The development of 5G significantly increased the health of older adults, study finds

by Huameng Tang, Chao Guo , Medical Xpress

Alluvial diagram of the self-rated health change among older adults by 5G policy development in different provinces. Note: Province code Beijing 11; Tianjin 12; Hebei 13; Shanxi 14; Liaoning 21; Jilin 22; Heilongjiang 23; Shanghai 31; Jiangsu 32; Zhejiang 33; Anhui34; Fujian 35; Jiangxi 36; Shandong 37; Henan 41; Hubei 42; Hunan 43; Guangdong 44; Guangxi 45; Chongqing 50; Sichuan 51; Guizhou 52; Yunnan 53; Shanxi 61; Gansu 62. Credit: Global Transitions (2023). DOI: 10.1016/j.glt.2023.08.002

The Chinese government attaches great importance to the construction of Fifth Generation Mobile Communication Technology infrastructure (5G), which has been shown in a new study to play a positive role in the self-rated health of older adults in mainland China, indicating the health-promoting effects of technological advances.

14 oct 2023--China has built one of the largest and most technologically advanced 5G networks, and 5G industry applications have been integrated into more than 60 national economic categories including the medical and health care industries, aiming at meeting the growing medical and health needs of the people. However, as a new and emerging technology, the impact of 5G on public health at the national level has not been well elucidated with reliable empirical evidence.

In our study published in Global Transitions, we explored the effects of 5G development on self-rated health (SRH) among older adults with different sociodemographic features in mainland China. Using the nationally representative data from the China Family Panel Studies (CFPS) in 2018 and its follow-up in 2020, we used the development of 5G as a natural experiment to capture the impact of 5G development on the health of older adults.

Older adults from provinces with 5G policies in varying levels between 2018 and 2020 were considered as the exposure group while others were considered as the reference group, and the differences in SRH of the older adults were compared in provinces with different numbers of policies.

The effect of 5G policies on self-rated health and heterogeneity across age groups, gender, and living areas among older adults. A number of covariates, including age, province, living areas, marriage status, income, employment, chronic disease, depression and health-related behaviors were controlled for in the total sample analysis and in the subgroup analysis. Credit: Global Transitions (2023). DOI: 10.1016/j.glt.2023.08.002

The health effects of 5G development

Our findings revealed that the development of 5G significantly increased the SRH of older adults. After the enactment of the 5G policies, the probability of self-rated good health increased by 31% for each unit increase in the development level of 5G policies. And there were notable disparities in age group, gender and living areas.

The improvement effect of the 5G policies on SRH was intensified in the younger cohort, those aged 65 to 74 years, females, and those living in urban areas. The probability of self-rating good health of older adults aged 75 years and above, males, and those living in rural areas also increased after being exposed to the 5G policies but was not statistically significant.

Public health facilitated by technological development

To the best of our knowledge, our study provides novel insights into the impact of 5G development on the SRH of older adults for the first time. The findings are that 5G development has a positive effect on the SRH of older adults and SRH is found to be particularly improved in the 65- to 74-year-old groups, female groups, and urban participants.

The introduction of 5G policy provides a micro-opportunities and a macro-environment for older adults to promote their health status. At the micro level, 5G enables more older adults to use smart devices and access the internet, facilitating access to health information and promoting social participation. At the macro level, 5G-related application in the medical and health care industry contributes to meeting the medical and health needs of the older adults.

However, considering the heterogeneity, some older adults are in the economic, health and digital divide at the same time, and the gap between them and the older adults who occupy the advantage of digital resources is gradually increasing with the trend of technology development. Target measures should be adopted to avoid worsening inequality and improve the health of all older adults.

We hope that the fast penetration of digital technologies such as 5G will facilitate and scale up the innovations that can create and spread health, allowing public health to fulfill it vision of everyone, regardless of gender and age, being able to enjoy a healthy life at last.

More information: Huameng Tang et al, The effect of 5G policy development on self-rated health among Chinese older adults: A quasi-experimental study, Global Transitions (2023). DOI: 10.1016/j.glt.2023.08.002

 

Can ChatGPT help us form personal narratives?

by Erica Moser, University of Pennsylvania

Participant ratings of accuracy, surprise, and insight of the individual AI-generated personal narratives as a function of the degree of accuracy, surprise, and insight and the number of participants in each rating category. The Journal of Positive Psychology (2023). DOI: 10.1080/17439760.2023.2257642

Research has shown that personal narratives—the stories we tell ourselves about our lives—can play a critical role in identity and help us make sense of the past and present. Research has also shown that by helping people reinterpret narratives, therapists can guide patients toward healthier thoughts and behaviors.

