How to reduce medications in older generations

New research published today in the Journal of Gerontology has developed new ways to characterise older people who take multiple medicines and those who are open to "deprescribing", a process where medicines are reviewed in order to reduce or stop less effective medicines.

30 nov 2017--Lead researcher from the University of Sydney's School of Public Health, Kristie Weir, says; "Polypharmacy (multiple medications) in the older population is increasing and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing), but a collaborative approach between patient and doctor is required."
"Deprescribing isn't new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients. We provide a novel approach to describe these differences between older people who are happy to take multiple medicines, and those who are open to deprescribing.
"Ultimately, considering these variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.
"We categorized three distinct types of people which could help guide the type of advice given by clinicians to older patients when discussing the issues around taking multiple medicines," she says. "Recognising these three types of patients can help clinicians tailor their communication approaches," she says.

Type one:

People who are resistant to deprescribing and are very attached to their medications as they are perceived as highly important to their wellbeing. This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.

Type two:

These people indicated they were open to deprescribing and preferred an active role in decision making to share responsibility with their doctor. They would consider deprescribing and said they didn't like the idea of completely relying on medications to stay healthy. This group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:

People who were less engaged in decision making, most deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn't give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.
"This research shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care," says Ms Weir.
"For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.
"We need to develop ways to support clinicians and patients to have these important but challenging conversations," she says.


Provided by University of Sydney

Benzodiazepines increase mortality in persons with Alzheimer's disease

Benzodiazepine and related drug use is associated with a 40 percent increase in mortality among persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. The findings were published in the International Journal of Geriatric Psychiatry.

28 nov 2017--The study found that the risk of death was increased right from the initiation of benzodiazepine and related drug use. The increased risk of death may result from the adverse events of these drugs, including fall-related injuries, such as hip fractures, as well as pneumonia and stroke.
The study was based on the register-based MEDALZ (Medication Use and Alzheimer's Disease) cohort, which includes all persons diagnosed with Alzheimer's disease in Finland during 2005-2011. Persons who had used benzodiazepines and related drugs previously were excluded from this study, and therefore, the study population consisted of 10,380 new users of these drugs. They were compared with 20,760 persons who did not use these drugs.
Although several treatment guidelines state that non-pharmacological options are the first-line treatment of anxiety, agitation and insomnia in persons with dementia, benzodiazepines and related drugs are frequently used in the treatment of these symptoms. If benzodiazepine and related drug use is necessary, these drugs are recommended for short-term use only. These new results encourage more consideration for benzodiazepine and related drug use in persons with dementia.

More information: Laura Saarelainen et al. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study, International Journal of Geriatric Psychiatry (2017). DOI: 10.1002/gps.4821


Provided by University of Eastern Finland

Prototype ear plug sensor could improve monitoring of vital signs

Scientists have developed a sensor that fits in the ear, with the aim of monitoring the heart, brain and lungs functions for health and fitness.
In previous pilot studies that involved trialling the device with 24 people, the researchers from Imperial College London have demonstrated the prototype's potential for monitoring brain, heart and breathing activity.

26 nov 2017--Now, the latest study from Professor Danilo Mandic's team from Imperial has shown that their 'Hearable' technology also has potential as a heart monitor. In the preliminary study, the new in-ear heart monitoring device was found to accurately capture heart data in six people.
The device detected heart pulse by sensing the dilation and constriction of tiny blood vessels in the ear canal, using the 'mechanical' part of the electro-mechanical sensor. The electrode part of the sensor is used to detect a full and clinically valid electrocardiogram, which records the electrical activity of the heart.
The new research was published in the journal Royal Society Open Science.
Based on these results and previous preliminary findings, the researchers suggest Hearable may in the future go on to identify and manage heart conditions such as heart attack or irregular heart beat, and also serve to observe the general health state of body.
They suggest the device for heart monitoring may also be easier and more convenient for patients and clinicians to use. Traditional electrocardiogram (ECG) testing involves wearing a chest belt for 24 hours. However, the in-ear device fits discreetly in the ear, meaning it can be worn for longer, providing a longer-term picture of the patient's heart activity.
Hearable is made of foam and moulds to the shape of the ear like a conventional ear plug. As well as mechanical sensors, it uses electrical sensors to detect brain activity.

Credit: Imperial College London

Professor Mandic, lead author of the study from the Department of Electrical and Electronic Engineering, said: "This is the latest piece of research on what we think could be a versatile new piece of wearable technology. We've now completed a number of tests on our sensor that focused on detecting vital signs within the body. Our early results are proving interesting and, although we are still a way off from seeing it used outside of experiments, we have many exciting avenues to explore."

Future applications

The technology is still in its early development, but the researchers say the device also has other potential applications such as in sleep science and monitoring fatigue, epilepsy, drug delivery, and person authentication. By monitoring the brain, the device could be used as a new method for cyber security, where brain signals, much like the fingerprint lock on a smart phone, are used to activate a device. Unlike a fingerprint, brain waves are impossible to forge.
It may also be useful in other settings such as in the health and fitness industry. By monitoring the heart and lungs, the researchers believe that the sensor could perform similar functions to wrist-worn fitness trackers.
However, unlike wrist-worn trackers, which monitor from the arm at the body's extremity, the ear-worn sensor, despite a relatively weaker signal, may get more stable results because the position of the ear relative to the internal organs is nearly always the same.
During previous pilot trials in humans, the researchers showed that the prototype can be used to monitor a combination of vital signs and brain function, which could be used to screen for and monitor stress, anxiety, sleep disorders, and heart disease.
Ultimately, the researchers are aiming for the device to wirelessly transmit the data to clinicians in real-time to provide immediate results and analysis. This could open up new possibilities in patient care.
For example, patients who are monitored overnight in sleep clinics are usually asked to wear lung, heart, and brain monitors, all of which provide an unnatural sleeping environment. The earpiece would mean patients could be monitored for a number of days and sleep in their own beds, while transmitting data in real time, to improve monitoring.
Professor Mandic said: "This is a very exciting piece of technology but its evidence in humans is limited. We will now work to put these preliminary results into practice and could eventually use this in real life situations."

More information: Wilhelm von Rosenberg et al. Hearables: feasibility of recording cardiac rhythms from head and in-ear locations, Royal Society Open Science (2017). DOI: 10.1098/rsos.171214


Provided by Imperial College London

Resistance training improves quality of life and psychological functioning for older adults

Resistance training can promote environmental quality of life and sense of coherence in older adults. This was observed in a study carried out at the University of Jyväskylä, Faculty of Sport and Health Sciences, Finland, in co-operation with the Gerontology Research Center and the Neuromuscular Research Center.

