New research quantifies the 'wow' factor of sunrise and sunset

January 19, 2023

Science Daily/University of Exeter

A new study has identified the impact that fleeting natural events, such as sunrises and sunsets, can have on people, and sought to quantify their effects for the first time.

Despite a large body of research examining the impacts of nature on our mental health, most studies have assessed these effects under calm, blue skies. Surprisingly few have considered how we respond to variations in weather and the daily rhythms of the sun, changes referred to as 'ephemeral phenomena'.

To help close this gap, researchers used the latest computer graphics to show carefully controlled images of both urban and natural environments to more than 2,500 participants. When these scenes featured elements such as sunrise and sunset, participants considered them to be substantially more beautiful than when seen under sunny conditions at any other time of day.

Unexpectedly, the paper revealed that sunrise and sunset could also trigger significant boosts in people's feelings of awe. A typically difficult emotion to elicit, research indicates that awe has the potential to improve mood, enhance positive social behaviour, and increase positive emotions -- all valuable factors in enhancing overall wellbeing.

Published in the Journal of Environmental Psychology, the paper also considered rarer events, such as rainbows, thunderstorms, and starry, moonlit skies in the experiment. Each of these phenomena altered the extent to which people experienced beauty and awe in different landscapes, when compared to sunny, blue skies.

Crucially, these changes were also behind variations in how the environments were valued -- assessed by asking participants how much they would be willing to pay to experience each scene in the real world.

Participants were prepared to pay a premium of almost 10 per cent to visit a natural setting at sunrise compared to under blue skies. The research team said this kind of added value is normally attributed to more permanent features, such as scenic lakes or historic buildings. They suggested that encouraging people to experience sunsets and sunrises could help boost wellbeing, and might be used as part of green prescribing, where nature plays a therapeutic role in mental health treatment.

Alex Smalley, PhD fellow at the University of Exeter and lead author of the research, said: "We're all familiar with the urge to take a photo of a brilliant sunset or unexpected rainbow. The term 'sunset' has over 300 million tags on Instagram and people told us they'd be willing to pay a premium to experience these phenomena, but of course we can all experience them for free. Our research indicates that getting up a bit earlier for sunrise or timing a walk to catch sunset could be well worth the effort -- the 'wow' factor associated with these encounters might unlock small but significant bumps in feelings of beauty and awe, which could in turn have positive impacts for mental wellbeing."

The authors also noted how the occurrence of the phenomena they tested could vary greatly based on where people live. Those on east-facing coastlines might find sunrise easier to see, whilst those in the west might more frequently experience sunset. Equally, thunderstorms may be more common in summer in the UK, yet rainbows appear more often in winter. Alex Smalley added: "Most of the phenomena we tested can be fleeting and unpredictable, and we think this novelty is partly behind the effects we're seeing. Given their potential to change people's experiences in both natural and urban landscapes, there could be real value in highlighting how and where these events might be experienced, particularly in towns and cities."

https://www.sciencedaily.com/releases/2023/01/230119112753.htm

Music education benefits youth wellbeing

January 18, 2023

Science Daily/University of Southern California

The latest USC research on the impact of music education shows that for adolescents, the benefits appear to extend beyond a surge in neural connections in their brains. It actually boosts their wellbeing.

The study published Wednesday by the journal Frontiers In Psychology comes just weeks after voters statewide approved Prop. 28 to increase funding for arts and music education in California public schools.

A USC Thornton School of Music researcher said the results are especially meaningful amid a nationwide mental health crisis.

"We know that the pandemic has taken a toll on student mental health. The many narratives of learning loss that have emerged since the start of the pandemic paint a grim picture of what some call a 'lost generation'," said Beatriz Ilari, an associate professor of music education at the USC Thornton School of Music and corresponding author of the study. "Music might be an activity to help students develop skills and competencies, work out their emotions, engage in identity work and strengthen connections to the school and community."

The work was supported by grants including one from the Fender Play Foundation, a nonprofit organization that places instruments in the hands of youth who aspire to play and reap the powerful benefits of music education.

Evidence of those benefits continues to mount, although many states and school districts have reduced the amount of class time, faculty and curriculum dedicated to the arts amid budget crunches and changes in curriculum standards.

Ilari contributed to prior studies, including a longitudinal one by the USC Brain and Creativity Institute, that demonstrated children who learn a musical instrument have enhanced cognitive function. Other research also has shown music education contributes to improved creativity and confidence, better mental health and emotional stability, and student performance, according to a paper published last year by the International Journal of Environmental Research and Public Health.

Greater hope for the future

For the study, researchers examined the impact of music on "positive youth development," a measure of the strengths of adolescents and their potential to contribute to society developed by scholars from Tufts University. Researchers also included measures for school connectedness and hopeful future expectations.

The researchers administered anonymous, online surveys to 120 students from 52 Los Angeles Unified School District middle schools. The survey questions covered the key domains of positive youth development including competence and confidence. Past research shows that adolescents who manifest these attributes are more likely to make positive contributions to society and less likely to engage in risky behaviors later in life.

Ilari and her fellow researchers, including USC Thornton alumna Eun Cho, found many positive effects. They found that students who started music education before age 8 were more hopeful about the future, and younger students receiving musical training scored higher in key measures of positive youth development.

The research team also found that younger students scored higher in key development measures than their older peers. Sixth-grade students, for example, scored higher for overall positive youth development than -- eighth-graders, and scored higher in the confidence domain than both seventh and eighth-graders. Seventh-grade students also scored higher in overall positive youth development than eighth-graders.

In completing the study's survey questions, students were invited to choose from multiple gender categories beyond the usual binary gender options, including "non-binary" and "prefer not to answer," to identify themselves. Non-binary students scored lower in overall positive youth development and connection than girls. They also scored lower in confidence and connection than boys.

"Given the high levels of depression and suicide ideation among LGBTQ+ and non-gender conforming students, it is crucial that research examining adolescent well-being move beyond the gender binary," Ilari said. "In addition to filling critical gaps in the existing literature, results from our study can be used to inform the development of programs and policy for all young people."

The study included students of diverse backgrounds. However, students participating in a virtual music education program primarily came from poor neighborhoods, indicating disparities in access to formal music education.

In addition, the study explored students' engagement in different music programs, including the Virtual Middle School Music Enrichment (VMSME), a tuition-free, extracurricular program that focuses on popular music education and virtual learning. The program is available through a school district partnership with the Fender Play Foundation. Researchers found that students participating in multiple forms of music education and for longer periods of time scored higher in measures for competence and hopeful future expectations. Some participants in these groups were also enrolled in private lessons and/or playing in small ensembles that offer more individual attention than large group classes. In contrast, students in the extracurricular VMSME program came from low-income neighborhoods and participated in fewer extracurricular activities.

"By expanding access to instruments and music classes for students from low socioeconomic areas -- a population that is often left out of school music programs -- VMSME contributed to the democratization of music education," Ilari said. "Throughout the pandemic, students in public schools, especially in urban areas, were disproportionately impacted by the lockdowns that deprived them of physical and social contact with peers. VMSME brought together students from different neighborhoods and at a time when forming peer groups is essential to social identity development."

More research is needed to better understand disparities in access to formal music education, Ilari said, but she said programs that give student agency in their learning and allow them to engage with peers from other schools, like VMSME, have the potential to promote learning and wellbeing.

https://www.sciencedaily.com/releases/2023/01/230118195730.htm

Good news for athletes who are slow to recover from concussion

Most need just one more month to return to play

January 18, 2023

Science Daily/American Academy of Neurology

A new study suggests that athletes who recover more slowly from concussion may be able to return to play with an additional month of recovery beyond the typical recovery time, according to a new study published in the January 18, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. Slow recovery was defined as taking more than 14 days for symptoms to resolve or taking more than 24 days to return to play, both of which are considered the typical recovery times for about 80% of athletes with concussion.

"Although an athlete may experience a slow or delayed recovery, there is reason to believe recovery is achievable with additional time and injury management," said study author Thomas W. McAllister, MD, of the Indiana University School of Medicine in Indianapolis. "This is an encouraging message that may help to relieve some of the discouragement that athletes can feel when trying to return to their sport. While some athletes took longer than 24 days to return to play, we found that three-quarters of them were able to return to sports if given just one more month to recover."

The study looked at 1,751 college athletes who had been diagnosed with a concussion by a team physician. Of the athletes, 63% were male and 37% were female. Male athletes participated primarily in football, soccer and basketball. Female athletes participated primarily in soccer, volleyball and basketball.

Participants were evaluated five times: within six hours after their injury, one to two days later, once free of symptoms, once cleared to return to play and at six months.

Participants reported symptoms daily to medical staff, up to 14 days following injury and then weekly if they had not yet returned to play.

A total of 399 athletes, or 23%, had a slow recovery.

Researchers found that of the athletes who took longer than 24 days to return to play, more than three-fourths, or 78%, were able to return to play within 60 days of injury, and four-fifths, or 83%, were able to return to play within 90 days of injury. Only 11% had not returned to play six months after injury.

For the slow recovery group, the average time for returning to play was 35 days after injury, compared to 13 days in the overall group.

"The results of this study provide helpful information for athletes and medical teams to consider in evaluating expectations and making difficult decisions about medical disqualification and the value of continuing in their sport," McAllister said.

A limitation of the study is that participants were all collegiate varsity athletes and may not be representative of other age groups or levels of sport, and the results may not apply to other types of mild brain injuries.

https://www.sciencedaily.com/releases/2023/01/230118195719.htm

In the wake of a wildfire, embers of change in cognition and brain function linger

People exposed to the deadly Camp Fire in 2018 displayed altered cognitive function months later; it's new evidence of a growing phenomenon known as 'climate trauma'

January 18, 2023

Science Daily/University of California - San Diego

n November 2018, the Camp Fire burned a total of 239 square miles, destroyed 18,804 structures and killed 85 people, making it the deadliest and most destructive wildfire in California history.

Three years later, researchers at University of California San Diego, published a novel study that looked at the psychological consequences, finding that exposure to "climate trauma" for affected residents resulted in increased and chronic mental health problems, such as post-traumatic stress disorder and depression.

