One in 20 cases of dementia occurs in people under 65

by Amy Norton Healthday Reporter

Dementia is largely a disease of old age, but a new study finds that up to 5% of all cases are among people in the prime of their lives.

21 july 2021--Looking at 95 international studies, researchers estimated that nearly 4 million people worldwide are living with young-onset dementia—cases that strike between the ages of 30 and 64.

In the United States, an estimated 175,000 people have the condition, accounting for roughly 3% of all dementia cases nationwide.

In context, that means young-onset dementia is rare, said Dr. David Knopman, a neurologist who specializes in dementia care at the Mayo Clinic in Rochester, Minn.

But it's important for people, including doctors, to be aware that dementia can arise unusually early in life, Knopman said.

Because young-onset dementia is so uncommon, he noted, most doctors—including neurologists—have little or no experience in diagnosing it.

And since dementia is typically associated with aging, it's natural to attribute younger people's memory issues to conditions that are far more common in their age group.

"Their symptoms are often chalked up to depression or anxiety," said Knopman, who wrote an editorial published with the study July 19 in JAMA Neurology.

"And to be fair," he added, "most memory complaints in younger patients probably are related to those conditions."

However, Knopman said, some red flags include symptoms that are "pervasive" and worsen over time. The "breadth" of the symptoms also matters, he noted: "Are there cognitive complaints that go beyond memory lapses?"

"Cognitive" symptoms include an array of problems related to thinking, reasoning, judgment and learning.

While young-onset dementia is far less common than the typical "late-onset" form, the disease is particularly devastating.

"These people are in the prime of their lives," Knopman said. They and their spouses have jobs, children and, often, elderly parents to care for.

That means they need health care and other services that meet their specific needs, said Stevie Hendriks, one of the researchers on the new study.

Given that, Hendriks and colleagues at Maastricht University's Alzheimer Center Limburg in the Netherlands wanted to get clearer figures on just how many people are living with young-onset dementia.

After analyzing dozens of previously published studies, they estimated there are 119 cases of young-onset dementia per 100,000 people worldwide. That translates to 3.9 million people living with the disease.

Based on the global prevalence of dementia, the young-onset form may account for about 5% of all cases, according to Knopman.

Not surprisingly, Hendriks' team found, dementia was exceedingly rare among the youngest adults, at roughly 1 case per 100,000 among 30- to 34-year-olds. People in their early 60s had the highest prevalence—about 77 cases per 100,000.

Unfortunately, people with young-onset dementia typically go for years without a diagnosis. One published study found that it took an average of 4.5 years—versus just under three years among older adults with dementia.

Hendriks agreed that lack of awareness and experience among doctors likely help explain that.

But young-onset dementia can also be difficult to diagnose, Hendriks added—even for specialists.

"We see that the first symptoms in young people are usually not the symptoms you would expect when you think of dementia," Hendriks said. "Instead of memory impairment, young people more often present with changes in behavior or emotions, or sometimes language problems."

That can lead to misdiagnoses of not only depression, but also "burnout" or even relationship problems, Hendriks noted.

As for the causes of early dementia, they include the same culprits seen in late-onset—namely, Alzheimer's disease and vascular conditions, like stroke, that impair blood flow to the brain.

But another rare type of dementia, frontotemporal dementia, is most often diagnosed at a younger age. That disease is inherited in about one-third of cases, according to the Alzheimer's Association.

Because young-onset dementia is uncommon, finding specialized services is often a challenge, too, Knopman said. When the time comes for a care facility, for example, it can be hard to find an opening for a younger patient. Families may need to place a loved one in a center hours from home.

One good resource for families, Knopman said, is their local chapter of the Alzheimer's Association. Among its services are support groups for caregivers of people with young-onset dementia.

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More information: The Alzheimer's Association has more on young-onset dementia.

 

Older people are worse at learning to self-help, but just as good learning to help others

by University of Birmingham

Credit: Pixabay/CC0 Public Domain

Older adults may be slower to learn actions and behaviors that benefit themselves, but new research shows they are just as capable as younger people of learning behaviors that benefit others.