25 nov 2017--"The importance of resistance training for the muscular strength and physical functioning in older adults is well known, but the links to psychological functioning have been studied less," says doctoral student Tiia Kekäläinen from the University of Jyväskylä.
The study included 104 healthy older adults aged 65 to 75 who did not meet the physical activity recommendations for aerobic exercise at baseline and did not have a previous strength training experience.
Participants were randomized to three training groups and a control group. The training groups participated in supervised resistance training for nine months. For the first three months, all training groups trained twice a week to become familiar with resistance training methods, and for the next six months they participated in progressive resistance training with different frequencies: once, twice or three times a week. Psychological functioning was assessed through physical, psychological, social and environmental quality of life, sense of coherence, and depressive symptoms.
Environmental quality of life improved after three months of resistance training. After nine months training, also sense of coherence increased, but only among those older adults who trained the whole nine months with twice a week frequency.
"The results suggest that older adults´ ability to manage their environment and life could be improved by resistance training. In the future, it would be interesting to investigate the stability of these changes over a longer period than nine months. There is also a need for further research on the frequency of training, as this study does not allow us to say whether the differences between training groups were due to training frequency or continuity," Kekäläinen says.
This study supports the findings of previous studies that resistance training has positive effects on the psychological functioning of older people. Consequently, regular resistance training could be recommended to older adults not only for physical benefits, but also for the promotion of psychological functioning.

More information: Tiia Kekäläinen et al. Effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults: randomized controlled trial, Quality of Life Research (2017). DOI: 10.1007/s11136-017-1733-z


Provided by University of Jyväskylä

Thanksgiving traditions that can boost health and wellness

USC Leonard Davis School of Gerontology experts Carin Kreutzer and Leah Buturain Schneider shared Thanksgiving tips that benefit both the mind and body.

Mind: Give thanks

23 nov 2017--Gratitude is good for you. Research shows it can lower blood pressure, decrease depression and improve quality of life.
"Gratitude works," said Buturain Schneider, a gerontologist, theologian and mindful aging expert at USC.
But gratitude is not a feeling, it is a behavior we can practice every day of the year, she said.
"You can strengthen an awareness of gratitude by sharing what you are thankful for or letting people know you appreciate them. Expressing this helps build bridges, connects us to the sacrifices of others and allows us to see abundance rather than what we lack."

Serve up strong relationships

Social isolation has recently been cited as possibly being more harmful to health than smoking or obesity. Despite the headaches of travel and stress that family dynamics can bring, Thanksgiving helps build community by encouraging shared experiences with family and friends, or even welcoming strangers.
"Until age 80, most people say they want to be healthy. After 80, people say what matters most is relationships," Buturain Schneider said. "The Thanksgiving holiday is a powerful reminder of how coming together to share a meal can provide a sense of fellowship and belonging that many people, particularly older adults, are missing in their lives."

Extend a helping hand

Many homeless shelters and retirement communities are inundated with individuals who sign up to serve meals on Thanksgiving. And like gratitude, research shows that helping others can bring health benefits to the giver.
"We feel most alive when using our gifts and helping other people," Buturain Schneider said. "The challenge is to make time in our lives to do this year-round so the recipients can express their own gratitude and get support on more than just one holiday."

Body: Make lunch your largest meal

Research Increasingly shows that it is not just what we eat, but when we eat that matters. Many families eat their Thanksgiving meal in the afternoon, not in the evening, and that is a step in the right direction for all days, said dietitian Kreutzer, director of the Master of Science in Nutrition, Healthspan, and Longevity program at the USC Leonard Davis School.
"Our bodies are more efficient at burning calories during the day when we are active versus storing excess calories as fat at night while we sleep. Front-loading calories gives you time to digest all those calories well before bedtime, which can have benefits for weight loss and overall health, including controlling weight and managing and preventing diabetes and obesity."

Move after meals

From local Turkey trots to family flag football games, Thanksgiving offers annual opportunities to exercise. Along with maintaining a healthy diet, moderate daily activity is a proven intervention that can reduce risk for a variety of diseases, including heart disease, cancer, diabetes and Alzheimer's.
"Thanksgiving is the perfect time to begin to incorporate movement into your day. A daily walk or other form of movement is good for your body and your brain."

Leave some leftovers

Some people actually prefer Friday's turkey sandwich to Thursday's main meal. Whatever your choice, it's important to spread the bounty. Practicing portion control at every meal helps ensure we don't eat too much in one sitting.
"When it comes to protein, three to four ounces is enough for most people," Kreutzer said. "Saving food for the next few days allows you to enjoy the meal multiple times and spares you from taking in too many calories at once."


Provided by University of Southern California

'Lesser of two evils' argument used to defend antipsychotic overuse for dementia

The increasing use of antipsychotic drugs to manage dementia in care homes has been explained by some practitioners as "the lesser of two evils", despite clear risks for patients.

23 nov 2017--New research published today in The Gerontologist explored attitudes of professionals who work with people living with dementia in care homes and found that interviewees used the explanation to defend the use of potentially harmful drugs to manage patient behaviour, and saw their use as less harmful or unpleasant compared to when the same patients aren't medicated.
Dr Parastou Donyai, Associate Professor of Social and Cognitive Pharmacy at the University of Reading who led the research said:
"What we saw was that using 'the lesser of two evils' argument to justify the overprescribing of antipsychotics comes with assumptions about what is best for patients and carers, often without a good understanding of what risks are associated with using the medication or alternative ways to manage behaviour. Dementia is one of the most prevalent diseases affecting the world with more than 45 million people experiencing it in some form or another, so it's really important that we understand the best ways of caring for our loved ones and stop the uncritical over-prescription of drugs that may not be suitable for patients."
Care home workers also shared the attitude of "medicines not Smarties", seeing antipsychotics as drugs prescribed far too often and often as an "easy option".
Among the ways in which professionals cited the idea of the drugs being doled out like sweets, one said that they knew that "staff are lowly paid, poorly motivated" and "very overworked". This attitude is critical of the overuse of antipsychotics, although people who work in dementia care used this language to protect themselves from being associated with any overprescribing.
Dr Donyai continued:
"What we see is that people providing dementia care can built up a way to rationalise the over-prescription of antipsychotics while protecting themselves when discussing the issue. We do know that similar attitudes are adopted with other medication, and we need to look further at how to correct the unquestioned assumptions that lie behind what was expressed in interviews."

More information: Dilbagh Gill et al. "The Lesser of Two Evils" Versus "Medicines not Smarties": Constructing Antipsychotics in Dementia, The Gerontologist (2017). DOI: 10.1093/geront/gnx178


Provided by University of Reading

Study: For older women, every movement matters

Folding your laundry or doing the dishes might not be the most enjoyable parts of your day. But simple activities like these may help prolong your life, according to the findings of a new study in older women led by the University at Buffalo.

