Older people can learn to spend less time sitting down
Older adults spend 8.5 waking hours a day sitting or lying down—time linked to obesity, heart disease, diabetes, and death—even if they're physically active at other times. A new study showed it was feasible to coach older people to spend less time sitting: an average of a half hour less per day. They reported feeling more able to accomplish everyday tasks—and they walked faster and had fewer depression symptoms.
10 april 2015--"I feel lethargic when I sit all day," said Gerald Alexander, an 82-year-old retired social service worker among the 25 Group Health patients who participated in the Take Active Breaks from Sitting (TABS) pilot study. "I feel much peppier when I stand and take walks."
Retirement may be more golden if less of it is spent in a resting position. Yet older adults spend an average of 8.5 waking hours a day sitting or lying down, according to TABS study leader Dori Rosenberg, PhD, MPH, an assistant scientific investigator at Group Health Research Institute. More of this kind of time has been linked to obesity, heart disease, diabetes, and death—even if people are physically active at other times of the day.
"We're not sure whether older people can improve their health by reducing the time they spend sitting," Dr. Rosenberg said. "To prove that, we need randomized trials—and none have been done yet in older adults." As a first step toward such a trial, she conducted the TABS study, which showed that it was feasible to coach adults aged 60 and older to spend less time sitting: an average of 27 minutes less per day. They reported feeling more able to accomplish everyday tasks. And data suggested that after coaching, they also walked faster and had fewer symptoms of depression.
Health Education & Behavior published the new study's quantitative results: "The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults." And The Gerontologist published its results from interviews with participants: "Motivators and Barriers to Reducing Sedentary Behavior Among Overweight and Obese Older Adults."
How coaching worked
In the TABS study, health coaches talked by phone with each participant five times during eight weeks. The coaches used motivational interviewing to engage participants in setting personalized goals to sit less by standing and moving more—and to take more breaks from sitting throughout the day. Participants tracked how much they thought they were sitting. And at baseline, midway through the study, and at its end, participants used two devices for a week to measure how much they were sitting. They also received charts showing feedback from these measurements. Participants found the feedback charts most helpful, followed by the coaching phone calls.
"The feedback was like a reward for standing up and moving," Mr. Alexander said.
Provided by Group Health Research Institute
Wednesday, April 08, 2015
Efforts needed to standardize criteria for age-related muscle loss
The term "sarcopenia" is most often used to describe age-related loss in muscle mass and strength, and it is commonly considered analogous to osteoporosis. Yet unlike osteoporosis, which can be diagnosed based on widely accepted clinical criteria, sarcopenia is not recognized as a clinical condition even though it can impair physical function and contribute to disability, falls, and hospitalizations.
08 april 2015--A new review addresses this concern and points to efforts aimed at developing and refining sarcopenia criteria.
"For over 20 years, the lack of a consensus definition for sarcopenia has been a significant barrier for the development of interventions aimed at preserving or improving muscle mass and strength in older adults," said Dr. Robert McLean, lead author of the Journal of Bone and Mineral Research review. "The recent and ongoing efforts of the Foundation for the National Institutes of Health Sarcopenia Project are a major advancement toward closing this important gap."
This study is published in the Journal of Bone and Mineral Research.
Provided by Wiley
Tuesday, April 07, 2015
Study links Facebook use to depressive symptoms
Credit: University of Houston
The social media site, Facebook, can be an effective tool for connecting with new and old friends. However, some users may find themselves spending quite a bit of time viewing Facebook and may inevitably begin comparing what's happening in their lives to the activities and accomplishments of their friends.
07 april 2015--According to University of Houston (UH) researcher Mai-Ly Steers, this kind of social comparison paired with the amount of time spent on Facebook may be linked to depressive symptoms. Steers' research on the topic is presented in the article, "Seeing Everyone Else's Highlight Reels: How Facebook Usage is Linked to Depressive Symptoms" published in the Journal of Social and Clinical Psychology.
"Although social comparison processes have been examined at length in traditional contexts, the literature is only beginning to explore social comparisons in online social networking settings," said Steers, a doctoral candidate in social psychology at UH.
Steers conducted two studies to investigate how social comparison to peers on Facebook might impact users' psychological health. Both studies provide evidence that Facebook users felt depressed when comparing themselves to others.
"It doesn't mean Facebook causes depression, but that depressed feelings and lots of time on Facebook and comparing oneself to others tend to go hand in hand," said Steers.
The first study found an association between time spent on Facebook and depressive symptoms for both genders. However, the results demonstrated that making Facebook social comparisons mediated the link between time spent on Facebook and depressive symptoms for men only. Similarly, the second study found a relationship between the amount of time spent on Facebook and depressive symptoms was mediated by social comparisons on Facebook. Unlike the first study, gender did not moderate these associations.
The concept of social comparison is not new. In fact, it has been studied in face-to-face contexts since the 1950's. However, engaging in social comparisons on online social media sites may make people feel even worse.
"One danger is that Facebook often gives us information about our friends that we are not normally privy to, which gives us even more opportunities to socially compare," Steers said. "You can't really control the impulse to compare because you never know what your friends are going to post. In addition, most of our Facebook friends tend to post about the good things that occur in their lives, while leaving out the bad. If we're comparing ourselves to our friends' 'highlight reels,' this may lead us to think their lives are better than they actually are and conversely, make us feel worse about our own lives."
Steers said that people afflicted with emotional difficulties may be particularly susceptible to depressive symptoms due to Facebook social comparison after spending more time on medium. For already distressed individuals, this distorted view of their friends' lives may make them feel alone in their internal struggles, which may compound their feelings of loneliness and isolation.
"This research and previous research indicates the act of socially comparing oneself to others is related to long-term destructive emotions. Any benefit gained from making social comparisons is temporary and engaging in frequent social comparison of any kind may be linked to lower well-being," said Steers.
Steers hopes the results of these studies will help people understand that technological advances often possess both intended and unintended consequences. Further, she hopes her research will help guide future interventions that target the reduction of Facebook use among those at risk for depression.
Older people at higher risk of emergency cancer diagnosis
People over 60 are at higher risk of being diagnosed with lung or bowel cancer as an emergency in hospital than younger people, according to a Cancer Research UK-supported report , published today by BMJ Open.
