Friday, November 17, 2017

Computerized speed training group showed significantly less risk of dementia - averaging a 29 percent risk reduction


Computerized brain-training is now the first intervention of any kind to reduce the risk of dementia among older adults. The breakthrough results from a randomized controlled trial were just published in the journal Alzheimer's & Dementia: Translational Research & Clinical Interventions.

The article, "Speed of Processing Training Results in Lower Risk of Dementia", reports on the latest findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study funded by the National Institutes of Health.

"Speed of processing training resulted in decreased risk of dementia across the 10-year period of, on average, 29 percent as compared to the control," said lead author Jerri Edwards, PhD, University of South Florida. "When we examined the dose-response, we found that those who trained more received more protective benefit."

The ACTIVE Study enrolled 2,802 healthy older adults at six sites around the United States and followed them for 10 years (as they aged from an average of 74 to 84). Participants were randomized into a control group or one of three intervention arms using different types of cognitive training: 1) a group receiving instruction on memory strategies; 2) a group receiving instruction on reasoning strategies; and 3) a group receiving individualized computerized speed of processing training. Participants in the cognitive training groups were offered 10 initial sessions of training (60-75 minutes per session) which was conducted over the first six weeks of the study.

All participants were assessed on a number of cognitive and functional measures at the beginning of the study, after the first six weeks, and at 1, 2, 3, 5 and 10 years. Subsets of each intervention group also received four additional "booster" training sessions in months 11 and 35 of the study. Researchers found no significant difference in risk of dementia for the strategy-based memory or reasoning training groups, as compared to the control group. However, as compared to the control group, the computerized speed training group showed significantly less risk of dementia - averaging a 29 percent risk reduction.

When reviewing the impact of each computerized speed training session completed, researchers found those who completed more sessions had lower risk. Among those who completed 15 or more sessions across all three intervention groups, the risk of dementia for the computerized speed training group was lowest at 5.9%, as compared to 9.7% and 10.1% for the memory and reasoning groups, respectively. The control group, which did not engage in any training, had a dementia incidence rate of 10.8%.

Participants in the computerized speed training group were trained on a highly specific task designed to improve the speed and accuracy of visual attention, including both divided and selective attention exercises. To perform the divided attention training task, a user identified an object (i.e., car or truck) at the center of gaze while at the same time locating a target in the periphery (i.e., car). As the user got the answers correct, the speed of presentation becomes progressively briefer, while the targets become more similar. In the more difficult training tasks, the target in the periphery is obscured by distracting objects, engaging selective attention.

There is substantial prior scientific literature on this training exercise, which is referred to as "speed of processing training", "useful field of view training", or "UFOV training." The exercise was developed by Dr. Karlene Ball of the University of Alabama Birmingham and Dr. Dan Roenker of Western Kentucky University. It is now exclusively licensed to Posit Science Corporation, and is available as the "Double Decision" exercise of the BrainHQ.com brain training program.

The paper notes that this particular type of computerized brain training, as updated by its inventors and Posit Science over the years, has previously been shown effective across more than 18 clinical trials in older adults on standard measures of cognitive abilities (e.g., speed of processing and attention) and functional abilities (e.g., maintaining the ability to live independently, depressive symptoms, feelings of control, and health-related quality of life), as well as in real world activities (e.g., driving safety, balance and gait).

"We need to further delineate what makes some computerized cognitive training effective, while other types are not," said Dr. Edwards. "We also need to investigate what is the appropriate amount of training to get the best results. The timing of intervention is also important. Existing data indicate speed training is effective among older adults with and without mild cognitive impairment, but it is important to understand this is preventative to lower risk of dementia and is not a treatment for dementia. Our ongoing research is examining this intervention among persons with Parkinson's disease as well as other types of cognitive interventions."

The preliminary results reported at the Alzheimer's Association International Conference were confirmed in this report. However, to be more conservative, the publication used a narrower definition of dementia. The article "Speed of Processing Training Results in Lower Risk of Dementia" reflects the ACTIVE study's conclusion based on 3 criteria for dementia: cognitive and functional impairment, outcome of the Mini-Mental State Examination (MMSE) and/or diagnosis of dementia or Alzheimer disease as reported by the participant or a relative of the participant. The risk reduction from randomization to speed training ranged from 29-33%, depending on how dementia was defined.

