Loss of Y chromosome in blood cells associated with developing Alzheimer's disease

Men with blood cells that do not carry the Y chromosome are at greater risk of being diagnosed with Alzheimer's disease. This is in addition to an increased risk of death from other causes, including many cancers. These new findings by researchers at Uppsala University could lead to a simple test to identify those at risk of developing Alzheimer's disease.

27 may 2016--The results are presented today in American Journal of Human Genetics.
The loss of the Y chromosome (LOY) is known to affect up to 20 percent of men who are aged over 80, and is the most common genetic mutation acquired during a man's lifetime. Professors Lars Forsberg and Jan Dumanski, from the Department of Immunology, Genetics and Pathology at Uppsala University, and colleagues from Sweden, France, the UK, the US and Canada, investigated loss of the Y chromosome in over 3200 men with an average age of 73, and an age range of 37-96. Around 17 percent of them showed LOY in blood cells, and this increased with age. The researchers found that those with an existing diagnosis of Alzheimer's disease (AD) had a higher degree of LOY, and that LOY was also a marker for the likelihood of developing the disease during the follow-up period.
'The idea for this research project came to me when I was writing our first paper on the relationship between LOY and the development of non-blood cancers. In thinking about the process known as immunosurveillance - the body's ability to fight disease development throughout life - I found that it had been well studied in AD, and hence it occurred to me that LOY might be involved in this disease too,' says Lars Forsberg.
Using standard molecular techniques, the identification of LOY in blood is easy to determine when it occurs in 10 percent or more of blood cells with a nucleus containing DNA. As well as being relatively common in older men, it also occurs less frequently in those who are younger.
Since women do not carry a Y chromosome, and men have, on average, shorter lives, it is possible that LOY may be related to the earlier death of men. However, the researchers say, the mechanisms and causes for their findings are still not properly understood. They are currently investigating the functional effects of LOY, and looking at its role in different groups of men and in other diseases, in order to understand better which types of cancer are associated with LOY, as well as whether there is a link with early signs of dementia, for example mild cognitive impairment.
Another question to be answered relates to how LOY in blood cells can be related to disease in other organs.
'The blood cells we studied are involved in the immune system, and the fact that LOY in them is associated with disease in other tissues is striking. We therefore hypothesise that the loss of LOY in blood cells leads them to lose part of their immune function,' says Jan Dumanski.
Previous research by the same group has shown that smoking greatly increases the risk of acquiring LOY, by as much as 400 percent. However, smoking appears to have a transient effect, and is also dose-dependent, so quitting could reverse the effect. This could be important to emphasise in smoking-cessation programmes, the researchers say.
More difficult to tackle is the question of diagnosis and treatment of serious conditions such as AD and cancer. This is currently based on identifying clinical symptoms, and the development of diagnostic tools for their earlier detection could lead to strategies aimed at preventing their development before symptoms occur. For example, in the future it might be possible to use an LOY test to identify men at risk and then carry out oncological or neurological evaluations to try to detect early, mild, symptoms of disease. LOY might also become an important diagnostic tool in combination with other biomarkers that may be used to predict risks for various diseases.
'The addition of LOY testing in the general population could give medical practitioners the possibility of using preventive strategies in men at risk. For example, in cancer, primary tumours are usually not deadly; it is the metastatic process that it normally responsible for deaths. If we could predict which men have an increased risk of cancer, we could watch them closely for the development of disease and also use appropriate preventive treatments. In short, the widespread use of LOY testing could radically decrease male mortality rates, and even perhaps eliminate the difference in life expectancy between the sexes,' says Lars Forsberg.

More information: American Journal of Human Genetics, Dumanski et al.: "Mosaic loss of chromosome Y in blood is associated with Alzheimer's disease"

http://www.cell.com/ajhg/fulltext/S0002-9297(16)30149-5 , DOI: 10.1016/j.ajhg.2016.05.014


Provided by Uppsala University

Development of portable device to detect arrhythmias in real time

Portable device to detect arrhythmias in real time

Researchers at the Technological Institute of Morelia (ITM) in Mexico created a portable device for detecting cardiac arrhythmias in real time using electrodes placed on the chest of the patient or as part of clothing. It also alerts medical personnel of any irregularity in the heartbeat.

26 may 2016--Dr. Jose Gutierrez explained that the device sends real-time results to doctors with a wireless measurement system. It also stores data for subsequent analysis.
One of the advantages of this new technology is that it is smaller than existing devices on the market. The device developed at the ITM measures less than half of typical devices, at 20 x 20 centimeters.
The device enables the detection of eight different types of arrhythmias. Its design considers user safety as a primary factor. One of the challenges in the development of this device, explains Gutierrez, is improved recharging. He adds that future devices can be made even smaller.
In addition, this technology can be used by people who currently have not been found to have a cardiovascular disease for prevention and, where appropriate, early detection, essential to diagnose the development of this disease.
Moreover, the device fits the patient's body, which allows detection of heart rhythm through electrodes placed in a shirt.
The specialist explained that given the high amount of data to analyze, both computer systems and specialists have trouble detecting irregularities, especially occasional ones.
For five years, the researchers developed various measurement systems for both detection and signal processing. This technology has social importance, since cardiovascular disease is a common cause of mortality and morbidity around the world . In Mexico, these diseases are increasing due to widespread unhealthy eating habits with high content of saturated and trans fats, increased sodium intake, smoking and alcohol abuse and physical inactivity.
Gutiérrez Gnecchi and other researchers at ITM are also working on a device to determine deafness in babies, and another for detecting breast cancer without the hassles of current mammography.


Provided by Investigación y Desarrollo

Study finds that yoga and meditation can help minimize cognitive impairment

Inner peace and a flexible body may not be the most valuable benefits that yoga and meditation have to offer, suggests new research by a UCLA-led team of neuroscientists.

22 may 2016--The team found that a three-month course of yoga and meditation practice helped minimize the cognitive and emotional problems that often precede Alzheimer's disease and other forms of dementia—and that it was even more effective than the memory enhancement exercises that have been considered the gold standard for managing mild cognitive impairment.
"Memory training was comparable to yoga with meditation in terms of improving memory, but yoga provided a broader benefit than memory training because it also helped with mood, anxiety and coping skills," said Helen Lavretsky, the study's senior author and a professor in residence in UCLA's department of psychiatry.
People with mild cognitive impairment are two-and-a-half times more likely to develop Alzheimer's disease and other forms of dementia.
The study, which appears May 10 in the Journal of Alzheimer's Disease, is the first to compare outcomes from yoga and meditation with those from memory training, which incorporates activities ranging from crossword puzzles to commercially available computer programs. The study of 25 participants, all over the age of 55, measured changes not just in behavior but also in brain activity.
"Historically and anecdotally, yoga has been thought to be beneficial in aging well, but this is the scientific demonstration of that benefit," said Harris Eyre, the study's lead author, a doctoral candidate at Australia's University of Adelaide and a former Fulbright scholar at UCLA's Semel Institute for Neuroscience and Human Behavior. "We're converting historical wisdom into the high level of evidence required for doctors to recommend therapy to their patients."
Lavretsky and Eyre studied participants who had reported issues with their memory, such as tendencies to forget names, faces or appointments or to misplace things. Subjects underwent memory tests and brain scans at the beginning and end of the study.
Eleven participants received one hour a week of memory enhancement training and spent 20 minutes a day performing memory exercises—verbal and visual association and other practical strategies for improving memory, based on research-backed techniques.
The other 14 participants took a one-hour class once a week in Kundalini yoga and practiced 20 Kirtan Kriya meditation at home for 20 minutes each day. Kirtan Kriya, which involves chanting, hand movements and visualization of light, has been practiced for hundreds of years in India as a way to prevent cognitive decline in older adults, Lavretsky said.
After 12 weeks, the researchers saw similar improvements among participants in both groups in verbal memory skills—which come into play for remembering names and lists of words. But those who had practiced yoga and meditation had better improvements than the other subjects in visual-spatial memory skills, which come into play for recalling locations and navigating while walking or driving.
The yoga-meditation group also had better results in terms of reducing depression and anxiety and improving coping skills and resilience to stress. That's important because coming to terms with cognitive impairment can be emotionally difficult.
"When you have memory loss, you can get quite anxious about that and it can lead to depression," said Lavretsky, who is also a researcher at the Semel Institute.
The researchers report that the participants' outward improvements in memory corresponded with perceptible changes in their brain activity. Using functional magnetic resonance imaging, they showed that subjects in both groups had changes in their brain connectivity, but the changes among the yoga group were statistically significant, whereas the changes in the memory group were not.
The researchers attribute the positive "brain fitness" effects of mindful exercise to several factors, including its abilities to reduce stress and inflammation, improve mood and resilience, and enhance production of brain-derived neurotrophic growth factor, a protein the stimulates connections between neurons and kick-start telomerase activity, a process that replaces lost or damaged genetic material.
"If you or your relatives are trying to improve your memory or offset the risk for developing memory loss or dementia, a regular practice of yoga and meditation could be a simple, safe and low-cost solution to improving your brain fitness," Lavretsky said.


