Gerontologist Offers Suggestions for Families Coping with Dementia

Newswise, December 18, 2015— The holidays can be especially disquieting when a family member, such as Grandma or Grandpa who has always been the center of the family, is suffering from dementia. A Kansas State University gerontologist suggests ways to help the family cope and include Grandma in the celebration.

It is important that families communicate with one another ahead of time and inform each other, especially those family members who live farther away, about Grandma's current condition, advised Laci Cornelison, instructor with Kansas State University's Center on Aging, a part of the College of Human Ecology.

This will help reduce surprise about Grandma's condition and reduce the more intense emotional reactions that may come with it. Then arm all loved ones with information and knowledge about positive ways to interact with Grandma, Cornelison said.

She offered specific suggestions:

• Be in the moment. Avoid trying to get Grandma to remember things. For example: "This is my boyfriend, Todd, you remember him, don't you Grandma?" Avoid focusing on details, dates and names.

• Keep festivities in a familiar place. Research shows that new environments can make symptoms of dementia worse and escalate anxiety.

• Involve Grandma in the event. Avoid developing the attitude "Grandma can't do it anymore so we'll have to take over." Don't take over but instead help fill in the gaps.

• Talk to the kids. If you have children, discuss with them what is going on with Grandma and address any fears they have about Grandma's illness. Cornelison recommends the following video on ways to start conversations with kids, http://www.hbo.com/alzheimers/grandpa-do-you-know-who-i-am.html.

• Find a quiet space. Research shows that lots of stimulation can be difficult for people with dementia. If Grandma becomes anxious, bring her to a quieter space and do something that is familiar to her. For example, if Grandma likes to read, read to her.

• Be aware of emotions and body language used around Grandma. They can significantly impact her behavior throughout the celebration. Research finds that elders with dementia continue to be extremely responsive to emotion. If you are chaotic and stressed, Grandma will pick up on this and become chaotic and stressed. If you are calm and content, Grandma will pick on those emotions, too.

• Lastly, remember that memory making doesn't stop for you even though Grandma's memory is declining, Cornelison said. Continue to make good memories for you and your family to cherish.

Getting Forgetful with Age? Clinical Trial to Test Ways to Combat Mental Decline

Cognitive effects of exercise, stress reduction and education to be measured in seniors

Newswise, December 18, 2015 — Some decline in memory and cognitive function is a normal part of aging, but what if it could be prevented? Researchers at University of California, San Diego School of Medicine and Washington University in St. Louis have launched a major clinical trial to investigate whether mental decline in seniors can be slowed or halted through exercise and other health-related interventions.

Funded by the McKnight Brain Research Foundation and a $15 million grant from the National Institutes of Health, the trial will explore how Mindfulness Based Stress Reduction (MBSR), physical exercise and health education influence cognitive processes, such as attention and memory in older adults. 

Approximately 580 seniors in San Diego and St. Louis will be recruited for the trial.

“This will be one of the largest and most comprehensive studies of its kind,” said Julie Wetherell, PhD, co-principal investigator and professor in UC San Diego School of Medicine’s Department of Psychiatry. 

“Our overall goal is to find out how to improve memory and concentration in older people.”

The researchers note that the trial is timely given the rising numbers of elderly. Currently, 10,000 Baby Boomers turn 65 every day and in the next few decades the country’s population aged 65 and older will almost double, from 43 million in 2012 to nearly 84 million by 2050.

“As our society ages, we want to preserve cognitive function and enhance it if possible,” said Wetherell. 

“We know the brain is capable of growing new connections into old age. If we demonstrate that one, two or all three of these interventions work, it will be good news for older people who want to maintain and improve their cognitive abilities.”

Earlier research conducted by Wetherell and Washington University researchers suggests there is room for optimism. 

In two smaller studies looking at the effects of Mindfulness Based Stress Reduction and health education on cognitive function in the elderly, they found improvements in the participants’ memory and thinking, with the stress reduction group showing greater gains.

The current clinical trial will add exercise to the mix and will place participants into one of four groups. Three of the groups will test the interventions individually and a fourth group will test a combination of exercise plus Mindfulness Based Stress Reduction.

“We’ll be doing a huge battery of tests looking at memory and executive functions, such as planning and sequential switching between tasks,” said Wetherell. 

Participants will undergo baseline MRI brain scans and will be retested at intervals. The scans will assess brain size, neural activity and other standard measures of cognitive function.