In a new study, published in the January 18, 2023 online issue of PLOS Climate, senior author Jyoti Mishra, PhD, associate professor in the Department of Psychiatry at UC San Diego School of Medicine, director of the Neural Engineering and Translation Labs at UC San Diego, and associate director of the UC Climate and Mental Health Initiative, delved deeper with her colleagues. The study team reported that in a subset of persons exposed to the Camp Fire, significant differences in cognitive functioning and underlying brain activity were revealed using electroencephalography (EEG).

Specifically, the researchers found that fire-exposed individuals displayed increased activity in the regions of the brain involved in cognitive control and interference processing -- the ability to mentally cope with unwanted and often disturbing thoughts.

"To function well day-to-day, our brains need to process information and manage memories in ways that help achieve goals while ignoring or dispensing with irrelevant or harmful distractions," said Mishra.

"Climate change is an emerging challenge. It is already well-documented that extreme climate events result in significant psychological impacts. Warming temperatures, for example, have even been linked to greater suicide rates. As planetary warming amplifies, more forest fires are expected in California and globally, with significant implications for mental health effects.

"In this study, we wanted to learn whether and how climate trauma affected and altered cognitive and brain functions in a group of people who had experienced it during the Camp Fire. We found that those who were impacted, directly or indirectly, displayed weaker interference processing. Such weakened cognitive performance may then impair daily functioning and reduce wellbeing."

The study sample included 27 persons directly exposed to the Camp Fire (for example, their homes were destroyed), 21 who were indirectly exposed (they witnessed the fire, but were not directly impacted) and 27 control individuals. All participants underwent cognitive testing with synchronized EEG brain recordings.

Sixty-seven percent of the individuals directly exposed to the fire reported having experienced recent psychological trauma, as did 14 percent of the indirectly exposed individuals. None of the control individuals reported recent trauma exposure.

The EEG recordings showed that the brains of those individuals reporting trauma worked harder at interference processing and cognitive control, suggesting a compensatory effort but at a cost: potentially heightened risk of neurological dysfunction elsewhere.

"The evidence of diminished interference processing, along with altered functional brain responses, is useful because it can help guide efforts to develop resiliency intervention strategies," said Mishra.

"As the planet warms, more and more individuals will face extreme climate exposures, like wildfires, and having therapeutic tools that can address underlying neuro-cognitive issues will be an important complement to other socio-behavioral therapies."

https://www.sciencedaily.com/releases/2023/01/230118195708.htm

Vitamin D benefits and metabolism may depend on body weight

People with higher body mass index had a blunted response to vitamin D supplementation, explaining observed differences in outcomes such as cancer, diabetes, and autoimmune disease

January 17, 2023

Science Daily/Brigham and Women's Hospital

Researchers from Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system, have found new evidence that vitamin D may be metabolized differently in people with an elevated body mass index (BMI). The study, appearing in JAMA Network Open, is a new analysis of data from the VITAL trial, a large nationwide clinical trial led by Brigham researchers that investigated whether taking vitamin D or marine omega-3 supplements could reduce the risk of developing cancer, heart disease, or stroke.

"The analysis of the original VITAL data found that vitamin D supplementation correlated with positive effects on several health outcomes, but only among people with a BMI under 25," said first author Deirdre K. Tobias, ScD, an associate epidemiologist in Brigham's Division of Preventive Medicine. "There seems to be something different happening with vitamin D metabolism at higher body weights, and this study may help explain diminished outcomes of supplementation for individuals with an elevated BMI."

Vitamin D is an essential nutrient involved in many biological processes, most notably helping our body absorb minerals, such as calcium and magnesium. While some of the vitamin D we need is made in the body from sunlight, vitamin D deficiencies are often treated with supplementation. Evidence from laboratory studies, epidemiologic research and clinical research has also suggested that vitamin D may play a role in the incidence and progression of cancer and cardiovascular disease, and it was this evidence that prompted the original VITAL trial.

The VITAL trial was a randomized, double-blind, placebo-controlled trial in 25,871 U.S. participants, which included men over the age of 50 and women over the age of 55. All participants were free of cancer and cardiovascular disease at the time of enrollment. While the trial found little benefit of vitamin D supplementation for preventing cancer, heart attack, or stroke in the overall cohort, there was a statistical correlation between BMI and cancer incidence, cancer mortality, and autoimmune disease incidence. Other studies suggest similar results for type 2 diabetes.

The new study aimed to investigate this correlation. The researchers analyzed data from 16,515 participants from the original trial who provided blood samples at baseline (before randomization to vitamin D), as well as 2,742 with a follow-up blood sample taken after two years. The researchers measured the levels of total and free vitamin D, as well as many other novel biomarkers for vitamin D, such as its metabolites, calcium, and parathyroid hormone, which helps the body utilize vitamin D.

"Most studies like this focus on the total vitamin D blood level," said senior author JoAnn E. Manson, MD, DrPH, chief of the Division of Preventive Medicine at the Brigham and principal investigator of VITAL. "The fact that we were able to look at this expanded profile of vitamin D metabolites and novel biomarkers gave us unique insights into vitamin D availability and activity, and whether vitamin D metabolism might be disrupted in some people but not in others."

The researchers found that vitamin D supplementation increased most of the biomarkers associated with vitamin D metabolism in people, regardless of their weight. However, these increases were significantly smaller in people with elevated BMIs.

"We observed striking differences after two years, indicating a blunted response to vitamin D supplementation with higher BMI," Tobias said. "This may have implications clinically and potentially explain some of the observed differences in the effectiveness of vitamin D supplementation by obesity status."

"This study sheds light on why we're seeing 30-40 percent reductions in cancer deaths, autoimmune diseases, and other outcomes with vitamin D supplementation among those with lower BMIs but minimal benefit in those with higher BMIs, suggesting it may be possible to achieve benefits across the population with more personalized dosing of vitamin D," said Manson. "These nuances make it clear that there's more to the vitamin D story."

The authors conclude that the VITAL findings are a call to action for the research community to continue exploring the potential benefits of vitamin D supplementation for preventing cancer and other diseases and to take BMI into account when evaluating the supplement's health impacts.

https://www.sciencedaily.com/releases/2023/01/230117110511.htm

Study explores effects of dietary choline deficiency on neurologic and system-wide health

Reaching adequate dietary choline intake is critical to offset organ pathologies and may help protect the brain against Alzheimer's disease

January 17, 2023

Science Daily/Arizona State University

Choline, an essential nutrient produced in small amounts in the liver and found in foods including eggs, broccoli, beans, meat and poultry, is a vital ingredient for human health. A new study explores deficiency in dietary choline adversely affects the body and may be a missing piece in the puzzle of Alzheimer's disease.

It's estimated that more than 90% of Americans are not meeting the recommended daily intake of choline. The current research, conducted in mice, suggests that dietary choline deficiency can have profound negative effects on the heart, liver and other organs.

Lack of adequate choline is also linked with profound changes in the brain associated with Alzheimer's disease. These include pathologies implicated in the development of two classic hallmarks of the illness, amyloid plaques, which aggregate in the intercellular spaces between neurons, and tau tangles, which condense within the bodies of neurons.

The new research, led by scientists at Arizona State University, describes pathologies in normal mice deprived of dietary choline as well as choline deficient transgenic mice, which already exhibit symptoms associated with the disease. In both cases, dietary choline deficiency results in liver damage, enlargement of the heart and neurologic alterations in the AD mice typically accompanying Alzheimer's disease, including increased levels of plaque-forming amyloid-beta protein and disease-linked alterations in tau protein.

Further, the study illustrates that choline deficiency in mice causes significant weight gain, and alterations in glucose metabolism, (which are tied to conditions such as diabetes), and deficits in motor skills.

In the case of humans, "it's a twofold problem," according to Ramon Velazquez, senior author of the study and Assistant professor with the ASU-Banner Neurodegenerative Disease Research Center. "First, people don't reach the adequate daily intake of choline established by the Institute of Medicine in 1998. And secondly, there is vast literature showing that the recommended daily intake amounts are not optimal for brain-related functions."

Ramon Velazquez led the new study on the importance of dietary choline for the brain and other organs. He is a researcher in the ASU-Banner Neurodegereative Disease Research Center.

The research highlights a constellation of physical and neurological changes linked to choline deficiency. Sufficient choline in the diet reduces levels of the amino acid homocysteine, which has been recognized as a neurotoxin contributing to neurodegeneration and is important for mediating functions such as learning and memory, through the production of acetylcholine.

The growing awareness of choline's importance should encourage all adults to ensure proper choline intake. This is particularly true for those on plant-based diets, which may be low in naturally occurring choline, given that foods high in choline are eggs, meats, and poultry.

Plant-based, choline-rich foods, including soybeans, Brussel sprouts and toast can help boost choline in these cases. Further, inexpensive, over-the-counter choline supplements are encouraged to ensure system-wide health and guard the brain from the effects of neurodegeneration.

Brain-boosting nutrient

Choline is needed to produce acetylcholine, a neurotransmitter that plays an essential role in memory, muscle control and mood. Choline also builds cell membranes and helps regulate gene expression. The established recommendations set forth by the Institute of Medicine were based on evidence preventing fatty liver disease in men. New lines of evidence imply that the established recommended daily intake of dietary choline for adult women (425mg/day) and adult men (550mg/day) may not be optimal for proper brain health and cognition. Additionally, ~90% of Americans are not meeting the recommendation levels and may not even be aware that dietary choline is required on a daily basis.

Despite decades of research and billions of dollars invested since the discovery of the devastating ailment over a century ago, there remains no therapy capable of slowing the advance of the illness. Yet, new research findings suggest that environmental and lifestyle changes, including adequate choline, may help protect the brain from Alzheimer's disease as well as improving overall health.

Velazquez is joined on the study by co-lead authors Nikhil Dave and Jessica Judd. The work is highly interdisciplinary, including researchers from the ASU Biosciences Mass spectrometry facility, and the Translational Cardiovascular Research Center at the University of Arizona College of Medicine in Phoenix, AZ.