Provided by University of California, Los Angeles

New recommendations focus on how nutritional needs change as we age

Older adults “need to be a little more careful about choosing food,” says Alice H. Lichtenstein. “The amount of nutrients per calorie should be relatively high.” Credit: Depositphotos

21 may 2016--Eating right as an older adult takes a bit more effort. Even if you stay the same weight as you age, you have less lean muscle mass and your metabolism slows down, which means you need fewer calories than you once did. At the same time, your nutrient needs stay the same or even increase. Your body may have trouble absorbing certain nutrients, such as B12 and magnesium.
That's why making every bite count is even more important for seniors.
"One needs to be a little more careful about choosing food. The amount of nutrients per calorie should be relatively high," says Alice H. Lichtenstein, director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts.
To help, Lichtenstein and other HNRCA scientists, with the support of the AARP Foundation, recently released an updated MyPlate for Older Adults, a graphic that provides an at-a-glance overview of what constitutes a healthy diet. On May 18, representatives from the HNRCA and the AARP Foundation will meet with policymakers and advocates for older adults in Washington, D.C., to present the graphic and discuss the nutritional needs of seniors, who often don't get enough of important nutrients. Rep. Jim McGovern, D-Mass., chair of the House Hunger Caucus, will be the featured speaker.
While this is the fourth iteration of the graphic since 1999, its creators say it has never been more important to get such tools into the hands of those who can benefit the most.
A recent survey by the AARP Foundation found that while interest in eating nutritious foods increases with age, understanding of nutrition labels declines. "There is a real need to fill that gap and ensureolder adults have the knowledge and resources they need when they are choosing what to eat," says Alex Lewin-Zwerdling, a senior advisor for the AARP Foundation's Hunger Impact Program.
MyPlate for Older Adults is based on the 2015-2020 Dietary Guidelines for Americans, and its overarching advice could apply to adults of any age. But the graphic and accompanying website provide tips and reminders that are particularly suited to the needs and concerns of seniors.
Lichtenstein, who served as vice chair of the 2015 Dietary Guidelines Advisory Committee, says one of the goals is letting seniors know that they have options. As with the familiar MyPlate put out by the federal government, the MyPlate for Older Adults recommends that half of what seniors eat should be fruits and vegetables.
But getting to the store regularly for fresh produce may be difficult for those who no longer drive, or who "may be reluctant in the winter to go out, especially if they think it is going to be icy," Lichtenstein says. That's why the modified graphic gives equal prominence to frozen fruits and vegetables, as well as to low-sodium canned versions, which have longer shelf lives.

The graphic also acknowledges that seniors may no longer be cooking for a big family, or even a spouse. "With a bag of pre-peeled carrots or frozen broccoli, you can snip it open and just take out a single serving," she says.

Protein and Heart-Healthy Fats

While the general MyPlate gives dairy its own space, the modified MyPlate points out that cheese and yogurt have something in common with fish, eggs, poultry and nut butter. "We moved them into the protein quadrant because dairy is an excellent source of high-quality protein," Lichtenstein says. Some studies have indicated that our need for protein may even increase as we age.
Also with age, people's sense of thirst may decline, and certain medicines increase the risk for dehydration. So the new MyPlate for Older Adults makes a special note of the various ways to get enough fluid in your diet: water, tea, coffee, soups and even many fruits and vegetables.
The graphic also depicts vegetable oils and soft margarines, which provide heart-healthy fats, and reminds seniors to stay active with exercises such as walking, biking and swimming. Recognizing that our sense of taste may change as we age, but that sodium intake may be a concern, the MyPlate for Older Adults encourages the use of herbs and spices, rather than salt, for flavor.
Seniors need more calcium and vitamin D to maintain bone and muscle health, and increasing potassium may lower the risk of developing high blood pressure. Simin Nikbin Meydani, director of the HNRCA and its Nutritional Immunology Laboratory, says that optimal nutrition is particularly important for fighting off illness when we get older. With age, some parts of the immune system start to overperform—resulting in inflammation—and some parts start to underperform—making us more susceptible to infections.
"You have to think of the immune system as a factory," she says. "The factory needs to be ready as soon as it is attacked to produce all kinds of defensive mechanisms. And in order to produce those defensive weapons, it needs to have protein, essential amino acids, essential fatty acids, all kinds of micronutrients. And if you don't have that, it can't make what it needs to get rid of those pathogens."
Infections can also take away appetite and decrease the body's ability to metabolize nutrients, further decreasing the immune system's arsenal. "It becomes a vicious cycle," Meydani says.
Even small changes, such as switching from iceberg lettuce to nutrient-rich spinach in a salad, could make a difference in overall health. (Add in some carrots, apples and berries while you're at it.) All it may take is a pictorial reminder.
"It's very important to have easy ways of helping seniors achieve a healthy diet through user-friendly tools such as MyPlate for Older Adults," Meydani says.


Provided by Tufts University

Ageing affects test taking, not language, study shows

The ability to understand language could be much better preserved into old age than previously thought, according to researchers from the University of Cambridge, who found older adults struggle more with test conditions than language processing.

15 may 2016--Scientists from the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) scanned participants during testing and found that the areas of the brain responsible for language performed just as well in older adults as in younger ones.
The research, published in the Journal of Neuroscience, suggests that increased neural activation in the frontal brain regions of older adults reflects differences in the way they respond to the demands of the task compared with younger adults, rather than any difference in language processing itself.
"These findings suggest our ability to understand language is remarkably preserved well into old age, and it's not through some trick of the mind, or reorganisation of the brain," says co-author Professor Lorraine Tyler, who leads Cam-CAN. "Instead, it's through the continued functioning of a well-used language processing machine common to all humans."
Professor Tyler says cognitive neuroscientists attempting to explain how the mind and brain work typically approach the question with tasks designed to measure particular cognitive abilities, such as memory or language. However, it's rarely as simple as that, she says, and tasks never end up measuring only one thing.
"Scientists claim that they are studying language, when really they are studying language plus your motivation to do well, plus your understanding of the instructions, plus your ability to focus, and so on," says lead author Dr Karen Campbell, now based at Harvard University. "These poorly defined tasks become even more problematic when it comes to studying the older brain, because older adults sometimes show increased neural activation in frontal brain regions, which is thought to reflect a change in how older brains carry out a given cognitive function. However, this extra activation may simply reflect differences in how young and older adults respond to the demands of the task."
Campbell and her Cam-CAN colleagues tried to isolate the effect of the testing by scanning 111 participants aged 22-87 using functional magnetic resonance imaging (fMRI) while they either passively listened to sentences or decided if the sentences were grammatical or not.
The researchers found that simply listening to and comprehending language, as we do in everyday life, "lights up" brain networks responsible for hearing and language, whereas performing a cognitive task with the same sentences leads to the additional activation of several task-related networks.
Age had no effect on the language network itself, but it did affect this network's ability to "talk with" other task-related networks.

