Alcohol problems severely undertreated

Heavy drinkers see doctors regularly, but few receive treatment for disorder

May 17, 2021

Science Daily/Washington University School of Medicine

Some 16 million Americans are believed to have alcohol use disorder, and an estimated 93,000 people in the U.S. die from alcohol-related causes each year. Both of those numbers are expected to grow as a result of heavier drinking during the COVID-19 pandemic.

Yet, in a new study involving data from more than 200,000 people with and without alcohol problems, researchers at Washington University School of Medicine in St. Louis found that although the vast majority of those with alcohol use disorder see their doctors regularly for a range of issues, fewer than one in 10 ever get treatment for drinking.

The findings are published in the June issue of the journal Alcoholism: Clinical & Experimental Research.

Analyzing data gathered from 2015 through 2019 via the National Survey on Drug Use and Health, the researchers found that about 8% of those surveyed met the current criteria for alcohol use disorder, the medical diagnosis for those with an addiction to alcohol. Of these people who met the criteria, 81% had received medical care in a doctor's office or spent time in a hospital or clinic during the previous year. But only 12% reported they had been advised to cut down on their drinking, 5% were offered information about treatment, and 6% received treatment, some of whom were not referred by their doctors but sought out treatment on their own.

"It's not that these people aren't in the health-care system," said first author Carrie M. Mintz, MD, an assistant professor of psychiatry. "But although they see doctors regularly, the vast majority aren't getting the help they need."

Mintz and her colleagues evaluated data from 214,505 people. The researchers first wanted to learn whether people with alcohol use disorder had access to health care and if they did, whether they had been screened about their alcohol use; they were considered to have been screened if their doctors simply had asked how much they drink. The researchers also evaluated whether people with drinking problems had been advised to cut down on drinking, had received additional information about treatment, or had received treatment or counseling.

The researchers found that although most people with alcohol use disorder had access to health care and although 70% reported they had been asked about alcohol use, that's where the care stopped.

"Some primary care doctors may not feel comfortable telling patients they should cut down on drinking, prescribing medication to help them cut back or referring them to treatment because they don't specialize in treating alcohol misuse; but the result is that many people who need treatment aren't getting it," said senior author Laura Jean Bierut, MD, the Alumni Endowed Professor of Psychiatry. "We used to see the same thing with smoking, but when physicians became educated about smoking and learned that many of their patients wanted to quit or cut back, doctors began offering more treatment, and more people were able to quit. We think the same thing may be possible with alcohol."

Among treatments that could be prescribed are the FDA-approved medications naltrexone, acamprosate and disulfiram, as well as psychotherapy and mutual-aid approaches, such as the 12-step program used by Alcoholics Anonymous.

"Alcohol use disorder is a chronic disease, but compared to other chronic diseases, it's wildly untreated," Bierut said. "For example, two-thirds of patients with HIV and 94% of patients with diabetes receive treatment, compared with only 6% of people with alcohol use disorder."

The researchers noted that during the pandemic, alcohol sales in the U.S. increased by 34%. Consequently, they expect that as the country emerges from COVID-19 and returns to normal, the number of people with alcohol use disorder will have climbed.

"We know alcohol use and misuse have increased during the pandemic," Mintz said. "It seems there has been a shift toward heavier drinking. Plus, many doctor's offices, AA groups and other support groups were shut down for a period of time, so we would hypothesize that even the relatively small percentage of people in treatment may have declined during the past year."

Mintz, C, Hartz S, Fisher S, Ramsey A, Geng E, Grucza R, Bierut L. A cascade of care for alcohol use disorder: using 2015-2019 National Survey on Drug Use and Health data to identify gaps in past 12-month care. Alcoholism: Clinical & Experimental Research, published online May 16, 2021.

https://www.sciencedaily.com/releases/2021/05/210517144730.htm

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Studies reveal skull as unexpected source of brain immunity

Immune cells from skull bone marrow guard the brain, spinal cord

June 3, 2021

Science Daily/Washington University School of Medicine

The immune system is the brain's best frenemy. It protects the brain from infection and helps injured tissues heal, but it also causes autoimmune diseases and creates inflammation that drives neurodegeneration.

Two new studies in mice suggest that the double-edged nature of the relationship between the immune system and the brain may come down to the origins of the immune cells that patrol the meninges, the tissues that surround the brain and spinal cord. In complementary studies published June 3 in the journal Science, two teams of researchers at Washington University School of Medicine in St. Louis unexpectedly found that many of the immune cells in the meninges come from bone marrow in the skull and migrate to the brain through special channels without passing through the blood.

These skull-derived immune cells are peacekeepers, dedicated to maintaining a healthy status quo. It's the other immune cells, the ones that arrive from the bloodstream, that seem to be the troublemakers. They carry genetic signatures that mark them as likely to promote autoimmunity and inflammation, and they become more abundant with aging or under conditions of disease or injury. Taken together, the findings reveal a key aspect of the connection between the brain and the immune system that could inform our understanding of a wide range of brain disorders.

"There has been this gap in our knowledge that applies to almost every neurological disease: neuro-COVID, Alzheimer's disease, multiple sclerosis, brain injury, you name it," said Jonathan Kipnis, PhD, the Alan A. and Edith L. Wolff Distinguished Professor of Pathology & Immunology and a BJC Investigator. Kipnis is the senior author on one of the papers. "We knew immune cells were involved in neurological conditions, but where were they coming from? What we've found is that there's a new source that hasn't been described before for these cells."

Earlier this year, Kipnis showed that immune cells stationed in the meninges keep tabs on the brain. As part of these new studies, Kipnis and Marco Colonna, MD, the Robert Rock Belliveau, MD, Professor of Pathology and the senior author on the other paper, independently launched projects to find where such cells come from. Kipnis focused on the innate arm of the immune system and Colonna on the adaptive arm. Innate immune cells are responsible for inflammation, which helps defend against infection and heal injuries, but also can damage tissues and contribute to degenerative conditions such as Alzheimer's and Parkinson's disease. Adaptive immune cells are capable of specifically targeting undesirables such as viruses and tumors, but they also can mistakenly home in on the body's own healthy tissues, resulting in autoimmune diseases such as multiple sclerosis.

Colonna and colleagues -- including co-first authors Simone Brioschi, PhD, a postdoctoral researcher, Wei-Le Wang, PhD, a postdoctoral researcher, and Vincent Peng, a graduate student -- traced the development of B cells, antibody-producing members of the adaptive immune system. They found that most B cells in the meninges arose and matured in the skull bone marrow. As B cells mature, they must be taught to distinguish between normal proteins from the body, which pose no threat, and foreign proteins that signal infection or disease and require a response. For B cells destined for a life patrolling the boundaries of the central nervous system, the skull is a convenient site for this education.

"B cells in the bone marrow of the skull come into contact with the central nervous system and are educated by the central nervous system," said Colonna, who is also a professor of medicine. "That would not happen if they were released into the blood. Because they are directly in contact with the brain, they learn to be tolerant of brain proteins."

Along with the tolerant B cells derived from the skull, the researchers also discovered a population of B cells that come into the meninges from the blood. These blood-derived B cells are not trained to ignore normal central nervous system proteins. Some of these cells may wrongly recognize harmless central nervous system proteins as foreign and produce antibodies against them, Colonna said. Moreover, the number of these blood-derived B cells increases with age, providing a clue to why the risk of neuro-immune conditions is higher in older people.

Meanwhile, Kipnis' team -- led by co-first authors Andrea Cugurra, a graduate student, Tornike Mamuladze, MD, a visiting researcher, and Justin Rustenhoven, PhD, a postdoctoral researcher -- was searching for the source of meningeal myeloid cells, a group of innate immune cells. They found that myeloid cells arose in the bone marrow of the skull and spinal vertebrae and entered the meninges via direct channels through the bone.

Using mouse models of multiple sclerosis and of brain and spinal cord injuries, Kipnis and colleagues found that myeloid cells swarm into the brain and spinal cord in response to injury or disease. Most of the entering cells are drawn from the resident population of myeloid cells in the meninges. These are biased toward regulating and modulating the immune response. But some myeloid cells come in from the blood, and these are more inflammatory, capable of causing damage if not properly controlled.

