Alzheimer’s Disease as a Model for Palliative Care

By Claudia Burlá, MD, PhD

Dementia is a model disease for palliative care, which should begin at the time of diagnosis.

Worldwide, the age group increasing the most is that of people aged 60 and over, which is growing at a rate of 3% a year and currently accounts for 13% of the world’s population1.

As populations age, the pattern of diseases that people suffer from and die of also changes. Increasingly, more people die as a result of serious chronic and degenerative conditions than from acute diseases. A typical condition for which age is a risk factor is dementia. Dementia is a syndrome, usually of a chronic and progressive nature, caused by a variety of brain illnesses that affect memory, thinking, behavior, and the ability to perform everyday activities. Therefore, dementia is one of the major causes of disability and dependency among older persons worldwide, posing an increasingly heavy burden on family members and caregivers throughout the course of the disease until the death of the patient.

A major achievement of humankind has been the increase of life expectancy. Advances in medical technology, improvement of living conditions, and greater access to health care services (such as vaccination) have resulted in a change from high fertility and high mortality rates to one of low fertility and low mortality. It is the triumph of life over time.

1 new case diagnosed every 3 seconds

Over time, the pattern of diseases that people suffer from and die of also changes. Nearly 10 million people develop dementia each year (an average of one new case every three seconds)2,4. The number of people currently living with dementia worldwide is estimated at 50 million; Alzheimer’s disease is the most common form of dementia, accounting for approximately 60% to 70% of cases4.

A major cause of global deathsRisk factors for the development of dementia include ageing, midlife hypertension, poor formal education, diabetes mellitus, tobacco use, physical inactivity, obesity, unbalanced diets, excessive use of alcohol, mid-life depression, social isolation, and cognitive inactivity.

Dementia rose swiftly to become the fifth leading cause of global mortality in 2016, more than doubling since 20003.

According to the 2018 IAHPC definition of palliative care, palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers, and addresses the need to provide support to the family and the caregivers during the patient’s illness, and in their own bereavement.

PC as part of the continuum of care

Palliative care should be applied as a continuum, in step with other treatments pertaining to the case, based on the diagnosis of an incurable and progressive illness. Considering that dementia is incurable from the time of diagnosis, albeit available therapies aimed at slowing the rate of progression — it may take years until death — and managing related symptoms, it is a model disease for palliative care, which should begin at the time of diagnosis. Palliative care is, indeed, the necessary therapeutic approach to persons with dementia evolving towards the end of life.

References

1. United Nations, Department of Economic and Social Affairs, Population Division. 2017. World Population Ageing 2017 (ST/ESA/SER.A/408).
2. Alzheimer’s Disease International (ADI). London, 2018. World Alzheimer Report 2018. Accessed online on March 17, 2019.
3. World Health Organization. Fact Sheet, May 2018. The Top 10 Causes of Death.
4. World Health Organization. December 2017. Dementia: Key Facts.

Too much of a good thing? High doses of vitamin D can lead to kidney failure

by Canadian Medical Association Journal

Credit: CC0 Public Domain

A case study in CMAJ highlights the dangers of taking too much vitamin D.

09 april 2019--A 54-year-old man, after returning from a trip to Southeast Asia where he spent much of his holiday sunbathing, showed increased levels of creatinine, suggesting kidney damage or malfunction. After referral to a kidney specialist and further testing, it was discovered that he had been prescribed high doses of vitamin D by a naturopath, who recommended a dose of 8 drops every day. Over 2 ½ years, the patient, who did not have a history of bone loss or vitamin D deficiency, took 8-12 drops of vitamin D daily, totalling 8000-12 000 IU. As a result, he had very high levels of calcium in the blood, which left him with significant kidney damage.

"Although vitamin D toxicity is rare owing to a large therapeutic range, its widespread availability in various over-the-counter formulations may pose a substantial risk to uninformed patients," writes Dr. Bourne Auguste, a Clinical Fellow in Home Dialysis at Toronto General Hospital and the University of Toronto.

The recommended daily allowance is 400-1000 IU, with 800-2000 IU recommended for adults at high-risk of osteoporosis and for older adults.

"Our experience informs us that patients and clinicians should be better informed about the risks regarding the unfettered use of vitamin D. Given new findings from the US Preventive Services Task Force, current Canadian guidelines regarding its use in low-risk individuals should be revisited," the authors suggest.

"Use of vitamin D drops leading to kidney failure in a 54-year-old man" is published April 8, 2019.