More information: K. L. Campbell et al. Robust Resilience of the Frontotemporal Syntax System to Aging, Journal of Neuroscience (2016). DOI: 10.1523/JNEUROSCI.4561-15.2016


Provided by University of Cambridge

Italian woman, 116, seen as last living person born in 1800s

Emma Morano sits on her bed in her apartment in Verbania, Italy, Friday, May 13, 2016. Emma Morano is now the oldest person in the world. Not only that, but she is believed to be the last surviving person in the world who was born in the 1800s, coming into the world on Nov. 29, 1899. That's just 4 and a half months after Susannah Mushatt Jones, who died Thursday in New York at the age of 116. (Antonino Di Marco/ANSA via AP)

Surrounded by relatives and friends, Italy's Emma Morano greeted with a smile the news that she, at 116, is now the oldest person in the world.
Not only that, but Morano is believed to be the last surviving person in the world born in the 1800s, with a birthdate of Nov. 29, 1899. That's just 4 ½ months after Susannah Mushatt Jones, who died Thursday in New York, also at 116.
Journalists on Friday descended upon Morano's home in Verbania, a northern Italian mountain town overlooking Lake Major, to document her achievement, but had to wait until she finished a nap to greet her.
Morano lives in a neat one-room apartment, which she no longer leaves, and is kept company by a caregiver and two elderly nieces.
"I am doing fine —116!" she told well-wishers from her bed Friday.
"I finished school and I went to work. I used to sing. I had a beautiful voice," she added, summing up her life in a frail voice.
Her physician of 23 years, Dr. Carlo Bava, delivered the news earlier that she was officially the world's oldest person.
"She was very, very happy" and sitting up in a chair, he told The Associated Press in a phone interview. "She was all proud and contented."

Emma Morano sits on her bed in her apartment in Verbania, Italy, Friday, May 13, 2016. Emma Morano is now the oldest person in the world. Not only that, but she is believed to be the last surviving person in the world who was born in the 1800s, coming into the world on Nov. 29, 1899. That's just 4 and a half months after Susannah Mushatt Jones, who died Thursday in New York at the age of 116. (Antonino Di Marco/ANSA via AP)

For the occasion, he brought flowers as well seven Easter cakes called Colomba, an Italian specialty that he managed to procure out of season to satisfy her sweet tooth until Christmas, when Panettone is available.
The doctor said Morano has never had a very balanced diet, relying mostly on animal protein, the occasional banana and grapes in season. Her diet now includes two raw eggs and 100 grams of raw steak a day, which Bava prescribed after she had a bout of anemia some years back. Her nieces also make her apple sauce.
Italy is known for its centenarians—many of whom live on the Mediterranean island of Sardinia—and gerontologists at the University of Milan are studying Morano, along with a handful of Italians over 105, to try to figure out why they live so long.
Bava, who visits her every Friday, is convinced there's a genetic component to Morano's longevity in addition to her positive attitude. One of her sisters lived to be over 100 and another to nearly 100.
She has been in stable health for years, Bava said, with no chronic ailments.

In this Friday, June 26, 2015 photo, Emma Morano, 116, sits in her apartment in Verbania, Italy. At 116 years of age, Emma is now the oldest person in the world and is believed to be the last surviving person in the world who was born in the 1800s, coming into the world on Nov. 29, 1899. That's just 4 and a half months after Susannah Mushatt Jones, who died Thursday in New York at the age of 116. (AP Photo/Antonio Calanni, File)

"Her longevity is a genetic fact, nothing else," Bava said. "She is a person who from a young age had a difficult life that would have sapped the energy out of anyone."
He said Morano's husband beat her and she lost an infant son to crib death at 6 months. She supported herself working in a factory making jute bags, then in a hotel, working well past retirement age.
"She abandoned the husband in the Fascist era, when women were supposed to be submissive. She was always very decisive," her doctor said.
Bava, who has known Morano since she was 90, also praised her emotional stability.
"She is always a very serene. The beauty of Emma is that it is normal that she smiles, but also in difficulties, she is very decisive," he said. "But perhaps this tranquility comes with age, which becomes wisdom. Who knows?"

In this Friday, June 26, 2015 photo, Emma Morano, 116, sits in her apartment in Verbania, Italy. At 116 years of age, Emma is now the oldest person in the world and is believed to be the last surviving person in the world who was born in the 1800s, coming into the world on Nov. 29, 1899. That's just 4 and a half months after Susannah Mushatt Jones, who died Thursday in New York at the age of 116. (AP Photo/Antonio Calanni, File)

During a visit by the AP last summer, Morano was in feisty spirits, displaying the sharp wit and fine voice that used to stop men in their tracks.
"I sang in my house, and people on the road stopped to hear me singing. And then they had to run, because they were late and should go to work," she recalled, before breaking into a round of the 1930s Italian love song "Parlami d'amore Mariu."
"Ahh, I don't have my voice anymore," she lamented.

Wellderly study suggests link between cognitive decline genes and healthy aging

An eight-year-long accrual and analysis of the whole genome sequences of healthy elderly people, or 'Wellderly,' has revealed a higher-than-normal presence of genetic variants offering protection from cognitive decline, researchers from the Scripps Translational Science Institute reported today in the journal Cell. Credit: Sigrid Knemeyer and Scripps Translational Science Institute

An eight-year-long accrual and analysis of the whole genome sequences of healthy elderly people, or "Wellderly," has revealed a higher-than-normal presence of genetic variants offering protection from cognitive decline, researchers from the Scripps Translational Science Institute (STSI) reported today in the journal Cell.

07 may 2016--The initial findings from the Wellderly Study suggest a possible link between long-term cognitive health and protection from chronic diseases, including cancer, heart disease and diabetes, which account for 90 percent of all deaths in the United States and other industrialized nations and more than 75 percent of health care costs.
"The Wellderly, as we've defined, are exceptional individuals who live into their ninth decade and beyond without developing a significant chronic medical condition," said STSI Director Eric Topol, M.D., who is one of the study's senior authors. "Our findings indicate that protection from cognitive decline is associated, not necessarily cause and effect, with healthspan. Since healthspan is woefully understudied, much more work in large numbers of individuals across all ancestries is desperately needed. For this reason, we have made all the genomic data available to the research community and public to help spawn further research."
Results of the Wellderly Study were published online today by Cell. The report also will appear in the journal's May print edition.
STSI is a National Institutes of Health-sponsored site led by Scripps Health in collaboration with The Scripps Research Institute. This innovative research partnership is leading the effort to translate wireless and genetic medical technologies into high-quality, cost-effective treatments and diagnostics for patients.
STSI researchers launched the Wellderly Study in 2007 in hopes of unlocking the genetic secrets behind lifelong health. The ongoing project has enrolled more than 1,400 people from across the country ranging in age from 80 to 105 who have not developed any chronic medical conditions or diseases including cancer, stroke, Alzheimer's, Parkinson's disease, diabetes and heart attack.
"This study is exciting because it is the first large one using genetic sequencing to focus on health," said Stanford University Department of Genetics Chairman Michael Snyder, Ph.D., who was not involved with the research. "Most of the world's scientists are studying disease, but what we really want to understand is what keeps us healthy. That is what the Wellderly Study is all about."
John Rawlings, 90, of San Diego is one of the study's participants. The Indiana native and World War II veteran started playing softball in his 70s and was inducted into the National Senior Softball Hall of Fame in 2009. He also is an avid reader.
"When I turned 90, they said, 'Let's have a big party,'" Rawlings said. "I told them, 'You'd better wait until I turn 100.'"
For the study, researchers sequenced the whole genomes of 600 study participants and compared their DNA with genetic data gathered from 1,507 adults by Inova Translational Medicine Institute as part of a separate study. The ITMI cohort represented the general population. All of the genomes were mapped using the Complete Genomics sequencing platform.
After filtering to control for ethnic differences and blood relatedness, downstream DNA analyses were conducted on the genomes of 511 Wellderly individuals and 686 ITMI individuals. Researchers ended up analyzing 24,205,551 individual gene variants in both groups.
The Wellderly group had a significantly lower genetic risk for Alzheimer's and coronary artery disease, researchers found. However, no difference was found between the two groups in genetic risk for cancer, stroke or type 2 diabetes, suggesting protective behaviors or other genetic characteristics might be at play among the Wellderly.
"We didn't find a silver bullet for healthy longevity," said Ali Torkamani, Ph.D., director of genome informatics at STSI and one of the study's co-authors. "Instead, we found weaker signals among common as well as rare variant sites, which collectively suggest that protection against cognitive decline contributes to healthy aging."
Of particular interest was a group of ultra-rare coding variants found among 10 Wellderly individuals in the COL25A1 gene, which encodes for a major component of amyloid plaques found in the brains of Alzheimer's disease patients. None of the coding variants were found among the ITMI individuals.
"Those gene variants might offer a pathway for the development of new treatments for Alzheimer's," Torkamani said.
"For many decades, we have searched for the genetic causes of disease in sick individuals," noted founding director of the Icahn Institute for Genomics and Multiscale Biology at Mount Sinai Eric Schadt, Ph.D., who was not involved with the STSI research. "The Wellderly Study presents an attractive alternative by studying those who are well in order to uncover the solutions nature has provided to protect us against disease. The initial discoveries around protective factors for Alzheimer's disease and coronary artery disease demonstrate the keys the Wellderly may hold in unlocking ways in which we all may live healthier lives."