Coffee consumption = reduced risk of liver disease



A new roundtable report from the Institute for Scientific Information on Coffee (ISIC) on 'Looking after the liver: coffee, caffeine and lifestyle factors' highlights the potential role of coffee consumption in reducing the risk of liver diseases such as liver cancer and cirrhosis.
Roundtable delegates including academics, media medics and representatives from national liver associations from across seven European countries, met to discuss the most recent research into coffee and liver health, and the potential mechanisms behind a suggested reduced risk of liver disease.

The roundtable, held at the Royal Society of Medicine in London, was chaired by Professor Graeme Alexander (University College London and senior advisor to the British Liver Trust) who also presented on the prevalence of liver disease in Europe and the role of lifestyle. Dr. Carlo La Vecchia (Professor of Medical Statistics and Epidemiology, Dept. of Clinical Sciences and Community Health, Università degli Studi di Milano) discussed the latest research on coffee and liver health and potential mechanisms. Group discussion focussed on how best to disseminate the latest findings and challenges for both liver associations and healthcare professionals.

Liver disease is a significant concern across Europe, where chronic liver disease is the fifth most common cause of death1 and approximately 29 million people in the European Union suffer from a chronic liver condition2.

Key research findings highlighted in the report include:
  • Meta-analyses have suggested that coffee consumption versus no coffee consumption is associated with up to a 40% risk reduction of liver cancer, although this appears to be a dose-dependent relationship3-5.
  • Research from the US6 and Italy7,8 suggests that coffee consumption is consistently associated with a reduced risk of cirrhosis, with a potential risk reduction of 25-70%.
  • Research suggests an inverse association between coffee consumption and risk of chronic liver disease, with an average risk reduction of 25-30% in low coffee consumers, and up to 65% in high coffee consumers9.*.
During the roundtable, Professor Alexander suggested that it is likely that liver cancer develops from an existing liver disease, and proposed that the association between coffee consumption and a reduced risk of liver cancer may in fact link back to an effect of coffee drinking on liver disease.
One of the main issues discussed at the roundtable was the diagnosis of liver disease, and the fact that a majority of sufferers are unaware of their condition. Even though the liver is a vital organ, the perception in some European countries is that liver health is not considered as high a priority as other conditions, such as heart disease.

Professor Graeme Alexander, senior advisor to the British Liver Trust, commented: "Liver disease is on the rise across Europe and it is important that we understand how coffee, one of the most popular drinks in the world, and diet affects the disease. Research suggests that coffee may reduce the risk of liver diseases and it is important patients have access to dietary information and advice from health care professionals in a manner that is easy for them to understand and act upon."

Judi Rhys, Chief Executive, British Liver Trust said: "Liver disease is a silent killer as often there are no symptoms until it's too late. Coffee is something that is easily accessible to everyone and regularly drinking it - filtered, instant or espresso - may make a difference in preventing and, in some cases, slowing down the progression of liver disease- it is an easy lifestyle choice to make."


Redefining obesity in postmenopausal women


There is no doubt the prevalence of obesity has increased significantly across all age groups, creating greater health risks. What exactly constitutes obesity, however, is subject to debate, especially for postmenopausal women who have a different body composition than younger women. A study published online today in Menopause, the journal of The North American Menopause Society (NAMS), demonstrates that the long-accepted BMI definition for obesity may no longer be accurate.

Body mass index (BMI) is the most widely used indicator of obesity. Despite its common usage, there is growing concern in the medical community that BMI is not a valid measure of obesity in older adults because it doesn't account for the location of body tissue used for the storage of fat, differentiate between fat mass and lean mass, or account for variation in body composition. This creates challenges for healthcare providers who must assess obesity-related health risks in their patients. The challenge is magnified when treating older women because of the significant physical changes that occur during the postmenopausal period, including changes in body weight, redistribution of fat tissue, decrease in skeletal muscle mass, and loss of height.

