Antidepressant does not reduce hospitalization, death for HF patients with depression

In a study appearing in the June 28 issue of JAMA, Christiane E. Angermann, M.D., of University Hospital Wurzburg, Germany, and colleagues examined whether 24 months of treatment with the antidepressant escitalopram would improve mortality, illness, and mood in patients with chronic heart failure and depression.

28 jun 2016--Previous meta-analysis indicates that depression prevalence in patients with heart failure is 10 percent to 40 percent, depending on disease severity. Depression has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing in parallel with depression severity. Long-term efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression, is unknown for patients with heart failure and depression.
For this study, 372 patients with chronic heart failure with reduced ejection fraction (a measure of heart function) and depression were randomly assigned to receive escitalopram or matching placebo in addition to optimal heart failure therapy. During a median participation time of 18.4 months (n = 185) for the escitalopram group and 18.7 months (n = 187) for the placebo group, the primary outcome of death or hospitalization occurred in 116 (63 percent) patients and 119 (64 percent) patients, respectively. There was no significant improvement on a measure of depression for patients in the escitalopram group.
"These findings do not support the use of escitalopram in patients with chronic systolic heart failure and depression," the authors write.

More information: JAMA, DOI: 10.1001/jama.2016.7207


Provided by The JAMA Network Journals

New study helps determine which older adults might need help taking medications

As age increases, older adults can develop problems taking their medications. But until now, few studies have examined the traits that might cause elders to need help with their medications, or how widespread a problem this might be.

26 jun 2016--In a study published in the Journal of the American Geriatrics Society, researchers investigated this issue using data from the 10-year Duke EPESE study. They examined data from 4,106 African American and white older adults living in five counties in North Carolina.
The researchers asked the participants the question, "Are you able to take your medicine without help (in the right doses at the right time)?" The participants' health conditions included: poor vision, poor hearing, or having been diagnosed with stroke, diabetes, hypertension (also known as high blood pressure), heart attack, or cancer (except skin cancer).
The researchers also tested the participants' mental abilities and reviewed their medication containers to learn how many prescription and over-the-counter medications they took.
At the beginning of the study, 7.1 percent of participants needed help taking their medications. Three years later, 11 percent needed help who did not need help at the beginning of the study. Predictors of a new need for medication help were similar to those seen at the beginning of the study:

• Being 75-years-old or older
• Being male
• Having memory problems
• Having problems performing activities of daily living

The researchers reported that people aged 80 and older were 1.5 to 3 times as likely to need help with their medications than were people aged 65 to 69.
Men were 1.5 to 2 times as likely as women to need help. The odds of needing help were 3 to 5 times greater among people with memory challenges.
"Health conditions may worsen or not improve if older adults skip or don't take their medications properly," said Brenda D. Jamerson, PharmD, Center on Biobehavioral Health Disparities Research at Duke University. "Serious side effects may also occur from taking medications at the wrong time or in the wrong dose. Some older adults can put themselves at risk for experiencing problems if they don't receive the assistance they may need," added Dr. Jamerson.
The researchers noted their study helped identify which characteristics make it more likely that an older adult will need help taking his or her medication.

More information: Brenda D. Jamerson et al, A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale,Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14166


Provided by American Geriatrics Society

Some older adults live well, despite advancing years and the burdens of chronic diseases

You might believe that older adults who deal with extensive chronic illnesses or serious diseases would be more likely to be frail and to have a poorer quality of life than healthier older adults. That may be true for some elders—but not for all. Researchers writing in the Journal of the American Geriatrics Society suggest that an undefined coping mechanism of some sort may play a role in how well older adults are able to live despite having burdensome illnesses.

25 jun 2016--The researchers examined three groups of participants enrolled in the Cardiovascular Health Study, a large research project that examined adults 65-years-old and older from four cities around the country.
Researchers assigned people to one of three groups, based on the extent of their disease and their level of vigor or frailty:
1. The expected agers (3,528 people) had higher disease but also higher frailty levels. They spent 47 percent of the remainder of their lives able and healthy.
2. The adapters (882 people) had higher disease levels as well as relatively high vigor (being active and mobile) levels. They spent 55 percent of the reminder of their lives able and healthy.
3. The prematurely frail (885 people) had lower disease levels but higher frailty levels. They spent 37 percent of their remaining lives able and healthy.
The researchers said "adapter" older adults who were more vigorous than expected, based on their disease burden, lived longer lives when compared to those who were more frail than expected based on their disease burden. These "adapters" could have unique characteristics, perhaps some undefined coping mechanism, that should be studied further, suggested the researchers.

