Screen older adults for mental health symptoms as pandemic continues

As the pandemic enters a new phase, and talk of getting “back to normal” fades in the face of surging cases of COVID-19 and lagging vaccination against it, a new study suggests a need to check on the mental health of people over 50.

Based on a poll of more than 2,000 older adults nationwide, the researchers from the University of Michigan recommend that health providers screen older adults for symptoms of depression, anxiety and sleep problems brought on or worsened by the pandemic, and help them connect to resources and care.

Certain groups – those ages 50 to 64, women, those with higher levels of education and those who say their physical health is fair or poor – are more likely to have experienced worsened mental health during the first nine months of the pandemic, the study shows.

“These findings show we need to continue to look for and address the mental health effects of the pandemic and connect people to treatment resources. Poor mental health can decrease functioning, independence, and quality of life for older adults but treatment can significantly help,” says Lauren Gerlach, D.O., M.Sc., lead author of the new paper and a geriatric psychiatrist at Michigan Medicine, U-M’s academic medical center.

While 20% of all older adults in the national sample reported worse mental health during the pandemic, people in these subgroups were much more likely to report this. Adults ages 65 through 80 were less likely to report such effects, a sign of resilience in this age group, says Gerlach.

The findings, published in the Journal of General Internal Medicine, draw from the National Poll on Healthy Aging. The poll, based at the U-M Institute for Healthcare Policy and Innovation,  receives support from AARP and Michigan Medicine, and originally published initial findings from the mental health poll in May.

The new paper included further analysis of the poll data. For instance, it shows that women were more likely to have discussed mental health concerns during the pandemic with their primary care physician, or to consider taking medication to treat a mental health concern brought on by the pandemic.

The poll was conducted in late January, when COVID-19 case rates were high across the nation and vaccination of older adults had just begun. Laptops and Internet access were provided to poll respondents who did not already have them.

The poll also reveals hopeful signs that many older adults are showing long-term resilience. Two-thirds say their current mental health is excellent or very good. Just over 80% say their mental health is as good as, or better than, it was 20 years ago. Nearly one in three (29%) say that they have made a lifestyle change to improve their mental health since the start of the pandemic such as exercise, diet, and meditation.

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The Michigan Medicine Department of Psychiatry developed a mental health guide for older adults during the pandemic, and the Centers for Disease Control and Prevention offers information on pandemic-related stress and coping strategies for all adults and children.

Healthy lifestyle may help mitigate high genetic risk of cancer

 As genetic research continues to uncover loci, or areas in DNA, with specific changes that influence cancer risk, researchers can define polygenic risk scores (PRS)—personalized estimates of an individual’s cancer risk—based on a patient’s unique combination of these changes. However, most PRS are generated for a specific cancer type, rather than for overall cancer risk.

“A PRS indicating risk of a certain cancer is important but not enough,” Jin said. “We tried to create an indicator—the cancer polygenic risk score (CPRS)—to measure the genetic risk of cancer as a whole.”

How the Study Was Conducted: Jin and colleagues calculated individual PRS for 16 cancers in men and 18 cancers in women, using available data from genome-wide association studies. They then used statistical methods to combine these scores into a single measure of cancer risk, based on the relative proportion of each cancer type in the general population. Separate CPRS were generated for men and women.

To validate their CPRS, the researchers utilized genotype information from 202,842 men and 239,659 women from the UK Biobank, a cohort of general-population participants recruited from England, Scotland, and Wales between 2006 and 2009, and calculated a CPRS for each individual.

UK Biobank participants were surveyed upon enrollment for various lifestyle factors, including smoking and alcohol consumption, body mass index, exercise habits, and typical diet. Based on these factors, Jin and colleagues classified each patient as having an unfavorable (zero to one healthy factors), intermediate (two to three healthy factors), or favorable (four to five healthy factors) overall lifestyle.

Results: Patients with the highest quintile CPRS were nearly twice as likely (for men) and 1.6 times as likely (for women) to have a cancer diagnosis by their most recent follow-up, in 2015 or 2016. Notably, 97 percent of patients in the study had a high genetic risk (top quintile) of at least one cancer type. “This suggests that almost everyone is susceptible to at least one type of cancer,” Jin said. “It further indicates the importance of adherence to a healthy lifestyle for everyone.”

Patients with an unfavorable lifestyle and the highest quintile genetic risk were 2.99 times (in men) and 2.38 times (in women) more likely to develop cancer than those with a favorable lifestyle and the lowest quintile of genetic risk.

Among patients with high genetic risk, the five-year cancer incidence was 7.23 percent in men and 5.77 percent in women with an unfavorable lifestyle, compared with 5.51 percent in men and 3.69 percent in women with a favorable lifestyle. The decreased percentages are comparable to the cancer risk in individuals with intermediate genetic risk, Jin said. Similar trends were observed in all genetic risk categories, suggesting that patients could benefit from a healthy lifestyle regardless of genetic risk.

Author’s Comments: “Our findings indicate that everyone should have a healthy lifestyle to decrease overall cancer risk,” Jin said. “This is particularly important for individuals with a high genetic risk of cancer. We hope our CPRS could be useful to improve a person’s awareness of their inherited susceptibility of cancer as a whole and facilitate them to participate in healthy activities.”

Study Limitations: Limitations of this study include the fact that only the strongest genetic risk loci were included in the individual PRS, which disregards the influence of loci with weaker effects. Researchers also noted an imbalance in the number of loci included between different cancer types, which can potentially skew their individual impact.

Postmenopausal women can dance their way to better health

Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of comradery from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

New insights into the relationship between how we feel and our views on aging

A new study finds that the disconnect between how old we feel and how old we want to be can offer insights into the relationship between our views on aging and our health.

Subjective age discordance (SAD) – the difference between how old you feel and how old you would like to be – is a fairly new concept in the psychology of aging. However, the work to this point has used SAD to look at longitudinal data and how people’s views on aging evolve over months or years.

“We wanted to see whether SAD could help us assess day-to-day changes in our views on aging, and how that may relate to our physical health and well-being,” says Shevaun Neupert, co-author of the study and a professor of psychology at North Carolina State University.

SAD is determined by taking how old you feel, subtracting how old you would like to be and then dividing it by your actual age. The higher the score, the more you feel older than you want to be.