21 july 2021--Researchers at the Universities of Birmingham and Oxford found that youngsters, in contrast, tend to learn much faster when they are making choices that benefit themselves.

The study, published in Nature Communications, focused on reinforcement learning—a fundamental type of learning in which we make decisions based on the positive outcomes from earlier choices. It allows us to adapt our choices to our environment by learning the associations between choices and their outcomes.

Dr. Patricia Lockwood is senior author on the paper at the University of Birmingham's School of Psychology and Centre for Human Brain Health. She said: "Reinforcement learning is one of the key ways in which humans—as well as animals and even plants—learn from and adapt to their environment."

"We need to make decisions and learn all the time based on the positive or negative feedback we receive. This allows us to optimize our choices to choose the best course of action in the future from many possible alternatives. We find that older adults are worse than younger adults at learning from positive feedback on their own behavior. However, surprisingly, when making choices that give positive feedback—money—to another person, older adults are just as good as younger adults".

In the study, the team worked with 80 younger and 80 older participants. They were each asked to make a series of choices between two symbols on a computer screen. After each selection, they received feedback on whether they got reward points from the selection they had made.

On some rounds, points translated into increased money for the participant, in others they translated into money for someone else. In a third, control condition, participants could get points but these weren't worth money for anyone.

The results revealed that, on average, the older group learned to choose the most advantageous option more slowly than the younger group when their selections would only benefit themselves. However, when making choices on behalf of another person, older people learned equally as fast as the younger group. Across all age groups, the researchers found that learning was slowest when the points weren't worth anything.

Dr. Jo Cutler, lead author and also at the University of Birmingham, said: "We recognize that in general, cognitive processes and learning ability tend to get worse as people get older. So it's really interesting to see that when making choices that will benefit others, older adults' learning ability is preserved. By better understanding what motivates older people in this way, we can contribute to strategies that promote healthy aging."

The research program also yielded some surprising findings in terms of differences between the young and older adults in psychopathic traits, including lack of empathy and concern for others. The team found that these characteristics were lower in older adults, suggesting psychopathic traits are not fixed across a person's lifespan, but may tail off as we age. In older adults, their level of psychopathic traits explained differences in learning speed specifically when they were learning to benefit others.

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More information: Cutler, J., Wittmann, M. K., Abdurahman, A., Hargitai, L., Drew, D., Husain, M. & Lockwood., P. L. (2021) (2021). Ageing is associated with disrupted reinforcement learning whilst learning to help others is preserved. Nature Communications, DOI: 10.1038/s41467-021-24576-w

Provided by University of Birmingham

 

A team is developing a new, inexpensive way to heal chronic wounds

by Michigan State University

An illustrated schematic shows a potential configuration of the clear bandage that molds to the shape of a wound, which is also part of the illustration that penetrates pink skin tissue and exposes red blood vessels. Insets magnify proteins (green triangles labeled FSTL-1) that help blood vessels regenerate, iron oxide nanoparticles (red orbs labeled SPIONs) that fight bacteria and stimulate immune cells (larger orbs labeled M1 and M2) and peptides (blue crosses) that prevent the immune response from becoming too aggressive. Credit: The Journal of Molecular Pharmaceutics

Tens of millions of patients around the world suffer from persistent and potentially life-threatening wounds. For these chronic wounds, which are also a leading cause of amputation, there are treatments, but the cost of existing wound dressings can prevent them from reaching people in need.

19 july 2021--Now, a Michigan State University researcher is leading an international team of scientists to develop a low-cost, practical biopolymer dressing that helps heal these wounds.

"The existing efficient technologies are far too expensive for most health care systems, greatly limiting their use in a timely manner," said Morteza Mahmoudi, an assistant professor in the Michigan State University College of Human Medicine and the Precision Health Program. "An economically accessible, practical and effective technology is needed."

To develop that new technology, Mahmoudi tapped into years of experience and expertise, having studied advanced materials to heal heart tissue, fight infections and support immune systems. But the team also kept an eye on cost, working to develop a product that could be made available to as many patients as possible, even in resource constrained markets.

"My goal is always to make something that works and is practical," Mahmoudi said. "I want to see my research become clinical products that help patients."