More information: Cell, DOI: 10.1016/j.cell.2016.03.022

Provided by Scripps Health

Walking speed could be a new indicator of health

Walking speed is making strides toward becoming a key metric of a person's health with the launch of the 6th Vital Sign, a first-of-its kind study being conducted by the Duke Clinical Research Institute (DCRI). 

06 may 2016--The Duke research team is asking volunteers to download a free ResearchKit app from the Apple iTunes store, answer some questions and then take a two-minute stroll. The app securely uploads walking speed captured on a phone along with demographic data to calculate a reliable and personalized health measure.
"Walking speed is recognized, yet underutilized, as a measure and predictor of a person's health. It can be used as a vital sign much like blood pressure, temperature, heart and breathing rate and pain," said study team leader Janet Prvu Bettger, ScD, an associate professor and director of health policy and implementation science in Duke's Department of Orthopaedic Surgery.
Vital signs measure the body's basic functions and should be easy to measure at home, in a hospital or at a health clinic. "Mobility, or a person's ability to move, reflects the health of all of our body's systems," Bettger said. On the other hand, immobility impacts a person's muscles, heart, digestive system, joints, and even mood.
"As a 6th Vital Sign, walking speed can be used to track a person's recovery from illness or injury, declines in health, or even risks for falls, or depression," Bettger said. "Among older adults we know that walking speed can even be used to predict survival."
The 6th Vital Sign study is designed to:

• Create walking speed norms based on mobile phone rather than clinic measures.
• Develop walking speed comparison charts by age and gender for all adults (like height and weight charts).
• Create maps of how walking speed varies by where people live.
• Increase awareness of the importance of walking speed.
• Make walking speed a vital sign used in homes, health care and communities around the globe.

"We are very excited by the possibilities of mobile apps such as the 6th Vital Sign to reach large cross-sections of the population and stimulate healthy behaviors," said DCRI Executive Director Eric Peterson, M.D. "DCRI is committed to evaluating how we can use innovative mobile technologies in research as well as in promoting population health in general."
To participate in the study, adults are being asked to download the 6th Vital Sign mobile app free from the iPhone Store, answer a few questions, and take a two-minute walk. Anyone living in the United States, over the age of 18, and with access to an iPhone 5s, 6, or 6 plus can join the study. (This is an iPhone-only and English language study at this time.) Participants will receive feedback on their walking performance compared to others their age and gender and can save or share their results. Participants can complete the walk test more than once and monitor their status over time to learn more about their own personal walking speed.
"We're conducting this study because we don't know enough about the walking speed across the human lifespan," said Miriam Morey, Ph.D., a professor of medicine and senior fellow in the Center for the Study of Aging and Human Development at Duke.
"As we get older, our systems start to decline and we have age-related declines that are normal," Morey said. "However, we can influence the pace of this decline by how we take care of ourselves. Right now, we don't routinely measure walking and strength so we don't know what's going on – or what we need to be doing. The 6th Vital Sign study examines a new approach to be measuring mobility."
"This research app allows us to create new mobile-phone based standards and norms for walking speed for people, first around the U.S. and eventually around the world," Bettger said. "The more people who participate in the study, the more representative our findings. This will help us create more accurate predictions of future health and measure-based action plans to promote health, recovery from an injury, and prevention of falls. And because smart phones are so common among people of all ages, there is a great potential to engage an unlimited population in research and create new knowledge for entire populations."


Provided by Duke University

Sarcopenia, which affects up to 20 percent of European seniors, may increase 63 percent by 2045

Today, at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. researchers from the University of Liège, Belgium presented a study that reveals the enormous and growing burden of sarcopenia in Europe.

01 may 2016--Sarcopenia is a disease associated with the ageing process. Hallmark signs of the disorder are loss of muscle mass and strength, which in turn affects balance, gait and overall ability to perform tasks of daily living.
Due to its complexity, there is as yet no global consensus on the definition of the disease for diagnostic purposes. The European Working Group on Sarcopenia in Older People (EWGSOP) has defined sarcopenia as low muscle mass with low muscle strength OR with low gait speed. With two cutoff points available for each of the three components of this definition, eight different methods of diagnosis of sarcopenia can be used.
Using the Eurostat online database, the researchers retrieved age and gender-specific population projections from 2016-2045 for 28 European countries. The age and gender-specific prevalence of sarcopenia was assessed from a study that precisely compared prevalence estimates according to the different diagnostic cutoffs of the EWGSOP proposed definition.
The prevalence estimates were interpolated for adults above 65 years of age. The estimates of sarcopenia prevalence were then applied to population projections until 2045. The results showed that:

• Using the definition providing the lowest prevalence estimates, the number of individuals with sarcopenia in Europe in 2016 is 10,869,527. This will rise to 18,735,173 in 2045 (a 72.4% increase). The overall prevalence of sarcopenia in the elderly will rise from 11.1% in 2016 to 12.9% in 2045. Women currently account for 44.2% of prevalent cases.
• Using the definition providing the highest prevalence estimates, the number of individuals with sarcopenia in Europe is 19,740,527 in 2016, rising to 32,338,990 in 2045 (a 63.8% increase). The overall prevalence of sarcopenia in the elderly will rise from 20.2% in 2016 to 22.3% in 2045. Women currently account for 66.4% of prevalent cases.

Presenting author Dr. Olivier Ethgen stated, "Regardless of which diagnostic cutoff is used to define sarcopenia, the prevalence of this condition is expected to rise substantially in Europe. It is therefore essential that we implement effective prevention and disease management strategies. Health authorities must take action in order to limit the impact on increasingly strained healthcare systems and to help Europeans enjoy healthy, active ageing."

More information: OC24 The Future Prevalence of Sarcopenia in Europe, O. Ethgen, C. Tchokonte, C. Beaudart1, F. Buckinx, J.-Y. Reginster, O. Bruyère
Abstract book: WCO-IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, 14 -17 April 2016, Malaga, Spain Osteoporosis International, Volume 27/ Suppl 1/ 2016


Provided by International Osteoporosis Foundation

Vaccinations are more effective when administered in the morning

Credit: National Cancer Institute

New research from the University of Birmingham has shown that flu vaccinations are more effective when administered in the morning.