For this study, researchers enrolled 116 adults aged 60-90 and 107 adults aged 18-36. Study participants filled out an online survey every day for eight days. The survey was designed to assess how old participants felt each day, their ideal age, their positive and negative mood over the course of the day, any stresses they experienced, and any physical complaints, such as backaches or cold symptoms.

“We found that both older adults and younger adults experienced SAD,” Neupert says. “It was more pronounced in older adults, which makes sense. However, it fluctuated more from day to day in younger adults, which was interesting.”

“We think younger adults are getting pushed and pulled more,” says Jennifer Bellingtier, first author of the paper, and a researcher at Friedrich Schiller University Jena. “Younger adults are concerned about negative stereotypes associated with aging, but may also be dealing with negative stereotypes associated with younger generations and wishing they had some of the privileges and status associated with being older.”

Two additional findings stood out.

“On days when the age you feel is closer to your ideal age, people tend to have a more positive mood,” Bellingtier says. “And, on average, people who have more health complaints also had higher SAD scores.”

Neither finding was surprising, but both show the value of the SAD concept as a tool for understanding people’s views on age and aging. It may also offer a new approach for the way we think about aging and its impacts on health.

“Previous research has found that how old you feel can affect your physical and mental well-being, and interventions to address that have focused on trying to make people feel younger,” Neupert says.

“That approach is problematic, in that it effectively encourages ageism,” says Bellingtier. “Our findings in this study suggest that another approach to improving well-being would be to find ways to reduce this subjective age discordance. In other words, instead of telling people to feel young, we could help people by encouraging them to raise their ‘ideal’ age.”

The paper, “Daily Experiences of Subjective Age Discordance and Well-Being,” is published in the journal Psychology and Aging. The paper was co-authored by Fiona Rupprecht and Frieder Lang of Friedrich-Alexander University of Erlangen-Nuremberg.

65+ and lonely? Don't talk to your doctor about another prescription

Lonely, older adults are nearly twice as likely to use opioids to ease pain and two-and-a-half times more likely to use sedatives and anti-anxiety medications, putting themselves at risk for drug dependency, impaired attention, falls and other accidents, and further cognitive impairment, according to a study by researchers at UC San Francisco.

The study found that just over half of 6,000 respondents in a nationally representative survey of seniors living independently were not lonely, while 40 percent were moderately lonely, and 7 percent were highly lonely.

The proportion of seniors in each group who had prescriptions for opioids and anti-anxiety medications and sedatives, which included drugs like Valium, Xanax, BuSpar and Ambien, correlated with their degree of loneliness, according to the study, which publishes in JAMA Internal Medicine on June 26, 2021.

"There's a misconception that as we age, we become more withdrawn and less sociable," said first author Ashwin Kotwal, MD, of the UCSF Division of Geriatrics and of the San Francisco VA Medical Center. "In fact, older people are more socially active than other age groups and frequently play major roles in their communities. When older people are not socially active, we need to recognize that there's a problem."

The researchers used data from the National Social Life, Health and Aging Project, a population-based study of health and social factors, and checked each participant's medications if they were used "on a regular schedule, like every day or every week." The participants' average age was 73; 46 percent were male, and 84 percent were white (7 percent were Black and 6 percent were Hispanic).

The researchers found that 6 percent of the non-lonely group used prescription opioids, versus 8 percent for the moderately lonely group and 11 percent for the highly lonely group. For anti-anxiety medications and sedatives - which includes anti-cholinergic drugs, like Valium, Unisom and tricyclic antidepressants, which have been associated with a higher risk for dementia - 9 percent of the non-lonely group used them, versus 13 percent for the moderately lonely group and 23 percent for the highly lonely group.

Similar patterns were found with antidepressants and NSAIDs, prescription and over-the-counter painkillers that may cause ulcers and bleeding in long-term use by older adults. The highly lonely group was also more likely to be on five or more medications - 58 percent versus 46 percent for the non-lonely participants.

Replacing Prescriptions with Social Contact

Kotwal advocates for fewer prescriptions of psychotropic drugs for older adults who are lonely, and in its place "social prescribing" to local resources in the community. This can be done by "link workers," based in primary care practices or within the community, with connections to amenities like senior centers, exercise classes, grief groups or volunteer programs.

He notes that the pandemic has taken the stigma out of loneliness, giving older adults an opportunity to discuss their feelings in clinic. Asking patients what might help can be a good first step to referring them to programs that might fit their needs.

"We don't want to pathologize loneliness. Most people experience loneliness at some point in their lives, but when experiences of loneliness persist for many months or years, it can cause physiologic changes, such as a ramped-up stress response, sleep problems, and even heart disease," said Kotwal. "And, a lack of social contact can erode our social skills, making it more difficult over time to connect with others and creating a vicious cycle."

De-Prescribing a Challenge for Patients in Distress

While physicians are well aware of the dangers of prescribing medications that should not be used in the long term, Kotwal noted that it "takes time and effort to de-prescribe," and switching a drug that acts promptly with one that may take several weeks to have an effect may be very challenging to patients in distress.

In busy practices with complex patients, contraindications may not come to light until a patient is suddenly hospitalized, said Kotwal. "It's only then that we might find out that a patient's prescriptions include Valium and he's been taking it for more than 20 years."

A recent previous study, also led by Kotwal, found that in the last four years of life, 19 percent experienced social isolation, 18 percent were lonely and 5 percent experienced both social isolation and loneliness. Factors associated with loneliness included female gender, pain, incontinence and cognitive impairment.

Excess coffee: A bitter brew for brain health

It's a favourite first-order for the day, but while a quick coffee may perk us up, new research from the University of South Australia shows that too much could be dragging us down, especially when it comes to brain health.

In the largest study of its kind, researchers have found that high coffee consumption is associated with smaller total brain volumes and an increased risk of dementia.

Conducted at UniSA's Australian Centre for Precision Health at SAHMRI and a team of international researchers*, the study assessed the effects of coffee on the brain among 17,702 UK Biobank participants (aged 37-73), finding that those who drank more than six cups of coffee a day had a 53 per cent increased risk of dementia.

Lead researcher and UniSA PhD candidate, Kitty Pham, says the research delivers important insights for public health.

"Coffee is among the most popular drinks in the world. Yet with global consumption being more than nine billion kilograms a year, it's critical that we understand any potential health implications," Pham says.