06 april 2015--The researchers also found that women and less affluent people are at higher risk of an emergency lung cancer diagnosis. While being unmarried, divorced or widowed was associated with having bowel cancer diagnosed as an emergency.
The Cancer Research UK review looked at over 20 studies featuring more than 687,000 lung or bowel cancer cases, of which more than 200,000 cases were diagnosed with cancer after an emergency admission to hospital. Some were admitted after seeing a GP, while others were admitted after going to an A&E department, or directly from a hospital outpatient clinic. The researchers wanted to find out more about why so many patients are diagnosed through this emergency route, particularly as emergency-diagnosed cancers tend to have poorer survival rates.
Almost 40 per cent of lung cancers and 25 per cent of bowel cancers in England were diagnosed as an emergency in hospital between 2006 and 2010. Previous research showed that eleven per cent of lung cancer patients with an emergency diagnosis survived their cancer for at least one year, compared to 42 per cent of patients diagnosed following a GP referral under the two-week-wait system. One year survival for emergency-diagnosed bowel cancer patients was 49 per cent compared to 83 per cent for two-week-wait patients.
Lead review author Dr Liz Mitchell, Senior Research Fellow at the Leeds Institute of Health Sciences said: "It may be that some patients don't go to their GP about early cancer symptoms -especially if they live alone - or they become ill very quickly, leading to an emergency diagnosis in hospital. But our review shows that other factors such as a person's age and gender might also have an influence. Knowing more about these influences could help us to find ways of ensuring that more cancers are spotted earlier, when patients often have a better chance of survival."
Sara Hiom, director of early diagnosis at Cancer Research UK said: "We need a better understanding of why some people are having their cancer diagnosis made via an emergency admission. This is important because we know that their survival chances are lower if people are diagnosed this way. This interesting review sheds some light on the factors that could be involved. We're now funding further research on the subject and calling on the Government to ensure more cancers are diagnosed at the earliest possible stage because this can make such a difference for patients."
More information: Elizabeth D Mitchell, Benjamin Pickwell-Smith, Una Macleod. 'Risk factors for emergency presentation with lung and colorectal cancers: a systematic review. DOI: 10.1136/bmjopen-2014-006965
Provided by Cancer Research UK
Sunday, April 05, 2015
Alzheimer's study on women at risk suggests functional decline relates to deteriorating brain wiring
In their latest brain imaging study on women at risk for Alzheimer's disease, York University researchers have found deterioration in the pathways that serve to communicate signals between different brain regions needed for performing everyday activities such as driving a car or using a computer.
05 mar 2015--"We observed a relationship between the levels of deterioration in the brain wiring and their performance on our task that required simultaneous thinking and moving; what we see here is a result of communication failure," explains Professor Lauren Sergio in the School of Kinesiology & Health Science.
In an interview, Sergio in whose lab the study was conducted, says the findings also suggest that their computerized, easily-administered task that the study participants performed, can be used to test those at risk for Alzheimer's disease to flag early warning signs. "The test is a clinically feasible substitute to the more involved braining imaging tasks that people don't, or can't, have done routinely."
Typically, Alzheimer's disease is associated with memory loss, perception and other aspects of cognition, while debility in complex movements is observed at a much later stage.
The study, Diffusion Tensor Imaging Correlates of Cognitive-Motor Decline in Normal Aging and Increased Alzheimer's Disease Risk, recently published in the Journal of Alzheimer's Disease, was conducted on 30 female participants of whom 10 were in their mid-20s. The rest were in their 50s or older, with half of them at high risk for Alzheimer's disease.
"We decided to focus this study on women, as there is higher prevalence in this group, and also women who carry the ApoE4 gene are more vulnerable to the degradation of white matter," notes PhD candidate Kara Hawkins who led the study, adding that the genetic risk factor for Alzheimer's disease was one of the traits tested for in the current study.
"We scanned the brains of the participants, aiming to see if the impaired cognitive-motor performance in the high risk group was related to brain alterations over and above standard aging changes," Hawkins adds.
According to the researchers, the big question ahead is 'what can be done to prevent a decline in function of a person's brain showing signs of communication problems.' And the answer they are exploring is in finding ways to use these thinking and moving tasks in a proactive way, as part of a game-like cognitive-motor integration training method.
Provided by York University
Saturday, April 04, 2015
A new tool for understanding Parkinson's disease
EPFL scientists have developed a new method that can accurately simulate the chemical modification of the protein behind Parkinson's disease. The technique, has opened a new way of understanding Parkinson's, and can be expanded to other proteins and diseases as well.
04 mar 2015--Parkinson's disease is characterized by the aggregation of the protein alpha-synuclein in brain cells that control movement, giving rise to the disease's symptoms. Evidence suggests that alpha-synuclein begins to aggregate when it undergoes a chemical process where nitrogen groups are attached to four of its amino acids. This process, called nitration, has been impossible to study on alpha-synuclein in the lab. Scientists at École Polytechnique Fédérale de Lausanne (EPFL) have developed the first-ever method where alpha-synuclein can be nitrated to simulate the nitration patterns seen in Parkinson's disease. The method, which can be expanded to investigate the effect of nitration in other proteins, is published in theJournal of the American Chemical Society and opens new possibilities for understanding the role of this nitration in health and disease.
The exact causes of Parkinson's disease, which affects around ten million people worldwide, are still unclear. But one place to look is the protein alpha-synuclein, which begins to clump together inside brain cells to form long fibrils, which then evolve into aggregates that eventually destroy the cell. This has been linked to a several chemical modifications of alpha-synuclein, one of which is nitration, where nitrogen groups attach to its tyrosine amino acids.
However, nitration of alpha-synuclein has proven hard to study in the lab. The problem is that current nitrating methods generate non-homogeneous mixtures of α-synucleins that are nitrated at different amino acid sites. As a result, the proteins have different properties to natural alpha-synuclein, and cannot be used effectively to mimic and study what happens in Parkinson's disease.
A new approach to dissecting nitration
Hilal Lashuel's team at EPFL has now developed the first technique to produces homogeneous α-synucleins, where one or more of its tyrosines can be properly nitrated. The scientists used a sophisticated protein synthesis technique to make fragments of alpha-synuclein where nitrated tyrosines could be incorporated and therefore nitrated independently from each other. Because of this, it was also possible to control the exact number or combinations of nitrated tyrosines, which offers a powerful tool to study this process.