"Understanding where these cells come from and how they behave is a critical part of understanding the basic mechanisms of neuro-immune interactions, so we can design new therapeutic approaches for neurological conditions associated with inflammation," said Kipnis, who is also a professor of neurosurgery, of neurology and of neuroscience. "The location of these cells in the skull makes them relatively accessible, and opens up the possibility of designing therapies to alter the behavior of these cells and treat neuro-immune conditions."

https://www.sciencedaily.com/releases/2021/06/210603171058.htm

Secondary infections inflame the brain, worsening cognition in Alzheimer's disease

June 3, 2021

Science Daily/Trinity College Dublin

New research into Alzheimer's disease (AD) suggests that secondary infections and new inflammatory events amplify the brain's immune response and affect memory in mice and in humans -- even when these secondary events occur outside the brain.

Scientists believe that key brain cells (astrocytes and microglia) are already in an active state due to inflammation caused by AD and this new research shows that secondary infections can then trigger an over-the-top response in those cells, which has knock-on effects on brain rhythms and on cognition.

In the study, just published in Alzheimer's & Dementia, the journal of the Alzheimer's Association, mice engineered to show features of AD were exposed to acute inflammatory events to observe the downstream effects on brain inflammation, neuronal network function and memory.

These mice showed new shifts in the output of astrocytes and microglia and displayed new cognitive impairment and disturbed 'brain rhythms' that did not occur in healthy, age-matched, mice. These new onset cognitive changes are similar to acute and distressing psychiatric disturbances like delirium, that frequently occur in elderly patients.

Although it is difficult to replicate these findings in patients, the study additionally showed that AD patients who died with acute systemic infection showed heighted brain levels of IL-1β -- a pro-inflammatory molecule that was important in causing the heightened immune response and the new onset disruptions seen in the AD mice.

Colm Cunningham, Associate Professor in Trinity's School of Biochemistry and Immunology, and the Trinity Biomedical Sciences Institute, led the research. He said:

"Alzheimer's disease is the most common form of dementia, affecting more than 5% of those over 60 and this distressing, debilitating condition causes difficulties for a huge number of people across the globe. The more we know about the disease and its progression the better chance we have of treating those living with it. We believe our work adds to this knowledge base in a few ways. Primarily, we show that the Alzheimer's-affected brain has a greater vulnerability to acute inflammatory events, even if they occur outside the brain.

Placing this within the context of the slowly evolving progression of AD, we propose that these hypersensitive responses, now seen in multiple cell populations, may contribute to the negative outcomes that follow acute illness in older patients, including episodes of delirium and the accelerated cognitive trajectory that has been observed in patients who experience delirium before or during their dementia."

The research was supported by the US National Institutes of Health (NIH) and by the Wellcome Trust.

https://www.sciencedaily.com/releases/2021/06/210603083545.htm

Healthy lifestyle linked to better cognition for oldest adults -- regardless of genetic risk

New study suggests importance of maintaining healthy lifestyle even after age 80

June 1, 2021

Science Daily/PLOS

A new analysis of adults aged 80 years and older shows that a healthier lifestyle is associated with a lower risk of cognitive impairment, and that this link does not depend on whether a person carries a particular form of the gene APOE. Xurui Jin of Duke Kunshan University in Jiangsu, China, and colleagues present these findings in the open-access journal PLOS Medicine.

The APOE gene comes in several different forms, and people with a form known as APOE ε4 have an increased risk of cognitive impairment and Alzheimer's disease. Previous research has also linked cognitive function to lifestyle factors, such as smoking, exercise, and diet. However, it has been unclear whether the benefits of a healthy lifestyle are affected by APOE ε4, particularly for adults over 80 years of age.

To clarify the relationship between APOE ε4 and lifestyle, Jin and colleagues examined data from 6,160 adults aged 80 or older who had participated in a larger, ongoing study known as the Chinese Longitudinal Healthy Longevity Survey. The researchers statistically analyzed the data to investigate links between APOE ε4, lifestyle, and cognition. They also accounted for sociodemographics and other factors that could impact cognition.

The analysis confirmed that participants with healthy lifestyles or intermediately healthy lifestyles were significantly less likely to have cognitive impairment than those with an unhealthy lifestyle, by 55 and 28 percent, respectively. In addition, participants with APOE ε4 were 17 percent more likely to have cognitive impairment than those with other forms of APOE.

A previous study suggested that in individuals at low and intermediate genetic risk, favorable lifestyle profiles are related to a lower risk of dementia compared to unfavorable profiles. But these protective associations were not found in those at high genetic risk. However, the investigation showed the link between lifestyle and cognitive impairment did not vary significantly based on APOE ε4 status which represented the genetic dementia risk. This suggests that maintaining a healthier lifestyle could be important for maintaining cognitive function in adults over 80 years of age, regardless of genetic risk.

This cross-sectional study emphasized the importance of a healthy lifestyle on cognitive health. While further research will be needed to validate these findings among different population, this study could help inform efforts to boost cognitive function for the oldest of adults.

In the next step, the team will explore this association using the AD polygenetic risk score (AD-PRS) and explore the interactive relationship between AD-PRS and lifestyle on cognition with the longitudinal data.

https://www.sciencedaily.com/releases/2021/06/210601152005.htm

Role of sleep-related brain activity in clearing toxic proteins and preventing Alzheimer's disease

June 1, 2021

Science Daily/PLOS

Evidence of sleep-dependent low-frequency (<0.1 Hz) global brain activity in the clearance of Alzheimer's disease-related toxin buildup is presented in research published on 1st June 2021 in the open access journal PLOS Biology by Xiao Liu and colleagues at The Pennsylvania State University. This neuronal activity was more strongly linked with cerebrospinal fluid flow in healthy controls than higher risk groups and patients, and the findings could serve as a potential imaging marker for clinicians in evaluating patients.

The development of Alzheimer's disease is believed to be driven by the buildup of the toxic proteins amyloid-β and tau in the brain. The brain's glymphatic system plays a crucial role in clearing these toxins and previous work has shown a possible relationship between sleep-dependent global brain activity and the glymphatic system by showing this activity is coupled by cerebrospinal fluid flow essential for the glymphatic system.

Using 118 subjects in the Alzheimer's Disease Neuroimaging Initiative project, the researchers measured this global brain activity and cerebrospinal fluid flow as well as looking at behavioral data. Individuals underwent resting-state fMRI sessions two years apart, and the team compared their findings with neurobiological and neuropsychological markers related to Alzheimer's disease, such as levels of the toxic protein amyloid-β.

The strength of the connection between brain activity and cerebrospinal fluid flow was weaker in individuals at a higher risk or who had already developed Alzheimer's disease. Additionally, this weaker connection was associated with higher levels of amyloid-β and disease-related behavioral measures two years later. This suggests an important role for sleep-dependent global brain activity in the clearance of brain waste, and its connection to cerebrospinal fluid flow could be helpful as a future marker for clinical evaluation.

Dr. Liu adds, "The study linked the coupling between the resting-state global brain activity and cerebrospinal fluid flow to Alzheimer's disease pathology. The finding highlights the potential role of low-frequency (<0.1 Hz) resting-state neural and physiological dynamics in the neurodegenerative diseases, presumably due to their sleep-dependent driving of cerebrospinal fluid flow to wash out brain toxins. Future studies are warranted to fully understand the global brain activity and associated physiological modulations and their role in glymphatic clearance and neurodegenerative diseases."

https://www.sciencedaily.com/releases/2021/06/210601152018.htm

Memory details fade over time, with only the main gist preserved

May 26, 2021

Science Daily/University of Birmingham

What information is retained in a memory over time, and which parts get lost? These questions have led to many scientific theories over the years, and now a team of researchers at the Universities of Glasgow and Birmingham have been able to provide some answers.

Their new study, which is published today in Nature Communications, demonstrates that our memories become less vibrant and detailed over time, with only the central gist eventually preserved. Moreover, this 'gistification' of our memories is boosted when we frequently recall our recent experiences.