With his latest work, published July 19 in the journal Molecular Pharmaceutics, Mahmoudi is getting closer to that goal. He's working with partners in the United Kingdom who have started a company to oversee the development and approval of the new technology.

"We are building an experienced and expert team in the U.K. who will be able to efficiently commercialize the dressing," Mahmoudi said. "The company has just won a very competitive Eurostar grant to accelerate product development."

Working with his collaborators, Mahmoudi conducted a small pilot trial of the wound dressing with 13 patients with chronic wounds, all of whom were cured, he said.

Patients with advanced chronic wounds—those which do not respond to traditional therapies—are estimated to number over 45 million globally, making this one of the world's most pressing and urgent health care needs, Mahmoudi said.

The United States is home to about 5% of this population, yet more than 90% of the sales of "active" wound care technologies happen in the U.S. That essentially means that the rest of the world is left out, Mahmoudi said.

Venous leg ulcers and pressure ulcers associated with immobility in older and paralyzed patients are also major causes of chronic wounds, but perhaps the best-known examples of this type of injury being diabetic foot ulcers. Worldwide, there are more than 400 million people living with diabetes, and some studies have estimated that up to a quarter of those patients will develop foot ulcers within their lifetime.

Even with the high level of care available in the U.S., more than 30% of patients who develop a diabetic foot ulcer will die within five years of its onset. For reference, that percentage is higher than breast cancer, prostate cancer and colon cancer.

Diabetic foot ulcers also illustrate many of the reasons why chronic wounds can be so challenging to treat.

Patients with diabetes can be dealing with restricted blood flow and other factors that slow their immune response, compromising the body's ability to heal the wound on its own. They can also have nerve damage that dulls the wound's pain and can delay patients from seeking treatment. When wounds heal more slowly and stay open longer, bacteria have more opportunities to cause infections and lead to serious complications. Put bluntly, there's a lot going wrong in a chronic wound.

"Chronic wounds are some of the most complicated things doctors have to treat," Mahmoudi said. "If you want to make a dressing that works, it has to address all those problems. And in order to be relevant to the majority of patients in the world, it has to be easy to use, practical and inexpensive as well."

There are many technologies available to support healing in chronic wounds, but those that can stimulate tissue regeneration are typically derived from harvested natural tissues. This is complex and expensive, resulting in products that cost upwards of $1,000, putting them out of reach for many patients and health care systems.

To attack those problems, Mahmoudi drew on a wealth of experience in developing new materials for biomedical applications. By designing a product that can be manufactured from readily available biopolymers, production costs can be kept low, and the team could add various other materials to lead to improved healing.

The team starts with a flexible framework of nanofibers—exceedingly thin threads—of natural polymers, including collagen, a structural-support protein found in our skin and cartilage. The framework provides a three-dimensional scaffold that fosters cell migration and the development of new blood vessels, essentially replicating the function of the extracellular matrix, the natural support system found in healthy, living tissue.

"It's important that the physical and mechanical properties of the dressing are really close to that of skin," Mahmoudi said. "In order to heal, the new cells have to feel like they're at home."

To that framework, the team can incorporate proteins, peptides and nanoparticles that not only spur the growth of new cells and blood vessels but also fight off bacteria by encouraging a patient's own immune system to join the charge. (The team's experiences on these elements were documented in earlier publications in Nature Nanotechnology and Trends in Biotechnology).

The dressing also degrades over time, meaning that nobody would have to change or remove it and potentially aggravate the wound site. And at roughly $20 apiece, Mahmoudi believes that the dressings—if and when approved by regulatory agencies—will be affordable to even resource-strapped health care systems faced with treating these serious wounds.

Although there are many existing wound care products, Mahmoudi is optimistic that the new dressing will stand out thanks to its low cost, high performance and another piece of research he did years ago.

For this previous project, though, he wasn't developing any new technology. He was interviewing hundreds of health care workers around the U.S., asking them what they wanted and needed in a wound dressing.

"We developed this dressing to solve the problems they were having. One of the clinicians told me, "When you see too many products on the market, that means none of them works,'" said Mahmoudi, a researcher driven to make things that work.

