Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life

An update to the Lancet Commission on dementia prevention, intervention and care adds excessive alcohol intake, head injury and air pollution to nine previously identified modifiable risks

UNIVERSITY OF SOUTHERN CALIFORNIA - HEALTH SCIENCES

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IMAGE: MODIFYING 12 RISK FACTORS OVER A LIFETIME COULD DELAY OR PREVENT 40% OF DEMENTIA CASES. view more 

CREDIT: COURTESY OF KECK MEDICINE OF USC

LOS ANGELES -- Modifying 12 risk factors over a lifetime could delay or prevent 40% of dementia cases, according to an updatedreport by the Lancet Commission on dementia prevention, intervention and care presented at the Alzheimer's Association International Conference (AAIC 2020).

Twenty-eight world-leading dementia experts added three new risk factors in the new report -- excessive alcohol intake and head injury in mid-life and air pollution in later life. These are in addition to nine factors previously identified by the commission in 2017: less education early in life; mid-life hearing loss, hypertension and obesity; and smoking, depression, social isolation, physical inactivity and diabetes later in life (65 and up).

"We are learning that tactics to avoid dementia begin early and continue throughout life, so it's never too early or too late to take action," says commission member and AAIC presenterLon Schneider, MD, co-director of the USC Alzheimer Disease Research Center's clinical core and professor of psychiatry and the behavioral sciences and neurology at the Keck School of Medicine of USC.

Dementia affects some 50 million people globally, a number that is expected to more than triple by 2050, particularly in low- and middle-income countries where approximately two-thirds of people with dementia live, according to the report. Women are also more likely to develop dementia than men.

However, in certain countries, such as the United States, England and France, the proportion of older people with dementia has fallen, probably in part due to lifestyle changes, demonstrating the possibility of reducing dementia through preventative measures, Schneider says.

Schneider and commission members recommend that policymakers and individuals adopt the following interventions:

• Aim to maintain systolic blood pressure of 130 mm Hg or less from the age of 40.
• Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
• Reduce exposure to air pollution and second-hand tobacco smoke.
• Prevent head injury (particularly by targeting high-risk occupations).
• Limit alcohol intake to no more than 21 units per week (one unit of alcohol equals 10 ml or 8 g pure alcohol).
• Stop smoking and support others to stop smoking.
• Provide all children with primary and secondary education.
• Lead an active life into mid-life and possibly later life.
• Reduce obesity and the linked condition of diabetes.

The report also advocates for holistic, individualized and evidenced-based care for patients with dementia, who typically have more hospitalizations for conditions that are potentially manageable at home and are at greater risk for COVID-19. In addition, it recommends providing interventions for family caregivers who are at risk for depression and anxiety.

The commission members conducted a thorough investigation of all the best evidence in the field, including systematic literature reviews, meta-analyses and individual studies, to reach their conclusions.

Laughter acts as a stress buffer -- and even smiling helps

People who laugh frequently in their everyday lives may be better equipped to deal with stressful events - although this does not seem to apply to the intensity of laughter. These are the findings reported by a research team from the University of Basel in the journal PLOS ONE.

It is estimated that people typically laugh 18 times a day - generally during interactions with other people and depending on the degree of pleasure they experience. Researchers have also reported differences related to time of day, age, and gender - for example, it is known that women smile more than men on average. Now, researchers from the Division of Clinical Psychology and Epidemiology of the Department of Psychology at the University of Basel have recently conducted a study on the relationship between stressful events and laughter in terms of perceived stress in everyday life.

Questions asked by app

In the intensive longitudinal study, an acoustic signal from a mobile phone app prompted participants to answer questions eight times a day at irregular intervals for a period of 14 days. The questions related to the frequency and intensity of laughter and the reason for laughing - as well as any stressful events or stress symptoms experienced - in the time since the last signal.

Using this method, the researchers working with the lead authors, Dr. Thea Zander-Schellenberg and Dr. Isabella Collins, were able to study the relationships between laughter, stressful events, and physical and psychological symptoms of stress ("I had a headache" or "I felt restless") as part of everyday life. The newly published analysis was based on data from 41 psychology students, 33 of whom were women, with an average age of just under 22.