In the U.S. study of more than 6,000 white, African-American and Hispanic women ages 63 to 99, researchers reported significantly lower risk of death in those who were active at levels only slightly higher than what defines being sedentary.
Women who engaged in 30 minutes per day of light physical activity—as measured by an accelerometer instead of a questionnaire—had a 12 percent lower risk of death. Women who were able to do a half-hour each day of moderate to vigorous activity had a 39 percent lower mortality risk, according to the study, published online ahead of print today in the Journal of the American Geriatrics Society.
For the age group in this study, light physical activities include regular chores such as folding clothes, sweeping the floor or washing the windows. Activities like these account for more than 55 percent of how older people spend their daily activity. Moderate to vigorous activities would be brisk walking or bicycling at a leisurely pace.
The bottom line? "Doing something is better than nothing, even when at lower-than-guideline recommended levels of physical activity," said the study's lead author, Michael LaMonte, research associate professor of epidemiology and environmental health in UB's School of Public Health and Health Professions. "To the best of our knowledge, this is the first study to show this."
Even when researchers simultaneously accounted for the amount of each type of activity (light and moderate-to-vigorous) a woman did, they still observed significantly lower mortality associated with each time, independently of the other.
"This is remarkable because current public health guidelines require that physical activity be of at least moderate or higher intensity to confer health benefits," LaMonte, PhD, said. "Our study shows, for the first time in older women, that health is benefited even at physical activity levels below the guideline recommendations."
"The mortality benefit of light intensity activity extended to all subgroups that we examined," added study principal investigator Andrea LaCroix, professor and chief of epidemiology at the University of California, San Diego.
The mortality benefit was similar for women younger than 80 compared to women over the age of 80. It was similar across racial/ethnic backgrounds, and among obese and non-obese women. "Perhaps most importantly for this population, the mortality benefit was similar among women with high and low functional ability," LaCroix, PhD, said.
While the study focused on older women, researchers say their findings send a powerful message to younger women and men - that it's important to develop healthy habits around physical activity while you are young so that you are more likely to maintain them when you get older.

A recent study at UC San Diego School of Medicine reports that light physical lowers mortality risks for women age 65 and older. 

Novel approach using motion sensing devices

The study incorporated a novel approach. Unlike the majority of previous studies on this issue in which physical activity was measured using questionnaires, researchers measured physical activity using accelerometers.
These motion-sensing devices electronically document and store daily movement patterns and intensity on a 24-hour clock for as many days as the device is worn. Women in this study wore the devices for between four and seven days. Researchers then downloaded the information and analyzed it.
To make their analysis of physical activity even more specific to older women, they also conducted a laboratory study in a subset of study participants during which they aligned the accelerometer information with completion of activity tasks germane to older women's usual daily activity habits.
"No other study as large as ours and specifically on older women has included this step to enhance interpretation of accelerometer data in a context relevant to the study participants," LaMonte said.

Aging well in an aging society

The findings could have implications for national public health guidelines for physical activity for older U.S. women, especially when considering the projected growth of this particular population over the next several decades.
The researchers' findings are being considered by the U.S. Department of Health and Human Services' 2018 Physical Activity Guidelines Advisory Committee. The guidelines were first introduced in 2008 under then-HHS Secretary Michael O. Leavitt.
By 2050, the population group aged 65 and older will have doubled since 2000, reaching nearly 77 million, according to LaMonte, adding that women in this age group will outnumber men 2-to-1 at the current expected growth pattern. "Our results suggest that the health benefits of lighter activity could reach a large swath of women in an aging society," LaMonte said.
"These findings are especially relevant to aging well in an aging society," he added. "Some people, because of age or illness or deconditioning, are not able to do more strenuous activity. Current guidelines do not specifically encourage light activity because the evidence base to support such a recommendation has been lacking."

More information: Michael J. LaMonte et al, Accelerometer-Measured Physical Activity and Mortality in Women Aged 63 to 99, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.15201


Provided by University at Buffalo

Primary care physicians cautious about new guidelines for high blood pressure

The lower threshold recommended by the American College of Cardiology and the American Heart Association classifies 46 percent of U.S. adults as having high blood pressure, compared with 32 percent under the previous definition.

Primary care faculty at UMass Medical School will continue counseling patients about lifestyle modifications as well as medication to manage blood pressure and reduce cardiovascular disease risk rather than striving to achieve a set point for all, despite stringent new guidelines from the American College of Cardiology and the American Heart Association.

19 nov 2017--Formerly called "prehypertensive," systolic blood pressure between 121 and 129 over diastolic pressure of between 80 and 89 is now defined as "elevated blood pressure." This lowered threshold classifies 46 percent of U.S. adults as having high blood pressure, compared with 32 percent under the previous definition.
"Cardiovascular disease is a public health problem and we should address it as such, recommending healthy lifestyles for everyone," said Ronald Adler, MD, associate professor of family medicine & community health. "Pushing to reach the same aggressive blood pressure target for all our patients will inevitably lead to the unintended consequences of medication adverse effects plus complications such as dizziness and falls from blood pressure that is too low."
The guidelines also call for providers to assess a patient's 10-year-risk for cardiovascular disease using the ASCVD Risk Calculator—also a source of debate—to guide doctor–patient conversations and shared decision making about how to manage elevated blood pressure.
"While I have many concerns about the calculator's ability to predict future disease, it does open up the opportunity for providers and patients to discuss risk modification when discussing blood pressure," said Frank Domino, MD, professor of family medicine & community health. "To that end, I tell patients if they do not want to take a blood pressure pill, they only need to get 20 minutes of aerobic exercise five days a week."
Other American and international health organizations define high blood pressure as more than 150/90 for those older than 60 years and more than 140/90 for everyone else, including diabetics, regardless of age.
"I worry that the new guideline doesn't account for the potential harms of overdiagnosis and overtreatment, especially in the elderly," said Dr. Adler. "Our medical care should focus on controlling those with more significantly elevated blood pressure and cardiovascular risk to ensure that we reach targets about which there is widespread consensus more reliably."
The new guidelines were announced Nov. 13 and published in the journal Hypertension.

More information: Paul K. Whelton et al. 2017

ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, Hypertension (2017). DOI: 10.1161/HYP.0000000000000065


Provided by University of Massachusetts Medical School

High blood pressure is redefined as 130, not 140: US guidelines (Update)

In this June 6, 2013, file photo, a patient has her blood pressure checked by a registered nurse in Plainfield, Vt. New medical guidelines announced Monday, Nov. 13, 2017, lower the threshold for high blood pressure, adding 30 million Americans to those who have the condition. 

High blood pressure was redefined Monday by the American Heart Association, which said the disease should be treated sooner, when it reaches 130/80 mm Hg, not the previous limit of 140/90.
Doctors now recognize that complications "can occur at those lower numbers," said the first update to comprehensive US guidelines on blood pressure detection and treatment since 2003.

19 nov 2017--A diagnosis of the new high blood pressure does not necessarily mean a person needs to take medication, but that "it's a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches," said Paul Whelton, lead author of the guidelines published in the American Heart Association journal, Hypertension, and the Journal of the American College of Cardiology.
Healthy lifestyle changes include losing weight, exercising more, eating healthier, avoiding alcohol and salt, quitting smoking and avoiding stress.
The new standard means that nearly half (46 percent) of the US population will be defined as having high blood pressure.
Previously, one in three (32 percent) had the condition, which is the second leading cause of preventable heart disease and stroke, after cigarette smoking.
The normal limit for blood pressure is considered 120 for systolic, or how much pressure the blood places on the artery walls when the heart beats, and 80 for diastolic, which is measured between beats.
Once a person reaches 130/80, "you've already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure," said Whelton.
"We want to be straight with people—if you already have a doubling of risk, you need to know about it."