More information: CMAJ (2019). www.cmaj.ca/lookup/doi/10.1503/cmaj.180465

Provided by Canadian Medical Association Journal 

Ageism linked to poorer health in older people in England

by Lancet

Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal. Despite the known prevalence of age discrimination and existing evidence that other forms of discrimination, like racism, are linked to poorer health, this is the first study to examine the association between ageism and health and wellbeing.

06 april 2019--Considering the demographic changes underway in high-income countries and the steadily increasing population of older people in the UK, these findings highlight the vital need to tackle ageism to improve the health and wellbeing of people as they age.

1,943 of 7,731 (25%) over 50-year olds surveyed experienced age discrimination. Those who reported age discrimination were more likely to rate their health as fair or poor compared to those who had not reported it (29% versus 24%).

Certain serious health problems were also more common among those who reported age discrimination compared to those who had not—including heart disease (17% versus 13%), chronic lung conditions (7% versus 5%), limiting longstanding illnesses (39% versus 33%), and depressive symptoms (19% versus 12%).

In addition to worse reports of their existing health, participants who reported age discrimination were more likely to develop a serious health problem during the study's six-year study period compared to those who did not report age discrimination—including higher rates of diabetes (6% versus 5%), heart disease (4% versus 3%), stroke (5% versus 3%), chronic lung disease (5% versus 3%), a limiting longstanding illness (26% versus 21%), or depressive symptoms (10% versus 7%).

The authors note that the follow-up data was only available for 5,595 of the 7,731 participants included in the original analyses. Participants who dropped out in the intervening six years tended to be older and less affluent, which may have led to conservative numbers of newly developed conditions.

Notably, 45% (883/1,943) of participants who reported age discrimination also reported discrimination based on other personal characteristics (eg. sex, physical disability) and the negative health effects were most pronounced in this group. The authors therefore stress that other factors, like socioeconomic status and disability, may intersect with and compound experiences of age discrimination.

Advocating for an approach that aims to tackle discriminatory behaviours in society and mitigate the effects of discrimination of older people, study author, Dr. Sarah Jackson from University College London, UK, says: "As a society, we need to increase public awareness of what constitutes ageism and how it can affect health and wellbeing so we can build collective movements, like those that brought about legislative and social change for other forms of discrimination. On a clinical level, raising the issue of age discrimination with older patients could help to identify those at risk of future health problems."

The research was conducted using data from the English Longitudinal Study of Ageing, a nationally representative sample of over 50-year olds. Participants reported experiences of age discrimination and rated their own health via self-completed questionnaires and face-to-face computer-assisted personal interviews in 2010-11. Follow-up questionnaires and interviews collected data on participants' health after a six-year period to record any health conditions they had developed since.

There are some limitations to the study. Age discrimination was self-reported so is subject to recall bias and reflects the participants own perceptions, rather than the act of discrimination itself. To minimise bias, participants were asked about a range of types of discrimination (not only age discrimination). Health conditions were also self-reported.

The authors discuss several possible ways that ageism could negatively impact health. Firstly, previous studies have shown that exposure to age discrimination can provoke stress responses harmful to both mental wellbeing and physical health. Secondly, people may use unhealthy behaviours, like smoking, drinking, poor diet or physical inactivity, to cope with experiences of age discrimination.

Thirdly, they suggest that age discrimination in healthcare could mean that older patients are not receiving the same standard of care as their younger counterparts. 41% (804/1,943) of those who reported experiencing age discrimination specified has said that they "receive poorer service or treatment than other people from doctors or hospitals" and the authors point out that age-related biases in recommended treatments are common. For example, older patients with cancer are less likely to receive treatments that aim to cure the disease and older people are rarely included in clinical trials for drugs to treat heart disease.

Finally, the authors highlight the lack of existing research into ageism and health, despite an established body of evidence that examines other forms of discrimination as social determinants of health and wellbeing. In light of this, they call for more research into how ageism operates to inform interventions and policies to tackle it.

Writing in a linked Comment, Professor Martin Gulliford, King's College London, UK, says: "The public health community has been slow to acknowledge the central role of discrimination in health inequality... Although the interrelationships between age, socioeconomic status, health status and experienced discrimination are complex, these findings suggest that not only does age discrimination cause short-term psychological distress to older people, but could also have an important effect on their long-term mental and physical health."

