of screening for these patients regardless of the healthcare setting. The authors stressed that optimal results in CRC screening depend on good technical performance and reporting of tests and ensuring that patients undergo appropriate follow-up after testing.
"Screening often originates in the doctor's office, and in that setting, colonoscopy is particularly attractive, because it needs to be performed so infrequently. However, if patients decline colonoscopy, they should be offered FIT, and if they decline FIT, a second-tier test should be offered," said Dr. Rex.
"In the doctor's office, it's also reasonable to present the pros and cons of both colonoscopy every 10 years and annual FIT to patients, so they can choose between the two tests. This approach provides a framework for screening that is simple and accommodates almost every healthcare setting," Dr. Rex continued. "These recommendations constitute a practical approach toward the ultimate goal of maximizing screening rates, while using well accepted, effective and cost-effective tests."

More information: 1. Robertson DJ, Lee JK, Boland CR, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: a consensus statement by the U.S. Multisociety Task Force on colorectal cancer. Gastrointest Endosc 2016: 85:2-21


Provided by American Society for Gastrointestinal Endoscopy

Older adults who take 5+ medications walk slower than those who take fewer medications

"Polypharmacy" is the term used when someone takes many (usually five or more) different medications. Experts suggest that, for most older adults, taking that many medications may not be medically necessary. Taking multiple medications also can be linked to problems such as falls, frailty, disability, and even death. 

27 jun 2017--Polypharmacy also is a problem for older adults due to side effects or interactions resulting from the use of different medications. Older adults may have difficulties taking the medications properly, and the medications may interfere with a person's ability to function well.
The ability to walk well is a sign of independence and good health for older adults, for example, and it may be affected by the use of multiple medications. Although healthcare providers know that some treatments can slow or hamper an older person's ability to walk, little is known about the effects of polypharmacy on walking while performing other tasks, like talking. In a new study, researchers examined how polypharmacy affected walking while talking. They published their study in the Journal of the American Geriatrics Society.
The researchers examined information from 482 people age 65 and older who were enrolled in the "Central Control of Mobility in Aging" study. That study's main purpose was to determine how changes to the brain and our central nervous system occur during aging, and how they might impact an older person's ability to walk.
Researchers confirmed the medications (prescriptions as well as herbal and other over-the-counter supplements) study participants were taking. The researchers defined "polypharmacy" as using five or more of these treatments.
Participants took detailed exams assessing physical health, mental well-being, and mobility at the start of the study and at yearly follow-up appointments. Among other evaluations, the researchers measured the participants' walking speed. None of the participants used walking aides (such as canes or walkers) or monitors. The participants were asked to walk at their normal pace on a special 20-foot long walkway, and to walk while talking. The research team also interviewed the participants to learn about their medical conditions, ability to think and make decisions, and brain function.
Among the 482 participants in the study, 34 percent used five or more medications during the study period (June 2011-February 2016); 10 percent used more than eight medications. The participants were mostly in their late 70s.
People in the polypharmacy group were more likely to have high blood pressure, congestive heart failure, diabetes, and a history of heart attacks. They were also more likely to have had a fall within the last year and were more overweight than people in the non-polypharmacy group.
After accounting for chronic health problems, a history of falls, and other issues, the people in the polypharmacy group had a slower walking speed (or gait) than the people in the non-polypharmacy group. Those who took 8 or more medications had slower walking speed when walking while talking. The researchers concluded that there was a link between polypharmacy and walking speed, and that more studies would be needed to follow-up on their findings and the effect specific medications might have on overall well-being.
The researchers also noted that at their check-ups, older adults should be asked about all the medications they take, including herbal and other over-the-counter supplements. They also suggested that healthcare professionals measure walking speed during regular check-ups.

More information: Claudene George et al, Polypharmacy and Gait Performance in Community-dwelling Older Adults, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14957


Provided by American Geriatrics Society

More frequent sexual activity can boost brain power in older adults, according to study

More frequent sexual activity has been linked to improved brain function in older adults, according to a study by the universities of Coventry and Oxford.