“We’re also looking at certain physiological indicators, such as glucose tolerance,” said Wetherell. Impaired glucose tolerance, which plays havoc with blood sugar levels, can damage parts of the brain. 

In addition, diabetes is a known risk factor for vascular dementia.

Wetherell said levels of cortisol, a stress hormone, will also be tracked. “Elevated levels of cortisol have been shown to have a malign influence on the hippocampus and frontal lobes, which are areas associated with memory and executive function,” she said.

The researchers hope that the trial’s stress reduction, exercise and education measures will improve both physiological indicators and the brain. “We hope we’ll be able to tell a causal story showing that the trial’s interventions will lead to improvements in these risk factors and changes in actual brain function,” she said.

The trial is in its early stages and participants are sought. Qualifying individuals must be 65 to 84 years old and not currently engaged in regular physical activity, but healthy enough to start an exercise program. 

Excluded health conditions include diabetes, cardiac issues or dementia. Each participant’s involvement will last 18 months; the study will run over the next five years.

To learn more about the trial, call 858-534-8118, email medexstudy@ucsd.edu or view the study website at medexstudy.com

A Prescription to Improve Drug-Related Health Among Seniors

 A Concordia researcher is co-leading a research team that is developing guidelines to reduce medication use in the elderly

Newswise, December 14, 2015— We’re not getting any younger. According to the Administration for Community Living, by 2060, there will be about 98 million older persons in the United States — more than twice their number in 2013.

Advancing age leads to more medical problems. It’s not uncommon to see seniors suffering from a host of ailments — and using a range of drugs to deal with them. Seniors 65 years and older represent 13 percent of the population, but are responsible for over than one-third of total outpatient spending on prescription drugs in the United States.

While this “polypharmacy” approach might help cure some problems, it can often lead to others, such as an increased risk of falls, hospitalization, institutionalization and mortality.

A group of researchers — led by James Conklin, an associate professor in Concordia University’s Department of Applied Human Sciences, and by Barbara Farrell of the Bruyère Research Institute and Department of Family Medicine, University of Ottawa — is working to reverse the trend through a new project, "Deprescribing Guidelines for the Elderly."

Funded by the Government of Ontario through OPEN — Ontario Pharmacy Research Collaboration — the project aims to develop and evaluate guidelines to support health-care professionals in tapering or stopping medications in elderly patients, while monitoring for withdrawal reactions.

“Polypharmacy among the elderly is such a difficult problem in Canada, with significant impacts upon both quality of life and health-system costs. As life changes, medications that were once right for a person may no longer be the best choice for them,” says Conklin.

For the project, Conklin and his colleagues examined three commonly used classes of drugs:

1.      Proton pump inhibitors — they reduce acid production in the stomach, commonly used to treat heartburn.
2. Benzodiazepine receptor agonists — they cause sedation, commonly used for insomnia.
3. Antipsychotics — they cause sedation, commonly used for behavioural symptoms of dementia and sometimes for insomnia.

For each drug class, the team developed evidence-based guidelines along with decision-aid algorithms, which provide advice for primary care clinicians, and those who practice at long-term care facilities.

They use the algorithms to help reduce medications that may be causing problems or are no longer needed for their patients.

The researchers have implemented the algorithms in three Family Health Teams and three long-term care homes in eastern Ontario.

“My hope is that the guidelines and algorithms we develop will help improve the medication-related health of seniors,” says Conklin.

“Fewer medications taken mean fewer adverse drug reactions. At the same time, I hope that having set guidelines will help improve the confidence of clinicians in tapering or stopping medications, while supporting a cultural shift in health care toward reassessing medication use as people age.”

New Research Shows Gray Divorced Women Are More Likely to Be Poor

Newswise, December 14, 2015--More and more adults are entering their golden years alone, either through gray divorce, or by choosing to stay unmarried, and for older women, Social Security benefits often aren’t enough to stave off poverty.

Bowling Green State University sociologists Drs. I-Fen Lin and Susan Brown, along with Ph.D. student Anna Hammersmith, used data from the 2010 Health and Retirement Study (HRS) to look at a diverse range of marital biographies and examine three indicators of economic well-being: Social Security receipt, Social Security benefit levels, and poverty status. “Marital Biography, Social Security Receipt, and Poverty” is in press at the journal Research on Aging.

The researchers restricted the sample to HRS respondents and their spouses/partners who were age 63 and older in 2010 due to Social Security eligibility rules. In total, the analysis consisted of 9,649 individuals.