The work could have implications in a number of areas, including the nature of memories in post-traumatic stress disorder, the repeated questioning of eye-witness testimonies and even in best practice for exam studying.

While memories are not exact carbon copies of the past -- remembering is understood to be a highly reconstructive process -- experts have suggested that the contents of a memory could change each time we bring it back to mind.

However, exactly how our memories differ from the original experiences, and how they are transformed over time, has until now proven difficult to measure in laboratory settings.

For this study the researchers developed a simple computerised task that measures how fast people can recover certain characteristics of visual memories when prompted to do so. Participants learned word-image pairs and were later required to recollect different elements of the image when cued with the word. For example, participants were asked to indicate, as fast as possible, if the image was coloured or greyscale (a perceptual detail), or whether it showed an animate or inanimate object (a semantic element).

These tests, probing the quality of the visual memories, happened immediately after learning and also after a two-day delay. Reaction time patterns showed that participants were faster to recollect meaningful, semantic elements than surface, perceptual ones.

Julia Lifanov, lead author of the study from the University of Birmingham, said: "Many memory theories assume that over time, and as people re-tell their stories, they tend to forget the surface details but retain the meaningful, semantic content of an event.

"Imagine reminiscing about a pre-COVID dinner with a friend -- you realize that you cannot recall the table décor but know exactly what you ordered; or you remember the conversation with the bartender, but not the colour of his shirt. Memory experts call this phenomenon 'semanticization'."

Prof Maria Wimber, senior author on the study from the University of Glasgow, said: "The pattern towards recollection of meaningful semantic elements we demonstrate in this study indicates that memories are biased towards meaningful content in the first place -- and we have shown in previous studies that this bias is clearly reflected in brain signals too.

"Our memories change with time and use and that is a good and adaptive thing. We want our memories to retain the information that is most likely to be useful in the future, when we encounter similar situations."

The researchers found that the bias towards semantic memory content becomes significantly stronger with the passage of time, and with repeated remembering. When participants came back to the lab two days later, they were much slower at answering the perceptual-detailed questions, but they show relatively preserved memory for the semantic content of the images. However, the shift from detail-rich to more concept-based memories was far less pronounced in a group of subjects who repeatedly viewed the images, rather than being asked to actively bringing them back to mind.

The study has implications for probing the nature of memories in health and disease. It provides a tool to study maladaptive changes, for example in post-traumatic stress disorder where patients often suffer from intrusive, traumatic memories, and tend to over-generalize these experiences to novel situations. The findings are also highly relevant for understanding how eyewitness memories may be biased by frequent interviews and repeatedly recalling the same event.

The findings also demonstrate that testing yourself prior to an exam (for example, by using flashcards) will make the meaningful information stick for longer, especially when followed by periods of rest and sleep.

https://www.sciencedaily.com/releases/2021/05/210526085058.htm

'Rejuvenating' the Alzheimer's brain

May 25, 2021

Science Daily/Netherlands Institute for Neuroscience - KNAW

Alzheimer's disease is the main cause of dementia and current therapeutic strategies cannot prevent, slow down or cure the pathology. The disease is characterized by memory loss, caused by the degeneration and death of neuronal cells in several regions of the brain, including the hippocampus, which is where memories are initially formed. Researchers from the Netherlands Institute for Neuroscience (NIN) have identified a small molecule that can be used to rejuvenate the brain and counteract the memory loss.

New cells in old brains 

The presence of adult-born cells in the hippocampus of old people was recently demonstrated in scientific studies. It suggests that, generally speaking, the so-called process of adult neurogenesis is sustained throughout adulthood. Adult neurogenesis is linked to several aspects of cognition and memory in both animal models and humans, and it was reported to sharply decrease in the brains of patients with Alzheimer's disease. Researchers also found that higher levels of adult neurogenesis in these patients seem to correlate with better cognitive performance before death. "This could suggest that the adult-born neurons in our brain may contribute to a sort of cognitive reserve that could later on provide higher resilience to memory loss," says Evgenia Salta, group leader at the NIN. Therefore, researchers from the NIN investigated if giving a boost to adult neurogenesis could help prevent or improve dementia in Alzheimer's disease.

A small molecule with big potential 

Salta: "Seven years ago, while studying a small RNA molecule that is expressed in our brain, called microRNA-132, we came across a rather unexpected observation. This molecule, which we had previously found to be decreased in the brain of Alzheimer's patients, seemed to regulate homeostasis of neural stem cells in the central nervous system." Back then, Alzheimer's was thought to be a disease affecting only mature neuronal cells, so at first glance this finding did not seem to explain a possible role of microRNA-132 in the progression of Alzheimer's.

In this study, the researchers set out to address whether microRNA-132 can regulate adult hippocampal neurogenesis in healthy and Alzheimer's brains. Using distinct Alzheimer's mouse models, cultured human neural stem cells and post-mortem human brain tissue, they discovered that this RNA molecule is required for the neurogenic process in the adult hippocampus. "Decreasing the levels of microRNA-132 in the adult mouse brain or in human neural stem cells in a dish impairs the generation of new neurons. However, restoring the levels of microRNA-132 in Alzheimer's mice rescues neurogenic deficits and counteracts memory impairment related to adult neurogenesis," Sarah Snoeck, technician in the group of Salta, explains.

These results provide a proof-of-concept regarding the putative therapeutic potential of bringing about adult neurogenesis in Alzheimer's. Salta: "Our next goal is to systematically assess the efficacy and safety of targeting microRNA-132 as a therapeutic strategy in Alzheimer's disease."

https://www.sciencedaily.com/releases/2021/05/210525113701.htm

Press (re)play to remember - How the brain strengthens memories during sleep

May 25, 2021

Science Daily/University of Birmingham

While we sleep, the brain produces particular activation patterns. When two of these patterns -- slow oscillations and sleep spindles -- gear into each other, previous experiences are reactivated. The stronger the reactivation, the clearer will be our recall of past events, a new study reveals.

Scientists have long known that slow oscillations (SOs) and sleep spindles -- sudden half-second to two-second bursts of oscillatory brain activity -- play an important role in the formation and retention of new memories.

But experts in the UK and Germany have discovered that the precise combination of SOs and sleep spindles is vital for opening windows during which memories are reactivated; helping to form and cement memories in the human brain.

Researchers at the University of Birmingham and Ludwig-Maximilians-University Munich today published their findings in Nature Communications.

Co-author Dr Bernhard Staresina, from the University of Birmingham's School of Psychology, commented: "Our main means of strengthening memories while we sleep is the reactivation of previously learnt information, which allows us to solidify memories in neocortical long-term stores.

"We have discovered an intricate interplay of brain activity -- slow oscillations and sleep spindles -- which create windows of opportunity enabling this reactivation."

Co-author Dr Thomas Schreiner, from Ludwig-Maximilians-University, Munich, commented: "Memory reactivation is specifically bound to the presence of SO-spindle complexes. These results shed new light on the memory function of sleep in humans and emphasise the importance of orchestrated sleep rhythms in strengthening our powers of recall and orchestrating the creation of memories."

Before this study, evidence of the brain's capacity to reactivate memories during sleep was scarce, but the team devised novel tests where participants were shown information before taking a nap and closely monitored brain activity during non-rapid eye movement (NREM) sleep using EEG recording. Those taking part were then tested on their memory recall after waking up, allowing the researchers to link the extent of memory reactivation during sleep to memory performance.

The results revealed reactivation of learning material during SO-spindle complexes, with the precision of SO-spindle coupling predicting how strongly the memory would be reactivated by the brain. This in turn predicted the level of memory consolidation across participants and the subsequent clarity of recall.

https://www.sciencedaily.com/releases/2021/05/210525084300.htm

A complex link between body mass index and Alzheimer's

Study finds combined genetic risk, lower BMI predict disease progression

May 19, 2021

Science Daily/Ohio State University

Though obesity in midlife is linked to an increased risk for Alzheimer's disease, new research suggests that a high body mass index later in life doesn't necessarily translate to greater chances of developing the brain disease.

In the study, researchers compared data from two groups of people who had been diagnosed with mild cognitive impairment -- half whose disease progressed to Alzheimer's in 24 months and half whose condition did not worsen.