"This is the most extensive investigation into the connections between coffee, brain volume measurements, the risks of dementia, and the risks of stroke - it's also the largest study to consider volumetric brain imaging data and a wide range of confounding factors.

"Accounting for all possible permutations, we consistently found that higher coffee consumption was significantly associated with reduced brain volume - essentially, drinking more than six cups of coffee a day may be putting you at risk of brain diseases such as dementia and stroke."

Dementia is a degenerative brain condition that affects memory, thinking, behaviour and the ability to perform everyday tasks. About 50 million people are diagnosed with the syndrome worldwide. In Australia, dementia is the second leading cause of death, with an estimated 250 people diagnosed each day.

Stroke is a condition where the blood supply to the brain is disrupted, resulting in oxygen starvation, brain damage and loss of function. Globally, one in four adults over the age of 25 will have a stroke in their lifetime. Data suggests that 13.7 million people will have a stroke this year with 5.5 million dying as a result.

Senior investigator and Director of UniSA's Australian Centre for Precision Health, Professor Elina Hyppönen, says while the news may be a bitter brew for coffee lovers, it's all about finding a balance between what you drink and what's good for your health.

"This research provides vital insights about heavy coffee consumption and brain health, but as with many things in life, moderation is the key," Prof Hyppönen says.

"Together with other genetic evidence and a randomised controlled trial, these data strongly suggest that high coffee consumption can adversely affect brain health. While the exact mechanisms are not known, one simple thing we can do is to keep hydrated and remember to drink a bit of water alongside that cup of coffee.

"Typical daily coffee consumption is somewhere between one and two standard cups of coffee. Of course, while unit measures can vary, a couple of cups of coffee a day is generally fine.

"However, if you're finding that your coffee consumption is heading up toward more than six cups a day, it's about time you rethink your next drink."

Coffee doesn't raise your risk for heart rhythm problems

Research News

In the largest study of its kind, an investigation by UC San Francisco has found no evidence that moderate coffee consumption can cause cardiac arrhythmia.

In fact, each additional daily cup of coffee consumed among several hundred thousand individuals was associated with a 3 percent lower risk of any arrhythmia occurring, including atrial fibrillation, premature ventricular contractions, or other common heart conditions, the researchers report. The study included a four-year follow up.

The paper is published July 19, 2021, in JAMA Internal Medicine.

"Coffee is the primary source of caffeine for most people, and it has a reputation for causing or exacerbating arrhythmias," said senior and corresponding author Gregory Marcus, MD, professor of medicine in the Division of Cardiology at UCSF.

"But we found no evidence that caffeine consumption leads to a greater risk of arrhythmias," said Marcus, who specializes in the treatment of arrhythmias. "Our population-based study provides reassurance that common prohibitions against caffeine to reduce arrhythmia risk are likely unwarranted."

While some professional societies suggest avoiding caffeinated products to lower the risk for arrhythmia, this connection has not been consistently demonstrated - indeed, coffee consumption may have anti-inflammatory benefits and is associated with reduced risks of some illnesses including cancer, diabetes, and Parkinson disease.

In the new study, UCSF scientists explored whether habitual coffee intake was associated with a risk of arrhythmia, and whether genetic variants that affect caffeine metabolism could modify that association. Their investigation was conducted via the community-based UK Biobank, a prospective study of participants in England's National Health Services.

Some 386,258 coffee drinkers took part in the coffee research, with an average mean age of 56 years; slightly more than half were female. It was an unprecedented sample size for this type of inquiry.

In addition to a conventional analysis examining self-reported coffee consumption as a predictor of future arrhythmias, the investigators employed a technique called "Mendelian Randomization," leveraging genetic data to infer causal relationships. As those with the genetic variants associated with faster caffeine metabolism drank more coffee, this analysis provided a method to test the caffeine-arrhythmia relationship in a way that did not rely on participant self-report and should have been immune to much of the confounding inherent to most observational studies.

With a mean four-year follow up, data were adjusted for demographic characteristics, health and lifestyle habits.

Ultimately, approximately 4 percent of the sample developed an arrhythmia. No evidence of a heightened risk of arrhythmias was observed among those genetically predisposed to metabolize caffeine differently. The researchers said that higher amounts of coffee were actually associated with a 3 percent reduced risk of developing an arrhythmia.

The authors noted limitations including the self-reporting nature of the study, and that detailed information on the type of coffee - such as espresso or not - was unavailable.

"Only a randomized clinical trial can definitively demonstrate clear effects of coffee or caffeine consumption," said Marcus. "But our study found no evidence that consuming caffeinated beverages increased the risk of arrhythmia. Coffee's antioxidant and anti-inflammatory properties may play a role, and some properties of caffeine could be protective against some arrhythmias."

"Springing forward" affects early birds less than night owls

 Every spring, the Daylight Saving Time shift robs people of an hour of sleep - and a new study shows that DNA plays a role in how much the "spring forward" time change affects individuals. People whose genetic profile makes them more likely to be "early birds" the rest of the year can adjust to the time change in a few days, the study shows. But those who tend to be "night owls" could take more than a week to get back on track with sleep schedule, according to new data published in Scientific Reports by a team from the University of Michigan. 

The study uses data from continuous sleep tracking of 831 doctors in the first year of post-medical school training when the time shift occurred in spring 2019. All were first-year residents or "interns" in medical parlance, and taking part in the Intern Health Study based at the Michigan Neuroscience Institute. From the large UK Biobank dataset, the researchers calculated genomic "chronotype" predisposition information, also known as the Objective Sleep Midpoint polygenic score. People with low scores were genomically predisposed to be "early birds" and those with high scores were genomically "night owls." The team then applied these genomic scores in the intern sample and focused on the two groups of about 130 physicians each that had the strongest tendencies to be "early birds" and "night owls" based on their scores. 

The researchers looked at how their sleep patterns changed from the week before DST to the weekend after it. In general, the difference in post-DST weekday wakeup times between the two groups was not large - probably because first-year medical residents have very strict work schedules. In fact, the stressful duties and demanding schedules that interns endure is what made this population such an interesting one to study, and the larger Intern Health Study that the data come from has yielded important findings about the relationship between stress, sleep, genetics, mood and mental health. But the time they got to sleep on the nights before workdays, and both sleep and wake times on the weekend, varied significantly between the two groups. The DST change made the differences even more pronounced. Early birds had adjusted their sleep times by Tuesday, but night owls were still off track on the following Saturday. 

