Dermoscopic criteria identified for diagnosing melanoma in situ

The most frequent dermatoscopic network, and irregular dots and/or globules, according to a study published online Feb. 21 in JAMA Dermatology.

25 feb 2018--Aimilios Lallas, Ph.D., from Aristotle University in Thessaloniki, Greece, and colleagues conducted a diagnostic accuracy study with retrospective patient enrollment in three centers, including 1,285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors. Three independent investigators evaluated dermoscopic images of MIS and other flat pigmented skin tumors for the presence of predefined criteria.
The researchers found that 25.3 percent of the lesions were MIS. The most frequent dermoscopic criteria for MIS were regression, atypical network, and irregular dots and/or globules (92.9, 85.5, and 50.2 percent, respectively). Five main positive indicators of MIS were identified in multivariate analysis: atypical network, regression, irregular hyperpigmented areas, prominent skin markings, and angulated lines (3.7-, 4.7-, 5.4-, 3.4-, and 2.2-fold, respectively). Two of these criteria remained potent MIS indicators when compared with excised nevi: irregular hyperpigmented areas and prominent skin markings (4.3- and 2.7-fold, respectively).
"Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS," the authors write.

More information: Abstract/Full Text
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Antidepressant response within hours? Experts weigh evidence on ketamine as fast-acting treatment for depression

Recent studies suggest that ketamine, a widely used anesthetic agent, could offer a wholly new approach to treating severe depression—producing an antidepressant response in hours rather than weeks. Two reviews of recent evidence on ketamine and related drugs for treating depression appear in the Harvard Review of Psychiatry.

24 feb 2018--Ketamine and related drugs may represent a "paradigm shift" in the treatment of major depressive disorder (MDD) and bipolar depression—especially in patients who do not respond to other treatments, according to a review by Carlos A. Zarate, Jr, MD and colleagues at the National Institute of Mental Health. A second article explores evidence on the mechanisms behind ketamine's rapid antidepressant effects.

Growing Evidence, Clinical Caution about Ketamine for Severe Depression

Current treatments for MDD and bipolar depression have major limitations. Many patients with severe depressive symptoms don't respond to available antidepressant drugs. Even for those who do respond, it may take several weeks before symptoms improve.
Ketamine, an anesthetic, is one of several glutamatergic drugs affecting neurotransmitters in the central nervous system. Over the past decade, several studies have reported "rapid, robust, and relatively sustained antidepressant response" to ketamine, injected intravenously at low, subanesthetic doses.
Dr. Zarate and colleagues review the research on ketamine and other glutamatergic drugs for depression. Ketamine, by far the best-studied of these medications, is notable for its very rapid antidepressant effects. In patients with treatment-resistant MDD, ketamine has produced initial reductions in depressive symptoms within two hours, with peak effects at 24 hours.
Ketamine may also rapidly reduce suicidal thoughts. Combined with other medications, ketamine has also produced rapid antidepressant effects in patients with treatment-resistant bipolar depression.
Prompted by these studies, some doctors are already using ketamine in patients with severe or treatment-resistant depression. However, since it is FDA-approved only as an anesthetic, use of ketamine in depressive disorders is "off-label," unregulated, and not standardized. Many questions remain about its short- and long-term side effects and potential for abuse.
"Efforts are underway to bring ketamine to market, standardize its use, and determine its real-world effectiveness," Dr. Zarate and coauthors write. They also present evidence on several other glutamatergic drugs. One drug, esketamine, has been given "breakthrough therapy" status by the FDA for patients at imminent risk of suicide.
Cristina Cusin, MD of Massachusetts General Hospital and colleagues review neuroimaging studies evaluating ketamine's effects in the brain. The studies show ketamine-induced changes in several brain areas involved in the development of depression. Ketamine may exert its antidepressant effects by "acutely disabl[ing] the emotional resources required to perpetuate the symptoms of depression," as well as by increasing emotional blunting and increasing activity in reward processing.
Independent of how ketamine works or its ultimate role in clinical treatment, antidepressant response to glutamatergic drugs points to an exciting conclusion: "that rapid antidepressant effects are indeed achievable in humans," Dr. Zarate and coauthors write. "This paradigm shift lends additional urgency to the development of novel treatments for MDD and bipolar depression, particularly for patient subgroups that do not respond to currently available therapies."

More information: Dawn F. Ionescu et al. Ketamine-Associated Brain Changes, Harvard Review of Psychiatry (2018). DOI: 10.1097/HRP.0000000000000179
Ioline D. Henter et al. Glutamatergic Modulators in Depression, Harvard Review of Psychiatry (2018). DOI: 10.1097/HRP.0000000000000183


Provided by Wolters Kluwer Health

Largest study of its kind finds alcohol use biggest risk factor for dementia

Alcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia. This according to a nationwide observational study, published in The Lancet Public Health journal, of over one million adults diagnosed with dementia in France.

23 feb 2018--This study looked specifically at the effect of alcohol use disorders, and included people who had been diagnosed with mental and behavioural disorders or chronic diseases that were attributable to chronic harmful use of alcohol.
Of the 57,000 cases of early-onset dementia (before the age of 65), the majority (57%) were related to chronic heavy drinking.
The World Health Organization (WHO) defines chronic heavy drinking as consuming more than 60 grams pure alcohol on average per day for men (4-5 Canadian standard drinks) and 40 grams (about 3 standard drinks) per day for women.
As a result of the strong association found in this study, the authors suggest that screening, brief interventions for heavy drinking, and treatment for alcohol use disorders should be implemented to reduce the alcohol-attributable burden of dementia.
"The findings indicate that heavy drinking and alcohol use disorders are the most important risk factors for dementia, and especially important for those types of dementia which start before age 65, and which lead to premature deaths," says study co-author and Director of the CAMH Institute for Mental Health Policy Research Dr. Jürgen Rehm. "Alcohol-induced brain damage and dementia are preventable, and known-effective preventive and policy measures can make a dent into premature dementia deaths."
Dr. Rehm points out that on average, alcohol use disorders shorten life expectancy by more than 20 years, and dementia is one of the leading causes of death for these people.
For early-onset dementia, there was a significant gender split. While the overall majority of dementia patients were women, almost two-thirds of all early-onset dementia patients (64.9%) were men.
Alcohol use disorders were also associated with all other independent risk factors for dementia onset, such as tobacco smoking, high blood pressure, diabetes, lower education, depression, and hearing loss, among modifiable risk factors. It suggests that alcohol use disorders may contribute in many ways to the risk of dementia.
"As a geriatric psychiatrist, I frequently see the effects of alcohol use disorder on dementia, when unfortunately alcohol treatment interventions may be too late to improve cognition," says CAMH Vice-President of Research Dr. Bruce Pollock. "Screening for and reduction of problem drinking, and treatment for alcohol use disorders need to start much earlier in primary care." The authors also noted that only the most severe cases of alcohol use disorder - ones involving hospitalization - were included in the study. This could mean that, because of ongoing stigma regarding the reporting of alcohol-use disorders, the association between chronic heavy drinking and dementia may be even stronger.