26 april 2016--The findings, published in the journal Vaccine, suggest administering vaccinations in the morning, rather than the afternoon, could induce greater, and thus more protective, antibody responses.
24 general practices in the West Midlands, UK, were analysed between 2011 and 2013 in a cluster-randomised trial during the annual UK influenza vaccination programme.
276 adults aged over 65 were vaccinated against three strains of influenza, either in morning surgeries (9-11am) or afternoon surgeries (3-5pm).
In two of the three given influenza virus strains, those in the morning cohort saw a significantly larger increase in antibody concentration one month following vaccination, when compared with those in the afternoon cohort. In the third strain, there was no significant difference between morning and afternoon.
Dr Anna Phillips, the Principal Investigator of the study from the School of Sport, Exercise and Rehabilitation Sciences at the University of Birmingham explained, "We know that there are fluctuations in immune responses throughout the day and wanted to examine whether this would extend to the antibody response to vaccination. Being able to see that morning vaccinations yield a more efficient response will not only help in strategies for flu vaccination, but might provide clues to improve vaccination strategies more generally."
The influenza vaccination is part of the seasonal vaccination programme carried out by general practices across the UK, and in many other countries, with a particular focus on patients over 65 years old.
Despite this, the influenza virus is responsible for between 250,000 and 500,000 deaths each year worldwide. The age-related decline in immunity reduces the ability of older adults to produce adequate antibody responses following vaccination, compromising the given protection.
Other interventions to improve outcomes of vaccination have been attempted with limited success, including exercise routines and additives to the vaccine itself.
Professor Janet Lord, a co-investigator on the study from the Institute of Inflammation and Ageing at the University of Birmingham, said, "A significant amount of resource is used to try and prevent flu infection each year, particularly in older adults, but less than half make enough antibody to be fully protected. Our results suggest that by shifting the time of those vaccinations to the morning we can improve their efficiency with no extra cost to the health service."
The team will now look to investigate further in a large scale study. This is important to see if the morning vaccination strategy benefits a wide range of over 65s including those with conditions like diabetes, liver and kidney disease that impair immunity. They will also look to see if the morning vaccination strategy is effective for the pneumococcal vaccine that protects against pneumonia; a vaccine recommended to all individuals aged 65 years old in the UK.

More information: "Morning vaccination enhances antibody response over afternoon vaccination: a cluster-randomised trial," Vaccine, DOI: 10.1016/j.vaccine.2016.04.032


Provided by University of Birmingham

Palliative care viewed as a stigma, despite improving quality of life

The term palliative care carries a stigma for patients and their caregivers, who regard it as synonymous with impending death. Education, and possibly a name change, will be necessary to be able to integrate palliative care into routine advanced cancer care, according to new research in CMAJ (Canadian Medical Association Journal).

19 april 2016--Palliative care is designed to improve the quality of life of patients with a serious illness and their families. The World Health Organization and all major national and international cancer societies encourage early access to palliative care. Research indicates that for people with advanced cancer, early palliative care benefits both physical and mental health and can even extend life.
However, a new study found that even patients who have benefited from early palliative care feel stigmatized because they see it as being associated with the end of life.
The study, conducted at Princess Margaret Cancer Centre, Toronto, Ontario, included 71 participants (48 patients and 23 caregivers) in a randomized clinical trial of early palliative care versus standard cancer care. Of the participants, 40 had received early referral to palliative care (in addition to standard cancer care), and 31 had received standard cancer care alone. Participants had cancers from the five most common types: lung, gastrointestinal, genitourinary, breast and gynecologic, and had an estimated survival (by their oncologist) of 6-24 months. At the end of the trial, researchers interviewed the 71 patients and caregivers about their attitudes and perceptions to palliative care.
"Patients with advanced cancer and their caregivers described palliative care as carrying a negative stigma associated with death and with care at the very end of life, which provoked fear and avoidance," writes Dr. Camilla Zimmermann, Princess Margaret Cancer Centre, University Health Network, Toronto, and her coauthors. "Participants' perceptions often originated from interactions with health care professionals."
"A prominent theme was that palliative care should be explicitly rebranded," the researchers found, with participants suggesting public education, better explanation by health care professionals and routine involvement of palliative care at cancer diagnosis to break down stigma.
The authors suggest that the study has implications for clinical practice and health care policy.
"[Our findings show that] the persistence of the definition of palliative care as end-of-life care in the minds of patients and their caregivers, despite an international change in that definition more than a decade ago," write the authors. "A name change may be considered, but would achieve nothing without a fundamental shift in the manner in which palliative care is practised and portrayed."
The authors caution that the way in which physicians inform patients and their caregivers about palliative care has a major impact on how it is perceived. Many health care professionals still suggest palliative care as a final option or as an alternative to further treatment.
In a related commentary, Dr. Anthony Caprio, Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina, writes that the study shows that "patients and caregivers view health care professionals as having an important role in explaining and recommending palliative care. Although changing the name to supportive care may help promote a more positive view of palliative care, the stigma will persist if this type of care is recommended only as default treatment when curative or life-prolonging treatments are deemed ineffective or undesired."
Palliative care should begin at diagnosis and continue throughout cancer care, regardless of prognosis.

More information: Canadian Medical Association 

Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.151171
Canadian Medical Association Journal, www.cmaj.ca/lookup/doi/10.1503/cmaj.160206

Provided by Canadian Medical Association Journal

First diagnosed case of Alzheimer's disease in HIV-positive individual reported

R. Scott Turner, M.D., Ph.D., Director, Georgetown Memory Disorders Program. Credit: Georgetown University

Georgetown University researchers are reporting the first case of Alzheimer's disease diagnosed in an HIV-positive individual. The finding in a 71-year-old man triggers a realization about HIV survivors now reaching the age when Alzheimer's risk begins to escalate.

17 april 2016--Published online in the open access journal Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, neurologist R. Scott Turner, MD, PhD, diagnosed the patient after a PET scan showed deposition of amyloid in the brain. Until this point, Turner says, clinicians thought that individuals with HIV may not develop AD because HIV-related inflammation in the brain may prevent amyloid clumps from forming.
"This patient may be a sentinel case that disputes what we thought we knew about dementia in HIV-positive individuals," says Turner, who leads the Memory Disorders Program at Georgetown University Medical Center.
In addition, Turner says the finding suggests that some older HIV-positive patients with dementia may be misdiagnosed with HIV-associated neurocognitive disorders (HAND) when they may be developing AD. It also may be possible that some patients experience HAND and AD—a new type of mixed dementia, Turner says. "Chronic HIV infection and amyloid deposition with aging may represent a "double-hit" to the brain that results in progressive dementia."
"While it may be challenging to diagnose the cause of dementia in an HIV-positive patient, the diagnosis matters because HAND and AD are treated differently," he says. "For Alzheimer's disease, we now have four FDA-approved drugs and more effective treatments are on the way. For HAND, we prescribe anti-retroviral drugs that have a better chance of penetrating the brain. So getting a correct diagnosis is important, and a critical first step in advancing the field."
HAND will develop in 30-50 percent of individuals with long-term HIV infections. But HAND symptoms are identical to those with AD, Turner says. He adds, "The medical community assumes that dementia with HIV is caused by HAND. Physicians haven't considered Alzheimer's, so it's possible that a number of older HIV-positive individuals may be misdiagnosed."
Published studies to date point to only five individuals with HAND who have undergone amyloid PET imaging, and all were negative; however, the oldest of these patients was 67, Turner says.
Diagnosis of dementia in older HIV-infected individuals is on the rise. HIV-infected adults over 55 comprise the fastest growing age group in the HIV-positive population.
According to the most recent CDC HIV Surveillance Report with data through 2013, 53,000 people in the U.S. living with HIV are 65 and older, the age when Alzheimer's disease risk begins to escalate. That number is expected to double in less than 10 years and doesn't include those who have not been diagnosed. Worldwide, more than 37 million people are living with HIV.
"This case report reveals important new insights into the specific issue of HIV-related neurological impairment," says Jeffrey Crowley, MPH, program director of the National HIV/AIDS Initiative at the O'Neill Institute for National and Global Health Law at Georgetown Law. Crowley is former director of the White House Office of National AIDS Policy and senior advisor on disability policy. "This finding must lead to additional population-based studies, as well as timely clinical and programmatic interventions to better support individuals with HIV who are facing neurological decline."