Margit Burmeister, Ph.D., the U-M neuroscientist and geneticist who is the paper's senior and corresponding author, says the study gives one more strong reason for abolishing Daylight Saving Time. "It's already known that DST has effects on rates of heart attacks, motor vehicle accidents, and other incidents, but what we know about these impacts mostly comes from looking for associations in large data pools after the fact," she says. "These data from direct monitoring and genetic testing allows us to directly see the effect, and to see the differences between people with different circadian rhythm tendencies that are influenced by both genes and environment. To put it plainly, DST makes everything worse for no good reason." 

Sleep schedules depend on a combination of many factors - but the fact that people can react so differently to the same abrupt change in time makes it important to study further. The researchers also looked at the "fall back" time change in autumn and found no significant differences between early birds and night owls in how they reacted to the abrupt addition of an hour of sleep. The findings have implications not just for the annual spring time change, but also for shift workers, travelers across time zones and even people deciding which profession to choose, the researchers note. 

Burmeister says she hopes to look further at differences between people in different professions in future studies. Co-author Srijan Sen, M.D., Ph.D. who leads the Intern Health Study and directs the Frances and Kenneth Eisenberg and Family Depression Center at U-M, continues to lead other studies of how each year's crop of interns at over 100 hospitals react to the stresses of their training. The interns in the newly published study, like all interns, are in general chronically sleep-deprived because of the number of hours they need to be on duty or preparing for duty. "This study is a demonstration of how we much we vary in our response to even relatively minor challenges to our daily routines, like DST," he said. "Discovering the mechanisms underlying this variation can help us understand our individual strengths and vulnerabilities better."

Weight management program with access to anti-obesity medications results in greater weight loss

A Cleveland Clinic study demonstrates that adults with obesity lost significantly more weight when they had access to medications for chronic weight management in conjunction with their employer-based weight management program, compared to adults who did not have access to the medications. The study was published in JAMA Network Open.

Obesity is a complex disease that is caused by multiple factors, including genetic, environmental, and biological. A lifestyle intervention with a focus on nutrition and exercise is often not enough to treat obesity, which is a chronic disease that requires long-term therapy. The U.S. Food and Drug Administration (FDA) has approved several prescription medications for weight loss and chronic weight management, also called anti-obesity medications. However, they have limited health insurance coverage.

"The research results support the need to treat patients with a multidisciplinary weight management program that incorporates safe and effective medications to lose weight and maintain weight loss," said Bartolome Burguera, M.D., Ph.D., chair of Cleveland Clinic's Endocrinology & Metabolism Institute and primary investigator of the study. "Doctors prescribe medications to treat some of the health consequences associated with obesity, such as hypertension and type 2 diabetes. However, medications for weight loss and chronic weight management are underutilized."

The Centers for Disease Control and Prevention (CDC) reported that more than 42% of U.S. adults have obesity. In addition to the serious health conditions associated with obesity – such as type 2 diabetes, obstructive sleep apnea, high-blood pressure, heart disease and stroke – the CDC also reported the economic impact of obesity on the U.S. healthcare system. The estimated medical care costs of the disease in the United States represented $147 billion (in 2008 dollars).

The objective of this study was to determine the effect of combining anti-obesity medications with a multidisciplinary employer-based weight management program.

The one-year, single-center, pragmatic clinical trial was conducted in the real-world setting of a workplace health plan. The study included 200 adults with obesity (body mass index of 30 or greater) who were enrolled in the Cleveland Clinic Employee Health Plan between January 2019 and May 2020. As part of the health plan, participants had access to a comprehensive weight management program.

In this real-world setting, eligible participants were randomized 1:1 to either a weight management program with FDA-approved anti-obesity medications or a weight management program alone. The weight management program was administered through monthly shared medical appointments (SMAs) that offered a multidisciplinary approach, including nutrition education. The monthly SMA visits focused on adopting a healthier lifestyle and addressed the five components of the weight management program: nutrition, physical activity, appetite control, sleep, and mental health. Due to the COVID-19 pandemic, some of the SMAs were conducted virtually.

The 100 study participants, randomized to the weight management program combined with access to the medications, received their prescriptions at the time of their monthly SMAs, based on recommended clinical practice.

Patients were prescribed one of five FDA-approved medications for chronic weight management - orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, liraglutide 3.0 mg. The medication selected for each patient was at the discretion of the treating provider, and was determined after a thorough assessment and discussion with the participants. (Lorcaserin was withdrawn from the market in February 2020. The eight patients taking lorcaserin at the time were notified immediately and either switched medications or discontinued medication due to proximity to the end of the study.)

Research results showed that the participants who had access to the anti-obesity medications averaged significantly greater weight loss at 12 months (-7.7%), compared to the participants who were in the weight management program alone (-4.2%). In the group who had access to the medications, 62.5% of the participants lost at least 5% of their weight, compared to 44.8% of the participants in the group with the weight management program alone. SMA attendance was higher among the participants who had access to the weight loss medications.

"Many patients see improvement in their health when they lose 5% of their weight," said Kevin M. Pantalone, D.O., first author of the study and an endocrinologist at Cleveland Clinic. "Based on our study results, access to anti-obesity medications combined with a multidisciplinary weight management program provides a more effective treatment compared to a weight management program without access to these medications."

More long-term research is needed in real-world, employer-based settings to evaluate the costs and benefits of anti-obesity medications and their use in conjunction with workplace wellness plans.

 

Breastfeeding, even for a few days, linked to lower blood pressure in early childhood

AMERICAN HEART ASSOCIATION

 Babies who were breastfed, even for a few days, had lower blood pressure as toddlers and these differences in blood pressure may translate into improved heart and vascular health as adults, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.

Research has found that cardiovascular disease risk factors, including high blood pressure, can start in childhood. Studies have also confirmed breastfeeding is associated with lower cardiovascular disease risk in adulthood. However, the amount and length of time breastfeeding that is needed to achieve cardiovascular benefit has not been clear.

"This is the first study to evaluate the association of breastfeeding in the first days of life and blood pressure in early childhood," said lead study author Kozeta Miliku, M.D., Ph.D., clinical science officer of the CHILD Cohort Study and post-doctoral fellow in medicine at McMaster University in Hamilton, Ontario, Canada. "Infants who received even a relatively small amount of their mother's early breast milk, also known as colostrum, had lower blood pressure at 3 years of age, regardless of of how long they were breastfed or when they received other complementary foods."