People in 40s most affected

Once considered mainly a disorder among people 50 and older, the new guidelines are expected to lead to a surge of people in their 40s with high blood pressure.
"The prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45," according to the report.
Damage to the blood vessels is already beginning once blood pressure reaches 130/80, said the guidelines, which were based in part on a major US-government funded study of more than 9,000 people nationwide.
The category of prehypertension, which used to refer to people with systolic pressure of 120-139, no longer exists, according to the new guidelines.
"People with those readings now will be categorized as having either Elevated (120-129 and less than 80) or Stage I hypertension (130-139 or 80-89)."
Medication is only recommended for people with Stage I hypertension "if a patient has already had a cardiovascular event such as a heart attack or stroke, or is at high risk of heart attack or stroke based on age, the presence of diabetes mellitus, chronic kidney disease or calculation of atherosclerotic risk."
The proper technique must be used to measure blood pressure, and levels "should be based on an average of two to three readings on at least two different occasions," said the report.
"I absolutely agree with the change in what is considered high blood pressure because it allows for early lifestyle changes to be addressed," said Satjit Bhusri, a cardiologist at Lenox Hill Hospital in New York.
"It is important, however, to realize that the change in the definition does not give course to increase prescription of medications, rather that it brings to light the need to make lifestyle changes," Bhusri said in an email to AFP.
The new guidelines were announced at the American Heart Association's 2017 Scientific Sessions conference in Anaheim, California.

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

No cardiovascular disease reduction with intensive blood pressure lowering treatment

Blood pressure lowering treatment does not reduce death or cardiovascular disease in healthy individuals with a systolic blood pressure below 140. This is shown in a systematic review and meta-analysis from Umeå University. The results, published in JAMA Internal Medicine, support current guidelines and contradict the findings from the Systolic Blood Pressure Intervention Trial (SPRINT).

19 nov 2017--Blood pressure treatment goals have been intensively debated since the publication of the SPRINT study in 2015. While current guidelines recommend a systolic blood pressure goal < 140 mm Hg, SPRINT found additional mortality and cardiovascular diseasereduction with a goal < 120 mm Hg.
A systematic review and meta-analysis from Umeå University, published today in JAMA Internal Medicine, contradicts these findings. The Umeå study shows that treatment does not affect mortality or cardiovascular events if systolic blood pressure is < 140 mm Hg. The beneficial effect of treatment at low blood pressure levels is limited to trials in people with coronary heart disease.
"Our findings are of great importance to the debate concerning blood pressure treatment goals," says Dr Mattias Brunström, researcher at the Department of Public Health and Clinical Medicine, Umeå University and lead author.
The study is a meta-analysis, combining data from 74 randomized clinical trials, including more than 300 000 patients. The researchers separated primary preventive studies from studies in people with coronary heart disease or previous stroke. The analysis found that the treatment effect was dependent on how high blood pressure was in previously healthy individuals. If systolic blood pressure was above 140 mm Hg, treatment reduced the risk of death and cardiovascular disease. Below 140 mm Hg, treatment did not affect mortality or the risk of first-ever cardiovascular events.
"Several previous meta-analyses have found that blood pressure lowering treatment is beneficial down to levels below 130 mm Hg. We show that the beneficial effect of treatment at low blood pressure levels is limited to trials in people with coronary heart disease. In primary preventive trials, treatment effect was neutral," says Mattias Brunström.

More information: JAMA Internal Medicine (2017). DOI: 10.1001/jamainternmed.2017.6015


Provided by Umea University

Extreme swings in blood pressure are just as deadly as having consistently high blood pressure

Extreme ups and downs in systolic blood pressure may be just as deadly as having consistently high blood pressure, according to a new study from the Intermountain Medical Center Heart Institute in Salt Lake City.

Extreme ups and downs in systolic blood pressure may be just as deadly as having consistently high blood pressure, according to a new study from the Intermountain Medical Center Heart Institute in Salt Lake City.

19 nov 2017--Following a review of electronic medical records, researchers from the Intermountain Medical Center Heart Institute discovered that patients with systolic blood pressure numbers that varied by as much as 30 or 40 between doctor visits over an extended period of time were more likely to die than those with less extreme variances in their blood pressure.
The systolic blood pressure reading (the upper number) indicates how much pressure blood is exerting against the artery walls when the heart beats. According to the American Heart Association, a normal systolic blood pressure is less than 120. High blood pressure is categorized as above 140.
"Blood pressure is one of those numbers we encourage people to keep track of, as it's one indicator of your health heart," said Brian Clements, DO, an internal medicine specialist with the Intermountain Medical Center Heart Institute, and lead invesigator of the study. "The takeaway from the study is, if you allow your blood pressure to be uncontrolled for any period of time, or notice big changes in your blood pressure between doctor visits, you increase your risk of stroke, heart attack, kidney or heart failure, or even death."
Results of the study of nearly 11,000 patients will be reported at the 2017 American Heart Association Scientific Sessions in Anaheim, CA, on Monday, November 13.
Researchers at the Intermountain Medical Center Heart Institute modeled their study after an analysis of the largest hypertension clinical trial ever conducted - the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
They examined visit-to-visit variability of systolic blood pressure in 10,903 patient records from Intermountain Healthcare facilities. The patients were required to have had seven blood pressure measurements between 2007 and 2011. After the date of their seventh recorded systolic blood pressure measurement, the patients were followed for five years, with researchers looking at all causes of mortality.
"The call to action for patients as a result of this study is to do everything they can to control their blood pressure on a regular basis," said Dr. Clements. "Eat healthy foods, exercise regularly, and if your doctor has prescribed you medications for your blood pressure, be sure and take them consistently. Because any time your blood pressure is out of control, you're at higher risk of injury or death."
In most people, systolic blood pressure rises steadily with age due to increased stiffness of large arteries, long-term build-up of plaque, and increased incidence of cardiac and vascular disease, according to the the American Heart Association.
Dr. Clements also recommends that people control their environment when measuring their blood pressure to help reduce additional variables from influencing the measurement.

• Sit or lay down for 15 minutes prior to taking your blood pressure. Don't do things that will cause you stress, as that may raise your blood pressure.
• Use a blood pressure cuff that fits. Make sure it's not too tight or too large.

"After the ALLHAT study, we were in a unique position because Intermountain Healthcare has such a rich database of records that are perfect for identifying trends and outcomes," said Dr. Clements. "In this case, we're working to identify the cause of the variances in systolic blood pressure and learn if it's an independent predictor of mortality, thus helping clinicians work with their patients to better manage their heart health."


Provided by Intermountain Medical Center

Virtual reality training may be as effective as regular therapy after stroke

A blood clot forming in the carotid artery. 

Using virtual reality therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, according to a study published in the November 15, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology.