Provided by Georgetown University Medical Center

Self-management group rehab benefits persons with dementia

15 april 2016—Self-management group rehabilitation is beneficial for persons with dementia (PwD) and their spouses, according to a study published online April 5 in the Journal of the American Geriatrics Society.
Marja-Liisa Laakkonen, M.D., Ph.D., from Laakso Hospital in Helsinki, Finland, and colleagues conducted a randomized controlled trial in primary care and memory clinics involving 136 PwD and their 136 spouses. Couples were randomly allocated to receive usual care or eight weekly sessions of self-management group rehabilitation.
The researchers found that the spouse physical component of the RAND-36 improved for those undergoing the intervention and worsened for controls at three months (P = 0.006 after adjustment for age, sex, and baseline value). No between-group differences were seen on the mental component of the RAND-36, the Spousal Sense of Competence Questionnaire, or the 15-dimensional health-related quality of life (HRQoL) of PwD instrument. PwD change in verbal fluency was −0.38 in the intervention group and −1.60 in the control group at nine months (P = 0.011 after adjustment for age, sex, and Mini-Mental State Examination score); similar scores were seen on the Clock Drawing Test. Differences in incremental costs between the groups were −436€ and −896€ per person per year for PwD (P = 0.35) and spouses (P = 0.51), respectively.
"The intervention had beneficial effects on the HRQoL of spouses and the cognitive function of PwD without increasing total costs," the authors write.

More information: Abstract

New dietary guidelines for Americans issued for 2015-2020

09 april 2016—New U.S. dietary guidelines have been released for 2015 to 2020, according to a health policy brief published online March 31 in Health Affairs.
T.R. Goldman, a freelance journalist based in Washington, D.C., reviewed the most recent guidelines, which are officially known by their five-year range rather than a single year. The recommendations were formulated after extensive review of 300 studies, which were used to address 83 questions. In addition, 29,000 public comments were reviewed.
Goldman notes that although most of the new guidelines are consistent with previous advice, there are some differences. The guidelines' overall emphasis is on eating patterns, rather than individual food groups and nutrients. There is a newly introduced recommended limit for added sugars (10 percent of daily calories). Drinking three to five cups of coffee per day is considered part of a healthy eating pattern. The dietary cholesterol limit has been lifted and the recommendation that specific populations reduce their sodium intake from 2,300 to 1,500 mg/day has been removed. In addition, men and teenage boys are encouraged to reduce protein consumption.
"The guidelines undeniably shape the general perception of what healthy eating means, and that perception is ultimately reflected in the food sold everywhere," Goldman writes.

More information: Full Text

Successful dying: Researchers define the elements of a 'good death'

For most people, the culmination of a good life is a "good death," though what that means exactly is a matter of considerable consternation. Researchers at the University of California, San Diego School of Medicine surveyed published, English-language, peer-reviewed reports of qualitative and quantitative studies defining a "good death," ultimately identifying 11 core themes associated with dying well.

06 april 2016--The findings are published in the April 2016 issue of the American Journal of Geriatric Psychiatry.
The research team, headed by senior author Dilip Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences and director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego School of Medicine, focused on three groups of stakeholders: patients, family members (before or during bereavement) and health care providers.
"This is the first time that data from all of the involved parties have been put together," said Jeste, who is also associate dean for healthy aging and senior care at UC San Diego School of Medicine. "Death is obviously a controversial topic. People don't like to talk about it in detail, but we should. It's important to speak honestly and transparently about what kind of death each of us would prefer."
The literature search culled through 32 qualifying studies. It identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and "other."
The top three themes across all stakeholder groups were preferences for specific dying process, pain-free status and emotional well-being. For other themes, however, different stakeholders put somewhat different levels of emphasis. For example, patients more often cited religiosity/spirituality as important than did family members, who believed dignity and life completion were more critical to a good death. Health care providers tended to represent a middle ground between patients and family members.
"Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life", said first author Emily Meier, PhD, a psychologist at Moores Cancer Center at UC San Diego Health. "Ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life."
The bottom line, said Jeste, is "ask the patient."
"Usually, patients know what they want or need and there is relief in talking about it. It gives them a sense of control. I hope these findings spur greater conversation across the spectrum. It may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before."

More information: Emily A. Meier et al. Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue, The American Journal of Geriatric Psychiatry (2016). DOI: 10.1016/j.jagp.2016.01.135


Provided by University of California - San Diego

Exercise may slow brain aging by 10 years for older people

Credit: Peter Griffin/public domain

Exercise in older people is associated with a slower rate of decline in thinking skills that occurs with aging. People who reported light to no exercise experienced a decline equal to 10 more years of aging as compared to people who reported moderate to intense exercise, according to a population-based observational study published in the March 23, 2016, online issue of Neurology, the medical journal of the American Academy of Neurology.

05 april 2016--"The number of people over the age of 65 in the United States is on the rise, meaning the public health burden of thinking and memory problems will likely grow," said study author Clinton B. Wright, MD, MS, of the University of Miami in Miami, Fla., and member of the American Academy of Neurology. "Our study showed that for older people, getting regular exercise may be protective, helping them keep their cognitive abilities longer."
For the study, researchers looked at data on 876 people enrolled in the Northern Manhattan Study who were asked how long and how often they exercised during the two weeks prior to that date. An average of seven years later, each person was given tests of memory and thinking skills and a brain MRI, and five years after that they took the memory and thinking tests again.
Of the group, 90 percent reported light exercise or no exercise. Light exercise could include activities such as walking and yoga. They were placed in the low activity group. The remaining 10 percent reported moderate to high intensity exercise, which could include activities such as running, aerobics, or calisthenics. They were placed in the high activity group.
When looking at people who had no signs of memory and thinking problems at the start of the study, researchers found that those reporting low activity levels showed a greater decline over five years compared to those with high activity levels on tests of how fast they could perform simple tasks and how many words they could remember from a list. The difference was equal to that of 10 years of aging. The difference also remained after researchers adjusted for other factors that could affect brain health, such as smoking, alcohol use, high blood pressure and body mass index.
"Physical activity is an attractive option to reduce the burden of cognitive impairment in public health because it is low cost and doesn't interfere with medications," said Wright. "Our results suggest that moderate to intense exercise may helpolder people delay aging of the brain, but more research from randomized clinical trials comparing exercise programs to more sedentary activity is needed to confirm these results."


Provided by American Academy of Neurology

Endocrine Society encourages clinicians to avoid prescribing compounded hormones

A new Scientific Statement issued today by the Endocrine Society advises clinicians to avoid using compounded hormone medications to treat menopausal symptoms, female sexual dysfunction and other hormone conditions.

02 april 2016--Sometimes called bioidentical compounded hormones, these products are typically a mixture of hormones. Compounded hormone medications are prepared by licensed professionals or facilities specifically for an individual's use. Compounded medications are meant to be an alternative when an individual does not have access to or has an adverse reaction to a medication approved by the U.S. Food & Drug Administration.
Compounded hormone medications can be unsafe when inappropriate practices are used. More than 60 people died from cases of fungal meningitis attributed to compounded medications in a 2010 case.
"In extreme cases, advertisers have marketed compounded products as being able to prevent the ravages of aging and implied they are risk free," said Nanette Santoro, MD, and the chair of the Society task force that developed the statement. "Few, if any, of these claims are supported by science."
Widely available hormone treatments that are 100 percent chemically identical to the native hormones found in the body and that are approved by the U.S. Food & Drug Administration (FDA) offer effective and safe options for people with hormone disorders, and those approved treatments should be prescribed whenever possible, Santoro said.
Despite limited oversight of quality and dosage, bioidentical compounded hormones are used by millions of women to treat menopausal symptoms such as hot flashes and night sweats. Several market surveys indicate that custom-compounded menopausal hormone therapies earn $1 billion dollars in annual sales - enough to treat 2 million to 3 million women. The sales are equivalent to a quarter to a third of sales of menopausal hormone therapies approved by the U.S. Food & Drug Administration.
Although a large 2002 government study called the Women's Health Initiative (WHI) raised concerns about menopausal hormone therapy raising the risks of blood clots, stroke, breast cancer and heart attacks in postmenopausal women, additional research conducted in the ensuing years has found that the level of risk depends on the individual woman's health history, age and other factors. Experts have formed a consensus that the benefits of menopausal hormone therapy exceed the risks for most healthy women seeking relief from menopausal symptoms.
Some women turned to custom-compounded menopausal hormone therapy (MHT) because of a misconception that is was safer than FDA-approved treatments. No large-scale, long-term studies have been conducted to examine the effectiveness and safety of custom-compounded MHT. When women use a customized preparation of estrogen and/or progestin, there are concerns that it could be harmful due to an overdose of the hormones or ineffective due to under-dosing. There is no scientific or medical reason to use a custom-compounded treatment that could have an unknown effect on the body when there are numerous FDA-approved options for treating menopausal symptoms, according to the statement.
The statement also examined compounded hormone treatments used to boost testosterone levels in women experiencing sexual dysfunction. There are no FDA-approved testosterone or dehydroepiandrosterone (DHEA) therapies for women, and scientific studies, while indicating some effectiveness for testosterone in specific circumstances, do not support the use of DHEA for sexual dysfunction. There are also concerns about under- or overdosing as well as side effects from these treatments.
Compounded medications also are used to treat thyroid disorders. FDA-approved thyroid medications to supplement the body's naturally produced thyroid hormone remain the treatment of choice because they are highly effective and safe, according to the statement. However, some patients may benefit from compounded thyroid medications or desiccated thyroid hormone exacted from animals. Patients prescribed these alternatives need to have their Thyroid-Stimulating Hormone (TSH) levels and symptoms monitored carefully.
New regulations being developed by the FDA may lead to improved safety and quality control for compounded medications, Santoro said. In the meantime, compounded therapies should be used in limited situations due to concerns about the risks of under-dosing, overdosing or contamination.
"Custom-compounded hormones should be reserved for situations in which a patient is allergic to or does not tolerate any of the FDA-approved therapies, and treatment is necessary for his or her health," Santoro said.

