One in three older adults take something to help them sleep but many don't talk to their doctors

The percentage of Americans age 65-80 who report trouble falling asleep. 

Sleep doesn't come easily for nearly half of older Americans, and more than a third have resorted to some sort of medication to help them doze off at night, according to new results from the National Poll on Healthy Aging.

30 sept 2017--But most poll respondents said they hadn't talked to their doctor about their sleep, even though more than a third said their sleep posed a problem. Half believe—incorrectly—that sleep problems just come naturally with age.
The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and is sponsored by AARP and Michigan Medicine, U-M's academic medical center.
Those who turn to medications may not realize that prescription, over-the-counter and even "natural" sleep aids carry health risks, especially for older adults, either alone or in combination with other substances. In fact, national guidelines strongly warn against prescription sleep medicine use by people over age 65.
Despite this, the nationally representative poll of people ages 65 to 80 finds that 8 percent of older people take prescription sleep medicine regularly or occasionally. Among those who report sleep troubles three or more nights a week, 23 percent use a prescription sleep aid. Most who use such drugs to help them sleep had been taking them for years. Manufacturers and the U.S. Food and Drug Administration say such drugs are only for short-term use.

Medication: not the only option

"Although sleep problems can happen at any age and for many reasons, they can't be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say," says poll director Preeti Malani, M.D., a U-M physician trained in geriatric medicine. "Some of these medications can create big concerns for older adults, from falls and memory issues to confusion and constipation," even if they're sold without a prescription.
"The first step for anyone having trouble sleeping on a regular basis should be to talk to a doctor about it," she continues. "Our poll shows that nearly two-thirds of those who did so got helpful advice - but a large percentage of those with sleep problems simply weren't talking about it."
She notes that non-medication-based sleep habits are the first choice for improving sleep in older people. Sleep and health
In all, 46 percent of those polled had trouble falling asleep one or more nights a week. Fifteen percent of the poll respondents said they had trouble falling asleep three or more nights a week.

This image shows what older Americans (age 65-80) are taking to help them get to sleep. National guidelines recommend that prescription sleep aids not be used by people in this age group. 

Other health conditions can contribute to sleep difficulties. Twenty-three percent of poll respondents who had trouble sleeping said it was because of pain. And 40 percent of those with frequent sleep problems said their overall health was fair or poor. Other reasons for sleep troubles included having to get up to use the bathroom at night, and worry or stress.
Insomnia and other irregular sleep patterns can interfere with daytime functioning, and are associated with memory issues, depression and an increased risk of falls and accidents. Even so, many said they didn't see sleep issues as a health problem - in fact, this belief was the most common reason that poll respondents said they didn't talk to their doctor about sleep.
This also highlights the need for doctors to ask their older patients about their sleep habits and what they're doing to address any issues they may be having
"We know that sleep is a critical factor for overall health as we age, and this new research highlights sleep problems as both a significant health issue for older adults and an underacknowledged one both by patients and their providers," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We need to help people understand that lack of sleep is not just a natural part of aging."

More about medication use

In all, 14 percent of the poll respondents said they regularly took a prescription sleep medication, prescription pain medication, OTC sleep aid or herbal supplement to help them sleep. Another 23 percent took one of these options occasionally; most of the occasional users said they chose OTC sleep aids.
The most recent Beers Criteria established by the American Geriatrics Society, which guides the use of medications among older people, gives a strong warning against use of prescription sleep drugs, which are sold under such names as Ambien, Lunesta and Sonata.
Meanwhile, even though OTC sleep aids can be purchased without a doctor's guidance or prescription, they still carry health risks for older people, Malani notes. Most of them contain diphenhydramine, an antihistamine that can cause side effects such as confusion, urinary retention and constipation.
Among poll respondents with frequent sleep problems who took something occasionally to help them sleep, OTC sleep remedies were the most common choice. But among those with frequent sleep issues who took something on a regular basis to try to sleep, prescription sleep medications were the most common option, with 17 percent reporting use.
Use of melatonin and other herbal remedies may be perceived as safer, but less is known about their potential side effects and they are not subject to the FDA's approval process for medications, says Malani. But any issue that prompts someone to buy an OTC or herbal remedy on a regular basis is something they should discuss with their doctor, she adds.
The poll results are based on answers from a nationally representative sample of 1,065 people ages 65 to 80, who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.
A full report of the findings and methodology is available at www.healthyagingpoll.org


Provided by University of Michigan

Aging populations often thoroughly contemplate housing decisions, researchers find

As people approach their final stage of life, whether they decide to remain in their home or seek to move to a more supportive place, it's often a well-thought-out choice and not a reactive decision, according to a new study that includes a University of Kansas researcher.

29 sept 2017--"The literature discusses housing choices and decisions as people reacting to events, such as they become sick or the neighborhood changes around them," said David Ekerdt, professor of sociology and gerontology. "This model is that people are reacting to external events, but our view is that people are proactive and always thinking about what might happen and whether their living arrangement is good for them."
Ekerdt is the corresponding author of a study, "Residential Reasoning and the Tug of the Fourth Age," which will appear in the October issue of the journal The Gerontologist. His co-author on the paper is Catheryn Koss, a KU graduate, who is now at Sacramento State University.
The researchers interviewed 30 community-dwelling retirees ages 67-97 in the United States about how they prepared for the future, including their housing decisions.
Gerontology researchers have termed the "third age" as an active retirement where people have left their traditional work and family roles though they are still relatively independent. The "fourth age" refers to the next phase, which might include disability or a health decline toward the end of one's life.
The study is part of the larger international project "Aging as Future" supported by a grant from the Volkswagen Foundation in Germany. Ekerdt has joined with researchers from the Chinese University of Hong Kong, North Carolina State University at Raleigh, the University of Erlangen-Nuremberg in Germany and the University of Jena in Germany.
Ekerdt said the findings about how people later in life think about their housing decisions is important because it provides a different angle to the perception that people often wait and react based on a health event or some other immediate circumstance.
"In this case, people are constantly having the specter of the fourth age ahead of them. They are continually thinking about, 'Where is the best place that I should grow old?'" he said. "People are continually thinking about and evaluating the residences where they live."
The researchers did identify two categories of people based on how they did approach their housing decisions: pre-emptive and contingent. Participants who used pre-emptive reasoning anticipated their current homes would be suitable over the long term, and they explained why. Those who engaged in contingent reasoning imagined a possible future move to more supportive housing and possibly had a destination in mind.
Several factors could also influence which camp respondents landed in, Ekerdt said, including the effects of peers and relationship with spouses and children.
Either way, the process was something that seemed to be well thought out, he said.
"The fourth age is remarkably present to people's imagination about the future," Ekerdt said. "'What would happen if I was to become unable to function in the place that I'm living?'—as opposed to other decisions you might make and put aside."
These findings might be good news for companies who market senior housing or for those who renovate homes, he said.
"There is a great opportunity to try to reach people as they are processing their setting and their dwellings," Ekerdt said. "Later-life housing also has other implications. Homes are very important to health care and people's ability to fit into their environments. A dwelling not just a place to live. It's a place to manage your health."

More information: Catheryn Koss et al. Residential Reasoning and the Tug of the Fourth Age, The Gerontologist (2016). DOI: 10.1093/geront/gnw010


Provided by University of Kansas

Exercise, not vitamin D, recommended to prevent falls

Falls and fractures are a major cause of disability in old age. An influential U.S. medical task force is recommending exercise and, in some cases, medical evaluation to help seniors stay on their feet.