14 oct 2023--Now, researchers from the Positive Psychology Center at the University of Pennsylvania have tested the ability of ChatGPT-4 to generate individualized personal narratives based on stream-of-consciousness thoughts and demographic details from participants, and showed that people found the language model's responses accurate.

In a new study in the Journal of Positive Psychology, Abigail Blyler and Martin Seligman found that 25 of the 26 participants rated the AI-generated responses as completely or mostly accurate, 19 rated the narratives as very or somewhat surprising, and 19 indicated they learned something new about themselves.

Seligman, the Zellerbach Family Professor of Psychology, is the director of the Positive Psychology Center, and Blyler is his research manager.

"This is a rare moment in the history of scientific psychology: Artificial intelligence now promises much more effective psychotherapy and coaching," Seligman says.

For each participant, the researchers fed ChatGPT-4 recorded stream-of-consciousness thoughts, which Blyler likened to diary entries with thoughts as simple as "I'm hungry" or "I'm tired."

In a second study published concurrently in The Journal of Positive Psychology, they fed five narratives rated "completely accurate" into ChatGPT-4, asked for specific interventions, and found that the chatbot generated highly plausible coaching strategies and interventions.

"Since coaching and therapy typically involve a great deal of initial time spent fleshing out such an identity, deriving this automatically from 50 thoughts represents a major savings," the authors write.

What are personal narratives, how do they shape identity, and what is their role in therapeutic approaches?

Stories of the self, the way people talk about the journey of their lives and who they are, is really what pulled me into psychology. I've come to understand that these narratives impact our behaviors, how we view the world and others, and, importantly, our well-being.

One thing Marty [Seligman] and I have discussed a lot is, How do we get to knowing what our narratives are? Narratives help to construct a coherent story, make sense of everything in our lives.

We found that ChatGPT was able to, with just 50 of those thoughts and very basic demographic information, come up with a highly accurate and detailed personal narrative. This could be a tool for helping people gain self-insight. We see this as something that can be used in the therapeutic context, not as something that would replace a therapist.

Can the coach use this to help understand the client better, and can the client in turn understand themselves better? We're hoping there's this reciprocal relationship, where this speeds up the process of getting to mutual understanding, so the deep work can take place.

How did you come up with the idea of using ChatGPT-4 to create personal narratives?

I really credit Marty [Seligman]. He has been such a leader in the field of positive psychology for so long. To me, he is the paragon of curiosity, particularly when it comes to the cutting-edge, and so he's been really steeped in the things that people are doing with AI and psychology.

The idea came from a series of discussions we were having around my interest in personal narratives, asking, What are the things we're consistently telling ourselves? Might that give us a window into the narratives that play on a loop in people's minds? Can AI be of use here?

The personal narratives were generated from 50 stream-of-consciousness thoughts the participants recorded. What instructions were they given?

We didn't give any description of what the content of the thoughts should be, just that they should be fairly automatic. We asked that people try not to edit them in their minds. We gave them the option to record it via a voice memo or write it down in a Word document or Notes app. However they chose to do it, we gave them 48 hours to just collect 50 of them.

How did you determine the coaching strategies and interventions ChatGPT-4 generated were highly plausible?

We based it on the literature. There are very many evidence-based therapeutic interventions, and what the machine does here is select the ones that seem most appropriate to the narrative identity. This research is exploratory; there is absolutely a need to continue the research and deploy this with coaches.

That's where we are now, getting this into the hands of coaches. We have just begun collaborations to find out if therapy and coaching are more effective when assisted by our new methods.

More information: Abigail P. Blyler et al, Personal narrative and stream of consciousness: an AI approach, The Journal of Positive Psychology (2023). DOI: 10.1080/17439760.2023.2257666

Abigail P. Blyler et al, AI assistance for coaches and therapists, The Journal of Positive Psychology (2023). DOI: 10.1080/17439760.2023.2257642

 

Scientists discover 'long colds' may exist, as well as long COVID

by Queen Mary, University of London

Credit: CC0 Public Domain

A new study from Queen Mary University of London, published in eClinicalMedicine, has found that people may experience long-term symptoms—or "long colds"—after acute respiratory infections that test negative for COVID-19.

