Diet plays key role in ADHD symptoms in children

Study finds more fruits and veggies means less inattention

May 19, 2022

Science Daily/Ohio State University

Here's a good reason for children with attention deficit hyperactivity disorder (ADHD) to eat their fruits and vegetables: It may help reduce inattention issues, a new study suggests.

As part of a larger study, researchers asked parents of 134 kids with ADHD symptoms to complete a detailed questionnaire about the typical foods the children ate, including portion sizes, over a 90-day period.

Another questionnaire asked parents to rate symptoms of inattention -- a hallmark of ADHD -- in their kids, such as having trouble staying focused, not following instructions, difficulty remembering things, and difficulty regulating emotions.

Results showed that kids who consumed more fruits and vegetables showed less severe symptoms of inattention, said Irene Hatsu, co-author of the study and associate professor of human nutrition at The Ohio State University.

"Eating a healthy diet, including fruits and vegetables, may be one way to reduce some of the symptoms of ADHD," Hatsu said.

The study was published online recently in the journal Nutritional Neuroscience.

The data for this research was collected as part of the Micronutrients for ADHD in Youth (MADDY) Study, which examined the efficacy of a 36-ingredient vitamin and mineral supplement to treat symptoms of ADHD and poor emotional control in the 134 kids aged 6 to 12.

The study that evaluated the effectiveness of the supplement showed that children who took the micronutrients were three times as likely to show significant improvement in their ADHD and emotional dysregulation symptoms than those who took a placebo. That study was published last year in the Journal of the American Academy of Child and Adolescent Psychiatry.

Another study involving the same children, published earlier this year in the journal Nutrients, showed that kids whose families had higher levels of food insecurity were more likely than others to show more severe symptoms of emotional dysregulation, such as chronic irritability, angry moods and outbursts of anger.

The three studies all paint a similar picture, Hatsu said: A healthy diet that provides all the nutrients that children require can help reduce the symptoms of ADHD in children.

"What clinicians usually do when kids with ADHD start having more severe symptoms is increase the dose of their treatment medication, if they are on one, or put them on medication," Hatsu said.

"Our studies suggest that it is worthwhile to check the children's access to food as well as the quality of their diet to see if it may be contributing to their symptom severity."

Children in the MADDY study, all of whom met the criteria for ADHD, were recruited from three sites: Columbus, Ohio; Portland, Oregon; and Lethbridge, Alberta, Canada. The study took place between 2018 and 2020. Participants were either not taking medication or stopped using it two weeks before the study began.

The studies on fruit and vegetable intake and the role of food insecurity were based on data collected when the children were first enrolled in the study, before they began taking the micronutrient supplement or placebo.

Why may diet be so important in ADHD?

Researchers believe that ADHD is related to low levels of some neurotransmitters in the brain -- and vitamins and minerals play a key role as cofactors in helping the body make those important neurochemicals and in overall brain function, Hatsu said.

Food insecurity may play an additional role.

"Everyone tends to get irritated when they're hungry and kids with ADHD are no exception. If they're not getting enough food, it could make their symptoms worse," she said.

Also, the stress of parents who are upset about not being able to provide enough food for their children can create family tension that could lead to more symptoms for children with ADHD.

The MADDY study is one of the first to look at the relationship between ADHD symptoms and diet quality among children in the United States and Canada, Hatsu said.

That's important because Western diets are more likely than many others, such as the Mediterranean diet, to fall short on fruit and vegetable intake, she said.

"We believe clinicians should assess the food security status of children with ADHD before creating or changing a treatment program," Hatsu said.

"Some symptoms might be more manageable by helping families become more food secure and able to provide a healthier diet."

https://www.sciencedaily.com/releases/2022/05/220519115333.htm

Childhood circumstances and personality traits are associated with loneliness in older age

May 18, 2022

Science Daily/PLOS

Life circumstances during childhood -- including having fewer friends and siblings, low-quality relationships with parents, bad health and growing up in a poorer household -- are all correlated with a higher rate of loneliness in older age, according to a new study published this week in the open-access journal PLOS ONE by Sophie Guthmuller of Vienna University of Economics and Business, Austria.

Loneliness has been a growing topic of interest over the last decade, as it has been shown to be linked with ill health and to increase with age. Loneliness is correlated with a higher risk of developing mental conditions, a deterioration in physical health, and is linked to mortality and higher health care utilization.

In the new study, Guthmuller used data from the large cross-national Survey on Health, Ageing, and Retirement in Europe (SHARE), which collects information from individuals across Europe aged 50 and older on health, socioeconomic status, and social and family networks. Loneliness was measured with the R-UCLA Loneliness Scale.

Guthmuller found that, while ill health is the main factor correlated with loneliness in older age, explaining 43.32% of the variance in loneliness, social support in older age also accounts for 27.05% of the variance, personality traits account for 10.42% and life circumstances during childhood account for 7.50%. The odds of loneliness age 50 and over were 1.24 times higher for people who rarely or never had comfortable friends in childhood compared to those who more often had friends, 1.34 times higher in those who had a fair or poor relationship with their mother as a child compared to those with an excellent maternal relationship, and 1.21 times higher when one grew up in a household with poor wealth compared to those in a wealthy household. Loneliness was more common in individuals with a neurotic personality (OR 1.20) and less common in those who scored highly for conscientiousness, extraversion, agreeableness and openness.

Guthmuller points out that the findings of this study confirm the importance of social networks and support in older age, as well as the role of personality traits, and childhood circumstances. She concludes that early interventions are key to targeting later loneliness and that interventions aimed at increasing social support in later life need to be adapted to all personality types.

The author adds: "The study finds, as expected, that health status and social support at older ages are the two main factors correlated with loneliness at age 50+. Interestingly, the study reveals that personality traits and life circumstances during childhood are significantly associated with loneliness later in life, after controlling for a large set of later life conditions. In light of the trend of increasing childhood loneliness, and the impact of the COVID-19 pandemic on children's life, the findings of this study confirms the importance of early life interventions to tackle long term effect on loneliness."

https://www.sciencedaily.com/releases/2022/05/220518140714.htm

Major uptick reported in cannabis vaping for all adolescents

Largest increases found among high-school seniors, tripling in 2 years from 5 to 14 percent

May 19, 2022

Science Daily/Columbia University's Mailman School of Public Health

Cannabis vaping is increasing as the most popular method of cannabis delivery among all adolescents in the U.S., as is the frequency of cannabis vaping, according to research at Columbia University Mailman School of Public Health. The study found that the frequency of vaping cannabis among adolescents from all demographic groups is reported at six or more times per month, and rising faster than occasional use. Those who vape and smoke nicotine are more than 40 times more likely to also vape and smoke cannabis.

Until now time trends in vaping use had largely been unexamined including trends in use frequency, emerging disparities, and co-occurring use of other substances, which are all critical for surveillance and public health programmatic efforts. The findings are published in the journal Addiction.

"Heavy and frequent use of cannabis is increasing among U.S. adolescents, and vaped systems for products for both cannabis and nicotine are growing in number so understanding the prevalence and patterns of frequent cannabis vaping is important public health information for prevention," said Katherine Keyes, PhD, professor of epidemiology at Columbia Mailman School. "Given rising concerns about cannabis vaping in terms of safety, and potential for transition to cannabis use disorder especially at frequent levels of use, these results indicate a necessity for public health intervention and increased regulation."

The findings are based on the U.S.-based representative annual survey, Monitoring the Future, a population of 51,052 school-attending adolescents. Schools were randomly selected and invited to participate for two years.