Lin and Brown found gray divorced women suffered the most economically, with a whopping 27 percent of them classified as poor. Just 11 percent of gray divorced men are in poverty. Never-married women also suffer economically in their later years, with 25 percent living in poverty.

“Gray divorced and never married women face considerable economic instability. Their Social Security benefits are typically low and their poverty rates are quite high, indicating Social Security alone is not sufficient to prevent them from falling into poverty. By comparison, those who were widowed late in life are the most advantaged singles,” said Brown.

Lin and Brown point out that prior research on economic well-being in later life did not take into account gray divorce, which is on the rise. “Those who divorce later have fewer years of working life remaining and may not be able to fully recover economically from a gray divorce. In fact, gray divorce appears to diminish wealth more than an earlier divorce,” according to Lin.

Couples who divorce can access Social Security spousal benefits provided they were married at least 10 years and do not remarry before age 60. But the share of divorced women who qualify for spousal benefits is projected to decline in the coming years. Recent studies show lowering this 10-year marriage rule by just a few years would substantially reduce poverty levels among low-income divorced women.

The researchers point out that Social Security was designed during an era when most elders were married, a scenario that is less common today and is likely to be even less typical in the future. In fact, the decline in marriage is linked to reduced spousal and survivor benefit eligibility for Social Security among women.

“Given the broader retreat from marriage, fewer older women may be eligible for spousal or survivor benefits, whether because they divorced less than 10 years into their marriage, they did not remarry, or they never married in the first place,” Brown noted.

There are also concerns about the expected rise in the number of adults experiencing gray divorce due to the aging of the population, which would result in a larger share of singles at risk for economic hardship.

“In short, more older Americans are economically insecure, without an adequate safety net to respond to major life events, such as the onset of disability or chronic disease, that can be financially devastating. Future research should address how marital biographies are linked to the health and well-being of older adults,” said Lin.

'Purpose in Life' Linked to Lower Mortality and Cardiovascular Risk

Newswise, December 8, 2015 — People who have a higher sense of purpose in life are at lower risk of death and cardiovascular disease, reports a pooled data analysis in Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published by Wolters Kluwer.

"Possessing a high sense of purpose in life is associated with a reduced risk for mortality and cardiovascular events," according to the study by Drs. Randy Cohen and Alan Rozanski and colleagues at Mt. Sinai St. Luke's-Roosevelt Hospital, New York. While the mechanisms behind the association remain unclear, the findings suggest that approaches to strengthening a sense of purpose might lead to improved health outcomes.

How Does Purpose in Life Affect Health and Mortality Risks?

Using a technique called meta-analysis, the researchers pooled data from previous studies evaluating the relationship between purpose in life and the risk of death or cardiovascular disease. 

The analysis included data on more than 136,000 participants from ten studies—mainly from the United States or Japan. The US studies evaluated a sense of purpose or meaning in life, or "usefulness to others." The Japanese studies assessed the concept of ikigai, translated as "a life worth living."

The study participants, average age 67 years, were followed up for an average of seven years. During this time, more than 14,500 participants died from any cause while more than 4,000 suffered cardiovascular events (heart attack, stroke, etc).

The analysis showed a lower risk of death for participants with a high sense of purpose in life. After adjusting for other factors, mortality was about one-fifth lower for participants reporting a strong sense of purpose, or ikigai.

A high sense of purpose in life was also related to a lower risk of cardiovascular events. 

Both associations remained significant on analysis of various subgroups, including country, how purpose in life was measured, and whether the studies included participants with pre-existing cardiovascular disease..

There is a well-documented link between "negative psychosocial risk factors" and adverse health outcomes, including heart attack, stroke, and overall mortality. "Conversely, more recent study provides evidence that positive psychosocial factors can promote healthy physiological functioning and greater longevity," according to the authors.

The new analysis assembles high-quality data from studies assessing the relationship between purpose life and various measures of health and adverse clinical outcomes. 

The researchers write, "Together, these findings indicate a robust relationship between purpose in life and mortality and/or adverse cardiovascular outcomes."

While further studies are needed to determine how purpose in life might promote health and deter disease, preliminary data suggest a few basic mechanisms. The association might be explained physiologically, such as by buffering of bodily responses to stress; or behaviorally, such as by a healthier lifestyle.

"Of note, having a strong sense of life purpose has long been postulated to be an important dimension of life, providing people with a sense of vitality motivation and resilience," Dr. Rozanski comments. 