The fragments were then recombined to produce the entire alpha-synuclein with correctly nitrated tyrosines. Normally, this recombining involves a desulfurization step that can ruin the attached nitrogen groups by adding electrons to them (this is known as "reduction"). But lead author Ritwik Burai conceived of a way to bypass the problem by modifying the desulfurization process.
The new method produced a completely homogenously nitrated or tailored mixture of nitrated alpha-synuclein. When tested in in vitro, the modified proteins lost their ability to interact properly with vesicles, such as those found in cells. Further tests also showed that site-specific nitration changed alpha-synuclein's structure, which directly influences the protein's tendency to form the aggregates seen in Parkinson's disease.
Tools that shape the future
Hilal Lashuel's team has been working on chemical modifications of alpha-synuclein and other proteins for over five years. This method is the latest achievement in this line, overcoming the last barrier, nitration. "These advances allow us now to reconstruct, in vitro, a-synuclein species with the same chemical properties as those isolated from diseased human brains," says Hilal Lashuel. Since the normal functions of alpha-synuclein are still a mystery, being able to reconstruct its chemical properties as they exist in the human brain may also open new avenues for understanding its biological role, and how it can become impaired in disease.
The new method is not limited to alpha-synuclein, but can be used across different proteins and different types of chemical modifications, which often underlie a multitude of diseases. Just in the context of Parkinson's disease, Lashuel anticipates that the chemical tools his group has developed will have an tremendous impact: "These advances will facilitate the development of antibodies and imaging agents for the detection and quantification of different a-synuclein species and aggregates along the progression of Parkinson's disease, which could lead to novel approaches for its diagnosis and treatment."
More information: "Elucidating the role of site-specific nitration of α-synuclein in the pathogenesis of Parkinson's disease via protein semisynthesis and mutagenesis." JACS 13 March 2015. DOI: 10.1021/ja5131726
Provided by Ecole Polytechnique Federale de Lausanne
Friday, April 03, 2015
Older workers bring valuable knowledge to the job, study says
Credit: Ethan, SportSuburban, Flickr via Creative Commons.
In the workplace, age matters - but hiring or promoting based on age-related mental abilities can be a minefield, according to new research published by the American Psychological Association.
03 april 2015--Older executives bring valuable skills to the job, such as higher "crystallized intelligence," which includes verbal ability and knowledge born of experience, according to a study published in APA's Journal of Applied Psychology. But compared with their younger counterparts, older executives show marked declines in "fluid intelligence," which involves the ability to reason, the research found.
"We found that older executives performed somewhat worse on tests of general mental ability, and markedly worse on figural and inductive reasoning tests, which assess fluid intelligence," said lead researcher Rachael M. Klein, a doctoral candidate at the University of Minnesota. "Given the rising numbers of older employees in the workforce, as well as the rise in age-based discrimination cases, it is increasingly important for employers to be careful regarding which tests of cognitive abilities they administer."
The article details several studies designed to measure the general mental ability of older workers. One sample included 3,375 individuals applying to executive-level jobs - vice president or general manager positions within professional, technical, line and sales occupations. Participants' ages ranged from 20-74 at the time of application. These applicants completed standardized psychological tests that were part of a managerial and professional test battery.
Tests of both fluid and crystallized cognitive abilities were administered. According to Deniz S. Ones, PhD, a study co-author, solving problems on fluid ability measures does not depend on prior learning, but rather on abstract reasoning ability. In one test that measured fluid intelligence, applicants were instructed to identify one of four pictures that best matched a target picture. High scores on this test, which is representative of tests typically used in employment settings, indicate more advanced non-verbal and analytical reasoning skills. Another fluid intelligence test involved showing participants a series of letters and asking them to quickly identify the letter that would complete the sequence.
"Crystallized cognitive abilities represent acquired knowledge," said Ones. To measure crystallized cognitive ability, participants were given a vocabulary test.
The researchers found that general mental ability decreased gradually across age groups relative to applicants under age 30, with more marked declines for groups older than 59. "Beyond 59, average test scores for the older age groups decreased more rapidly," they wrote.
With respect to crystallized intelligence, older individuals had higher scores on average compared with younger ones. However, fluid abilities showed the largest declines with age, while inductive reasoning slid downward as well, according to the study. The researchers replicated these findings in several large, representative general population samples.
These results should be used by employers to help them avoid age discrimination, according to the researchers. "Organizations should be cautious when using certain tests of inductive reasoning, given the magnitude of age differences we found in this research," said Stephan Dilchert, PhD, the second author of the study. "Hiring or promoting on such measures alone may lead to younger individuals being selected at much greater rates than older candidates."
Future research should focus on how best to help older workers transition to new positions or careers, the authors said. "Future research is needed on training outcomes for older employees who are learning new job skills unrelated to their current position or career," Klein said.
More information: "Cognitive Predictors and Age-Based Adverse Impact Among Business Executives," by Rachael M. Klein, University of Minnesota; Stephan Dilchert, PhD, Baruch College, The City University of New York; Deniz. S. Ones, PhD, University of Minnesota; and Kelly Dages, PhD, General Dynamics Information Technology. Journal of Applied Psychology, published online Mar. 30, 2015.
Provided by American Psychological Association
Thursday, April 02, 2015
Internet searches create illusion of personal knowledge, research finds
Searching the Internet for information may make people feel smarter than they actually are, according to new research published by the American Psychological Association.
02 april 2015--"The Internet is such a powerful environment, where you can enter any question, and you basically have access to the world's knowledge at your fingertips," said lead researcher Matthew Fisher, a fourth-year doctoral candidate in psychology at Yale University. "It becomes easier to confuse your own knowledge with this external source. When people are truly on their own, they may be wildly inaccurate about how much they know and how dependent they are on the Internet."
In a series of experiments, participants who searched for information on the Internet believed they were more knowledgeable than a control group about topics unrelated to the online searches. In a result that surprised the researchers, participants had an inflated sense of their own knowledge after searching the Internet even when they couldn't find the information they were looking for. After conducting Internet searches, participants also believed their brains were more active than the control group did. The research was published online in the Journal of Experimental Psychology: General.