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More information: Rahimeh B. Atashgah et al, Restoring Endogenous Repair Mechanisms to Heal Chronic Wounds with a Multifunctional Wound Dressing, Molecular Pharmaceutics (2021). DOI: 10.1021/acs.molpharmaceut.1c00400

Provided by Michigan State University 

 

'All the lonely people': The impact of loneliness in old age on life and health expectancy

by Federico Graciano, Duke-NUS Medical School

Credit: CC0 Public Domain

In 1966, The Beatles cemented the plight of lonely older people in the popular imagination with "Eleanor Rigby," a song that turned pop music on its head when it stayed at No. 1 on the British charts for four weeks. Today, the impact of loneliness in old age on life and health expectancy has been categorically quantified for the first time in a study by scientists at Duke-NUS Medical School (Singapore), Nihon University (Tokyo, Japan) and their collaborators, published in the Journal of the American Geriatrics Society.

18 july 2021--"We found that lonely older adults can expect to live a shorter life than their peers who don't perceive themselves as lonely," said the study's lead author, Assistant Professor Rahul Malhotra, head of research at Duke-NUS' Centre for Aging Research and Education (CARE). "Furthermore, they pay a penalty for their shorter life by forfeiting potential years of good health."

Associate Professor Angelique Chan, executive director of CARE and a senior author of the study, noted, "Besides being the year associated with the coronavirus disease, 2019 was also when the number of adults aged over 30 made up half the total global population for the first time in recorded history, marking the start of an increasingly aging world. In consequence, loneliness among seniors has become an issue of social and public health concern."

Research Project Professor Yasuhiko Saito, from the College of Economics, Nihon University, a senior co-author of the study, added, "This study is timely because stay-at-home and physical distancing measures instituted since the start of the COVID-19 pandemic have only intensified concern for the mental and physical well-being of older persons."

Key findings: Loneliness has real, physical consequences

The study findings show that people aged 60 who perceive themselves to be sometimes lonely or mostly lonely can expect to live three to five years less, on average, compared to peers who perceive themselves as never lonely. Similarly, at ages 70 and 80, lonely older persons can, on average, expect to live three to four and two to three years less, respectively, compared to non-lonely peers.

Using the same dataset, the researchers found that the perception of loneliness has a similar impact on two types of health expectancy—remaining years of life lived in a self-rated state of good health as well as remaining years of life lived without being limited when going about 'activities of daily living'. Such activities include routines like bathing and dressing, rising from or settling into a bed or chair, and preparing meals.

At age 60, sometimes lonely or mostly lonely seniors can expect to spend three to five fewer years of their remaining life, on average, without limitations in daily living activities, compared to never-lonely peers. At age 70, their active life expectancy goes down to two to four fewer years, on average. At age 80, it is at one to three fewer years, on average.

How common is loneliness among older adults in Singapore?

Singapore is a particularly relevant setting for studying how loneliness impacts older adults because the country has a rapidly aging population, and a 'collectivistic' culture, in which relationships and the interconnectedness between people are central—in contrast to an 'individualistic' culture, where each individual's needs and desires are considered to be more important. Previous studies found levels of loneliness to be higher in collectivistic societies, suggesting loneliness may have a more detrimental impact in Singaporean society.

In 2016 and 2017, CARE researchers conducted a study—known as the Transitions in Health, Employment, Social Engagement, and Intergenerational Transfers in Singapore (THE SIGNS) study—to look into factors influencing health, well-being, and activity and productivity levels in older Singaporeans. Nationally representative data, collected from more than 2,000 older Singapore citizens and permanent residents, showed that a third (34 percent) perceived themselves to be lonely. This proportion increased with age, from 32 percent among those aged 60–69 years, to 40 percent among those aged 80 and above.

More males (37 percent) were lonely, relative to females (31 percent). Across education levels, the proportion of lonely older Singaporeans was lowest (33 percent) among those with no formal education, and highest (38 percent) among those with higher-than-tertiary education. This proportion was nearly 10 percent higher among seniors who lived alone (43 percent) compared to those who did not live alone (33 percent).