Intensity of laughter has less influence

The first result of the observational study was expected based on the specialist literature: in phases in which the subjects laughed frequently, stressful events were associated with more minor symptoms of subjective stress. However, the second finding was unexpected. When it came to the interplay between stressful events and intensity of laughter (strong, medium or weak), there was no statistical correlation with stress symptoms. "This could be because people are better at estimating the frequency of their laughter, rather than its intensity, over the last few hours," says the research team.

Older Americans receive cancer screenings past recommended age

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Older Americans may be receiving cancer screenings not recommended by the U.S. Preventive Services Task Force, according to Penn State College of Medicine researchers.

The task force recommends routine screening for colorectal, cervical and breast cancers. These recommendations end for people at upper ages or who develop a condition that decreases their life expectancy. A routine screening above the recommended age is called overscreening.

"There are two reasons why people should stop screening for cancer," Jennifer Moss, assistant professor of family and community medicine and public health sciences, said. "First, when they 'age-out' of the recommended screening age, or second, when their life expectancy is too low. As with any clinical procedure, there are risks from the cancer screening tests. These risks are even higher for people who have aged-out or who have a low life expectancy."

To determine the extent of overscreening nationally, the researchers analyzed data from the Center for Disease Control and Prevention's 2018 Behavioral Risk Factor Surveillance System. This survey collects data about a variety of health behaviors, including cancer screening. In total, researchers reviewed data for 20,937 men and 34,244 women for colorectal cancer, 82,811 women for cervical cancer and 38,356 women for breast cancer. Researchers identified overscreened patients as those over age 75 for colorectal cancer screening, and women over 65 for cervical and over 75 for breast cancer screenings. The researchers also determined patient location and whether the patient lived in or near a city.

"We can never exactly know a person's life expectancy, but my co-authors and I used a scientifically-accepted index to calculate estimated risk of death over the next 10 years," Moss said. "We hypothesized that people who are older or who have lower life expectancies would be less likely to report having received their cancer screenings recently, but we didn't see strong evidence of this. This pattern shows us that too many people are getting screened after a point when the screening is probably not going to provide benefit and may cause harm."

Researchers found overscreening of 59.3% of men and 56.2% of women for colorectal cancer; 45.8% of women for breast cancer and 73% of women for breast cancer. Research results appear in the journal JAMA Network Open.

"This pattern emphasizes the need for additional research to identify risks and benefits of screening in older adults and determine who may benefit from screening after the recommended upper-age limits," the researchers reported.

Overscreening was higher for women who live in or near cities. Researchers offer several reasons this may be. First, women who live in more rural areas may have longer and more trusting relationships with their healthcare providers, allowing for conversations about stopping cancer screenings. Second, rural women may have less access to screening facilities, reducing the number overscreened. Third, women who live in or near cities may receive automated screening reminders from more technologically-advanced healthcare facilities. Lastly, beliefs about cancer differ between rural and city populations. Those who live in or near a city may be more open to screening. Why men do not have the same overscreening difference is not known.

Preventing screenings that are not recommended is challenging, said the researchers. One reason is that life expectancy estimates are not always accurate. Another reason is that doctors and patients may not be comfortable discussing life expectancy and using it to make medical decisions. A third reason is that the healthcare system often encourages screening. A fourth reason is that awareness campaigns often do not highlight that screenings are not recommended for all ages.

"Guidelines for cancer screening must balance risks with benefits," the researchers reported. "Individuals with limited life expectancy can anticipate fewer benefits of cancer screening, particularly for colonoscopy."

This research helps inform the general healthcare system. Patients should discuss their individual health decisions, including cancer screening, with their healthcare providers.

Enjoying short-term pleasurable activities contributes much to a happy life

Relaxing on the sofa or savoring a delicious meal: Enjoying short-term pleasurable activities that don't lead to long-term goals contributes at least as much to a happy life as self-control, according to new research from the University of Zurich and Radboud University in the Netherlands. The researchers therefore argue for a greater appreciation of hedonism in psychology.