For nine experiments, a range of 152 to 302 participants were recruited online, with different participants taking part in each experiment. In one experiment, the Internet group used online searches to research four questions (e.g., "How does a zipper work?") and provided a website link with the best answer. The control group was given the exact text from the most common website used by the Internet group to answer the questions. Both groups then rated their ability to answer other questions (e.g., "Why are cloudy nights warmer?") on topics unrelated to the Internet searches, although they didn't have to answer those questions. The Internet group members consistently rated themselves as more knowledgeable than the control group about those unrelated topics.
The Internet group reported an inflated sense of personal knowledge after Internet searches even when its members could not find complete answers to very difficult questions (e.g., "Why is ancient Kushite history more peaceful than Greek history?") or when they found no answers at all because of Google filters that were used. The cognitive effects of "being in search mode" on the Internet may be so powerful that people still feel smarter even when their online searches reveal nothing, said study co-author Frank Keil, PhD, a psychology professor at Yale.
In another experiment, participants who did online searches thought their brains would be more active than the control group, and they chose magnetic resonance images of a brain with more active areas highlighted as representative of their own brains. This result suggests that the participants searching the Internet believed they had more knowledge in their heads, rather than simply thinking they knew more because they had access to the Internet, Fisher said.
The use of Internet searches, not just access to the Internet, appeared to inflate participants' sense of personal knowledge. When the Internet group members were given a particular website link to answer questions, they didn't report higher levels of personal knowledge on the unrelated topics than the control group.
People must be actively engaged in research when they read a book or talk to an expert rather than searching the Internet, Fisher said. "If you don't know the answer to a question, it's very apparent to you that you don't know, and it takes time and effort to find the answer," he said. "With the Internet, the lines become blurry between what you know and what you think you know."
The growing use of smartphones may exacerbate this problem because an Internet search is always within reach, Keil said, and the effects may be more pronounced when children who are immersed in the Internet from an early age grow up to be adults.
An inflated sense of personal knowledge also could be dangerous in the political realm or other areas involving high-stakes decisions, Fisher said.
"In cases where decisions have big consequences, it could be important for people to distinguish their own knowledge and not assume they know something when they actually don't," he said. "The Internet is an enormous benefit in countless ways, but there may be some tradeoffs that aren't immediately obvious and this may be one of them. Accurate personal knowledge is difficult to achieve, and the Internet may be making that task even harder."
More information: "Searching for Explanations: How the Internet Inflates Estimates of Internal Knowledge;" Matthew Fisher, MA, Mariel K. Goddu, BA, and Frank C. Keil, PhD; Yale University; Journal of Experimental Psychology: General, online, Mar. 31, 2015.
Provided by American Psychological Association
Wednesday, April 01, 2015
New recommendations for treating patients with high blood pressure and CVD
Blood pressure cuff. Credit: copyright American Heart Association
A new scientific statement issued jointly by three medical organizations and published in the American Heart Association's journal Hypertension, addresses how low to aim when treating patients with high blood pressure who also have vascular diseases.
01 april 2015--The document provides an up-to-date summary on treating hypertension in patients who have both high blood pressure and have had a stroke, heart attack or some other forms of heart disease, said Elliott Antman, M.D., President of the American Heart Association and professor of medicine at Harvard Medical School.
"The writing committee reinforces the target of less than 140/90 to prevent heart attacks and strokes in patients with hypertension and coronary artery disease," he said. "This is important since confusion has arisen in the clinical community over the last year regarding the appropriate target for blood pressure management in the general population."
The current statement is issued jointly by the American Heart Association, American College of Cardiology, and American Society of Hypertension. The writing committee consisted of internationally recognized experts in the fields of cardiology and high blood pressure research.
According to the statement, while a target of less than 140/90 is reasonable to avoid heart attacks and strokes, a lower target of less than 130/80 may be appropriate in some individuals with heart disease who have already experienced a stroke, heart attack, or mini-stroke (also called a transient ischemic attack or TIA) or who have other cardiovascular conditions such as a narrowing of leg arteries or abdominal aortic aneurysm.
Blood-pressure lowering can be done safely, and the vast majority of individuals will not experience problems when standard medications are used, the committee writes. However, the statement recommends that clinicians use caution in patients with coronary artery blockages, advising that blood pressure should be lowered slowly, and not strive to decrease the diastolic (lower number) blood pressure to less than 60 mm Hg, particularly in patients more than 60 years old.
The statement offers specific, evidence-based recommendations and contraindications to help clinicians select which anti-hypertensive medications to use in patients with various types of heart disease. For most patients, that will mean taking a beta-blocker by itself or in combination with other classes of drugs.
"In the spectrum of drugs available for the treatment of hypertension, beta-blockers assume center stage in patients with coronary artery disease," said Clive Rosendorff, M.D., Ph.D., chair of the writing committee, professor of medicine at the Icahn School of Medicine at Mount Sinai Medical Center in New York, and director of graduate medical education at the Veterans Administration in the Bronx. In addition to their effect on blood pressure, beta-blockers slow the heart rate and reduce the force of cardiac contraction, both of which reduce the heart's consumption of oxygen. They also increase blood flow to the heart by prolonging the time between contractions, which is when blood flows into the heart muscle.
"In addition to treating hypertension, this statement also recognizes the importance of modifying other risk factors for heart attack, stroke and other vascular disease, including abdominal obesity, abnormal cholesterol, diabetes, and smoking," Rosendorff said.
Provided by American Heart Association
Tuesday, March 31, 2015
New model for predicting cardiovascular disease risk worldwide
Researchers have developed the first global model for predicting cardiovascular disease (CVD) risk. The model—developed by Harvard T.H. Chan School of Public Health, Imperial College London, and colleagues—will be of particular help to public health professionals, clinicians, and patients in developing countries for prevention of CVD.
31 mar 2015--A paper on the new CVD risk prediction method, and its application in several example countries, appears online March 26, 2015 in The Lancet Diabetes & Endocrinology.
"This new tool allows healthcare professionals around the world to make optimal clinical decisions about treatment of their patients and for health policy makers to efficiently allocate resources to CVD prevention," said Goodarz Danaei, assistant professor of global health at Harvard Chan School.