More information: Sarah E Jackson et al. Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing, The Lancet Public Health (2019). DOI: 10.1016/S2468-2667(19)30035-0

Provided by Lancet 

Global life expectancy up 5.5 years since 2000: WHO

Credit: CC0 Public Domain

Global life expectancy grew by 5.5 years between 2000 and 2016, the World Health Organization said Thursday, warning though that unequal income and access to healthcare translates into far shorter lives for many.

05 april 2019--The UN health agency also stressed significant gender differences in life expectancy worldwide.

On average, a child born in 2016 can expect to live 72 years, up from 66.5 in 2000, according to the annual World Health Statistics report.

The first 16 years of the century saw dramatic drops in deaths among children under five, especially in sub-Saharan Africa, where progress has been made against malaria, measles and other communicable diseases, WHO said.

Life expectancy has also increased thanks to advances against HIV/AIDS, which ravaged much of Africa in the 1990s.

But despite progress in poorer countries, WHO said there remained significant life expectancy gaps between developed and developing nations.

People in low-income countries live 18 fewer years on average than those in high-income nations, statistics showed.

In Lesotho, for instance, people on average live to be just 52, or 53 in the Central African Republic 53 years of age, compared to over 83 for Switzerland and over 84 in Japan.

While most people who die in rich countries are old, nearly one in three deaths in poorer countries are children under five, WHO said.

'Shocking differences'

For the first time, WHO broke down its global health statistics by sex, clearly showing that females have better longevity prospects than males.

At birth, babies are more likely to be male than female, with some 73 million boys expected to be born this year, compared to 68 million girls, WHO said.

But due to greater biological frailty and riskier behaviours, mortality rates tend to be higher among boys and men, and the ratio shifts as the population ages.

At a global scale, girls born in 2016 are expected to live to the age of 74.2, while and boys on average will make it to 69.8 years, the report showed.

One reason why women appear to live longer is that they tend to be better about using available healthcare.

In countries facing HIV epidemics, for instance, women are far more likely to take HIV tests and access antiretroviral therapies than their male counterparts. Female TB patients are also more likely to seek treatment, WHO said.

It is therefore perhaps not surprising that the gap between men's and women's life expectancy is narrowest in places where women lack access to health services.

In low-income countries with scarcer services, one in 41 women die from maternal causes, compared to one in 3,300 women in high-income countries.

These are "shocking differences", WHO's head of data and analytics, Samira Asma, told reporters.

Overall, the statistics showed that life expectancy has risen in most countries, including significant jumps in places like Eritrea, where people on average are now expected to live 22 years longer than the 43 years predicted in 2000.

In Syria, meanwhile, which has been ravaged by eight years of conflict, life expectancy dropped by a decade, from 73 years in 2000 to 63.8 years in 2016.

People in the United States have meanwhile seen their life expectancy slip from 79 years in 2014 to 78.5 years two years later, the WHO numbers showed.

Asma said the drop was in part driven by the obesity epidemic.

Three easy measures to predict metabolic syndrome in elderly

by Mary Ann Liebert, Inc

Credit: Mary Ann Liebert, Inc., publishers

A new study found a surprisingly high rate of metabolic syndrome among individuals aged 60-100 years. Three easy-to-measure anthropometric indicators were predictive of metabolic syndrome in both men and women and could be useful for indicating the need for preventive care and further testing, according to the findings published in Metabolic Syndrome and Related Disorders.

04 april 2019--The article, which evaluated nearly 500 elderly individuals, is entitled "Performance of Anthropometric Indicators in the Prediction of Metabolic Syndrome in the Elderly" and was coauthored by Carla Helena Augustin Schwanke, MD, Ph.D. and colleagues from Pontifical Catholic University of Rio Grande do Sul, Brazil. About 60% of the study participants had metabolic syndrome. The researchers assessed the predictive value of five anthropometric measures in men and women, which included waist diameter (from front to back), waist diameter/height, neck circumference, and indices comprised of a combination of weight, height, and waist circumference. All of these measures are easy to obtain in a primary care physicians office.

"This study reinforces the importance of simple clinical observation and measurement in the effort to recognize and treat metabolic disease associated with obesity," says Dr. Adrian Vella, MD, FRCP (Edin.) Editor-in-Chief of Metabolic Syndrome and Related Disorders and Professor, Mayo Clinic College of Medicine, Rochester, MN.