More information: Nanette Santoro et al. Compounded Bioidentical Hormones in Endocrinology Practice: An Endocrine Society Scientific Statement, The Journal of Clinical Endocrinology & Metabolism (2016). DOI: 10.1210/jc.2016-1271


Provided by The Endocrine Society

Low-normal sodium deemed major risk for mortality in elderly

A slightly lower serum sodium concentration within the normal range is a major risk factor for mortality in elderly adults, according to a study published in the March issue of the Journal of the American Geriatrics Society.

28 mar 2016--Shin Y. Ahn, M.D., from Seoul National University Bundang Hospital in South Korea, and colleagues randomly selected, community-based 949 elderly adults with a corrected serum sodium level between 135.0 and 145.0 mEq/L from the Korean Longitudinal Study on Health and Aging cohort. Patients were stratified by sodium level: 73 in Group 1 (sodium 135.0 to 138.0 mEq/L), 635 in Group 2 (sodium 138.1 to 142.0 mEq/L), and 241 in Group 3 (sodium 142.1 to 145.0 mEq/L).
The researchers found that deaths significantly varied by group: 34 deaths in Group 1, 124 in Group 2, and 52 in Group 3 (P < 0.001). A 2-mEq/L higher sodium level reduced the risk of death by 14.9 percent (P = 0.048). Group 1 had risk of mortality that was 2.7 times as high as that of Group 2 (P < 0.001). Those with a measured sodium level of ≤138.0 mEq/L and a corrected sodium level >138.0 mEq/L had a better survival rate than those with a measured sodium level of ≤138.0 mEq/L and a corrected sodium level of ≤138.0 mEq/L.
"Sodium level corrected according to serum glucose concentration was a more meaningful risk factor than measured sodium level," the authors write.

More information:

 Abstract

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Aging is portrayed as mainly negative in popular music lyrics

A recent analysis of popular music reveals that while older age and aging are represented both negatively and positively in music lyrics, negative representations predominate.
Most of the music texts were generated from a young person's perspective and their imaginings of old age.

25 mar 2016--While negative and positive emotions can influence health and well-being, further research is needed to explore what impact negative texts in popular music may have on older individuals.
"Recommendations from these studies suggest more sensitive, positive, inclusive and less stereotypical media reporting of issues and activities relating to ageing and older people," the authors of the Journal of Advanced Nursing study wrote. "While it may prove an impossible task and an infringement on free expression to censor all negative expressions of old age, it is important nonetheless that awareness is raised and some efforts exerted to suspend stereotypes and negative age and ageing identities in popular music due to the penetrating effects of melody and lyrics on peoples' mindsets."

More information: Jacinta Kelly et al. Representation of age and ageing identities in popular music texts, Journal of Advanced Nursing (2016). DOI: 10.1111/jan.12916


Provided by Wiley

Adherence to Japanese diet guidelines linked to longer life

Credit: Jm Verastigue/public domain

Closer adherence to Japanese dietary guidelines is associated with a lower risk of death from all causes and death from cardiovascular disease, particularly stroke, finds a study published by The BMJtoday.

24 mar 2016--The findings suggest that balanced consumption of grains, vegetables, fruits and adequate intake of fish and meat, can contribute to longevity in the Japanese population.
In 2005, the Japanese government developed the spinning top - a Japanese food guide - to illustrate the balance and quantity of food in the daily Japanese diet.
A team of researchers, led by Kayo Kurotani at the National Centre for Global Health and Medicine in Tokyo, set out to examine the association between adherence to the food guide and total and cause specific mortality.
They used data from detailed food and lifestyle questionnaires completed by 36,624 men and 42,920 women aged 45-75. Participants had no history of cancer, stroke, heart disease, or chronic liver diseaseand were followed-up for 15 years.
They found that both men and women with higher scores on the food guide (better adherence) had a 15% lower total mortality rate over 15 years. This protective association was mainly attributable to a reduction in mortality from cerebrovascular disease.
The researchers conclude: "Our findings suggest that balanced consumption of energy, grains, vegetables, fruits, meat, fish, eggs, soy products, dairy products, confectionaries, and alcoholic beverages can contribute to longevity by decreasing the risk of death, predominantly from cardiovascular disease, in the Japanese population."

More information: Quality of diet and mortality among Japanese men and women: Japan Public Health Center-based Prospective Study, The BMJ, www.bmj.com/cgi/doi/10.1136/bmj.i1209


Provided by British Medical Journal

Antipsychotic drugs may not be effective against delirium

A recent review of the medical literature does not support the use of antipsychotic medications for preventing or treating delirium in hospitalized patients.

23 mar 2016--Investigators analyzed 19 relevant studies. In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention in postoperative patients, there was no significant effect on delirium incidence. Using data reported from all 19 studies including medical and surgical patient populations, antipsychotic use was not associated with change in delirium duration, severity, hospital length of stay, or mortality. There was considerable variability in design and outcome measures among studies, however.
"When we combine all available evidence right now, there is no compelling signal to support the routine use of antipsychotic medications to reduce delirium," said Dr. Karin Neufeld, co-author of the Journal of the American Geriatrics Societystudy.

More information: Journal of the American Geriatrics Society, dx.doi.org/10.1111/jgs.14076

Provided by Wiley

'Lost' memories can be found

This image represents a coronal section of hippocampal dentate gyrus (DG) from a mouse model of early Alzheimer's disease. These AD mice exhibit severe β-amyloid plaques (red) in the DG at 9-months of age. Using these mice combined with a novel viral strategy, memory engram cells (green) for a contextual fear memory were labeled. Credit: RIKEN

In the early stages of Alzheimer's disease, patients are often unable to remember recent experiences. However, a new study from MIT suggests that those memories are still stored in the brain—they just can't be easily accessed.

17 mar 2016--The MIT neuroscientists report in Nature that mice in the early stages of Alzheimer's can form new memories just as well as normal mice but cannot recall them a few days later.
Furthermore, the researchers were able to artificially stimulate those memories using a technique known as optogenetics, suggesting that those memories can still be retrieved with a little help. Although optogenetics cannot currently be used in humans, the findings raise the possibility of developing future treatments that might reverse some of the memory loss seen in early-stage Alzheimer's, the researchers say.
"The important point is, this a proof of concept. That is, even if a memory seems to be gone, it is still there. It's a matter of how to retrieve it," says Susumu Tonegawa, the Picower Professor of Biology and Neuroscience and director of the RIKEN-MIT Center for Neural Circuit Genetics at the Picower Institute for Learning and Memory.
Tonegawa is the senior author of the study, which appears in the March 16 online edition of Nature. Dheeraj Roy, an MIT graduate student, is the paper's lead author.