28 sept 2017--But the new draft recommendations from the U.S. Preventive Services Task Force (USPSTF) say there isn't enough evidence at this time to either endorse or advise against taking vitamin D or calcium supplements to prevent broken bones.
And based on current evidence, the panel recommends against taking vitamin D solely to prevent falls.
For Americans 65 and older, falls are the leading cause of injuries and injury-related deaths, according to the U.S. Centers for Disease Control and Prevention. On average, one older person falls every second in the United States, the CDC says.
"Fortunately, there are things we can do to help prevent falls," said Dr. Alexander Krist, a task force member.
However, "we found that it is unclear whether vitamin D and calcium can help prevent fractures at higher doses," said Krist, an associate professor of family medicine and population health at Virginia Commonwealth University. "They do not prevent fractures at lower doses."
More research is needed to evaluate the potential benefit of high-dose calcium and vitamin D supplementation for fracture prevention after menopause, the task force noted.
"We hope that you talk to your primary care provider about exercise to prevent falls if you have any concerns about falling, as well as vitamin D or calcium supplementation if you have any questions about your personal risk of fractures," Krist added.
The USPSTF, an independent panel of experts, provides guidance to physicians about how to prevent medical problems.
The proposed guidelines are intended to help prevent falls and fractures in generally healthy adults aged 65 and older who live at home and don't have medical problems such as osteoporosis, vitamin D deficiency, Parkinson's disease or dementia.
After reviewing the available studies, "we found that exercise had a moderate benefit in preventing falls in older adults at increased risk for falls," Krist said.
The task force didn't suggest any particular type of exercise. Still, "supervised exercise that improves balance, the way someone walks, and helps with completing common tasks are helpful," Krist said.
"These can be done in group or individual classes and either at home or in the community. Patients should talk with their clinician about what exercise programs are best for them," he added.
The task force also recommends that health care providers "selectively check older adults' risks for falls, and then offer tailored interventions that address those specific risks."
However, one expert doubts that such risk assessments will become common.
"Medical offices are businesses. Anything that adds time to the office visit, without adding revenue, is unlikely to be added to the majority of visits," said Dr. Chris Sciamanna, a professor of medicine and public health sciences at Penn State College of Medicine. He wasn't involved in writing the draft recommendations.
Sciamanna suggested that seniors test themselves: "If you can't stand on either leg for 10 seconds without grabbing onto something, you're at risk and should talk to your doctor," he said.
But, he added, "the reality is that there's little for doctors to do other than to refer you to an exercise program or, in some cases, reduce the dose of a medicine that may be hurting your balance, like a blood pressure medicine."
In a perfect world, Sciamanna said, he would have his patients enroll in a strength and balance program three times each week, and also "get aerobic exercise, preferably something that would be fun and build their agility."
Although the task force recommends against taking vitamin D to prevent falls, there's no recommendation regarding whether seniors should take vitamin D for general health.
As for other ideas, the task force said there's not enough evidence to show the value of single strategies like managing medications or making the home environment safer.
The task force released its draft recommendations Sept. 26 and is accepting comments about them on their website until Oct. 23.

More information: Alexander Krist, M.D., MPH, associate professor of family medicine and population health, Virginia Commonwealth University, Richmond, Va.; Chris Sciamanna, M.D., MPH, professor, medicine and public health sciences and vice chair, research, department of medicine, Penn State College of Medicine, Hershey, Pa.; U.S. Preventive Services Task Force, draft recommendations, Sept. 26, 2017.

Evidence Review 1
Draft Recommendation Statement 1
Comment on Recommendation 1
Evidence Review 2
Draft Recommendation Statement 2
Comment on Recommendation 2

How ketogenic diets curb inflammation

Ketogenic diets – extreme low-carbohydrate, high-fat regimens that have long been known to benefit epilepsy and other neurological illnesses – may work by lowering inflammation in the brain, according to new research by UC San Francisco scientists.

26 sept 2017--The UCSF team has discovered a molecular key to the diet's apparent effects, opening the door for new therapies that could reduce harmful brain inflammation following stroke and brain trauma by mimicking the beneficial effects of an extreme low-carb diet.
"It's a key issue in the field – how to suppress inflammation in the brain after injury," said Raymond Swanson, MD, a professor of neurology at UCSF, chief of the neurology service at the San Francisco Veterans Affairs Medical Center, and senior author of the new study.
In the paper, published online Sept. 22 in the journal Nature Communications, Swanson and his colleagues found the previously undiscovered mechanism by which a low-carbohydrate diet reduces inflammation in the brain. Importantly, the team identified a pivotal protein that links the diet to inflammatory genes, which, if blocked, could mirror the anti-inflammatory effects of ketogenic diets.
"The ketogenic diet is very difficult to follow in everyday life, and particularly when the patient is very sick," Swanson said. "The idea that we can achieve some of the benefits of a ketogenic diet by this approach is the really exciting thing here."

Low-Carb Benefits

The high-fat, low-carbohydrate regimen of ketogenic diets changes the way the body uses energy. In response to the shortage of carb-derived sugars such as glucose, the body begins breaking down fat into ketones and ketoacids, which it can use as alternative fuels.
In rodents, ketogenic diets – and caloric restriction, in general – are known to reduce inflammation, improve outcomes after brain injury, and even extend lifespan. These benefits are less well-established in humans, however, in part because of the difficulty in maintaining a ketogenic state.
In addition, despite evidence that ketogenic diets can modulate the inflammatory response in rodents, it has been difficult to tease out the precise molecular nuts and bolts by which these diets influence the immune system.

Intricate Molecular Waltz

In the new study, the researchers used a small molecule called 2-deoxyglucose, or 2DG, to block glucose metabolism and produce a ketogenic state in rats and controlled laboratory cell lines. The team found that 2DG could bring inflammation levels down to almost control levels.
"I was most surprised by the magnitude of this effect, because I thought ketogenic diets might help just a little bit," Swanson said. "But when we got these big effects with 2DG, I thought wow, there's really something here."
The team further found that reduced glucose metabolism lowered a key barometer of energy metabolism – the NADH/NAD+ ratio – which in turn activated a protein called CtBP that acts to suppress activity of inflammatory genes.
In a clever experiment, the researchers designed a drug-like peptide molecule that blocks the ability of CtBP to enter its inactive state – essentially forcing the protein to constantly block inflammatory gene activity and mimicking the effect of a ketogenic state.
Peptides, which are small proteins, don't work well themselves as drugs because they are unstable, expensive, and people make antibodies against them. But other molecules that act the same way as the peptide could provide ketogenic benefits without requiring extreme dietary changes, Swanson said.
The study has applications beyond brain-related inflammation. The presence of excess glucose in people with diabetes, for example, is associated with a pro-inflammatory state that often leads to atherosclerosis, the buildup of fatty plaques that can block key arteries. The new study could provide a way of interfering with the relationship between the extra glucose in patients with diabetes and this inflammatory response.

More information: Yiguo Shen et al. Bioenergetic state regulates innate inflammatory responses through the transcriptional co-repressor CtBP, Nature Communications (2017). DOI: 10.1038/s41467-017-00707-0


Provided by University of California, San Francisco

Bicycling 'overloads' movement networks with Parkinson's

Bicycling suppresses abnormal beta synchrony in the Parkinsonian basal ganglia, according to a study published online Sept. 11 in the Annals of Neurology.

23 sept 2017--Lena Storzer, Ph.D., from Heinrich Heine University Düsseldorf in Germany, and colleagues compared bicycling and walking in Parkinson's disease patients (five patients with and eight patients without freezing of gait) with electrodes implanted in the subthalamic nuclei for deep brain stimulation. Low (13 to 22 Hz) and high (23 to 35 Hz) beta power changes were analyzed in 13 patients (57.5 years; four female).
The researchers found that in patients without freezing of gait, both bicycling and walking led to a suppression of subthalamic beta power (13 to 35 Hz), and this suppression was stronger for bicycling. For those with freezing of the gait, a similar pattern was observed, in general. However, a movement-induced, narrowband power increase around 18 Hz was evident even in the absence of freezing.
"Abnormal ~18 Hz oscillations are implicated in the pathophysiology of freezing of gait, and suppressing them may form a key strategy in developing potential therapies," the authors write.
Several authors disclosed financial ties to the medical device industry.