Past 30-day frequent cannabis use with vaping increased (2.1 percent to 5.4 percent), while occasional use with vaping rose from 1.2 to 3.5 percent from 2017 to 2019. Past 30-day frequent (3.8 to 2.1 percent) and occasional (6.9 to 4.4 percent) cannabis use without vaping declined. Certain groups, such as Hispanic/Latino or lower socioeconomic status adolescents, experienced particularly notable increases in frequent cannabis use with vaping (e.g., prevalence among Hispanic/Latino adolescents in 2017: 2.2 percent, 2019: 6.7 percent)

According to Keyes, tobacco use and e-cigarettes, as well as binge drinking, are strongly linked to frequent cannabis use -- both vaping and non-vaping. The evidence indicates that young adults who use nicotine, especially through vaporizers, are more likely to subsequently use vaped cannabis.

In fact, adolescents who reported smoking and vaping nicotine on more than 10 occasions of binge drinking, were 42 times and 10 times more likely to report past 30-day cannabis use with vaping, respectively, compared to no use.

"Given that it is easier for adolescents to conceal vaping than cannabis smoking, this mode of cannabis use may facilitate more frequent use," comments Keyes.

Prevalence increased across grades, with the largest burden among high school seniors for whom past-30-day prevalence almost tripled from 5 percent (2017) to 14 percent (2019). The one-year increase in this grade from 2018 to 2019 (7.5 percent to 14 percent) is the second largest one-year increase in any type of substance use prevalence ever tracked by Monitoring the Future.

"This persisting prevalence of daily cannabis use, which in 2020 use was higher than any year since 1981, is of further alarm for several reasons, observes Keyes. "Heavy levels of cannabis use are associated with adverse cognitive and social outcomes for youth, as well as long-term trajectories of drug use that may have adverse health and other consequences."

Also concerning is that high levels of tetrahydrocannabinol (THC) can be delivered through vaping devices, which may lead to dangerous consequences for youth users with lower tolerance.

"In addition, of note, is the evidence that the increases we are seeing in vaping as compared with smoking are concentrated among non-Hispanic white and higher socioeconomic status adolescents, the latter possibly reflecting the higher price point for vaping devices compared with other administration methods, "noted Keyes.

"As cannabis legalization continues across U.S. states, and as products, delivery systems, potency and marketing proliferate within a for-profit industry, increased attention to youth trends, including investment in sustained and evidence-based prevention and intervention, is increasingly urgent."

https://www.sciencedaily.com/releases/2022/05/220519115311.htm

Four-year college students drink more, use marijuana less than community college peers

May 18, 2022

Science Daily/Washington State University

Students at four-year colleges and universities drink nearly twice as much alcohol as their peers in two-year colleges, according to a survey of college students in the Seattle area. On the other hand, students in community colleges and other two-year institutions use marijuana nearly twice as often as four-year students.

The results are detailed in a study led by a Washington State University researcher published in the Journal of American College Health.

"I expected differences in both alcohol and marijuana use among two- and four-year college students, but was surprised by the magnitude of the differences given that the subjects are the same ages," said Jennifer Duckworth, an assistant professor in WSU's Department of Human Development and lead author of the paper.

More research is needed to understand why these differences in alcohol and cannabis use exist, but perceptions of peer use may be one factor. Specifically, four-year students thought their peers drank more than two-year students believed their peers drank, whereas two-year students thought that their peers used cannabis more than four-year students thought their peers did.

In the study, the authors found that, among college students near Seattle, four-year students averaged over seven drinks per week, while two-year students averaged around 3.5 drinks each week, based on a self-reported questionnaire.

For marijuana use, two-year students averaged using it on over eight days in the previous month, while four-year students averaged nearly 4.5 days of use.

Both groups reported experiencing consequences of their substance use, Duckworth said.

The study included 517 students who reported drinking in the past year and who were between the ages of 18-23 at two- and four-year schools in Washington state. The young adults in the study filled out confidential online monthly surveys and received a stipend for participation. That combination of confidentiality, financial incentive, and ease of use led to a very high retention rate, Duckworth said.

She hopes to take the results of this study and conduct additional research on two-year students.

"Two-year students are a much harder group to study because they tend to have more variability in terms of age, work status, and they are more likely to be from underrepresented racial and/or ethnic minority groups," Duckworth said. "We know a lot more about four-year students, at least partly because most of the people doing the research are on four-year campuses."

Many four-year schools have research-based intervention programs to decrease the use of alcohol. She hopes to expand those to two-year campuses as well.

One such tool is a normative feedback intervention, which focuses on correcting misconceptions -- in this case misconceptions students have about peer substance use. Studies have shown that four-year students think their peers are using substances much more than they really are.

"If you think your peers are drinking more than they really are, that leads you to drink more," said Duckworth, who hopes to create and implement something similar for two-year students and marijuana use.

"Two-year students are using marijuana more than four-year students, but they also think their peers are using it more than they probably are," she said. "I say probably because we need more research to assess peer use. It's an important next step is studying this often understudied population."

https://www.sciencedaily.com/releases/2022/05/220518130707.htm

Concussion symptoms in children may have multiple underlying causes

May 17, 2022

Science Daily/McGill University

Different types of brain damage caused by a concussion may lead to similar symptoms in children, according to research led by McGill University. A new way of studying concussions could help develop future treatments.

While most children fully recover after a concussion, some will have lasting symptoms. The findings published in eLife help explain the complex relationships that exist between symptoms and the damage caused by the injury.

The researchers found that certain combinations of brain damage were associated with specific symptoms such as attention difficulties. Other symptoms, such as sleep problems, occurred in children with multiple types of injuries. For example, damage to areas of the brain that are essential for controlling sleep and wakefulness could cause challenges with sleeping, as could damage to brain regions that control mood.

The brain's white matter holds clues

To do this, they examined how damage to the brain resulting from concussion affected its structural connection network, known as white matter. They then used statistical modelling techniques to see how these changes related to 19 different symptoms reported by the children or their caregivers.

Analysing symptoms may advance treatment

"Despite decades of research, no new treatment targets and therapies for concussions have been identified in recent years," says lead author Guido Guberman, a Vanier Scholar and MDCM Candidate at McGill University. "This is likely because damage to the brain caused by concussions, and the symptoms that result from it, can vary widely across individuals. In our study, we wanted to explore the relationships that exist between the symptoms of concussion and the nature of the injury in more detail."

Guberman and his colleagues analysed data collected from 306 children, aged nine to 10 years old, who had previously had a concussion. The children were all participants in the Adolescent Brain Cognitive Development (ABCD) Study.

"The methods used in our study provide a novel way of conceptualising and studying concussions," says senior author Maxime Descoteaux, a Professor of Computer Science at Université de Sherbrooke. "Once our results are validated and better understood, they could be used to explore potential new treatment targets for individual patients. More broadly, it would be interesting to see if our methods could also be used to gather new insights on neurological diseases that likewise cause varied symptoms among patients."

https://www.sciencedaily.com/releases/2022/05/220517151823.htm

Motivation for sports and school go hand in hand for adolescent athletes

Male students less interested in school than female students

May 17, 2022

Science Daily/University of Eastern Finland

Adolescent athletes with high motivation for school also have high motivation for sports. Male students tend to be less interested in school than their female peers, a new study from Finland shows.

Successfully integrating elite sports with education requires motivation to commit oneself to both domains. In Europe, the EU has instructed its Member States to formulate and adopt national guidelines on dual careers of athletes. Sufficient policy actions are needed in support of combining elite sports with academic education. In Finland, for example, talented and elite adolescent athletes have the opportunity to complete their upper secondary education in special sports upper secondary schools, which offer equal competitive sport opportunities for both genders and often specialise in multiple sports.

A new study conducted among nearly 400 adolescent athletes in Finland examined the development of, and gender differences in, their task values for school and sports across the upper secondary school years. The students were aged 15-16 at the beginning of the study, and they were all completing their upper secondary education in a sports upper secondary school. They were followed four times during their upper secondary school years.

The researchers found that the task values for school and sports among the students were strongly related to each other. Students with high motivation for school also had high motivation for sports. On the other hand, students with lower motivation for school struggled to maintain their motivation for sports, too.