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More information: Jamile Ceolin et al, Performance of Anthropometric Indicators in the Prediction of Metabolic Syndrome in the Elderly, Metabolic Syndrome and Related Disorders (2019). DOI: 10.1089/met.2018.0113

Provided by Mary Ann Liebert, Inc 

Sexual satisfaction among older people about more than just health

by University of Glasgow

Communication and being in a happy relationship, along with health, are important for sexual satisfaction among older people, according to new research published in PLOS ONE.

02 april 2019--Sexual expression is increasingly recognised as important throughout the life course, in maintaining relationships, promoting self-esteem and contributing to health and well-being. Although health care professionalsare being urged to be more proactive in helping older patients achieve a satisfying sex life, there is a distinct lack of evidence to help guide practitioners.

Led by the London School of Hygiene & Tropical Medicine (LSHTM), the University of Glasgow and UCL, the study is one of the first to look at how health, lifestyle and relationship factors can affect sexual activity and satisfaction in later life, and examine how people respond and deal with the consequences.

The researchers carried out a mixed methods study combining survey data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) and in-depth interviews with older men and women. Out of nearly 3,500 people aged between 55-74, the survey found that one in four men and one in six women reported having a health problem that affected their sex life. Among this group, women were less likely than men to be sexually active in the previous six months (54 percent vs 62 percent) but just as likely to be satisfied with their sex life (42 percent vs 42 percent).

Follow up interviews with a sample of participants revealed that older people found it difficult to separate the effects of declining health from those of increasing age. Ill health impacted sexual activity in many ways but most crucially it influenced whether individuals had a partner with whom to have sex. Some older people were more accepting of not having a sex life than others.

For those in a relationship, sexual satisfaction was strongly associated with both the quality of communication with their partner and contentment with their relationship. The impact of health issues was not always negative; some men and women found themselves having to experiment with new ways of being sexually active and their sex lives improved as a result.

Natsal-3 is the largest scientific study of sexual health and lifestyles in Britain. Conducted by LSHTM, UCL and NatCen Social Research, the studies have been carried out every 10 years since 1990, and have involved interviews with more than 45,000 people to date.

Bob Erens, lead author and Associate Professor at LSHTM, said: "Looking at the impact of health on sexual activity and satisfaction as we age is important, however few studies have examined the relationship between the two.

"Health can affect an individual's sex life in various ways, from having or finding a partner, to physical and psychological limitations on sexual expression.

"We identified that not many people who reported experiencing problems or lack of satisfaction sought help. Although this could be an individual choice or because of a perceived lack of support, it is vital that individuals feel able to make enquiries with health care professionals. In particular, discussing problems can often lead to identification of underlying medical conditions."

Although some individuals the research team spoke to were not affected by not being sexually active, it seemed to be important that health professionals make sensitive enquiries for patients who might want to access help, which can lead to significant improvements in their wellbeing and quality of life.

Kirstin Mitchell, co-author and Senior Research Fellow in Social Relationships and Health Improvement at the University of Glasgow, said: "We're seeing numerous, interconnected factors influencing sexual activity in older people. Not being in good health can influence mood, mobility and whether a person has a partner, which in turn impact on sexual activity. Medication taken for health conditions often compounds the problem.

"The study findings suggest that pharmacological approaches, like Viagra, do not always help to resolve sexual difficulties, which need to be seen in the wider context of older people's lives."

The authors acknowledge the limitations of the study, including that Natsal had an upper age limit of 74 years, and so the study is unable to describe the sexual health and wellbeing of people at older ages.

Natsal-3 is the largest and most comprehensive study of sexual attitudes and lifestyles in the world, and is a major source of data informing sexual and reproductive health policy in Britain.

More information: Bob Erens et al. Health status, sexual activity and satisfaction among older people in Britain: A mixed methods study, PLOS ONE (2019). DOI: 10.1371/journal.pone.0213835

Journal information: PLoS ONE 

Provided by University of Glasgow 

Trips to the toilet at night are a sign of high blood pressure

by European Society of Cardiology

Credit: CC0 Public Domain

Trips to the toilet at night are a sign of high blood pressure, according to results from the Watari study presented today at the 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS 2019).

31 mar 2019--"Our study indicates that if you need to urinate in the night—called nocturia—you may have elevated blood pressure and/or excess fluid in your body," said study author Dr. Satoshi Konno, of the Division of Hypertension, Tohoku Rosai Hospital, Sendai, Japan. "If you continue to have nocturia, ask your doctor to check your bloodpressure and salt intake."