More information: Jason L. Sanders et al, Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults, Journal of the American Geriatrics Society (2016). DOI: 10.1111/jgs.14163


Provided by American Geriatrics Society

Diabetes raises risk of heart attack death by 50 percent

Having diabetes increases the risk of dying from the effects of a heart attack by around 50 per cent, a University of Leeds study has found.

Researchers in the School of Medicine tracked 700,000 people who had been admitted to hospital with a heart attack between January 2003 and June 2013.
Of these, 121,000 had diabetes.

24 jun 2016--After stripping out the effects of age,sex, any other illnesses and differences in the emergency medical treatment received, the team found stark differences in survival rates.
People with diabetes were 56 per cent more likely to have died if they had experienced a ST elevation myocardial infarction (STEMI) heart attack – in which the coronary artery is completely blocked – than those without the condition.
They were 39 per cent more likely to have died if they had a non-ST elevation myocardial infarction (NSTEMI) heart attack – in which the artery is partially blocked - than those without diabetes.
Lead researcher Dr Chris Gale, Consultant Cardiologist and Associate Professor in the School of Medicine, said: "These results provide robust evidence that diabetes is a significant long-term population burden among patients who have had a heart attack.
"Although these days people are more likely than ever to survive a heart attack, we need to place greater focus on the long-term effects of diabetes in heart attack survivors.
"The partnership between cardiologists, GPs and diabetologists needs to be strengthened and we need to make sure we are using established medications as effectively as possible among high-risk individuals."
He added that the next step in their research would be finding out exactly what it is about having diabetes that increases the risk of death following heart attack.
Dr Mike Knapton, Associate Medical Director at the British Heart Foundation, which funded the study said: "We knew that following a heart attack, you are less likely to survive if you also have diabetes.
"However, we did not know if this observation was due to having diabetes or having other conditions which are commonly seen in people with diabetes.
"This paper is the first to conclusively show that the adverse effect on survival is linked to having diabetes, rather than other conditions people with diabetes may suffer from.
"This research highlights the need to find new ways to prevent coronary heart disease in people with diabetes and develop new treatments to improve survival after a heart attack.
"The British Heart Foundation is committed to funding research in this area.
"We are currently funding researchers in Leeds to find new ways of keeping blood vessels healthy in people with diabetes in the fight for every heartbeat."
Dr Anna Morris, Head of Research Funding at Diabetes UK, said: "While researchers tackle this issue, we know that managing diabetes effectively can reduce the risk of developing cardiovascular disease.
"This includes eating healthily, keeping active and taking medications as prescribed by your doctor.
"It's essential that people with diabetes get the support they need to do this effectively, and that we continue to fund research across the UK aimed at preventing the onset of complications in the first place."
The study is published in the Journal of Epidemiology and Community Health.

More information: O A Alabas et al. Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study, Journal of Epidemiology and Community Health (2016). DOI: 10.1136/jech-2016-207402


Provided by University of Leeds

Impaired decision-making may contribute to motor symptoms in Parkinson's disease

Michele Basso. Credit: UCLA

UCLA researchers have discovered that people with Parkinson's disease have a form of impaired decision-making that may be a major contributor to the movement problems that characterize the disease. The finding suggests that the neurological factors underlying Parkinson's, which currently affects nearly 1 million people in the United States, may be more complex than commonly believed. The study also could pave the way for strategies to detect Parkinson's earlier in its course.