The researchers zeroed in on two risk factors: body mass index (BMI) and a cluster of genetic variants associated with higher risk for Alzheimer's disease.

Their analysis showed that a higher genetic risk combined with a lower BMI was associated with a higher likelihood for progression to Alzheimer's, and that the association was strongest in men.

The finding does not suggest people should consider gaining weight in their later years as a preventive effort -- instead, researchers speculate that lower BMI in these patients was likely a consequence of neurodegeneration, the progressive damage to the brain that is a hallmark of Alzheimer's. Brain regions affected by Alzheimer's are also involved in controlling eating behaviors and weight regulation.

"We don't want people to think they can eat everything they want because of this lower BMI association," said senior study author Jasmeet Hayes, assistant professor of psychology at The Ohio State University.

"We know that maintaining a healthy weight and having a healthy diet are extremely important to keeping inflammation and oxidative stress down -- that's a risk factor that is modifiable, and it's something you can do to help improve your life and prevent neurodegenerative processes as much as possible," she said. "If you start to notice rapid weight loss in an older individual, that could actually be a reflection of a potential neurodegenerative disease process."

The study was published online recently in the Journals of Gerontology: Series A.

Previous research has found a link between obesity and negative cognitive outcomes, but in older adults closer to the age at which Alzheimer's disease is diagnosed, the results have been mixed, Hayes said. And though a variant to the gene known as APOE4 is the strongest single genetic risk factor for Alzheimer's, it explains only about 10 to 15% of overall risk, she said.

Hayes has focused her research program on looking at multiple risk factors at the same time to see how they might interact to influence risk -- and to identify health behaviors that may help reduce the risk.

"We're trying to add more and more factors. That is my goal, to one day build a more precise and better model of the different combinations of risk factors," said Hayes, also an investigator in Ohio State's Chronic Brain Injury Initiative. "Genetic risk is important, but it really explains only a small part of Alzheimer's disease, so we're really interested in looking at other factors that we can control."

For this study, the research team obtained data from the Alzheimer's Disease Neuroimaging Initiative, compiling a sample of 104 people for whom BMI and polygenic risk scores were available. Fifty-two individuals whose mild cognitive impairment (MCI) had progressed to Alzheimer's in 24 months were matched against demographically similar people whose MCI diagnosis did not change over two years. Their average age was 73.

Statistical analysis showed that individuals with mild cognitive impairment who had both a lower BMI and higher genetic risk for Alzheimer's were more likely to progress to Alzheimer's disease within 24 months compared to people with a higher BMI.

"We think there's interaction between the genetics and lower BMI, and having both of these risk factors causes more degeneration in certain brain regions to increase the likelihood of developing Alzheimer's disease," said Jena Moody, a graduate student in psychology at Ohio State and first author of the paper.

The effect of the BMI-genetic risk interaction was significant even after taking into account the presence of beta-amyloid and tau proteins in the patients' cerebrospinal fluid -- the core biomarkers of Alzheimer's disease.

The relationship between low BMI and high genetic risk and progression to Alzheimer's was stronger in males than in females, but a larger sample size and additional biological data would be needed to expand on that finding, the researchers said.

Because brain changes can begin long before cognitive symptoms surface, a better understanding of the multiple risk factors for Alzheimer's could open the door to better prevention options, Moody said.

"If you can identify people at higher risk before symptoms manifest, you could implement interventions and prevention techniques to either slow or prevent that progression from happening altogether," she said.

To date, scientists have suggested preventive steps include maintaining a healthy weight and diet and participating in activities that reduce inflammation and promote neurofunctioning, such as exercise and mentally stimulating activities.

"We're finding again and again how important inflammation is in the process," Hayes said. "Especially in midlife, trying to keep that inflammation down is such an important aspect of maintaining a healthy lifestyle and preventing accelerated aging."

https://www.sciencedaily.com/releases/2021/05/210519120835.htm

What Is Telemedicine In Healthcare?

Guest post by John Mullen Training COR

*We do not endorse guest posts. For informational purposes only.

Telemedicine is a novel new way of getting you healthy without having to see the doctor in person. Offering you innovative solutions and twenty-four-hour access to your medical records and results, you have the best opportunity to meet with your doctor and talk about your concerns without stepping outside your house. That offers great benefit to those who suffer from anxiety and fear of getting sick during the pandemic.

Using Technology

 Technology is your friend when using telemedicine. By using the app or the patient portal, you can talk to your doctor quickly. You also have access to your complete set of files and full knowledge of what is going on with your health. In addition to that, you have an easier time understanding your lab results, medication, and notes from the doctor. 

You also have the chance to speak with your doctor freely through text or call them from your phone. That saves time and frustration because you can call them anytime, no matter what location you find yourself in.  It will work when your parked and waiting for the kids at school, at home, or if you are walking somewhere. The service is around the clock, so you never go without professional help should you need it. When you need instant urgent care telemedicine options, service anytime is what you need. 

A Virtual Appointment

The way telemedicine works for an appointment is that you call your doctor's office like usual, and then on the day of your appointment, they will call you on your phone when it's time. If you are using video calling, you will be able to see them, and the same is true with Skype. 

That option works better for people because they don't have to go to the doctor's office in person. It helps them retain their schedule, and it's more convenient, which is something they appreciate. It also works for people stuck in areas that make it hard to get to the doctor or people who are not well enough to make the trip to the doctor. Those at risk with the pandemic can't leave the house either but still need medical help. This system was put in place with them in mind. 

Try Telemedicine

It’s easy to have appointments virtually instead of in person. It’s easier on you, your car, and your time. It also helps the doctor help you medically. Insurance isn't a problem; there are no hidden fees; it is the perfect way to see a doctor when you need assistance during this pandemic. 

Eating more fruit and vegetables linked to less stress

May 14, 2021

Science Daily/Edith Cowan University

Eating a diet rich in fruit and vegetables is associated with less stress, according to new research from Edith Cowan University (ECU).

The study examined the link between fruit and vegetable intake and stress levels of more than 8,600 Australians aged between 25 and 91 participating in the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study from Baker Heart and Diabetes Institute.

The findings revealed people who ate at least 470 grams of fruit and vegetables daily had 10 per cent lower stress levels than those who consumed less than 230 grams. The World Health Organization (WHO) recommends eating at least 400 grams of fruit and vegetables per day.

Lead researcher, PhD candidate Simone Radavelli-Bagatini from ECU's Institute for Nutrition Research, said the study strengthens the link between diets rich in fruit and vegetables and mental wellbeing.

"We found that people who have higher fruit and veggie intakes are less stressed than those with lower intakes, which suggests diet plays a key role in mental wellbeing," said Ms Radavelli-Bagatini.

A growing issue

Mental health conditions are an increasing problem in Australia and around the world. Around one in two Australians will experience a mental health issue in their lifetime. Globally, approximately 1 in 10 people live with a mental health disorder.

According to Ms Radavelli-Bagatini, some stress is considered normal, but long-term exposure can significantly impact mental health.

"Long-term and unmanaged stress can lead to a range of health problems including heart disease, diabetes, depression and anxiety so we need to find ways to prevent and possibly alleviate mental health problems in the future," said Ms Radavelli-Bagatini.

The benefits of a healthy diet are well known, but only 1 in 2 Australians eat the recommended two serves of fruit per day and fewer than 1 in 10 eat the recommended five serves of vegetables each day.

"Previous studies have shown the link between fruit and vegetable consumption and stress in younger adults, but this is the first time we're seeing similar results across adults of all ages," said Ms Radavelli-Bagatini.

"The study's findings emphasise that it's important for people to have a diet rich in fruit and vegetables to potentially minimise stress."

Food and mood

While the mechanisms behind how fruit and vegetable consumption influences stress are still unclear, Ms Radavelli-Bagatini said key nutrients could be a factor.

"Vegetables and fruits contain important nutrients such as vitamins, minerals, flavonoids and carotenoids that can reduce inflammation and oxidative stress, and therefore improve mental wellbeing," she said.

"Inflammation and oxidative stress in the body are recognised factors that can lead to increased stress, anxiety and lower mood."