More information: Abstract
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Pelvic Floor Society statement—use of mesh surgeries for constipation and rectal prolapse

In light of ongoing concerns by the media and the public surrounding the use of mesh in women with pelvic organ prolapse and urinary incontinence, the Pelvic Floor Society has issued a consensus statement addressing the use of mesh for the treatment of constipation and rectal prolapse (via a surgical procedure called ventral mesh rectopexy, or VMR). The Statement is published in Colorectal Disease.

22 sept 2017--Mesh is a synthetic or biological material used to offer extra internal support. In a small number of patients, such meshes may cause problems, but according to the Pelvic Floor Society, evidence suggests that mesh-related complications for VMR are far lower than those seen in transvaginal procedures. The Society's statement addresses proper training and accreditation regarding VMR, as well as recommendations on tracking and recording complications and providing detailed consent forms and information booklets to patients.
"This important paper presents the evidence to support the use of Ventral Mesh Rectopexy in the treatment of constipation and rectal prolapse. It should reassure the profession and public that we take potential mesh complications very seriously," said Andrew Williams, Chair of the Pelvic Floor Society. "We are doing everything possible to improve education, provide detailed patient information, and record any complications to better understand the outcomes following this surgery."

More information: Colorectal Disease, DOI: 10.1111/codi.13893


Provided by Wiley

Do ketogenic diets help you lose weight?

Ketogenic diets involve eating mostly fats. 

Is a ketogenic diet effective for weight loss? The answer depends on whether it achieves a reduction in total kilojoule intake or not.

What is a ketogenic diet?

A classical ketogenic diet follows a strict ratio for total grams of fat to combined grams of carbohydrate and protein and typically has 80-90% of total kilojoules coming from fat, which is very high fat. Carbohydrate intake varies from 20 to 50 grams a day, or 5-10% of total energy, while protein intakes are moderate.
The difference between a strict ketogenic diet and diets that are described as low-carb is that ketogenic diets specifically aim to achieve elevated blood levels of ketone bodies which are chemicals produced as a consequence of your body burning fat. Hence general low-carb diets are not as high in fat as classical ketogenic diets.
Research on the use of classical ketogenic diets for weight loss is limited. But there are many studies that compare lower-carb diets to other approaches.
These show that aiming for a carbohydrate restriction of 20-30 grams a day, without setting a daily kilojoule target, leads to 2-4 kilograms greater weight loss compared to a low kilojoule diet, in studies up to six months.
In longer studies with follow-up between one to five years there is no difference in weight loss. A review of weight loss diets with a moderate carbohydrate restriction (45% or less of total energy intake) compared to low fat diets (under 30% fat) found they were equally effective in reducing body weight in studies from six months to two years.

How much carbohydrate do we eat?

In Australia, current carbohydrate intakes range from approximately 210 to 260 grams a day, or about 45% of total energy intake. More than a third of what Australians currently eat comes from discretionary, or "junk" foods. It is definitely a good idea to cut down on discretionary foods. These are commonly ultra-processed and contain refined carbohydrates and include burgers, chips, pizza, crumbed foods, biscuits, cake, pastry, lollies, cordial, sugar sweetened juices and soft drink.
The problem is most people do not eat enough minimally processed, nutrient rich foods that contain carbohydrate, like legumes, wholegrain breads, cereals and other grains, vegetables, fruit, nuts, milk and yoghurt. These foods contain important nutrients, from dietary fibre, to B vitamins, and minerals and trace elements like iron, zinc, magnesium, calcium, selenium and iodine.
Your body needs these nutrients for digestion, metabolism, growth and repair of cells and to help protect the brain, heart, muscles and nerves.

What happens when you go on a ketogenic diet to lose weight?

If you severely limit all foods that contain carbohydrate, such as during a ketogenic diet, you end up cutting out many foods. This means you eat less total kilojoules and therefore lose weight.
Whether you follow a classical ketogenic diet or a very low energy diet you may end up producing "ketone bodies", which may help with weight loss, particularly fat mass.
Carbohydrate is used in the body as the major source of fuel, like petrol is used to fuel a car. Your body has a store of carbohydrate in the liver and muscles called glycogen. When glycogen stores are low your body switches to burning fat, which leads to production of ketone bodies.
Glycogen becomes limited when your total energy intake is very low, such as during a strict weight loss diet, a fast, or when you do not eat foods containing carbohydrate. This means your body burns the fat you eat, as well as body fat, leading to a loss of stored body fat. You still produce small amounts of glucose through a process called gluconeogenesis by breaking down protein and some fat.
Ketogenic diets and appetite
A systematic review evaluated how people perceived their appetite before and during a very low energy diet that contained less than 3,300 kilojoules a day or a ketogenic low carbohydrate diet containing less than 10% energy from carbohydrate (50 grams or less per day). Those following the very low energy diet reported less hunger and greater fullness and satiety during weight loss, while those following the ketogenic diet reported feeling less hunger and having less desire to eat. The authors concluded that although the absolute change in subjective appetite ratings were small, they were important in terms of helping people stick to a weight loss diet.
One research study followed 18 obese men during eight weeks of a ketogenic very low energy diet of 2300-2700 kilojoules per day, followed by four weeks of weight maintenance. They measured changes in appetite and blood concentrations of appetite hormones and ketones.
While hunger increased significantly by day three and up until the men lost 5% of their starting body weight, it did not get worse after that while they were dieting. Once they increased their food intake during maintenance, they had an increase in hunger. The good news was that while they were producing ketones, they appeared to be able to tolerate feeling hungry.

Ketogenic diets and weight loss

One randomised controlled trial randomly allocated 45 obese adults to either a ketogenic low energy diet of 2500-300 kilojoules per day for about two months or a low kilojoule diet where total daily energy intake was reduced by 10%.
As you would expect, those in the low energy group lost significantly more weight after one year. After two years, and accounting for those who dropped out, both groups lost weight (low energy 7kg versus 5.3kg low kilojoule). Of note was that a greater number in the low energy group lost 5% or more of their initial body weight at 12 months.
A systematic review of nine studies in adults with type 2 diabetes following lower-carb diets (less than 130 grams a day or less than 25% energy from carbohydrate) compared to control weight loss diets found weight loss was greater up to one year in the lower-carb groups.
While there was no long-term difference in weight loss between dietary approaches, blood triglyceride concentrations were significantly lower and HDL (good) cholesterol concentrations were higher, but there was no reduction in total or LDL (bad) cholesterol.

Should you or shouldn't you?

If you have a family history of bowel cancer then don't follow a ketogenic weight loss diet. The World Cancer Research Fund has shown convincing evidence for a higher risk of colorectal cancer in association with low fibre and higher red and processed meat intakes.
Prevention guidelines recommend having greater variety, and higher intakes, of legumes, wholegrains, non-starchy vegetables and fruit.
When it comes to weight management, reduce your carbohydrate intake by reducing energy-dense, nutrient-poor foods. Increase minimally processed foods high in fibre and phytonutrients, including vegetables, legumes/pulses and wholegrains and only use classical ketogenic diets under supervision of your health care team.
This article was originally published on The Conversation. Read the original article.

Provided by The Conversation

Seven steps to keep your brain healthy from childhood to old age

A healthy lifestyle benefits your brain as much as the rest of your body—and may lessen the risk of cognitive decline (a loss of the ability to think well) as you age, according to a new advisory from the American Heart Association/American Stroke Association.