Colostrum is known to be especially rich in growth factors, immunologic components and stem cells that are extremely beneficial to newborns and only found in human breastmilk.

Researchers used data from the ongoing Canadian CHILD Cohort Study - a study of over 3,000 children who were born between 2009-2012 and have been followed ever since to understand how early life experiences shape health and development. They analyzed infant feeding information collected from hospital records and caregiver questionnaires for nearly 2,400 children.

Among those children, 98% were breastfed to some extent, including 4% who received "early limited breastfeeding" defined as a few breastfeedings during the hospital stay. Only 2% of children in the study were not breastfed at all.

Among breastfed children, 78% were breastfed for six months or more and 62% were exclusively breastfed for at least three months. Exclusive breastfeeding meant breast milk only, without any formula, solid foods or other fluids since birth. On average, mothers who never breastfed were younger, more likely to smoke during pregnancy and less likely to have a post-secondary degree, compared to the mothers who breastfed briefly or beyond their hospital stay.

Researchers found:

At 3 years of age, the children who were never breastfed had higher blood pressure measures (average 103/60 mm Hg), compared to those who were breastfed for any duration (average of 99/58 mm Hg).

Among the infants who received only limited early breastfeeding while in the hospital as newborns, blood pressure measures were also lower (average of 99/57 mm Hg) compared to those who were never breastfed (average of 103/60 mm Hg).

Blood pressure among the toddlers who had been breastfed was lower regardless of their body mass index at age 3 or their mothers' social, health or lifestyle factors.

Blood pressure was also lower among toddlers who had been breastfed, regardless of how long they were breastfed or if they received other complementary nutrition and foods.

"The benefits of sustained and exclusive breastfeeding are well documented for numerous health conditions, including respiratory infections and diarrheal disease during infancy, and chronic conditions including asthma and obesity later in life," said senior study author Meghan B. Azad, Ph.D., deputy director of the CHILD Cohort Study, associate professor of pediatrics and child health at the University of Manitoba, and research scientist at the Children's Hospital Research Institute of Manitoba in Winnipeg, Canada. "Our study suggests that for cardiovascular outcomes such as blood pressure, even a brief period of breastfeeding is beneficial. This points to colostrum as a key factor in shaping developmental processes during the newborn period. For many reasons, sustained breastfeeding should be strongly supported, and it is also important to understand that 'every drop counts,' especially in those critical first few days of life."

"Doctors and public health policymakers should consider the importance of educating new mothers about breastfeeding and offering immediate postpartum lactation support," said Azad, who co-directs the Manitoba Interdisciplinary Lactation Centre. "Our study's results suggest the short-term savings from not providing in-hospital breastfeeding support and discharging moms too quickly could be greatly outweighed by the long-term costs from reduced cardiovascular health later in life."

Researchers noted further investigation is warranted to examine the bioactive components of colostrum, understand how they influence cardiovascular development and determine their long-term associations with cardiovascular health. The study has some limitations including its observational design, meaning it does not allow researchers to confirm a cause-and-effect relationship between breastfeeding and blood pressure in early life. In addition, researchers collected only a single blood pressure measurement, rather than taking the average of at least two measurements, and there were few infants who had never been breastfed, which limited comparisons.

"This important study provides ongoing support for the premise that care during infancy can influence heart health. While further investigation is needed to understand the mechanisms responsible for the positive impact of early breastfeeding on blood pressure in young children, the authors should be commended for their identification of a modifiable factor that has the potential to improve child health," said Shelley Miyamoto, M.D., FAHA, chair of the American Heart Association's Council on Lifelong Congenital Heart Disease and Heart Health in the Young (Young Hearts) and Jack Cooper Millisor Chair in Pediatric Heart Disease and director of the Cardiomyopathy Program at Children's Hospital Colorado in Aurora.

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Three in ten Americans increased supplement use since onset of pandemic

 

 Twenty-nine percent of Americans are taking more supplements today than they were before the COVID-19 pandemic, bringing the percentage of U.S. supplement-takers to 76%, according to a new survey conducted by The Harris Poll on behalf of Samueli Foundation. Nearly two-thirds of those who increased supplement use (65%) cited a desire to enhance their overall immunity (57%) or protection from COVID-19 (36%) as reasons for the increase. Other common reasons for increasing supplement use were to take their health into their own hands (42%), improve their sleep (41%), and improve their mental health (34%).

"The COVID-19 pandemic is a catalyst for increased supplement use," said Wayne Jonas, MD, executive director of Integrative Health Programs at Samueli Foundation. "Supplements--when used under the guidance of health care professionals--can be beneficial for one's health. Unfortunately, however, many people are unaware of the risks and safety issues associated with their use."

More than half of Americans taking supplements (52%) mistakenly believe that most dietary supplements available for purchase have been declared safe and effective by the Food and Drug Administration, according to the June 2021 online survey of more than 2,000 U.S. adults. Nearly one-third of supplement-takers (32%) believe that if a supplement could be dangerous, it would not be allowed to be sold in the U.S.

"Contrary to what many believe, the FDA does not regulate supplements. In fact, many supplements are not identified as dangerous until after people are negatively affected by them," said Jonas. "There are benefits to one's health from supplements, but also risks, so I encourage anyone who is taking a supplement or thinking of taking one to discuss it with your health care provider first."

Fewer than half of Americans who use supplements (47%) say they consulted with their health care provider before use, despite national guidelines that strongly recommend doing so. Further, 46% of Americans currently taking prescription medications say they have not discussed with their health provider the potential interactions that supplements could have with their prescriptions. But the desire to speak to their physicians is there.

Four in five Americans said they would feel comfortable sharing which supplements they take with their health care provider (81%) and say it is important to tell their health care provider whether or not they are taking supplements (80%). They also identified various barriers to discussing supplements with their health care providers:

-41% of those currently taking supplements said that it hasn't occurred to them to discuss their supplement use with their health care provider, including half of those ages 18-34 (49%).

-35% of all Americans said they don't think their health care provider is interested in whether or not they are taking supplements.

-32% of Americans don't think their health care provider knows enough about supplements to advise them properly.

-26% of those currently taking supplements are worried that their health care provider will judge them based on the supplements they are taking.