"These findings encourage more research into diet and specifically what fruits and vegetables provide the most benefits for mental health."

The research is part of ECU's recently launched Institute for Nutrition Research, which aims to investigate how nutrition can help prevent and treat chronic health conditions.

'Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan' was published in Clinical Nutrition.

https://www.sciencedaily.com/releases/2021/05/210513100030.htm

Drivers with shift work sleep disorder 3x more likely to be in crash

May 13, 2021

Science Daily/University of Missouri-Columbia

People who work nontraditional work hours, such as 11 p.m.-7 a.m., or the "graveyard" shift, are more likely than people with traditional daytime work schedules to develop a chronic medical condition -- shift work sleep disorder -- that disrupts their sleep. According to researchers at the University of Missouri, people who develop this condition are also three times more likely to be involved in a vehicle accident.

"This discovery has many major implications, including the need to identify engineering counter-measures to help prevent these crashes from happening," said Praveen Edara, department chair and professor of civil and environmental engineering. "Such measures can include the availability of highway rest areas, roadside and in-vehicle messaging to improve a driver's attention, and how to encourage drivers who may have a late-night work shift to take other modes of transportation, including public transit or ride-share services."

Edara, one of the authors on the study, said the analysis was based on data collected from a real-world driving study for the second Strategic Highway Research Program established by the U.S. Congress.

As the demand for 24/7 business operations has increased in recent years to meet customer needs during all hours of the day and across multiple time zones, the traditional work day -- once defined as 9 a.m.-5 p.m. -- has shifted for many people to include evening and night shifts, causing sleeping difficulties and leading to shift work sleep disorder. Edara said he was surprised to see shift work sleep disorder increase the risk of a traffic crash by nearly 300%, as compared to both sleep apnea and insomnia, which both increased the risk of a crash by approximately 30%.

Edara said previous studies have shown sleep disorders increase the risk for a traffic crash, but the majority of these studies were conducted in a controlled environment, such as a laboratory driving simulator. He believes this real-world data now validates those efforts.

"In the past, researchers have studied sleep disorders primarily in a controlled environment, using test-tracks and driving simulators," Edara said. "Our study goes a step further by using actual observed crash and near-crash data from approximately 2,000 events occurring in six U.S. states. We've known for a while now that sleep disorders increase crash risk, but here we are able to quantify that risk using real world crash data while accounting for confounding variables such as roadway and traffic characteristics."

Edara said some of the limitations of their study include not having data for fatal crashes, and no formal measurement to define drowsiness.

Putting a spotlight onto a national problem

In the United States, the National Transportation Safety Board, or NTSB, is the federal agency that investigates major traffic accidents. Each year, they issue an annual "most wanted list" of safety improvements, and their 2019-2020 list includes "screening and treating obstructive sleep apnea" among the top 10 topic areas.

Edara said he hopes that by showing how big of a risk there is for traffic crashes caused by excessive daytime sleepiness, the researchers can help draw additional attention toward finding ways to keep people safe behind the wheel, including taking the driver out of the equation with ride-sharing options and automated vehicles. He said the ideal next step in this research would be to partner with medical professionals who have expertise in this area to better understand why this is happening.

"We want to partner with public health and medical professionals whose expertise is in sleep-related research to better understand why this is happening," Edara said. "That will also allow us to explore what kind of countermeasures we can develop and test to improve the overall safety of these drivers and the other motorists around them."

https://www.sciencedaily.com/releases/2021/05/210513142334.htm

Long term use of prescription meds for insomnia not linked to better quality sleep

No difference between those who did and didn't take these drugs for 1-2 years

May 11, 2021

Science Daily/BMJ

Long term use of prescription meds for insomnia doesn't seem to improve disturbed sleep in middle-aged women, suggests research published in the online journal BMJ Open.

There was no difference in sleep quality or duration between those who did and didn't take these meds for 1 to 2 years, the findings show.

Disturbed sleep -- difficulty falling and/or staying asleep and waking early -- is common. An estimated 9 million adults in the US alone say they take prescription meds to try and get a good night's sleep.

Poor quality sleep is associated with ill health, including diabetes, high blood pressure, pain and depression, and various drugs are prescribed to induce shut-eye.

These include benzodiazepines, Z-drugs which include zolpidem, zaleplon and eszopiclone, as well as other agents mostly intended for other conditions (off label use), such as quelling anxiety and depression.

The clinical trial data indicate that many of these drugs work in the short term (up to 6 months), but insomnia can be chronic, and many people take these drugs for longer, say the researchers.

They therefore wanted to assess the effectiveness of drugs used to tackle insomnia over the long term among an ethnically diverse group of middle aged women who developed sleep disorders.

The women were all part of the Study of Women's Health Across the Nation (SWAN), a long term multicentre study looking at biological and psychosocial changes arising during the menopause. The women's average age was 49.5 and around half were white.

Sleep disturbances were defined as difficulty falling asleep, frequent awakening, and waking up early and rated on a 5-point scale, ranging from no difficulty on any night (1) to difficulty on 5 or more nights of the week (5), reported during an average of 21 years of monitoring.

Sleep disturbances, as measured on the ratings scale, were compared among those who did and didn't take prescription meds to improve their sleep after 1 and 2 years.

Some 238 women who started using medication to tackle insomnia during the monitoring period were matched with 447 women who didn't take these drugs.

Both groups of women reported difficulty falling asleep on 1 out of every 3 nights, waking frequently on 2 out of 3 nights, and waking up early on 1 in every 3 nights of the week. More than 70% of women in both groups reported disturbed sleep at least 3 times a week.

To begin with, sleep disturbance ratings were similar between the two groups of women. Those taking prescription meds for their sleep problems had average scores for difficulty falling asleep, waking up frequently, and for waking up early of 2.7, 3.8, and 2.8 respectively.

This compares with equivalent ratings of 2.6, 3.7, and 2.7, respectively, for those not taking prescription meds to get a good night's sleep.

After 1 year, average ratings among those taking the meds were 2.6, 3.6, and 2.8, respectively. The equivalent average scores among those not using prescription meds for their sleep problems were 2.3, 3.5, and 2.5, respectively.

None of the 1 year changes was statistically significant nor did they differ between the two groups. And after 2 years there were no statistically significant reductions in sleep disturbances among those taking prescription meds compared with those who didn't.

This is an observational study, and as such can't establish cause, only correlation. What's more, around half of the women were current or former smokers and 1 in 5 were moderate to heavy drinkers, both of which may affect sleep quality.

Information collected on prescription meds was also collected only at annual or biennial study visits, and there may have been intermittent or periods of no use between visits, say the researchers. Nor were there any objective measures of sleep quality.

Nevertheless, conclude the researchers: "Sleep disturbances are common and increasing in prevalence. The use of sleep medications has grown, and they are often used over a long period, despite the relative lack of evidence from [randomised controlled trials]."

These drugs may work well in some people with sleep disturbances over several years, but the findings of this study should give pause for thought to prescribing clinicians and patients thinking about taking prescription meds for sleep disturbances in middle age, they add.

https://www.sciencedaily.com/releases/2021/05/210511201131.htm

Bacteria do not colonize the gut before birth

It happens during and after birth

May 10, 2021

Science Daily/McMaster University

It is well known that each person's gut bacteria is vital for digestion and overall health, but when does that gut microbiome start?

New research led by scientists from McMaster University and Charité -- Universitätsmedizin Berlin in Germany has found it happens during and after birth, and not before.

McMaster researchers Deborah Sloboda and Katherine Kennedy examined prenatal stool (meconium) samples collected from 20 babies during breech Cesarean delivery.

"The key takeaway from our study is we are not colonized before birth. Rather, our relationship with our gut bacteria emerges after birth and during infancy," said Kennedy, first author of the study and a PhD student, whose findings are published in Nature Microbiology.

Recent studies have sparked controversy by claiming that we are colonized by gut bacteria before birth. But, Kennedy said, studies such as these have been criticized for the ways they control for contamination.

"By including only breech caesarean deliveries in healthy pregnant women we were able to avoid the transmission of bacteria that occurs naturally during a vaginal birth," said Thorsten Braun, co-senior author and lead obstetric consultant and deputy director of the Department of 'Experimental Obstetrics' at Charité -- Universitätsmedizin Berlin.