We all set ourselves long-term goals from time to time, such as finally getting into shape, eating less sugar or learning a foreign language. Research has devoted much time to finding out how we can reach these goals more effectively. The prevailing view is that self-control helps us prioritize long-term goals over momentary pleasure and that if you are good at self-control, this will usually result in a happier and more successful life.

"It's time for a rethink," says Katharina Bernecker, researcher in motivational psychology at the University of Zurich. "Of course self-control is important, but research on self-regulation should pay just as much attention to hedonism, or short-term pleasure." That's because Bernecker's new research shows that people's capacity to experience pleasure or enjoyment contributes at least as much to a happy and satisfied life as successful self-control.

Distraction disrupts pleasure

Bernecker and her colleague Daniela Becker of Radboud University developed a questionnaire to measure respondents' capacity for hedonism, i.e. their ability to focus on their immediate needs and indulge in and enjoy short-term pleasures. They used the questionnaire to find out whether people differ in their capacity to pursue hedonic goals in a variety of contexts, and whether this ability is related to well-being.

They found that certain people get distracted by intrusive thoughts in moments of relaxation or enjoyment by thinking about activities or tasks that they should be doing instead. "For example, when lying on the couch you might keep thinking of the sport you are not doing," says Becker. "Those thoughts about conflicting long-term goals undermine the immediate need to relax." On the other hand, people who can fully enjoy themselves in those situations tend to have a higher sense of well-being in general, not only in the short term, and are less likely to suffer from depression and anxiety, among other things.

More isn't always better

"The pursuit of hedonic and long-term goals needn't be in conflict with one another," says Bernecker. "Our research shows that both are important and can complement each other in achieving well-being and good health. It is important to find the right balance in everyday life."

Unfortunately, simply sitting about more on the sofa, eating more good food and going to the pub with friends more often won't automatically make for more happiness. "It was always thought that hedonism, as opposed to self-control, was the easier option," says Bernecker. "But really enjoying one's hedonic choice isn't actually that simple for everybody because of those distracting thoughts."

Conscious planning of downtime

This is currently a topical issue with more people working from home, as the environment where they normally rest is suddenly associated with work. "Thinking of the work you still need to do can lead to more distracting thoughts at home, making you less able to rest," says Bernecker.

So what can you do to enjoy your downtime more? More research is needed, but the researchers suspect that consciously planning and setting limits to periods of enjoyment could help to separate them more clearly from other activities, allowing pleasure to take place more undisturbed.

Lithium in drinking water linked with lower suicide rates

Naturally occurring lithium in public drinking water may have an anti-suicidal effect -- according to a new study from Brighton and Sussex Medical School (BSMS) and the Institute of Psychiatry, Psychology & Neuroscience at King's College London.

Published in the British Journal of Psychiatry, the study collated research from around the world and found that geographical areas with relatively high levels or concentration of lithium in public drinking water had correspondingly lower suicide rates.

Professor Anjum Memon, Chair in Epidemiology and Public Health Medicine at BSMS and lead author of the study, said: "It is promising that higher levels of trace lithium in drinking water may exert an anti-suicidal effect and have the potential to improve community mental health. The prevalence of mental health conditions and national suicide rates are increasing in many countries. Worldwide, over 800,000 people die by suicide every year, and suicide is the leading cause of death among persons aged 15-24 years."

"In these unprecedented times of COVID-19 pandemic and the consequent increase in the incidence of mental health conditions, accessing ways to improve community mental health and reduce the incidence of anxiety, depression and suicide is ever more important."

Lithium, sometimes referred to as the 'Magic Ion', is widely and effectively used as a medication for the treatment and prevention of manic and depressive episodes, stabilising mood and reducing the risk of suicide in people with mood disorders. Its anti-aggressive properties can help reduce impulsivity, aggression, violent criminal behaviour and chronic substance abuse.

Lithium is a naturally occurring element and is found in variable amounts in vegetables, grains, spices and drinking water. It is present in trace amounts in virtually all rocks, and is mobilised by weathering into soils, ground and standing water, and thus into the public water supply.

The health benefits and curative powers of naturally occurring lithium in water have been known for centuries. The Lithia Springs, an ancient Native American sacred medicinal spring, with its natural lithium-enriched water, is renowned for its health-giving properties. In fact, the popular soft drink 7-Up contained lithium when it was created in 1929.