21 jun 2016--Publishing in the June 16 issue of the journal Current Biology, the UCLA-led team found that, compared to healthy individuals, people with early-stage Parkinson's have difficulty with perceptual decision-making only when the sensory information before them is weak enough that they must draw on prior experiences. When the sensory information is strong, individuals with Parkinson's are able to make decisions as well as people who are healthy.
The finding may help explain a well-known phenomenon associated with Parkinson's, called paradoxical movement, in which people with the disease - often even while medicated with dopamine therapy - have difficulty initiating walking. Typically, these people have a shuffling gait, along with stooped posture. But when the same people are assisted by strong sensory information, such as horizontal lines drawn on the floor for them to step over, their walking and gait are significantly improved.
"This tells us that the problem for people with Parkinson's disease is not walking per se, but rather in generating the walking pattern without the assistance of sensory information," said study senior author Michele Basso, a professor in UCLA's Semel Institute for Neuroscience and Human Behavior and the department of neurobiology in the David Geffen School of Medicine at UCLA and director of the Fuster Laboratory of Cognitive Neuroscience in the Semel Institute. "The patients with Parkinson's disease in our study were impaired only when they had to rely on memory information to guide their actions. We believe this fundamental problem of decision-making in the absence of sufficient sensory information may be what is underlying some of the movement disorder symptoms."
In making perceptual decisions, people integrate memory information with the sensory information before them. For example, when people are contemplating crossing a street when a car is headed their way from a distance, they use past experience to help determine whether they have sufficient time to proceed safely. Sometimes the current information is so clear that relying on prior experiences is not necessary, but when that current information is ambiguous, it becomes more important to draw on memories.
Building on nearly two decades' worth of findings by Basso and other researchers on the neurophysiological underpinnings of decision-making in monkeys, the UCLA team conducted decision-making experiments with a dozen early-stage Parkinson's disease patients and a comparison group of healthy individuals. The task involved making decisions about visual information that was more or less ambiguous, requiring the participants to draw on memories of similar previous experiences. In those cases, the patients with Parkinson's disease had trouble integrating the information from memory and making a decision, even when verbally instructed by the research team.
The discovery by the UCLA team adds to a growing body of evidence that is beginning to redefine how researchers view Parkinson's. The disease has no cure, although medication or surgery can relieve symptoms to a certain extent.
"Parkinson's disease has long been seen as purely a motor problem, limited mostly to a section of the brain called the basal ganglia and a neurotransmitter called dopamine that is not produced at sufficient levels," Basso said.
But she noted that the patients in the UCLA study were in the early stages of the disease and on medication to normalize dopamine production. Moreover, preliminary results from Basso's group show that the decision-making impairment related to memory seems unaffected by medication in early-stage patients with Parkinson's disease.
"The field is realizing that Parkinson's disease is a multisystem disease that probably involves many brain areas and neurotransmitter systems," Basso said. "Our finding suggests that the dysfunction we uncovered may actually be unrelated to dopamine. New efforts by us and others are geared at finding out which other brain areas and neurotransmitters are involved, and how."
Given that all of the patients in the UCLA study were in the early stage of the disease but still showed the decision-making dysfunction, Basso and her colleagues also hope to build on the discovery to identify a biological marker for early-stage Parkinson's disease. Detecting and treating the disease earlier would be an important strategy, given that by the time patients begin to express motor symptoms, a significant amount of damage has already been done to the brain.
The next steps for the UCLA team are to perform imaging experiments in both healthy people and patients with Parkinson's disease to determine the neurological factors involved in the decision-making dysfunction.

More information: Current Biology, www.cell.com/current-biology/fulltext/S0960-9822(16)30534-6


Provided by University of California, Los Angeles

Judgment, memory better for older adults with optimistic outlook

When older adults feel optimistic about their future, they are less likely to experience decreases in memory, problem solving and judgment, according to new research conducted at the University of Michigan.

19 jun 2016--Optimism has been linked to positive health behaviors, such as exercising and eating healthier diets, and lower risk for a variety of health conditions, including stroke and heart attacks.
This is believed to be the first study to look at the relationship between optimism and cognitive health in adults ages 65 and older. The researchers used data from the Health and Retirement Study, a national survey funded by the National Institute on Aging and conducted at U-M's Institute for Social Research.
During a four-year period, about 500 of the study's more than 4,600 participants developed cognitive impairment, a condition in which individuals experience decreased memory and/or have difficulty solving problems and making sound decisions. However, study participants who reported high levels of optimism had decreased risk of cognitive impairment, researchers said.
The findings are important given that the number of people living with cognitive impairment and dementia is projected to surge from 5.1 million in 2015 to 13.8 million by 2050. In addition, the costs of dementia are projected to catapult from 226 million in 2015 to 1.1 trillion in 2050.
"We felt like this was an important topic to investigate and to our knowledge, it's the first study to examine the link between optimism and cognitive impairment in older adults," said lead author Katerina Gawronski, a U-M graduate now at the University of Pennsylvania. "We found that optimism was indeed associated with better cognitive health over time."
Gawronski and Eric Kim of Harvard University conducted the research as students at U-M.
They say that randomized controlled trial studies have shown that optimism can be modified using fairly simple paper and pencil exercises. For example, writing about one's "best possible self" has been shown to increase optimism.
"Therefore, optimism may be a novel and promising target for prevention and intervention strategies aimed at improving cognitive health," Kim said.
The findings appear in the online issue of Psychosomatic Medicine.