"As more people begin taking supplements, we need to be sure that they have the information needed to make informed and healthy decisions," said Jonas. "My obligation, as a physician, is to help patients understand which supplements can play a safe and effective part of their overall health and well-being goals. The good news is that patients are willing to discuss this topic, but it is up to providers to ask."

Other findings from the survey showed further differences based on race and ethnicity:

-86% of White (non-Hispanic) Americans said they would be comfortable sharing which supplements they take with their health care provider, compared to only 67% of Hispanics and 75% of Blacks.

-Black (49%) and Hispanic (50%) supplement users were more likely than Whites (36%) to say that it hasn't occurred to them to discuss their supplement use with their health care provider.

-More than 1 in 3 Hispanic adults (35%) said they worry that their health care provider will judge them based on the supplements they take, and 46% said they don't think their health care provider is interested (compared to 31% of White (non-Hispanic) adults).

The need for nuance in carbohydrate recommendations

A more complex, holistic and non-reductionist approach to defining carbohydrate quality is needed

 

Carbohydrates have traditionally been the largest source of energy intake for much of the world's population1. However, without a standard definition for carbohydrate quality, some foods that contain carbohydrates are often stigmatized based on isolated and reductionist assessment methods that fail to consider their contributions to nutrient intakes and balanced, healthy diets. A new perspective piece, published in Advances in Nutrition, brings to light the pressing need to define carbohydrate quality, to better assess the value of nutrient-dense carbohydrate-containing foods in healthy lifestyles. Ultimately, the authors call for a more holistic approach to carbohydrate guidance to address the complex needs of both people and the planet.

"To date, terms like 'good carbs' and 'bad carbs' have been inconsistently assigned to a plethora of foods based on overly simplistic and narrowly focused measures, like glycemic index (GI) or fiber content," states Rebekah Schulz of University of Minnesota and perspective piece coauthor. "While these aspects can be individual pieces of the puzzle, they don't reflect the full picture of carbohydrate quality. For example, while GI may be a useful index in isolation, it is not representative of real-life dietary intake when carbohydrates are consumed with other foods, nor does it account for a food's overall nutrient content or planetary impact."

This paper addresses the strengths and weaknesses of current methods used to assess carbohydrate quality, proposes additional indices to include in a standardized quality carbohydrate definition, and defines research questions for further exploration. Within the perspective piece, authors analyzed various existing frameworks for carbohydrate quality and weighed the pros and cons of indexing based solely on measures such as GI, whole grain foods, fiber and added sugar.

The authors concluded that, "for truly relevant and applicable dietary guidance, the framework should focus on nutrient contributions and take into account various ways to measure and analyze nutrients, as well as be nimble to adjust for new research findings and data."

Carbohydrate Quality: Spotlight on Fruits & Vegetables

The authors also note that current approaches to assessing carbohydrate quality may lead to even greater consumer confusion of nutritional recommendations for specific foods, including fruits and vegetables. Given that one in 10 Americans fall short of meeting their fruit and vegetable requirements2, it's important that a holistic and standardized approach to dietary carbohydrate guidance is established to promote both human and planetary health as effectively as possible.

"Potatoes are one example of a food that tends to be misclassified or misunderstood based significantly on their GI value - even though preparation techniques and common consumption methods are not reflected accurately within a GI value," points out Joanne Slavin, PhD, RD of University of Minnesota and perspective piece coauthor. "Potatoes are a nutrient-dense vegetable that provide several important nutrients - like fiber, potassium, Vitamin C and resistant starch - to Americans' diets and have been consumed for centuries as a main staple in various cultures. Additionally, potatoes serve an important role in food security in developing countries."

A Forward-Looking Solution: Establishing a Standardized Carbohydrate Quality Metric

Overall, there is a general shift away from one-directional and overly simplified dietary guidance, as any food or nutrient can have a place as part of a healthy lifestyle. Thus, to best define high quality carbohydrates, the authors call for a standardized carbohydrate quality metric, such as an algorithm that encompasses a broader spectrum of factors.

"There is a need to provide easy tools grounded in strong science," added Schulz. "When consumers need to make a quick choice about carbohydrate-containing foods, they should feel comfortable knowing that there is a comprehensive, science-backed formula or algorithm behind-the-scenes helping guide this decision."

The authors propose several potential quality indices to be considered when assessing carbohydrate quality:

• Whole-grain, fiber, and added-sugar content
• Ratios of total carbohydrate to fiber and added sugar to fiber in a food
• Protein quality
• Degree of processing
• Environmental impact of a food

"As dietary guidance rightly moves away from isolated nutrient recommendations toward broader and more flexible dietary patterns, it's clear we need to better define the quality underpinnings of these patterns, including carbohydrates," notes Slavin. "By establishing an algorithm to assess carbohydrate quality, the result would positively impact both health and environmental outcomes and create consistent ways to measure intake across populations."

Ultra-processed food linked to higher risk of IBD

 A higher intake of ultra-processed food is associated with higher risk of inflammatory bowel disease (IBD), finds a study published by The BMJ today.

Ultra-processed foods include packaged baked goods and snacks, fizzy drinks, sugary cereals, ready meals containing food additives, and reconstituted meat and fish products -- often containing high levels of added sugar, fat and salt, but lacking in vitamins and fibre.

Inflammatory bowel disease (IBD) is more common in industrialised nations and it is thought that dietary factors might play a role, but data linking ultra-processed food intake with IBD are limited.

To explore this further, an international team of researchers drew on detailed dietary information from 116,087 adults aged 35-70 years living in 21 low, middle, and high income countries who were taking part in the Prospective Urban Rural Epidemiology (PURE) study.

PURE is examining the impact of societal influences on chronic diseases in different countries around the world.

Participants were enrolled in the study between 2003 and 2016 and were assessed at least every three years. Over an average follow-up of 9.7 years, new diagnoses of IBD, including Crohn's disease or ulcerative colitis, were recorded.

During this time, 467 participants developed IBD (90 with Crohn's disease and 377 with ulcerative colitis).

After taking account of other potentially influential factors, the researchers found that higher intake of ultra-processed food was associated with a higher risk of IBD.

For example, compared with less than one serving of ultra-processed food per day, they found an 82% increased risk of IBD among those who consumed five or more servings per day, and a 67% increased risk for 1-4 servings per day.

Different subgroups of ultra-processed food, including soft drinks, refined sweetened foods, salty snacks, and processed meat, each were associated with higher risks of IBD.