Researchers found that people who engaged in more regular sexual activity scored higher on tests that measured their verbal fluency and their ability to visually perceive objects and the spaces between them.

22 jun 2017--The study, published today in the Journals of Gerontology, Series B: Psychological and Social Sciences, involved 73 people aged between 50 and 83.
Participants filled in a questionnaire on how often, on average, they had engaged in sexual activity over the past 12 months - whether that was never, monthly or weekly - as well as answering questions about their general health and lifestyle.
The 28 men and 45 women also took part in a standardised test, which is typically used to measure different patterns of brain function in older adults, focussing on attention, memory, fluency, language and visuospatial ability.
This included verbal fluency tests in which participants had 60 seconds to name as many animals as possible, and then to say as many words beginning with F as they could - tests which reflect higher cognitive abilities.
They also took part in tests to determine their visuospatial ability which included copying a complex design and drawing a clock face from memory.
It was these two sets of tests where participants who engaged in weekly sexual activity scored the most highly, with the verbal fluency tests showing the strongest effect.
The results suggested that frequency of sexual activity was not linked to attention, memory or language. In these tests, the participants performed just as well regardless of whether they reported weekly, monthly or no sexual activity.
This study expanded on previous research from 2016, which found that older adults who were sexually active scored higher on cognitive tests than those who were not sexually active.
But this time the research looked more specifically at the impact of the frequency of sexual activity (i.e. does it make a difference how often you engage in sexual activity) and also used a broader range of tests to investigate different areas of cognitive function.
The academics say further research could look at how biological elements, such as dopamine and oxytocin, could influence the relationship between sexual activity and brain function to give a fuller explanation of their findings.
Lead researcher Dr Hayley Wright, from Coventry University's Centre for Research in Psychology, Behaviour and Achievement, said:
"We can only speculate whether this is driven by social or physical elements - but an area we would like to research further is the biological mechanisms that may influence this.
"Every time we do another piece of research we are getting a little bit closer to understanding why this association exists at all, what the underlying mechanisms are, and whether there is a 'cause and effect' relationship between sexual activity and cognitive function in older people.
"People don't like to think that older people have sex - but we need to challenge this conception at a societal level and look at what impact sexual activity can have on those aged 50 and over, beyond the known effects on sexual health and general wellbeing."

More information: Hayley Wright et al, Frequent Sexual Activity Predicts Specific Cognitive Abilities in Older Adults, The Journals of Gerontology: Series B (2017). DOI: 10.1093/geronb/gbx065


Provided by Coventry University

Worldwide consensus on the terminology that supports research into sedentary behavior

A worldwide network of scientists examining the links between sedentary lifestyles and health problems such as obesity and cardiovascular disease today announced a new dictionary of terms to support research into sedentary behaviour.

18 jun 2017--The results of the 'terminology consensus project' led by the Children's Hospital of Eastern Ontario Research Institute's (CHEO RI) Sedentary Behaviour Research Network (SBRN) are published today in the International Journal of Behavioral Nutrition and Physical Activity in a paper co-authored by 84 scientists from 20 countries.
"This is the world's most extensive agreement to date on consensus definitions for researchers examining sedentary behaviour, an emerging global public health priority," said lead author Dr. Mark Tremblay, director of the CHEO RI's Healthy Active Living and Obesity Research Group (HALO) and a professor at the University of Ottawa. "There is an urgent need for clear, common and accepted terminology worldwide to facilitate the interpretation and comparison of research. We have made tremendous progress by defining terms such as physical inactivity, stationary behaviour, sedentary behaviour, and screen time. These terms have already been translated into several languages for rapid global uptake."
The paper, entitled "Sedentary Behaviour Research Network: Terminology Consensus Project Process and Outcome", provides refined definitions to suit all age groups, including babies, young children and people with chronic disease or mobility impairment. It also describes how bouts, breaks and interruptions should be defined and measured in the context of assessing sedentary behaviour and in relation to health outcomes.
The conceptual framework described in the paper also illustrates how both energy expenditure and posture are important components and how the terms relate to movement behaviours throughout a 24-hour period, including physical activity and sleep. Examples provided distinguish between active and passive sitting, active and passive standing, sedentary and stationary behaviour, screen time and non-screen-based sedentary time. Sedentary behaviour for a baby, for example, includes sitting in a car seat with minimal movement and, for a toddler, watching TV while sitting, reclining or lying down.
The 84 SBRN co-authors, which include researchers, trainees, graduate students, health practitioners and government employees, agree that standardization of the terminology is crucial to advancing future research, especially since this rapidly growing field of health science involves multi-disciplinary researchers, practitioners and industries.
"These consensus definitions will help scientists and practitioners navigate and understand the rapidly evolving field of sedentary behaviour research, allowing for more consistent and robust exploration of behaviours across 24 hours - sleep, sedentary behaviours and various intensities of physical activity - and may facilitate future research exploring ways to alter behaviours to improve health," Dr. Tremblay said. "Our hope is that these will reduce confusion and advance research related to sedentary behaviour and, ultimately, promote healthy active living."
Dr. Tremblay will chair a discussion of the project's findings at a workshop today at the International Society of Behavioral Nutrition and Physical Activity annual meeting in Victoria, British Columbia. Consensus definitions have been translated into French, Spanish, Portuguese, Dutch, Korean, German, Greek, Traditional Chinese, and Japanese.