To develop the model, which will be available later this year at http://www.globorisk.org, the researchers analyzed data from more than 50,000 participants in eight existing long-term studies, which included risk factors such as blood pressure, cholesterol, diabetes, and smoking, as well as gender and age.
The researchers generated risk charts that estimated risk of fatal CVD over a span of 10 years for 11 countries in different regions of the world. The risk of fatal CVD was lowest in South Korea, Spain, Japan, and Denmark, and highest in the Czech Republic, China, Iran, and Mexico. In the former group of countries, only 5%-10% of men and women had more than a 10% risk of fatal CVD. But in China, 33% of men and 28% of women had a 10-year fatal CVD risk of 10% or higher. In Mexico the prevalence of high-risk CVD was 16% for men and 11% for women.
The researchers found that more people were at high risk of CVD in many developing countries compared with developed ones. Within developed countries, they found that the U.S. had a larger share of its population at high risk of CVD than England, Japan, South Korea, Denmark, or Spain.
The results emphasize the need to use the current momentum for universal health coverage to ensure that people at high risk of CVD in low- and middle-income countries receive the same basic treatments available to those in the high-income world, according to the authors. The U.S. results also demonstrate the urgent need for equitable access to primary health care as a tool for CVD prevention.
More information: "Globorisk - A novel risk score for predicting cardiovascular disease risk in national populations: a pooled analysis of prospective cohorts and health examination surveys," Kaveh Hajifathalian, Peter Ueda, Yuan Lu, Mark Woodward, Alireza Ahmadvand, Carlos A. Aguilar-Salinas, Fereidoun Azizi, Renata Cifkova, Mariachiara Di Cesare, Louise Eriksen, Farshad Farzadfar, Nayu Ikeda, Davood Khalili, Young-Ho Khang, Vera Lanska, Luz León-Muñoz, Dianna Magliano, Kelias P. Msyamboza, Kyungwon Oh, Fernando Rodríguez-Artalejo, Rosalba Rojaz-Martinez, Jonathan E. Shaw, Gretchen A. Stevens, Janne Tolstrup, Bin Zhou, Joshua A Salomon, Majid Ezzati, and Goodarz Danaei, Lancet Diabetes & Endocrinology, online March 26, 2015, DOI: 10.1016/S2213-8587(15)00081-9
Provided by Harvard School of Public Health
Monday, March 30, 2015
Walking after meals could save older people from a fall
Going for a walk instead of resting after eating could help to save older people from some falls caused by a sudden loss in blood pressure, according to new research.
30 mar 2015--Post-prandial hypotension is a fall in blood pressure seen within two hours of eating a meal. This health condition commonly affects older people – after a meal (usually breakfast), an older person may feel tired, dizzy or even experience a fall.
"Although this condition is common in older people, many are not aware of it," says the University of Adelaide's Professor Renuka Visvanathan, Director of the Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, and Director of Aged and Extended Care Services at The Queen Elizabeth Hospital.
"Falls among older people often result in fractures, and those who experience a fall may lose confidence as well as lose their independence. Falls can also be fatal for older people," she says.
Professor Visvanathan says researchers have been trying to better understand the reasons as to why this condition occurs, in the hopes of developing improved treatments or preventing post-prandial hypotension.
Research by University of Adelaide student Dr Shailaja Nair and University of South Australia student Ms Zoe Kopsaftis, working under the supervision of Professor Visvanathan and Dr Diana Piscitelli from the University of South Australia, has now confirmed that older people with post-prandial hypotension should be encouraged to walk intermittently at a normal pace for at least 120 minutes after a meal, as a means of reducing the fall in bloodpressure.
"This advice, coupled with other practical strategies, such as drinking a glass of water with meals, may help older people avoid the consequences of post-prandial hypotension," Professor Visvanathan says.
"Much of the research conducted to date has been undertaken in healthy older people, but this new research has involved people with a confirmed diagnosis of the condition," she says.
Provided by University of Adelaide
Sunday, March 29, 2015
Ultrasound against Alzheimer's shows promise in lab animals
Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.
Queensland scientists have found that non-invasive ultrasound technology can be used to treat Alzheimer's disease and restore memory.
29 mar 2015--University of Queensland researchers discovered that the innovative drug-free approach breaks apart the neurotoxic amyloid plaques that result in memory loss and cognitive decline.
Welcoming the findings today at UQ's Queensland Brain Institute, Queensland Premier Annastacia Palaszczuk said they could have a wide impact for the community.
"The Government's $9 million investment into this technology was to drive discoveries into clinics, and today's announcement indicates that together with the Queensland Brain Institute, it was a worthwhile investment," Ms Palaszczuk said.
"I want my Government to encourage more of this type of innovative research.
"Our Advance Queensland initiative aims to increase research and discoveries like this and to put this state's research at the forefront internationally by supporting local researchers and helping to keep them in Queensland.
"These exciting findings will hopefully be of benefit to all Australians in the future."
QBI Founding Director Professor Perry Bartlett said the discovery – a result of 'game-changing' work performed at the Queensland Brain Institute's Clem Jones Centre for Ageing Dementia Research – was made possible through the support of the State and Federal Governments and philanthropic support led by the Clem Jones Foundation.
"The farsighted investment of government and philanthropic partners has allowed us to build the research excellence and capacity required to make major discoveries such as this," Professor Perry Bartlett said.
"I believe the work opens up an entirely novel avenue for future therapeutic treatment."
Clem Jones Centre for Ageing Dementia Research director Professor Jürgen Götz said the new treatment method could revolutionise Alzheimer's treatment by restoring memory.
"We're extremely excited by this innovation of treating Alzheimer's without using drug therapeutics," Professor Götz said.
"The ultrasound waves oscillate tremendously quickly, activating microglial cells that digest and remove the amyloid plaques that destroy brain synapses.
"The word 'breakthrough' is often mis-used, but in this case I think this really does fundamentally change our understanding of how to treat this disease, and I foresee a great future for this approach."
Alzheimer's affects more than two-thirds of dementia patients, and approximately a quarter of a million Australians.
The total number of dementia cases in Australia is expected to rise to 900,000 by 2050.
"With an ageing population placing an increasing burden on the health system, an important factor is cost, and other potential drug treatments using antibodies will be expensive," Professor Götz said.