"In this study, we focused especially on potential gender differences. Female students are generally expected to have higher motivation for an academic career than male students, whereas in sports, gender role stereotypes often exert an impact on the importance attached to masculine characteristics. It has been suggested that, from the motivational perspective, such a masculine performance narrative directs males more easily towards dedication to sports," Professor Jaana Viljaranta from the University of Eastern Finland says.

The results showed that male students' school-related task values were lower than female students' task values at the beginning of upper secondary school, and that the gender differences remained across the school years. However, no gender differences were found in the students' motivation for an athletic career.

"These findings indicate that female students may be more committed to integrating elite sports and education than male students."

To support the processes of dual career construction for male students, special attention should be paid to developing their motivation for school.

"Awareness of the gender differences shown in this study could help better understand what kind of support students need in sports upper secondary school to guarantee them the possibility of a dual career," Professor Viljaranta points out.

https://www.sciencedaily.com/releases/2022/05/220517112234.htm

Both nature and nurture contribute to signatures of socioeconomic status in the brain

May 18, 2022

Science Daily/University of Pennsylvania

Researchers found that a person's genetics and the environment in which they live contribute to how socioeconomic status shapes the architecture of the brain.

Your education, your job, your income, the neighborhood you live in: Together these factors are considered to represent socioeconomic status (SES) and contribute to a variety of health and social outcomes, from physical and mental health to educational achievement and cognitive capacities.

The brain acts as an obvious mediator between SES and many of these outcomes. But the mechanism by which it does so has remained hazy, and scientific studies have failed to show whether SES's impact on the brain is encoded in our genes or driven by the environment in which we live.

In a new report in Science Advances, an international research team led by scientists at the University of Pennsylvania and Vrije Universiteit Amsterdam take strides to tease apart the relative contributions of genes and environment. Using the largest dataset ever applied to this question, the team found evidence that both genetics and environmental influences contribute to SES's impact in a complex interplay with effects that span a variety of brain regions.

"What we saw in the study is that some of the relationship between the brain and socioeconomic status could be explained by genetics, but there is a lot more to that relationship that remains even after you account for genetics," says Gideon Nave, a marketing professor in Penn's Wharton School and a study coauthor. "This suggests that socioeconomic conditions get under the skin in some way, and can have additional negative influences on the social and economic disparities we see around us."

The work is a product of a large academic collaboration co-led by Nave and Vrije's Philipp Koellinger, a senior author on the study, called BIG BEAR, for Brain Imaging and Genetics in Behavioral Research. Martha Farah, another co-senior author on the work and a psychology professor at Penn, is a principal investigator in the collaboration.

Mapping SES's footprint in the brain

A significant body of research has shown that SES has a signature in the brain.

"I study the relation between SES and the brain," says Farah, "and a question that always comes up is: What causes these differences? Are characteristics of SES encoded in the genome, or does life experience at different levels of SES have these effects on the brain? We were able to show that it is both, and also that genes and environment seem to exert different effects on different parts of the brain."

In the work, the researchers used a massive dataset, the UK Biobank, to better understand those relative contributions. Earlier studies used smaller sample sizes to study the link between the brain and SES or were inconsistent in how they defined SES. In contrast, the UK Biobank encompasses a vast range of types of data, including brain scans and genomic sequencing as well as SES measures, all collected in a standardized fashion. As a result, the research team was able to search for patterns among SES factors and brain scan information for nearly 24,000 individuals.

Each individual was assigned two SES "scores," one combining income, occupation, and educational attainment, and a second combining neighborhood and occupation. Looking at the two scores together, they accounted for about 1.6% of variation in total brain volume -- a finding that had been seen previously.

The researchers then dug more deeply into the brain scan data, looking for specific regions of the brain that tracked with SES. They found a whole host of different brain regions related to SES, including some surprises. Of note, the cerebellum, not analyzed by many previous studies, showed a substantial connection to SES. Located near the brainstem, the cerebellum is responsible for movement and balance as well as higher level functions involving cognition and learning.

"We see correlations popping up all over the brain between SES and gray matter volume," says Nave. "They're small, but with the large sample size of our study, we can be confident that they're real."

Adds Hyeokmoon Kweon, the study's first author and a doctoral student at Vrije Universiteit Amsterdam, "Importantly, these small regional correlations do not imply that the overall relationship between the brain and SES is also small. In fact, we can predict a sizable amount of SES differences by aggregating these small brain-SES relationships.

Nature vs. nurture

Because tens of thousands of individuals in the UK Biobank have also had their genomes sequenced, the researchers could look for evidence of the genetic influence of SES in the brain. For this analysis, they created a single index of SES and genetic linkages based on previous research that identified single nucleotide polymorphisms -- variations of one "letter" of the DNA code -- that correlate with SES.

Using this index, they found that genetics could explain a bit over half of the relationship between gray matter volume and SES in some regions. The prefrontal cortex and insula -- responsible for capacities like communication, decision making and empathy -- turned up as particularly strongly governed by genetic influence. However the relationship between SES and gray matter volume in other brain regions -- the cerebellum and lateral temporal lobe, for instance -- were less correlated with genetics, a sign that alterations there may instead be environmentally influenced.

Underscoring the influence that the environment can have, the researchers look at another variable in the data: body mass index (BMI). While genetics plays a role in BMI, BMI also arises from non-genetic factors, including nutrition and physical activity. Even after controlling for the known genetic linkages between brain anatomy and SES, they found BMI could account for an average of 44% of the relationship between SES and gray matter volume.

The finding suggests that the environmental factors, not just genetic determinants, that can contribute to elevated BMI -- such as poor nutrition and insufficient physical exercise -- may also manifest in brain structure.

A rationale for intervention

The researchers say that their findings, far from suggesting that there's nothing to be done to ameliorate the impact of SES on the brain, instead underscore that thoughtful policymaking could address health and social disparities connected to SES differences.

"The issue of genetic or environmental contributions to SES differences is controversial, in part because of its perceived implications for policy," Farah says. "Many people think that if the difficulties of low SES people are caused by the environment, then we can and should modify the environment, but then go on to an illogical conclusion: to the extent that they are genetic, there's nothing to be done. Genetically-caused problems can also be ameliorated with environmental interventions, for example dietary changes for people with the serious inborn metabolic syndrome PKU or eyeglasses for commonplace vision problems."

Policy interventions could be one solution, the researchers say, addressing, for example, environmental justice concerns that are linked with poorer neighborhoods. "If air quality is worse in lower-SES neighborhoods, that can be triggering inflammation and other negative effects in the brain," says Nave. "As just one example, regulations that mitigate air pollution could remove that harm and improve health and well-being across the board, no matter what neighborhood one lives in. Free, high-quality preschool can do the same thing. Genetics, in this case, is not destiny."

More studies are needed, the team says, to move from identifying correlations to pinning down causations in terms of understanding the environmental effects of SES on the brain. "With more and more data becoming available," says Kweon, "I expect we will be soon able to produce such studies, which will help shape targeted interventions."

https://www.sciencedaily.com/releases/2022/05/220518140703.htm

How the brain changes during depression treatment

May 18, 2022

Science Daily/University of British Columbia

Researchers have shown what happens to the brain when a person receives a depression treatment known as repetitive transcranial magnetic stimulation (rTMS). rTMS is a depression treatment typically used when other approaches -- such as medications -- haven't been effective for a patient. By stimulating the dorsolateral pre-frontal cortex, rTMS activates several other regions of the brain involved in multiple functions, from managing emotional responses to memory and motor control.

For the first time, researchers have shown what happens to the brain when a person receives a depression treatment known as repetitive transcranial magnetic stimulation (rTMS). The results were published today in the American Journal of Psychiatry.

rTMS is a depression treatment typically used when other approaches -- such as medications -- haven't been effective for a patient. It is estimated that approximately 40 per cent of people with major depression do not respond to antidepressants.