More information: Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study, The Lancet Public Health (2018). dx.doi.org/10.1016/S2468-2667(18)30022-7


Provided by Centre for Addiction and Mental Health

Haloperidol does not prevent delirium or improve survival rates in ICU patients

Prophylactic use of the drug haloperidol does not help to prevent delirium in intensive care patients or improve their chances of survival. Therefore, there is no reason anymore to administer the drug as a preventive measure to reduce the burden of delirium. This was revealed following a three-year, large-scale study among 1,800 patients in 20 Dutch ICUs, headed by Radboud university medical center. The results of this world's largest research project into delirium prevention in the ICU have been published on February 20 in the Journal of the American Medical Association (JAMA).

22 feb 2018--Acute confusion, or delirium, occurs in approximately one third to half of all patients in the intensive care unit (ICU), and hasserious short-term and long-term consequences. Patients who develop delirium need mechanical ventilation for a longer time and their stay in the ICU and in the hospital is also longer. Also, patients with delirium are more likely to die compared to patients without delirium. If a patient develops delirium, the drug haloperidol is often used to treat it.

Large-scale research

There were indications that haloperidol could be effective not only to treat, but also to prevent delirium. A large-scale trial, headed by Mark van den Boogaard from the Radboud university medical center, was conducted in 20 Dutch ICUs to investigate if prophylactic use of haloperidol could reduce delirium and its consequences. A total of 1,800 ICU patients with a high risk of delirium were included in this trial and received a low dose of haloperidol, or a placebo. This trial, funded by ZonMw (the Netherlands Organisation for Health Research and Development), is worldwide the largest trial in this field.
As mortality rates among patients with delirium are higher, the researchers tried to find out whether using prophylactic haloperidol would reduce the mortality and delirium and its sequelae.
The conclusions of this trial were crystal clear: prophylactic therapy with haloperidol did not affect any of the endpoints being studied. Principal investigator Mark van den Boogaard: "This large-scale study shows indisputably that use of prophylactic haloperidol in ICU patients has no beneficial effects whatsoever. These findings will lead to fewer unnecessary drugs being prescribed to ICU patients."
Head of the research, Professor Peter Pickkers: "The scope of the study and the fact that the results are so unambiguous make the message from our research abundantly clear: there is absolutely no point in administering haloperidol to ICU patients as a preventive measure."

More information: Mark van den Boogaard et al. Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium, JAMA (2018). DOI: 10.1001/jama.2018.0160 Mark van den Boogaard et al. Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium, JAMA (2018). DOI: 10.1001/jama.2018.0160


Provided by Radboud University

Life expectancy diverges between England's wealthiest and poorest neighbourhoods

New research from the Longevity Science Panel (LSP) shows life expectancy diverging between England's wealthiest and poorest neighbourhoods since 2001. This widening gap in outcomes applies to children born today and to people already in older age.

21 feb 2018--A boy born in one of the most advantaged 20 percent of neighbourhoods in 2015 can now expect to outlive his counterpart, born in one of the least advantaged 20 percent of neighbourhoods, by 8.4 years. In 2001, that gap was 7.2 years. For girls, the difference has risen from 5 years to 5.8 years over the same period.
A sixty-year-old man living in the most advantaged 20 percent of neighbourhoods could expect to live 4.1 years longer than his counterpart from the least advantaged 20 percent in 2001, increasing to 5.0 years longer in 2015. A sixty-year-old women living in the most advantaged 20 percent of neighbourhoods could expect to live 3.1 years longer than her counterpart in the least advantaged 20 percent in 2001, increasing to 4.2 years longer in 2015.
Death rates for people aged 60-89 improved for all groups between 2001 and 2015. However, the improvement was greatest for the best-off. The most advantaged fifth of older men experienced a reduction in death rates of 32 percent, compared with 20 percent for the least advantaged fifth. Women in this age group experienced a 29 percent fall in death rates for the most advantaged fifth, and 11 percent for the least advantaged fifth.
Differing improvement rates meant that by 2015, men aged 60-89 from the least advantaged fifth of the country were 80 percent more likely to die in any given year than those from the most advantaged fifth. This figure has climbed from 52 percent in 2001. The equivalent figures for women are 44 percent in 2001 and 81 percent in 2015.
The LSP's analysis shows that, of the many factors comprising the Index of Multiple Deprivation, income levels have the most powerful influence over neighbourhood death rates.
Commenting on the research, LSP's Dame Karen Dunnell said:
"Dying earlier if you are poor is the most unfair outcome of all. So we should all be concerned about the growing divergence in rich-poor life expectancy. To reduce the risk of further widening, we need better understanding of the precise causes, followed by co-ordinated policy initiatives across health, work, welfare, pension and housing to improve outcomes for all."
Co-author, Professor Steve Haberman, Professor of Actuarial Sciences, Cass Business School said:
"Our main finding is that the socioeconomic gap in life expectancy in England has widened over the last 15 years. This has happened despite life expectancy increasing across all sections of the population—it is clear that some groups are being left behind. As the population ages, these inequalities are likely to increase further. To solve this problem, we will need better coordinated policies involving central and local government, civil society and the private sector."

More information: Life Expectancy: Is the Socio-Economic Gap Narrowing? www.longevitypanel.co.uk/viewp … nomic-gap-narrowing/


Provided by City University London

Just a few minutes of light intensity exercise linked to lower death risk in older men