18 nov 2017--"Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke," said study author Iris Brunner, PhD, of Aarhus University, Hammel Neurocenter in Denmark. "Future studies could also look at whether people could use virtual reality therapy remotely from their homes, which could lessen the burden and cost of traveling to a medical center for standard therapy."
The study involved 120 people with an average age of 62 who had suffered a stroke on average about a month before the study started. All of the participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms. The participants had four to five hour-long training sessions per week for four weeks. The participants' arm and hand functioning was tested at the beginning of the study, after the training ended and again three months after the start of the study.
Half of the participants had standard physical and occupational therapy. The other half had virtual reality training that was designed for rehabilitation and could be adapted to the person's abilities. The participants used a screen and gloves with sensors to play several games that incorporated arm, hand and finger movements.
"Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results," Brunner said. "These results suggest that either type of training could be used, depending on what the patient prefers."
Brunner noted that the virtual reality system was not an immersive experience. "We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training," she said.


Provided by American Academy of Neurology

Memory complaints and cognitive decline: Data from the GuidAge study

A memory complaint, also called Subjective Cognitive Decline (SCD), is a subjective disorder that appears to be relatively common, especially in elderly persons.

17 nov 2017--The reports of its prevalence in various populations range from approximately 10% to as high as 88%, although it is generally thought that the prevalence of everyday memory problems lie within the range of 25% to 50%. It has been suggested that SCD may be an indication of cognitive decline at a very early stage of a neurodegenerative disease (i.e. preclinical stage of Alzheimer's disease) that is undetectable by standard testing instruments. SCD may represent the first symptomatic manifestation of Alzheimer's disease in individuals with unimpaired performance on cognitive tests.
The McNair and Kahn Scale or Cognitive Difficulties Scale was employed to define and characterize cognitive complaints in the GuidAge study, involving a population of more than 2800 individuals aged 70 years or older having voluntarily complained of memory problems to their general practitioner (GPs). It contains items that are related to difficulties in attention, concentration, orientation, memory, praxis, domestic activities and errands, facial recognition, task efficiency, and name finding.
The results of the GuidAge study suggest that the assessment of cognitive complaint voluntarily reported to primary-care physicians, by the McNair and Kahn scale can predict a decline in cognitive performance, as 5 items out of 20 were statistically significant.

These 5 items are:

• item 1, "I hardly remember usual phone numbers",
• item 5, "I forget appointment, dates, where I store things",
• item 6, "I forget to call people back when they called me",
• item 10, "I forget the day of the week",
• item 13, "I need to have people repeat instructions several times".

Thanks to this short scale GPs, in clinical practice, can identify which patients with memory complaints should be referred to a memory center to assess cognitive functions.


Provided by IOS Press

Landmark study may impact standard stroke treatment guidelines

A blood clot forming in the carotid artery. 

Standard guidelines for stroke treatment currently recommend clot removal only within six hours of stroke onset. But a milestone study with results published today in the New England Journal of Medicine shows that clot removal up to 24 hours after stroke led to significantly reduced disability for properly selected patients.

16 nov 2017--The international multi-center clinical study, known as the DAWN trial, randomly assigned 206 stroke victims who arrived at the hospital within six to 24 hours to either endovascular clot removal therapy, known as thrombectomy, or to standard medical therapy.
Thrombectomy involves a catheter placed in the femoral artery and snaked up the aorta and into the cerebral arteries where the clot that is blocking the artery, and causing the neurological symptoms, is retrieved.
Almost half of the patients (48.6 percent) who had clot removal showed a considerable decrease in disability, meaning they were independent in activities of daily living 90 days after treatment. Only 13.1 percent of the medication group had a similar decrease. There was no difference in mortality or other safety end-points between the two groups.
"These findings could impact countless stroke patients all over the world who often arrive at the hospital after the current six-hour treatment window has closed," says co-principal investigator Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital.
"When the irreversibly damaged brain area affected by the stroke is small, we see that clot removal can make a significant positive difference, even if performed outside the six-hour window," says co-principal investigator Tudor Jovin, MD, director of the University of Pittsburgh Medical Center Stroke Institute. "However, this does not diminish urgency with which patients must be rushed to the ER in the event of a stroke. The mantra 'time is brain' still holds true."
To select patients for the trial, the researchers used a new approach which used brain imaging and clinical criteria as opposed to just time alone.
"Looking at the physiological state of the brain and evaluating the extent of tissue damage and other clinical factors seems to be a better way to decide if thrombectomy will benefit patients as opposed to adhering to a rigid time window," says Nogueira.
The researchers planned to enroll a maximum of 500 patients over the course of the study period. However, a pre-planned interim review of the treatment effectiveness after 200 patients were enrolled in the trial led the independent Data Safety Monitoring Board overseeing the study to recommend early termination of the trial, based on pre-defined criteria demonstrating that clot removal provided significant clinical benefit in the studied patients.
"Our research and clinical teams are immensely proud of these breakthrough findings, which are so profound they will likely result in a paradigm shift that will not be seen again for many years in the field of stroke therapeutics," says Michael Frankel, MD, professor of neurology, Emory University School of Medicine, chief of neurology and director of the Marcus Stroke and Neuroscience Center for the Grady Health System.
According to Frankel, the Emory neuroscience team was a major contributor to the DAWN trial, working at Grady Memorial Hospital, the second leading site of the trial's enrollment.
The DAWN trial included trial locations in the United States, Spain, France, Australia and Canada. The trial was sponsored by Stryker Corporation, a medical technology company that manufactures the clot removal devices used in the study.
The DAWN trial results were presented at the European Stroke Organization Conference in May.


Provided by Emory University

US regulators approve first digital pill to track patients

FDA approved the first drug in the United States with a digital ingestion tracking system, in an unprecedented move to ensure that patients with mental illness take the medicine prescribed for them. The drug Abilify MyCite was developed by Otsuka Pharmaceutical