During an rTMS session, a device containing an electromagnetic coil is placed against a patient's scalp. The device then painlessly delivers a magnetic pulse that stimulates nerve cells in a region of the brain involved in mood control -- called the dorsolateral pre-frontal cortex.

Although proven to be effective, the mechanisms behind how rTMS affects the brain have not been well understood.

"When we first started this research, the question we were asking was very simple: we wanted to know what happens to the brain when rTMS treatment is being delivered," says Dr. Fidel Vila-Rodriguez, an assistant professor in UBC's department of psychiatry and researcher at the Djavad Mowafaghian Centre for Brain Health (DMCBH).

To answer this question, Dr. Vila-Rodriguez and his team delivered one round of rTMS to patients while they were inside a magnetic resonance imaging (MRI) scanner. Since the MRI can measure brain activity, the researchers were able to see in real time what changes were happening in the brain.

The team found that by stimulating the dorsolateral pre-frontal cortex, several other regions of the brain were also activated. These other regions are involved in multiple functions -- from managing emotional responses to memory and motor control.

The participants then underwent another four weeks of rTMS treatment and the team assessed whether the activated regions were associated with patients having fewer symptoms of depression when their treatment ended.

"We found that regions of the brain that were activated during the concurrent rTMS-fMRI were significantly related to good outcomes," says Dr. Vila-Rodriguez.

With this new map of how rTMS stimulates different areas of the brain, Dr. Villa Rodriguez hopes the findings could be used to determine how well a patient is responding to rTMS treatments.

"By demonstrating this principle and identifying regions of the brain that are activated by rTMS, we can now try to understand whether this pattern can be used as a biomarker," he says.

Dr. Vila-Rodriguez is now exploring how rTMS can be used to treat a range of neuropsychiatric disorders. He has received funding through the Djavad Mowafaghian Centre for Brain Health Alzheimer's Disease Research Competition to look at rTMS as a way to enhance memory in patients who are showing early signs of Alzheimer's disease. He also received a grant from the Canadian Institutes of Health Research (CIHR) to study whether the rTMS brain activation patterns can be detected by changes in heart rate.

Dr. Vila-Rodriguez says this is type of research will hopefully encourage more widespread adoption and accessibility of rTMS treatments across the country. Despite being approved by Health Canada 20 years ago, rTMS is still not widely available. In British Columbia, there are some private clinics that offer rTMS, but it is not covered by the provincial health plan.

https://www.sciencedaily.com/releases/2022/05/220518080559.htm

Statins may provide protection against depression

Medications linked with reduced negative emotional bias

May 17, 2022

Science Daily/Elsevier

Statins have been hailed as a wonder drug; the cholesterol-lowering drugs have been prescribed to tens of millions of people since their approval in the late 1980s to prevent heart attack and stroke. But the drugs may yet have additional benefits, some research has hinted, including on mental health. Now, a new study examines the influence of statins on emotional bias, a marker for risk of depression. The study appears in Biological Psychiatry, published by Elsevier.

Researchers led by Amy Gillespie, PhD, at the University of Oxford, Oxford, UK, conducted the online observational study from April 2020 through February 2021, at the height of the SARS-CoV-2 pandemic, when global stress levels were elevated and the incidence of psychiatric disorders spiked.

Over 2000 participants in the UK recorded information about their current psychiatric symptoms, medications, and other lifestyle factors. They also performed cognitive tasks meant to measure memory, reward, and emotion processing, which are linked to depression vulnerability. One task required participants to identify the emotional expressions of faces, which displayed varying degrees of fear, happiness, sadness, disgust, anger, or fear.

The vast majority of subjects (84%) were not taking either medication, but a small group were taking only statins (4%), only a different class of anti-hypertension medication (6%), or both (5%).

Participants taking statins were less likely to recognize fearful or angry faces and more likely to report them as positive, indicating they had reduced negative emotional bias.

Dr. Gillespie said, "We found that taking a statin medication was associated with significantly lower levels of negative emotional bias when interpreting facial expressions; this was not seen with other medications, such as blood pressure medications."

"We know that reducing negative emotional bias can be important for the treatment of depression," said Dr. Gillespie. "Our findings are important as they provide evidence that statins may provide protection against depression. Of particular note, we saw these results during the high-stress context of the COVID-19 pandemic. Our findings also provide the first potential psychological explanation of statins' mental health benefits," in that they seem to affect emotion processing. It remains unclear exactly how statins could protect against mental illness, but one possibility is that they may work through anti-inflammatory mechanisms, which have also been implicated in depression.

John Krystal, MD, Editor of Biological Psychiatry, said of the work, "Statins are among the most commonly prescribed medications based on their ability to prevent heart attacks and strokes. These new data raise the possibility that some of their positive effects on health could be mediated by the effects of these drugs on the brain that promote emotional resilience."

"Researchers should prioritize investigating the possible use of statins as a preventative intervention for depression. Before use in clinical practice, it is important that future research confirms the potential psychological benefits of statins through controlled, randomized clinical trials," Dr. Gillespie concluded.

https://www.sciencedaily.com/releases/2022/05/220517130746.htm

Deaths from alcohol use disorder surged during pandemic

Researchers found alcohol use disorder mortality rates were 25% higher than projected in 2020, 22% higher in 2021

Date:

May 16, 2022

Source:

Science Daily/Cedars-Sinai Medical Center

Deaths involving alcohol use disorder increased dramatically during the pandemic, according to a new study by Cedars-Sinai investigators. The study also found that young adults 25 to 44 years old experienced the steepest upward trend in alcohol use disorder mortality.

In the study, published this month in the peer-reviewed journal JAMA Network Open, investigators used predictive modeling to compare expected -- also called projected -- alcohol use disorder mortality rates to actual rates. They found that alcohol use disorder-related mortality rates increased among all ages and sexes during the pandemic.

"During the first few months of the pandemic, my colleagues and I saw increased numbers of patients being treated for acute alcohol use-related conditions in the intensive care unit and through out the medical center," said Yee Hui Yeo, MD, MSc, lead author of the study. "We also became aware of reports from single centers of elevated alcohol use-related complications. That prompted us to think, maybe this is a significant public health crisis."

Investigators obtained de-identified mortality data for seven years -- 2012-2019 -- from a Centers for Disease Control and Prevention database that registers more than 99% of all deaths in the U.S. They then used predictive modeling to determine 2020 and 2021 projected mortality rates based on previous years' trends, and compared those with the rates that were actually observed.

"What we found in our analysis reflects what we had been seeing anecdotally in our patients and in academic papers tracking complications like alcohol-related liver disease," Yeo said.

Results include:

• In 2020, the observed alcohol use disorder-related deaths were about 25% higher than the projected rates.

• In 2021, the observed rates were about 22% higher than projected.

• The increase in predicted versus observed mortality was similar for both sexes -- approximately 25% for women and men in 2020 versus 20% for women and 22% for men in 2021.

• Although the older adult group had the highest mortality rate throughout the study period, it was the younger group (ages 25-44 years) who suffered the greatest surge during the pandemic, which warrants public attention.

"We also know that alcohol use disorder is often under-reported, so actual mortality rates related to alcohol use may be even higher than reported," Yeo said.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the reference that mental health professionals use to categorize mental health disorders, defines alcohol use disorder as "a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period."

The manual then lists 11 criteria, such as a craving or strong urge to use alcohol; recurring use of alcohol that results in a failure to fulfill obligations at school, work or home; and continued alcohol use despite having persistent social or interpersonal problems that are created or exacerbated by alcohol use.