"This collaborative work, spanning multiple institutions and surveying the molecular processes of aging at the systems level, adds to the body of evidence produced around the importance of dietary choline in healthy aging," said Nikhil Dave.

"What I found particularly compelling about this project was that multiple organs, whose malfunction can have implications for brain health, were negatively impacted by a choline deficient diet," said Jessica Judd.

The research appears in the current issue of the journal Aging Cell.

A prolific and mysterious killer

Alzheimer's disease is the leading cause of dementia and the fifth leading cause of death among Americans aged 65 and older. Today, Alzheimer's affects 6.5 million in the U.S. alone and is projected to strike close to 14 million Americans by 2060. By this time, the costs of managing Alzheimer's are expected to exceed a $20 trillion, threatening the healthcare infrastructure while causing immense suffering.

The accumulation of sticky protein fragments outside neurons, (which form amyloid-beta plaques), and the buildup of an abnormal form of the protein tau within the bodies of neurons (tau tangles) have long been recognized signposts of Alzheimer's disease. These brain alterations are typically followed by neurodegeneration, involving the damage and destruction of neurons. Plaques are believed to damage cell-to-cell communications in the brain while tangles block the transport of vital nutrients essential for proper cell function and survival.

In addition to amyloid-beta plaques and neurofibrillary tangles, the disease causes cell death in the brain and increasing cognitive impairment. The current work also found dysregulation of proteins in the hippocampus, a key structure affected in Alzheimer's disease, tied to learning and memory. Both normal and AD mice showed dysregulated proteins in the hippocampus with a choline deficient diet, with the AD model showing severe effects.

Gathering storm

The recent, dramatic increase in Alzheimer's disease incidence is of grave concern. Although deaths from stroke, heart disease and HIV decreased between 2000 and 2019, deaths from Alzheimer's increased more than 145%. In addition to the toll on patients caused by the disease, Alzheimer's has placed an immense burden on those caring for the sick. In 2021 alone, 16 billion hours of care were provided by over 11 million family members and other unpaid caregivers.

The first outward symptoms of the disease are usually related to language, memory, and thinking problems, as brain regions associated with these tasks tend to be among the first affected. Yet researchers now know that by the time the disease causes observable symptoms, it has been quietly ravaging the brain for 20 years or more.

Many factors contribute to the development of Alzheimer's disease, from genetic predisposition to age, lifestyle and environmental influences. For reasons that remain murky, females face an increased risk of developing the disease.

Recent studies have identified diet as a significant factor associated with preventing cognitive decline. In earlier research, Velazquez and his colleagues demonstrated that when mice were fed a high choline diet, their offspring showed improvements in spatial memory, compared with a normal choline regimen in the womb. Intriguingly, the beneficial effects of choline supplementation are transgenerational, not only protecting mice receiving choline supplementation during gestation and lactation, but also the subsequent offspring of these mice, suggesting inherited modifications in their genes.

Subsequent studies in the Velazquez lab showed that choline administered to female mice throughout life yielded improvements in spatial memory, compared with those receiving a normal choline regimen.

Multifaceted effects

The new study examines mice at 3-12 months or early to late adulthood, (roughly equivalent to 20-60 years of age for humans). In the case of both normal and transgenic mice displaying symptoms of Alzheimer's, those exposed to a deficient choline diet exhibited weight gain and adverse effects to their metabolism. Damage to the liver was observed through tissue analysis, as well as enlargement of the heart. Elevated soluble, oligomeric and insoluble amyloid-beta protein were detected as well as modifications to tau protein characteristic of those leading to neurofibrillary tangles in the brain.

Further, choline deficient mice performed poorly in a test of motor skills, when compared with mice receiving adequate choline in their diet. These adverse effects were heightened in the transgenic mice. Translating these findings to humans, this implies that people who are predisposed to Alzheimer's disease or in the throes of the illness should ensure they are getting enough choline.

The study also involved a detailed exploration of proteins in the hippocampus, an area of the brain acutely affected by Alzheimer's disease, as well as proteins detected in blood. Dietary choline deficiency altered important hippocampal networks. These pathologies include disruption of pathways associated with microtubule function and postsynaptic membrane regulation -- both essential for proper brain function. In blood, proteins produced in the liver that play a role in metabolic function were particularly dysregulated with the choline deficient diet.

"Our work provides further support that dietary choline should be consumed on a daily basis given the need throughout the body," Velazquez says.

Ultimately, controlled human clinical trials will be essential for establishing the effectiveness and appropriate dosages of choline, before encouraging lifelong choline supplementation. Nevertheless, the powerful new findings offer hope that choline may be one tool in the arsenal needed to defend the brain from neurodegeneration and age-related cognitive decline.

https://www.sciencedaily.com/releases/2023/01/230117193006.htm

The link between mental health and ADHD is strong -- so why aren't we paying attention?

January 16, 2023

Science Daily/University of Bath

Adults with high levels of attention-deficit hyperactivity disorder (ADHD) symptoms are more likely to experience anxiety and depression than adults with high levels of autistic traits, according to new research led by psychologists at the University of Bath in the UK.

This study is the first to show that ADHD is more predictive of poor mental health outcomes in adults than other neurodevelopmental conditions, like autism.

Until now, there has been a dearth of information on the effects of ADHD on poor mental health, with far more research focusing on the impact of autism on depression, anxiety and quality of life. As a result, people with ADHD have often struggled to access the clinical care they need to cope with their symptoms.

The authors of the study hope their findings will trigger new research into ADHD and ultimately improve the mental health outcomes for people with the condition. ADHD is a neurodevelopmental condition characterised by inattention and/or hyperactivity and impulsivity. The condition is estimated to affect between 3% and 9% of the population.

Blue Monday

Speaking on Blue Monday (January 16) -- the third Monday of January, described by some as the gloomiest day of the year -- lead researcher, Luca Hargitai, said: "Scientists have long known that autism is linked to anxiety and depression, but ADHD has been somewhat neglected.

"Researchers have also struggled to statistically separate the importance of ADHD and autism for mental health outcomes because of how frequently they occur together."

Ms Hargitai, a PhD Researcher at Bath, added: "Our aim was to precisely measure how strongly ADHD personality traits were linked to poor mental health while statistically accounting for autistic traits."

The new research -- a collaborative effort between the Universities of Bath, Bristol and Cardiff, and King's College London -- is published this week in Scientific Reports. It comes in the same month that two British TV personalities -- Johnny Vegas and Sue Perkins -- have opened up about their recent diagnoses of ADHD.

"The condition affects many people -- both children and adults -- and the fact that more people are willing to talk about it is to be welcomed," said Ms Hargitai. "The hope is that with greater awareness will come more research in this area and better resources to support individuals in better managing their mental health."

Overly active, as though driven by a motor

The study used a large, nationally representative sample of adults from the UK population. All participants completed gold standard questionnaires -- one on autistic traits, the other on ADHD traits -- responding to statements such as "I frequently get strongly absorbed in one thing" and "How often do you feel overly active and compelled to do things, like you were driven by a motor?"

The researchers found that ADHD traits were highly predictive of the severity of anxiety and depression symptoms: the higher the levels of ADHD traits, the more likely a person is to experience severe mental health symptoms. Through innovative analytical techniques, the study authors further confirmed that having more of an ADHD personality was more strongly linked to anxiety and depression than autistic traits.

These results were replicated in computerised simulations with a 100% 'reproducibility rate'. This showed, with great confidence, that ADHD traits are almost certainly linked to more severe anxiety and depression symptoms in adults than autistic traits.

Shifting the focus of research and clinical practice

Ms Hargitai said: "Our findings suggest that research and clinical practice must shift some of the focus from autism to ADHD. This may help to identify those most at risk of anxiety and depression so that preventative measures -- such as supporting children and adults with the management of their ADHD symptoms -- can be put in place earlier to have a greater impact on improving people's wellbeing."

According to Dr Punit Shah, senior author and associate professor of Psychology at Bath, another important aspect of the new study is that it advances scientific understanding of neurodevelopmental conditions.

"By addressing the shortcomings of previous research, our work provides fresh information about the complex links between neurodiversity and mental health in adults -- an area that is often overlooked.

"Further research is now needed to delve deeper into understanding exactly why ADHD is linked to poor mental health, particularly in terms of the mental processes that might drive people with ADHD traits to engage in anxious and depressive thinking.

"At the moment, funding for ADHD research -- particularly psychological research -- is lacking. This is especially pronounced when you compare it to the relatively high level of funds directed at autism.

"As the evidence becomes clear that ADHD isn't just a childhood condition but persists throughout life, we must adjust our research agendas to better understand ADHD in adulthood."

Commenting on the new findings, Dr Tony Floyd, CEO of ADHD Foundation, The Neurodiversity Foundation, said: "This research demonstrates clear evidence of the increased risks of mental health comorbidities associated with adult ADHD. This is a step towards recognising the broader impact of unmanaged and untreated ADHD. We hope this research will lead to more research being commissioned in this area. We also hope it will result in changes to the design and delivery of health services.

"The cost implications to the NHS of leaving ADHD untreated, and the need to better train health practitioners in both primary and secondary care, are now more apparent. And of course there are other costs too that need to be considered -- to the health of UK citizens with ADHD and to their family life, employability and economic wellbeing. These costs are often hidden but they are considerable.

"This research from Bath University will add to the growing national debate and the business case for a national review of health services for ADHD across a person's lifespan."

https://www.sciencedaily.com/releases/2023/01/230116112600.htm

Managing emotions better could prevent pathological aging

January 13, 2023

Science Daily/Université de Genève

Negative emotions, anxiety and depression are thought to promote the onset of neurodegenerative diseases and dementia. But what is their impact on the brain and can their deleterious effects be limited? Neuroscientists at the University of Geneva (UNIGE) observed the activation of the brains of young and older adults when confronted with the psychological suffering of others. The neuronal connections of the older adults show significant emotional inertia: negative emotions modify them excessively and over a long period of time, particularly in the posterior cingulate cortex and the amygdala, two brain regions strongly involved in the management of emotions and autobiographical memory. These results, to be published in Nature Aging, indicate that a better management of these emotions -- through meditation for example -- could help limit neurodegeneration.