14 oct 2023--Some of the most common symptoms of the "long cold" included coughing, stomach pain, and diarrhea more than four weeks after the initial infection. While the severity of an illness appears to be a key driver of risk of long-term symptoms, more research is being carried out to establish why some people suffer extended symptoms while others do not.

The findings suggest that there may be long-lasting health impacts following non-COVID acute respiratory infections, such as colds, influenza, or pneumonia, that are currently going unrecognized. However, the researchers do not yet have evidence suggesting that the symptoms have the same severity or duration as long COVID.

The research compared the prevalence and severity of long-term symptoms after an episode of COVID-19 vs. an episode of another acute respiratory infection that tested negative for COVID-19. Those recovering from COVID-19 were more likely to experience light-headedness or dizziness and problems with taste and smell compared to those who had a non-COVID-19 respiratory infection.

While long COVID is now a recognized condition, there have been few studies comparing long-term symptoms following SARS-CoV-2 coronavirus infection vs. other respiratory infections.

The study is the latest output from COVIDENCE UK, Queen Mary University of London's national study of COVID-19, launched back in 2020 and still in follow-up, with over 19,000 participants enrolled. This study analyzed data from 10,171 UK adults, with responses collected via questionnaires and statistical analysis carried out to identify symptom clusters.

Giulia Vivaldi, researcher on COVIDENCE UK from Queen Mary University of London and the lead author of the study, said, "Our findings shine a light not only on the impact of long COVID on people's lives, but also other respiratory infections. A lack of awareness—or even the lack of a common term—prevents both reporting and diagnosis of these conditions.

"As research into long COVID continues, we need to take the opportunity to investigate and consider the lasting effects of other acute respiratory infections.

"These 'long' infections are so difficult to diagnose and treat primarily because of a lack of diagnostic tests and there being so many possible symptoms. There have been more than 200 investigated for long COVID alone."

Professor Adrian Martineau, Chief Investigator of COVIDENCE UK and Clinical Professor of Respiratory Infection and Immunity at Queen Mary University of London, added, "Our findings may chime with the experience of people who have struggled with prolonged symptoms after having a respiratory infection despite testing negative for COVID-19 on a nose or throat swab.

"Ongoing research into the long-term effects of COVID-19 and other acute respiratory infections is important because it can help us to get to the root of why some people experience more prolonged symptoms than others. Ultimately this could help us to identify the most appropriate form of treatment and care for affected people."

Victoria King, Director of Funding and Impact at Barts Charity, said, "Barts Charity swiftly supported COVIDENCE UK in response to the outbreak of COVID-19 to help inform of its risk factors and impacts. These findings highlight not only the long-term symptoms experienced by people after COVID infection, but by people after other acute respiratory infections as well. As we learn more about long COVID symptoms and their possible treatments, studies like this help to build greater awareness around other prolonged respiratory infections that may be going unrecognized."

More information: Vivaldi et al, Long-term symptom profiles after COVID-19 vs other acute respiratory infections: a population-based observational study, eClinicalMedicine (2023). doi.org/10.1016/j.eclinm.2023.102251

 

Antidepressants versus running for depression: Is there a winner?

by European College of Neuropsychopharmacology

Credit: Pixabay/CC0 Public Domain

The first study to compare effects of antidepressants with running exercises for anxiety, depression and overall health shows that they have about the same benefits for mental health—but a 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants lead to a slightly worse physical condition, as has been suggested by previous studies. However, the drop-out rate was much higher in the group which initially chose exercise.

14 oct 2023--Professor Brenda Penninx (Vrije University, Amsterdam) is set to present the work at the 36th ECNP Congress, Barcelona, 7–10 October 2023, after recent publication in the Journal of Affective Disorders, saying, "We wanted to compare how exercise or antidepressants affect your general health, not just your mental health."

The researchers studied 141 patients with depression and/or anxiety. They were offered a choice of treatment; SSRI antidepressants for 16 weeks, or group-based running therapy for 16 weeks. 45 chose antidepressants, with 96 participating in running. The members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.