"In publishing this article, we want everyone, especially policymakers and physicians on the front lines, to know that during the pandemic, there is really a significant surge in alcohol use disorder-related deaths," Yeo said. "We also want to recognize that patients who die from alcohol use disorder-related causes tend to have social determinants of health, like lower socioeconomic status, that can make it harder for them to access healthcare and help. Finally, we want to make sure that patients who do seek treatment for alcohol or substance use have access to follow-up care to prevent secondary complications."

https://www.sciencedaily.com/releases/2022/05/220516124005.htm

Quantifying cognitive decline in dogs could help humans with Alzheimer's disease

May 9, 2022

Science Daily/North Carolina State University

Researchers have found that a suite of complementary tests can quantify changes in dogs suspected of suffering from cognitive decline. The approach could not only aid owners in managing their elderly canine's care, but could also serve as a model for evaluating cognitive decline progression in -- and treatments for -- humans with Alzheimer's disease.

Canine cognitive dysfunction syndrome (CCDS) is similar to Alzheimer's disease in humans in that cognitive decline is associated with the development of amyloid plaques as well as cortical atrophy, a progressive degeneration of brain tissue. CCDS is also challenging to diagnose. Traditionally, CCDS is diagnosed based on ruling out any obvious physical conditions and an owner's answers to a questionnaire.

"One problem with the current approach is that questionnaires only capture a constellation of home behaviors," says Natasha Olby, the Dr. Kady M. Gjessing and Rahna M. Davidson Distinguished Chair in Gerontology at North Carolina State University and co-senior author of a paper describing the work. "There can be other reasons for what an owner may perceive as cognitive decline -- anything from an undiagnosed infection to a brain tumor."

Olby and co-senior author Margaret Gruen, assistant professor of behavioral medicine at NC State, wanted to determine whether cognitive function could be accurately quantified in dogs.

"Our goal was to bring together multiple tools in order to get a more complete picture of how CCDS presents in dogs," Gruen says.

To that end, the researchers recruited 39 dogs from 15 breeds. All of them were in the senior and geriatric age range, but in good health overall. A dog is considered "senior" if it is in the last 25% of its expected life span based on breed and size, and geriatric beyond that.

The dogs underwent physical and orthopedic exams, as well as lab work that included a blood test that is a marker of neuronal death. Their owners filled out two commonly used diagnostic questionnaires, and then the dogs participated in a series of cognitive tests designed to assess executive function, memory and attention.

"The approach we took isn't necessarily designed to be diagnostic; instead, we want to use these tools to be able to identify dogs at an early stage and be able to follow them as the disease progresses, quantifying the changes," Olby says.

The team found that cognitive and blood test results correlated well with the questionnaire scores, suggesting that a multi-dimensional approach can be used to quantify cognitive decline in aging dogs.

"Being able to diagnose and quantify CCDS in a way that is clinically safe and relevant is a good first step toward being able to work with dogs as a model for Alzheimer's disease in humans," Olby says. "Many of the current models of Alzheimers disease -- in rodents, for example -- are good for understanding physiological changes, but not for testing treatments."

"Dogs live in our homes and develop naturally occurring disease just like we do," Gruen says. "These findings show promise for both dogs and humans in terms of improving our understanding of disease progression as well as for potentially testing treatments."

The work appears in the Journal of Alzheimer's Disease. NC State postdoctoral fellows Gilad Fefer and Wojciech K. Panek are co-first authors of the work.

https://www.sciencedaily.com/releases/2022/05/220509150745.htm

Stressed' cells offer clues to eliminating build-up of toxic proteins in dementia

May 6, 2022

Science Daily/University of Cambridge

It's often said that a little stress can be good for you. Now scientists have shown that the same may be true for cells, uncovering a newly-discovered mechanism that might help prevent the build-up of tangles of proteins commonly seen in dementia.

A characteristic of diseases such as Alzheimer's and Parkinson's -- collectively known as neurodegenerative diseases -- is the build-up of misfolded proteins. These proteins, such as amyloid and tau in Alzheimer's disease, form 'aggregates' that can cause irreversible damage to nerve cells in the brain.

Protein folding is a normal process in the body, and in healthy individuals, cells carry out a form of quality control to ensure that proteins are correctly folded and that misfolded proteins are destroyed. But in neurodegenerative diseases, this system becomes impaired, with potentially devastating consequences.

As the global population ages, an increasing number of people are being diagnosed with dementia, making the search for effective drugs ever more urgent. However, progress has been slow, with no medicines yet available that can prevent or remove the build-up of aggregates.

In a study published today in Nature Communications, a team led by scientists at the UK Dementia Research Institute, University of Cambridge, has identified a new mechanism that appears to reverse the build-up of aggregates, not by eliminating them completely, but rather by 'refolding' them.

"Just like when we get stressed by a heavy workload, so, too, cells can get 'stressed' if they're called upon to produce a large amount of proteins," explained Dr Edward Avezov from the UK Dementia Research Institute at the University of Cambridge.

"There are many reasons why this might be, for example when they are producing antibodies in response to an infection. We focused on stressing a component of cells known as the endoplasmic reticulum, which is responsible for producing around a third of our proteins -- and assumed that this stress might cause misfolding."

The endoplasmic reticulum (ER) is a membrane structure found in mammalian cells. It carries out a number of important functions, including the synthesis, folding, modification and transport of proteins needed on the surface or outside the cell. Dr Avezov and colleagues hypothesised that stressing the ER might lead to protein misfolding and aggregation by diminishing its ability to function correctly, leading to increased aggregation.

They were surprised to discover the opposite was true.

"We were astonished to find that stressing the cell actually eliminated the aggregates -- not by degrading them or clearing them out, but by unravelling the aggregates, potentially allowing them to refold correctly," said Dr Avezov.

"If we can find a way of awakening this mechanism without stressing the cells -- which could cause more damage than good -- then we might be able to find a way of treating some dementias."

The main component of this mechanism appears to be one of a class of proteins known as heat shock proteins (HSPs), more of which are made when cells are exposed to temperatures above their normal growth temperature, and in response to stress.

Dr Avezov speculates that this might help explain one of the more unusual observations within the field of dementia research. "There have been some studies recently of people in Scandinavian countries who regularly use saunas, suggesting that they may be at lower risk of developing dementia. One possible explanation for this is that this mild stress triggers a higher activity of HSPs, helping correct tangled proteins."

One of the factors that has previous hindered this field of research has been the inability to visualise these processes in live cells. Working with teams from Pennsylvania State University and the University of Algarve, the team has developed a technique that allows them to detect protein misfolding in live cells. It relies on measuring light patterns of a glowing chemical over a scale of nanoseconds -- one billionth of a second.

"It's fascinating how measuring our probe's fluorescence lifetime on the nanoseconds scale under a laser-powered microscope makes the otherwise invisible aggregates inside the cell obvious," said Professor Eduardo Melo, one of the leading authors, from the University of Algarve, Portugal.

https://www.sciencedaily.com/releases/2022/05/220506102618.htm

Promising treatment for dementia

Sodium selenate slows behavioural variant frontotemporal dementia -- second most common dementia in under 60s

May 5, 2022

Science Daily/Monash University

A Monash University led study has found a promising new treatment for patients with behavioural variant frontotemporal dementia, the second most common form of dementia in the under 60s -- resulting in a stabilising of what would normally be escalating behavioural issues, and a slowing of brain shrinkage due to the disease. It is the second clinical trial to show that the drug, sodium selenate, may slow cognitive decline and neurodegenerative damage that is the hallmark of many dementias including Alzheimer's Disease.

Behavioural variant frontotemporal dementia (bvFTD) is a rapidly progressing destructive disease and can occur in people as young as 35 years of age. It is characterised by behavioural disturbances and personality changes and can be highly disruptive and distressing for both patients and their families. Currently there are no treatments or cures for bvFTD and typical survival is 5-7 years from diagnosis.

The Phase 1 trial run in conjunction with the Royal Melbourne Hospital, the only one in Australia targeting non-genetic bvFTD, and one of a handful worldwide, showed that the drug, sodium selenate is safe and well-tolerated in patients with bvFTD over a period of 12 months. Importantly, the majority of patients receiving sodium selenate showed no change in their cognitive or behavioural symptoms, and reduced rates of brain atrophy over the trial period. The results from the trial, led by Dr Lucy Vivash, from the Monash University's Department of Neuroscience, have just been published in the journal, Alzheimer's and Dementia: Translational Research and Clinical Interventions.