"Building on THE SIGNS study, our recent findings highlight the population health impact of loneliness, and the importance of identifying and managing it among older adults," said Asst Prof Malhotra. "This is part of a series of studies to assess the impact of important health and social constructs, like loneliness, sensory impairments, obesity, gender and education, on life and health expectancy among older adults."

"With older persons at potentially greater risk of loneliness as a result of pandemic control measures, there has been increasing policy interest in loneliness around the world," said Assoc Prof Chan. "In 2018, the UK launched a national strategy for tackling loneliness and, in 2021, Japan appointed a 'Minister of Loneliness'. We hope this study helps galvanize more policies to tackle loneliness among older persons."

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More information: Malhotra R, Tareque MI, Saito Y, Ma S, Chiu C-T, Chan A. Loneliness and health expectancy among older adults: A longitudinal population-based study. J Am Geriatr Soc. 2021;1–11. doi.org/10.1111/jgs.17343

Provided by Duke-NUS Medical School 

 

What is the evidence on how to improve older adults' functional abilities at home?

by Wiley

Credit: Pixabay/CC0 Public Domain

A new analysis called an evidence and gap map has mapped what we know about improving the functional ability of older adults living at home or in nursing homes, retirement homes, or other long-term care facilities.

18 july 2021--A total of 548 studies were included in the map, which is published in Campbell Systematic Reviews. The most common interventions studied were home-based rehabilitation for older adults and home-based health services for disease prevention, mostly delivered by visiting healthcare professionals.

Investigators found substantial evidence for interventions to promote functional ability—especially related to basic needs and mobility—in older adults at home, but few studies have looked at impacts on social participation, financial security, ability to maintain relationships, and communication. There were very few studies done in low and middle income countries.

"This Campbell Collaboration evidence and gap map on enabling functional ability at home for older adults helps people find relevant studies and systematic reviews to support evidence-informed decisions for ageing safely and well in place," said corresponding author Vivian Welch, Ph.D., MSc, a scientist at Bruyère Research Institute, an associate professor at the University of Ottawa, and Editor-in-Chief of the Campbell Collaboration. "This evidence map is one of the cornerstones of the baseline report for the United Nations Decade of Healthy Ageing, 2021-2030."

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More information: Vivian Welch et al, Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map, Campbell Systematic Reviews (2021). DOI: 10.1002/cl2.1175

Provided by Wiley 

 

Machine learning can identify signs of Alzheimer's in patients recalling the story of Cinderella

by St. George's University of London

Credit: Photo by Robina Weermeijer on Unsplash.

A new study by researchers from the Neurosciences Research Centre at St George's has identified the strengths and limitations of different tasks used to detect the early signs of Alzheimer's disease through speech analysis and machine learning. Published in the journal Frontiers in Computer Science, the study demonstrates that while machine learning can be used to assess speech patterns for signs of disease, the specific task assigned to the person being tested plays a critical role in test accuracy.

18 july 2021--Previous research by the group has shown that Alzheimer's disease affects language very early on in the disease and, therefore, language assessments can be used to detect the disease at an earlier stage. The earlier it is picked up, the sooner interventions can be considered to help the patient.

This latest study adds to the evidence by seeking to assess the measures and tasks that can be used to test for Alzheimer's. By recording the audio from tasks performed by participants, the research team then employed a machine learning program, developed at St George's, to assess signs of disease.

The tasks used in the study represent a range of methods used in healthcare scenarios. One of the most common approaches used by clinicians is to ask patients to describe a scene known as the "Cookie Theft" picture. Other approaches include asking the patient to narrate a learned story, such as well-known fairy-tales like Cinderella—a complex task, which requires them to integrate a series of characters and events into a timeline that they can recall.

For this study, the researchers used the above assessments, as well as procedural recall (recounting how to make a cup of tea), novel narrative retelling (describing a story from pictures presented in a wordless children's story book), and conversational speech (giving instructions to another person, describing a route through landmarks on a map), to detect signs of Alzheimer's through speech analysis.

After assessing the results of 50 trial participants (25 with mild Alzheimer's disease or mild cognitive impairment and 25 healthy controls), the team found that narrating an overlearned story, such as Cinderella gave the most accurate results. The machine learning system used was able to identify whether a participant had Alzheimer's or mild cognitive impairment with 78% accuracy, with the "Cookie Theft' task close behind on 76%—results which are comparable to existing tests for disease. The other tasks assessed gave accuracies ranging between 62% (novel narrative retelling) and 74% (procedural recall).