Provided by Children's Hospital of Eastern Ontario Research Institute

Is white or whole wheat bread 'healthier?' Depends on the person

This visual abstract shows the findings of Korem et al. who performed a crossover trial of industrial white or artisanal sourdough bread consumption and found no significant difference in clinical effects, with the gut microbiome composition remaining generally stable. They showed the glycemic response to bread type to be person specific and microbiome associated, highlighting the importance of nutrition personalization.

17 jun 2017--Despite many studies looking at which bread is the healthiest, it is still not clear what effect bread and differences among bread types have on clinically relevant parameters and on the microbiome. In the journal Cell Metabolism on June 6, Weizmann Institute researchers report the results of a comprehensive, randomized trial in 20 healthy subjects comparing differences in how processed white bread and artisanal whole wheat sourdough affect the body.
Surprisingly, the investigators found the bread itself didn't greatly affect the participants and that different people reacted differently to the bread. The research team then devised an algorithm to help predict how individuals may respond to the bread in their diets.
All of the participants in the study normally consumed about 10% of their calories from bread. Half were assigned to consume an increased amount of processed, packaged white bread for a week—around 25% of their calories—and half to consume an increased amount of whole wheat sourdough, which was baked especially for the study and delivered fresh to the participants. After a 2-week period without bread, the diets for the two groups were reversed.
Before the study and throughout the time it was ongoing, many health effects were monitored. These included wakeup glucose levels; levels of the essential minerals calcium, iron, and magnesium; fat and cholesterol levels; kidney and liver enzymes; and several markers for inflammation and tissue damage. The investigators also measured the makeup of the participants' microbiomes before, during, and after the study.
"The initial finding, and this was very much contrary to our expectation, was that there were no clinically significant differences between the effects of these two types of bread on any of the parameters that we measured," says Eran Segal, a computational biologist at the Weizmann Institute of Science and one of the study's senior authors. "We looked at a number of markers, and there was no measurable difference in the effect that this type of dietary intervention had."
Based on some of their earlier work, however, which found that different people have different glycemic responses to the same diet, the investigators suspected that something more complicated may be going on: perhaps the glycemic response of some of the people in the study was better to one type of bread, and some better to the other type. A closer look indicated that this was indeed the case. About half the people had a better response to the processed, white flour bread, and the other half had a better response to the whole wheat sourdough. The lack of differences were only seen when all findings were averaged together.
"The findings for this study are not only fascinating but potentially very important, because they point toward a new paradigm: different people react differently, even to the same foods," says Eran Elinav (@EranElinav), a researcher in the Department of Immunology at the Weizmann Institute and another of the study's senior authors. "To date, the nutritional values assigned to food have been based on minimal science, and one-size-fits-all diets have failed miserably."
He adds: "These findings could lead to a more rational approach for telling people which foods are a better fit for them, based on their microbiomes."
Avraham Levy, a professor in the Department of Plant and Environmental Sciences and another coauthor, adds a caveat to the study: "These experiments looked at everyone eating the same amounts of carbohydrates from both bread types, which means that they ate more whole wheat bread because it contains less available carbohydrates. Moreover, we know that because of its high fiber content, people generally eat less whole wheat bread. We didn't take into consideration how much you would eat based on how full you felt. So the story must go on."