In contrast, intakes of white meat, red meat, dairy, starch, and fruit, vegetables, and legumes (such as peas, beans and lentils) were not associated with IBD.

Results were consistent for Crohn's disease and ulcerative colitis, and were similar after further analysis to test the risk of developing IBD based on age and region, suggesting that the findings are robust.

This is an observational study so can't establish causality. What's more, results relied on self-reported diagnoses and did not account for dietary changes over time. And the researchers cannot rule out the possibility that other unmeasured (confounding) factors may have affected their results.

Nevertheless, they say their findings "support the hypothesis that intake of ultra-processed foods could be an environmental factor that increases the risk of IBD."

As white meat, unprocessed red meat, dairy, starch, and fruit, vegetables, and legumes were not found to be associated with development of IBD, this study suggests that it might not be the food itself that confers this risk but rather the way the food is processed or ultra-processed, they explain.

"Further studies are needed to identify specific potential contributory factors among processed foods that might be responsible for the observed associations in our study," they conclude.

Study shows diet causes 84% drop in troublesome menopausal symptoms--without drugs

PHYSICIANS COMMITTEE FOR RESPONSIBLE MEDICINE

A new study, published by the North American Menopause Society in the journal Menopause, found a plant-based diet rich in soy reduces moderate-to-severe hot flashes by 84%, from nearly five per day to fewer than one per day. During the 12-week study, nearly 60% of women became totally free of moderate-to-severe hot flashes. Overall hot flashes (including mild ones) decreased by 79%.

The study, called the WAVS trial--the Women's Study for the Alleviation of Vasomotor Symptoms-shows that diet changes can be much more powerful for treating hot flashes than scientists had thought. Vasomotor symptoms refer to night sweats, hot flashes, and flushes.

The study used no hormone medications or extracts. Instead, the research team tested a combination of a low-fat plant-based diet plus 1/2 cup of ordinary soybeans added to a salad or soup each day.

"This is a game changer for women aged 45 and over, most of whom we now know can get prompt relief from the most severe and troubling menopause symptoms without drugs," says lead researcher Neal Barnard, MD, president of the Physicians Committee and adjunct professor at the George Washington University School of Medicine.

As many as 80% of postmenopausal women suffer from hot flashes. Heat wells up from the chest, causing flushing, sweating, and chills. At night, hot flashes interfere with sleep. Estrogen-based medications were once routinely used to treat hot flashes but have been shown to increase the risk of breast cancer and other serious problems. Isoflavone extracts from soybeans work only modestly, leaving women and their doctors with few effective options.

Study Details

Postmenopausal women reporting two or more hot flashes per day were randomly assigned to either an intervention group--consisting of a low-fat, vegan diet, including half a cup of cooked soybeans daily--or to a control group that made no diet changes for 12 weeks. Frequency and severity of hot flashes were recorded using a mobile application, and vasomotor, psychosocial, physical, and sexual symptoms were assessed using the Menopause Specific Quality of Life Questionnaire (MENQOL).

Each participant was given a digital self-calibrating scale to track body weight day by day, a mobile app to track hot flashes in real time, and an Instant Pot to prepare soybeans at home. Each week, the group got together with the research team via Zoom.

"Previous studies have shown that soy could be beneficial, so we decided to put a diet change to the test," says study author Hana Kahleova, MD, PhD, director of clinical research for the Physicians Committee. "We believe that the combination is what is important. By the end of the study, the majority of women on a plant-based diet rich in soy reported that they no longer experienced moderate-to-extreme hot flashes at all and that they experienced significant improvements in their quality of life."

Key Findings

Total hot flashes decreased by 79% and moderate-to-severe hot flashes decreased by 84% in the intervention group. At the study's conclusion, 59% of intervention-group participants reported becoming free of moderate and severe hot flashes. There was no change in this variable in the control group.

In previous randomized trials, soy products have been shown to modestly reduce the frequency of hot flashes. The researchers theorize that the effect may be a result of soy products containing isoflavones, which can be metabolized by gut bacteria into equol--a nonsteroidal compound that has been shown in some studies to reduce the incidence and severity of hot flashes. Previous studies have also shown that those following vegetarian or vegan diets produce higher levels of equol. The new study showed a more robust response, using the combination of a plant-based diet plus soy.

Many study participants also reported improvements in sexual symptoms, mood, and overall energy.

"This was basically a lifesaver for me," said one study participant. "I've got my quality of life back." Another said, "I am sleeping better, and my hot flashes diminished tremendously." Several participants also noticed significant weight loss and better digestion.
"Before you jump to any kind of medication, I would try this route, because it's easy," a study participant said. "Anybody can do it."

The study was based on the new approach to menopausal symptoms described by Dr. Barnard in his book Your Body in Balance. After the book was released in 2020, a reader contacted Dr. Barnard to let him know that his method eliminated her hot flashes within five days. Rather than using isoflavone extracts or soy foods such as soy milk or tofu, she used whole soybeans.

The effect of acute exercise in humans on cancer cell growth

New research presented at The Physiological Society's Annual Conference Physiology 2021 shows that molecules released into the bloodstream during exercise (such as small proteins) can act directly on bowel cancer cells to slow down their growth.

Previous research has shown that regular physical activity reduces the risk of developing bowel cancer. This is mainly thought to happen because physical activity can help individuals to maintain a healthy body weight.

This new research shows that being physically active may reduce the risk of getting bowel cancer, even if the physical activity does not lead to weight loss.

These are preliminary findings, but having a better understanding of the mechanisms linking physical activity and cancer risk will help develop the most effective exercise programmes for preventing cancer development.

It could also help develop drugs that can mimic some of the benefits of exercise.

Furthermore, this research could ultimately lead to exercise being part of standard care as part of bowel cancer screening programmes, which could reduce the number of people who develop cancer. ?

The study was done on 16 male participants who had lifestyle risk factors for bowel cancer (all participants were 50 years or older, had overweight or obesity, and did not regularly exercise).

The researchers collected blood samples from participants before and after 45 minutes of 'moderate' intensity indoor cycling, and before and after a non-exercise 'control' experiment.

They assessed whether exercise altered the concentration of specific proteins in the blood.

Finally, they then added the liquid portion of each blood sample that contains the proteins (known as serum) to bowel cancer cells in a laboratory and monitored cancer cell growth over 48 hours.