Professor Penninx said, "This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group."

Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviors. In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness and participate in a group activity.

The antidepressant group took the SSRI Escitalopram for 16 weeks. The running group aimed for two to three closely supervised 45-minute group sessions per week (over 16 weeks). The adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.

At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.

Brenda Penninx said, "Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation."

"It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant.

"We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behavior will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution."

She added, "Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good—and maybe even better—choice for some of our patients."

"In addition, let's also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health."

This is adapted from a commentary recently published in the journal European Neuropsychopharmacology.

Commenting, Dr. Eric Ruhe (Amsterdam University Medical Centers) said, "These are very interesting results that again show that physical health can influence mental health and that treatment of depression and anxiety can be achieved by exercising, obviously without the adverse effects of antidepressant drugs. "

"However, several remarks are important. First the patients followed their preference, which is common practice, but ideally we should advise patients what will work best. Following this choice is understandable from a pragmatic point of view when patients have strong preferences, which you have to take into account when doing a study like this.

"The downside is that the comparisons between groups might be biased compared to doing this in a truly randomized study. For example, patients in the antidepressant group were more depressed which might be associated with less chance of persisting engagement in the exercises. So, we have to be careful not to overinterpret the comparisons between groups, which the authors acknowledge properly.

"Finally, a very important finding is the difference in adherence between the interventions: 52% in the exercise group and 82% in the antidepressant group. This shows that it is more difficult to change a lifestyle habit than taking a pill. This is not exclusively found in psychiatry, indicating that we also have to focus on how to improve compliance to healthy behavior. This could have tremendous impact on health care more generally, but also on psychiatric diseases."

More information: Josine E. Verhoeven et al, Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders, Journal of Affective Disorders (2023). DOI: 10.1016/j.jad.2023.02.064

Conference abstract: "Medication and lifestyle interventions in regulating immune function and mental health."

 

Smartphones could be used to monitor liver disease patients at home

by University College London

Assessment of bilirubin levels in patients with cirrhosis via forehead, sclera and lower eyelid smartphone images. Credit: PLOS Digital Health (2023). DOI: 10.1371/journal.pdig.0000357

A smartphone camera was able to detect changes in skin tone and eye color that require patients to seek medical help, in new research from UCL and the Royal Free Hospital.

14 oct 2023--The study, published in PLOS Digital Health, is the first to assess and compare how smartphone images of the forehead, white of the eye and lower eyelid could be used to accurately predict the bilirubin level of patients with advanced cirrhosis. It found that images of the white of the eye was the best way to predict bilirubin level from an image.

The approach has the potential to monitor liver cirrhosis patients at home more closely, easily and cost effectively than they are currently. The authors expect that this would detect worsening of symptoms before the situation becomes critical, as well as simplify workflows for health care professionals.

Liver disease is the third most common cause of working-age premature death in the UK. While mortality rates have greatly improved for many chronic diseases, the mortality rate for liver disease in the UK increased by 400% between 1970 and 2010. This has increased the need to find non-invasive, cost-effective ways to monitor cirrhosis progression.

Bilirubin is a yellowish pigment that indicates poor liver function when visible in the skin or eye, a condition known as jaundice. Advanced cirrhosis patients' skin and eyes become more yellow as the bilirubin concentration in the blood becomes higher.

Bilirubin levels are currently checked by a blood test performed by a medical professional, which then has to be analyzed. This is usually done in a health care setting. If the level has increased, this indicates that the patient's liver function has deteriorated further and that they need medical help.

In this study, researchers developed a smartphone app that was able to detect the severity of jaundice with a high degree of accuracy. They used a smartphone to take photos of the forehead, white of the eye and lower eyelid of 66 cirrhosis patients. After calibrating the images for lighting conditions, they were analyzed and used to train an algorithm that could predict bilirubin level based on the degree of yellowness in the image.

When these predictions were checked against blood test data, the white of the eye images provided the strongest correlation.

Professor Raj Mookerjee (UCL Medicine), co-author of the study, said, "One of the reasons that liver disease is so challenging is that patients can deteriorate very quickly. It's an unfortunate fact that if a patient arrives at the clinic much more jaundiced than they were previously, the chances are that they have already progressed their disease considerably. The approach that we've assessed in this study could allow us to monitor patients from their own homes much more frequently, than is currently possible and, hopefully, detect worsening of clinical signs and symptoms before things become critical."