Clocking up just a few minutes at a time of any level of physical activity, including of light intensity, is linked to a lower risk of death in older men, suggests research published online in the British Journal of Sports Medicine
.
20 feb 2018--Providing the recommended 150 minute weekly tally of moderate to physical activity is reached, total volume, rather than activity in 10 minute bouts, as current guidelines suggest, might be key, the findings indicate.
This lower level of intensity is also likely to be a better fit for older men, most of whose daily physical activity is of light intensity, say the researchers.
Current exercise guidelines recommend accumulating at least 150 minutes a week of moderate to vigorous physical activity in bouts lasting 10 or more minutes. But such a pattern is not always easy for older adults to achieve, say the researchers.
To find out if other patterns of activity might still contribute to lowering the risk of death, the researchers drew on data from the British Regional Heart Study.
This involved 7735 participants from 24 British towns, who were aged between 40 and 59 when the study stated in 1978-80.
In 2010-12, the 3137 survivors were invited for a check-up, which included a physical examination, and questions about their lifestyle, sleeping patterns, and whether they had ever been diagnosed with heart disease.
They were also asked to wear an accelerometer—a portable gadget that continuously tracks the volume and intensity of physical activity—during waking hours for 7 days. Their health was then tracked until death or June 2016, whichever came first.
In all, 1566 (50%) men agreed to wear the device, but after excluding those with pre-existing heart disease and those who hadn't worn their accelerometer enough during the 7 days, the final analysis was based on 1181 men, whose average age was 78.
During the monitoring period, which averaged around 5 years, 194 of the men died.
The accelerometer findings indicated that total volume of physical activity, from light intensity upwards, was associated with a lower risk of death from any cause.
Each additional 30 minutes a day of light intensity activity, such as gentle gardening or taking the dog for a walk, for example, was associated with a 17 percent reduction in the risk of death. This association persisted even after taking account of potentially influential lifestyle factors, such as sedentary time.
Whilst the equivalent reduction in the risk of death was around 33 percent for each additional 30 minutes of moderate to vigorous intensity physical activity a day, the benefits of light intensity activity were large enough to mean that this too might prolong life.
And there was no evidence to suggest that clocking up moderate to vigorous activity in bouts of 10 minutes or more was better than accumulating it in shorter bouts. Sporadic bouts of activity were associated with a 41 percent lower risk of death; bouts lasting 10 or more minutes were associated with a 42 percent lower risk.
Sporadic bouts seemed easier to achieve as two thirds (66%) of the men achieved their weekly total of moderate to vigorous physical activity in this way while only 16% managed to do so in bouts of 10 or more minutes.
Finally, there was no evidence to suggest that breaking up sitting time was associated with a lower risk of death.
This is an observational study so no firm conclusions can be drawn about cause and effect. And those who wore the accelerometer tended to be younger and have healthier lifestyles than those who didn't, so this might have skewed the results, say the researchers. Nor is it clear if the findings would be equally applicable to younger age groups or older women.
Nevertheless, the results could be used to refine current physical activity guidelines and make them more achievable for older adults, suggest the researchers.
Future guidance might emphasise that all physical activity, however modest, is worthwhile for extending the lifespan—something that is particularly important to recognise, given how physical activity levels tail off rapidly as people age, they point out.
"[The ] results suggest that all activities, however modest, are beneficial. The finding that [low intensity physical activity] is associated with lower risk of mortality is especially important among older men, as most of their daily physical activity is of light intensity," write the researchers.
"Furthermore, the pattern of accumulation of physical activity did not appear to alter the associations with mortality, suggesting that it would be beneficial to encourage older men to be active irrespective of bouts," they add.

More information: Barbara J Jefferis et al. Objectively measured physical activity, sedentary behaviour and all-cause mortality in older men: does volume of activity matter more than pattern of accumulation?, British Journal of Sports Medicine (2018). DOI: 10.1136/bjsports-2017-098733


Provided by British Medical Journal

Will a machine pick your next medication?

18 feb 2018--What once seemed like a scene from a 22nd century sci-fi movie is reality today. High speed, big data-processing computers combine artificial intelligence with human know-how to crack complex health care conditions. This deep computer analysis may unveil new patterns that could bolster your provider's ability to prescribe precise therapies, make a diagnosis, recommend a clinical trial or even predict your risk of disease.
Mayo Clinic Center for Individualized Medicine (CIM) is collaborating with the Coordinated Science Laboratory (CSL) at the University of Illinois at Urbana Champaign (UIUC) to unleash the potential of artificial intelligence in patient care. Funded by a National Science Foundation (NSF) grant, the Mayo UIUC Alliance and corporate partners are conducting research into the big data challenge: how to develop computer systems that, combined with human intelligence, unlock new analysis of health and disease.

IDENTIFYING DEPRESSION THERAPY

Research within CIM is probing whether artificial intelligence can reduce or eliminate the trial and error of prescribing antidepression medication. In a clinical study with Mayo's department of psychiatry, researchers have combined machine learning, a type of artificial intelligence, with genomics, metabolomics and other clinical variables. This machine learning approach helps providers to choose a therapy most likely to work on the first try.
"We combined expertise from clinicians, engineers and biologists to create an algorithm that uncovered patterns of antidepressant response that each of these specialists alone might not be able to recognize," said Arjun Athreya, a Mayo- UIUC Alliance predoctoral research fellow. "Using this data with deep machine learning, we were able to predict with 75-85 percent accuracy whether a common antidepressant drug would work for each individual patient in the study. That compares to 58 percent accuracy when predictions are based only on clinical, demographic and social factors. In addition, we found that women and men respond differently to this antidepressant therapy."

Distributed by Tribune Content Agency, LLC.

Death of dementia patient stirs Belgium euthanasia fears

Protestors stand in front of a banner which reads "Euthanasia Stop", during an anti-euthanasia demonstration in Brussels. A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world's most liberal euthanasia laws.

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world's most liberal euthanasia laws.

17 feb 2018--The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium's euthanasia commission in protest over the group's actions on this and other cases.
Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia.
Although euthanasia has been legal in Belgium since 2002 and has overwhelming public support, critics have raised concerns in recent months about certain practices, including how quickly some doctors approve requests to die from psychiatric patients.
The AP revealed a rift last year between Dr. Willem Distelmans, co-chair of the euthanasia commission, and Dr. Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont's patients might have been killed without meeting all the legal requirements. Prompted by the AP's reporting, more than 360 doctors, academics and others have signed a petition calling for tighter controls on euthanasia for psychiatric patients.
Euthanasia—when doctors kill patients at their request—can be granted in Belgium to people with both physical and mental health illnesses. The condition does not need to be fatal, but suffering must be "unbearable and untreatable." It can only be performed if specific criteria are fulfilled, including a "voluntary, well-considered and repeated" request from the person.
But Belgium's euthanasia commission routinely violates the law, according to a September letter of resignation written by Dr. Ludo Vanopdenbosch, a neurologist, to senior party leaders in the Belgian Parliament who appoint members of the group.
The most striking example took place at a meeting in early September, Vanopdenbosch writes, when the group discussed the case of a patient with severe dementia, who also had Parkinson's disease. To demonstrate the patient's lack of competence, a video was played showing what Vanopdenbosch characterized as "a deeply demented patient."
The patient, whose identity was not disclosed, was euthanized at the family's request, according to Vanopdenbosch's letter. There was no record of any prior request for euthanasia from the patient.
After hours of debate, the commission declined to refer the case to the public prosecutor to investigate if criminal charges were warranted.
Vanopdenbosch confirmed the letter was genuine but would not comment further about the specific case details.