17 sept 2017--Both the heart and brain need adequate blood flow, but in many people, blood vessels slowly become narrowed or blocked over the course of their life, a disease process known as atherosclerosis, the cause of many heart attacks and strokes. Many risk factors for atherosclerosis can be modified by following a healthy diet, getting enough physical activity, avoiding tobacco products and other strategies.
"Research summarized in the advisory convincingly demonstrates that the same risk factors that cause atherosclerosis, are also major contributors to late-life cognitive impairment and Alzheimer's disease. By following seven simple steps—Life's Simple 7—not only can we prevent heart attack and stroke, we may also be able to prevent cognitive impairment," said vascular neurologist Philip Gorelick, M.D., M.P.H., the chair of the advisory's writing group and executive medical director of Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan.
Life's Simple 7 outlines a set of health factors developed by the American Heart Association to define and promote cardiovascular wellness. Studies show that these seven factors may also help foster ideal brain health in adults.
The Life's Simple 7 program urges individuals to:

• Manage blood pressure
• Control cholesterol
• Keep blood sugar normal
• Get physically active
• Eat a healthy diet
• Lose extra weight
• Don't start smoking or quit

A healthy brain is defined as one that can pay attention, receive and recognize information from our senses; learn and remember; communicate; solve problems and make decisions; support mobility and regulate emotions. Cognitive impairment can affect any or all of those functions.
The advisory, which is published in the American Heart Association's journal Stroke, stresses the importance of taking steps to keep your brain healthy as early as possible, because atherosclerosis—the narrowing of the arteries that causes many heart attacks, heart failure and strokes—can begin in childhood. "Studies are ongoing to learn how heart-healthy strategies can impact brain health even early in life," Gorelick said. Although more research is needed, he said, "the outlook is promising."
Elevations of blood pressure, cholesterol and blood sugar can cause impairment of the large and smaller blood vessels, launching a cascade of complications that reduce brain blood flow. For example, high blood pressure—which affects about 1 in 3 U.S. adults—is known to damage blood vessels that supply oxygen and nutrients to the heart and the brain, Gorelick noted. The damage can lead to a buildup of fatty deposits, or atherosclerosis as well as associated clotting. This narrows the vessels, can reduce blood flow to the brain, and can cause stroke or "mini-strokes." The resulting mental decline is called vascular cognitive impairment, or vascular dementia.
Previously, experts believed problems with thinking caused by Alzheimer's disease and other, similar conditions were entirely separate from stroke, but "over time we have learned that the same risk factors for stroke that are referred to in Life's Simple 7 are also risk factors for Alzheimer's disease and possibly for some of the other neurodegenerative disorders," Gorelick said.
The advisory also recognizes that it is important to follow previously published guidance from the American Heart Association, Institute of Medicine and Alzheimer's Association, which include controlling cardiovascular risks and suggest social engagement and other related strategies for maintaining brain health.
The action items from Life's Simple 7, which are based on findings from multiple scientific studies, meet three practical rules the panel developed in pinpointing ways to improve brain health—that they could be measured, modified and monitored, Gorelick said. Those three criteria make it possible to translate knowledge into action because healthcare providers can assess Life's Simple 7 elements—like blood pressure—easily; they can encourage proven, health-promoting steps and they can gauge changes over time.
The AHA advisory provides a foundation on which to build a broader definition of brain health that includes other influential factors, Gorelick said, such as the presence of atrial fibrillation, a type of irregular heartbeat that has been linked to cognitive problems; education and literacy; social and economic status; the geographic region where a person lives; other brain diseases and head injuries.
It is also a starting point for expanding research into areas such as whether there might be detectable markers, like genetic or brain imaging findings, that represent a susceptibiity for cardiovascular or brain illness, Gorelick said. "At some point in our lives, a 'switch' may be getting ready to 'flip,' or activate, that sets us in a future direction whereby we become at-risk for cognitive impairment and dementia."
Dementia is costly to treat. Direct care expenses are higher than for cancer and about the same for heart disease, estimates show. Plus, the value of unpaid caregiving for dementia patients may exceed $200 billion a year.
As lives stretch longer in the U.S. and elsewhere, about 75 million people worldwide could have dementia by 2030, according to the advisory. "Policy makers will need to allocate healthcare resources for this," Gorelick said. Monitoring rates of dementia in places where public health efforts are improving heart health "could provide important information about the success of such an approach and the future need for healthcare resources for the elderly," he said.
The authors of the advisory reviewed 182 published scientific studies to formulate their conclusions that following Life's Simple 7 has the potential to help people maintain a healthy brain throughout life.

More information: Stroke: Journal of the American Heart Association, DOI: 10.1161/STR.0000000000000148


Provided by American Heart Association

Talking to older adults about health prognosis may be helpful

Prognosis is the term for the most likely outcome of a medical condition. When it comes to health care, talking about your prognosis can be difficult for you, your family/friends, and even your healthcare providers. However, many of us prefer to talk to our healthcare providers about the expected course of an illness and about our life expectancy when living with a chronic or terminal illness. This is according to new research on advanced care planning (the technical term for having early conversations with our healthcare providers about our care needs, preferences, and expectations).

16 sept 2017--In a new study published in the Journal of the American Geriatrics Society, researchers examined how older adults with disabilities later in life might react to learning their prognosis, and how they evaluated their own prognosis compared to "official" estimates.
The study participants were 35 adults 70-years-old and older from four geriatrics clinics in the San Francisco Bay area. All the participants required help with daily activities, and they all participated in a 45-minute interview as part of the study.
The researchers asked older adults questions about how they would want to receive information about their life expectancy. For example, did they prefer hearing or reading news about their prognosis? Would they prefer receiving information about their prognosis while at home by themselves?
Additionally, participants circled the shortest, longest, and most likely number of years they thought they might live on a scale from zero to 30 years. Researchers then offered to give the participants an estimate of life expectancy with a visual presentation using an estimate system created for people older than age 50. Next, participants were given the option to see their prognosis. If they chose to see it, they discussed their reactions with the researchers. Afterward, researchers asked the participants 10 questions about their feelings based on hearing about estimated life expectancy. The researchers called the participants two to four weeks later to check on their reactions as a follow-up.
Over the course of the study, the researchers learned that:

• 16 participants (46 percent) had life expectancy estimates that were within two years of the "most likely" estimate from a healthcare professional.
• 15 participants (43 percent) over-estimated their own life expectancy by more than two years compared to the "most likely" estimate.
• 4 participants (11 percent) under-estimated their own life expectancy by more than two years compared to the "most likely" estimate.
• Overall, 30 participants (86 percent) estimated their life expectancy in a way that at least overlapped with the "official" estimated calculation.

The researchers concluded that most older adults wanted a health care practitioner to be present when discussing life expectancy. People in the study did not react with sadness or anxiety when they learned about life expectancies, though several disputed the calculated results.
"Health care practitioners may offer to discuss life expectancy with their older, disabled patients and expect the patients to tie the information into their own life narratives," said the researchers.
According to other research, key reasons for a healthcare professional's reluctance to have these discussions with their older adults may include:

• Fear of taking away hope
• Concern for a negative reaction
• Time restraints
• Poor training
• Worry about giving someone a mistaken prognosis, leading to incorrect information about a person's future

Addressing these and other important concerns remains key to advance care planning, which has been shown to improve the quality of care we receive as we age.

More information: Theresa W. Wong et al, Prognosis Communication in Late-Life Disability: A Mixed Methods Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15025


Provided by American Geriatrics Society

Older drivers who experience falls may be at a higher risk for car crashes

As we age, our ability to drive may help us live independently, shop for ourselves, and maintain social connections. Although car crash rates are low among older adults and are declining, older adults do still have higher rates of fatal crashes. Falls, which are a common and preventable cause of injury among older adults, may lower our ability to drive safely.

15 sept 2017--Experts believe that falls are related to driving in four ways:

• They can cause physical injury that limits mobility (our ability to move) and interferes with driving performance.
• Falling can increase the fear of falling, which leads to a reduction in physical activity . Reduced physical activity can weaken our physical strength, which also could reduce fitness for driving.
• Falls can affect an older adult's mental well-being, making them more fearful and leading to changes in driving behaviors.
• Falls and difficulty driving may be caused by common factors, such as vision problems.