For the past 20 years, neuroscientists have been looking at how the brain reacts to emotions. ''We are beginning to understand what happens at the moment of perception of an emotional stimulus,'' explains Dr Olga Klimecki, a researcher at the UNIGE's Swiss Centre for Affective Sciences and at the Deutsches Zentrum für Neurodegenerative Erkrankungen, who is last author of this study carried out as part of a European research project co-directed by the UNIGE. ''However, what happens afterwards remains a mystery. How does the brain switch from one emotion to another? How does it return to its initial state? Does emotional variability change with age? What are the consequences for the brain of mismanagement of emotions?''

Previous studies in psychology have shown that an ability to change emotions quickly is beneficial for mental health. Conversely, people who are unable to regulate their emotions and remain in the same emotional state for a long time are at higher risks of depression. ''Our aim was to determine what cerebral trace remains after the viewing of emotional scenes, in order to evaluate the brain's reaction, and, above all, its recovery mechanisms. We focused on the older adults, in order to identify possible differences between normal and pathological ageing,'' says Patrik Vuilleumier, professor in the Department of Basic Neurosciences at the Faculty of Medicine and at the Swiss Centre for Affective Sciences at the UNIGE, who co-directed this work.

Not all brains are created equal

The scientists showed volunteers short television clips showing people in a state of emotional suffering -- during a natural disaster or distress situation for example -- as well as videos with neutral emotional content, in order to observe their brain activity using functional MRI. First, the team compared a group of 27 people over 65 years of age with a group of 29 people aged around 25 years. The same experiment was then repeated with 127 older adults.

''Older people generally show a different pattern of brain activity and connectivity from younger people,'' says Sebastian Baez Lugo, a researcher in Patrik Vuilleumier's laboratory and the first author of this work. ''This is particularly noticeable in the level of activation of the default mode network, a brain network that is highly activated in resting state. Its activity is frequently disrupted by depression or anxiety, suggesting that it is involved in the regulation of emotions. In the older adults, part of this network, the posterior cingulate cortex, which processes autobiographical memory, shows an increase in its connections with the amygdala, which processes important emotional stimuli. These connections are stronger in subjects with high anxiety scores, with rumination, or with negative thoughts.''

Empathy and ageing

However, older people tend to regulate their emotions better than younger people, and focus more easily on positive details, even during a negative event. But changes in connectivity between the posterior cingulate cortex and the amygdala could indicate a deviation from the normal ageing phenomenon, accentuated in people who show more anxiety, rumination and negative emotions. The posterior cingulate cortex is one of the regions most affected by dementia, suggesting that the presence of these symptoms could increase the risk of neurodegenerative disease.

''Is it poor emotional regulation and anxiety that increases the risk of dementia or the other way around? We still don't know,'' says Sebastian Baez Lugo. ''Our hypothesis is that more anxious people would have no or less capacity for emotional distancing. The mechanism of emotional inertia in the context of ageing would then be explained by the fact that the brain of these people remains 'frozen' in a negative state by relating the suffering of others to their own emotional memories."

Could meditation be a solution?

Could it be possible to prevent dementia by acting on the mechanism of emotional inertia? The research team is currently conducting an 18-month interventional study to evaluate the effects of foreign language learning on the one hand, and meditation practice on the other. ''In order to further refine our results, we will also compare the effects of two types of meditation: mindfulness, which consists of anchoring oneself in the present in order to concentrate on one's own feelings, and what is known as 'compassionate' meditation, which aims to actively increase positive emotions towards others,'' the authors add.

This research is part of a large European study, MEDIT-AGEING, which aims to evaluate the impact of non-pharmacological interventions for better ageing.

https://www.sciencedaily.com/releases/2023/01/230113112746.htm

Support from others in stressful times can ease impact of genetic depression risk

Study in first-year doctors and recently widowed older adults shows greatest impact of social support in those with highest polygenic risk scores for depression

January 13, 2023

Science Daily/Michigan Medicine - University of Michigan

Reaching out to support a person when they're under stress is always a good idea. But a new study suggests that support could be especially important for someone whose genetic makeup makes them more likely to develop depression.

The study shows the importance of social support in buffering the risk of developing depression symptoms in general, using data from two very different groups of people under stress: new doctors in the most intense year of training, and older adults whose spouses recently died.

But the largest effect was seen in those who had the most genetic variation that raised the risk of depression.

The paper uses a measure of genetic risk called a polygenic risk score, which is based on decades of research about what tiny variations in specific genes are linked to depression risk.

Compared to individuals in the study who had low depression polygenic risk scores, the doctors and widows with higher risk scores had higher rates of depression after they lost social support, but also had lower rates of depression when they gained social support during stressful times.

The study, published in the American Journal of Psychiatry by a University of Michigan team, suggests that more could be done to target social support to those who can most benefit.

Genes, stress and social connection

"Our data show wide variability in the level of social support individuals received during these stressful times, and how it changed over time," said first author Jennifer Cleary, M.S., a psychology doctoral student at U-M who is doing her research with senior author Srijan Sen, M.D., Ph.D., of the U-M Medical School. "We hope these findings, which incorporate genetic risk scores as well as measures of social support and depressive symptoms, illuminate the gene-environment interactions and specifically the importance of social connection in depression risk."

Sen, who is the director of the Eisenberg Family Depression Center and a professor of psychiatry and neuroscience, adds that even as genetic research reveals more of the DNA variation related to depression vulnerability, learning how that variation leads to depression is crucial.

"Further understanding the different genetic profiles associated with sensitivity to loss of social support, insufficient sleep, excessive work stress and other risk factors could help us develop personalized guidance for depression prevention," he said. "In the meantime, these findings reaffirm how important social connections, social support and individual sensitivity to the social environment are as factors in wellbeing and preventing depression."

Different populations, similar patterns

The new study used data from two long-term studies that both capture genetic, mood, environment and other data from populations of participating individuals.

One is the Intern Health Study, which enrolls first-year medical residents (also called interns) around the United States and beyond, and which Sen directs.

The other is the Health and Retirement Study, based at the U-M Institute for Social Research and funded by the National Institute on Aging.

The data for the new paper came from 1,011 interns training at hospitals across the country, nearly half of whom were female, and from 435 recently widowed individuals, 71% of them women, who had data available from surveys conducted before and after their spouses died.

In the interns, as Sen and his team have shown in previous work, depressive symptoms increased dramatically (126%) during the stressful year of training that includes long and irregular work hours -- often in environments far from friends and family.

In the widows and widowers, depressive symptoms increased 34% over their pre-widowhood scores. This correlates with past research showing loss of a spouse can be one of the biggest stressors in a person's life, Cleary said.

A crossover effect

Then, the researchers factored together the depression symptom findings with each person's polygenic risk score for depression, and their individual responses to questions about connections with friends, family and other social supporters.

Most of the interns lost social support from their pre-internship days -- which fits well with the common experience of leaving the place where they attended medical school and going to a new environment where they may not know anyone.

Interns who had the highest polygenic risk scores and also lost social support had the highest scores on measures of depression symptoms later in the stressful intern year.

Those with the same high level of genetic risk who gained social support, though, had much lower depressive symptoms. In fact, it was lower than even their peers with low genetic risk, no matter what happened to their social support. The researchers call this a "crossover effect."

Unlike the interns, some widowed individuals reported an increase in social support after the loss of their spouse, potentially as friends and family reached out to offer help or just a listening ear.

But the crossover effect was visible in them, too. Widows with high genetic risk for depression who gained social support showed a much smaller increase in depressive symptoms than their peers with similar genetic risk who lost social support after losing a spouse.

There were also some widows who lost social support or didn't experience a change in support, and whose depressive symptoms didn't change. Cleary notes that in future work, it will be important to look at this group's history in light of any caregiving they may have done for a spouse with a long-term illness.

The team also hopes that other researchers will study this same interaction of genetic risk, stress and social support in other populations.

In the meantime, Cleary and Sen say, the message for anyone going through stressful times, or watching a friend or relative go through stressful times, is to reach out and maintain or strengthen social connections.

Doing so can have benefits both for the person under stress, and the person reaching out to them, they note.

Reducing the level of ongoing stress that the person is facing, whether it's at work, school, after a personal loss or in family situations can be critical.

And even though the study did not examine the role of professional mental health help, individual and group therapy is an important option for those who have developed depression or other mental health concerns.

Note: The polygenic risk score used in the study is validated for use on people of mainly European ancestry, which limits the ability to generalize the findings to people of other backgrounds. Sen notes that additional work is being done using data from the Intern Health Study and Health & Retirement Study to develop polygenic risk scores based on depression-related genetic traits in other populations including people of East Asian and African descent.

https://www.sciencedaily.com/releases/2023/01/230113112733.htm

Gut bacteria affect brain health

Findings suggest new approach to treating Alzheimer's, other neurodegenerative diseases

January 12, 2023

Science Daily/Washington University School of Medicine

A growing pile of evidence indicates that the tens of trillions of microbes that normally live in our intestines -- the so-called gut microbiome -- have far-reaching effects on how our bodies function. Members of this microbial community produce vitamins, help us digest food, prevent the overgrowth of harmful bacteria and regulate the immune system, among other benefits. Now, a new study suggests that the gut microbiome also plays a key role in the health of our brains, according to researchers from Washington University School of Medicine in St. Louis.

The study, in mice, found that gut bacteria -- partly by producing compounds such as short chain fatty acids -- affect the behavior of immune cells throughout the body, including ones in the brain that can damage brain tissue and exacerbate neurodegeneration in conditions such as Alzheimer's disease. The findings, published Jan. 13 in the journal Science, open up the possibility of reshaping the gut microbiome as a way to prevent or treat neurodegeneration.