More information: Cell Metabolism, Korem et al: "Bread affects clinical parameters and induces gut microbiome-associated personal glycemic responses." http://www.cell.com/cell-metabolism/fulltext/S1550-4131(17)30288-7 , DOI: 10.1016/j.cmet.2017.05.002


Provided by Cell Press

Older adults are good Samaritans to strangers

A study conducted by Asst Prof Yu Rongjun (right) and Dr Narun Pornpattananangkul (left) from the National University of Singapore found that older adults, compared to young adults, are more generous towards strangers.

13 jun 2017--People tend to become more generous as they age. This certainly holds true when it comes to helping strangers, according to a recent study by researchers from the National University of Singapore (NUS). Findings from the study showed that while the older adults treat their kin and friends the same as younger adults do, the elderly donate more to strangers than younger adults, even when their generosity is unlikely to be reciprocated.
"Greater generosity was observed among senior citizens possibly because as people become older, their values shift away from purely personal interests to more enduring sources of meaning found in their communities," explained Assistant Professor Yu Rongjun, who led the study. Asst Prof Yu is from the Department of Psychology at the NUS Faculty of Arts and Social Sciences, as well as the Singapore Institute for Neurotechnology at NUS.
The research results were first reported online in Journals of Gerontology: Psychological Sciences on 5 April 2017.

Generosity towards strangers is a function of age

Studies have shown that as people age, they are inclined to volunteer more frequently, are more attentive to ecological concerns, and are less interested in becoming rich. However, there is a lack of understanding of the core motive behind such altruistic behaviour. The team led by Asst Prof Yu sought to address this knowledge gap by looking at how social relationships with others influence how much older adults donate in comparison with younger adults.
The study, which was conducted from March 2016 to January 2017, involved 78 adults in Singapore. 39 of them were older adults with an average age of 70, while the other 39 were younger adults who were about 23 years old.
The NUS research team employed a framework known as social discounting to quantify generosity towards people. The framework works on the principle that people treat those they are closer with better than those whom they are more distantly acquainted, and much better than total strangers. The participants had to rate how close they were to people in their social environment, and the amount of money they would give to each respective person. Using a computational model, the NUS research team calculated the amount of money that the participants are willing to give to another person as a function of social distance.
The results revealed that both younger and older adults are equally generous to people who are close to them, such as family members or close friends. However, senior citizens are more generous to those who are more socially distant, such as total strangers, and the seniors' level of generosity does not decrease with distance as quickly as that of the younger adults. In addition, older adults are more likely to forgo their resources to strangers even when their generosity is unlikely to be reciprocated.
Dr Narun Pornpattananangkul, the first author of the research paper, said, "In psychology, the motivation to contribute to the greater good is known as an "ego-transcending" motivation. In our earlier work, we found that there is an enhancement of this motivation after people received oxytocin, a hormone related to maternal love and trust. In this study, we found a similar pattern of an ego-transcending motivation among the older adults, as if the older adults received oxytocin to boost their generosity. We speculate that age-related changes at the neurobiological level may account for this change in generosity." Dr Pornpattananangkul is a research fellow from the Department of Psychology at the NUS Faculty of Arts and Social Sciences.
Asst Prof Yu added, "Our findings shed light on the age-related changes among the elderly, and provide an understanding of why they are more inclined to lend a helping hand to strangers. Providing older adults with more opportunities to help others is not only beneficial to our society, but it might also be a boon to the well-being of older adults themselves. Future studies with direct well-being measures should further examine this hypothesis."