The two co-chairs of the euthanasia commission, Distelmans and Gilles Genicot, a lawyer, said the doctor treating the patient mistakenly called the procedure euthanasia, and that he should have called it palliative sedation instead. Palliative sedation is the process of drugging patients near the end of life to relieve symptoms, but it is not meant to end life.
"This was not a case of illegal euthanasia but rather a case of legitimate end-of-life decision improperly considered by the physician as euthanasia," Genicot and Distelmans said in an email.
Vanopdenbosch, who is also a palliative care specialist, wrote that the doctor's intention was "to kill the patient" and that "the means of alleviating the patient's suffering was disproportionate."
Though no one outside the commission has access to the case's medical records—the group is not allowed by law to release that information—some critics were stunned by the details in Vanopdenbosch's letter.
"It's not euthanasia because the patient didn't ask, so it's the voluntary taking of a life," said Dr. An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. "I don't know another word other than murder to describe this."
Kristof Van Assche, a professor of health law at the University of Antwerp, wrote in an email the commission itself wasn't breaking the law because the group is not required to refer a case unless two-thirds of the group agree— even if the case "blatantly disregards" criteria for euthanasia.
But without a request from the patient, the case "would normally constitute manslaughter or murder," he wrote. "The main question is why this case was not deemed sufficiently problematic" to prompt the commission to refer the case to prosecutors.
Vanopdenbosch, who in the letter called himself a "big believer" in euthanasia, cited other problems with the commission. He said that when he expressed concerns about potentially problematic cases, he was immediately "silenced" by others. And he added that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with "impunity."
Vanopdenbosch wrote that when cases of euthanasia are identified that don't meet the legal criteria, they are not forwarded to the public prosecutor's office as is required by law, but that the commission itself acts as the court.
In the 15 years since euthanasia was legalized in Belgium, more than 10,000 people have been euthanized, and just one of those cases has been referred to prosecutors.
Genicot and Distelmans said the group thoroughly assesses every euthanasia case to be sure all legal conditions have been met.
"It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it," they said. They said it was "absolutely false" that Vanopdenbosch had been muzzled and said they regretted his resignation.

Not being aware of memory problems predicts onset of Alzheimer's disease

Doctors who work with individuals at risk of developing dementia have long suspected that patients who do not realize they experience memory problems are at greater risk of seeing their condition worsen in a short time frame, a suspicion that now has been confirmed by a team of McGill University clinician scientists.

16 feb 2018--Some brain conditions can interfere with a patient's ability to understand they have a medical problem, a neurological disorder known as anosognosia often associated with Alzheimer's disease. In a study published today in Neurology, Dr. Pedro Rosa-Neto's team from McGill's Translational Neuroimaging Laboratory shows that individuals who experience this lack of awareness present a nearly threefold increase in likelihood of developing dementia within two years.
Joseph Therriault, a master's student in McGill's Integrated Program in Neuroscience and lead author of the paper drew on data available through the Alzheimer's Disease Neuroimaging Initiative (ADNI), a global research effort in which participating patients agree to complete a variety of imaging and clinical assessments.
Therriault analysed 450 patients who experienced mild memory deficits, but were still capable of taking care of themselves, who had been asked to rate their cognitive abilities. Close relatives of the patient also filled out the similar surveys. When a patient reported having no cognitive problems but the family member reported significant difficulties, he was considered to have poor awareness of illness.

Anosognosia is linked to Alzheimer's disease pathophysiology

Researchers then compared the poor awareness group to the ones showing no awareness problems and found that those suffering from anosognosia had impaired brain metabolic function and higher rates of amyloid deposition, a protein known to accumulate in the brains of Alzheimer's disease patients.
A follow up two years later showed that patients who were unaware of their memory problems were more likely to have developed dementia, even when taking into account other factors like genetic risk, age, gender and education. The increased progression to dementia was mirrored by increased brain metabolic dysfunction in regions vulnerable to Alzheimer's disease.
The finding provides crucial evidence about the importance of consulting with the patient's close family members during clinical visits.
"This has practical applications for clinicians: people with mild memory complaints should have an assessment that takes into account information gathered from reliable informants, such as family members or close friends," says Dr. Serge Gauthier, co-senior author of the paper and Professor of Neurology & Neurosurgery, Psychiatry and Medicine at McGill.
"This study could provide clinicians with insights regarding clinical progression to dementia," adds Dr. Rosa-Neto, co-senior author of the study and clinician scientist and director of the McGill Center for Studies in Aging, a research center affiliated with the Montreal West Island IUHSSC.
The scientists are now taking this research further by exploring how awareness of illness changes across the full spectrum of Alzheimer's disease, and how these changes are related to critical Alzheimer's biomarkers.

More information: Joseph Therriault et al. Anosognosia predicts default mode network hypometabolism and clinical progression to dementia, Neurology (2018). DOI: 10.1212/WNL.0000000000005120


Provided by McGill University

Everyday activities associated with more gray matter in brains of older adults

Rush University College of Nursing researcher Shannon Halloway, PhD and patient. 

Higher levels of lifestyle physical activity - such as house cleaning, walking a dog and gardening, as well as exercise - are associated with more gray matter in the brains of older adults, according to a study by researchers at Rush University Medical Center. The Journal of Gerontology: Psychological Sciences will publish the study's findings on Feb. 14.

15 feb 2018--The gray matter in the brain includes regions responsible for controlling muscle movement, experiencing the senses, thinking and feeling, memory and speech and more. The volume of gray matter is a measure of brain health, but the amount of gray matter in the brain often begins to decrease in late adulthood, even before symptoms of cognitive dysfunction appear.
"More gray matter is associated with better cognitive function, while decreases in gray matter are associated with Alzheimer's disease and other related dementias," said Shannon Halloway, PhD, the lead author of the Journal of Gerontology paper and the Kellogg/Golden Lamp Society Postdoctoral Fellow in the Rush University College of Nursing. "A healthy lifestyle, such as participating in lifestyle physical activity, is beneficial for brain health, and may help lessen gray matter atrophy (decreases)."

Study used accelerometer to measure activity of 262 older adults

The study measured the levels of lifestyle physical activity by 262 older adults in Rush's Memory and Aging Project, an ongoing epidemiological cohort study. Participants are recruited from retirement communities and subsidized housing facilities in and around Chicago to participate in annual clinical evaluations and magnetic resonance imaging (MRI) scans, and to donate their brains and other parts of their bodies for research after their deaths.
Participants in the lifestyle study wore a non-invasive device called an accelerometer continuously for seven to ten days. The goal was to accurately measure the frequency, duration and intensity of a participant's activities over that time.
Lifestyle physical activity is "more realistic for older adults" than a structured exercise program that might require them to go to a gym, according to Halloway.
"Accessibility becomes an issue as one ages," Halloway said. "Transportation can be a problem. Gym settings can be intimidating for any individual, but especially so for older adults."

Accelerometers provide more precise measures of activity

The use of accelerometers was only one of the ways in which this analysis differed from some other investigations of the health of older people. Most research that explores the effects of exercise relies on questionnaires, which ask participants to "self-report" their levels of activity, Halloway said. She added that questionnaires tend to ask in a fairly non-specific fashion about types and intensity of exercise.
The real problem with questionnaires, though, is that "sometimes, we get really inaccurate reports of activity," Halloway acknowledged. "People commonly over-estimate, and on the flip side, some underestimate the lifestyle activity they're getting from things they don't consider exercise, like household chores, for example."
As to the accelerometer, she says, "it's not as commonly used (in studies of exercise) as we would like," even though accelerometers provide more precise results than self-reporting.