One of the challenges the study sought to overcome is the degree of yellowness in patients with cirrhosis, which can be fifty times higher than normal.

"You can look at a patient and tell if they have jaundice right away. But it's a not a question of if the skin looks yellow or not, it's about how much more yellow it looks, which gives you an indication of how badly the liver function has deteriorated," said Professor Mookerjee. "The smartphone app gives us this degree of accuracy. It's a remarkable feat of engineering and shows the power of clinicians and engineers collaborating to solve urgent health care problems."

The next step would be a larger trial to validate the safety and accuracy of the approach. In practice, the approach would likely work by patients frequently taking pictures of their eye via an app, which would inform the clinical care providers of a meaningful change in bilirubin, that might require a change in patient management.

Dr. Terence Leung (UCL Medical Physics & Biomedical Engineering), co-author of the paper, said, "Smartphone camera technology is improving every year, which is allowing us to develop innovative solutions to unmet health care needs using devices that most people have at home. It's great to be able to engineer solutions that are not only cheap and easy to implement, but which will make a real difference to people's lives."

More information: Miranda Nixon-Hill et al, Assessment of bilirubin levels in patients with cirrhosis via forehead, sclera and lower eyelid smartphone images, PLOS Digital Health (2023). DOI: 10.1371/journal.pdig.0000357

 

Most seniors with RSV-linked hospitalization are aged ≥75, according to research

by Elana Gotkine

Most respiratory syncytial virus (RSV)-associated hospitalizations among seniors aged ≥60 years occur in those aged ≥75 years, and although RSV is less common among seniors, it is associated with more severe disease than COVID-19 or influenza, according to research published in the Oct. 6 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

14 oct 2023--Fiona P. Havers, M.D., from the CDC in Atlanta, and colleagues examined characteristics of 3,218 adults aged ≥60 years who were hospitalized with laboratory-confirmed RSV infection during July 2022 to June 2023.

The researchers found that 54.1% of a random sample of 1,634 older adult patients with RSV-associated hospitalizations were aged ≥75 years. Obesity, chronic obstructive pulmonary disease, congestive heart failure, and diabetes were the most common underlying medical conditions. Overall, 18.5% of patients aged ≥60 years had severe outcomes: 17.0, 4.8, and 4.7% were admitted to an intensive care unit, required mechanical ventilation, and died, respectively.

Diya Surie, M.D., also from the CDC, and colleagues characterized RSV-associated severity among 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory confirmed RSV, severe acute respiratory syndrome coronavirus 2, or influenza infection (5.3, 81.8, and 12.9%, respectively) from 25 hospitals in 20 U.S. states during Feb. 1, 2022, to May 31, 2023.

The researchers found that compared to those hospitalized with COVID-19 or influenza, patients hospitalized with RSV were more likely to receive standard flow oxygen, high-flow nasal cannula or noninvasive ventilation, intensive care unit admission, and invasive mechanical ventilation.

"Health care providers and older adults should consider RSV disease severity when making a shared clinical decision about RSV vaccination," Surie and colleagues write.

More information: Fiona P. Havers et al, Characteristics and Outcomes Among Adults Aged ≥60 Years Hospitalized with Laboratory-Confirmed Respiratory Syncytial Virus—RSV-NET, 12 States, July 2022–June 2023, MMWR. Morbidity and Mortality Weekly Report (2023). DOI: 10.15585/mmwr.mm7240a1

Diya Surie et al, Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years—IVY Network, 20 U.S. States, February 2022–May 2023, MMWR. Morbidity and Mortality Weekly Report (2023). DOI: 10.15585/mmwr.mm7240a2

 

Seniors, here are the meds that can harm your driving skills

by Amy Norton

Some common medications—including antidepressants, sleep aids and painkillers—may dull the driving skills of seniors, a new study finds.

14 oct 2023--Many different medication classes have been linked to the risk of driving impairment, as anyone who has ever read the label warning "do not operate heavy machinery" might have guessed.

But the new study took a particularly rigorous approach to investigating the issue—following older adults for up to 10 years and testing their driving skills with annual road tests.

And it turned out that those using certain classes of medications were at greater risk of failing the road test at some point.