A research team created a study to see whether falls were related to driving risks and behaviors among older adults. Their study was published in the Journal of the American Geriatrics Society.
To test their theory that falls are related to car crashes, crash-related injuries, and changes in driving performance, the researchers reviewed 15 studies of driving behavior among older adults involving nearly 47,000 people.
The researchers learned that older adults who had fallen were 40 percent more likely to experience a car crash after their fall than older adults who had not fallen.
Based on estimates of car crashes involving older drivers and older adults who fall, falls—or the things that cause falls and crashes—accounted for more than 177,000 additional car crashes each year.
Researchers also learned that falls may be an independent factor impairing an older adult's ability to drive safely, suggesting that some motor vehicle crashes might be caused by the falls themselves - regardless of the driver's underlying health and functioning.
The researchers suggested that taking steps to reduce the conditions that contribute to both falls and car crashes could reduce the occurrence of both. Some strategies for doing so include:

• Cataract surgery (a type of eye surgery that helps address cloudy vision)
• Exercise to improve physical and mental well-being
• Efforts to improve mental function

The researchers also suggested that for older adults who fall, post-fall rehabilitation might help improve functional ability and enable them to drive more safely.

More information: Kenneth A. Scott et al, Associations Between Falls and Driving Outcomes in Older Adults: Systematic Review and Meta-Analysis, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15047


Provided by American Geriatrics Society

Study shows so-called 'healthy obesity' is harmful to cardiovascular health

Clinicians are being warned not to ignore the increased cardiovascular health risks of those who are classed as either 'healthy obese' or deemed to be 'normal weight' but have metabolic abnormalities such as diabetes.
Academics at the University of Birmingham's Institute of Applied Health Research carried out the largest study of its kind to date comparing weight and metabolic status to cardiovascular disease risks, published today (September 11th) in the Journal of the American College of Cardiology.

14 sept 2017--The study showed that individuals who are 'metabolically healthy obese' (MHO) - those who are obese but do not suffer metabolic abnormalities such as diabetes, high blood pressure and high cholesterol - have an increased risk of cardiovascular disease events compared to those who are normal weight without metabolic abnormalities.
The academics used electronic health records of 3.5 million British adults who were all initially free of cardiovascular disease (CVD). They then revisited each patient's record, at an average of 5 years and four months later, in order to assess whether they had gone on to develop each of four kinds of CVD events - coronary heart disease (CHD), cerebrovascular disease (in particular strokes), heart failure, or peripheral vascular disease (PVD).
Patients were divided into four 'body size phenotypes' using Body Mass Index (BMI), which is calculated by dividing body weight (kg) by height (m) squared:
1. Underweight (BMI less than 18.5)
2. Normal weight (more than 18 but less than 25)
3. Overweight (more than 25 but less than 30)
4. Obese (more than 30).
Three metabolic abnormalities were taken into consideration during the study: diabetes, hypertension and hyperlipidaemia. A metabolically healthy person was classified as having no metabolic abnormalities.
The results showed that those who were MHO had a 49 per cent higher risk of coronary heart disease, seven per cent higher risk of cerebrovascular disease and a 96 per cent increased risk of heart failure than normal weight metabolically healthy individuals.
Importantly, it also showed that 'normal' weight individuals with one or more metabolic abnormalities had an increased risk of CHD, cerebrovascular disease, heart failure and PVD compared to normal weight individuals without metabolic abnormalities.
The research results raise questions around the concept of 'healthy obesity'. Whether metabolically healthy obesity is associated with excess risk of cardiovascular disease has remained a subject of debate for many years due to limitations in previous studies. Academics at the University of Birmingham sought to address these limitations in the largest prospective study of its kind.
Lead author and epidemiologist Dr Rishi Caleyachetty, of the Institute of Applied Health Research University of Birmingham, said: "In our study, we had unprecedented statistical power to examine body size phenotypes by the number of metabolic abnormalities, potentially reflecting several definitions of the 'metabolically healthy' phenotype in relation to a range of CVD events.
"Obese individuals with no metabolic risk factors are still at a higher risk of coronary heart disease, cerebrovascular disease and heart failure than normal weight metabolically healthy individuals.
"So-called 'metabolically healthy' obesity is clearly not a harmless condition and the term should no longer be used in order to prevent misleading individuals that obesity can be healthy."
Senior author Professor Neil Thomas, also of the University of Birmingham, said it was important that clinicians took on board the research findings.
"The finding that normal weight individuals with metabolic abnormalities also had similar risk of cardiovascular disease events than normal weight metabolically healthy individuals has important implications." he added.
"In many countries it is currently recommended that clinicians in primary care settings use overweight and obesity as the main criteria to screen adults for cardiovascular risk factors as part of cardiovascular risk assessment. Our research suggests that this could result in the failure to identify metabolic abnormalities, such as diabetes, high blood pressure and high cholesterol, in many normal weight patients."
Senior author and Public Health physician Dr Krish Nirantharakumar, also of the University of Birmingham, said: "We conclude that obese patients, irrespective of their metabolic status, should be encouraged to lose weight and that early detection and management of normal weight individuals with metabolic abnormalities will be beneficial in the prevention of CVD events."

More information: Metabolically healthy obese and incident cardiovascular disease events among 3.5 million men and women, Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.07.763


Provided by University of Birmingham

Vitamin D deficiency tied to neuropathic pain

Vitamin D deficiency may be associated with increased neuropathic pain (NP) in patients with rheumatoid arthritis (RA), according to a study published online Aug. 31 in the International Journal of Rheumatic Diseases.

14 sept 2017--Hilal Yesil, from Afyon Kocatepe University in Turkey, and colleagues used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 93 patients with RA. Other data were obtained from medical records and interviews.
The researchers found that 80 percent of patients were female and one-third were diagnosed with NP according to the LANSS. There was a negative correlation between vitamin D levels and the LANSS score (P = 0.001). Among patients with serum vitamin D levels <20 0.71="" 5.8="" a="" area="" curve="" d="" diagnoses="" good="" higher="" in="" levels="" ml.="" ml="" ng="" np="" of="" p="" patients="" predictor="" prevalence="" ra="" serum="" than="" the="" times="" under="" vitamin="" was="" were="" with="">"Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP," the authors write.

More information: Abstract
Full Text (subscription or payment may be required) 

Frailty and older men: Study identifies factors that speed/slow progression

As we age, we may be less able to perform daily activities because we may feel frail, or weaker than we have in the past. Frailer older adults may walk more slowly and have less energy. Frailty also raises a person's risks for falling, breaking a bone, becoming hospitalized, developing delirium, and dying.