"In contrast, this method uses relatively inexpensive ultrasound and microbubble technology which is non-invasive and appears highly effective.
The approach is able to temporarily open the blood-brain barrier, activating mechanisms that clear toxic protein clumps and restoring memory functions.
"With our approach the blood-brain barrier's opening is only temporary for a few hours, so it quickly restores its protective role," Professor Götz said.
Research has been conducted using mice with an Alzheimer's model, with the next step being to scale the research in higher animal models ahead of human clinical trials, which are at least two years away.
"This treatment restored memory function to the same level of normal healthy mice," Professor Götz said.
"We're also working on seeing whether this method clears toxic protein aggregates in neurodegenerative diseases other than Alzheimer's and whether this also restores executive functions, including decision-making and motor control."
Findings of the research, "Scanning ultrasound efficiently removes amyloid-β and restores memory in an Alzheimer's model", are published in the journal Science Translational Medicine.
Researchers help create 'gold standard' method for measuring an early sign of Alzheimer's
Diagram of the brain of a person with Alzheimer's Disease.
After six years of painstaking research, a UCLA-led team has validated the first standardized protocol for measuring one of the earliest signs of Alzheimer's disease—the atrophy of the part of the brain known as the hippocampus.
27 mar 2015--The finding marks the final step in an international consortium's successful effort to develop a unified and reliable approach to assessing signs of Alzheimer's-related neurodegeneration through structural imaging tests, a staple in the diagnosis and monitoring of the disease. The study is published in the journal Alzheimer's and Dementia.
Using brain tissue of deceased Alzheimer's disease patients, a group headed by Dr. Liana Apostolova, director of the neuroimaging laboratory at the Mary S. Easton Center for Alzheimer's Disease Research at UCLA, confirmed that the newly agreed-upon method for measuring hippocampal atrophy in structural MRI tests correlates with the pathologic changes that are known to be hallmarks of the disease—the progressive development of amyloid plaques and neurofibrillary tangles in the brain.
"This hippocampal protocol will now become the gold standard in the field, adopted by many if not all research groups across the globe in their study of Alzheimer's disease," said Apostolova, who was invited to play a key role in the consortium because of her reputation as one of the world's leading experts in hippocampal structural anatomy and atrophy. "It will serve as a powerful tool in clinical trials for measuring the efficacy of new drugs in slowing or halting disease progression."
The brain is the least accessible and most challenging organ to study in the human body; as a result, Alzheimer's disease can be diagnosed definitively only by examining brain tissue after death. In living patients, physicians diagnose Alzheimer's by evaluating other health factors, known as biomarkers, in combination with memory loss and other cognitive symptoms.
The hippocampus is a small region of the brain that is associated with memory formation, and memory loss is the earliest clinical feature of Alzheimer's disease. Its shrinkage or atrophy, as determined by a structural MRI exam, is a well-established biomarker for the disease and is commonly used in both clinical and research settings to diagnose the disease and monitor its progression.
But until now, the effectiveness of structural MRI has been limited because of the widely different approaches being used to identify the hippocampus and measure its volume—which has called into question the validity of this approach. A typical hippocampus is about 3,000 to 4,000 cubic millimeters in volume. But, Apostolova notes, two scientists analyzing the same structure can come up with a difference of as much as 2,000 cubic millimeters.
In addition, no previous study had verified whether estimates for the volume of the hippocampus using MRI corresponded to actual tissue loss.
To address these deficiencies, the European Alzheimer's Disease Consortium-Alzheimer's Disease Neuroimaging Initiative was established to develop a Harmonized Protocol for Hippocampal Segmentation, or HarP—an effort to establish a definitive method for measuring hippocampal shrinkage through structural MRI in a way that best corresponds to the Alzheimer's disease process.
Once the HarP was established, Apostolova and four other experts were invited to develop the gold standard for measuring the hippocampus to be used by anyone employing the HarP protocol. The UCLA-led team then validated the technique and ensured the changes in the hippocampus corresponded to the hallmark pathologic changes associated with Alzheimer's disease.
"The technique is meant to be used on scans of living human subjects, so it's important that we are absolutely certain that this methodology measures what it is supposed to and captures disease presence accurately," Apostolova said.
To do that, her group used a powerful 7 Tesla MRI scanner to take images of the brain specimens of 16 deceased individuals—nine who had Alzheimer's disease and seven who were cognitively normal—each for 60 hours. This provided unprecedented visualization of the hippocampal tissue, Apostolova said.
After applying the protocol to measure the hippocampal structures, the researchers analyzed the tissues for two changes that signify the disease: a buildup of amyloid tau protein and loss of neurons. The team found a significant correlation between hippocampal volume and the Alzheimer's disease indicators.
"As a result of the years of scientifically rigorous work of this consortium, hippocampal atrophy can finally be reliably and reproducibly established from structural MRI scans," Apostolova said.
Although the technique can be used immediately in research settings such as clinical trials, the next step, Apostolova noted, will be to use the standardized protocol to validate automated techniques available for measuring the hippocampus so the approach could be used more widely—including for the diagnosis of the disease in doctor's offices and other patient care settings.
Provided by University of California, Los Angeles
Thursday, March 26, 2015
Study finds the role of genes is greater with living to older ages
Genes appear to play a stronger role in longevity in people living to extreme older ages, according to a study of siblings led by Boston University and Boston Medical Center (BMC) researchers.
26 mar 2015--The study, published online in the Journal of Gerontology: Biological Sciences, found that for people who live to 90 years old, the chance of their siblings also reaching age 90 is relatively small - about 1.7 times greater than for the average person born around the same time. But for people who survive to age 95, the chance of a sibling living to the same age is 3.5 times greater - and for those who live to 100, the chance of a sibling reaching the same age grows to about nine times greater.
At 105 years old, the chance that a sibling will attain the same age is 35 times greater than for people born around the same time - although the authors note that such extreme longevity among siblings is very rare.
"These much higher relative chances of survival likely reflect different and more potent genetic contributions to the rarity of survival being studied, and strongly suggest that survival to age 90 and survival to age 105 are dramatically different phenotypes or conditions, with very different underlying genetic influences," the authors conclude.