15 nov 2017--U.S. regulators have approved the first drug with a sensor that alerts doctors when the medication has been taken, offering a new way of monitoring patients but also raising privacy concerns.
The digital pill approved Monday combines two existing products: the former blockbuster psychiatric medication Abilify—long used to treat schizophrenia and bipolar disorder—with a sensor tracking system first approved in 2012.
The technology is intended to help prevent dangerous emergencies that can occur when patients skip their medication, such as manic episodes experienced by those suffering from bipolar disorder.
But developers Otsuka Pharmaceutical Co. and Proteus Digital Health are likely to face hurdles. The pill has not yet been shown to actually improve patients' medication compliance, a feature insurers are likely to insist on before paying for the pill. Additionally, patients must be willing to allow their doctors and caregivers to access the digital information.
These privacy issues are likely to crop up more often as drugmakers and medical device companies combine their products with technologies developed by Silicon Valley.
Experts say the technology could be a useful tool, but it will also change how doctors relate to their patients as they're able to see whether they are following instructions.
"It's truth serum time," said Arthur Caplan, a medical ethicist at NYU's Langone Medical Center. "Is the doctor going to start yelling at me? Am I going to get a big accusatory speech? How will that interaction be handled?"
The technology carries risks for patient privacy too if there are breaches of medical data or unauthorized use as a surveillance tool, said James Giordano, a professor of neurology at Georgetown University Medical Center.
"Could this type of device be used for real-time surveillance? The answer is of course it could," said Giordano.
The new pill, Abilify MyCite, is embedded with a digital sensor that is activated by stomach fluids, sending a signal to a patch worn by the patient and notifying a digital smartphone app that the medication has been taken.
The FDA stressed however that there are limitations to monitoring patients.
"Abilify MyCite should not be used to track drug ingestion in 'real-time' or during an emergency," the statement said, "because detection may be delayed or may not occur."
Patients can track their dosage on their smartphone and allow their doctors, family or caregivers to access the information through a website.
In a statement issued last May at the time the FDA accepted submission of the product for review, the companies said "with the patient's consent, this information could be shared with their health care professional team and selected family and friends, with the goal of allowing physicians to be more informed in making treatment decisions that are specific to the patient's needs."
While it's the first time the FDA has approved such a pill, various specialty pharmacies and hospitals in the U.S. have previously "packaged" various drugs and sensors. But the federal endorsement increases the likelihood that insurers will eventually pay for the technology.
Drugmakers frequently reformulate their drugs to extend their patent life and to justify raising prices. For instance, Otsuka already sells a long-acting injectable version of Abilify intended to last for one month. The patent on the original Abilify pill expired in 2015.
The Japanese drugmaker has not said how it will price the digital pill. Proteus Digital Health, based in Redwood City California, makes the sensor.

Doctors and patients make more decisions together

In a shift away from the more patriarchal/matriarchal relationship between doctor and patient, patients report an increased partnership with their physicians in making medical decisions, reports a new study from Northwestern Medicine and Harvard University.

14 nov 2017--Shared decision-making between patients and their clinicians increased 14 percent from 2002 to 2014, the study reports. According to the study, patients generally felt their physicians more commonly:

• Asked them to help make medical decisions
• Listened carefully to them
• Explained things in a way that was easy to understand
• Showed respect for what they had to say
• Spent enough time with them

The paper will be published Monday in the Annals of Family Medicine.
"There has been increased attention among clinicians and health systems to involve patients in decision-making," said co-lead author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine internist. "Patients who have engaged in shared decision-making understand their condition and options better. They feel less uncertain about a chosen course of action."
Shared decision-making generally results in better-informed patients, who then decide not to use treatments or interventions that have marginal or no benefit, Linder said.
"Finally clinicians are realizing that just because we say, 'You should do that,' a patient will not necessarily comply with our recommendation," said co-lead author Dr. David Levine, an instructor in medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital in Boston. "Moving the conversation to a space where it is a shared decision likely improves adherence."
Although there was a significant increase in shared decision-making, there is still much room for improvement, the authors said. More than 30 percent of Americans felt their clinician did not always listen to them, and more than 40 percent felt their clinician did not always spend enough time with them.
The study also highlighted a few areas where shared decision-making is lacking. Shared decision-making scores were lower for patients in poor health and for patients who were of a different race/ethnicity than their clinician. Focusing on patients with poor health or of a different race/ethnicity than the doctor or clinician could increase shared decision-making in these groups.
The study was an analysis of a nationally representative survey of Americans. It involved about 10,000 people per year from 2002 to 2014.


Provided by Northwestern University

Research shows low chance of sudden cardiac arrest after sex

A small percentage of sudden cardiac arrest events are related to sexual activity, but survival rates in those cases remain low, according to a research letter published today in the Journal of the American College of Cardiology and presented at the American Heart Association's Scientific Sessions 2017. Despite these sexual activity related SCA events being witnessed by a partner, bystander CPR was performed in only one-third of cases.

13 nov 2017--Sudden cardiac arrest (SCA) is when the heart suddenly stops beating; it usually occurs without warning. If not treated immediately it can lead to sudden cardiac death, which results in around 350,000 deaths annually in the United States. It is known that sexual activity may trigger non-fatal cardiac events such as myocardial infarction, but researchers in this study sought to determine if sexual activity is a potential trigger for SCA in the general population.
The researchers looked at the community-based Oregon Sudden Unexpected Death Study (Oregon SUDS) database from 2002 to 2015 to discover the frequency to which SCA occurred during or within one hour after sexual activity for all persons over the age of 18. All reported cases of SCA were based on emergency medical service reports containing detailed information regarding cause of the cardiac arrest event.
In total, the researchers identified 4,557 SCAs in Portland during the 13-year study period. Of these, 34 (0.7 percent) of SCAs were linked to sexual activity. On average, these patients were more likely to be male, middle-aged, African-American and have a history of cardiovascular disease, with a majority taking cardiovascular medication. Patients who experienced SCA related to sexual activity also had a higher rate of ventricular fibrillation/tachycardia than those who did not.
Only one-third of these SCA cases received bystander CPR. The researchers determined that the low bystander CPR rate accounted for the less than 20 percent of patients who survived to hospital discharge.
"Even though SCA during sexual activity was witnessed by a partner, bystander CPR was performed in only one-third of the cases," said Sumeet Chugh, MD, senior study author and associate director of the Cedars-Sinai Heart Institute. "These findings highlight the importance of continued efforts to educate the public on the importance of bystander CPR for SCA, irrespective of the circumstance."
Limitations to the study included unknown information surrounding the frequency of sexual activity, so researchers could not determine relative risk compared to rest and physical activity.
Overall, the study authors said they found a relatively low burden of SCA in relation to sexual activity. The majority of cases were men with a previous history of cardiovascular disease. The researchers also noted that some cases of SCA after sexual activity may also involve medications, stimulants and alcohol use.

More information: Aapo L. Aro et al, Sexual Activity as a Trigger for Sudden Cardiac Arrest, Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.09.025 , dx.doi.org/10.1016/j.jacc.2017.09.025


Provided by American College of Cardiology

Online therapy proves effective for treating depression and anxiety

Providing an online computerized cognitive behavioral therapy (CCBT) program, both alone and in combination with an Internet Support Group (ISG), is a more effective treatment for anxiety and depression than a doctor's usual primary care, researchers from the University of Pittsburgh found. Results were published today in JAMA Psychiatry.