The location of fat affects a person's health, even though BMI does not take into account whether a woman has a pear-shaped body with more subcutaneous fat in the hips and thighs or an apple-shaped body consisting of a larger midsection. Use of BMI in a postmenopausal population where the location of stored fat is changing may result in the misclassification of obesity status and an inaccurate representation of obesity-related risks. There are, however, direct measures of adiposity (fat storage), such as dual-energy x-ray absorptiometry (DXA) scans, that provide a much more accurate measurement of body fat, but these require access to expensive specialized equipment and skilled technicians.

Findings from the study are published in the article, "Is BMI a valid measure of obesity in postmenopausal women?" Data was gathered from the more than 1,300 postmenopausal women participating in the Buffalo OsteoPerio Study. Researchers calculated sensitivity, specificity, positive predictive value, and negative predictive value to evaluate the validity of BMI-defined obesity relative to body fat percentage. Findings indicate that the use of BMI can lead to bias in measuring the effects of obesity on health outcomes in postmenopausal women. Because women are now expected to spend more than a third of their lives beyond the menopause transition, these findings on the shortcomings of using BMI to define obesity could have serious implications for healthcare providers with an aging patient population.

"Postmenopausal women lose hormones at menopause and this is associated with changes in metabolism and fat deposition, loss of muscle, bone density, and often loss of height," says Dr. JoAnn Pinkerton, NAMS executive director. "Traditional measurement of height and weight may not reflect the degree of obesity for a given woman. Currently, a BMI of 30 kg/m2 is used as a cut-off or measure of obesity for decisions about the degree of surgical risk and in research to determine the effect of obesity on mortality and morbidity. However, BMI may not be a valid measure of obesity for postmenopausal women as they age. A better measure is needed to determine which postmenopausal women meet the definition of obesity for research and clinical care purposes."

Daily activity can prolong life



That "to do" list of chores and errands could actually provide a variety of health benefits, according to researchers at the University of California San Diego School of Medicine. The study, published in the Journal of the American Geriatrics Society, found women over age 65 who engaged in regular light physical activity had a reduction in the risk of mortality.

"Every movement counts," said Andrea LaCroix, PhD, senior author of the study and professor in the Department of Family Medicine and Public Health at UC San Diego. "A lot of what we do on a daily basis is improving our health, such as walking to the mail box, strolling around the neighborhood, folding clothes and straightening up the house. Activities like these account for more than 55 percent of how older individuals get their daily activity."

The 6,000 women in the study, ages 65 to 99, were followed for up to four and a half years. They wore a measuring device called an accelerometer on their hip around-the-clock for seven days while going about their daily activities. The study found that 30 minutes of light physical activity per day lowered mortality risk by 12 percent while an additional 30 minutes of moderate activity, such as bicycling at a leisurely pace or brisk walking, exhibited a 39 percent lower risk.

"Improving levels of physical activity both light and moderate could be almost as effective as rigorous regular exercise at preventing a major chronic disease," said LaCroix, chief of the Division of Epidemiology at UC San Diego School of Medicine. "We don't have to be running marathons to stay healthy. The paradigm needs to shift when we think about being active."

The study also found that the benefit of light physical activity extended to all subgroups examined, including different racial/ethnic backgrounds, obese and non-obese women, women with high and low functional ability and women older and younger than age 80.

"Older people expend more energy doing the same kinds of activities they did when younger, so their daily movement has to accommodate for this," said LaCroix. "Think of it as taking a pill (activity level) at different doses (amounts of time) depending on the age of the patient. It's not one size fits all."

Current national public health guidelines recommend 150 minutes of moderate to vigorous physical activity a week for adults. The guidelines recommend persons 65 and older follow the adult guidelines to the degree their abilities and conditions allow.

"Our study shows, for the first time using device-measured light physical activity in older women, that there are health benefits at activity levels below the guideline recommendations. With the increasing baby boomer population in the United States, it is imperative that future health guidelines recommend light physical activity in addition to more strenuous activity," said LaCroix. "When we get up from the couch and chair and move around, we are making good choices and contributing to our health."