The study, led by Paola Sebastiani, PhD, professor of biostatistics at the BU School of Public Health, analyzed survival data of the families of 1,500 participants in the New England Centenarian Study, the largest study of centenarians and their family members in the world, based at BMC. Among those families, the research team looked at more than 1,900 sibling relationships that contained at least one person reaching the age of 90.
Sebastiani and co-author Thomas Perls, MD, MPH, professor of medicine at the BU School of Medicine and the centenarian study's founder and lead investigator, said the findings advance the idea that genes play "a stronger and stronger role in living to these more and more extreme ages," and that the combinations of longevity-enabling genes that help people survive to 95 years are likely different from those that help people reach the age of 105, who are about 1,000 times rarer in the population.
They said that previous studies of the determinants of survival to older ages have been clouded by researchers not being precise about what they call aging, life span, longevity, or even exceptional longevity.
"For a long time, based upon twins' studies in the 1980s and early '90s, scholars have maintained that 20 to 30 percent of longevity or even life span is due to differences in genes, and that the remainder is due to differences in environment, health-related behaviors or chance events. But the oldest twins in those studies only got to their mid- to late-80's," said Perls. "Findings from this and other studies of much older (and rarer) individuals show that genetic makeup explains an increasingly greater portion of the variation in how old people live to be, especially for ages rarer than 100 years."
Perls and Sebastiani said there is considerable inconsistency in the gerontological literature concerning definitions of aging, longevity and life span.
"The casual use of these terms leads to confusing claims regarding heredity and non-replicated genetic studies," Perls said. "Many researchers equate the term 'longevity' with 'old age,' and neither term is adequately specific."
Because genes play a much stronger differentiating role in living to 105-plus years, studies of such individuals are "much more powerful in discovering longevity-related genes than studies of people in their 90s," he said.
Sebastiani, Perls and co-authors call for investigators probing genetic influences to be precise in describing the rarity or percentile of survival that study subjects achieve.
Provided by Boston University Medical Center
Wednesday, March 25, 2015
Today's 75-year-olds are cognitively fitter and happier than the 75-year-olds of 20 years ago
Older adults today show higher levels of cognitive functioning and well-being than older adults of the same age 20 years ago. This has been found in a collaborative study among several research institutions in Berlin, including the Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, the Max Planck Institute for Human Development (MPIB), and the German Socio-Economic Panel (SOEP). The result will be published in the scientific journal Psychology and Aging.
25 mar 2015--For all of those who are worrying about getting old, here is some good news: Old age is getting younger. On average, today's 75-year-olds are cognitively much fitter than the 75-year-olds of 20 years ago. At the same time, the current generation of 75-year-olds also reports higher levels of well-being and greater life satisfaction. "The gains in cognitive functioning and well-being that we have measured here in Berlin are considerable and of great significance for life quality in old age," comments Ulman Lindenberger, Director of the Center for Lifespan Psychology at the Max Planck Institute for Human Development. The researchers relate the gains to sociocultural factors such as education. In their opinion, the increase in well-being is also due to better physical fitness and higher levels of independence in old age.
"However, we expect that these positive historical trends are attenuated at the end of life," adds Denis Gerstorf, Professor for Developmental Psychology at the Department of Psychology, Humboldt-Universität zu Berlin. During the final stage of life, the increase in good years of life is likely to give way to a rapid and marked drop in both cognition and well-being. Current studies by Gerstorf and colleagues examining old people's last years of life support this view.
The price of delirium: New study finds nearly half of patients have delirium
A new study presented today at the 2015 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that 48 percent of hip fracture patients, age 65 and older, had delirium, or acute confusion, before, during and after surgery (perioperative), resulting in significantly longer hospital stays and higher costs for care.
24 mar 2015--Approximately 300,000 Americans are hospitalized with hip fractures each year. The risk is particularly high in post-menopausal women who face an increased risk for osteoporosis, a disease that diminishes bone mass and increases fracture risk. Delirium is common among older hip fracture patients, and multiple studies have found that patients with postoperative delirium are more likely to have complications, including infections, and less likely to return to their pre-injury level of function. Delirium patients also are more frequently placed in nursing homes following surgery, and have an increased rate of mortality.
In this study, researchers at the University of Toronto sought to determine the economic implications of perioperative delirium in older orthopaedic patients by reviewing hip fracture records between January 2011 and December 2012. A total of 242 hip fracture patients with a mean age of 82 (ages 65 to 103) were studied. Demographic, clinical, surgical and adverse events data were analyzed. Perioperative delirium was assessed using the Confusion Assessment Method (CAM).The study found that 116 patients (48 percent) experienced delirium during hospital admission. The patients with delirium were significantly older (mean age 85), and were more likely to have a higher American Society of Anesthesiologists (ASA) score ("one" represents a "completely healthy fit patient," and "five," a patient not expected to live beyond 24 hours without surgery). After controlling for these differences, perioperative delirium was associated with 7.4 additional hospital days and $8,282 ($8,649 in U.S. dollars) in additional hospital costs (1.5 times the cost of patients who did not experience delirium).There were no differences in mean time between triage or admission and surgery, length of surgery, or anesthesia type between groups. A significantly greater proportion of patients who experienced perioperative delirium required long-term and/or skilled care facility admission follow their hospital stay (8 percent versus 0 percent).
"Older patients are at high risk of developing delirium during hospitalization for a hip fracture, which is associated with worse outcomes," said orthopaedic surgeon and lead study author Michael G. Zywiel, MD. "Our work demonstrates that delirium also markedly increases the cost of elderly patient care while in the hospital. Given the high number of patients hospitalized every year with a hip fracture, there is a real need to develop and fund improved interventions to prevent in-hospital delirium in these patients.
"Our research suggests that reducing the rate of delirium would simultaneously increase the quality of care while decreasing costs, presenting hospitals, surgeons and other stakeholders with promising opportunities to improve the value of hip fracture care," said Dr. Zywiel.
The American Academy of Orthopaedic Surgeons' (AAOS) new clinical practice guideline, "Management of Hip Fractures in the Elderly", makes a series of recommendations to reduce delirium in older hip fracture patients. They include:
Preoperative regional analgesia to reduce pain.
Hip fracture surgery within 48 hours of hospital admission.
Intensive physical therapy following hospital discharge to improve functional outcomes.