"We gave young mice antibiotics for just a week, and we saw a permanent change in their gut microbiomes, their immune responses, and how much neurodegeneration related to a protein called tau they experienced with age," said senior author David M. Holtzman, MD, the Barbara Burton and Reuben M. Morriss III Distinguished Professor of Neurology. "What's exciting is that manipulating the gut microbiome could be a way to have an effect on the brain without putting anything directly into the brain."

Evidence is accumulating that the gut microbiomes in people with Alzheimer's disease can differ from those of healthy people. But it isn't clear whether these differences are the cause or the result of the disease -- or both -- and what effect altering the microbiome might have on the course of the disease.

To determine whether the gut microbiome may be playing a causal role, the researchers altered the gut microbiomes of mice predisposed to develop Alzheimer's-like brain damage and cognitive impairment. The mice were genetically modified to express a mutant form of the human brain protein tau, which builds up and causes damage to neurons and atrophy of their brains by 9 months of age. They also carried a variant of the human APOEgene, a major genetic risk factor for Alzheimer's. People with one copy of the APOE4 variant are three to four times more likely to develop the disease than people with the more common APOE3variant.

Along with Holtzman, the research team included gut microbiome expert and co-author Jeffrey I. Gordon, MD, the Dr. Robert J. Glaser Distinguished University Professor and director of the Edison Family Center for Genome Sciences & Systems Biology; first author Dong-Oh Seo, PhD, an instructor in neurology; and co-author Sangram S. Sisodia, PhD, a professor of neurobiology at the University of Chicago.

When such genetically modified mice were raised under sterile conditions from birth, they did not acquire gut microbiomes, and their brains showed much less damage at 40 weeks of age than the brains of mice harboring normal mouse microbiomes.

When such mice were raised under normal, nonsterile conditions, they developed normal microbiomes. A course of antibiotics at 2 weeks of age, however, permanently changed the composition of bacteria in their microbiomes. For male mice, it also reduced the amount of brain damage evident at 40 weeks of age. The protective effects of the microbiome shifts were more pronounced in male mice carrying the APOE3 variant than in those with the high-risk APOE4variant, possibly because the deleterious effects of APOE4canceled out some of the protection, the researchers said. Antibiotic treatment had no significant effect on neurodegeneration in female mice.

"We already know, from studies of brain tumors, normal brain development and related topics, that immune cells in male and female brains respond very differently to stimuli," Holtzman said. "So it's not terribly surprising that when we manipulated the microbiome we saw a sex difference in response, although it is hard to say what exactly this means for men and women living with Alzheimer's disease and related disorders."

Further experiments linked three specific short-chain fatty acids -- compounds produced by certain types of gut bacteria as products of their metabolism -- to neurodegeneration. All three of these fatty acids were scarce in mice with gut microbiomes altered by antibiotic treatment, and undetectable in mice without gut microbiomes.

These short-chain fatty acids appeared to trigger neurodegeneration by activating immune cells in the bloodstream, which in turn somehow activated immune cells in the brain to damage brain tissue. When middle-aged mice without microbiomes were fed the three short-chain fatty acids, their brain immune cells became more reactive, and their brains showed more signs of tau-linked damage.

"This study may offer important insights into how the microbiome influences tau-mediated neurodegeneration, and suggests therapies that alter gut microbes may affect the onset or progression of neurodegenerative disorders," said Linda McGavern, PhD, program director at the National Institute of Neurological Disorders and Stroke (NINDS), which provided some of the funding for the study.

The findings suggest a new approach to preventing and treating neurodegenerative diseases by modifying the gut microbiome with antibiotics, probiotics, specialized diets or other means.

"What I want to know is, if you took mice genetically destined to develop neurodegenerative disease, and you manipulated the microbiome just before the animals start showing signs of damage, could you slow or prevent neurodegeneration?" Holtzman asked. "That would be the equivalent of starting treatment in a person in late middle age who is still cognitively normal but on the verge of developing impairments. If we could start a treatment in these types of genetically sensitized adult animal models before neurodegeneration first becomes apparent, and show that it worked, that could be the kind of thing we could test in people."

https://www.sciencedaily.com/releases/2023/01/230112155812.htm

Social isolation is a risk factor for dementia in older adults, point to ways to reduce risk

January 12, 2023

Science Daily/Johns Hopkins Medicine

In two studies using nationally representative data from the National Health and Aging Trends Study gathered on thousands of Americans, researchers from the Johns Hopkins University School of Medicine and Bloomberg School of Public Health have significantly added to evidence that social isolation is a substantial risk factor for dementia in community-dwelling (noninstitutionalized) older adults, and identified technology as an effective way to intervene.

Collectively, the studies do not establish a direct cause and effect between dementia and social isolation, defined as lack of social contact and interactions with people on a regular basis. But, the researchers say, the studies strengthen observations that such isolation increases the risk of dementia, and suggest that relatively simple efforts to increase social support of older adults -- such as texting and use of email -- may reduce that risk. In the United States, an estimated 1 in 4 people over age 65 experience social isolation, according to the National Institute on Aging.

"Social connections matter for our cognitive health, and it is potentially easily modifiable for older adults without the use of medication," says Thomas Cudjoe, M.D., M.P.H., assistant professor of medicine at the Johns Hopkins University School of Medicine and senior author of both of the new studies.

The first study, described Jan. 11 in the Journal of the American Geriatrics Society, used data collected on a group of 5,022 Medicare beneficiaries for a long-term study known as the National Health and Aging Trends, which began in 2011. All participants were 65 or older, and were asked to complete an annual two-hour, in-person interview to assess cognitive function, health status and overall well-being.

At the initial interview, 23% of the 5,022 participants were socially isolated and showed no signs of dementia. However, by the end of this nine-year study, 21% of the total sample of participants had developed dementia. The researchers concluded that risk of developing dementia over nine years was 27% higher among socially isolated older adults compared with older adults who were not socially isolated.

"Socially isolated older adults have smaller social networks, live alone and have limited participation in social activities," says Alison Huang, Ph.D., M.P.H., senior research associate at the Johns Hopkins Bloomberg School of Public Health. "One possible explanation is that having fewer opportunities to socialize with others decreases cognitive engagement as well, potentially contributing to increased risk of dementia."

Interventions to reduce that risk are possible, according to results of the second study, published Dec. 15 in the Journal of the American Geriatrics Society. Specifically, researchers found the use of communications technology such as telephone and email lowered the risk for social isolation.

Researchers for the second study used data from participants in the same National Health and Aging Trends study, and found that more than 70% of people age 65 and up who were not socially isolated at their initial appointment had a working cellphone and/or computer, and regularly used email or texting to initiate and respond to others. Over the four-year research period for this second study, older adults who had access to such technology consistently showed a 31% lower risk for social isolation than the rest of the cohort.

"Basic communications technology is a great tool to combat social isolation," says Mfon Umoh, M.D., Ph.D., postdoctoral fellow in geriatric medicine at the Johns Hopkins University School of Medicine. "This study shows that access and use of simple technologies are important factors that protect older adults against social isolation, which is associated with significant health risks. This is encouraging because it means simple interventions may be meaningful."

Social isolation has gained significant attention in the past decade, especially due to restrictions implemented for the COVID-19 pandemic, but more work needs to be done to identify at-risk populations and create tools for providers and caregivers to minimize risk, the researchers say. Future research in this area should focus on increased risks based on biological sex, physical limitations, race and income level.

https://www.sciencedaily.com/releases/2023/01/230112113224.htm

Fall rate nearly 50% among older Americans with dementia

Targeting specific fall-risk factors could improve fall screening and prevention strategies

January 12, 2023

Science Daily/Drexel University

With falls causing millions of injuries in older adults each year, it is an increasingly important public health concern. Older adults living with dementia have twice the risk of falling and three times the risk of incurring serious fall-related injuries, like fractures, compared to those without dementia. For older adults with dementia, even minor fall-related injuries can lead to hospitalization and nursing home admission. A new study from researchers in Drexel University's College of Nursing and Health Professions, has shed light on the many and varied fall-risk factors facing older adults in community-living environments.

Recently published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, the research led by Safiyyah Okoye, PhD, an assistant professor at Drexel, and Jennifer L. Wolff, PhD, a professor at Johns Hopkins Bloomberg School of Public Health, examined a comprehensive set of potential fall-risk factors -- including environmental factors, in addition to health and function -- in older community-living adults in the United States, both with and without dementia.

"Examining the multiple factors, including environmental ones like a person's home or neighborhood, is necessary to inform fall-risk screening, caregiver education and support, and prevention strategies for this high-risk population of older adults," said Okoye.

Despite awareness of this elevated risk, there are very few studies that have examined fall-risk factors among people with dementia living in a community setting (not nursing homes or other residential facilities). The studies that do exist, overwhelmingly focus on health and function factors. According to the authors, this is the first nationally representative study to compare a comprehensive set of potential risk factors for falls for older Americans living with dementia to those without dementia.

The research team examined data from the 2015 and 2016 National Health and Aging Trends Study (NHATS), a population-based survey of health and disability trends and trajectories of adults 65 and older in the U.S. They were able to obtain potential sociodemographic, health and function predictors of falls, as well as potential social and physical environmental predictors.

Data from NHATS showed that nearly half (45.5%) of older adults with dementia had experienced one or more falls in 2016, compared to less than one third (30.9%) of older adults without dementia.

Among older adults living with dementia, three characteristics stood out as significantly associated with a greater likelihood of falls: a history of falling the previous year; impaired vision; and living with others (versus alone). For older adults without dementia, financial hardship, a history of falling, fear of falling, poor lower extremity performance, depressive symptoms and home disrepair were strongly associated with increased risk of falls.

While prior history of falling and vision impairment are well-known risk factors for falls among older adults in general; the researchers' findings indicate that these were strong risk factors for falls among people living with dementia. According to the team, this suggests that people living with dementia should be assessed for presence of these characteristics. If they're present, the individuals should receive further assessment and treatment, including examining their feet and footwear, assessing their environment and ability to carry out daily living activities, among other items.