When older folks were taking either antidepressants, sedative/hypnotics (sleep medications) or non-steroidal anti-inflammatory drugs (NSAIDs), they were nearly three times more likely to get a failing or "marginal" grade than non-users.

The findings do not prove the medications are to blame, said lead researcher Dr. David Carr, a specialist in geriatric medicine at Washington University's School of Medicine in St. Louis.

It can be hard, he said, to draw a direct line between a particular medication and diminished driving skills: Is it that drug, or the medical condition it's treating or another medication an older adult is taking?

In this study, though, Carr and his colleagues were able to account for many factors, including participants' medical conditions, memory and thinking skills, vision problems and whether they lived in more affluent or disadvantaged neighborhoods.

And certain medication groups were still linked to poorer driving performance.

Beyond that, Carr said, many of the medications in question are known to act on the central nervous system—with potential side effects, like drowsiness and dizziness, that could affect driving.

"The bottom line is, we need to pay attention to this and advise our patients," Carr said, adding that he doubts this is happening routinely.

Unfortunately, he added, during busy, time-limited doctor visits, discussions of medication side effects may fall by the wayside.

So that's where patients need to be proactive, Carr said, Ask questions about potential side effects when you get a new prescription. And if you're wondering whether your sluggishness or other symptoms could be due to a medication, talk to your health care provider.

"We wouldn't want anyone to just stop taking their medication on their own," Carr stressed. "Talk to your health care provider about any changes."

That point was echoed by Jake Nelson, director of traffic safety advocacy and research at the nonprofit AAA.

The good news, Nelson said, is that your doctor might be able to make some changes—like switching to a different medication or adjusting the dose or time of day you take a particular drug.

"Don't feel like you're being a burden by asking these questions," said Nelson, who was not involved in the study. "This is about putting your health and safety first."

He also, however, stressed the role of the pharmaceutical industry in tackling the issue. There are better ways, Nelson said, to alert medication users to the risk of driving impairment—which is typically buried in the "fine print."

The study—published Sept. 29 in JAMA Network Open — involved 198 adults who were 73, on average, at the outset. None had signs of cognitive impairment (problems with memory, judgment or other thinking skills).

Study participants had annual check-ups, which included a road test with a professional driving instructor, for up to 10 years (about five years, on average). During that period, 35% received a failing and marginal road test grade at some point.

Seniors on antidepressants, sleep aids or NSAIDs were at heightened risk. The odds were greatest for those on an antidepressant or sleep medication—with 16% to 17% putting in a poor road performance per year overall. That compared with rates of 6% to 7% of their peers not using those medications.

There were a couple of surprises, Carr said. Researchers found no link between antihistamines or anticholinergic medications and seniors' driving performance.

Antihistamines are notorious for making users drowsy. Anticholinergic medications are used to treat a range of conditions, from overactive bladder to chronic obstructive pulmonary disease (COPD) to Parkinson's symptoms. They can cause side effects like sedation and blurred vision.

But, Carr said, it's possible that older drivers in this study were using newer, non-drowsy antihistamines or there were too few people taking anticholinergics to detect a significant effect.

No matter which medications they may be using, Carr said older adults should talk to their doctor about any red flags—like feeling drowsy or slower to react, or having a "close call" on the road.

More information: David B. Carr et al, Medication and Road Test Performance Among Cognitively Healthy Older Adults, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.35651

 

Certain navigational mistakes could be early signs of Alzheimer's disease

by University College London

Credit: Pixabay/CC0 Public Domain

People with early Alzheimer's disease have difficulty turning when walking, according to a new study using virtual reality led by UCL researchers.

14 oct 2023--The study, published in Current Biology, used a computational model to further explore the intricacies of navigational errors previously observed in Alzheimer's disease.

Researchers, led by Professor Neil Burgess and colleagues in the Space and Memory group at the UCL Institute of Cognitive Neuroscience, grouped participants into three categories: healthy younger participants (31 total), healthy elderly participants (36 total) and patients with mild cognitive impairment (43 total). They then asked them to complete a task while wearing virtual reality goggles, which allowed them to make real movements.

In the trial, participants walked an outbound route guided by numbered cones, consisting of two straight legs connected by a turn. They then had to return to their starting position unguided.