Future studies to examine neural mechanisms involved in decision making

To further their understanding on how decision making shifts among the elderly, Asst Prof Yu and his team at NUS are embarking on studies to examine the neural mechanisms underlying the changes in decision making by using brain-imaging technologies. Research findings from these studies have the potential to be translated into effective intervention programmes to promote healthy ageing, and may help tackle age-related conditions such as Parkinson's disease and Alzheimer's disease, which are often characterised by deficits in decision making.

More information: Narun Pornpattananangkul et al, Social Discounting in the Elderly: Senior Citizens are Good Samaritans to Strangers, The Journals of Gerontology: Series B (2017). DOI: 10.1093/geronb/gbx040


Provided by National University of Singapor

First large-scale population analysis reinforces ketamine's reputation as antidepressant

Better known as an anesthetic or as an illicit hallucinogenic drug, ketamine has also long been noted for alleviating depression. But ketamine has not been tested in a large clinical trial, and all evidence of its antidepressant effects has come from anecdotes and small studies of fewer than 100 patients. 

10 jun 2017--Now, in the largest study of its kind, researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego mined the FDA Adverse Effect Reporting System (FAERS) database for depression symptoms in patients taking ketamine for pain. They found that depression was reported half as often among the more than 41,000 patients who took ketamine, as compared to patients who took any other drug or drug combination for pain.
The study, published May 3 in Scientific Reports, also uncovered antidepressant effects for three other drugs typically used for other purposes—Botox, the pain reliever diclofenac and the antibiotic minocycline.
"Current FDA-approved treatments for depression fail for millions of people because they don't work or don't work fast enough," said senior author Ruben Abagyan, PhD, professor of pharmacy. "This study extends small-scale clinical evidence that ketamine can be used to alleviate depression, and provides needed solid statistical support for wider clinical applications and possibly larger scale clinical trials."
Abagyan led the study with pharmacy students Isaac Cohen and Tigran Makunts, and Rabia Atayee, PharmD, associate professor of clinical pharmacy, all at Skaggs School of Pharmacy.
The FAERS database contains more than 8 million patient records. The research team focused on patients in the database who received ketamine, narrowing their study population down to approximately 41,000. They applied a mathematical algorithm to look for statistically significant differences in reported depression symptoms for each patient.
"While most researchers and regulators monitor the FAERS database for increased incidences of symptoms in order to spot potentially harmful drug side effects, we were looking for the opposite—lack of a symptom," Cohen said.
The team found that the incidence of depression symptoms in patients who took ketamine in addition to other pain therapeutics dropped by 50 percent (with an error margin less than 2 percent) compared to the patients who took any other drug or drug combination for pain. Patients who took ketamine also less frequently reported pain and opioid-associated side effects, such as constipation, as compared to patients who received other pain medications.
According to Abagyan, it is possible that another factor common to patients taking ketamine was driving the antidepressant effect, such as the fact that ketamine also relieves pain. That's why they compared ketamine patients with patients taking other pain medications. That control group eliminated the possibility that people who take ketamine have less depression because they have less pain. Abagyan says it's still possible, though unlikely, the effect could be due to a still unidentified confounding factor.
Three other drugs with previously under-appreciated antidepressant effects also emerged from this analysis: Botox, used cosmetically to treat wrinkles and medically to treat migraines and other disorders; diclofenac, a nonsteroidal anti-inflammatory drug (NSAID); and minocycline, an antibiotic.
After the diclofenac finding, Abagyan and team went back and looked at ketamine patients who did not also take NSAIDs and compared them to patients who took any other combination of drugs for pain except NSAIDs. Depression rates in patients taking ketamine remained low.
The researchers hypothesize that the antidepressant effects of diclofenac and minocycline may be due, at least in part, to their abilities to reduce inflammation. For Botox, the potential mechanism for reducing depression is less clear. The team is now working to separate Botox's beauty effects (which could indirectly make a person feel better emotionally) and its antidepressant effects. To do this, they are first using FAERS data to determine if collagen fillers and other cosmetic treatments similarly affect depression rates.
According to the World Health Organization, more than 300 million people experience depression worldwide. If not effectively treated, depression can become a chronic disease that increases a person's risk of mortality from suicide, heart disease or other factors. Depression is currently treated with five classes of antidepressants, most commonly serotonin reuptake inhibitors.
For financial and ethical reasons, ketamine has never been tested for its safety and effectiveness in treating depression in a large-scale clinical trial, but it reportedly works much more rapidly than standard antidepressants. Ketamine is relatively inexpensive and is covered by most health insurance plans if three other antidepressants fail.
"The approach we used here could be applied to any number of other conditions, and may reveal new and important uses for thousands of already approved drugs, without large investments in additional clinical trials," Makunts said.