The main limitation of this research is that the cancer cells were grown in a dish under tightly-controlled laboratory conditions. Cancer tumours in humans are more complex and interact with the environment around them, such as surrounding blood vessels and immune cells. This means that the findings may not necessarily apply to real-life cancer tumours - this is something the researchers will investigate in the future.

Dr Sam Orange, the presenter and lead author of this research said: Following on from this research, we want to understand a few more things, including which specific molecules in the blood are responsible for reducing the growth of the bowel cancer cells, and whether exercise performed at a high-intensity has a more pronounced effect on bowel cancer cell growth than exercise performed at a moderate-intensity.

A recent study shows that spending time outdoors has a positive effect on our brains

If you're regularly out in the fresh air, you're doing something good for both your brain and your well-being. This is the conclusion reached by researchers at the Max Planck Institute for Human Development and the Medical Center Hamburg-Eppendorf (UKE). The longitudinal study recently appeared in The World Journal of Biological Psychiatry.

During the Corona pandemic, walks became a popular and regular pastime. A neuroscientific study suggests that this habit has a good effect not only on our general well-being but also on our brain structure. It shows that the human brain benefits from even short stays outdoors. Until now, it was assumed that environments affect us only over longer periods of time.

The researchers regularly examined six healthy, middle-aged city dwellers for six months. In total, more than 280 scans were taken of their brains using magnetic resonance imaging (MRI). The focus of the study was on self-reported behavior during the last 24 hours and in particular on the hours that participants spent outdoors prior to imaging. In addition, they were asked about their fluid intake, consumption of caffeinated beverages, the amount of time spent outside, and physical activity, in order to see if these factors altered the association between time spent outside and the brain. In order to be able to include seasonal differences, the duration of sunshine in the study period was also taken into account.

Brain scans show that the time spent outdoors by the participants was positively related to gray matter in the right dorsolateral-prefrontal cortex, which is the superior (dorsal) and lateral part of the frontal lobe in the cerebral cortex. This part of the cortex is involved in the planning and regulation of actions as well as what is referred to as cognitive control. In addition, many psychiatric disorders are known to be associated with a reduction in gray matter in the prefrontal area of the brain.

The results persisted even when the other factors that could also explain the relationship between time spent outdoors and brain structure were kept constant. The researchers performed statistical calculations in order to examine the influence of sunshine duration, number of hours of free time, physical activity, and fluid intake on the results. The calculations revealed that time spent outdoors had a positive effect on the brain regardless of the other influencing factors.

"Our results show that our brain structure and mood improve when we spend time outdoors. This most likely also affects concentration, working memory, and the psyche as a whole. We are investigating this in an ongoing study. The subjects are asked to also solve cognitively challenging tasks and wear numerous sensors that measure the amount of light they are exposed to during the day, among other environmental indicators," says Simone Kühn, head of the Lise Meitner Group for Environmental Neuroscience at the Max Planck Institute for Human Development and lead author of the study.

The results therefore, support the previously assumed positive effects of walking on health and extend them by the concrete positive effects on the brain. Because most psychiatric disorders are associated with deficits in the prefrontal cortex, this is of particular importance to the field of psychiatry.

"These findings provide neuroscientific support for the treatment of mental disorders. Doctors could prescribe a walk in the fresh air as part of the therapy - similar to what is customary for health cures," says Anna Mascherek, post-doctoral fellow in the Department of Psychiatry and Psychotherapy of the Medical Center Hamburg-Eppendorf (UKE) and co-author of the study.

In the ongoing studies, the researchers also want to directly compare the effects of green environments vs urban spaces on the brain. In order to understand where exactly the study participants spend their time outdoors, the researchers plan to use GPS (Global Positioning System) data and include other factors that may play a role such as traffic noise and air pollution.

Keeping your brain active may delay Alzheimer's dementia 5 years

AMERICAN ACADEMY OF NEUROLOGY

Research News

Keeping your brain active in old age has always been a smart idea, but a new study suggests that reading, writing letters and playing card games or puzzles in later life may delay the onset of Alzheimer's dementia by up to five years. The research is published in the July 14, 2021, online issue of Neurology, the medical journal of the American Academy of Neurology.

"The good news is that it's never too late to start doing the kinds of inexpensive, accessible activities we looked at in our study," said study author Robert S. Wilson, PhD, of Rush University Medical Center in Chicago. "Our findings suggest it may be beneficial to start doing these things, even in your 80s, to delay the onset of Alzheimer's dementia."

The study looked at 1,978 people with an average age of 80 who did not have dementia at the start of the study. The people were followed for an average of seven years. To determine if they had developed dementia, participants were given annual examinations, which included a number of cognitive tests.

When the study began, people rated their participation in seven activities on a five-point scale. The questions included: "During the past year, how often did you read books?" and "During the past year, how often did you play games like checkers, board games, cards or puzzles?"

Participants also answered questions about cognitive activity in childhood, adulthood and middle age.

Researchers then averaged each person's responses, with a score of one meaning once a year or less and score of five meaning every day or almost every day. People in the group with high cognitive activity scored an average of 4.0 which meant activities several times per week, compared to an average score of 2.1 for those with low cognitive activity, which meant activities several times per year.

During the study follow-up period, 457 people with an average age of 89 were diagnosed with Alzheimer's dementia. People with the highest levels of activity, on average, developed dementia at age 94. The people with the lowest cognitive activity, on average, developed dementia at age 89, a difference of five years. The results were similar when researchers adjusted for other factors that could affect dementia risk, such as education level and sex.

To test the idea that low cognitive activity may be an early sign of dementia, not the other way around, researchers also looked at the brains of 695 people who died during the study. Brain tissue was examined for markers of Alzheimer's like amyloid and tau protein deposits, but researchers found no association between how active they were cognitively and markers of Alzheimer's disease and related disorders in their brains.

"Our study shows that people who engage in more cognitively stimulating activities may be delaying the age at which they develop dementia," Wilson said. "It is important to note, after we accounted for late life level of cognitive activity, neither education nor early life cognitive activity were associated with the age at which a person developed Alzheimer's dementia. Our research suggests that the link between cognitive activity and the age at which a person developed dementia is mainly driven by the activities you do later in life."

A limitation of the study is that it was based on a group of mainly white people who had high levels of education. Further research will be needed to determine if the findings apply to the general population.