Provided by University of Michigan

Physical activity in dementia

This figure shows the amount of time each group spent physically active over a 24 hour period. The healthy control group engages in the largest amount of activity, with the institutionalized dementia group engaging in significantly less. 

It has been recognised for over 60 years that regular physical activity provides health benefits. Our bodies are designed to be stimulated by physical exertion. Fitness is associated with lower all-cause mortality, along with improved sleep, quality of life, social life and reduced stress. On the other hand, physical inactivity predicts obesity, diabetes, cardiovascular disease, mental health issues, reduced quality of life and overall mortality. The evidence is clear: we need to get moving.

18 jun 2016--In addition to health outcomes, cognition and physical activity are intrinsically linked. This is increasingly true within the senior population. More physically active older adults show less cognitive decline than those who are not active. Older adults participating in physical activity programs often demonstrate improvements in their cognitive abilities – particularly with attention and executive function. In frailer older adults with many health problems, physical activity interventions facilitate better cognition, physical capacity and quality of life. Regular physical activity has also been associated with reduced risk of cognitive decline and development of dementia. Many hypotheses have been postulated regarding the role of physical activity in staving off cognitive impairment. It may protect cardiovascular changes in the brain by maintaining cerebral blood flow, facilitate the growth of new neurons or relieve stress and therefore improve cognitive function.
But what does physical activity look like in the cognitively impaired population – specifically within dementia? A recent study in PLOS ONE aimed to quantify and characterize physical activity in dementia patients objectively. While previous studies report that dementia patients are less physically active than older adults without cognitive impairment, the majority of these findings come from self-reported measures. These are often not as reliable or accurate as they are subjective, and may be impacted by memory recall problems. Van Alphen and colleagues chose to use the Actiwatch, a wrist-worn accelerometer, to collect objective data on the frequency, duration and intensity of daily physical activity in dementia patients. One hundred and twenty dementia patients were included in the study, recruited from 13 nursing homes and four day-care centers, along with 26 older adult controls. All participants were required to wear the Actiwatch for at least six days, 24 hours a day.
The researchers were interested in the differences in physical activity levels between community-dwelling dementia patients and institutionalized patients. To this end, daily physical activity levels were significantly different between institutionalized patients and community-dwelling patients and controls, with institutionalized patients engaging in physical activity 23.5% less than community-dwelling patients and 40% less than controls. This is important to note as infrastructures and activities could be implemented in care homes to encourage physical activity.

This figure demonstrates the amount of time the different groups spend sedentary compared to other levels of physical intensity. The first bars (0-99) represent sedentary time, while the rest of the bars show a gradual climb in activity intensity. 