In almost half of the cases with bvFTD, the damage to the neurons in the brain is caused by the build-up of a protein called tau. This protein is a major target for research in the prevention and treatment of Alzheimer's and other dementias, as a way to reverse the neurodegeneration caused by this tau accumulation.

According to Dr Vivash, sodium selenate upregulates an enzyme in the brain that effectively breaks down the tau protein. "We have previously shown, in a Phase 2 trial, that sodium selenate given to patients with mild to moderate Alzheimer's Disease resulted in less neurodegeneration than in those who did not," she said. Importantly those patients in the trial with higher levels of selenium, a breakdown product of sodium selenate, in their bloodstream showed less cognitive decline.

The research group is now conducting a larger study at many hospitals across Australia and New Zealand to further test whether this drug is beneficial for patients with bvFTD.

https://www.sciencedaily.com/releases/2022/05/220505102147.htm

Higher antioxidant levels linked to lower dementia risk

May 4, 2022

Science Daily/American Academy of Neurology

People with higher levels of antioxidants in their blood may be less likely to develop dementia, according to a study published in the May 4, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study found that people with the highest levels of the antioxidants lutein and zeaxanthin and beta-cryptoxanthin in their blood were less likely to develop dementia decades later than people with lower levels of the antioxidants. Lutein and zeaxanthin are found in green, leafy vegetables such as kale, spinach, broccoli and peas. Beta-cryptoxanthin is found in fruits such as oranges, papaya, tangerines and persimmons.

"Extending people's cognitive functioning is an important public health challenge," said study author May A. Beydoun, PhD, MPH, of the National Institutes of Health's National Institute on Aging in Baltimore, Maryland. "Antioxidants may help protect the brain from oxidative stress, which can cause cell damage. Further studies are needed to test whether adding these antioxidants can help protect the brain from dementia."

The study involved 7,283 people who were at least 45 years old at the beginning of the study. They had a physical exam, interview and blood tests for antioxidant levels at the beginning of the study. They were then followed for an average of 16 years to see who developed dementia.

The participants were divided into three groups based on their levels of antioxidants in the blood. People with the highest amounts of lutein and zeaxanthin were less likely to develop dementia than those with lower levels. Every standard deviation increase in lutein and zeaxanthin levels, approximately 15.4 micromols/liter, was associated with a 7% decrease in risk of dementia. For beta-cryptoxanthin, every standard deviation increase in levels, approximately 8.6 micromols/liter, was associated with a 14% reduced risk of dementia.

"It's important to note that the effect of these antioxidants on the risk of dementia was reduced somewhat when we took into account other factors such as education, income and physical activity, so it's possible that those factors may help explain the relationship between antioxidant levels and dementia," Beydoun said.

A limitation of the study is that antioxidant levels were based on one measurement of blood levels and may not reflect people's levels over their lifetime.

https://www.sciencedaily.com/releases/2022/05/220504170826.htm

Links between paranormal beliefs and cognitive function described by 40 years of research

New evaluation of prior studies finds increasing quality and areas for further improvement

May 4, 2022

Science Daily/PLOS

In a review of 71 studies that explored links between belief in paranormal phenomena and cognitive function, most of the findings align with the hypothesis that such beliefs are associated with cognitive differences or deficits. Charlotte E. Dean and colleagues at the University of Hertfordshire, U.K., present this evaluation in the open-access journal PLOS ONE on May 4.

For several decades, researchers have examined potential links between cognitive functioning and belief in paranormal phenomena, such as psychokinesis, hauntings, and clairvoyance. However, about 30 years have passed since a non-systematic review of this literature was last conducted. To provide updated insights into the findings and quality of studies on this topic, Dean and colleagues systematically identified and evaluated 70 published studies and one unpublished doctoral thesis produced between 1980 and 2020.

The 71 studies explored a range of cognitive functions, such as reasoning ability, thinking style, and memory. Overall, the findings align with the hypothesis that beliefs in paranormal phenomena are associated with differences or deficits in cognitive function. For example, a particularly consistent association was found between paranormal beliefs and an intuitive thinking style.

The review found that most of the 71 studies were of good methodological quality and that quality has improved over time; for instance, most had clear objectives and appropriate study designs. However, certain areas for improvement emerged; for instance, many studies lacked a discussion of their own methodological limitations, and undergraduate students made up a large portion of study participants, meaning that the findings may not necessarily apply to the general population.

The authors note that no specific profile of cognitive functioning for paranormal believers has emerged from this literature. They suggest that future research could not only address the methodological weaknesses they observed, but also explore the possibility that paranormal beliefs might be associated with a more overarching difference of cognition -- which could help explain why past studies have found links with seemingly disparate types of cognitive dysfunction.

The authors add: "Four decades of research suggests that belief in the paranormal is linked to our degree of cognitive flexibility and fluid intelligence; however, methodological improvements in future research are required to further our understanding of the relationship."

https://www.sciencedaily.com/releases/2022/05/220504144537.htm

Poor eyesight unfairly mistaken for brain decline

May 9, 2022

Science Daily/University of South Australia

Millions of older people with poor vision are at risk of being misdiagnosed with mild cognitive impairments, according to a new study by the University of South Australia.

Cognitive tests that rely on vision-dependent tasks could be skewing results in up to a quarter of people aged over 50 who have undiagnosed visual problems such as cataracts or age-related macular degeneration (AMD).

Age-related macular degeneration is a leading cause of vision loss for older people. It doesn't cause complete vision loss, but severely impacts people's ability to read, drive, cook, and even recognise faces. It has no bearing on cognition.

UniSA researchers recruited 24 participants with normal vision to complete two cognitive tests -- one involving vision-dependent reactive tasks and the other based on verbal fluency.

Using a set of goggles to simulate AMD, the participants scored far lower on the cognitive test involving reaction time tasks than without the goggles. There was no statistical difference with verbal fluency tests when using the goggles.

The study has been published in Scientific Reports.

UniSA PhD candidate Anne Macnamara, who led the study, says the results are a stark reminder that visual impairments -- which affect approximately 200 million people worldwide over the age of 50 -- unfairly affect cognitive scores when tests involve visual abilities.

"A mistaken score in cognitive tests could have devastating ramifications, leading to unnecessary changes to a person's living, working, financial or social circumstances," Macnamara says.

"For example, if a mistaken score contributed to a diagnosis of mild cognitive impairment, it could trigger psychological problems including depression and anxiety.

"People with AMD are already experiencing multiple issues due to vision loss and an inaccurate cognitive assessment is an additional burden they don't need."

Visual impairments are often overlooked in research and clinical settings, the UniSA researchers say, with reduced vision underestimated in up to 50 per cent of older adults.

And with this figure expected to increase in line with an ageing population, it is critical that neuro-degenerative researchers control for vision when assessing people's cognition.

"Mobile apps can now be used to overlay simulated visual impairments onto test materials when piloting their stimuli," Macnamara says.

"Also, researchers can incorporate quick and simple screening tasks before getting people to do cognitive tests. Verbal tasks should always be part of the assessment, too."

https://www.sciencedaily.com/releases/2022/05/220509204939.htmMay 9, 2022

Science Daily/University of South Australia

Millions of older people with poor vision are at risk of being misdiagnosed with mild cognitive impairments, according to a new study by the University of South Australia.

Cognitive tests that rely on vision-dependent tasks could be skewing results in up to a quarter of people aged over 50 who have undiagnosed visual problems such as cataracts or age-related macular degeneration (AMD).

Age-related macular degeneration is a leading cause of vision loss for older people. It doesn't cause complete vision loss, but severely impacts people's ability to read, drive, cook, and even recognise faces. It has no bearing on cognition.