A single memory engram cell in the hippocampal dentate gyrus region of a mouse model of early Alzheimer's disease. To optically manipulate specific connections to these engram cells, a blue light-sensitive protein oChIEF was expressed in an upstream brain region, i.e., medial entorhinal cortical inputs (red) to the DG. The majority of DG granule cells were not active during engram labeling (blue, non-engram cells). Credit: RIKEN

Lost memories

In recent years, Tonegawa's lab has identified cells in the brain's hippocampus that store specific memories. The researchers have also shown that they can manipulate these memory traces, or engrams, to plant false memories, activate existing memories, or alter a memory's emotional associations.
Last year, Tonegawa, Roy, and colleagues found that mice with retrograde amnesia, which follows traumatic injury or stress, had impaired memory recall but could still form new memories. That led the team to wonder whether this might also be true for the memory loss seen in the early stages of Alzheimer's disease, which occurs before characteristic amyloid plaques appear in patients' brains.
To investigate that possibility, the researchers studied two different strains of mice genetically engineered to develop Alzheimer's symptoms, plus a group of healthy mice.
All of these mice, when exposed to a chamber where they received a foot shock, showed fear when placed in the same chamber an hour later. However, when placed in the chamber again several days later, only the normal mice still showed fear. The Alzheimer's mice did not appear to remember the foot shock.
"Short-term memory seems to be normal, on the order of hours. But for long-term memory, these early Alzheimer's mice seem to be impaired," Roy says.

A coronal section of hippocampal dentate gyrus from a mouse model of early Alzheimer's disease. These AD mice lack β-amyloid plaques at 7-months of age. Using these mice combined with a novel viral strategy, memory engram cells (green) for a contextual fear memory were labeled with a light-sensitive protein ChR2. Credit: RIKEN

"An access problem"

The researchers then showed that while the mice cannot recall their experiences when prompted by natural cues, those memories are still there.
To demonstrate this, they first tagged the engram cells associated with the fearful experience with a light-sensitive protein called channelrhodopsin, using a technique they developed in 2012. Whenever these tagged engram cells are activated by light, normal mice recall the memory encoded by that group of cells. Likewise, when the researchers placed the Alzheimer's mice in a chamber they had never seen before and shined light on the engram cells encoding the fearful experience, the mice immediately showed fear.
"Directly activating the cells that we believe are holding the memory gets them to retrieve it," Roy says. "This suggests that it is indeed an access problem to the information, not that they're unable to learn or store this memory."
The researchers also showed that the engram cells of Alzheimer's mice had fewer dendritic spines, which are small buds that allow neurons to receive incoming signals from other neurons.
Normally, when a new memory is generated, the engram cells corresponding to that memory grow new dendritic spines, but this did not happen in the Alzheimer's mice. This suggests that the engram cells are not receiving sensory input from another part of the brain called the entorhinal cortex. The natural cue that should reactivate the memory—being in the chamber again—has no effect because the sensory information doesn't get into the engram cells.
"If we want to recall a memory, the memory-holding cells have to be reactivated by the correct cue. If the spine density does not go up during learning process, then later, if you give a natural recall cue, it may not be able to reach the nucleus of the engram cells," Tonegawa says.

Long-term connection

The researchers were also able to induce a longer-term reactivation of the "lost" memories by stimulating new connections between the entorhinal cortex and the hippocampus.
To achieve this, they used light to optogenetically stimulate entorhinal cortex cells that feed into the hippocampal engram cells encoding the fearful memory. After three hours of this treatment, the researchers waited a week and tested the mice again. This time, the mice could retrieve the memory on their own when placed in the original chamber, and they had many more dendritic spines on their engram cells.
However, this approach does not work if too large a section of the entorhinal cortex is stimulated, suggesting that any potential treatments for human patients would have to be very targeted. Optogenetics is very precise but too invasive to use in humans, and existing methods for deep brain stimulation—a form of electrical stimulation sometimes used to treat Parkinson's and other diseases—affect too much of the brain.
"It's possible that in the future some technology will be developed to activate or inactivate cells deep inside the brain, like the hippocampus or entorhinal cortex, with more precision," Tonegawa says. "Basic research as conducted in this study provides information on cell populations to be targeted, which is critical for future treatments and technologies."

More information: Dheeraj S. Roy et al. Memory retrieval by activating engram cells in mouse models of early Alzheimer's disease, Nature (2016). DOI: 10.1038/nature17172


Provided by Massachusetts Institute of Technology

The up- and downside of caloric restriction for aging and health

It's already well known that a diet may have a life-extending effect. Researchers from Leibniz Institute on Aging – Fritz Lipmann Institute (FLI) in Jena, Germany, now showed that besides improving the functionality of stem cells in mice, a caloric restriction also leads to a fatale weakening of their immune system – counteracting the life-lengthening effect of a diet. The results are published in the Journal of Experimental Medicine on March, 14. 2016.

16 mar 2016--Only few years ago, researchers succeeded in prolonging the lifespan of worm C. elegans, fruit fly D. melongaster and rats by almost 50% through a simple caloric restriction – which immediately fueled hopes for having found one key to a longer life also for humans. However, transferring these results to long-lived primates short after was not equally successful and cooled down enthusiasms quite quickly. Now, aging researcher Karl Lenhard Rudolph, Scientific Director at the Leibniz Institute on Aging – Fritz Lipmann Institute (FLI) in Jena, Germany, and his team showed that caloric restriction even has a severe downside. In feeding experiments, the stem cells of mice, which were set on a diet, were found to age slower – but the murine immune system was almost completely cut down. Outside of optimal, sterile laboratory conditions, this could lead to severe live-shortening infections. The results of the study are published in the Journal of Experimental Medicine's current issue.

Caloric restriction slows down the aging of blood stem cells

The study focused on the effects of caloric restriction on blood stem cells (so-called hematopoietic stem cells, HSC) that are responsible for building red blood cells or lymphocytes (immune cells). Like for any other adult stem cell, HSC functionality decreases with every single cell division – the stem cells age. This is why they stay in a resting phase (quiescence) most of the time and are only activated when a massive cell reproduction is required (e.g. after acute blood loss). In their study, the researchers from Jena investigated how a 30% food restriction effects stem cell aging in mice. One main result was that the HSC stayed in a quiescent state even if simulated stress would have required their activation. This effect was found regardless of how long the diet lasted. Thus, during diet, the blood stem cells did not age at all and their functionality to build new blood cells remained increased even one year after diet.

Caloric restriction weakens the immune system

But the long-term diet had a downside, as well: The mice's immune system almost completely was cut down. Although the diet had no strong effect on the overall cell number of blood cells, the production of lymphocytes – needed for immune defense – was decreased by up to 75%. As a consequence, mice were particularly prone to bacterial infections.

Slowing down aging under laboratory conditions is not yet transferable to humans

"The study provides the first experimental evidence that long-term caloric restriction – as intervention to slow down aging – increases stem cell functionality, but results in immune defects in the context of prolonged bacterial infection, too. Thus, positive effects of a diet are not transferable to humans one to one", Rudolph sums up the study results. Even if – under laboratory conditions – aging of single cells or tissues may be slowed down through a diet, the immune suppression may have fatal consequences in real life. To benefit from caloric restriction or medicinal mimetika aiming at increasing health in the elderly, possible risks of such interventions to come down with life-threatening infections remain to be elucidated. "In sepsis patients, we see a higher survival rate for those with a higher body weight than for patients who are very lean", Prof. Dr. Michael Bauer, Director of the Center for Sepsis Control and Care at University Hospital Jena (UKJ), concurs.

More information: Duozhuang Tang et al. Dietary restriction improves repopulation but impairs lymphoid differentiation capacity of hematopoietic stem cells in early aging, The Journal of Experimental Medicine (2016). DOI: 10.1084/jem.20151100


Provided by Leibniz Institute on Aging