Study provided insights into activity levels of people past 80

Another departure in Halloway's study from some other investigations was the opportunity she had to assess the effects of exercise on individuals older than 80. In fact, the mean age in this study was 81 years, compared with 70 years for other studies Halloway used as a reference.
"One great strength of the Rush Alzheimer's Disease Center is its amazing ability to follow up with participants, and its high retention rates of participants," Halloway says. As a result, the Memory and Aging Project captures a number of participants in that older age group.
However, no one was included in Halloway's analysis who had a diagnosis or symptoms of dementia, or even mild cognitive impairment; a history of brain surgery; or brain abnormalities such as tumors, as seen on MRIs.
The study compared gray matter volumes as seen in participants' MRIs with readings from the accelerometers and other data, which all were obtained during the same year. Halloway's analysis found the association between participants' actual physical activity and gray matter volumes remained after further controlling for age, gender, education levels, body mass index and symptoms of depression, all of which are associated with lower levels of gray matter in the brain.
"Our daily lifestyle physical activities are supportive of brain health, and adults of all ages should continue to try and increase lifestyle physical activity to gain these benefits," Halloway said. "Moving forward, our goal is to develop and test behavioral interventions that focus on lifestyle physical activity for older adults at increased risk for cognitive decline due to cardiovascular disease."


Provided by Rush University Medical Center

Pimavanserin: Relief from psychosis in dementia, without devastating side-effects

Clive Ballard, Professor of Age-Related Diseases, University of Exeter Medical School.

A new kind of antipsychotic has been found to relieve terrifying and disturbing symptoms suffered by millions of people with Alzheimer's disease worldwide.

14 feb 2018--New research led by the University of Exeter Medical School, and published today in Lancet Neurology found that pimavanserin significantly improves psychosis symptoms in people with the condition, without the devastating side-effects of currently-used antipsychotics. The research found an even greater benefit in those with the most severe psychotic symptoms.
Up to half of the 45 million people worldwide who are living with Alzheimer's disease will experience psychotic episodes, a figure that is even higher in some other forms of dementia. Psychosis is linked to a faster deterioration in dementia.
Currently there is no approved safe and effective treatment for these distressing symptoms. In people with dementia, widely-used antipsychotics lead to sedation, falls and can double the speed at which brain function deteriorates. Their use increases risk of falls, and leads to 1,660 unnecessary strokes and 1,800 unnecessary deaths in the UK every year. Despite all of these negative effects they have very little benefit in improving psychosis in people with dementia Pimavanserin works differently to other antipsychotics, by blocking a very specific nerve receptor (THT2A) in the brain. Now, it has been found to effectively reduce symptoms of psychosis in people with Alzheimer's disease without the damaging effects of other antipsychotics.
Clive Ballard, Professor of Age-Related Diseases at the University of Exeter Medical School, who led the research, said: "Psychosis is a particularly terrifying symptom of Alzheimer's disease. People may experience paranoia, or see, hear or smell things that are not there. It's distressing both for those experiencing the delusions and for their carers.
"It's particularly encouraging that most benefit was seen in those with the most severe psychotic symptom, as this group is most likely to be prescribed antipsychotics. We are talking about vulnerable elderly, frail people who are suffering terrifying symptoms, being sedated with current antipsychotics even though its well known that they cause terrible health issues and even death in people with dementia, and have very little benefit. We urgently need to do better by them, and our encouraging results provides hope. We're delighted that our results have led to a larger phase 3 clinical trial which is now ongoing." The findings are the result of a double-blind, placebo-controlled exploratory trial designed to evaluate the efficacy and safety of pimavanserin in 181 patients with Alzheimer's disease psychosis, with 90 of them given pimavanserin and 90 of them on a placebo. Its safety and efficacy in reducing psychotic symptoms in dementia is now being assessed in a larger-scale clinical trial in the US.
The results build on previous research that found pimavanserin was effective for people with dementia related to Parkinson's disease. Pimavanserin has been approved for use by the Food and Drug Administration (FDA) in the US for this purpose, but has not yet been submitted for approval to the European equivalent, the European Medicines Agency.
Previously, the Alzheimer's Society said it is "imperative" that it goes through European approval processes for Parkinson's Disease Dementia.
Pimavanserin is currently the subject of a Phase III trial In the US to assess its safety in a wider group, and to see if it can prevent relapse of psychotic symptoms in some of the most common forms of dementia.
The paper, Evaluation of the efficacy, tolerability, and safety of pimavanserin versus placebo in patients with Alzheimer's disease and psychosis: phase 2, randomised, placebo-controlled, double blind study, is published today in Lancet Neurology.


Provided by University of Exeter

New study highlights the impact companion animals have on owners

A new study, published in BMC Psychiatry, conducted by researchers from the universities of Liverpool, Manchester and Southampton, suggests that pets provide benefits to those with mental health conditions.

11 feb 2018--There is increasing recognition of the therapeutic function pets can play in relation to mental health. However, there has been no systematic review of the evidence related to the comprehensive role of companion animals and how pets might contribute to the work associated with managing a long-term mental health condition.
The study, led by Dr Helen Brooks from the University of Liverpool's Institute of Psychology, Health and Society, aimed to explore the extent, nature and quality of the evidence implicating the role and utility of pet ownership for people living with a mental health condition.

Positive, negative and neutral impacts

The study team systematically reviewed 17 international research papers, to identify the positive, negative and neutral impacts of pet ownership.
The research highlighted the 'intensiveness' of connectivity people with companion animals reported, and the multi-faceted ways in which pets contributed to the work associated with managing a mental health condition, particularly in times of crisis.
The negative aspects of pet ownership were also highlighted, including the practical and emotional burden of pet ownership and the psychological impact that losing a pet has.

Support

Dr Brooks, said: "Our review suggests that pets provide benefits to those with mental health conditions. Further research is required to test the nature and extent of this relationship, incorporating outcomes that cover the range of roles and types of support pets confer in relation to mental health and the means by which these can be incorporated into the mainstay of support for people experiencing a mental health problem."

More information: The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence, DOI: 10.1186/s12888-018-1613-28-018-1613-2 , https://link.springer.com/article/10.1186%2Fs12888-018-1613-2


Provided by University of Liverpool

Talking to doctors about your bucket list could help advance care planning

For physicians, asking patients about their bucket lists, or whether they have one, can encourage discussion about making their medical care fit their life plans, according to a study by researchers at the Stanford University School of Medicine.