"Our results show that by altering the tasks used to assess Alzheimer's, we have the potential to be detecting disease with higher accuracy through speech analysis," says study author and final year Ph.D. student at St George's, Natasha Clarke.

Noting that larger studies are needed to improve their understanding of their assessments even further, Clarke adds, "In the long-term, we hope that this technology could be used remotely, such as through smartphone apps, reducing anxiety around testing for disease. If we can make testing easier, then hopefully we can identify disease earlier and start treating people sooner."

Following the results of this study, the team are now looking to follow up study participants one year later to assess changes over time and learn more about disease progression.

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More information: Natasha Clarke et al, A Comparison of Connected Speech Tasks for Detecting Early Alzheimer's Disease and Mild Cognitive Impairment Using Natural Language Processing and Machine Learning, Frontiers in Computer Science (2021). DOI: 10.3389/fcomp.2021.634360

Provided by St. George's University of London 

 

Benzodiazepines, 'z-drugs' increase death risk when taken with opioids

by Vanderbilt University Medical Center

Credit: CC0 Public Domain

A new study by Vanderbilt University Medical Center researchers of more the 400,000 Medicare patients taking medications for insomnia found that the risk of death is increased when either benzodiazepines or 'z-drugs' are taken with opioids.

18 july 2021--The study, published July 15 in PLOS Medicine and led by Wayne Ray, Ph.D., professor of Health Policy at VUMC, compared patients taking these drugs with opioids to comparable patients taking trazodone, another commonly prescribed sleep medication for older patients. The researchers found that those using benzodiazepines had a 221% increase in the risk of death from any cause and those taking non-benzodiazepine hypnotics, or 'z-drugs', had a 68% increased risk.

"Our findings indicate that the risks of benzodiazepine-opioid use go well beyond the recognized hazards of overdose. They also suggest that the z-drugs, thought to have better safety than the benzodiazepines, in fact are dangerous when prescribed in combination with opioid pain medications," Ray said.

Benzodiazepines, including brand names such as Restoril, Ativan, and Halcion and the 'z-drugs', a type of medication known more commonly under names like Ambien, Lunesta and Sonata, are among the most frequently prescribed medications for older adults.

Trazodone, a medication initially introduced for depression, is often prescribed in low doses for insomnia. Although researchers have speculated about the relative safety of these sleep medications, there is limited relative safety data.

Ray said the study findings could help to fill this data gap and thus lead to changes in both provider behavior and policy.

"Our findings add urgency to efforts to limit concurrent prescribing of benzodiazepines and opioids. They also suggest that targeted warnings are needed to advise older patients and their providers regarding the potential risks of taking z-drugs with opioids," Ray said.

The study was supported by a grant from the National Heart, Lung and Blood Institute.

More information: Wayne A. Ray et al, Mortality and concurrent use of opioids and hypnotics in older patients: A retrospective cohort study, PLOS Medicine (2021). DOI: 10.1371/journal.pmed.1003709

Provided by Vanderbilt University Medical Center 

 

Common medication used to reduce cholesterol levels may reduce COVID-19 severity

by University of California - San Diego

Credit: Pixabay/CC0 Public Domain

In a new study from University of California San Diego School of Medicine, researchers have confirmed that patients taking statin medications had a 41 percent lower risk of in-hospital death from COVID-19. The findings were published July 15, 2021 in PLOS ONE and expand upon prior research conducted at UC San Diego Health in 2020.

18 july 2021--Statins are commonly used to reduce blood cholesterol levels by blocking liver enzymes responsible for making cholesterol. They are widely prescribed: The Centers for Disease Control estimates that 93 percent of patients who use a cholesterol-lowering drug use a statin.

"When faced with this virus at the beginning of the pandemic, there was a lot of speculation surrounding certain medications that affect the body's ACE2 receptor, including statins, and whether they may influence COVID-19 risk," said Lori Daniels, MD, lead study author, professor and director of the Cardiovascular Intensive Care Unit at UC San Diego Health.