JCS 2019 takes place from 29 to 31 March in Yokohama. Joint scientific sessions are being held by the European Society of Cardiology (ESC) and JCS as part of the ESC Global Activities programme.

Previous research from Japan has reported that high salt intake is associated with nocturia. Compared to western countries, people in Japan eat more salt and are more likely to be "salt sensitive", meaning that their blood pressure rises more when salt is consumed. Taken together, these two factors mean that people in Japan are at greater risk of developing high blood pressure.

This study examined the link between nocturia and hypertension in the general Japanese population. The study enrolled 3,749 residents of Watari who had an annual health check in 2017. Blood pressure was measured and information on nocturia was obtained by questionnaire. Participants with blood pressure 140/90 mmHg or higher or prescribed antihypertensive drugs were considered hypertensive.

Nocturia (one or more nocturia events per night) was significantly associated with hypertension after controlling for possible confounders

Of the 1,882 participants who answered the questionnaire, 1,295 (69%) had nocturia. Dr. Konno said the results do not prove a causal relationship between nocturia and hypertension and may not apply to populations outside Japan. He said: "The relationship may be influenced by various factors including lifestyle, salt intake, ethnicity, and genetic background."

Dr. Mutsuo Harada, press coordinator for JCS 2019, said: "Hypertension is a national disease in Japan. The average salt intake in Japan is approximately 10 g/day, which is more than double the average salt intake worldwide (4 g/day). This excessive salt intake is related to our preference for seafood and soy sauce-based food, so salt restriction is difficult to carry out. Early detection and management of hypertension are very important to prevent cardiovascular diseases. We should keep in mind that nocturia is not only caused by urinary organ problems but also by systemic diseases such as hypertension."

ESC President Professor Barbara Casadei said: "More than one billion people have high blood pressure worldwide. High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015. ESC guidelines recommend medication to reduce the risk of stroke and heart disease.3 A healthy lifestyle is also advised, including salt restriction, alcohol moderation, healthy eating, regular exercise, weight control, and smoking cessation."

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More information: Tomohiro Matsuo et al. Daily salt intake is an independent risk factor for pollakiuria and nocturia, International Journal of Urology (2017). DOI: 10.1111/iju.13321

Bryan Williams et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension, European Heart Journal (2018). DOI: 10.1093/eurheartj/ehy339

Journal information: European Heart Journal

Provided by European Society of Cardiology

The first complete mapping of cerebral functional lateralisation

by CNRS

Cerebral functional lateralisation represented in a 4-dimensional space along the symbolic communication axis (green), the perception/action axis (cyan), the emotions axis (pink) and the decision-making axis (yellow). Credit: Karoliset al./Nature Communications

Some cerebral processes preferably occur in the brain's right or left hemisphere. But which functions and which side? A Franco-Italian research team directed by a CNRS researcher from the Institut du Cerveau et de la Moelle Epinière (AP-HP/CNRS/INSERM/Sorbonne Université) has just answered this question by delivering the first complete mapping of cerebral functional lateralisation, published on 29 March 2019 in Nature Communications. Their results show for the very first time that as well as perception, action and emotions, decision-making uses the right half of the brain more. On the other hand, symbolic communication uses the left half of the brain more.

29 mar 2019--That was until the recent research by Michel Thiebaut de Schotten, a CNRS researcher at the Institut du Cerveau et de la Moelle Epinière (AP-HP/CNRS/INSERM/Sorbonne Université), and his colleagues at the University of Padua, Italy. Using functional MRI data collected worldwide for more than 15 years, they have produced the first global map of cerebral function lateralisation.In 1865, French physician Paul Broca noted that among patients with brain damage, only those with the left frontal lobe affected had speech difficulties. This is the first time that functional asymmetry has been observed between the two hemispheres. Much research followed to try to identify the "dominant" hemisphere for various brain functions, but without global investigation of lateralisation.

The researchers have identified four groups of extremely lateralised functions using common cerebral regions: symbolic communication (where we find language, reading and calculation, for example) very much on the left; the perception/action and emotions groups on the right and decision-making, which is in the right frontal lobe area. The last point is completely innovative. No team had previously described asymmetry between hemispheres for decision-making.

In addition, this study answered a problematic question on connections between hemispheres: are the very lateralised regions not substantially connected with the other hemisphere so that information is processed faster, or on the contrary are they very connected so that they influence and dominate the opposite hemisphere in some cases? The researchers' map shows that the more lateralised the function, the less it establishes connections with the other hemisphere, so validating the hypothesis that to be more efficient, a function's dominant hemisphere is not highly connected with the other side.