10feb 2018--A bucket list is a list of things you'd like to do before you die, like visiting Paris or running a marathon. It's a chance to think about the future and put lifelong dreams or long-term goals down on a piece of paper.
For doctors, knowing their patients' bucket lists is a great way to provide personalized care and get them to adopt healthy behaviors, said VJ Periyakoil, MD, clinical associate professor of medicine, who said she that she routinely asks her patients if they have a bucket list.
"Telling a patient not to eat sugar because it's bad for them doesn't work nearly as well as saying, for example, if you are careful now, you will be able to splurge on a slice of wedding cake in a few months when your son gets married," Periyakoil said.
The study will be published Feb. 8 in the Journal of Palliative Medicine. Periyakoil, an expert in geriatrics and palliative care, is lead author.
The researchers, who surveyed 3,056 participants across the United States, found that by far the majority of respondents—91 percent—had made a bucket list. Survey results also showed that respondents who reported that faith and spirituality were important to them were more likely to have made a bucket list. The older the respondents were, the more likely they were to have a bucket list, and, not surprisingly, those younger than 26 tended to include more "crazy things" on their lists, such as skydiving.

Bucket list categories

Six general themes tended to describe the items on respondents' bucket lists: 79 percent included travel; 78 percent included accomplishing a personal goal, such as running a marathon; 51 percent included achieving a life milestone, such as a 50th wedding anniversary; 16.7 percent included spending quality time with friends and family; 24 percent included achieving financial stability; and 15 percent included a daring activity.
"When you just Google the term 'bucket list,' it's huge how much interest there is in this," Periyakoil said. "It provides a very nice framework for thinking about your life goals, health and your mortality."
Past research has found that when doctors talk to patients—especially those with chronic or terminal illnesses—about the patients' goals for future care, it can be a vital part of the advance-care planning process. But it's often awkward to have these conversations, particularly when they are about the end of life, the study said.
"If a patient wants to attend a beloved grandchild's wedding or travel to a favored destination, treatments that could potentially prevent her from doing so should not be instituted without ensuring her understanding of the life impact of such treatments," the study said.
Discussing a patient's bucket list is just a good way to start these conversations, Periyakoil said. Most people are far more open to talking about their life's goals in this context before filling out an advance directive, a written statement of a person's wishes regarding medical treatment at the end of life, Periyakoil said.

'Find out what actually motivates them'

"It's important for physicians to talk to patients and find out what actually motivates them," she said. She encourages both doctors and patients to bring up the topic of a bucket list. By discussing how a treatment or surgery might affect the patient's life, and then discussing what the patient's goals are, the best possible care plan can be laid out, she said.
"I had a patient with gall bladder cancer," Periyakoil said. "He was really stressed because he wanted to take his family to Hawaii but had treatment scheduled. He didn't know he could postpone his treatment by two weeks. When doctors make recommendations, patients often take it as gospel."
After an informed discussion about his options and the side effects of the cancer treatments, he and his physician decided to postpone the treatment. He made the trip to Hawaii with his family, then returned to start cancer treatments, the study said.
"Patients don't see the relevance of an advance directive," said Periyakoil. "They do see the relevance of a bucket list as a way to help them plan ahead for what matters most in their lives."

More information: Vyjeyanthi S. Periyakoil et al, Common Items on a Bucket List, Journal of Palliative Medicine (2018). DOI: 10.1089/jpm.2017.0512


Provided by Stanford University Medical Center

Blood sodium levels may affect cognition in older adults

A new study has found that lower level of sodium in the blood—known as hyponatremia—is linked with declines in cognitive function with advancing age. The results, which are described in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), raising the possibility that addressing sodium levels may help preserve cognition as individuals age.

09 feb 2018--Hyponatremia occurs when the sodium level in the blood falls below 135 mmol/L. Mild hyponatremia was once thought to be asymptomatic, but recent studies suggest that it may be associated with higher risks of attention deficits, gait disturbances, falls, cardiovascular events, and even premature death. Severe hyponatremia has been linked with cognitive impairment and neurological disturbances, but the association between different levels of serum sodium and cognition in older adults had been uncertain.
To investigate, Kristen Nowak, PhD, MPH (University of Colorado Anschutz Medical Campus) and her colleagues examined information on 5435 asymptomatic community-dwelling men aged >65 years who were followed for a median of 4.6 years. A total of 100 men had serum levels indicative of hyponatremia.
The researchers found that slightly lower sodium levels in the blood were related to both cognitive impairment and declines in cognitive function over time. Compared with men with sodium levels of 141-142 mmol/L, men with levels of 126-140 mmol/L were 30% more likely to have cognitive impairment at baseline and 37% more likely to experience cognitive decline over time. The investigators also found an association of high serum sodium (143-153 mmol/L) with cognitive decline over time.
"Slightly lower sodium levels in the blood are likely to be unnoticed in clinical practice," said Dr. Nowak. "Because both slightly lower serum sodium levels and mild changes in cognitive function are common occurrences with advancing age, future research on this topic is important—including determining whether correcting lower sodium levels affects cognitive function."

More information: "Serum Sodium and Cognition in Older Community-Dwelling Men," Clinical Journal of the American Society of Nephrology (2018). DOI: 10.2215/CJN.07400717


Provided by American Society of Nephrology

AHA names top heart disease and stroke research advances of 2017

New medicines to fight heart disease, updated guidelines for strokes and high blood pressure, and research into genome editing are among the top heart disease and stroke advances in 2017, according to the American Heart Association and American Stroke Association.

08 feb 2018--The AHA, one of the top funders of heart- and stroke-related research worldwide, has been compiling an annual top 10 list of major advances in heart disease and stroke science since 1996. Here, in no particular order, are the organization's picks for leading research accomplishments published in 2017.

Advancing the treatment of strokes

Following publication in 2017 of the DAWN study in The New England Journal of Medicine showing benefits of mechanical clot removal for longer periods after a stroke starts, the AHA/ASA released new guidelines for treating acute ischemic stroke. The guidelines were released at the International Stroke Conference in January 2018 and included additional data from DEFUSE 3, also presented at the meeting.
The new guidelines, published in the journal Stroke, say the clot-removal treatment window may be increased from six hours to up to 24 hours for specific patients who have clots in large vessels in the brain. The guidelines also increase the number of patients who will have access to a clot-dissolving drug proven to lower the chances for disability. The guidelines reiterated the need for fast action when a person shows the symptoms of a stroke, the second-leading cause of death in the world and a leading cause of disability.

Fixing a gene mutation in human embryos

A study in Nature suggests genome editing could be used to correct disease-causing mutations in the heart muscle of human embryos. Researchers focused on the MYBPC3 gene – which provides instructions for making a protein found in heart muscle cells and causes a form of inherited hypertrophic cardiomyopathy – and used new approaches to allow safe and accurate correction of the abnormal gene.
While early, this research furthers the potential for genome editing to correct mutations that pass from parent to child.

A deeper understanding of heart health for those living in food deserts

Health researchers have focused a lot in recent years on so-called food deserts: low-income neighborhoods with low access to healthy food. But a new study found that it's not so much the "desert" itself as it is low income in general that is linked to poor heart health.
The study, in Circulation: Cardiovascular Quality and Outcomes, studied food deserts in metro Atlanta and found people who live there have higher rates of cardiovascular risk factors such as oxidative stress, inflammation and arterial stiffness. However, researchers concluded these associations are mostly due to low income of the area and its residents rather than proximity to a grocery store – a finding which could impact the future use of public health resources in poor neighborhoods.