An osteoporosis evaluation, as well as vitamin D and calcium supplements, for patients following a hip fracture.
Provided by American Academy of Orthopaedic Surgeons
Monday, March 23, 2015
Peak cognitive skills not strictly a feature of youth, study finds
New research is changing long-held ideas of how our minds age, painting a richer picture of different cognitive skills peaking across a lifetime, with at least one—vocabulary—peaking at a time when many are considering retirement.
23 mar 2015--The study, supported by results from tens of thousands of volunteers who participated in a series of online tests, also hinted that at least some cognitive skills are plastic and that their decline can be delayed by changes in education, environment, or lifestyle. Researchers' analysis of existing tests from different decades showed vocabulary skills peaking later and later in life, a trend they ascribe in part to improvements in education and the rise of white-collar jobs.
"What we're seeing is that, across adulthood, some things 'age' in the sense that processing speed does go down," said co-author Laura Germine, a research associate in Harvard's Psychology Department and a postdoctoral fellow at Harvard-affiliated Massachusetts General Hospital. "But other things are doing something very different from what is implied by the word 'aging.' They're maturing, they're getting refined over time. For the everyday person, the word 'aging' implies a breakdown of things. 'Ripening' might be better."
Germine conducted the research with Joshua Hartshorne, a postdoctoral fellow at the Massachusetts Institute of Technology. Published this month in the journal Psychological Science, it presents the results of a fine-grained analysis enabled by the many volunteers—more than 48,000—who went to www.testmybrain.org and www.gameswithwords.org and took a series of game-like tests that measured an array of cognitive skills, including brain processing speed, memory, emotional cognition, and so-called "crystalized intelligence," the application of learned knowledge such as vocabulary and arithmetic.
The results present a much more nuanced picture of changes in cognitive skills over a lifetime than that provided by current theoretical frameworks, Germine said. It has traditionally been believed that many cognitive skills peak early—late teens and 20s—and decline with age, with crystallized intelligence, thought to peak in the 40s, being the exception.
The view that there is a broad decline in most cognitive skills likely emerged due to limitations in the population that can be easily tested for studies on aging, Germine said. Because most adults are busy working and raising families, they have little time to come to a lab and participate in experiments. Instead, she said, such tests are most often taken by college students and by retirees, giving psychologists a good view of the two ends of the lifespan but much less data about what goes on in between.
"Regular old adults have been some of the hardest participants to get for this kind of research," Germine said.
The Web-based tests used by Germine and Hartshorne (who runs gameswithwords.org) are different because they can be done from any computer and take just a few minutes, making them more accessible to working adults. The trick in designing such tests, Germine said, is to make them engaging so that participants feel rewarded enough to take a second test, or to tell others.
The two began working together as Ph.D. students at Harvard after Germine published results from online testing in 2011 showing that the ability to recognize and remember faces peaks between ages 30 and 34, later than was thought. Hartshorne approached Germine because work he was doing on a different aspect of memory also showed a later peak than the accepted average.
Because Hartshorne too had gathered his data through Web-based experiments, the pair worried they were measuring some quirk of people in their late 20s and early 30s who used the Internet. So they obtained the results of older, paper-based tests of intelligence and memory, broke down the data, and reanalyzed it to see if it revealed the same unexpected peaks as the Web findings. To their relief, it did.
The pair then continued with the study released this month, which shows a series of cognitive peaks through life. Peak mental processing speed occurs, as expected, in late teens and early 20s and declines relatively rapidly afterward. But other skills peak at different times. Working memory climbs in the late 20s to early 30s, and then declines only slowly over time. Social cognition, the ability to detect others' emotions, peaks even later—in the 40s to age 50—and doesn't start to significantly decline until after 60.
"That fits with absolutely no theoretical framework that we currently have," Germine said.
Crystalized intelligence, measured as vocabulary skills, didn't have a peak. Instead, it continued to improve as respondents aged, until 65 to 70. The result was so startling, it sent Germine and Hartshorne back again to paper tests—this time the large-scale General Social Survey. Their first look at the GSS indicated that vocabulary skills peaked decades earlier than in their study, from 45 to 50. But before dismissing their own results, the researchers decided to break down the GSS by decade.
From 1974 through 1987, they found, vocabulary skills peaked in the early 40s. From 1988 through 1997, they peaked at around 50, and from 1998 to 2012, they peaked at 65, matching their data.
Germine attributed the change in vocabulary skills over time to broader changes in society, including an increased emphasis on education, both early in life and lifelong; the rise of white-collar jobs that require more reading and writing; and to a general improvement in nutrition and physical well-being, factors that support cognitive health.
Baby boomers "are the most educated generation of all generations that have ever retired," Germine said.
Though the research enriches scientific understanding of changes in cognition, in many ways it only confirms what people in their homes, schools, and workplaces already know, Germine said.
"A lot of people have this intuition that one matures as one gets older. It's not just because there's more information in the brain, there's lots of other things, too. As we get older, we get better at solving certain kinds of problems, though we may not have the quickness of our 20s. It's a rich process of change. … In a lot of ways, our results are surprising from a theoretical standpoint, but they also kind of really make sense."
Provided by Harvard University
Sunday, March 22, 2015
New assessment tool helps predict risk of cognitive decline
22 mar 2015—A new assessment tool may be able to predict risk of mild cognitive impairment (MCI) in older adults, according to a study published online March 18 in Neurology.
V. Shane Pankratz, Ph.D., from the University of New Mexico Health Sciences Center in Albuquerque, and colleagues developed risk scores to predict risk of MCI. Baseline demographic and clinical variables from participants (aged 70 to 89 years at baseline in October 2004) in a longitudinal cohort were used to inform the risk models.
The researchers found that 401 of the 1,449 cognitively normal participants developed MCI (27.7 percent). An augmented model improved the C statistic of the basic model from 0.60 (0.58 for women and 0.62 for men) to 0.70 (0.69 for women and 0.71 for men). In the augmented model, the highest versus lowest sex-specific quartiles had an approximately seven-fold higher risk of developing MCI for both men and women. Inclusion of APOE ε4 carrier status significantly improved the model (P = 0.002).
"These models may be useful in identifying patients who might benefit from more expensive or invasive diagnostic testing, and can inform clinical trial design," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