13 sept 2017--No one knows exactly how many older adults are frail—estimates range from 4 percent to 59 percent of the older adult population, according to a 2015 study. Researchers say that frailty seems to increase with age, and is more common among women than men and in people with lower education and income. Being in poorer health and having several chronic illnesses also have links to being frail.
Frailty also tends to worsen over time, but in at least two studies, a small number (9 percent to 14 percent) of frail older adults became stronger and less frail as they aged. A team of researchers decided to find out what factors might predict whether frailty in older men worsens or improves over time. The researchers' findings were published in the Journal of the American Geriatrics Society.
The researchers examined information gathered from more than 5,000 men aged 65 or older (average age was about 73) who had volunteered for a study about bone fractures caused by osteoporosis (the medical term for a thinning of the bones, a loss of bone density, or increasingly fragile bones). At the start of the study, between 2000 and 2002, the men all lived independently and could walk; none had had hip replacements. Most of the men participated in a second examination about four years after the study began.
At the start of the study, the researchers determined the participants' frailty status by measuring levels of weakness, exhaustion, lean muscle mass, walking speed, and physical activity. They also asked the participants to fill out a questionnaire about their race, ethnicity, education, marital status, tobacco and alcohol use, and any diseases they had, as well as how they would self-rate their health.
The men were categorized as frail, pre-frail (had one or more signs of frailty, such as low grip strength, low energy, slow walking speed, low activity level or unintentional weight loss), or robust (showing no signs of frailty). The researchers tested the men to measure their ability to think and make decisions. They also assessed their ability to perform daily tasks such as eating, bathing, and performing other necessary activities. A group of 950 participants took blood tests to look for signs of inflammation.
At the start of the study, nearly 8 percent of the men were frail and 46 percent were pre-frail. The most common problems for the frail men were weakness, slowness, and low activity. Over four and a half years, the number of frail men increased while the proportion of robust men decreased. Among the men who were frail at both visits:

• 56 percent had no change in frailty status
• 35 percent had become frailer or had died
• 15 percent of pre-frail or frail men improved

Having greater leg power, being married, and reporting good or excellent health were linked to improvements in frailty status. In fact, married men were 3.6 times more likely to improve their frailty status. Men who had trouble performing their daily activities, as well as those with diabetes or COPD/, were less likely to improve their frailty level.
Activities that preserve strength and exercises that target leg muscles, prevent chronic conditions like diabetes and COPD, and improve social support might be good ways to improve frailty and slow its progression, suggested the researchers.

More information: Lauren R. Pollack et al, Patterns and Predictors of Frailty Transitions in Older Men: The Osteoporotic Fractures in Men Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15003


Provided by American Geriatrics Society

Alcohol industry misleading the public about alcohol-related cancer risk

Led by the London School of Hygiene & Tropical Medicine with the Karolinska Institutet, Sweden, the team analysed the information relating to cancer which appears on the websites and documents of nearly 30 alcohol industry organisations around the world between September 2016 and December 2016.

11 sept 2017--Most of the organisational websites (24/26) showed some sort of distortion or misrepresentation of the evidence about alcohol-related cancer risk, with breast and colorectal cancers being the most common focus of misrepresentation.
The most common approach involves presenting the relationship between alcohol and cancer as highly complex, with the implication or statement that there is no evidence of a consistent or independent link. Others include denying that any relationship exists or claiming inaccurately that there is no risk for light or 'moderate' drinking, as well discussing a wide range of real and potential risk factors, thus presenting alcohol as just one risk among many.
According to the study, the researchers say policymakers and public health bodies should reconsider their relationships to these alcohol industry bodies, as the industry is involved in developing alcohol policy in many countries, and disseminates health information to the public.
Alcohol consumption is a well-established risk factor for a range of cancers, including oral cavity, liver, breast and colorectal cancers, and accounts for about 4% of new cancer cases annually in the UK1. There is limited evidence that alcohol consumptionprotects against some cancers, such as renal and ovary cancers, but in 2016 the UK's Committee on Carcinogenicity concluded that the evidence is inconsistent, and the increased risk of other cancers as a result of drinking alcohol far outweighs any possible decreased risk².
This new study analysed the information which is disseminated by 27 AI-funded organisations, most commonly 'social aspects and public relations organisations' (SAPROs), and similar bodies. The researchers aimed to determine the extent to which the alcohol industry fully and accurately communicates the scientific evidence on alcohol and cancer to consumers. They analysed information on cancer and alcohol consumption disseminated by alcohol industry bodies and related organisations from English speaking countries, or where the information was available in English.
Through qualitative analysis of this information they identified three main industry strategies. Denying, or disputing any link with cancer, or selective omission of the relationship, Distortion: mentioning some risk of cancer, but misrepresenting or obfuscating the nature or size of that risk and Distraction: focussing discussion away from the independent effects of alcohol on common cancers.
Mark Petticrew, Professor of Public Health at the London School of Hygiene & Tropical Medicine and lead author of the study, said: "The weight of scientific evidence is clear - drinking alcohol increases the risk of some of the most common forms of cancer, including several common cancers. Public awareness of this risk is low, and it has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry. Our analysis suggests that the major global alcohol producers may attempt to mitigate this by disseminating misleading information about cancer through their 'responsible drinking' bodies."
A common strategy was 'selective omission' - avoiding mention of cancer while discussing other health risks or appearing to selectively omit specific cancers. The researchers say that one of the most important findings is that AI materials appear to specifically omit or misrepresent the evidence on breast and colorectal cancer. One possible reason is that these are among the most common cancers, and therefore may be more well-known than oral and oesophageal cancers.
When breast cancer is mentioned the researchers found that 21 of the organisations present no, or misleading, information on breast cancer, such as presenting many alternative possible risk factors for breast cancer, without acknowledging the independent risk of alcohol consumption.
Professor Petticrew said: "Existing evidence of strategies employed by the alcohol industry suggests that this may not be a matter of simple error. This has obvious parallels with the global tobacco industry's decades-long campaign to mislead the public about the risk of cancer, which also used front organisations and corporate social activities."
The researchers say the results are important because the alcohol industry is involved in conveying health information to people around the world. The findings also suggest that major international alcohol companies may be misleading their shareholders about the risks of their products, potentially leaving the industry open to litigation in some countries.
Professor Petticrew said: "Some public health bodies liaise with the industry organisations that we analysed. Despite their undoubtedly good intentions, it is unethical for them to lend their expertise and legitimacy to industry campaigns which mislead the public about alcohol-related harms. Our findings are also a clear reminder of the risks of giving the AI the responsibility of informing the public about alcohol and health.
"It has often been assumed that, by and large, the AI, unlike the tobacco industry, has tended not to deny the harms of alcohol. However, through its provision of misleading information it can maintain what has been called 'the illusion of righteousness' in the eyes of policymakers, while negating any significant impact on alcohol consumption and profits.
"It's important to highlight that if people drink within the recommended guidelines they shouldn't be too concerned when it comes to cancer. For accurate and accessible information on the risks, the public can visit the NHS website."
The authors acknowledge limitations of their study including that there are many other mechanisms and organisations through which industry disseminates health-related information which they did not examine, although it is unlikely that the messages would be different.
The researchers also say there is an urgent need to examine other industry websites, documents, social media and other materials in order to assess the nature and extent of the distortion of evidence, and whether it extends to other health information, for example, in relation to cardiovascular disease.

More information: Mark Petticrew et al, How alcohol industry organisations mislead the public about alcohol and cancer, Drug and Alcohol Review (2017). DOI: 10.1111/dar.12596


Provided by London School of Hygiene & Tropical Medicin

New diagnostic tool spots first signs of Parkinson's disease

The customized software records how a person draws a spiral and analyses the data in real time. A pen, paper and a large digital drawing tablet are the only equipment needed to run the test.

07 sept 2017--Researchers have developed the first tool that can diagnose Parkinson's disease when there are no physical symptoms, offering hope for more effective treatment of the condition.
There are currently no laboratory tests for Parkinson's and by the time people present to a neurologist with symptoms, nerve cells in their brains have already suffered irreversible damage.
The new diagnostic software developed by researchers from RMIT University in Melbourne, Australia, works with readily available technologies and has an accuracy rate of 93 per cent.
The research team hope the tool could one day be used as a standard screening test to spot the condition in its earliest stages.
Chief investigator Professor Dinesh Kumar said many treatment options for Parkinson's were effective only when the disease was diagnosed early.
"Pushing back the point at which treatment can start is critical because we know that by the time someone starts to experience tremors or rigidity, it may already be too late," Kumar said.
"We've long known that Parkinson's disease affects the writing and sketching abilities of patients, but efforts to translate that insight into a reliable assessment method have failed - until now.
"The customised software we've developed records how a person draws a spiral and analyses the data in real time. The only equipment you need to run the test is a pen, paper and a large drawing tablet.
"With this tool we can tell whether someone has Parkinson's disease and calculate the severity of their condition, with a 93 per cent accuracy rate.
"While we still have more research to do, we're hopeful that in future doctors or nurses could use our technology to regularly screen their patients for Parkinson's, as well as help those living with the disease to better manage their condition."
More than 10 million people worldwide are estimated to be living with Parkinson's disease, including 80,000 Australians. Parkinson's is the second most common neurological disease in Australia after dementia, with about 20 per cent of sufferers under 50 years old and 10 per cent diagnosed before the age of 40.
PhD researcher Poonam Zham led the study by the RMIT biomedical engineering research team, which specialises in e-health and the development of affordable diagnostic technologies.
Working with Dandenong Neurology in south-east Melbourne, the study involved 62 people diagnosed with Parkinson's disease - half had no visible symptoms and half ranged from mildly to severely affected.