"Nevertheless, the medical implications of living with a high or low sense of life purpose have only recently caught the attention of investigators. The current findings are important because they may open up new potential interventions for helping people to promote their health and sense of well-being."

Click here to read “Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis.”

Article: “Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis” (doi: 10.1097/PSY.0000000000000274)

About Psychosomatic Medicine
Psychosomatic Medicine, Journal of Biobehavioral Medicine, founded in 1939, is the official peer-reviewed journal of the American Psychosomatic Society. It publishes experimental and clinical studies dealing with various aspects of the relationships among social, psychological, and behavioral factors and bodily processes in humans and animals. Psychosomatic Medicine, Journal of Biobehavioral Medicine is an international, interdisciplinary journal devoted to experimental and clinical investigation in behavioral biology, psychiatry, psychology, physiology, anthropology, and clinical medicine. The print journal is published nine times a year; most articles are published online ahead of print.

About the American Psychosomatic Society
The mission of the American Psychosomatic Society is to promote and advance the scientific understanding and multidisciplinary integration of biological, psychological, behavioral and social factors in human health and disease, and to foster the dissemination and application of this understanding in education and health care.

The American Psychosomatic Society is a worldwide community of scholars and clinicians dedicated to the scientific understanding of the interaction of mind, brain, body and social context in promoting health. The organization is devoted to biopsychosocial research and integrated clinical care, and to providing a forum via its website, Annual Meeting and journal, Psychosomatic Medicine, for sharing this research. Its members are from around the world, including specialists from all medical and health-related disciplines, the behavioral sciences, and the social sciences.

About Wolters Kluwer
Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2014 annual revenues of €3.7 billion. The group serves customers in over 170 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on NYSE Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY).

For more information about our products and organization, 

visit www.wolterskluwerhealth.com, 

follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.

Federal Investments in Research Enabling Improvements in How We Age

December 8, 2015 – Federal investments in research are paying off in scientific breakthroughs that are “unleashing the power and potential of proteins” in humans, which, by 2034, will have a significant effect on aging, according to an essay published by the Washington, D.C.-based Science Coalition.

 

“Many harbor this dream to age successfully, to maintain their ability to function well as they age; to live longer and better. 

By 2034, we may be able live the dream,” according to “Science 2034” essay author Deepak Vashishth, Ph.D., director of the Center for Biotechnology and Interdisciplinary Studies (CBIS) at Rensselaer Polytechnic Institute (RPI).

Science 2034 is an initiative by The Science Coalition to focus on the possibilities of the future. The Science Coalition notes that, while we don’t know what the next “Big Thing” will be, we can make some educated predictions about how well-funded scientific research might change our lives and our world. 

Scientists, policymakers, and thought leaders weigh in on what they think science will enable by 2034 and what that will mean to individuals, society, and the world.

“Proteins are the fabric of our lives. The human body and its microbiota potentially produce millions of proteins. With time, these proteins get modified, inactivated, damaged, or under- or over- produced. Therein lies the hazards and hopes,” Vashishth wrote.

For example, “In my lab at CBIS, we have identified protein modifications in bone that, with aging, diabetes, and certain long-term drug treatments, make bone brittle. Armed with that knowledge, and the mechanisms that cause such modifications, we now know how to make old bones new again,” Vashishth wrote. He also discusses progress in Alzheimer’s research and the future for personalized medicines.

“Collaborative research at CBIS and elsewhere, all of which engages students and prepares the next generation as interdisciplinary experts, is made possible by support from the National Institutes of Health (NIH) and the National Science Foundation (NSF). 

"Through continued federal support and public-private global partnerships among universities and industries, there is great potential to move the outcomes from the lab to the marketplace with extraordinary impact on health-care delivery and on day-to-day living for individuals,” according to Vashishth.

“Biotechnology and advanced techniques are unleashing a new era with solutions to old problems and a lifeline to emerging personalized treatments. At the current pace of change—capitalizing on our ability to better understand, alter, and produce proteins—we can begin to imagine that diseases such as Parkinson’s, Alzheimer’s, and osteoporosis, that now wreak havoc on our golden years, will become a distant memory,” he wrote.

To read Vashishth’s full essay “Unleashing the Power and Potential of Proteins” and to listen to the podcast, go to http://www.science2034.org/medicine/podcast-the-power-and-potential-of-proteins/

.

Deepak Vashishth, Ph.D., is director of the Center for Biotechnology and Interdisciplinary Studies at Rensselaer Polytechnic Institute. He was named a fellow of the American Institute for Medical and Biological Engineering (AIMBE) in recognition of his groundbreaking bone research.