"At the time, we thought that statins may inhibit SARS-CoV-2 infection through their known anti-inflammatory effects and binding capabilities, which could potentially stop progression of the virus."

Using data from the American Heart Association's COVID-19 Cardiovascular Disease Registry, the research team at UC San Diego applied their original findings to a much larger cohort: more than 10,000 hospitalized COVID-19 patients across the United States.

Specifically, researchers analyzed anonymized medical records of 10,541 patients admitted for COVID-19 over a nine-month period, January through September 2020, at 104 different hospitals.

"From this data, we performed more advanced analyses as we attempted to control for coexisting medical conditions, socioeconomic status and hospital factors," said Daniels. "In doing so, we confirmed our prior findings that statins are associated with a reduced risk of death from COVID-19 among patients hospitalized for COVID-19."

Daniels said it appears most of the benefit is among patients with good medical reasons to be taking statins, such as a history of cardiovascular disease or high blood pressure. According to the research team, the use of statins or an anti-hypertension medication was associated with a 32 percent lower risk of death among COVID-19 inpatients with a history of cardiovascular disease or hypertension.

In the study, statistical matching techniques were used to compare outcomes for patients who used statins or an anti-hypertension medication with similar patients who did not.

"We matched each patient to one or more similar patients, using hospital site, month of admission, age, race, ethnicity, gender, and a list of pre-existing conditions, in order to make the two groups as comparable as possible" said Karen Messer, Ph.D., study co-author and professor of biostatistics at UC San Diego School of Medicine.

The ACE2 receptor—the regulatory target of statins—helps control blood pressure. In 2020, it was discovered that SARS-CoV-2 virus primarily uses the same receptor to enter lung cells.

According to researchers, statins and anti-hypertension medications stabilize the underlying diseases for which they are prescribed, making patients more likely to recover from COVID-19.

"As with any observational study, we cannot say for certain that the associations we describe between statin use and reduced severity of COVID-19 infection are definitely due to the statins themselves; however, we can now say with very strong evidence that they may play a role in substantially lowering a patient's risk of death from COVID-19," said Daniels. "We hope that our research findings are an incentive for patients to continue with their medication."

The initial study included 170 anonymized medical records from patients receiving care at UC San Diego Health. Researchers found that statin use prior to hospital admission for COVID-19 resulted in a more than 50 percent reduction in risk of developing severe infection.

The American Heart Association's COVID-19 Cardiovascular Disease Registry contains de-identified health data on patients treated for COVID-19 at more than 140 participating hospitals across the country. As of July 2021, data from more than 49,000 patient records had been contributed into the platform.

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More information: Lori B. Daniels et al, Relation of prior statin and anti-hypertensive use to severity of disease among patients hospitalized with COVID-19: Findings from the American Heart Association's COVID-19 Cardiovascular Disease Registry, PLOS ONE (2021). DOI: 10.1371/journal.pone.0254635

Provided by University of California - San Diego 

 

Real world methods to improve dementia care

by Flinders University

Credit: Pixabay

Using real-world training and coaching, two new Flinders University research projects are aiming to bring much needed improvements to the care provided to people living with dementia.

01 July 2021--In one project, published in the journal BMJ Open Quality, a Flinders University lead research team has evaluated a quality improvement collaborative to improve the quality of dementia care.

Clinicians were invited to take part in a structured program for over nine months, during which they were provided clear coaching and remote support to develop improvement plans in their own work setting, including practical insights from people living with dementia and their caregivers.

"Despite the existence of Clinical Guidelines for the care of people with dementia, translating the evidence from the guidelines into practice is complex and slow," says lead author Dr. Lenore de la Perrelle from Flinders University's College of Medicine and Public Health.

"Our evaluation found that a structured quality improvement collaborative program led to an improvement in the clinicians adhering to the guidelines, while also providing them confidence and flexibility to adapt their practice and enable them to reflect on and overcome a sense of pessimism about how to improve dementia care."

The study showed the collaborative program would only need a minimum of 100 participants to prove cost effective.

"Given the large numbers of clinicians working with people with dementia, this type of quality improvement could easily be up-scaled, while still providing a return on investment," says Dr. de la Perrelle.