UniSA researchers recruited 24 participants with normal vision to complete two cognitive tests -- one involving vision-dependent reactive tasks and the other based on verbal fluency.

Using a set of goggles to simulate AMD, the participants scored far lower on the cognitive test involving reaction time tasks than without the goggles. There was no statistical difference with verbal fluency tests when using the goggles.

The study has been published in Scientific Reports.

UniSA PhD candidate Anne Macnamara, who led the study, says the results are a stark reminder that visual impairments -- which affect approximately 200 million people worldwide over the age of 50 -- unfairly affect cognitive scores when tests involve visual abilities.

"A mistaken score in cognitive tests could have devastating ramifications, leading to unnecessary changes to a person's living, working, financial or social circumstances," Macnamara says.

"For example, if a mistaken score contributed to a diagnosis of mild cognitive impairment, it could trigger psychological problems including depression and anxiety.

"People with AMD are already experiencing multiple issues due to vision loss and an inaccurate cognitive assessment is an additional burden they don't need."

Visual impairments are often overlooked in research and clinical settings, the UniSA researchers say, with reduced vision underestimated in up to 50 per cent of older adults.

And with this figure expected to increase in line with an ageing population, it is critical that neuro-degenerative researchers control for vision when assessing people's cognition.

"Mobile apps can now be used to overlay simulated visual impairments onto test materials when piloting their stimuli," Macnamara says.

"Also, researchers can incorporate quick and simple screening tasks before getting people to do cognitive tests. Verbal tasks should always be part of the assessment, too."

https://www.sciencedaily.com/releases/2022/05/220509204939.htm

Study finds increased risk of dementia after hospitalization for major TBI

Minor traumatic brain injury did not increase dementia risk

May 12, 2022

Science Daily/American Academy of Neurology

People who have been hospitalized for a major traumatic brain injury (TBI) may have a higher risk of developing dementia when compared to people who do not have a TBI, according to a new study published in the May 11, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology. Major TBI was defined as having bleeding in the brain and a hospital stay of three or more days. Researchers did not find an increased risk for people who had minor TBI, which was defined as a concussion with no more than a one-day hospital stay.

"Traumatic brain injury has been identified as a possible risk factor for dementia, and due to increasing numbers of people living with dementia, it is imperative to identify risk factors that might be modifiable to decrease the number of people who develop dementia in the future," said study author Rahul Raj, MD, PhD, of the University of Helsinki in Finland. "The goal of our study was to assess the association between TBI and dementia while adjusting for other relevant dementia risk factors like high blood pressure, smoking, alcohol consumption and physical activity."

For the study, researchers used a Finnish national database that includes health surveys collected every five years. Focusing on a 20-year period, they identified 31,909 people who completed one or more surveys that included details on lifestyle factors such as physical activity, smoking and alcohol use.

Researchers then looked at national health registries. Of the study group, they identified 288 people hospitalized due to a major TBI and 406 hospitalized due to a minor TBI who did not have dementia within one year of their injury. A total of 976 people developed dementia over an average 16-year follow-up period.

Of those with a major TBI, 27 people, or 9%, developed dementia. Of those with a minor TBI, nine people, or 2%, developed dementia. And of those with no TBI, 940 people, or 3% developed dementia.

After adjusting for age and sex, researchers found that people who were hospitalized due to a major TBI had a 1.5 times greater risk of dementia than those without a TBI.

But after further adjustment for other relevant dementia risk factors such as education, smoking, alcohol consumption, physical activity and high blood pressure, the association weakened. Raj explained that alcohol use and physical activity appeared to play the biggest role in weakening the association.

Researchers found no increased risk of dementia for people hospitalized for minor TBI.

"Approximately one in 10 people in our study who had major TBI did develop dementia," said Raj. "Considering that there is no cure for dementia or TBI, the results of our study suggest that prevention of other dementia risk factors such as excess alcohol consumption and physical inactivity could possibly reduce the risk of dementia in people with major TBI. More research is needed in larger groups of people."

A limitation of the study was that it included only people hospitalized for TBI, so people who did not seek care for a mild TBI were not included.

https://www.sciencedaily.com/releases/2022/05/220512092701.htm

Clues about concussions from the gut

Research showed microbiome may be used to track impact of injuries and recovery timeline

May 10, 2022

Science Daily/Houston Methodist

Scientists suggest telltale signs of concussions might be found in the gut. By taking blood, stool and saliva samples from 33 football players, the researchers were able to examine the diagnostic potential of the gut's microbiome. They say their findings demonstrate that a simple, objective diagnostic test could be developed to track the impact of concussions and signal when it's safe to return to action.

A recently published study by Houston Methodist scientists suggests telltale signs of concussions might be found in the gut. By taking blood, stool and saliva samples from 33 Rice University football players, the researchers were able to examine the diagnostic potential of the gut's microbiome. They say their findings demonstrate that a simple, objective diagnostic test could be developed to track the impact of concussions and signal when it's safe to return to action.

The findings of this study are described in a paper titled "Alterations to the gut microbiome after sport-related concussion in a collegiate football players cohort: A pilot study" appearing in the May issue of Brain, Behavior, & Immunity -- Health, a peer-reviewed journal of the Psychoneuroimmunology Research Society with an emphasis on research that has translational impact and clinical implications. Sonia Villapol, Ph.D., an assistant professor of neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute, is the corresponding author on the study.

While brain movement within the skull may cause injury to nerve cells, such microscopic cellular injuries are not visible on imaging tests like X-rays, CT scans and MRIs, which are more capable of finding injuries on the scale of skull fractures, brain bleeding or swelling. So, the most commonly used test for diagnoses of concussions relies exclusively on self-reported symptoms like blurry vision, dizziness, nausea and headaches, which can be very vague, subjective and often underreported by athletes who want to continue playing. This can make them notoriously difficult to diagnose.

The study, conducted over the course of one season, found a post-concussion drop-off of two bacterial species normally found in abundance in stool samples of healthy individuals. It also found a correlation between traumatic brain injury linked proteins in the blood and one brain injury linked bacterial species in the stool.

While there have been dozens of brain injury biomarkers identified, there has been limited success in developing commercial blood tests sensitive enough to detect tiny increases in biomarker concentrations. However, the central nervous system is also intimately linked to the enteric nervous system, occurring in the intestines, and head trauma invariably leads to changes in the gut microbiota, Villapol said.

After a concussion, the injuries cause inflammation, sending small proteins and molecules circulating through the blood that breach the intestinal barrier and cause changes in the gut, affecting metabolism.

She said these changes in the microbiota could offer an opportunity to acquire a readout of the ongoing injury to the central nervous system.

"Until your gut microbiome has returned to normal, you haven't recovered," Villapol said. "This is why studying the gut is so useful. It doesn't lie. And that is why there is so much interest in using it for diagnostic purposes."

While only four of the players in the study were diagnosed with major concussions, the researchers say the results will need to be confirmed in a larger sample size. They also plan to conduct a similar study soon using women's soccer athletes, who similarly have frequent head trauma.

"Women and men don't have the same immunities or gut microbiomes, and as a woman and a mother of daughters, I would hate to be that researcher who only looks at men's issues while overlooking women," Villapol said. "Women soccer players have very high rates of concussions, as well, and all the same problems when it comes to existing diagnostic methods."

https://www.sciencedaily.com/releases/2022/05/220510151514.htm

Coaching program reduces burnout among resident physicians

May 6, 2022

Science Daily/University of Colorado Anschutz Medical Campus

A coaching program aimed at decreasing burnout among female resident physicians significantly reduced emotional exhaustion and imposter syndrome while increasing self-compassion over a six month period, according to researchers at the University of Colorado Anschutz Medical Campus.

"Physician burnout is linked to increased errors, higher patient mortality rates, depression, suicidal ideation and high job turnover," the study said. "The culture leading to burnout begins in medical school and worsens throughout training."

The study was published today in JAMA Network Open.