The researchers developed specialized software and combined it with a tablet computer that can measure writing speed, and a pen that can measure pressure on a page. They used the system to measure pen speed and pressure during a simple spiral sketching task in a sample of healthy volunteers and Parkinson's patients with different levels of disease severity. 

The researchers compared the effectiveness of different dexterity tasks - writing a sentence, writing individual letters, writing a sequence of letters and sketching a guided Archimedean spiral - and determined that the spiral was the most reliable and also the easiest for participants to complete.
"Our study had some limitations so we need to do more work to validate our results, including a longitudinal study on different demographics and a trial of patients who are not taking medication," Zham said.
"But we're excited by the potential for this simple-to-use and cost-effective technology to transform the way we diagnose Parkinson's, and the promise it holds for changing the lives of millions around the world."
The research is published on 6 September in the journal Frontiers in Neurology.

More information: Poonam Zham et al, Distinguishing Different Stages of Parkinson's Disease Using Composite Index of Speed and Pen-Pressure of Sketching a Spiral, Frontiers in Neurology (2017). DOI: 10.3389/fneur.2017.00435


Provided by RMIT University

Is dementia declining among older Americans?

Here's some good news for America's seniors: The rates of Alzheimer's and other forms of dementia have dropped significantly over the last decade or so, a new study shows.

06 sept 2017--The analysis of nearly 1,400 men and women 70 and older found that the number of dementia cases dropped from 73 among those born before 1920 to just 3 among those born after 1929.
The reasons for the decline aren't clear, researchers said. But one factor stands out: The rates of stroke and heart attack decreased across generations. The rate of diabetes, however, has increased.
"It may be that we are seeing the benefits of years of success in cardiovascular disease prevention," said lead researcher Carol Derby, a research professor at the Albert Einstein College of Medicine in New York City.
That doesn't appear to account for all of the decrease in dementia rates, however.
Although the rate of dementia has declined, the actual number of people with dementia is expected to increase dramatically as the population bubble caused by baby boomers ages, Derby said.
"Whether the changes of the rate of the onset of dementia is going to offset that population shift remains to be seen," she said.
Around the world, more than 47 million people suffer from dementia, and 7 million new cases develop each year, according to the researchers.
The number of cases of dementia is projected to double every 20 years, and to reach 115 million by 2050.
The number of people suffering from Alzheimer's disease, the most common cause of dementia, is expected to climb to 106 million by 2050, the investigators said.
"While the rates may be going down, the problem is far from going away," said James Hendrix, director of global science initiatives at the Alzheimer's Association.
Dementia, an impairment of brain functions marked mainly by memory problems and personality changes, is still one of the most expensive chronic conditions, with a huge impact on patients and families.
Hendrix believes that living a healthy lifestyle might help prevent dementia. In fact, a recent study found that if people exercised, ate a healthy diet, stopped smoking and kept chronic medical conditions such as diabetes at bay, 35 percent of dementia cases around the world could be prevented, he said.
"It's about brain health during your entire life," said Hendrix, who was not involved with the study.
The report was published online Sept. 5 in the journal JAMA Neurology.
For the study, Derby and her colleagues analyzed the rate of dementia in nearly 1,400 men and women who took part in the Einstein Aging Study from 1993 through 2015.
When participants entered the study, they were 70 or older and didn't suffer from dementia.
Over the course of the study, Derby's team found that the rate of dementia dropped steadily.
Among the 369 people born before 1920, 73 developed dementia, that number decreased to 43 among the 285 born between 1920 and 1924.
Cases of dementia dropped to 31 for the 344 born between 1925 and 1929 and to 3 for the 350 born after 1929.
"This is not unexpected," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City. "Similar trends have been documented in Europe."
Gandy, who was not involved with the study, believes that much of the decline in the rate of dementia is the result of declining rates of stroke.
"As cardiovascular health has improved, stroke incidence has fallen," he said.
The health of the blood vessels in the brain contribute to the risk for dementia, Gandy said.
"So one would predict that, over time, sustained reduction in stroke risk would be a precursor to reduced dementia risk," he said.
Although the rate of dementia has dropped, the number of cases are likely to increase, Gandy said.
"The aging baby boom is such that the overall number of dementia patients will continue to rise even while prevalence numbers are falling slightly," he said.

More information: Carol Derby, Ph.D., research professor, Albert Einstein College of Medicine, New York City; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; James Hendrix, Ph.D., director, global science initiatives, Alzheimer's Association; Sept. 5, 2017, JAMA Neurology, online

For more information on dementia, visit the Alzheimer's Association.

Eating protein three times a day could make our seniors stronger

Dr. Stéphanie Chevalier, scientist with the Metabolic Disorders and Complications Program at the Research Institute of the McGill University Health Centre and an assistant professor at the School of Human Nutrition at McGill University.

05 sept 2017--Loss of muscle is an inevitable consequence of aging that can lead to frailty, falls or mobility problems. Eating enough protein is one way to remedy it, but it would seem that spreading protein equally among the three daily meals could be linked to greater mass and muscle strength in the elderly. These are the findings of a study conducted at the Research Institute of the McGill University Health Centre (RI-MUHC) in collaboration with the Université de Sherbrooke and the Université de Montréal. The research team examined both the amount of protein consumed and its distribution among people aged 67 and over, using one of the most comprehensive cohort studies in Quebec.
The results of the study, which were published recently in the American Journal of Clinical Nutrition, shed new light on the diet of people in an aging population.
"Many seniors, especially in North America, consume the majority of their daily protein intake at lunch and dinner. We wanted to see if people who added protein sources to breakfast, and therefore had balanced protein intake through the three meals, had greater muscle strength," says the lead author of the study, Dr. Stéphanie Chevalier, who is a scientist with the Metabolic Disorders and Complications Program at the RI-MUHC and an assistant professor at the School of Human Nutrition at McGill University.

A rich database of nutrition data

To achieve these results, Dr. Chevalier and her team collaborated with the Université de Sherbrooke and used the database from the Quebec longitudinal study on nutrition and aging called NuAge (Nutrition as a Determinant of Successful Aging).
RI-MUHC researchers analyzed data from the NuAge cohort, which included nearly 1,800 people who were followed for three years. They reviewed the protein consumption patterns of 827 healthy men and 914 healthy women aged 67 to 84 years, all residents of Quebec, trying to establish links with variables such as strength, muscle mass or mobility.
"The NuAge study is one of the few studies gathering such detailed data on food consumption among a large cohort of elderly people. We are proud that the NuAge study can contribute to relevant research of this magnitude in Quebec," says study co-author Dr. Hélène Payette of the Centre for Research on Aging and a professor at the Faculty of Medicine at the Université de Sherbrooke.
"We observed that participants of both sexes who consumed protein in a balanced way during the day had more muscle strength than those who consumed more during the evening meal and less at breakfast. However, the distribution of protein throughout the day was not associated with their mobility," explains the first author of the study, Dr. Samaneh Farsijani, a former PhD student at the RI-MUHC supervised by Dr. Chevalier.