The finding that older adults living with dementia who lived with a spouse or with non-spousal others had higher odds of experiencing a fall, compared to those who lived alone, highlights that caregiver support and education are understudied components of fall prevention programs for older adults with dementia who live with family caregivers, and deserve greater attention from clinicians, researchers and policy makers.

"Overall, our findings demonstrate the importance of understanding and addressing fall-risk among older adults living with dementia," said Okoye. "It confirms that fall-risk is multidimensional and influenced by environmental context in addition to health and function factors."

The results of the study indicate the need to further investigate and design fall-prevention interventions, specifically for people living with dementia.

https://www.sciencedaily.com/releases/2023/01/230112090936.htm

Six minutes of high-intensity exercise could delay the onset of Alzheimer's disease

January 12, 2023

Science Daily/The Physiological Society 

Six minutes of high-intensity exercise could extend the lifespan of a healthy brain and delay the onset of neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. New research published in The Journal of Physiology shows that a short but intense bout of cycling increases the production of a specialised protein that is essential for brain formation, learning and memory, and could protect the brain from age-related cognitive decline. This insight on exercise is part of the drive to develop accessible, equitable and affordable non-pharmacological approaches that anyone can adopt to promote healthy ageing.  

The specialised protein named brain-derived neurotrophic factor (BDNF) promotes neuroplasticity (the ability of the brain to form new connections and pathways) and the survival of neurons. Animal studies have shown that increasing the availability of BDNF encourages the formation and storage of memories, enhances learning and overall boosts cognitive performance. These key roles and its apparent neuroprotective qualities have led to the interest in BDNF for ageing research.

Lead author Travis Gibbons from University of Otago, New Zealand said: “BDNF has shown great promise in animal models, but pharmaceutical interventions have thus far failed to safely harness the protective power of BDNF in humans. We saw the need to explore non-pharmacological approaches that can preserve the brain’s capacity which humans can use to naturally increase BDNF to help with healthy ageing.”

To tease apart the influence of fasting and exercise on BDNF production the researchers, from the University of Otago, New Zealand, compared the following factors to study the isolated and interactive effects:

• Fasting for 20 hours,

• Light exercise (90-minute low intensity cycling),

• High-intensity exercise (six-minute bout of vigorous cycling),

• Combined fasting and exercise.

They found that brief but vigorous exercise was the most efficient way to increase BDNF compared to one day of fasting with or without a lengthy session of light exercise. BDNF increased by four to five-fold (396 pg L-1 to 1170 pg L-1) more compared to fasting (no change in BDNF concentration) or prolonged activity (slight increase in BDNF concentration, 336 pg L-1 to 390 pg L-1).

The cause for these differences is not yet known and more research is needed to understand the mechanisms involved. One hypothesis is related to the cerebral substrate switch and glucose metabolism, the brain’s primary fuel source. The cerebral substrate switch is when the brain switches its favoured fuel source for another to ensure the body’s energy demands are met, for example metabolising lactate rather than glucose during exercise. The brain’s transition from consuming glucose to lactate initiates pathways that result in elevated levels of BDNF in the blood.

The observed increase in BDNF during exercise could be due to the increased number of platelets (the smallest blood cell) which store large amounts of BDNF. The concentration of platelets circulating in the blood is more heavily influenced by exercise than fasting and increases by 20%.

12 physically active participants (six males, six females aged between 18 and 56 years) took part in the study. The balanced ratio of male and female participants was to provide a better representation of the population rather than indicate sex differences.

Further research is underway to delve deeper into the effects of calorie restriction and exercise to distinguish the influence on BDNF and the cognitive benefits.

Travis Gibbons said: “We are now studying how fasting for longer durations, for example up to three days, influences BDNF. We are curious whether exercising hard at the start of a fast accelerates the beneficial effects of fasting. Fasting and exercise are rarely studied together. We think fasting and exercise can be used in conjunction to optimise BDNF production in the human brain.”

https://www.sciencedaily.com/releases/2023/01/230112090919.htm

Feeling loved, optimistic or happy as a teen may lead to better health in adulthood

January 11, 2023

Science Daily/American Heart Association

Teenagers who reported feeling optimism, happiness, self-esteem, belongingness, and feeling loved and wanted were more likely to reach their 20s and 30s in good cardiometabolic health compared to teens with fewer of these positive mental health assets, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Previous studies have found that psychological facets of mental well-being, such as optimism and happiness, may be important modifiable factors related to better cardiometabolic health over time. While most of this research was conducted among older adults, this study focused earlier in life and considered a broader measure of cardiometabolic health, which also included indicators of blood sugar levels and inflammation.

"We learned a lot in the last few decades about the impact of discrimination and other social risks youth of color face that may explain their elevated rates of cardiometabolic disease, however, much less attention is paid to the inherent strengths they possess and the ways those strengths may be leveraged to advance health equity," said lead study author Farah Qureshi, Sc.D., M.H.S., an assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "In this study, we wanted to shift the paradigm in public health beyond the traditional focus on deficits to one that concentrates on resource building."

Researchers examined data from the National Longitudinal Study of Adolescent Health, which enrolled nearly 3,500 U.S. high schoolers (average age 16 years) in 1994 and were followed for more than two decades. Nearly half were girls, 67% were white youth, 15% were Black teens, 11% were Latino teenagers and 6% reported their race as either Native American, Asian, or "other." Researchers periodically collected data on the participants' health and well-being, with the most recent wave of data collection occurring in 2018, when their average age was 38.

Using initial survey responses from when participants were teenagers, researchers identified five mental health assets related to better cardiometabolic health outcomes: optimism, happiness, self-esteem, a sense of belonging and feeling loved. This information was cross-referenced with health data recorded over 3 decades to assess whether teens who had more of these positive assets were more likely to maintain optimal cardiometabolic health in adulthood.

To examine cardiometabolic health in this study, researchers reviewed health measures for seven cardiovascular and metabolic disease risk factors collected during clinic visits when participants were in their late 20s and 30s. The factors included high-density lipoprotein (HDL), or "good" cholesterol; non-HDL cholesterol -- calculated as total cholesterol minus HDL cholesterol; systolic blood pressure (top number); diastolic blood pressure (bottom number); hemoglobin A1c, a measure of blood sugar; C-reactive protein, a measure of inflammation; and body mass index, or BMI, the ratio of height to weight to estimate body fat.

The analysis found:

• Overall, 55% of youth had zero to one positive mental health asset, while 29% had two to three assets and 16% had four to five assets.

• As young adults, only 12% of participants maintained cardiometabolic health over time, and white youth were more likely to maintain good health later in life compared to Black or Latino youth.

• Teens with four to five positive mental health assets were 69% more likely to maintain positive cardiometabolic health as young adults.

• There was also a cumulative effect, with each additional mental health asset conferring a 12% greater likelihood of positive cardiometabolic health.

• Although psychological assets were found to be protective across all racial and ethnic groups, the largest health benefits were noted among Black youth. Black teens also reported having more positive mental health assets than youth of any other racial or ethnic groups.

Despite Black teens having the most assets and deriving the most health benefits from them, racial disparities in cardiometabolic health were still apparent in adulthood. Black individuals were the least likely to maintain good cardiometabolic health over time.

"These somewhat counterintuitive findings were surprising," Qureshi said. "When we dug deeper, we found that the absence of psychological assets being was particularly health-damaging for Black youth." She further elaborated that the findings point to the role structural racism plays in shaping cardiometabolic health patterns in the first decades of life: "For Black youth -- who face numerous barriers to achieving and sustaining optimal cardiometabolic health in adulthood -- not having these additional mental health resources makes a big difference."

"This work suggests that early investments in youth mental health may be a critical new frontier in the advancement of cardiometabolic health equity," according to Qureshi.

"We need more large-scale studies to monitor these and other positive mental health factors starting in childhood to understand how these assets may influence health and disease over the life course. This information may help us identify new ways to improve health and reduce disparities," she said.

Limitations of the study include that there were relatively few participants who were Latino, Asian or Native American and there were variations in blood sample collection methods over time.

Health care professionals measure cardiovascular health with the American Heart Association's Life's Essential 8 tool, which measures 4 indicators related to cardiovascular and metabolic health status (blood pressure, cholesterol, blood sugar and body mass index); and 4 behavioral/lifestyle factors (smoking status, physical activity, sleep and diet). According to Life's Essential 8 data:

• only 45% of U.S. adolescents have five or more indicators of ideal cardiovascular health, and the percentage declines in adulthood; and

• there are persistent differences in cardiovascular health levels by self-reported race and ethnicity, and these disparities are larger at younger ages.

https://www.sciencedaily.com/releases/2023/01/230111075843.htm

An education doesn't just make you smarter -- it protects your gut, seriously

January 11, 2023

Science Daily/Edith Cowan University

We've long known education is important for many aspects of life, but now a new benefit has been discovered: it can look after your gut health.

Landmark Edith Cowan University (ECU) research has found a better education has a strong genetic correlation and a protective causal association with several gut disorders.

A previous study from ECU's Centre for Precision Health (CPH) discovered a genetic link between gut health and Alzheimer's Disease (AD) but couldn't conclude whether one caused the other.

This study breaks new ground by finding that a higher level of education protects against gut disorders.

CPH Director and study supervisor Professor Simon Laws said these findings build upon the centre's previous work to provide further evidence of the strong links between the brain and gut, known as the gut-brain axis.

"Gut disorders and Alzheimer's may not only share a common genetic predisposition but may be similarly influenced by genetic variations underpinning educational attainment," Professor Laws said.

This large-scale study examined the genetic information of more than 766,000 individuals, with an emphasis on AD, cognitive traits and gut disorders, including peptic ulcer disease (PUD), gastritis-duodenitis, gastroesophageal reflux disease (GERD), irritable bowel syndrome, diverticulosis and inflammatory bowel disease (IBD).

It found higher levels of education and cognitive functioning reduced the risk of gut disorders.

Lead researcher Dr Emmanuel Adewuyi said the findings have significant implications.

"The results support education as a possible avenue for reducing the risk of gut disorders

by, for example, encouraging higher educational attainment or a possible increase in the length of schooling," he said.