More information: Isaac V. Cohen et al, Population scale data reveals the antidepressant effects of ketamine and other therapeutics approved for non-psychiatric indications, Scientific Reports (2017). DOI: 10.1038/s41598-017-01590-x


Provided by University of California - San Diego

Burden of multiple chronic illness told through new chartbook

From the report 'Multiple Chronic Conditions in the United States.' 

A new publication illustrates the burden that chronic illnesses impose on American society, demonstrating through charts and graphics how 60 percent of American adults suffer from at least one chronic health condition and 42 percent have more than one.

04 jun 2017--The chartbook updates previous compendiums with more-recent information about the prevalence of multiple chronic conditions, as well as the associated health care utilization and spending.
The data confirms that the prevalence of multiple chronic conditions is highest among older adults. Women are more likely than men to have multiple chronic conditions, as many women live longer than men do.
A chronic condition is a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring or treatment.
When a patient has more than one chronic condition—such as diabetes, high blood pressure and depression—treatment can be difficult to manage, researchers say. Treatment strategies or drug regimens may be similar, but one chronic condition often is managed better than the others.
"We hope this updated chartbook helps both health professionals and the public better understand that chronic disease is a burden not only for patients, but also for the health care system overall," said Christine Buttorff, lead author of the study and an associate policy researcher at RAND, a nonprofit research organization.
The project was supported by the Partnership to Fight Chronic Disease. The report, "Multiple Chronic Conditions in the United States," is available at http://www.rand.org. Other authors of the report are Teague Ruder and Melissa Bauman.


Provided by RAND Corporation

Frailer patients at much greater risk of institutional care and death after discharge from hospital

Independent of age, frail patients are almost twice as likely to die in the year following admission to critical care, and even more likely to need nursing home care after discharge from hospital, compared with patients who are not frail, according to new research presented at this year's Euroanaesthesia Congress in Geneva (3-5 June).

03 jun 2017--Frailty (a decline in physiological reserve and function leading to increased vulnerability to poor health outcomes) is very common, affecting up to 1 in 10 people over 70 years old. While people who are frail are not disabled, they have reduced strength and endurance and find it difficult to carry out normal daily activities. Frailty is linked to earlier death, poor function, and increased hospitalisations. However, the role of frailty in critical care outcomes is unclear.
In this study, Professor Gary Mills from the University of Sheffield, UK and colleagues looked at data over a 3-year period for 7,732 adults aged 17 to 104 years old, who had been admitted to critical care departments in two hospitals in Sheffield, UK. They measured the effect of frailty on the risk of death in the year after hospitalisation. Smaller samples of patients were also assessed for changes to residence (3,469 patients) and differences in dependency (2,387) before and after admission. Of 7,732 patients 1,726 were considered to be frail with an average age of 72.5 years, based on an assessment of their health and function in line prior to this illness episode, using the Rockwood frailty score.
Results showed that around 40% of frail patients had died within one year of admission compared to 15% of non-frail patients. Analysis of the data showed that frail patients were at almost twice the risk of dying in the year after admission to critical care compared to non-frail patients, even after accounting for important characteristics like age, the number of organs supported during care and major comorbidities like metastatic disease or kidney failure. Frail patients were also nearly 2.5 times as likely to need institutional care and became more dependent after discharge from hospital.
The authors conclude: "Our findings suggest that being frail is associated with poorer outcomes after critical illness and this could affect decision making regarding appropriate care by patients. This study should trigger further research and quality improvement efforts aimed at improving the care and outcomes of the growing population of frail patients with critical illness."


Provided by European Society of Anaesthesiology