The task was performed under three different environmental conditions aimed at stressing the participant's navigational skills: an unchanged virtual environment, the ground details being replaced by a plain texture, and the temporary removal of all landmarks from the virtual reality world.

The researchers found that people with early Alzheimer's consistently overestimated the turns on the route and showed increased variability in their sense of direction. However, these specific impairments were not observed in the healthy older participants or people with mild cognitive impairment, who did not show underlying signs of Alzheimer's.

This suggests that these navigational errors are specific to Alzheimer's disease—rather than an extension of healthy aging or general cognitive decline—and could help with diagnosis.

Joint first author, Dr. Andrea Castegnaro (UCL Institute of Cognitive Neuroscience), said, "Our findings offer a new avenue for the early diagnosis of Alzheimer's disease by focusing on specific navigational errors. However, we know that more work is needed to confirm these early findings.

"We aim to develop practical tests that can be easily integrated into clinical settings, considering common constraints such as limited space and time. Traditional navigation tests often have requirements that are challenging to meet in a clinical environment. Our research focuses on specific aspects of navigation that are more adaptable to these constraints.

"We are designing these tests to be both quick and comprehensive, aiming to collect sufficient data for a reliable diagnosis in a time-efficient manner, thereby increasing the likelihood of their widespread adoption."

It is estimated that there are currently 944,000 people living with dementia in the UK and over 60% of those diagnosed are thought to have Alzheimer's disease.

Similar projections in the US estimate that the number of people aged 65 and older living with Alzheimer's dementia could double, growing to 13.8 million in the US by 2060, barring medical breakthroughs. These trends indicate the increasing burden of Alzheimer's on health care systems and society at large.

Early diagnosis is crucial for better management and treatment of the disease. While recent advancements in blood tests can detect levels of tau and amyloid proteins that could signal potential Alzheimer's disease, these tests might not be sufficient on their own.

Dr. Castegnaro said, "Cognitive assessments are still needed to understand when the first cognitive impairments develop, and when it comes to existing spatial memory tests used in clinics, those often rely on verbal competence. Our tests aim to offer a more practical tool that doesn't rely on language or cultural background."

More information: Overestimation in angular path integration precedes Alzheimer's dementia, Current Biology (2023). DOI: 10.1016/j.cub.2023.09.047. www.cell.com/current-biology/f … 0960-9822(23)01296-4

 

Risk factors for dementia vary by ethnicity, study finds

by Public Library of Science

Modifiable risk factors—including hypertension, obesity, diabetes, low HDL cholesterol and sleep disorders—confer a higher risk of dementia for people in some minority ethnic groups compared to White people, according to the new study. Credit: Mohamed_hassan, Pixabay, CC0 (creativecommons.org/publicdomain/zero/1.0/)

Modifiable risk factors—including hypertension, obesity, diabetes, low HDL cholesterol and sleep disorders—confer a higher risk of dementia for people in some minority ethnic groups compared to White people, according to a new study published in the open-access journal PLOS ONE by Naaheed Mukadam of University College London, UK, and colleagues.

14 oct 2023--The number of people with dementia is on the rise around the world. There has been increasing interest in potentially modifiable risk factors, as eliminating these could theoretically prevent around 40% of dementia cases. However, most risk factor studies have been conducted only in people of European descent. In the new study, researchers analyzed the relationship between risk factors and dementia onset using anonymized data from English primary care records, spanning 1997 to 2018, for 865,674 adults in diverse ethnic groups.

Overall, 12.6% of the study population developed dementia—16.0% of white people, 8.6% of South Asian people, 12.1% of Black people and 9.7% of those from other ethnic groups. Nearly all risk factors analyzed in the study were associated with dementia, with the same risk factors often conferring a higher risk of dementia in Black and South Asian people, particularly for cardiovascular risk.

After adjusting for comorbidity, age, sex and deprivation, hypertension conferred higher risk of dementia in Black people compared to White people; hypertension, obesity, diabetes low HDL and sleep disorders conferred a higher risk of dementia in South Asian people. Compared to the effects in White people, hypertension had 1.57 times more impact on dementia risk in South Asian people and 1.18 times more impact in Black people.

The results may explain previous findings of greater susceptibility, earlier age of dementia onset, and shorter survival after dementia diagnosis in minority ethnic groups, the authors say. They conclude that dementia prevention efforts should be targeted toward people from minority ethnic groups and tailored to risk factors of particular importance.