Kennedy said recent data suggest that a person's relationship with their own gut bacteria is most important in early life, during critical stages of immunological and physiological development.

Sloboda, co-senior author, agrees.

"The fact that colonization of infants' guts occurs during and after their births, means that not only is it vulnerable to early environmental influences, but could also offers a window of potential intervention," said Sloboda, professor of biochemistry and biomedical sciences at McMaster and the Canada Research Chair in perinatal programming.

"While many of the exact mechanisms surrounding gut bacteria and their role in our early development is unclear, discovering when and how we are colonized is a key first step."

https://www.sciencedaily.com/releases/2021/05/210510133138.htm

Vegetarians have healthier levels of disease markers than meat-eaters

May 9, 2021

Science Daily/European Association for the Study of Obesity

Vegetarians appear to have a healthier biomarker profile than meat-eaters, and this applies to adults of any age and weight, and is also unaffected by smoking and alcohol consumption, according to a new study in over 166,000 UK adults, being presented at this week's European Congress on Obesity (ECO), held online this year.

Biomarkers can have bad and good health effects, promoting or preventing cancer, cardiovascular and age-related diseases, and other chronic conditions, and have been widely used to assess the effect of diets on health. However, evidence of the metabolic benefits associated with being vegetarian is unclear.

To understand whether dietary choice can make a difference to the levels of disease markers in blood and urine, researchers from the University of Glasgow did a cross-sectional study analysing data from 177,723 healthy participants (aged 37-73 years) in the UK Biobank study, who reported no major changes in diet over the last five years.

Participants were categorised as either vegetarian (do not eat red meat, poultry or fish; 4,111 participants) or meat-eaters (166,516 participants) according to their self-reported diet. The researchers examined the association with 19 blood and urine biomarkers related to diabetes, cardiovascular diseases, cancer, liver, bone and joint health, and kidney function.

Even after accounting for potentially influential factors including age, sex, education, ethnicity, obesity, smoking, and alcohol intake, the analysis found that compared to meat-eaters, vegetarians had significantly lower levels of 13 biomarkers, including: total cholesterol; low-density lipoprotein (LDL) cholesterol -- the so-called 'bad cholesterol; apolipoprotein A (linked to cardiovascular disease), apolipoprotein B (linked to cardiovascular disease); gamma-glutamyl transferase (GGT) and alanine aminotransferase (AST) -- liver function markers indicating inflammation or damage to cells; insulin-like growth factor (IGF-1; a hormone that encourages the growth and proliferation of cancer cells); urate; total protein; and creatinine (marker of worsening kidney function).

However, vegetarians also had lower levels of beneficial biomarkers including high-density lipoprotein 'good' (HDL) cholesterol, and vitamin D and calcium (linked to bone and joint health). In addition, they had significantly higher level of fats (triglycerides) in the blood and cystatin-C (suggesting a poorer kidney condition).

No link was found for blood sugar levels (HbA1c), systolic blood pressure, aspartate aminotransferase (AST; a marker of damage to liver cells) or C-reactive protein (CRP; inflammatory marker).

"Our findings offer real food for thought," says Dr Carlos Celis-Morales from the University of Glasgow, UK, who led the research. "As well as not eating red and processed meat which have been linked to heart diseases and some cancers, people who follow a vegetarian diet tend to consume more vegetables, fruits, and nuts which contain more nutrients, fibre, and other potentially beneficial compounds. These nutritional differences may help explain why vegetarians appear to have lower levels of disease biomarkers that can lead to cell damage and chronic disease."

The authors point out that although their study was large, it was observational, so no conclusions can be drawn about direct cause and effect. They also note several limitations including that they only tested biomarker samples once for each participant, and it is possible that biomarkers might fluctuate depending on factors unrelated to diet, such as existing diseases and unmeasured lifestyle factors. They also note that were reliant on participants to report their dietary intake using food frequency questionnaires, which is not always reliable.

https://www.sciencedaily.com/releases/2021/05/210509153814.htm

Sleep disorders tally $94.9 billion in health care costs each year

May 7, 2021

Science Daily/Massachusetts Eye and Ear Infirmary

Sleep disorders are associated with significantly higher rates of health care utilization, conservatively placing an additional $94.9 billion in costs each year to the United States health care system, according to a new study from researchers at Mass Eye and Ear, a member hospital of Mass General Brigham.

In their new analysis, published in the Journal of Clinical Sleep Medicine, the researchers found the number of medical visits and prescriptions filled were nearly doubled in people with sleep disorders such as sleep apnea and insomnia, compared to similar people without. Affected patients were also more likely to visit the emergency department and have more comorbid medical conditions.

Costly medical care for sleep disorder patients 

The researchers sought out to determine the true diagnostic prevalence of sleep disorders and how expensive these conditions were to the health care system. They examined differences in health expenditures in similar patients with and without a sleep disorder diagnosis, as determined by their ICD-10 diagnosis code. The study included data from a nationally-representative survey of more than 22,000 Americans called the 2018 Medical Expenditure Panel Survey, which is administered by the Department of Health and Human Services' Agency for Healthcare Research and Quality.

They found 5.6 percent of respondents had at least one sleep disorder, which translated to an estimated 13.6 million U.S. adults. This likely represents a significant underestimate, according to the authors, as insomnia alone is felt to conservatively affect 10 to 20 percent of the population. These individuals accumulated approximately $7,000 more in overall health care expenses per year compared to those without a sleep disorder -- about 60 percent more in annual costs. This equates to a conservative estimate of $94.9 billion in health care costs per year attributable to sleep disorders.

The analysis revealed that patients with sleep disorders attended more than 16 office visits and nearly 40 medication prescriptions per year, compared to nearly 9 visits and 22 prescriptions for those without a sleep disorder. The study did not quantify non-health care related costs, but the authors noted it can be assumed that more doctors' appointments means more time off from work, school or other social obligations, not to mention decreased productivity associated with symptoms, only exacerbating costs to society.

Sleep disorders raise risk for other conditions 

Sleep disorders can take a toll on health and quality of life in numerous ways. Individuals with certain sleep disorders experience decrease daytime functionality related to sleepiness, mental fog and an increased risk of motor vehicle accidents, for instance. Obstructive sleep apnea is one of the most common sleep disorders and if untreated, can increase risk for neurocognitive issues, such as difficulty concentrating and mood disorders, as well as cardiovascular conditions including heart attacks, strokes, high blood pressure and irregular heart rhythms.

Getting a proper diagnosis at the sign of asleep problem can lead to an effective treatment for a sleep disorder.

"Fortunately, studies have demonstrated that treating certain sleep disorders effectively reduces health care utilization and costs. Therefore, sleep issues should not be ignored. Greater recognition of sleep disorders and an early referral to a sleep specialist are essential," said Dr. Huyett. "Your sleep is important, and if there's an issue with your sleep, seek help for it."

https://www.sciencedaily.com/releases/2021/05/210507160008.htm

New evidence links gut bacteria and neurodegenerative conditions

May 6, 2021

Science Daily/University of Florida

Neurodegenerative diseases such as Alzheimer's, Parkinson's and ALS affect millions of adults, but scientists still do not know what causes these diseases, which poses a significant roadblock to developing treatments or preventative measures.

Recent research suggests that people with these conditions exhibit changes in the bacterial composition of their digestive tract. However, given the vast diversity of microbes found in the human body, identifying which bacteria may be associated with neurodegeneration is like finding a needle in a haystack.

Seeking that proverbial needle, scientists at the University of Florida are looking in an unexpected place: the digestive tract of a tiny, translucent worm called Caenorhabditis elegans.

New research published in PLOS Pathogens establishes, for the first time, a link between specific bacteria species and physical manifestations of neurodegenerative diseases. The study's lead author is Alyssa Walker, a microbiology and cell science doctoral candidate in the UF/IFAS College of Agricultural and Life Sciences.

"Looking at the microbiome is a relatively new approach to investigating what causes neurodegenerative diseases. In this study, we were able to show that specific species of bacteria play a role in the development of these conditions," said Daniel Czyz, Walker's dissertation advisor.