12 nov 2017--Bruce Rollman, M.D., M.P.H., professor of medicine and director of the Pitt Center for Behavioral Health and Smart Technology, led the National Institutes of Mental Health-funded Online Treatment for Mood and Anxiety Disorders Trial, which enrolled 704 depressed and anxious patients from 26 UPMC-affiliated primary care offices across western Pennsylvania.
UPMC primary care physicians referred patients ages 18 to 75 to the trial between August 2012 and September 2014 using an electronic health record prompt. Eligible and consenting patients were then randomized to one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT program (CCBT-alone); care manager-guided access to both the CCBT program and a password-protected, moderated ISG that patients could access at any time via their smartphone or desktop computer (CCBT+ISG); or to their primary care physician's usual care.
Over the six-month intervention, 86 percent of patients randomized to CCBT started the program and completed an average of 5.4 sessions. Seventy-five percent of patients assigned to the ISG logged into the site at least once, and 62 percent made one or more posts or comments, with an average of 10.5 posts and comments per person. The maximum number of posts and comments from one participant was 306.
Six months later, patients randomized to the CCBT+ISG and CCBT-alone groups both reported significant improvements in their mood and anxiety symptoms versus patients receiving usual care, and these improvements lasted for six months after the end of the intervention. However, the addition of the moderated ISG provided no additional benefit over guided access to CCBT only. Additionally, the more CCBT sessions patients completed, the greater the improvement in their symptoms, highlighting the critical importance of patient engagement with online interventions.
Despite proven effectiveness at treating mood and anxiety disorders and use by many patients abroad, CCBT remains largely unknown and underutilized within the U.S., Rollman said. ISGs that enable individuals with similar conditions to access and exchange self-help information and emotional support have thrived in recent years, but benefits have yet to be established in randomized trials. This trial was the first to examine the effectiveness of incorporating either a CCBT program or an ISG into a collaborative care program for treating depression or anxiety in primary care.
"Providing access to these effective emerging technologies may be an ideal method to deliver mental health treatment to depressed and anxious patients at scale, especially to those who live in areas with limited access to care or personal obligations that make in-person counseling difficult to obtain," Rollman said. "Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention on the emerging field of e-mental health in the United States."

More information: Bruce L. Rollman et al. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care, JAMA Psychiatry (2017). DOI: 10.1001/jamapsychiatry.2017.3379


Provided by University of Pittsburgh

More physical activity, higher intensity may significantly reduce risk of death in older women in the short term

More physical activity and at higher intensities could lead to a big drop in the risk of death in older women from any cause, according to new research in the American Heart Association's journal Circulation.

07 nov 2017--Researchers found the volume of light intensity physical activity or sedentary behavior was not associated with death rate. However, light intensity activity may be beneficial for other health outcomes not studied in this research.
Previous studies, which used self-reports, showed that active people have about 20 percent to 30 percent lower death rates compared to their least active counterparts.
This research, conducted from 2011 to 2015, is among the first to investigate physical activity, measured using a wearable device called a triaxial accelerometer, and a clinical outcome. The device is capable of measuring activity along three planes: up and down, front to back and side to side. These capabilities increase sensitivity to detect physical activity and allow for more precise measurements.
"We used devices to better measure not only higher intensity physical activities, but also lower intensity activities and sedentary behavior, which has become of great interest in the last few years," said I-Min Lee, M.B.B.S., Sc.D., the study's first author and professor of medicine and epidemiology at Harvard University's medical and public health schools in Boston, Massachusetts.
More than 17,700 women (average age 72) who were asked to wear the device for seven days, when awake, returned their devices. Data were analyzed from 16,741 compliant participants (i.e., their devices showed it was worn for at least 10 hours a day, on at least four days). During an average follow-up of approximately two-and-a-half years, 207 women died.
Researchers found:

• More moderate to vigorous intensity physical activity (such as brisk walking) was associated with roughly a 60 percent to 70 percent lower risk of death at the end of the study among the most active women, compared to the least active.
• More light intensity activity (such as housework and slow walking - e.g., window shopping in a mall), or more sedentary behavior was not independently associated with death risk at the study's end. Researchers stressed this finding does not mean light activity isn't beneficial for other health outcomes not studied here.

Researchers chose this study population to begin addressing knowledge gaps, said Lee who is also an associate epidemiologist at Brigham and Women's Hospital in Boston. "Younger people in their 20s and 30s generally can participate in vigorous intensity activities, such as running or playing basketball. But for older people, vigorous intensity activity may be impossible, and moderate intensity activity may not even be achievable. So, we were interested in studying potential health benefits associated with light intensity activities that most older people can do."
The study's participants, selected from the Women's Health Study, were relatively healthy, and mostly white women, therefore the findings may have limited generalizability to other groups of people.
The findings support 2008 federal guidelines and American Heart Association that suggest at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous-intensity aerobic physical activity (or a combination of the two) and muscle-strengthening exercises two or more days a week.
"We hope to continue this study in the future to examine other health outcomes, and particularly to investigate the details of how much and what kinds of activity are healthful. What is irrefutable is the fact that physical activity is good for your health," Lee said.

More information: Circulation (2017). DOI: 10.1161/CIRCULATIONAHA.117.031300


Provided by American Heart Association

Colorectal cancer screening should start at 45, new research shows

Infographic on CRC. 

Screening for colorectal cancer (CRC) should begin at 45 years of age to match rising mortality rates in young adults, research presented today at the 25th UEG Week Barcelona reveals.

Scientists in France analysed 6,027 colonoscopies and found a 400% increase in the detection of neoplasia (the new, uncontrolled growth of abnormal tissue) in patients aged between 45-49 in comparison to patients aged 40-44. The neoplasia detection rate was also 8% higher in people aged between 45-49 than it was between 50-54, leading to calls for CRC screening programmes to begin at 45 years of age.
The mean number of polyps (growths on the inner lining of the colon that can turn cancerous if left untreated) and the adenoma detection rate (proportion of individuals undergoing a colonoscopy who have one or more adenomas detected) also increased by 95.8% and 95.4% respectively between the 40-44 and 45-49 age groups. This was far more substantial than the increase between the 45-49 and 50-54 age groups, which was 19.1% and 11.5% respectively.
Lead researcher, Dr David Karsenti, who will present the findings for the first time today at UEG Week, explains; "These findings demonstrate that it is at 45 years old that a remarkable increase in the colorectal lesions frequency is shown, especially in the detection rate of early neoplasia. Even when patients with a familial and personal history of polyps or cancer are excluded from the findings, there is still a noticeable increase in detection rates in patients from the age of 45."

The mean number of polyps, adenoma detection rate and neoplasia detection rate by age. Credit: UEG

CRC is the second most common cause of cancer-related death in Europe, killing 215,000 Europeans every year, with research recently revealing that three in ten CRC diagnoses are now among people younger than 55. There is strong evidence to demonstrate that screening for CRC reduces incidence and mortality rates, yet there are vast inequalities in CRC screening across Europe with both organised and opportunistic schemes, different types of tests and varying participation and detection rates. Despite the dramatic rise of CRC in young adults, the vast majority of screening programmes throughout Europe commence between the ages of 50 and 55, with some not beginning until the age of 60.
Dr Karsenti adds "Regardless of the type of screening that is in place, the results of our research strongly indicate that screening for colorectal cancer should begin at the age of 45. This will this help us to increase the early detection of colorectal cancer in young adults and also enable the identification and safe removal of polyps that may become cancerous at a later date."

The neoplasia detection rate by age. Credit: UEG

More information: 1. Karsenti, D. et al (2017), Adenoma detection rate according to age: colonoscopy screening should start at 45 years old, Presented at the 25th UEG Week Barcelona, October 30, 2017.
2. Epidemiology of colorectal cancer: international comparison, 4th European Colorectal Cancer Days 2015. Available at: www.crcprevention.eu/index.php … -cancer-epidemiology
3. Dramatic rise in colorectal cancer in younger adults (2017), Medscape. Available at: www.medscape.com/viewarticle/876409


Provided by United European Gastroenterology

Research lays groundwork for promising Alzheimer's-fighting drink

A nutrient mix based in part on research from the lab of MIT Professor Emeritus Richard Wurtman has shown promise in treating the early stages of Alzheimer’s disease. 