The authors add, "We found that not only are some risk factors for dementia more common in minority ethnic groups but that the impact of some of these risk factors is even greater than in the White population. So we need tailored dementia prevention, taking into account ethnicity and risk factor profile to ensure dementia prevention is equitable."

More information: South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records, PLoS ONE (2023). DOI: 10.1371/journal.pone.0289893 , journals.plos.org/plosone/arti … journal.pone.0289893

 

Most accurate test to date developed to measure biological aging

by University of Glasgow

Credit: Pixabay/CC0 Public Domain

A team of European researchers has developed a new test that can accurately measure biological aging in a clinical setting. The discovery was made while studying patients for the aging effects of chronic kidney disease.

14 oct 2023--The new test is an epigenetic clock—a type of biochemical assessment that looks at DNA to understand how well the body is aging in contrast to its chronological age—and is the first of these cutting-edge tests to be proven to perform accurately in a clinical setting, in both healthy and unhealthy tissue.

The work was led by a partnership between the University of Glasgow and the Karolinska Institutet, Stockholm, and is published in the Journal of Internal Medicine as part of a study into the aging effects of chronic kidney disease and its associated treatments. It is titled "Epigenetic clocks indicate that kidney transplantation and not dialysis mitigates the effects of renal aging."

The research team studied more than 400 patients with chronic kidney disease in Sweden alongside around 100 matched population controls, to better understand the impact on aging of the disease, including during dialysis treatment and after kidney transplant.

To do this, researchers used a range of tests including blood biomarkers, skin autofluorescence and epigenetic clocks. The team used the clocks to measure the change in biological age of around 47 patients one year after kidney transplantation, or one year after the start of their dialysis treatment, as well as how the healthy tissue in 48 controls aged by comparison.

The results showed that for patients with chronic kidney disease, their biological clock is ticking faster than the average person's. This continues to be the case even after dialysis treatment. Indeed, patients' biological clocks were only shown to slow down following a kidney transplant.

However, while the epigenetic clocks all showed a similar picture, the research team found that none of the current clocks could be shown to be accurate in a clinical setting, and all were found to be inaccurate to differing degrees when tested in healthy tissue over time.

To address this, the team developed a new, more accurate epigenetic clock—the Glasgow-Karolinska Clock—that works on healthy and unhealthy tissue. The results from this new clock matched what doctors saw in patients with chronic kidney disease, and also appeared to accurately assess healthy tissue too. This study is the first real-world test of epigenetic clocks in a normal aging setting, and against clinical parameters.

As the body ages, a series of factors lead to epigenetic changes and loss of a chemical tag (DNA methylation) from your DNA. This is often associated with a range of disease common to aging, such as chronic kidney disease, cancer and heart disease. Epigenetic clocks have been proposed as a "gold standard" for measuring age accurately, beyond a person's biological age, as they are able to measure methylation tags on DNA.

Professor Paul Shiels, lead author of the study for the University of Glasgow, said, "This study is the first time in a clinical setting that we can accurately report on the extent of biological as opposed to chronological aging in chronic kidney disease patients. Our findings, using the new Glasgow-Karolinska Clock—show that not only are these patients aging faster than people in the general population, their accelerated aging only slows down once they have had a transplant. Treatment with dialysis does not appear to impact this process.

"This is also the first clinical test of epigenetic clocks, and the discovery that most are inaccurate when compared with medical evidence has led us to develop a new more accurate test which can accurately measure methylation tags on DNA of both healthy and unhealthy tissue. We have proven it is accurate to the high standards of a clinical setting.

"Methylation tagging of DNA is impacted by what we eat and also out gut microbiome. As a result, this new clock has real potential to be able to evaluate lifestyle interventions, including diet, that could benefit the public and help to address issues such as health inequalities."

Peter Stenvinkel, professor at Karolinska Institutet, said, "I found the new tool to estimate effects of interventions on biological age of much interest. The tool could be used to study treatment strategies in patients with end-stage kidney disease—a group subjected to premature aging."

More information: Epigenetic clocks indicate that kidney transplantation and not dialysis mitigates the effects of renal ageing, Journal of Internal Medicine (2023). DOI: 10.1111/joim.13724 , onlinelibrary.wiley.com/doi/10.1111/joim.13724