Additionally, institutionalized patients spent 72% of their day in a sedentary state; 9.3% more than community-dwelling patients and 19% more than controls. These results remain significant after controlling for age, cognitive abilities and use of walking aids. While there were no significant differences in amount of physical activity between Alzheimer's disease patients and non-Alzheimer's disease patients (encompassing dementia with Lewy bodies, Parkinson's disease with dementia, vascular dementia and frontotemporal dementia), Alzheimer's disease patients did spend significantly less time (6.9%) in a sedentary state. Van Alphen and colleagues concluded that both institutionalized and community-dwelling dementia patients remained sedentary for the majority of the day and performed lower intensity activities than that of controls.
But why is it important to know about physical activity levels in dementia? The dangers of physical inactivity were highlighted earlier; for dementia patients, the ability to carry out everyday activities may be compromised, along with reduced quality of life and further cognitive decline. Studies have demonstrated that encouraging active participation in functional tasks – such as dressing and washing – and attending dance or exercise classes – can improve physical capacity and reduce fall risk in moderate-to-severe dementia. Bi-weekly exercise programs are associated with slower rates of cognitive and functional decline in dementia. Individuals with mild cognitive impairment – a pre-dementia stage – undergoing an aerobic fitness intervention demonstrate significant improvements in cognition, particularly executive function. Encouraging physical activity in this population holds a range of benefits – from improved mood, function, cognition and fitness to reduced stress and improved quality of life for their caregiver.
There is still much work to be done. Studies need to recruit larger samples of patients with non-Alzheimer's disease dementias to assess the differences across dementia subtypes. Type of activity should be examined; most accelerometers can provide data about frequency and duration of movement but fail to automatically specify what activities are being undertaken. Individual differences in activity type may predict different health outcomes. As Van Alphen and colleagues reported, dementia groups are more likely to engage in low-intensity activities such as walking or household chores. These activities are beneficial for cardiorespiratory capacity and body composition, and exercise interventions could be tailored to suit this preference. The effects of vigorous – such as sprinting or spinning – and low-intensity activities should also be compared. This is an area ripe for investigation and may be beneficial for the development of physical interventions.
Increasing physical activity levels is a global challenge and one that is continuously being addressed. The World Health Organization (WHO) recommends 30 minutes of moderate-to- vigorous exercise a day, which can be achieved by walking, gym classes and activities, sports or physical hobbies such as gardening. Governments develop policies, guidelines and initiatives to encourage people to participate in physical exercises, such as Let's Move. National campaigns – such as This Girl Can – promote a sense of unity in keeping active. Free exercise programs – such as Shape Up New York – allow people to engage in a range of fitness classes, from aerobics to Zumba. These all endorse the message to get up, get going and get active! Still 20% of individuals older than 15 years do not meet these physical activity guidelines. Therefore, I believe our approach to the promotion and facilitation of physical activity needs to change. Most people associate the prescription of getting active with problems like obesity and heart disease. More education on how active individuals incur health benefits beyond physical health is also needed.
Exercise is often portrayed as inaccessible without expensive gym facilities and a grueling experience for those who do take part – think of all those films depicting the embarrassment of being picked last in gym class. Facilities allowing engagement in moderate-intensity exercise – such as walking, cycling and running – should be built; fun and simple ways to get involved should be endorsed. Physical activity is an inexpensive, easily-accessible approach to improve health and overall well-being – and we should be taking full advantage of that.

More information: Helena J. M. van Alphen et al. Older Adults with Dementia Are Sedentary for Most of the Day, PLOS ONE (2016). DOI: 10.1371/journal.pone.0152457

Helena J. M. van Alphen et al. Older Adults with Dementia Are Sedentary for Most of the Day, PLOS ONE (2016). DOI: 10.1371/journal.pone.0152457

Renée F. A. G. de Bruijn et al. The association between physical activity and dementia in an elderly population: the Rotterdam Study, European Journal of Epidemiology (2013). DOI: 10.1007/s10654-013-9773-3

Samuel C. Dumith et al. Worldwide prevalence of physical inactivity and its association with human development index in 76 countries, Preventive Medicine (2011). DOI: 10.1016/j.ypmed.2011.02.017
Laura D. Baker et al. Effects of Aerobic Exercise on Mild Cognitive Impairment, Archives of Neurology (2010). DOI: 10.1001/archneurol.2009.307

Nicola T. Lautenschlager et al. Physical Activity and Mild Cognitive Impairment and Alzheimer's Disease, Current Neurology and Neuroscience Reports (2010). DOI: 10.1007/s11910-010-0121-7

E. Galik et al. Optimizing Function and Physical Activity Among Nursing Home Residents With Dementia: Testing the Impact of Function-Focused Care, The Gerontologist (2013). DOI: 10.1093/geront/gnt108

Physical activity for improving cognition in older people with mild cognitive impairment DOI: 10.1002/14651858.CD008198

The Role Of Physical Activity On The Prevention Of Cognitive Impairment. www.ncbi.nlm.nih.gov/pmc/articles/PMC4811348/