Much of Professor Emeritus Richard Wurtman's career in MIT's Department of Brain and Cognitive Sciences revolved around developing new treatments for diseases and conditions by modifying chemicals produced in the brain.

01 nov 2017--Since coming to MIT in 1970, Wurtman and his research group have generated more than 1,000 research articles and 200 patents, laying the groundwork for numerous successful medical products.
 "I'm very interested in using basic knowledge to ameliorate the human condition, to make living better," says Wurtman, who is also a medical doctor.
Now a nutrient mix based on essential research contributions by Wurtman has shown promise in treating the early stages of Alzheimer's disease, according to a new clinical trial funded by the European Union.
In the mid-2000s, Wurtman developed a nutrient cocktail aimed at treating what he considers "the root cause" of Alzheimer's: loss of brain synapses. The mixture increases production of new synapses and restores connectivity between brain regions, improving memory and other cognitive functions. A French company then combined this research with a multinutrient it was developing along with the LipiDiDiet consortium—a European collaboration of 16 universities and research centers—to create a drink, called Souvenaid, for Alzheimer's patients.
Over the years, Souvenaid has been the focus on several clinical trials to validate its efficacy. The mixture is not yet available in the United States, but it is being sold as a "medical food"—a category of regulated and safe foods that are designed for dietary management of diseases—in a number of countries across the globe.
In the new clinical trial, published in today's issue of Lancet Neurology, patients with prodromal Alzheimer's—the predementia stage of Alzheimer's with mild symptoms—were given either Souvenaid or a placebo. Compared to people who drank the placebo, patients who drank Souvenaid throughout the trial showed less worsening in everyday cognitive and functional performance and significantly less atrophy of the hippocampus, which is caused early in Alzheimer's by brain tissue loss.
"It feels like science-fiction, where you can take a drink of Souvenaid and you get more synapses … for improved cognitive function," Wurtman says. "But it works."
The co-authors of the study are from the University of Eastern Finland, Kuopio University Hospital, Karolinska Institutet and Karolinska University Hospital, the University of Masstricht, the VU University Medical Centre, Pentara Corporation, the University of Gothenburg, Sahlgrenska University Hospital, and Saarland University and the LipiDiDiet study group.

Making Souvenaid

Souvenaid's popularity may be on the rise today, but the product would not be possible without years of MIT research, Wurtman says.
In the mid-2000s, Wurtman's research led him to seek the mechanisms behind the body's production of phosphatides, a class of lipids that, along with proteins, form biological membranes. Production of these phosphatides, Wurtman discovered, depends on a set of nutrient precursors.
Specifically, Wurtman homed in on three naturally occurring dietary compounds: choline, uridine, and the omega-3 fatty acid DHA. Choline is found in meats, nuts, and eggs. Fish, flaxseeds, and certain meats contain omega-3 fatty acids. Uridine is mostly produced in the liver.
All those compounds taken simultaneously boost production of phosphatides, encouraging membrane development, which is critical in creating new synapses. Knowing that Alzheimer's-affected brains continuously lose synapses, Wurtman patented the work through MIT's Technology Licensing Office in hopes of using some version of the cocktail to treat Alzheimer's and any disease that leads to loss of synapses.
Then, in 2003, Wurtman presented the work at a meeting in Europe. Attending the event was a representative from Nutricia—a unit of Danone, a French company known as Dannon in the United States—which was experienced in making medical foods. Wurtman was invited to the company's headquarters, where a deal was hashed out to combine Wurtman's findings with a multinutrient the company was working on to create a new treatment for Alzheimer's.
By 2008, Danone had licensed the patent and Souvenaid was already a product. But Wurtman and several graduate students continued basic research behind Souvenaid, which gave the product a boost. "We were much more able to do the basic research at MIT," Wurtman says. "As soon as we found something in the research, we'd patent it. We never had the lag time. If you work in entrepreneurship and innovation that lag time could be the downfall of a prospective product."
Among the group's key discoveries was the finding that Souvenaid boosted the number of structures called dendritic spines, found in brain cells. When spines from one neuron contact another, a synapse is formed.
A 2010 study detailing those findings in Alzheimer's and Dementia indicated that Souvenaid improved verbal memory in patients with mild Alzheimer's. A 2012 study published in the Journal of Alzheimer's Disease confirmed and expanded these findings. Over six months, patients with mild Alzheimer's were given Souvenaid or a placebo. Patients taking the placebo deteriorated in their verbal-memory performance in the final three months of the study, while the Souvenaid patients continued to improve. Both trials were conducted by Philip Scheltens of the Alzheimer Center of the VU University Medical Centre in Amsterdam.

Future of Souvenaid

In the new clinical trial by the LipiDiDiet consortium, researchers conducted a 24-month trial, where more than 300 patients with prodromal Alzheimer's were randomly assigned Souvenaid or a placebo. The patients taking Souvenaid showed about 45 percent less cognitive decline than people taking the placebo, according to a measure known as the clinical dementia rating sum of boxes.
But the surprising finding, Wurtman says, is that the patients taking Souvenaid showed a substantial reduction is the loss of hippocampal volume. In early stages of Alzheimer's, the hippocampus—which plays an important role in memory—shrinks as tissue is destroyed. But rates of deterioration for those taking Souvenaid were about 26 percent lower than the control group.
"That's remarkable," Wurtman says. "I never would have guessed that something like that could happen. But if you suppress the loss of the hippocampus, it makes sense that you'd have better retention of cognitive function."
The results indicate that Souvenaid may be able to slow or stop full progression of very early Alzheimer's into full-blown Alzheimer's, Wurtman says.
With this new study, Wurtman has high hopes for Souvenaid. First, he says the findings could encourage more researchers to view synapse restoration as a treatment for Alzheimer's, which isn't a popular area of study. Most research today, he says, focuses on reducing the accumulation of amyloid plaques or minimizing damage caused by toxic metabolites in Alzheimer's-affected brains.
"Everyone who writes about Alzheimer's knows there's a synapse deficiency, and this impairs connections between brain regions," he says. "Even if the amyloid or another problem gets solved, one way or another, you'll have to replace these synapses."
Wurtman also hopes the study will "catalyze the rapid appearance of Souvenaid in the American market" and become a very early treatment for suspected Alzheimer's patients. Several potential biomarkers are being studied as indicators of early Alzheimer's. But it's somewhat useless to detect these biomarkers if nothing can be done about the disease at that point, Wurtman says. With Souvenaid, he says, that can change.
"Most people don't do a biomarker test, because … there's been nowhere to go from there. Now, it will be possible, I believe, for a doctor to tell a patient that, even though they have early Alzheimer's, they can take Souvenaid chronically to suppress the development of the disease."

This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

Provided by Massachusetts Institute of Technology