The Science Coalition is a nonprofit, nonpartisan organization of the nation’s leading public and private research universities dedicated to sustaining the federal government’s investment in basic scientific research as a means to stimulate the economy, spur innovation, and drive America’s global competitiveness.

About Rensselaer Polytechnic Institute: Founded in 1824 as the first technological research university in the United States, Rensselaer embodies “The New Polytechnic:” a new paradigm for teaching, learning, and research—a view of the technological research university as a fresh collaborative endeavor across disciplines, sectors, and global regions. Rensselaer is a driving force behind breakthroughs in engineering and science in virtually every arena—from transportation and infrastructure to business, medicine, manufacturing, big data, computation, outer space, and cyberspace. For more information, please visit www.rpi.edu.

Newly Evolved, Uniquely Human Gene Variants Protect Older Adults from Cognitive Decline

Humans evolved unique gene variants that protect older adults from neurodegenerative disease, thus preserving their valuable contributions and delaying dependency

Newswise, December 1, 2015 — Many human gene variants have evolved specifically to protect older adults against neurodegenerative and cardiovascular diseases, thus preserving their contributions to society, report University of California, San Diego School of Medicine researchers in the November 30 issue of Proceedings of the National Academy of Sciences.

“We unexpectedly discovered that humans have evolved gene variants that can help protect the elderly from dementia,” said Ajit Varki, MD, Distinguished Professor of Medicine and Cellular and Molecular Medicine at UC San Diego School of Medicine, adjunct professor at the Salk Institute for Biological Studies and co-director of the UC San Diego/Salk Center for Academic Research and Training in Anthropogeny (CARTA).

“Such genes likely evolved to preserve valuable and wise grandmothers and other elders, as well as to delay or prevent the emergence of dependent individuals who could divert resources and effort away from the care of the young.” Varki led the study, along with Pascal Gagneux, PhD, associate professor of pathology and associate director of CARTA.

The standard model of natural selection predicts that once the age of reproduction ends, individuals die.

That’s because selection early in life strongly favors variants that benefit reproductive success, even at the cost of negative consequences late in life — one major reason we age. This is indeed the case in almost all vertebrates.

Humans (and certain whales) are an exception to this rule, living decades beyond reproductive age. Such elders contribute to the fitness of younger individuals by caring for grandchildren and also by passing down important cultural knowledge.

Age-related cognitive decline compromises these benefits, and eventually burdens the group with the need to care for dependent older members.

In this first-of-its kind discovery, Varki, Gagneux and their teams initially focused on the gene that encodes the CD33 protein. CD33 is a receptor that projects from the surface of immune cells, where it keeps immune reactions in check, preventing “self” attack and curtailing unwanted inflammation.

Previous studies suggested that a certain form of CD33 suppresses amyloid beta peptide accumulation in the brain. Amyloid beta accumulation is thought to contribute to late-onset Alzheimer’s disease, a post-reproductive condition that uniquely affects humans and is aggravated by inflammation and cerebral vascular disease.

The researchers compared CD33 regulation in humans and our closest living relatives, chimpanzees. They found that levels of the CD33 variant that protects against Alzheimer’s are four-fold higher in humans than chimpanzees.

They also found human-specific variations in many other genes involved in the prevention of cognitive decline, such as APOE. The ancestral form of the gene, APOE4, is a notorious risk factor for Alzheimer’s and cerebral vascular disease. But this study finds that variants APOE2 and APOE3 seem to have evolved to protect from dementia. All of these protective gene variants are present in Africa, and thus predate the origin of our species. This finding is in keeping with the valuable role of the elderly across human societies.

“When elderly people succumb to dementia, the community not only loses important sources of wisdom, accumulated knowledge and culture, but elders with even mild cognitive decline who have influential positions can harm their social groups by making flawed decisions,” Gagneux said.

“Our study does not directly prove that these factors were involved in the selection of protective variants of CD33, APOE and other genes, but it is reasonable to speculate about the possibility.

“After all, inter-generational care of the young and information transfer is an important factor for the survival of younger kin in the group and across wider social networks or tribes.”

Additional study co-authors include Flavio Schwarz, Stevan A. Springer, Tasha Altheide, Nissi M. Varki, all of UC San Diego.

This research was funded, in part, by the National Institutes of Health (grants P01HL107150 and R01GM095882) and the Harold and Leila Mathers Foundation.

Full study: http://www.doi.org/10.1073/pnas.1517951112