Czyz is the senior author of the study and an assistant professor in the UF/IFAS department of microbiology and cell science.

"We also showed that some other bacteria produce compounds that counteract these 'bad' bacteria. Recent studies have shown that patients with Parkinson's and Alzheimer's disease are deficient in these 'good' bacteria, so our findings may help explain that connection and open up an area of future study," he added.

All neurodegenerative diseases can be traced to problems with the way proteins are handled in the body. If proteins are misfolded, they build up and accumulate in tissues. These protein aggregates, as scientists call them, interfere with cell functioning and lead to neurodegenerative disorders.

Czyz and his co-authors wanted to know if introducing certain bacteria into the C. elegans worms would be followed by protein aggregation in the worms' tissues.

"That is, in fact, what we observed. We have a way of marking the aggregates so they glow green under the microscope. We saw that worms colonized by certain bacteria species were lit up with aggregates that were toxic to tissues, while those colonized by the control bacteria were not," Czyz said. "This occurred not just in the intestinal tissues, where the bacteria are, but all over the worms' bodies, in their muscles, nerves and even reproductive organs."

Surprisingly, the offspring of affected worms also showed increased protein aggregation -- even though these offspring never encountered the bacteria originally associated with the condition.

"This is very interesting because it suggests that these bacteria generate some sort of a signal that can be passed along to the next generation," Czyz said.

Worms colonized by the "bad" bacteria also lost mobility, a common symptom of neurodegenerative diseases.

"A healthy worm moves around by rolling and thrashing. When you pick up a healthy worm, it will roll off the pick, a simple device that we use to handle these tiny animals. But worms with the bad bacteria couldn't do that because of the appearance of toxic protein aggregates," explained Walker, who developed this assessment method.

"You could compare the pick to an obstacle course: just as a person with a neurodegenerative disease will have trouble getting across, the same is true with these worms, just at a much smaller scale," Czyz added.

Fun fact: Human eyebrow hairs or eyelashes make for very good picks.

"The worms are very delicate, so you need a tool that won't damage them. They are also transparent and have a simple body plan. Studies like ours are possible because these worms normally feed on bacteria," Czyz said.

"The worms are only one millimeter long, and they each have exactly 959 cells," Czyz said. "But in many ways, they are a lot like us humans -- they have intestines and muscles and nerves, but instead of being composed of billions of cells, each organ is just a handful of cells. They are like living test tubes. Their small size allows us to do experiments in a much more controlled way and answer important questions we can apply in future experiments with higher organisms and, eventually, people."

Currently the Czyz lab is testing hundreds of strains of bacteria found in the human gut to see how they affect protein aggregation in C. elegans. The group is also investigating how bacteria associated with neurodegeneration cause protein misfolding at the molecular level.

Czyz is also interested in possible connections between antibiotic-resistant bacteria and protein misfolding.

"Almost all of the bacteria we found associated with protein misfolding are also associated with antibiotic-resistant infections in people. However, it will take many more years of research before we can understand what, if any, connection there is between antibiotic resistance and neurodegenerative diseases," Czyz said.

https://www.sciencedaily.com/releases/2021/05/210506142109.htm

Secret behind maintaining a healthy weight loss

May 6, 2021

Science Daily/University of Copenhagen - The Faculty of Health and Medical Sciences

Half of the Danish population have overweight, while 17 percent live with obesity. Worldwide, almost 40 procent have overweight and 13 procent live with obesity.

The condition is associated with increased risk for early death, as well as sequelae such as Type 2 diabetes, cardiovascular diseases, cancer, and infertility.

Weight regain after an initial successful weight loss in people with obesity, constitutes an important and unsolved problem. Until now, no well-documented study on which treatment method is best for maintaining a healthy weight loss has been available.

Researchers at University of Copenhagen and Hvidovre Hospital have completed a new, sensational study, which is being published in the world's most quoted medical journal, The New England Journal of Medicine. By testing four different types of treatment following a diet-induced weight loss, the researchers demonstrate for the first time how it is possible for people with obesity to maintain long-term weight loss, says Professor Signe Torekov at the Department of Biomedical Sciences.

In a randomized clinical trial, the group of researchers has demonstrated a highly effective treatment after a diet-induced weight loss, by combining moderate to vigorous-intensive exercise with appetite-inhibiting obesity medication, an analogue to the appetite-inhibiting hormone GLP-1.

"This is new knowledge for doctors, dietitians and physical therapists to use in practice. This is evidence that we have been missing," explains Signe Torekov, who has been heading the study.

"The problem is that people are fighting against strong biological forces when losing weight. The appetite increases simultaneously with decreased energy consumption, and this counteracts weight loss maintenance. We have an appetite-stimulating hormone, which increases dramatically when we lose weight, and simultaneously the level of appetite-suppressing hormones drops dramatically. In addition, a weight loss can provoke loss of muscle mass, while the body reduces the energy consumption. Thus, when the focus in obesity treatment has been on how to obtain a weight loss -- rather than how to maintain a weight loss -- it is really difficult to do something about your situation," says Signe Torekov.

Highly efficient when combining treatments

215 Danes with obesity and low fitness ratings participated in the study. The participants initially followed a low calorie diet over eight weeks, where they each lost approximately 13 kg, which brought significant improvements to their health with a drop in blood sugar level and blood pressure.

The participants were then randomly divided into four groups. Two of the groups received placebo medication, while the two other groups received obesity medication. Among the two placebo groups, one group followed an exercise program of minimum 150 minutes of physical activity at moderate intensity or 75 minutes at vigorous-intensity during the week or a combination of the two, while the other group maintained their current level of physical activity. The two groups receiving obesity medication were similarly divided into one group with and one group without an exercise program.

All participants in the study were weighed monthly and received nutritional and diet counseling with the focus on healthy weight loss according to the guidelines from the Danish health and food administrations.

After one year, the group with exercise alone and the group with obesity medication alone maintained the weight loss of 13 kg and health improvements. The placebo group gained half of the weight back with deterioration of all risk factors, for example for development of Type 2 diabetes and cardiovascular disease.

The most dramatic improvements occurred in the combination group, which followed the exercise program and received obesity medication. The researchers observed additional weight loss in this group, and the total weight loss was approximately 16 kg over one year. The health benefits were also double that of each of the single treatments, i.e., twice the loss of fat mass while preserving muscle mass, higher fitness ratings, reduced blood sugar and improved quality of life.

The two groups that exercised increased their fitness rating, lost fat mass, and gained muscle mass. This could indicate a healthier weight loss than for people, who had only lost fat mass without increasing the fitness rating.

"It is an important aspect to highlight, as you do not necessarily get a healthier body from losing weight if, at the same time, you lose a lot of muscle mass," says Signe Torekov.

"It is great news for public health that a significant weight loss can be maintained with exercise for approximately 115 minute per week performed mostly at vigorous-intensity, such as cycling. And that by combining exercise with obesity medication, the effect is twice as good as each of the individual treatments." "

With the study, the researchers now hope people with obesity, together with their care provider, can create a useful framework for maintaining the weight loss.

Fundamental lifestyle change

Signe Torekov points out that many people with obesity have tried to lose weight before, only to regain the weight. This happens, because the general advice is to eat healthier and exercise more.

"Without a follow-up on whether people actually have support to perform exercise, the treatment will not be enough. Therefore, we also followed up with the participants on an ongoing basis to ensure that they received the support they needed in order to exercise. That is necessary, because maintaining weight loss is extremely hard. People need to understand this. Once you have lost weight, you are not "cured." "The ongoing exercise and effort will likely need to continue for many years," says Signe Torekov.

"Our study also demonstrates that without a structured treatment plan, there is a high risk of gaining the weight back. There were 12 individual consultations over the course of a year, including weighing and diet advice from Danish authorities according to guidelines for healthy weight maintenance. This was just not enough for the placebo group without exercise program, in this group all health benefits gained by weight loss during the eight week program were gone after one year, despite frequent weighing and diet and nutritional counseling based on official guidelines." Torekov says.

According to Signe Torekov, this underscores the importance of participating in a mutual weight maintenance program based on feedback when starting a weight loss programme.