Dog ownership linked to lower mortality


A team of Swedish scientists have used national registries of more than 3.4 million Swedes aged 40 to 80 to study the association between dog ownership and cardiovascular health. Their study shows that dog owners had a lower risk of death due to cardiovascular disease or to other causes during the 12-year follow-up.

A total of more than 3.4 million individuals without any prior cardiovascular disease in 2001 were included in the researchers' study linking together seven different national data sources, including two dog ownership registers. The results are being published for the first time in Scientific Reports. The goal was to determine whether dog owners had a different risk of cardiovascular disease and death than non-dog owners.

"A very interesting finding in our study was that dog ownership was especially prominent as a protective factor in persons living alone, which is a group reported previously to be at higher risk of cardiovascular disease and death than those living in a multi-person household. Perhaps a dog may stand in as an important family member in the single households.

The results showed that single dog owners had a 33% reduction in risk of death and 11% reduction in risk of myocardial infarction during follow-up compared to single non-owners.

Another interesting finding was that owners to dogs from breed groups originally bred for hunting were most protected," says Mwenya Mubanga, lead junior author of the study and PhD student at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University.

In Sweden, every person carries a unique personal identity number. Every visit to a hospital is recorded in national databases, accessible to researchers after de-identification of data. Even dog ownership registration has been mandatory in Sweden since 2001. These scientists studied whether being registered as a dog-owner was associated with later diagnosis of cardiovascular disease or death from any cause.

"These kind of epidemiological studies look for associations in large populations but do not provide answers on whether and how dogs could protect from cardiovascular disease. We know that dog owners in general have a higher level of physical activity, which could be one explanation to the observed results. Other explanations include an increased well-being and social contacts or effects of the dog on the bacterial microbiome in the owner," says Tove Fall, senior author of the study and Associate Professor in Epidemiology at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University.

"There might also be differences between owners and non-owners already before buying a dog, which could have influenced our results, such as those people choosing to get a dog tending to be more active and of better health. Thanks to the population-based design, our results are generalisable to the Swedish population, and probably also to other European populations with similar culture regarding dog ownership," says Tove Fall.

Cardiorespiratory fitness is essential to reduce risk of coronary heart disease


Coronary heart disease (CHD) is a leading cause of death for men in the U.S. Both cardiorespiratory fitness (CRF) and the blood triglyceride/high-density lipoprotein ratio (TG:HDL ratio) are strong predictors of death from CHD. In the current issue of Mayo Clinic Proceedings, two new studies highlight the importance of CRF on subsequent CVD and mortality risk. These articles contribute substantive evidence on the importance of achieving moderate to high levels of CRF in both adults and children.

In an investigation led by Stephen W. Farrell, PhD, of The Cooper Institute, Dallas, TX, researchers found strong evidence that moderate-to-high level of fitness counteracted some of the negative effects of a high TG:HDL ratio.

"While it is still extremely important to measure traditional risk factors such as resting blood pressure, blood cholesterol, triglyceride, and glucose levels, having a measure or estimate of the patient's cardiorespiratory fitness level gives us additional information regarding cardiovascular disease risk," explained Dr. Farrell. "The results of this study support this recommendation.

Regardless of whether the blood TG:HDL ratio was low or high, having at least a moderate level of fitness provided some protection from CHD death when compared to having a low level of fitness."
A total of 40,269 men received a comprehensive physical examination between January 1, 1978 and December 31, 2010.

The exam included a maximal treadmill exercise test to measure cardiorespiratory fitness level, and also included measurement of the blood TG:HDL ratio. This ratio is easily calculated by taking the fasting blood triglyceride level and dividing it by the blood HDL cholesterol level.

A lower ratio is an indicator that insulin is working well, while a higher ratio indicates resistance to insulin. Higher ratios also indicate an increased risk of future prediabetes, type 2 diabetes, and cardiovascular disease.

The participants, categorized into low, moderate, and high CRF groups, were followed for an average period of 16.6 years, during which time 556 deaths due to coronary heart disease (CHD) occurred. Moderate to high levels of fitness provided significant protection from CHD death. Lower values for the TG:HDL ratio also provided significant protection.