Louis Bherer et al. A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults, Journal of Aging Research (2013). DOI: 10.1155/2013/657508

Pedro C Hallal et al. Physical activity: more of the same is not enough, The Lancet (2012). DOI: 10.1016/S0140-6736(12)61027-7

Pamela Das et al. Rethinking our approach to physical activity, The Lancet (2012). DOI: 10.1016/S0140-6736(12)61024-1

SNMMI Image of the Year: Novel PET imaging shows tau buildup link to neurodegeneration

The right lateral surface of projected z-score images, reflecting deviation from healthy controls; Yellow/red: higher uptake, blue: lower uptake as compared to controls 

Positron emission tomography (PET) with three different radiotracers can now measure amyloid plaques, tau tangles and metabolic activity in the brains of living Alzheimer's patients. This multimodal study shows significant correlation between increased tau and decreased metabolic activity in the brain—a clear sign of neurodegeneration—reveal researchers at the 2016 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

15 jun 2016--Each year, SNMMI chooses an image that exemplifies the most promising advances in the field of nuclear medicine and molecular imaging. The state-of-the-art technologies captured in these images demonstrate the capacity to improve patient care by detecting disease, aiding diagnosis, improving clinical confidence and providing a means of selecting appropriate treatments. This year, the SNMMI Image of the Year was chosen from more than 2200 abstracts submitted to the meeting and voted on by reviewers and the society leadership.
The 2016 SNMMI Image of the Year goes to a German team of researchers from the University Hospital of Cologne; the Jülich Research Center; and the German Center for Neurodegenerative Diseases. Measuring tau deposits using the novel radiotracer F-18-AV-1451 (F-18-T807), in conjunction with C-11-PiB to measure amyloid plaques and F-18-FDG to measure regional neurodegeneration, offers new insight into the neurodegenerative characteristics of Alzheimer's disease and shows that tau pathology may be an instrumental target for disease-modifying strategies.
"It is a big honor for us to receive this prestigious award. It represents a great reward for the entire team and will strongly motivate our group," said Alexander Drzezga, MD, of the Department of Nuclear Medicine at the University Hospital of Cologne in Cologne, Germany. "I am convinced that it will encourage particularly the young investigators involved in this project to continue with this type of research in the future. I would like to thank all the members of our team who contributed to this work. The study represents the result of an interdisciplinary effort, involving several clinical departments and scientists from different research centers. Also, I would like to thank all the subjects who participated in the study."
"We still do not understand fully how these abnormal amyloid and tau protein depositions affect brain functions and cause dementia," stated Satoshi Minoshima, MD, PhD, chair of the SNMMI Scientific Program Committee. "This Image of the Year study begins to address that fundamental question and leads to the next investigational study to determine the relative contributions of tau and amyloid pathology to neuronal dysfunction. In the United States, the Centers for Medicare and Medicaid Services are funding amyloid PET studies to demonstrate PET's potential clinical value. The Image of the Year study adds a new dimension to the role of PET in aiding the diagnosis and treatment of patients with dementia. It is a very exciting time for the field of molecular imaging."
More than 46 million people are currently living with Alzheimer's across the world, and that number is expected to rise steeply to 131.5 million by 2050. The global economic cost of the disease is expected to approach $1 trillion in the same period, according to the newest data from Alzheimer's Disease International.

More information: Scientific Paper 124: "Differential contributions of Amyloid and Tau burden to Neuro-degeneration in Alzheimer's Disease: A multimodal in vivo PET study." G. Bischof,  J. Hammes, T. van Eimeren, and A. Drzezga, Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital of Cologne, Germany, and B. Neumaier, Institute of Radiochemistry and Experimental Molecular Imaging, University of Cologne, Germany. The study has been performed in close cooperation with the Departments of Neurology and Psychiatry, University of Cologne, Germany, the Research Center Jülich, Germany, and the German Center for Neurodegenerative Diseases. Presented at SNMMI's 63rd Annual Meeting, June 11–15, 2016, San Diego, Calif.


Provided by Society of Nuclear Medicine

New model of Alzheimer's patient emotions can help guide health care

The Socio-Emotional Adaptation Model created by Emory researchers shows combinations of positive and negative contextual domains.  Credit: Emory University

A recent study published in The Gerontologist says understanding the emotional reactions of individuals diagnosed with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) will provide health care professionals with important information needed to develop suitable treatments.