"Therefore, it is important that there is a system for supporting people with obesity in maintaining the lifestyle change. Our study can help with this, because we can say this actually works to doctors, dietitians and municipalities, if they create a structured, joint treatment plan with the individual using ongoing follow-ups," says Torekov.

https://www.sciencedaily.com/releases/2021/05/210506105344.htm

Salad or cheeseburger? Your co-workers shape your food choices

April 22, 2021

Science Daily/Massachusetts General Hospital

Employees' cafeteria purchases -- both healthy and unhealthy foods -- were influenced by their co-workers' food choices, found a large, two-year study of hospital employees. The study made innovative use of cash register data to gain insights into how individuals' social networks shape their health behavior. The research suggests we might structure future efforts aimed at improving population health by capitalizing on how one person's behavior influences another.

The foods people buy at a workplace cafeteria may not always be chosen to satisfy an individual craving or taste for a particular food. When co-workers are eating together, individuals are more likely to select foods that are as healthy -- or unhealthy -- as the food selections on their fellow employees' trays. "We found that individuals tend to mirror the food choices of others in their social circles, which may explain one way obesity spreads through social networks," says Douglas Levy, PhD, an investigator at the Mongan Institute Health Policy Research Center at Massachusetts General Hospital (MGH) and first author of new research published in Nature Human Behaviour. Levy and his co-investigators discovered that individuals' eating patterns can be shaped even by casual acquaintances, evidence that corroborates several multi-decade observational studies showing the influence of people's social ties on weight gain, alcohol consumption and eating behavior.

Previous research on social influence upon food choice had been primarily limited to highly controlled settings like studies of college students eating a single meal together, making it difficult to generalize findings to other age groups and to real-world environments. The study by Levy and his co-authors examined the cumulative social influence of food choices among approximately 6,000 MGH employees of diverse ages and socioeconomic status as they ate at the hospital system's seven cafeterias over two years. The healthfulness of employees' food purchases was determined using the hospital cafeterias' "traffic light" labeling system designating all food and beverages as green (healthy), yellow (less healthy) or red (unhealthy).

MGH employees may use their ID cards to pay at the hospitals' cafeterias, which allowed the researchers to collect data on individuals' specific food purchases, and when and where they purchased the food. The researchers inferred the participants' social networks by examining how many minutes apart two people made food purchases, how often those two people ate at the same time over many weeks, and whether two people visited a different cafeteria at the same time. "Two people who make purchases within two minutes of each other, for example, are more likely to know each other than those who make purchases 30 minutes apart," says Levy. And to validate the social network model, the researchers surveyed more than 1,000 employees, asking them to confirm the names of the people the investigators had identified as their dining partners.

"A novel aspect of our study was to combine complementary types of data and to borrow tools from social network analysis to examine how the eating behaviors of a large group of employees were socially connected over a long period of time," says co-author Mark Pachucki, PhD, associate professor of Sociology at the University of Massachusetts, Amherst.

Based on cross-sectional and longitudinal assessments of three million encounters between pairs of employees making cafeteria purchases together, the researchers found that food purchases by people who were connected to each other were consistently more alike than they were different. "The effect size was a bit stronger for healthy foods than for unhealthy foods," says Levy.

A key component of the research was to determine whether social networks truly influence eating behavior, or whether people with similar lifestyles and food preferences are more likely to become friends and eat together, a phenomenon known as homophily. "We controlled for characteristics that people had in common and analyzed the data from numerous perspectives, consistently finding results that supported social influence rather than homophily explanations," says Levy.

Why do people who are socially connected choose similar foods? Peer pressure is one explanation. "People may change their behavior to cement the relationship with someone in their social circle," says Levy. Co-workers may also implicitly or explicitly give each other license to choose unhealthy foods or exert pressure to make a healthier choice.

The study's findings have several broader implications for public health interventions to prevent obesity. One option may be to target pairs of people making food choices and offer two-for-one sales on salads and other healthful foods but no discounts on cheeseburgers. Another approach might be to have an influential person in a particular social circle model more healthful food choices, which will affect others in the network. The research also demonstrates to policymakers that an intervention that improves healthy eating in a particular group will also be of value to individuals socially connected to that group.

"As we emerge from the pandemic and transition back to in-person work, we have an opportunity to eat together in a more healthful way than we did before," says Pachucki. "If your eating habits shape how your co-workers eat -- even just a little -- then changing your food choices for the better might benefit your co-workers as well."

https://www.sciencedaily.com/releases/2021/04/210422150341.htm

Meditative practice and spiritual wellbeing may preserve cognitive function in aging

May 11, 2021

Science Daily/IOS Press

It is projected that up to 152 million people worldwide will be living with Alzheimer's disease (AD) by 2050. To date there are no drugs that have a substantial positive impact on either the prevention or reversal of cognitive decline. A growing body of evidence finds that targeting lifestyle and vascular risk factors have a beneficial effect on overall cognitive performance. A new review in the Journal of Alzheimer's Disease, published by IOS Press, examines research that finds spiritual fitness, a new concept in medicine that centers on psychological and spiritual wellbeing, and Kirtan Kriya, a simple 12-minute meditative practice, may reduce multiple risk factors for AD.

"The key point of this review is that making a commitment to a brain longevity lifestyle, including spiritual fitness, is a critically important way for aging Alzheimer's disease free," explain authors Dharma Singh Khalsa, MD, Alzheimer's Research and Prevention Foundation, Tucson, AZ, USA, and Andrew B. Newberg, MD, Department of Integrative Medicine and Nutritional Sciences, Department of Radiology, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA. "We hope this article will inspire scientists, clinicians, and patients to embrace this new concept of spiritual fitness and make it a part of every multidomain program for the prevention of cognitive disability."

Research reveals that religious and spiritual involvement can preserve cognitive function as we age. The authors observe that today, spirituality is often experienced outside the context of an organized religion and may be part of every religion or separate to it. Spiritual fitness is a new dimension in AD prevention, interweaving basic, psychological and spiritual wellbeing. The authors discuss the research on how these factors affect brain function and cognition. For example, psychological wellbeing may reduce inflammation, cardiovascular disease, and disability. Significantly, individuals who have a high score on a "purpose in life" (PIL) measure, a component of psychological wellbeing, were 2.4 times more likely to remain free of AD than individuals with low PIL. In another study, participants who reported higher levels of PIL exhibited better cognitive function, and further, PIL protected those with already existing pathological conditions, thus slowing their decline.

Stress and stress management are under-discussed topics in AD prevention, yet the authors point out that there is ample evidence that physical, psychological, and emotional effects of stress may elevate AD risk. Kirtan Kriya (KK) is a 12-minute singing meditation that involves four sounds, breathing, and repetitive finger movements. It has multiple documented effects on stress, such as improving sleep, decreasing depression, and increasing wellbeing. It has also been found to increase blood flow to areas of the brain involved in cognition and emotional regulation and increases grey matter volume and decreases ventricular size in long-term practitioners, which may slow brain aging. Research in healthy individuals, caregivers, and those with cognitive decline found that the practice improves cognition, slows memory loss, and improves mood.

The overall relationship between spiritual fitness and a person's complete physical and mental health is a topic of investigation in the emerging field of study called neurotheology. Early work has focused on the development of models regarding which brain areas are affected through spiritual practices such as meditation or prayer. Over the last 20 years, there has been an extensive growth in neuroimaging and other physiological studies evaluating the effect of meditation, spiritual practices, and mystical experiences. A neuroimaging study of KK found long term brain effects, during meditation and afterwards. Neurotheological studies can help understanding of how a practice such as KK can lead to more permanent effects in brain function that support spiritual fitness, according to Dr. Khalsa and Dr. Newberg.

"Mitigating the extensive negative biochemical effects of stress with meditation practices, in tandem with the creation of heightened levels of spiritual fitness, may help lower the risk of AD. Small shifts in one's daily routine can make all the difference in AD prevention," Dr. Khalsa and Dr. Newberg conclude. "We are optimistic this article will inspire future research on the topic of spiritual fitness and AD."

https://www.sciencedaily.com/releases/2021/05/210511123727.htm