"Hence, policy efforts aimed at increasing educational attainment or cognitive training may contribute to a higher level of intelligence, which could lead to better health outcomes including a reduced risk of gut disorders."

It goes both ways

ECU's study further revealed the gut may also influence the brain.

GERD showed evidence of causing a decline in cognitive function across a number of cognitive traits assessed in the study, such as intelligence, cognitive performance, educational attainment and educational qualification.

Although this is the first study to report this finding, the results support recent research reporting an increased incidence of dementia and GERD, which Dr Adewuyi said could help with earlier diagnoses and potential treatments.

"GERD may be a risk factor for cognitive impairment, so it's important for health workers to look for signs or symptoms of cognitive dysfunction in patients presenting with the gut disorder," he said.

"This could lead to earlier detection of cognitive decline and therefore earlier interventions aimed at reducing the rate of cognitive decline.

"More studies are needed to investigate whether treatment for, cure or remission of GERD can contribute to a reduced risk of cognitive decline."

The curious case of IBD

Interestingly, higher levels of education and cognitive function protecting against gut disorders was true of all the disorders examined in the study -- but largely with the exception of inflammatory bowel disease.

Further analysis reveals different effects of IBD on cognitive traits and AD at different genomic locations, indicating its relationship depend on effects at specific locations across the genome.

This new understanding may explain the lack of significant genetic correlation of IBD with cognitive traits and AD, and the inconsistency reported in previous observational studies.

Dr Adewuyi said this finding was also important, as it brings a new insight into the relationship of IBD with cognitive traits (and AD), which may shape the direction of future studies.

"For example, some risk genes for AD may be protective against IBD, and vice versa," he said.

'Relationship of cognition and Alzheimer's disease with gastrointestinal tract disorders: a large-scale genetic overlap and Mendelian randomisation analysis' was published in the International Journal of Molecular Sciences.

https://www.sciencedaily.com/releases/2023/01/230111075855.htm

Obesity linked to macular degeneration

January 10, 2023

Science Daily/University of Montreal

A Canadian study published in the journal Scienceelucidates a new molecular mechanism that may cause age-related macular degeneration (AMD).

The research at Hôpital Maisonneuve-Rosement, in Montreal, shows how life stressors such as obesity reprogram immune system cells and make them destructive to the eye as it ages.

"We wanted to know why some people with a genetic predisposition develop AMD while others are spared," said Université de Montréal ophtalmology professor Przemyslaw (Mike) Sapieha, who led the study by his postdoctoral fellow Dr. Masayuki Hata.

"Although considerable effort has been invested in understanding the genes responsible for AMD, variations and mutations in susceptibility genes only increase the risk of developing the disease, but do not cause it," Sapieha explained.

"This observation suggests that we must gain a better understanding of how other factors such as environment and lifestyle contribute to disease development."

AMD is a major cause of irreversible blindness worldwide and affected approximately 196 million people in 2020. It comes in two forms:

• dry AMD, characterized by the accumulation of fatty deposits at the back of the eye and the death of nerve cells in the eye,

• and wet AMD, which is characterized by diseased blood vessels that develop in the most sensitive part of the sight-generating tissue, called the macula.

Contact with pathogens

It is already known that the immune system in the eye of a person with AMD becomes dysregulated and aggressive. Normally, immune cells keep the eye healthy, but contact with pathogens such as bacteria and viruses can make them go awry.

At the same time, immune cells are also activated when the body is exposed to stressors such as excess fat in obesity, making being overweight the number one non-genetic risk factor for developing AMD, after smoking.

In their study, Sapieha and Hata used obesity as a model to accelerate and exaggerate the stressors experienced by the body throughout life.

They found that transient obesity or a history of obesity leads to persistent changes in the DNA architecture within immune cells, making them more susceptible to producing inflammatory molecules.

"Our findings provide important information about the biology of the immune cells that cause AMD and will allow for the development of more tailored treatments in the future," said Hata, now an ophthalmology professor at Kyoto University, in Japan.

The researchers hope their discovery will lead other scientists to broaden their interest beyond obesity-related diseases to other diseases characterized by increased neuroinflammation, including Alzheimer's disease and multiple sclerosis.

https://www.sciencedaily.com/releases/2023/01/230110191415.htm

New study links hearing loss with dementia in older adults

Findings highlight potential benefit of hearing aid

January 10, 2023

Science Daily/Johns Hopkins Bloomberg School of Public Health

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that older adults with greater severity of hearing loss were more likely to have dementia, but the likelihood of dementia was lower among hearing aid users compared to non-users.

The findings, from a nationally representative sample of more than 2,400 older adults, are consistent with prior studies showing that hearing loss might be a contributing factor to dementia risk over time, and that treating hearing loss may lower dementia risk.

The findings are highlighted in a research letter published online January 10 in the Journal of the American Medical Association.

"This study refines what we've observed about the link between hearing loss and dementia, and builds support for public health action to improve hearing care access," says lead author Alison Huang, PhD, MPH, a senior research associate in the Bloomberg School's Department of Epidemiology and at the Cochlear Center for Hearing and Public Health, also at the Bloomberg School.

Hearing loss is a critical public health issue affecting two-thirds of Americans over 70. The growing understanding that hearing loss might be linked to the risk of dementia, which impacts millions, and other adverse outcomes has called attention to implementing possible strategies to treat hearing loss.

For the new study, Huang and colleagues analyzed a nationally representative dataset from the National Health and Aging Trends Study (NHATS). Funded by the National Institute on Aging, the NHATS has been ongoing since 2011, and uses a nationwide sample of Medicare beneficiaries over age 65, with a focus on the 90-and-over group as well as Black individuals.

The analysis covered 2,413 individuals, about half of whom were over 80 and showed a clear association between severity of hearing loss and dementia. Prevalence of dementia among the participants with moderate/severe hearing loss was 61 percent higher than prevalence among participants who had normal hearing. Hearing aid use was associated with a 32 percent lower prevalence of dementia in the 853 participants who had moderate/severe hearing loss.

The authors note that many past studies were limited in that they relied on in-clinic data collection, leaving out vulnerable populations that did not have the means or capacity to get to a clinic. For their study, the researchers collected data from participants through in-home testing and interviews.

How hearing loss is linked to dementia isn't yet clear, and studies point to several possible mechanisms. Huang's research adds to a body of work by the Cochlear Center for Hearing and Public Health examining the relationship between hearing loss and dementia.

The study authors expect to have a fuller picture of the effect of hearing loss treatment on cognition and dementia from their Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study. Results from the three-year randomized trial are expected this year.

https://www.sciencedaily.com/releases/2023/01/230110150943.htm

Feeling depressed? Performing acts of kindness may help

Study finds helping others reduces focus on your own symptoms

January 10, 2023

Science Daily/Ohio State University

People suffering from symptoms of depression or anxiety may help heal themselves by doing good deeds for others, new research shows.

The study found that performing acts of kindness led to improvements not seen in two other therapeutic techniques used to treat depression or anxiety.

Most importantly, the acts of kindness technique was the only intervention tested that helped people feel more connected to others, said study co-author David Cregg, who led the work as part of his PhD dissertation in psychology at The Ohio State University.

"Social connection is one of the ingredients of life most strongly associated with well-being. Performing acts of kindness seems to be one of the best ways to promote those connections," Cregg said.

Cregg conducted the research with Jennifer Cheavens, professor of psychology at Ohio State. Their study was published recently in The Journal of Positive Psychology.

The research also revealed why performing acts of kindness worked so well: It helped people take their minds off their own depression and anxiety symptoms.

This finding suggests that one intuition many people have about people with depression may be wrong, Cheavens said.

"We often think that people with depression have enough to deal with, so we don't want to burden them by asking them to help others. But these results run counter to that," she said.

"Doing nice things for people and focusing on the needs of others may actually help people with depression and anxiety feel better about themselves."

The study involved 122 people in central Ohio who had moderate to severe symptoms of depression, anxiety, and stress.

After an introductory session, the participants were split into three groups. Two of the groups were assigned to techniques often used in cognitive behavioral therapy (CBT) for depression: planning social activities or cognitive reappraisal.

The social activities group was instructed to plan social activities for two days a week. Another group was instructed in one of the staples of CBT: cognitive reappraisal. These participants kept records for at least two days each week that helped them identify negative thought patterns and revise their thoughts in a way that could reduce depression and anxiety.

Members of the third group were instructed to perform three acts of kindness a day for two days out of the week. Acts of kindness were defined as "big or small acts that benefit others or make others happy, typically at some cost to you in terms of time or resources."

Some of the acts of kindness that participants later said they did included baking cookies for friends, offering to give a friend a ride, and leaving sticky notes for roommates with words of encouragement.

Participants followed their instructions for five weeks, after which they were evaluated again. The researchers then checked with the participants after another five weeks to see if the interventions were still effective.

The findings showed that participants in all three groups showed an increase in life satisfaction and a reduction of depression and anxiety symptoms after the 10 weeks of the study.

"These results are encouraging because they suggest that all three study interventions are effective at reducing distress and improving satisfaction," Cregg said.

"But acts of kindness still showed an advantage over both social activities and cognitive reappraisal by making people feel more connected to other people, which is an important part of well-being," he said.

In addition, the acts of kindness group showed greater improvements than the cognitive reappraisal group for life satisfaction and symptoms of depression and anxiety, results showed.

Cheavens noted that just participating in social activities did not improve feelings of social connection in this study.

"There's something specific about performing acts of kindness that makes people feel connected to others. It's not enough to just be around other people, participating in social activities," she said.

Cregg said that while this study used techniques of CBT, it is not the same experience as going through CBT. Those who undergo the full treatment may have better results than those in this study.

But the findings also show that even the limited CBT exposure given in this study can be helpful, Cheavens said.

"Not everyone who could benefit from psychotherapy has the opportunity to get that treatment," she said. "But we found that a relatively simple, one-time training had real effects on reducing depression and anxiety symptoms."

And beyond traditional CBT, acts of kindness may have additional benefits in creating social connections, Cregg said.