Cholesterol-lowering drug cuts risk of heart attacks and strokes

A study in The New England Journal of Medicine found that the new injectable cholesterol-lowering drug evolocumab can reduce heart attacks and strokes among high-risk patients. The FOURIER study – paid for by Amgen, which makes and sells the PCSK9 inhibitor evolocumab under the brand name Repatha – showed that the drug cut the risk of having a heart attack, stroke or dying from a cardiovascular cause by 20 percent when added to intensive statin therapy.
The study reported that Repatha lowered "bad" LDL cholesterol by about 60 percent, to a median of 30.

SGLT2 inhibitors may lower rates of death and heart failure for people with diabetes

A large international study in Circulation showed lower rates of death and heart failure for diabetes patients treated with the SGLT2 inhibitors canagliflozin, dapagliflozin or empagliflozin, compared with other glucose-lowering drugs. The CVD-REAL study – paid for by AstraZeneca, which markets dapagliflozin under the brand name Farxiga – looked at more than 300,000 patients with Type 2 diabetes in the U.S., the U.K., Denmark, Norway and Sweden. The results suggest SGLT2 inhibitors may benefit a broad population of patients with Type 2 diabetes.

Improved therapy for treating patients with peripheral artery disease

According to a study in The Lancet, combining low doses of the blood thinner rivaroxaban and aspirin is more effective than aspirin alone in preventing cardiovascular deaths, heart attacks, strokes and major amputations for people with peripheral artery disease, or PAD.
The 33-country COMPASS study looked at 7,470 patients with PAD, a narrowing of the peripheral arteries to the legs, arms, stomach and head. Although major bleeding increased with the combination therapy, fatal or critical organ bleeding did not. Researchers said the new approach is a major advance in treating patients with peripheral artery disease.

A new treatment for fighting inflammation and reducing cardiovascular events

Scientists have long believed that reducing inflammation may reduce the risk of heart disease. The CANTOS study published in The New England Journal of Medicine looked at more than 10,000 high-risk patients who previously had heart attacks and found that canakinumab, a monoclonal antibody that targets interleukin-1 beta and blocks inflammation, significantly lowered their rate of having or dying from a heart attack, stroke or other cardiovascular cause. Although the drug did not reduce overall deaths from any cause and was associated with significant side effects, the principle underlying the use of a specific anti-inflammatory antibody is important.

Catheter-based procedure extended for more patients with aortic stenosis

Aortic stenosis – a narrowing of the aortic valve opening – is a common and serious valve disease problem. For patients with severe aortic stenosis at high risk for surgical complications, a procedure called transcatheter aortic-valve replacement, or TAVR, that can be done through a catheter rather than with open-heart surgery, is already an accepted alternative.
The SURTAVI study in The New England Journal of Medicine looked at severe aortic stenosis patients at intermediate risk for complications from surgery and found TAVR to be a viable alternative for them as well.


Provided by American Heart Association

Dementia care improved by just one hour of social interaction each week

Increasing the amount of social interaction for people with dementia living in care homes to just one hour a week improves quality of life when combined with personalised care.
A large-scale trial led by the University of Exeter, King's College London and Oxford Health NHS Foundation Trust found that the approach also saves money.

07 feb 2018--Previous research has found that in many care homes, residents have as little as two minutes of social interaction per day.
The new research, funded by the National Institute of Health Research and published today in the journal PLOS Medicine, upskilled key care home staff to deliver person-centred care. That involves simple measures such as talking to residents about their interests and involving them in decisions around their own care.
When combined with just one hour a week of social interaction, the programme improved quality of life and reduced agitation and aggression in people with dementia.
Professor Clive Ballard, of the University of Exeter Medical School, who led the research, said: "While many care homes are excellent, standards still vary hugely. We have previously found that the average amount of social interaction for people with dementia was just two minutes a day. It's hardly surprising when that has a knock-on effect on quality of life and agitation.
"Our approach improves care and saves money. We must roll out approaches that work to do justice to some of the most vulnerable people in society. Incredibly, of 170 carer training manuals available on the market, only four are based on evidence that they really work. That is simply not good enough - it has to change."
The trial involved more than 800 people with dementia across 69 care homes in South London, North London and Buckinghamshire. Two 'care staff champions' at each home were trained over four day-long sessions, to take simple measures that such as involve talking to residents about their interests and decisions around their own care. Importantly, the approach also saved money compared to standard care. Researchers say the next key challenge is to roll the programme to the 28,000 care homes in the UK to benefit the lives of the 300,000 people with dementia living in these facilities.
Dr Jane Fossey from the Oxford Health NHS Foundation Trust, said: "Taking a person-centred approach is about getting to know each resident as an individual - their interests and preferences - and reflecting these in all aspects of care. It can improve the lives of the person themselves and it can be rewarding for carers too. We've shown that this approach significantly reduces agitation and saves money. Rolling out the training nationwide could benefit many other people."
The results are the findings of the Improving Wellbeing and Health for People with Dementia (WHELD) trial, the largest non-pharmacological randomised control trial in people with dementia living in care homes to date.
Dr Doug Brown, Director of Research at Alzheimer's Society, said: "70% of people living in care homes have dementia, so it is vital that staff have the right training to provide good quality dementia care.
"A person-centred approach takes into account each individual's unique qualities, abilities, interests, preferences and needs. This study shows that training to provide this type of individualised care, activities and social interactions can have a significant impact of the well-being of people living with dementia in care homes. It also shows that this kind of effective care can reduce costs, which the stretched social care system desperately needs.
"Alzheimer's Society is committed to improving dementia care through research. That means getting interventions like this put into practice, and funding further research to improve the quality of life for people with dementia in their own homes, care homes and hospitals."


Provided by University of Exete

Deep brain stimulation may be promising Alzheimer's treatment

For patients with Alzheimer's disease (AD), the use of deep brain stimulation (DBS) at the ventral capsule/ventral striatum (VC/VS) region is well tolerated and is associated with less decline on the Clinical Dementia Rating-Sum of Boxes (CDR-SB), according to a study published online Jan. 30 in the Journal of Alzheimer's Disease.

06 feb 2018--Douglas W. Scharre, M.D., from The Ohio State University Wexner Medical Center in Columbus, and colleagues conducted a non-randomized phase I prospective open label intervention trial of three AD patients with matched comparison groups. The CDR-SB was compared for AD participants given DBS for at least 18 months at the VC/VS target to matched groups without DBS from the AD Neuroimaging Initiative cohort. In addition, over time, AD participants' serial 2-deoxy-2-[¹⁸F]fluoro-D-glucose (FDG) positron emission tomography (PET) images were compared longitudinally.
The researchers found that DBS was well tolerated by all participants, without significant adverse events. Relative to matched comparison groups, all three participants had less performance decline, and two had meaningfully less decline over time on CDR-SB using score trajectory slopes. After chronic DBS at the VC/VS target, minimal changes or increased metabolism were seen on FDG-PET in frontal cortical regions.
"The first use of DBS in AD at a frontal lobe behavior regulation target (VC/VS) was well tolerated and revealed less performance decline in CDR-SB," the authors write. "Frontal network modulation to improve executive and behavioral deficits should be furthered studied in AD."