05 jun 2016--Emory researchers developed a model, the Socio-Emotional Adaptation Theory, based on emotional reactions of individuals diagnosed with MCI and AD, which shows combinations of complex interactions and accompanying emotions. The model consists of four positive and negative contextual domains, including relationship with informal support partner (spouse or loved one), relationship with formal support partner (clinicians), locus of control, and coping mechanisms. By looking at areas of overlap, based on positive or negative contexts, researchers suggest it is possible to better understand the root cause of the emotions.
"If we can look at a person's connection with those around them along with emotions they experience, which are complex and do not present linearly, then clinicians will be better able to provide treatment, particularly for patients in later stages of AD who have difficulty explaining their emotional needs," says Sean N. Halpin, MA, lead author of the study and manager of research projects in geriatrics in the Emory University School of Medicine.
Halpin notes this is an initial effort to develop a cohesive model of the emotional changes experienced by patients with MCI/AD and to encourage health care practitioners to engage these patients as active partners in the process of fully understanding their disease.

More information: Sean N. Halpin et al. Socio-Emotional Adaptation Theory: Charting the Emotional Process of Alzheimer's Disease, The Gerontologist (2016). DOI: 10.1093/geront/gnw046


Provided by Emory University

Dietary fiber intake tied to successful aging, research reveals

Credit: Wikipedia.

Most people know that a diet high in fiber helps to keep us "regular." Now Australian researchers have uncovered a surprising benefit of this often-undervalued dietary component.

02 jun 2016--A new paper published in The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences by scientists from The Westmead Institute for Medical Research—reports that eating the right amount of fiber from breads, cereals, and fruits can help us avoid disease and disability into old age.
Using data compiled from the Blue Mountains Eye Study, a benchmark population-based study that examined a cohort of more than 1,600 adults aged 50 years and older for long-term sensory loss risk factors and systemic diseases, the researchers explored the relationship between carbohydrate nutrition and healthy aging.
They found that out of all the factors they examined—which included a person's total carbohydrate intake, total fiber intake, glycemic index, glycemic load, and sugar intake—it was the fiber that made the biggest difference to what the researchers termed "successful aging."
Successful aging was defined as including an absence of disability, depressive symptoms, cognitive impairment, respiratory symptoms, and chronic diseases including cancer, coronary artery disease, and stroke.
According to lead author of the paper, Associate Professor Bamini Gopinath, PhD, from the Institute's Centre for Vision Research, the study is the first to look at the relationship between carbohydrate intake and healthy aging, and the results were significant enough to warrant further investigation.
"Out of all the variables that we looked at, fiber intake—which is a type of carbohydrate that the body can't digest—had the strongest influence," she said. "Essentially, we found that those who had the highest intake of fiber or total fiber actually had an almost 80 percent greater likelihood of living a long and healthy life over a 10-year follow-up. That is, they were less likely to suffer from hypertension, diabetes, dementia, depression, and functional disability."
While it might have been expected that the level of sugar intake would make the biggest impact on successful aging, Gopinath pointed out that the particular group they examined were older adults whose intake of carbonated and sugary drinks was quite low.
Although it is too early to use the study results as a basis for dietary advice, Gopinath said the research has opened up a new avenue for exploration.
"There are a lot of other large cohort studies that could pursue this further and see if they can find similar associations. And it would also be interesting to tease out the mechanisms that are actually linking these variables," she said.
This study backs up similar recent findings by the researchers, which highlight the importance of the overall diet and healthy aging.
In another study published last year in The Journals of Gerontology, Westmead Institute researchers found that, in general, adults who closely adhered to recommended national dietary guidelines reached old age with an absence of chronic diseases and disability, and had good functional and mental health status.


Provided by The Gerontological Society of America

New procedure uses the heart rate to estimate the life expectancy of infarct patients

After five years, persons with only minor arrhythmia (red graph) were five times more at risk of dying than people with higher breathing-related fluctuations. Credit: JACC

The heart rate may be an indicator of a person's life expectancy. A research team at the Technical University of Munich (TUM) has to this end analyzed an effect which at first seems paradoxical: Minor irregularities in the heartbeat are indicative of a healthy body. A clinical study confirmed a strong correlation between this phenomenon and the survival prospects of heart attack patients. The new methods of measurement may soon be applied in medical practice.