Recent studies have also linked lithium to reduced incidence of Alzheimer's disease and other dementias. This raises the potential for its preventative use to combat the risk of dementia.

Professor Allan Young, Chair of Mood Disorders at King's College London, said: "This synthesis and analysis of all available evidence confirms previous findings of some individual studies and shows a significant relationship between higher lithium levels in drinking water and lower suicide rates in the community. The levels of lithium in drinking water are far lower than those recommended when lithium is used as medicine although the duration of exposure may be far longer, potentially starting at conception. These findings are also consistent with the finding in clinical trials that lithium reduces suicide and related behaviours in people with a mood disorder."

Professor Memon added: "Next steps might include testing this hypothesis by randomised community trials of lithium supplementation of the water supply, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance abuse and risk of suicide. This may provide further evidence to support the hypothesis that lithium could be used at the community level to reduce or combat the risk of these conditions."

Professor Carmine Pariante from the Royal College of Psychiatrists, commented: "This study shows that the boundaries between medication and nutritional interventions are not as rigid as we used to think, opening up the possibility of new treatments that span both domains. More knowledge of the beneficial properties of lithium and its role in regulating brain function can lead to a deeper understanding of mental illness and improve the wellbeing of patients with depression and other mental health problems."

The study involved systematic review and meta-analysis of all previous studies on the subject -- conducted in Austria, Greece, Italy, Lithuania, UK, Japan and USA -- which correlated naturally occurring lithium levels in drinking water samples and suicide rates in 1,286 regions/counties/cities in these countries.

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Flu vaccine could protect against serious heart and stroke complications

The rate of seasonal flu vaccinations among high-risk groups such as people over age 50 and nursing home residents is extremely low, and those who do get their flu vaccination significantly lower their cardiovascular risks for heart attack, TIA (transient ischemic attack), death and cardiac arrest, according to preliminary research to be presented July 27-30, 2020, at the virtual American Heart Association's Basic Cardiovascular Sciences 2020 Scientific Sessions. The meeting is a premier global exchange of the latest advances in basic cardiovascular science including research in fields like microRNAs, cardiac gene and cell therapy, and cardiac development.

The stress the influenza infection puts on the body may increase the risk of having a heart attack or stroke, which researchers note is well-known.

"These groups should have the highest vaccination rates because they are the most at risk; however, our findings show the opposite - flu vaccinations are under-utilized," said Roshni A. Mandania, B.S., lead author of the study and M.D. Candidate Class of 2021 at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine in El Paso, Texas. "As health care providers, we must do everything we can to ensure our most vulnerable populations are protected against the flu and its serious complications."

Using information from the 2014 National Inpatient Sample, the largest database of U.S. hospitals, researchers under the guidance of Debabrata Mukherjee, M.D., Chief of Cardiovascular Services at Texas Tech University Medical Center at El Paso, assessed the rate at which the flu vaccine was administered to patients designated by the Centers for Disease Control as high-risk (for the flu and its complications). The database includes people over age 50, HIV/AIDS patients, those residing in nursing homes and people who are obese. Researchers examined the impact of the flu vaccine on cardiovascular outcomes between patients who got vaccinated during hospitalization and those who did not.

Of more than 7 million high-risk patients hospitalized, researchers found:

only 168,325 received the flu vaccine;
adults age 50 and over were significantly less likely to be vaccinated compared to the general population (1.8% versus 15.3%);
however, the adults age 50 and over who were vaccinated had better outcomes in the year following vaccination, with a 28% lower risk of heart attack, a 73% lower risk of death, a 47% lower risk of TIA and an 85% lower risk of cardiac arrest;
the vaccination rate for patients with HIV/AIDS was 2.21%, compared to 8.2% who were free from this disease;
the vaccination rate for nursing home residents was 1.8%, versus 9.5% for those who live independently;
among obese patients, 2.4% were vaccinated, compared to 9% with a healthy weight;
cardiovascular outcomes were similar to adults over age 50 across the high-risk groups.