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

Disrupted rest and activity patterns could be an early indicator of Alzheimer's

Scientists from the US have found a link between certain biological fingerprints thought to indicate early stages of Alzheimer's and sleep disturbances. Their findings are published today in JAMA Neurology.
Links between poor sleep and dementia have been known of for some time but teasing out the precise cause and effect relationship is difficult – does poor sleep contribute to developing dementia, or is it that poor sleep is an early indicator of the condition?

04 feb 2018--To try to understand this relationship, a team of researchers from Washington University studied a group of 186 volunteers, using wearable activity monitors (actigraphy) day and night to measure periods of rest and activity as this group went about their normal daily lives in their homes. The study participants were all over the age of 45 (mean age, 66), and did not have any problems with memory or thinking. Participants (155 people) had donated samples of spinal fluid, in which the researchers measured the levels of two Alzheimer's proteins, tau and amyloid. Some participants (142 people) had also undergone specialised brain scans to measure the level of amyloid in their brain, called a PiB-PET scan.
The researchers found that increasing age was linked with decreased sleep quality, shown by a fragmenting of normal rest-activity patterns, such as increased napping during the day and being awake during the night. Looking at the brain scans, the researchers set a level to determine which scans showed amyloid build-up, finding 26 people showed amyloid high levels of amyloid in their brains and 116 people did not.
When they compared the two groups, the scientists found that people with amyloid build-up showed more fragmented rest-activity patterns, even when age and sex were taken into account. Similarly, people with an increased ratio of tau to amyloid in their spinal fluid, indicative of early Alzheimer's changes, were also found to have fragmented rest-activity patterns.
Dr. David Reynolds, Chief Scientific Officer at Alzheimer's Research UK, said:
"Research has faced a bit of a chicken and egg situation when looking at the links between sleep and dementia. While we know that people with Alzheimer's experience disturbed sleep patterns, whether this contributes to the disease or is an early consequence has been unclear. This study observes changes in daily rest and activity patterns at an early stage, where people are showing signs of Alzheimer's in the brain but before symptoms begin.
"In the past, studies have used sleep diaries to look at the links between sleep and health conditions, but the development of wearable activity monitors is helping researchers gain deeper and more accurate insight into the factors at play. We can't conclude from this study that napping more during the day can lead to dementia, and future studies will need to follow volunteers over longer periods of time. Studies like this add new pieces to the jigsaw of our understanding, and could lay the groundwork for new ways to detect the condition earlier, focusing on a range of factors and not just memory and thinking tests."


Provided by Alzheimer's Research UK

Low carb, Paleo or fasting – which diet is best?

At this time of year, we are bombarded with books and TV shows telling us what we should be eating and how best to lose weight. Particularly in vogue are low-carb diets, Paleo diets and intermittent fasting diets. But which diet is the most effective for sustained weight loss – not to mention good health?

01 feb 2018--First, let's look at low-carb diets, which include Atkins, Dukan and, more recently, the Pioppi diet. The argument behind these diets is that carbohydrates are bad for us because they are broken down into glucose, which stimulates the release of insulin, and insulin helps the body store the energy from food as fat – especially around our middles.
What is missed in this argument is that it is not only carbohydrates that encourage us to make insulin. Foods high in protein and fat do this, too. Beef, for example, increases insulin to a similar level as breakfast cereals.
Related to low-carb diets are the evolutionary-type approaches, such as the caveman diet and the Paleo diet. These diets recommend shunning processed foods and following a diet similar to that of our ancestors in the Paleolithic period – a period that began about 2.6m years ago and ended about 12,000 years ago.
Definitions of this diet vary, but they tend to exclude grains, which often results in a low-carbohydrate diet. Dairy products are also avoided. Both low-carb and Paleo diets encourage eating plenty of fresh food, including vegetables, and little or no highly processed food.
Evidence suggests that low-carb diets can help you lose weight, reduce your risk of type 2 diabetes and, perhaps, your risk of heart disease. However, these three potential benefits are largely linked to the energy restriction they cause and are not directly related to avoiding carbohydrates.
The reason for the drop in energy (calorie) intake is that carbohydrates normally make up a large part of the Western diet. Banishing carbs makes it difficult to make up for the lost energy intake because the food industry is geared to providing plenty of carbohydrate-rich foods.
Other studies suggest that eating protein and fat keep you feeling full for longer, and may suppress appetite that way. However, more research is needed to prove this theory.
There is some evidence that a low-carb diet can help you lose weight, for up to six months. And a study of people with type 2 diabetes suggests that it can help reduce the need for diabetes medication, even after two years.
The news is not all positive, though. Paleo diets, in particular, can cause side effects, such a diarrhoea, headaches and weakness. And both Paleo and low-carb diets tend to be more expensivethan a regular healthy diet (as per government guidelines), and require careful planning to meet nutritional needs.

The Eatwell guide.

Fasting

Intermittent fasting diets, such as the 5:2 diet and the warrior diet, are another recent fad. They usually involve going for 14 to 36 hours with few or no calories.
The 5:2 diet involves eating a normal amount of calories for five days of the week and eating reduced calories (25% of normal calorie intake) on two non-consecutive days. The warrior diet involves eating just one large meal a day.
These types of diets have been shown to result in weight loss. In a study published in the International Journal of Obesity, the 5:2 diet not only resulted in a loss of over 6kg, on average, in overweight and obese women, over a six-month period, it also improved several important markers of health, including LDL cholesterol, triglycerides and blood pressure.
The important thing for people embarking on fasting diets to remember is: you need to meet all of your nutritional needs, as per the UK government's Eatwell guide.
The diets we've discussed almost all recommend eating more vegetables and less sugar, refined carbohydrates and highly processed foods. The advocates of these diets differ on the role of fats and carbohydrates, but they all encourage people to think more about food and take control of the food they eat.

Reclaiming the word 'diet'

The evidence seems clear, most diets are equally effective when it comes to weight loss. The important thing is to find a diet that works for you – one you can enjoy in the long term.
Perhaps we need to remember the origins of the word diet, coming from the Greek "diata", meaning way of life. This meaning has been adapted over time to mean a restriction. It's time we reclaim the word diet for its true meaning, and look to find ways of eating that are both enjoyable and improve health.
What we have learned from countries where people live long and healthy lives is that they tend not to focus on specific diets – counting calories, fussing about carbs – instead they eat local produce that is affordable and enjoyable.

This article was originally published on The Conversation. Read the original article.

Provided by The Conversation