Currently, between 40-80% of residents and physicians experience burnout with surveys showing females feel it most acutely.

"When it comes to physician burnout people tend to either blame the system or the individual and miss the physician culture," said study co-author Tyra Fainstad, MD, visiting associate professor at the University of Colorado School of Medicine. "Right now, the physician culture is toxic."

Fainstad and fellow co-author Adrienne Mann, MD, assistant professor at the CU School of Medicine, are both certified life coaches who were alarmed at burnout rates among female residents.

Both had experienced it -- overwork, anxiety and creeping despair. Both found life coaching to be immensely helpful for their experience as doctors, so they each pursued professional certification to help other physicians. They created a coaching program for women resident physicians called Better Together Physician Coaching that targeted often self-destructive attitudes. They expected perhaps 20 people to sign up. They got 101 instead. So they designed a study to test its effectiveness.

Half of the group was offered the 6-month, web-based coaching program facilitated by Mann and Fainstad during their residency program. The other half served as a control group and received training without the coaching program. They were offered coaching at the end of the study.

During the coaching program, participants could take part in two group video-conferencing coaching calls per week where up to five could be coached live on any topic in front of the group.

They could also access unlimited, anonymous written coaching in a forum where participants could submit a narrative reflection and receive a coach's response published to a secure website. The website also housed weekly, self-study sessions using videos and worksheets on topics like goal setting, growth mindset, receiving critical feedback, imposter syndrome and perfectionism.

Participants often cited similar issues: Career decisions. A lack of feedback or poor feedback from supervisors. Struggling to balance medical training and a family. Being expected to embrace unrealistic attitudes toward work. Incidents of sexism. Being unnecessarily hard on themselves.

Imposter syndrome was especially prevalent. Mann and Fainstad created an entire curriculum to address it.

"You feel like a fraud even though you have the evidence that you belong where you are," Mann said. "A lot of people believe if you are hard on yourself you will achieve more, that it will motivate you to succeed. But the exact opposite happens. You stop taking on new challenges for fear of failure all the while your brain is telling you that you don't deserve to succeed."

Other participants feared appearing `arrogant' if they felt pride in their expertise and accomplishments.

"Overworking is often idolized in this culture," Fainstad said. "Many of us land at martyrdom. We sacrifice our home lives for our work."

But coaching is not therapy, she said.

Coaching uses inquiry around perceptions, beliefs and habits to define, reframe and align work with personal values.

Unlike teaching, advising and mentoring, the researchers said, coaching uses extensive questioning to identify patterns of thought and behavior. This helps people manage their thoughts, feelings and actions.

"Unlike therapy, coaching does not diagnose or clinically treat the coachee," the study said. "When supported institutionally, coaching is highly accessible and does not require insurance approval or co-pay."

The researchers used the Maslach Burnout Inventory (MBI) to measure their work. The MBI has three subscales: Emotional exhaustion (EE) or feeling emotionally exhausted from work; Depersonalization (DP), detached and impersonal treatment of patients; Professional accomplishment (PA), beliefs around competence and success at work.

The EE score is a key construct in health care related burnout. A one point increase in the EE scale has been associated with a 7% increase in suicidal ideation and a 5-6% increase in major medical errors.

The study showed a reduced mean EE score among those that took part in the training and an increased EE score in those that did not. It also showed significantly reduced symptoms of imposter syndrome from baseline compared to those who didn't undergo coaching.

"Better Together participants had a meaningful and statistically significant reduction in emotional exhaustion, imposter syndrome and improvement in self-compassion scores," Fainstad said. "The magnitudes of EE reduction were substantial and higher than in previously described wellness interventions."

The success of the coaching program has led to its adoption by 20 other health care training sites around the nation. The researchers plan to study all of them together in the fall of 2022 to investigate generalizability, or how useful the results are for a broader group, and the feasibility of the scaled up coaching program.

https://www.sciencedaily.com/releases/2022/05/220506141142.htm

Cutting calories and eating at the right time of day leads to longer life in mice

May 5, 2022

Science Daily/Howard Hughes Medical Institute

In a study that followed hundreds of mice over their lifespans, calorie restriction combined with time-restricted eating boosted longevity.

One recipe for longevity is simple, if not easy to follow: eat less. Studies in a variety of animals have shown that restricting calories can lead to a longer, healthier life.

Now, new research suggests that the body's daily rhythms play a big part in this longevity effect. Eating only during their most active time of day substantially extended the lifespan of mice on a reduced-calorie diet, Howard Hughes Medical Institute Investigator Joseph Takahashi and colleagues report May 5, 2022, in the journal Science.

In his team's study of hundreds of mice over four years, a reduced-calorie diet alone extended the animals' lives by 10 percent. But feeding mice the diet only at nighttime, when mice are most active, extended life by 35 percent. That combo -- a reduced-calorie diet plus a nighttime eating schedule -- tacked on an extra nine months to the animals' typical two-year median lifespan. For people, an analogous plan would restrict eating to daytime hours.

The research helps disentangle the controversy around diet plans that emphasize eating only at certain times of day, says Takahashi, a molecular biologist at the University of Texas Southwestern Medical Center. Such plans may not speed weight loss in humans, as a recent study in the New England Journal of Medicine reported, but they could prompt health benefits that add up to a longer lifespan.

Takahashi's team's findings highlight the crucial role of metabolism in aging, says Sai Krupa Das, a nutrition scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging who was not involved with the work. "This is a very promising and landmark study," she says.

Fountain of youth

Decades of research has found that calorie restriction extends the lifespan of animals ranging from worms and flies to mice, rats, and primates. Those experiments report weight loss, improved glucose regulation, lower blood pressure, and reduced inflammation.

Butit has been difficult to systematically study calorie restriction in people, who can't live in a laboratory and eat measured food portions for their entire lives, Das says. She was part of the research team that conducted the first controlled study of calorie restriction in humans, called the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy, or CALERIE. In that study, even a modest reduction in calories "was remarkably beneficial" for reducing signs of aging, Das says.

Scientists are just beginning to understand how calorie restriction slows aging at the cellular and genetic level. As an animal ages, genes linked to inflammation tend to become more active, while genes that help regulate metabolism become less active. Takahashi's new study found that calorie restriction, especially when timed to the mice's active period at night, helped offset these genetic changes as mice aged.

Question of time

Recent years have seen the rise of many popular diet plans that focus on what's known as intermittent fasting, such as fasting on alternate days or eating only during a period of six to eight hours per day. To unravel the effects of calories, fasting, and daily, or circadian, rhythms on longevity, Takahashi's team undertook an extensive four-year experiment. The team housed hundreds of mice with automated feeders to control when and how much each mouse ate for its entire lifespan.

Some of the mice could eat as much as they wanted, while others had their calories restricted by 30 to 40 percent. And those on calorie-restricted diets ate on different schedules. Mice fed the low-calorie diet at night, over either a two-hour or 12-hour period, lived the longest, the team discovered.

The results suggest that time-restricted eating has positive effects on the body, even if it doesn't promote weight loss, as the New England Journal of Medicine study suggested. Takahashi points out that his study likewise found no differences in body weight among mice on different eating schedules -- "however, we found profound differences in lifespan," he says.

Rafael de Cabo, a gerontology researcher at the National Institute on Aging in Baltimore says that the Science paper "is a very elegant demonstration that even if you are restricting your calories but you are not [eating at the right times], you do not get the full benefits of caloric restriction."

Takahashi hopes that learning how calorie restriction affects the body's internal clocks as we age will help scientists find new ways to extend the healthy lifespan of humans. That could come through calorie-restricted diets, or through drugs that mimic those diets' effects.

In the meantime, Takahashi is taking a lesson from his mice - he restricts his own eating to a 12-hour period. But, he says, "if we find a drug that can boost your clock, we can then test that in the laboratory and see if that extends lifespan."

https://www.sciencedaily.com/releases/2022/05/220505143753.htm