"Something as simple as helping other people can go above and beyond other treatments in helping heal people with depression and anxiety," he said.

https://www.sciencedaily.com/releases/2023/01/230110103424.htm

Gardening may help reduce cancer risk, boost mental health

January 6, 2023

Science Daily/University of Colorado at Boulder

Get more exercise. Eat right. Make new friends.

As we compile our lists of resolutions aimed at improving physical and mental health in 2023, new CU Boulder research suggests one addition could have a powerful impact: Gardening.

Funded by the American Cancer Society, the first-ever, randomized, controlled trial of community gardening found that those who started gardening ate more fiber and got more physical activity -- two known ways to reduce risk of cancer and chronic diseases. They also saw their levels of stress and anxiety significantly decrease.

The findings were published Jan. 4 in the journal Lancet Planetary Health.

"These findings provide concrete evidence that community gardening could play an important role in preventing cancer, chronic diseases and mental health disorders," said senior author Jill Litt, a professor in the Department of Environmental Studies at CU Boulder.

Filling the research gap

Litt has spent much of her career seeking to identify affordable, scalable and sustainable ways to reduce disease risk, especially among low-income communities.

Gardening seemed an ideal place to start.

"No matter where you go, people say there's just something about gardening that makes them feel better," said Litt, who is also a researcher with the Barcelona Institute for Global Health.

But solid science on its benefits is hard to come by. Without evidence, it's hard to get support for new programs, she said.

Some small observational studies have found that people who garden tend to eat more fruits and vegetables and have a healthier weight. But it has been unclear whether healthier people just tend to garden, or gardening influences health.

Only three studies have applied the gold standard of scientific research, the randomized controlled trial, to the pastime. None have looked specifically at community gardening.

To fill the gap, Litt recruited 291 non-gardening adults, average age of 41, from the Denver area. More than a third were Hispanic and more than half came from low-income households.

After the last spring frost, half were assigned to the community gardening group and half to a control group that was asked to wait one year to start gardening.

The gardening group received a free community garden plot, some seeds and seedlings, and an introductory gardening course through the nonprofit Denver Urban Gardens program and a study partner.

Both groups took periodic surveys about their nutritional intake and mental health, underwent body measurements and wore activity monitors.

A fiber boost

By fall, those in the gardening group were eating, on average, 1.4 grams more fiber per day than the control group -- an increase of about 7%.

The authors note that fiber exerts a profound effect on inflammatory and immune responses, influencing everything from how we metabolize food to how healthy our gut microbiome is to how susceptible we are to diabetes and certain cancers.

While doctors recommend about 25 to 38 grams of fiber per day, the average adult consumes less than 16 grams.

"An increase of one gram of fiber can have large, positive effects on health," said co-author James Hebert, director of University of South Carolina's cancer prevention and control program.

The gardening group also increased their physical activity levels by about 42 minutes per week. Public health agencies recommend at least 150 minutes of physical activity per week, a recommendation only a quarter of the U.S. population meets. With just two to three visits to the community garden weekly, participants met 28% of that requirement.

Study participants also saw their stress and anxiety levels decrease, with those who came into the study most stressed and anxious seeing the greatest reduction in mental health issues.

The study also confirmed that even novice gardeners can reap measurable health benefits of the pastime in their first season. As they have more experience and enjoy greater yields, Litt suspects such benefits will increase.

Blooming relationships

The study results don't surprise Linda Appel Lipsius, executive director of Denver Urban Gardens (DUG), a 43-year-old nonprofit that helps about 18,000 people each year grow their own food in community garden plots.

"It's transformational, even life-saving, for so many people," Lipsius said.

Many DUG participants live in areas where access to affordable fresh fruits and vegetables is otherwise extremely limited. Some are low-income immigrants now living in apartments -- having a garden plot allows them to grow food from their home country and pass on traditional recipes to their family and neighbors.

The social connection is also huge.

"Even if you come to the garden looking to grow your food on your own in a quiet place, you start to look at your neighbor's plot and share techniques and recipes, and over time relationships bloom," said Litt, noting that while gardening alone is good for you, gardening in community may have additional benefits. "It's not just about the fruits and vegetables. It's also about being in a natural space outdoors together with others."

Litt said she hopes the findings will encourage health professionals, policymakers and land planners to look to community gardens, and other spaces that encourage people to come together in nature, as a vital part of the public health system. The evidence is clear, she said.

https://www.sciencedaily.com/releases/2023/01/230106144500.htm

Treatment for combat-related PTSD advances with method shown to be fast, effective

January 5, 2023

Science Daily/University of Texas Health Science Center at San Antonio

Study findings out today in JAMA Network Open show an important step forward in treating the psychological injuries of war.

Researchers report that treatment for combat-related post-traumatic stress disorder (PTSD), which affects hundreds of thousands of U.S. military personnel and veterans, can be both fast and effective for a majority of patients. Their study showed clinically significant reductions in PTSD symptoms in more than 60 percent of patients and long-term remission of the diagnosis in more than 50 percent after three weeks of outpatient Prolonged Exposure therapy. Study participants similarly showed significant improvements in related disability and daily functioning.

Results were comparable whether patients received traditional Prolonged Exposure, also called PE, condensed into three weeks of daily treatment or an intensive outpatient format including several enhancements to address specific challenges of PTSD in war fighters.

The research team, led by Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio (UT Health San Antonio), conducted the randomized clinical trial with 234 military personnel and veterans recruited from four locations in South and Central Texas. The effort was part of the work of the Consortium to Alleviate PTSD (CAP), a national network jointly funded by the U.S. Departments of Defense and Veterans Affairs.

Dr. Peterson, professor of psychiatry and behavioral sciences at UT Health San Antonio and director of the CAP and the STRONG STAR Consortium, said the findings advance the group's previous research and significantly improve upon earlier outcomes.

Improving outcomes for our war fighters

"We're excited to see a more than 10-point increase in PTSD remission rates compared to a previous PE study we conducted, when we initiated the first ever clinical trials evaluating PTSD treatments in active-duty military populations," said Dr. Peterson.

That first study tested the standard PE protocol, with 10 sessions of 90 minutes each over the course of eight weeks, as well as a massed format, with daily 90-minute sessions over two weeks. The two delivery formats proved equally effective in reducing symptoms and leading to a loss of diagnosis, with remission rates under 50 percent initially after treatment, and treatment gains maintained by about 40 percent of patients six months later. The massed format had much lower dropout rates.

"Those initial results were encouraging, indicating that PE is effective for combat-related PTSD," said Dr. Peterson. "But with much lower success rates than in civilians treated with this therapy, we wanted to make and test treatment adaptations potentially to address unique aspects of combat-related PTSD and improve outcomes," he said. That is what the current study did.

Design and rationale of the current study

Prolonged Exposure includes patients' repeated retelling of their trauma stories along with homework assignments to engage in activities patients otherwise avoid because they trigger traumatic memories or anxious feelings. The goal is to help patients process thoughts about their trauma, calm the anxiety the memories provoke, and regain control of their lives.

It was thought that, in the original study -- particularly with the massed format -- patients may not have had adequate time to complete homework assignments and may also have faced a number of distractions. So, for both arms of the current study, patients took leave from work or other daily responsibilities to devote themselves full-time to treatment and recovery.

Also with the current study, treatment time in both arms was expanded from two weeks to three, with the consideration that combat-related PTSD is more difficult to treat, and patients may need additional time to process traumatic memories.

The comparison arm, called Massed-PE, had these treatment delivery changes only. The other arm, called Intensive Outpatient or IOP-PE, had several additional enhancements that researchers hypothesized would improve treatment outcomes with combat-related PTSD.

Dr. Peterson explained one example. "Oftentimes, a civilian trauma involves a one-time traumatic event, such as an accident, or a repeated trauma of a certain type, such as abuse," he said. "In the course of one or more combat deployments, service members may experience hundreds of traumatic events involving different types of traumas. They also may have experienced other types of trauma outside the combat environment. And so we wanted to adapt the traditional PE protocol, in which a patient focuses only on one primary trauma during treatment, and allow patients in this study to work with therapists on their three top traumas."

He said the treatment involved starting with the least distressing of those three traumas to gain confidence in the therapy, then working up to the most distressing trauma. Some of the other modifications included team-based treatment, with more than one clinician supporting a patient's care; clinic-based completion of homework assignments to decrease avoidance; brief therapist feedback sessions during the day for added support and increased opportunities for processing; involvement of a family member or friend during educational sessions to help improve social support; and post-treatment booster sessions to help maintain treatment gains.

Findings, implications and next steps

Outcomes differed from researchers' expectations in that both arms showed similar levels of reductions in PTSD symptoms and related disability, as well as similar increases in PTSD remission rates and improved psychosocial functioning over time. With some measures, Massed-PE led to greater improvements initially that decreased by the six-month follow-up. IOP-PE patients were more likely to maintain their improvements six months after treatment.

Since long-term outcomes did not differ significantly, researchers say the additional investment of resources needed for the IOP-PE format may not be warranted, but the overall study findings are highly positive.

"With about two thirds of participants reporting clinically meaningful symptom improvement and more than half losing their PTSD diagnosis, this study provides important new evidence that combat-related PTSD can be effectively treated -- in as little as three weeks," said Dr. Peterson.

He and his colleagues stated that, while condensed treatments may not be feasible for everyone, "results show that compressed formats adapted to the military context resulted in significant, meaningful and lasting improvements in PTSD, disability and functional impairments for most participants."

They say this makes condensed treatments an important option for U.S. service members and veterans after two decades of military operations in Iraq and Afghanistan. These treatments also could gain attention now as the war in Ukraine has raised international concerns about the risk of PTSD in military personnel and civilians.

Moving forward, the study team notes that their findings show room for continued improvement in treating combat-related PTSD. They add that the compressed treatment formats evaluated in this study are well suited for the evaluation of new, alternative modes of therapy combining cognitive-behavioral treatments with medications and medical devices. "We have those types of studies already underway," said Dr. Peterson.

https://www.sciencedaily.com/releases/2023/01/230105151330.htm