29 may 2016--A healthy person's heart will beat slightly faster upon inhalation and slow down again upon exhalation. The reason for this is that inhaling dampens an effect that will normally regulate the heart rate down to the at rest rate of approximately 60 beats per minute. This phenomenon is called respiratory sinus arrhythmia, which may be translated as a "breathing-induced irregularity in the sinus node, the bundle of nerve fibers controlling the heart beat".
The phenomenon has been known since the 19th century. A body weakened by a heart attack will show a clearly smaller difference between heart rates during the exhaling and inhaling cycles. Therefore, several attempts at using arrhythmia characteristics to draw conclusions about the life expectancy of patients were made in the past. Thus far, however, the data taken on its own yielded no conclusions as to the life expectancy of a patient. This, however, is precisely what the scientists working with Prof. Georg Schmidt, head of the Biosignal Processing team at the University Hospital Klinikum rechts der Isar, have now achieved.

Breathing cycle and heart rate: The decisive moment

Whilst in the majority of earlier studies the full breathing cycle was correlated to the heart rate, the TUM team now focused on exhaling and specifically on the moment when the heart rate would normally be reduced again. "With our approach, you might say we are surgically selecting the moment when the decisive events take place," says Georg Schmidt. In the analysis of the heart rate data, an algorithm Schmidt and his team proposed in an article published in theLancet in 2006 has proven useful. The method renders the respiratory sinus arrhythmia measurable by - to put it simply - extracting other sources of heart rhythm variation from the data collected over a certain period. The algorithm calculates an average from the data, which may then be graphed.
"Our method produces a far more specific picture of the functional condition of the body," says Dr. Daniel Sinnecker, primary author of the study. "There is no other method as yet to isolate the vagal function as specifically as this."The vagal function, i.e. the activity of the vagus nerve, is responsible, among other, for reducing the heart rate of healthy persons as described above. Although the vagus nerve affects many other bodily processes, its activity is not directly measurable.

More than 900 patients examined

Within the framework of the study, published in the Journal of the American College of Cardiology, breathing cycles and heart beat rhythms of close on 950 heart attack patients were measured shortly after a heart attack. The data was analyzed to find respiratory sinus arrhythmia. The test persons were re-examined every six months over a five-year period. The result: Heart attack patients with less pronounced arrhythmia had a higher risk of dying within the period of observation. Examined persons with only minor arrhythmia were five times more at risk of dying over the five-year period than people with higher breathing-related fluctuations.
Two further clinical studies are currently under way with TUM participation, examining the respiratory sinus arrhythmia in different groups of persons. One of the studies (EU-Cert-ICD) examines different treatment strategies in people with pacemakers, whilst the other (INVADE) monitors elderly people with and without heart disease. Schmidt and his team are confident that the results of these studies will confirm that their method, taken on its own, will be a reliable indicator of risk.

Everyday application imminent

The developers are confident that the new method may soon be widely deployed. "We are quite close to everyday application since, by and large, the development of the method is complete," says Georg Schmidt. The technical hurdles are few: Since it is no longer necessary these days to measure breathing rate in addition to heart beat, a modern ECG unit would basically suffice. "Even the general practitioner could therefore within ten minutes record sinus arrhythmic activity."
The method may be fruitfully applied in more than 80 percent of the cases, says Schmidt. Irrespective whether the examined patients had recently suffered a heart attack, it could be used in combination with other indicators to assess the health risk. Hidden risks may in this way be detected in some persons and possibly mitigated with an implantable defibrillator, for instance. "In addition to that, the cost of treatments could be reduced by avoiding unnecessary procedures," says Georg Schmidt.
A next step might be to apply this method to examine the efficacy of different strategies for treatment. Should a patient's characteristics improve in the course of treatment, it is likely that the applied therapy was appropriate.

More information: Daniel Sinnecker et al. Expiration-Triggered Sinus Arrhythmia Predicts Outcome in Survivors of Acute Myocardial Infarction, Journal of the American College of Cardiology (2016). DOI: 10.1016/j.jacc.2016.03.484


Provided by Technical University Munich

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