A "boost" of amino acids

All body tissues, including the muscles, are composed of proteins, which consist of amino acids. If the protein intake decreases, the synthesis is not done correctly and this leads to a loss of muscle mass.
"Our research is based on scientific evidence demonstrating that older people need to consume more protein per meal because they need a greater boost of amino acids for protein synthesis," says Dr. Chevalier, adding that one of the essential amino acidsknown for protein renewal is leucine. "It would be interesting to look into protein sources and their amino acid composition in future studies to further our observations."

More information: American Journal of Clinical Nutrition (2017). DOI: 10.3945/ajcn


Provided by McGill University Health Centre

Dark chocolate with olive oil associated with improved cardiovascular risk profile

Dark chocolate enriched with extra virgin olive oil is associated with an improved cardiovascular risk profile, according to research presented today at ESC Congress.

04 sept 2017--"A healthy diet is known to reduce the risk of cardiovascular disease," said lead author Dr Rossella Di Stefano, a cardiologist at the University of Pisa, Italy. "Fruits and vegetables exert their protective effects through plant polyphenols, which are found in cocoa, olive oil, and apples. Research has found that the Italian Panaia red apple has very high levels of polyphenols and antioxidants."
This study tested the association between consumption of dark chocolate enriched with extra virgin olive oil or Panaia red apple (table 1) with atherosclerosis progression in healthy individuals with cardiovascular risk factors.
The randomised crossover study included 26 volunteers (14 men, 12 women) with at least three cardiovascular risk factors (smoking, dyslipidaemia, hypertension, or family history of cardiovascular disease) who received 40 grams of dark chocolate daily for 28 days. For 14 consecutive days it contained 10 percent extra virgin olive oil and for 14 consecutive days it contained 2.5 percent Panaia red apple. The two types of chocolate were given in random order.
Progression of atherosclerosis was assessed by metabolic changes (levels of carnitine and hippurate), lipid profile, blood pressure and levels of circulating endothelial progenitor cells (EPCs). EPCs are critical for vascular repair and maintenance of endothelial function.
Urine and blood samples were collected at baseline and after the intervention. Urine samples were analysed by proton nuclear magnetic resonance spectroscopy for endogenous metabolites. Circulating EPC levels were assessed with flow cytometry. Smoking status, body mass index, blood pressure, glycaemia and lipid profile were also monitored.
After 28 days, the researchers found that the chocolate enriched with olive oil was associated with significantly increased EPC levels and decreased carnitine and hippurate levels compared to both baseline and after consumption of apple-enriched chocolate. Olive oil-enriched chocolate was associated with significantly increased high-density lipoprotein ("good") cholesterol and decreased blood pressure compared to baseline. There was a non-significant decrease in triglyceride levels with apple-enriched chocolate.
Dr Di Stefano said: "We found that small daily portions of dark chocolate with added natural polyphenols from extra virgin olive oil was associated with an improved cardiovascular risk profile. Our study suggests that extra virgin olive oil might be a good food additive to help preserve our 'repairing cells,' the EPC."


Provided by European Society of Cardiology

Lifestyle factors may affect how long individuals live free of disability

New research published in the Journal of the American Geriatrics Society indicates that a healthy lifestyle may help reduce the duration of an individual's disabled period near the end of life.

03 sep 2017--In the community-based study of 5248 older adults recruited at an average age of 73 and followed for 25 years, the average number of disabled years was approximately 2.9 for men and 4.5 for women. Multiple lifestyle factors were significantly associated with years of life and years of able life. Greater distances walked and better-quality diet were associated with a relative compression of the disabled period. Obesity was associated with a relative expansion of the disabled period. Smoking was associated with a shorter life and fewer years of able life.
"We discovered that by improving lifestyle, we can postpone death, but even more so, we can postpone disability—in fact, it turns out that we're compressing that disabled end-of-life period to a shorter timeframe," said Dr. Anne Newman, senior author of the study. "This clearly demonstrates the value of investing in a healthy lifestyle."
September is Healthy Aging Month.

More information: Mini E. Jacob et al, Can a Healthy Lifestyle Compress the Disabled Period in Older Adults?, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14314


Provided by Wiley

Dutch scientists say human lifespan has limits

Dutch researchers said that while life expectancies had increased, there had been no major shift in maximum lifespan in the last 30 years

02 sept 2017--Dutch researchers claimed Thursday to have discovered the maximum age "ceiling" for human lifespan, despite growing life expectancy because of better nutrition, living conditions and medical care.
Mining data from some 75,000 Dutch people whose exact ages were recorded at the time of death, statisticians at Tilburg and Rotterdam's Erasmus universities pinned the maximum ceiling for female lifespan at 115.7 years.
Men came in slightly lower at 114.1 years in the samples taken from the data which spans the last 30 years, said Professor John Einmahl, one of three scientists conducting the study.
"On average, people live longer, but the very oldest among us have not gotten older over the last thirty years," Einmahl told AFP.
"There is certainly some kind of a wall here. Of course the average life expectancy has increased," he said, pointing out the number of people turning 95 in The Netherlands had almost tripled.
"Nevertheless, the maximum ceiling itself hasn't changed," he said.
Lifespan is the term used to describe how long an individual lives, while life expectancy is the average duration of life that individuals in an age group can expect to have—a measure of societal wellbeing.
The Dutch findings come in the wake of those by US-based researchers who last year claimed a similar age ceiling, but who added that exceptionally long-lived individuals were not getting as old as before.
Einmahl and his researchers disputed the latter finding, saying their conclusions deduced by using a statistical brand called "Extreme Value Theory", showed almost no fluctuation in maximum lifespan.
Einmahl said however there were still some people who had bent the norm, like Frenchwomen Jeanne Calment who died at the ripe old age of 122 years and 164 days.
Calment remains the oldest verified woman to date.
Extreme Value Theory is a brand of statistics that measures data and answers questions at extreme ends of events such as lifespan or disasters.
Einmahl said his group's findings will be submitted for publication in a peer review magazine "within the next month or so."

Healthy glucose levels the key to a healthy ageing brain

New research has found blood glucose levels even at the normal range can have a significant impact on brain atrophy in ageing.

01 sept 2017--Dr Erin Walsh, lead author and post-doctoral research fellow at ANU, said the impacts of blood glucose on the brain is not limited to people with type 2 diabetes.
"People without diabetes can still have high enough blood glucose levels to have a negative health impact," said Dr Walsh from the Centre for Research on Ageing, Health and Wellbeing (CRAHW) at ANU.
"People with diabetes can have lower blood glucose levels than you might expect due to successful glycaemic management with medication, diet and exercise.
"The research suggests that maintaining healthy blood glucose levels can help promote healthy brain ageing. If you don't have diabetes it's not too early and if you do have diabetes it's not too late."
Dr Walsh said people should consider adopting healthy lifestyle habits, such as regular exercise and healthy diets.
"Having a healthy lifestyle contributes to good glycaemic control without needing a diabetes diagnosis to spur them into adopting these good habits," she said.
"It helps to keep unhealthy highly processed and sugary foods to a minimum. Also, regular physical activity every day can help, even if it is just a going for walk."
The research is part of the "Too sweet for our own good: An investigation of the effects of higher plasma glucose on cerebral health" project led by Associate Professor Nicolas Cherbuin, which is part of the longitudinal PATH through life study led by Professor Kaarin Anstey at ANU.
"The work would not be possible without being able to longitudinally explore blood glucose in members of the general public," said Dr Walsh.
The research has been published in the journal Diabetes and Metabolism.

More information: E.I. Walsh et al. Brain atrophy in ageing: Estimating effects of blood glucose levels vs. other type 2 diabetes effects, Diabetes & Metabolism (2017). DOI: 10.1016/j.diabet.2017.06.004


Provided by Australian National University