The lowest risk of CHD death was seen among high fit men in the lowest category of TG:HDL ratio, while the highest risk of CHD death was seen among low fit men in the highest category of TG:HDL ratio. Within each of the four categories of TG:HDL ratio, having a moderate to high level of fitness provided significant protection against CHD death when compared to having a low level of fitness.

Therefore, knowing the patient's fitness level as well as their TG:HDL ratio provides much more information about CHD risk status than just knowing one or the other. When used in combination with other risk factors, such as the patient's blood pressure, bloodwork, family history, etc., measuring or estimating the patient's level of CRF can result in a much more accurate determination of their cardiovascular disease risk status.

There are also some studies that indicate that the TG:HDL ratio can be a proxy for LDL particle size, whereby small dense LDL particles are more likely to form plaques in blood vessels than large, less-dense particles.

It has often been said that "Exercise is Medicine." Many risk factors for chronic disease can be prevented or treated with sufficient amounts of exercise, weight loss, and healthy diet. Avoiding tobacco in all forms is also a must.

In another study researchers from several universities and institutes in Spain highlight the importance of monitoring CRF for early detection of present and future cardiovascular risk in youth. They describe how measuring CRF in 6- to 10-year-olds and later in 8- to 12-year-olds can reveal indicators of increased cardiovascular disease (CVD) risk later in life.

Lead investigator José Castro-Piñero, PhD, from the Department of Physical Education, School of Education, University of Cádiz, Puerto Real, Spain, noted, "Although CVD events occur most frequently during or after the fifth decade of life, there is evidence indicating that CVD precursors have their origin in childhood and adolescence. Moreover, adverse CVD risk factors during childhood have been found to track into adulthood. Consequently, early detection and diagnosis of CVD risk factors in children and adolescents will contribute to the development of effective prevention programs, counseling, school-based strategies, and public health policies."

Participants were part of the UP&DOWN study of 2225 youths between 6 and 18 years of age, and for this study, 213 primary schoolchildren were tested. CRF was expressed as an oxygen consumption value (units of mL/kg per minute) calculated from a shuttle-run test. Other data collected included skinfold thickness, blood pressure, serum triglyceride (TG) levels, total cholesterol (TC) level, high-density lipoprotein cholesterol (HDL-C) level, glucose level, insulin level, and CRF. From these data, single CVD risk factors were determined as well as an overall CVD risk score.

Researchers determined that several single CVD factors increased during the two-year follow-up period for both boys and girls, while overall CVD risk score increased significantly only for boys. Maximum oxygen consumption decreased for both boys and girls. Boys were about seven times more likely to have a favorable CVD risk score at follow-up if their CRF level was at least 39.0 mL/kg per minute at the beginning of the study. Girls were more than four times as likely to have favorable CVD risk with CRF of at least 37.5 mL/kg per minute at the beginning of the study.

In an accompanying editorial, Carl J. Lavie, MD, of the John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, observed that collectively the data presented in the study by Farrell et al support significant public health messages. First, CRF significantly modulates CVD risk associated with dyslipidemia. Second, accumulating 7 to 14 miles per week of moderate-intensity exercise, such as running, can potentially lower the risk associated with increased TG:HDL-C levels as reported by the current study. Finally, CRF must be considered by health care professionals when CVD risk is assigned to patients.

Dr. Lavie further stated that by focusing on young children and adding an important longitudinal analysis of how CRF changes relate to changes in CVD risk, Castro-Piñero et al have added two significant dimensions to the existing literature.

Wednesday, November 15, 2017

Sleep deprivation may increase risk of cardiovascular disease in older women


Older women who don't get enough sleep were more likely to have poor cardiovascular health, according to preliminary research presented at the American Heart Association's Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

In the new study, researchers considered sleeping at least two hours more during the weekend than on the weekday as a sign of being in sleep debt. Among the roughly 21,500 female health professionals between ages of 60 and 84 the research team followed, women who were in sleep debt were more likely to be obese and have hypertension.

When taking into account socioeconomic status and sources of stress, such as negative life events and work-related stress that could also influence cardiovascular health, quality of sleep was still an important factor for good overall cardiovascular health. The results suggest that not getting enough sleep during the week might throw the body off and may increase risk of cardiovascular disease in older women.