This discovery also validates the idea that brain functions became lateralised as the brain got larger, to optimise information processing. This optimisation occurred at the expense of another evolutionary advantage though: functional recovery after brain damage. Because of reduced connections between hemispheres, it is harder for the undamaged hemisphere to compensate for the lost functions.

The researchers will now continue this work by studying variations in function lateralisation between individuals and testing for example whether high lateralisation for a function in one person causes different lateralisation for other functions.

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More information: Vyacheslav R. Karolis et al. The architecture of functional lateralisation and its relationship to callosal connectivity in the human brain, Nature Communications (2019). DOI: 10.1038/s41467-019-09344-1

Journal information: Nature Communications

Alzheimer's disease: have we got the cause all wrong?

by Vicky Jones, The Conversation

Credit: Fer Gregory/Shutterstock

Early in the 20th century, Alois Alzheimer first described a disorder of progressive memory loss and confusion in a 50-year-old woman. After she died, he examined her brain and saw that it was full of unusual protein clumps, known as plaques. Over a century later, we know that these plaques are full of a protein called beta-amyloid and are a hallmark of the disease that bears Alzheimer's name. While other features of Alzheimer's disease have been discovered, the theory that beta-amyloid is the main cause of this incurable disease has dominated.

28 mar 2019--There are many subtle variations of the "beta-amyloid hypothesis", but generally the theory goes that beta-amyloid accumulates in the brain, then clumps together. Somewhere in this process, nerve cells in the brain become damaged, which leads to memory loss and other symptoms of Alzheimer's disease. So the approach to treating this should be rather straightforward: stop the clumping and you will halt the disease.

Unfortunately, decades of research, many millions of dollars of investment and many failed clinical trials later, it appears that this approach is not working. The most recent plaque-busting treatment to produce disappointing results has been aducanumab – an antibody-based therapy designed to stick to and destroy beta-amyloid.

Initial data suggested that the treatment did, indeed, clear beta-amyloid from the brain. But this week, Biogen and Esai, the drug companies behind aducanumab, ended clinical trials involving thousands of patients early, stating that the "trials were unlikely to meet their primary endpoint upon completion".

This has led many to ask whether the amyloid hypothesis of Alzheimer's disease should be abandoned. In reality, few neuroscientists still subscribe to the view that it is the beta-amyloid plaques themselves that cause the symptoms of Alzheimer's disease.

Studies with mice that mimic human Alzheimer's disease have shown that memory loss occurs before plaques form in the brain. Other studies have suggested that it is the smaller fragments ("oligomers") of beta-amyloid that are really toxic to nerve cells. And it has even been suggested that the formation of plaques is a way for the brain to round-up all these dangerous oligomers into one place for safety.

It's very hard to tell without the full information from the aducanumab trial, but maybe the disease had progressed too far in the participants for the treatment to be effective. Perhaps the small beta-amyloid oligomers had already done their damage, setting the disease in motion before the participants were even recruited to the trial.

Amyloid-beta plaques (yellow) clumping around brain cells (blue). Credit: Juan Gaertner/Shuterstock

Alzheimer's disease vs Alzheimer's dementia

At a recent Alzheimer's Research UK Conference, there was near universal agreement that it's time to separate the concept of Alzheimer's disease from the menace of dementia.

Alzheimer's disease is defined as the build up of beta-amyloid plaques and tangles of another protein, tau, combined with some mild memory changes. Dementia is a symptom of this disease. Advances in brain imaging mean that doctors can now spot these indicators of Alzheimer's disease much earlier (up to 25 years before dementia symptoms set in). An astonishingly under-reported fact is that progression to dementia is not a given. Not all people who show these clinical signs of Alzheimer's disease will progress to dementia in their lifetimes.

We are only beginning to study the reasons that some people with Alzheimer's disease avoid Alzheimer's dementia. Age is the single biggest risk factor for this progression; the younger you are when beta-amyloid starts to build up in the brain, the more likely you are to suffer from dementia. Diet, education and head injuriesmay also play a role in this process, but to what extent we do not know.

Another major factor we are only just beginning to understand is genetics. Small variations in our genes seem to influence not only whether we will get a build up of beta-amyloid in the brain, but whether that accumulation leads to dementia symptoms.