"Improvement in the quality of dementia care is much needed and this evaluation shows that not only are clinicians willing to do so, but a relatively small investment can deliver large returns."

In a second study, published in the Australasian Journal of Ageing, a Flinders University team investigated whether simulation training and coaching would help aged care workers to better prevent and manage aggressive events in older people living with dementia.

Aggressive events, defined as 'any incident in which a person is abused, threatened or assaulted in circumstances relating to their work', are very common in the aged-cared sector and with an ageing population their incidence is expected to rise.

Seventeen aged care workers from ACH Group, a not-for-profit community and residential aged care service provider, completed education modules alongside simulation training using actors and real-life scenarios, with real-time coaching.

Lead author Professor Sue Gordon, Chair of Restorative Care in Ageing at Flinders University's College of Nursing and Health Sciences, says one of main aims of the pilot study was to determine what impact high-intensity simulation training had on the self-belief of the carers themselves to manage aggressive events.

"What we do know is that most aggressive events are preventable by avoiding or managing behavioural causes and triggers and reacting appropriately," says Professor Gordon.

"Our study found that after the training, most carers reported a willingness to change their practices, and more than half had indeed made changes six months down the track."

Most study participants also reported that the training had contributed to them staying in their job and expressed support for the inclusion of coaching and simulations into the vocational training of aged care workers.

"As Australia's ageing population continues to grow, we must look at solutions to support our aged-care workers and in turn the clients they support.

"While further research is needed, our study shows that the inclusion of high-intensity simulation training and coaching could have a positive impact on both the carer and patient," says Professor Gordon.

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More information: Lenore de la Perrelle et al, How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation, BMJ Open Quality (2021). DOI: 10.1136/bmjoq-2020-001147

Susan Gordon et al, Simulation and coaching to prevent aggressive events in aged care: A pilot study, Australasian Journal on Ageing (2021). DOI: 10.1111/ajag.12961

Provided by Flinders University 

 

Alzheimer's and aducanumab: Unjust profits and false hopes

by The Hastings Center

Credit: CC0 Public Domain

The U.S. Food and Drug Administration's controversial decision to approve aducanumab for the treatment of Alzheimer's disease raises at least three major ethical issues that need to be addressed, states a new article in the Hastings Center Report:

Billions of dollars in Medicare resources (which is to say, taxpayer dollars) are at risk of being unjustly squandered.

• Physicians must choose between facilitating this unjust squandering and denying desperate patients and families access to this drug.
• Patients and families are having false hopes legitimated and encouraged when physicians prescribe aducanumab.

The drug's approval was contrary to the nearly unanimous judgment of an FDA advisory committee that there was little reliable evidence of significant benefit. And given the drug's $56,000 annual price and the 3.1 million people who are candidates for the drug, the total cost to Medicare or a private insurer would be $174 billion per year. An additional $93 billion in health care costs would be needed to cover infusion costs and the brain scans needed to monitor the risk of drug side effects, which include brain swelling or small-vessel brain bleeds.

"If the drug reversed and cured Alzheimer's, it would make ethical and economic sense to fully fund access to it, in my view," writes Leonard Fleck, a professor in the Center for Bioethics and Social Justice at Michigan State University. "But it does not do that."

Fleck concludes with a proposal to minimize the ethical issues cited above and set an important precedent for similar drugs in the pipeline. Medicare should require Biogen, the manufacturer, to provide aducanumab at cost—between $2,500 and $5,000 per year—(plus a modest profit) while it conducts further research to establish whether the drug is safe and effective.

Fleck suggests that "this is the best nonideal resolution we can achieve, given competing pressures form intense patient demands and the need for the just and prudent allocation of limited health care resources."

He adds, "Other pharmaceutical companies could expect the same crimped profits . . . if they could not prove decisively that their drug yielded substantial clinical benefits at a reasonable cost. This would be unforgettable tough love."

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More information: Leonard M. Fleck, Alzheimer's and Aducanumab: Unjust Profits and False Hopes, Hastings Center Report (2021). DOI: 10.1002/hast.1264

Provided by The Hastings Center