"The results we found are staggering. It's hard to ignore the positive effect the flu vaccine can have on serious cardiac complications," Mandania said. "Some people don't view flu vaccinations as necessary or important, and many may face barriers accessing health care including receiving the flu vaccine."

In this study, researchers assessed immunization solely in the hospital so it is possible some individuals may have received the flu vaccine in an outpatient setting. "Nevertheless, our study highlights the marked under-underutilization of flu vaccine in high-risk groups and underscores the need for a health care policy initiative to increase flu vaccinations among all patients and especially in high-risk groups," Mandania said.

According to the American Heart Association's Chief Medical Officer for Prevention, Eduardo Sanchez, M.D., M.P.H., FAAFP, this study provides additional merit for an Association project.

"We have partnered with the American Lung Association and the American Diabetes Association to collectively deliver a message to providers and to the general public that all adults and all children, by and large, should be getting influenza vaccinations year after year. In particular, for patients who have chronic diseases like high blood pressure, diabetes or emphysema, it is critically important to get the annual flu vaccine. The potentially serious complications of the flu are far, far greater for those with chronic diseases," said Sanchez.

Weight loss not always best strategy to enhance athletic fitness in young women

For young women seeking to improve their aerobic fitness and athletic performance, who are not overweight or obese, weight loss may be counterproductive, according to preliminary research to be presented July 27-30, 2020, at the American Heart Association's virtual Basic Cardiovascular Sciences 2020 Scientific Sessions. The meeting is a premier global exchange of the latest advances in basic cardiovascular science including research in fields like microRNAs, cardiac gene and cell therapy, and cardiac development.

"There is a common preoccupation among athletes in endurance sports that weight loss might improve their competitive performance; however, data on the topic has been mixed, based on small numbers and focused on men," said J. Sawalla Guseh, M.D., co-senior study author, an instructor in medicine at Harvard Medical School and a cardiovascular physician scientist at Massachusetts General Hospital in Boston.

Researchers evaluated the aerobic fitness of 805 women and 1,419 men, ages 17 through 94, who were patients at the Cardiovascular Performance Program at Massachusetts General Hospital between 2011 and 2019. Participants, tested because of suspected heart problems, ranged from professional athletes to non-athletes.

In the study, aerobic fitness was measured using peak VO2, the amount of oxygen a person consumes when they are exercising as hard as they can. The more oxygen a person can consume, the more aerobically fit they are. Highly fit women were those with at least a 20% greater VO2 than would have been predicted by their height, weight and gender.

Plotting the relationship between aerobic fitness and body mass index (BMI, a ratio of body weight in relation to height), researchers found:

among men of all ages and women 30 and older, aerobic fitness declined steadily with increases in BMI;
the relationship was more complex in women under 30, with the lowest aerobic fitness among those with the highest BMI and somewhat poorer aerobic fitness in women with low BMI; and
women under 30 who had the best aerobic fitness - aerobic capacity 20% better than expected of typical aerobic athletes - had an average BMI of 23.2 (such as a woman five feet five inches tall, weighing 140 pounds), which is at the upper range of the World Health Organization's recommended optimal BMI for good health.

"This serves as a reminder that low BMI is not a prerequisite for higher aerobic fitness," Guseh said. "In women who are not overweight or obese, a lower BMI may be aerobically counterproductive. Given the risks that can come with weight loss in athletes, and given that there are many other variables an athlete can adjust to maximize performance - such as training intensity, training frequency, skill acquisition, competition strategy, sleep and nutrition - we advocate that BMI and weight as targets should be de-emphasized for young adult women."

Researchers stress that there can be both short- and long-term negative consequences when an athlete consumes too few calories to support their activity level.

"The negative health risks include low bone mineral density, bone fractures, menstrual irregularities, higher circulating cholesterol levels, anemia, blood pressure and heart rate irregularities, depression and the development of eating disorders," Guseh said. "It's critical that if coaches or trainers want a young, normal-weight, female athlete to further lower her BMI, she should be empowered to ask why. Members of the athletic care team should be receptive to having this conversation in the context of the athlete's overall health and the potential adverse health impact."

The cross-sectional design of the study did not allow the researchers to prove a cause-and-effect relationship between BMI and aerobic fitness.