The process of finding these so-called "risk genes", however, is slow. Progress has mostly come from "big data" studies that track tiny changes in the two billion odd DNA bases of the human genome across tens of thousands of individuals and try to find patterns between these changes and rates of Alzheimer's.

There are around 30 areas of the human genome that have been linked to the risk of developing Alzheimer's dementia, although there are certainly more to be discovered.

Aducanumab: right treatment, wrong time?

As with treatments for many other human diseases, it might be that treatments such as aducanumab might only be effective if they are given early enough, before the disease has caused irreversible changes. A better understanding of the environmental and genetic factors behind Alzheimer's disease combined with ever more sensitive brain imaging techniques will help doctors identify warning signs even earlier, before even minor memory loss occurs.

While screening and diagnosing people – before symptoms have set in – for an as-yet incurable disease, raises many ethical dilemmas, it might present a fresh window of opportunity to retest beta-amyloid drugs, such as aducanumab. Ultimately, we need to focus our research on understanding the early stages of the disease so that we can prevent Alzheimer's disease before dementia takes hold.

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Provided by The Conversation

Older people are more digitally savvy, but aged care providers need to keep up

by Dr. Wendy Wrapson, The Conversation

Moving into aged care can affect a person’s ability to remain connected to their local community, but most aged care facilities don’t provide access to digital devices. Credit: www.shutterstock.com, CC BY-SA

Older adults are more digitally connected than ever, even though their uptake of internet-based technologies remains lower than for younger age groups.

27 mar 2019--Today's senior citizens are likely to spend their spare time tweeting about their social lives and Facetiming their grand kids. This is good news because research shows that social interactions benefit us.

The drive to join the digital community is no doubt influenced by social media becoming an important platform for news and information, sharing experiences and connecting with friends and family. Nevertheless, age-related gaps in digital engagement ("the digital divide") still exist.

As our research shows, people who live in aged care environments are at risk of being excluded from the digital world.

A digital community

Moving into aged care can affect a person's ability to remain connected to their local community. The facility might be some distance away from the neighbourhood in which they have lived. They may be unable to travel to maintain relationships.

Low levels of social connectedness and participation are related to poor health and higher mortality risks, as well as a significant reduction in quality of life. Family can provide an important source of social contact and support but geographic distance can again make frequent visits difficult.

Digital engagement in later life might not always be desired or possible. But access to online resources can enhance older adults' well-being through improved access to information and more frequent social interactions.

The social internet

An early study reported psychosocial benefits from providing computer training in internet use for aged care residents. These include improvements in life satisfaction and lower levels of depression and loneliness. In another study, a once weekly video conference with a family member had a positive impact on loneliness and perceived social support.

But there is little information on informal and unstructured use of the internet by residents because the use of digital technologies in aged care remains largely invisible. Residents are omitted from many surveys and reports.

In a recent Swiss study, where all residents in a facility were offered wi-fi access, 14% used the internet. This percentage is similar in that age group living in the community.

Staying connected

We conducted telephone interviews with over 70 members of the public who had a family member or friend living in residential aged care. We spoke to family and friends rather than seniors because we wanted to hear about residents who had physical and mental challenges, as well as healthy seniors who tend to volunteer for research. To reduce the risk of bias, we did not mention in our study advertising that we wished to talk to people about technology use.

Our research highlighted the enthusiasm with which many older people have adopted digital technologies. Nearly half of the 80 residents spoken about owned a computer or a smartphone. The average age of residents was 86 years, and the oldest was 102. Sometimes the family had purchased a device for the resident, specifically to make communication easier.

Mobile phone calls, texts and emails were the most common methods of communication using these devices. Technology not only enabled residents to interact with family and friends they seldom saw (for example, those overseas) but also resulted in increased interactions with people who visited more often. While dementia and other serious health issues reduced the likelihood of uptake, the frequency of personal visits was not affected by technology use.

Family help

Importantly, family members were essential to residents' digital connectedness. They often bought the device, set up software and troubleshooted any technical problems. They were also involved in the day-to-day use of technology. For example, some residents used video conferencing, but needed assistance to initiate the call.

Interviewees endorsed the use of digital devices if they were used to supplement social contact, rather than supplanting it. The majority reported that they were not aware of computers being available for residents in common areas of the facility they visited.

Aged care operators do not generally provide wi-fi access to residents. They have to arrange this with their own internet provider. These deficits are of concern because residents don't always have family or friends to help them become digitally connected.

Devices were also often criticised for their small keys and buttons which are difficult to manage for arthritic hands and by people with vision impairments. Older users, it seems, must try to adapt their abilities to devices that have been designed for younger people.

Senior citizens are an important consumer group which is only going to increase in number in the future. The time has come for aged care operators and the technology industry to engage in meaningful efforts to meet their needs.

Provided by The Conversation

'Technoference': We're more tired and less productive because of our phones

by Queensland University of Technology

Credit: CC0 Public Domain

One in five women and one in eight men are now losing sleep due to the time they spend on their mobile phones, according to new QUT-led research that has found a jump in 'technoference' over the past 13 years.

26 mar 2019--Researchers surveyed 709 mobile phone users across Australia aged 18 to 83 in 2018, using questions replicated from a similar survey back in 2005.

They then compared the findings and discovered significant increases in people blaming their phones for losing sleep, becoming less productive, taking more risks while driving and even getting more aches and pains.

Study leader Dr. Oscar Oviedo-Trespalacios from QUT's Centre for Accident Research and Road Safety—Queensland (CARRS-Q) said the survey results showed 24 per cent of women and 15 per cent of men could now be classified as "problematic mobile phone users".

For 18 to 24 year-olds, the figure jumps to 40.9 per cent, with 23.5 per cent of respondents aged 25 to 29 also suffering technoference.

Participants were also asked about their driving habits, with researchers finding a correlation between problem phone use off the road and on the road.

Key findings of the 2018 national survey include:

• One in five women (19.5 per cent) and one in eight men (11.8 per cent) now lose sleep due to the time they spend on their mobile phone (vs 2.3 per cent of women and 3.2 per cent of men in 2005).
• 12.6 per cent of men say their productivity has decreased as a direct result of the time they spend on their mobile – compared to none in 2005 – and 14 per cent of women have also noticed a productivity decline (2.3 per cent in 2005).
• 14 per cent of women try to hide the amount of time they spend on the phone (3 per cent in 2005), as do 8.2 per cent of men (3.2 per cent in 2005)
• 54.9 per cent of women believe their friends will find it hard to get in touch with them if they don't have a mobile (up from 28.8 per cent), and 41.6 per cent of men thought this (almost identical to 41.9 in 2005).
• 8.4 per cent of women (up from 3 per cent) and 7.9 per cent of men (up from 1.6 per cent) have aches and pains they attribute to mobile phone use   
• 25.9 per cent of women (up from 3.8) and 15.9 per cent of men (up from 6.5) say there are times when they would rather use their mobile phone than deal with more pressing issues. For 18 to 25 year-olds, this figure was 51.4 per cent (up from 10.5).

Dr. Oviedo-Trespalacios said the survey had uncovered an interesting pattern of "technoference".

"When we talk about technoference we're referring to the everyday intrusions and interruptions that people experience due to mobile phones and their usage," he said.

"Our survey found technoference had increased among men and women, across all ages.

"For example, self-reports relating to loss of sleep and productivity showed that these negative outcomes had significantly increased during the last 13 years.

"This finding suggests that mobile phones are potentially increasingly affecting aspects of daytime functioning due to lack of sleep and increasing dereliction of responsibilities."

But on the positive side, less people reported they had received phone bills they could not afford to pay. And, perhaps surprisingly, the number of people who found it difficult to switch off their phone remained fairly constant across the 13-year time span.

Dr. Oviedo-Trespalacios said the survey results also indicated that phones were being used as a coping strategy, with one in four women and one in six men saying they'd rather use their phone than deal with more pressing issues.

He said Australia had one of the highest smartphone penetration rates in the world, with about 88 per cent of adults now owning a smartphone. Globally, the world is expected to pass 2.5 billion smartphone users this year.

"The speed and depth of smartphone take-up in Australia makes our population particularly vulnerable to some of the negative consequences of high mobile phone use," he said.

"Rapid technological innovations over the past few years have led to dramatic changes in today's mobile phone technology—which can improve the quality of life for phone users but also result in some negative outcomes.

"These include anxiety and, in some cases, engagement in unsafe behaviours with serious health and safety implications such as mobile phone distracted driving."

The paper on the study, Problematic Use of Mobile Phones in Australia…is it Getting Worse?, has been published in Frontiers in Psychiatry.

More information: Oscar Oviedo-Trespalacios et al, Problematic Use of Mobile Phones in Australia…Is It Getting Worse?, Frontiers in Psychiatry (2019). DOI: 10.3389/fpsyt.2019.00105

Provided by Queensland University of Technology