Monthly Archives: December 2025

Tai chi matches therapy in chronic insomnia care

Tai chi, a gentle form of mind–body exercise widely practised within Chinese communities, appears to offer benefits comparable to talking therapy for middle-aged and older adults with chronic insomnia, according to a clinical trial from Hong Kong published today in The BMJ. The findings suggest that tai chi may offer a practical, accessible long-term treatment option for persistent sleep problems in later life. Chronic insomnia is one of the most common sleep disorders among older adults and has been linked to higher risks of cardiovascular disease, mental health conditions, and cognitive decline. Although cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment, access is often restricted due to high costs, limited availability of trained therapists, and long waiting times. While previous studies have indicated that tai chi can improve sleep, direct comparisons with established psychological treatments have been lacking.

To address this gap, researchers investigated whether tai chi could be considered “non-inferior” to CBT-I for managing chronic insomnia in adults aged 50 and over. The trial involved 200 Chinese participants diagnosed with chronic insomnia and recruited between May 2020 and July 2022. All participants were able to walk unassisted, had no primary medical conditions affecting sleep, were not engaged in regular exercise, had not previously received CBT-I, and were not working shifts. They were randomly assigned to receive either tai chi or CBT-I in the form of one-hour group sessions held twice a week over three months, for a total of 24 sessions. Changes in insomnia severity were measured using the Insomnia Severity Index (ISI) immediately after the intervention and again at 12-month follow-up. A four-point margin on the ISI was set as the threshold for determining non-inferiority.

At the start of the study, both groups showed moderate insomnia severity. After three months, ISI scores fell by 6.67 points in the tai chi group and by 11.19 points in the CBT-I group, meaning tai chi did not initially meet the criteria for non-inferiority. However, by month 15, the reductions were 9.51 points for tai chi and 10.18 points for CBT-I, with a between-group difference of just 0.68 points. At this stage, tai chi was considered non-inferior to CBT-I. Both groups also showed similar improvements in subjective sleep quality, quality of life, mental health, and physical activity levels, and no adverse events were reported. The authors note that sustained benefits in the tai chi group may be partly due to continued practice after the intervention ended, and further research is needed to determine whether the findings apply to other populations. Nevertheless, the researchers conclude that tai chi represents a safe and effective alternative approach for the long-term management of chronic insomnia in middle-aged and older adults.

More information: Parco M Siu et al, Tai chi or cognitive behavioural therapy for treating insomnia in middle aged and older adults: randomised non-inferiority trial, The BMJ. DOI: 10.1136/bmj-2025-084320

Journal information: The BMJ Provided by BMJ Group

Chronic pain could be putting adults at greater risk of high blood pressure

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Adults living with chronic pain may face a significantly higher risk of developing high blood pressure, particularly when pain is widespread and accompanied by depression, according to new research published today in Hypertension, a journal of the American Heart Association. The study found that both the location and extent of pain play an important role in shaping cardiovascular risk, and that mental health is a key factor linking persistent pain to hypertension.

Researchers analysed long-term health data from more than 200,000 adults in the United States. They discovered that people who reported chronic, widespread pain were far more likely to develop high blood pressure than those who experienced no pain, short-term discomfort or pain limited to one area of the body. “The more widespread a person’s pain, the greater their risk of developing high blood pressure,” said lead author Dr Jill Pell, Henry Mechan Professor of Public Health at the University of Glasgow. She explained that depression appeared to play an important role in this relationship, with chronic pain increasing the likelihood of depression, which in turn raised the risk of hypertension. The findings suggest that earlier detection and treatment of depression in people with chronic pain could help reduce their long-term risk of high blood pressure.

High blood pressure, also known as hypertension, occurs when the force of blood against artery walls remains consistently too high, placing strain on the heart and blood vessels and increasing the risk of heart attack and stroke. Blood pressure readings of 130/80 mm Hg or higher fall into the category of stage one or stage two hypertension. According to the latest 2025 joint guidelines from the American Heart Association and the American College of Cardiology, nearly half of all adults in the United States are affected by elevated blood pressure or hypertension, making it the leading cause of death both in the U.S. and worldwide.

Participants in the study completed detailed questionnaires at the outset, reporting whether they had experienced pain in the previous month that interfered with daily activities and whether that pain had lasted for more than three months. They recorded the specific location of pain, including the head, neck or shoulders, back, abdomen, hips and knees, or whether pain was felt throughout the body. Symptoms of depression were assessed through questions about mood, energy and interest levels over the previous two weeks, while inflammation was measured using blood tests that assessed C-reactive protein levels. Over an average follow-up of 13.5 years, nearly 10 per cent of participants developed high blood pressure.

Compared with people without pain, those with chronic widespread pain had the highest risk, with a 75 per cent increase in the likelihood of developing hypertension. Chronic abdominal pain raised risk by 43 per cent, headaches by 22 per cent, and persistent neck, shoulder, hip and back pain by between 16 and 19 per cent. Depression and inflammation together explained nearly 12 per cent of the link between chronic pain and high blood pressure. “When caring for people with chronic pain, clinicians need to be aware that these patients face elevated cardiovascular risk, either directly or through depression,” Dr Pell said. “Recognising and treating these issues early may help prevent future heart disease.”

More information: Pei Qin et al, Chronic Pain and Hypertension and Mediation Role of Inflammation and Depression, Hypertension. DOI: 10.1161/HYPERTENSIONAHA.125.25544

Journal information: Hypertension Provided by American Heart Association

Study links untreated sleep apnoea to a heightened risk of Parkinson’s disease

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New findings indicate that people living with untreated obstructive sleep apnoea face a significantly greater likelihood of developing Parkinson’s disease. Yet, this risk can be meaningfully reduced by improving sleep quality through consistent use of continuous positive airway pressure, or CPAP. The research, published today in JAMA Neurology, analysed electronic health records from more than 11 million U.S. military veterans who received care through the Department of Veterans Affairs between 1999 and 2022. The project was carried out by investigators at Oregon Health & Science University in collaboration with the Portland VA Health Care System.

Parkinson’s disease, a neurodegenerative disorder that affects movement and various neurological functions, currently impacts an estimated one million people across the United States. Its prevalence increases gradually with age, particularly among those aged 60 and older. According to the study, people with untreated sleep apnoea appear to face a notably increased long-term risk of developing the condition. Even after adjusting for common confounding factors such as obesity, age and hypertension, researchers observed a strong association between unmanaged sleep apnoea and Parkinson’s. Among the millions of individuals documented with sleep apnoea, those who did not use CPAP therapy were found to be nearly twice as likely to develop Parkinson’s as those who adhered to treatment.

Co-author Gregory Scott, M.D., PhD, an assistant professor of pathology in the OHSU School of Medicine and a pathologist at the Portland VA, emphasised that while the findings do not imply an inevitable diagnosis, the elevated risk is substantial enough to warrant attention. Sleep apnoea is characterised by repeated interruptions in breathing during sleep, leading to reduced oxygen levels that can affect the proper functioning of neurons. Lead author Lee Neilson, M.D., an assistant professor of neurology at OHSU and a neurologist with the Portland VA, explained that years of nightly oxygen deprivation may cumulatively contribute to nervous system vulnerability. In contrast, regular CPAP use could provide a degree of resilience against neurodegeneration.

In light of these results, Neilson noted that he intends to place an even stronger emphasis on the importance of healthy sleep in his clinical practice, acknowledging that the study’s insights may shape how he advises patients in the future. Scott added that although some people with sleep apnoea struggle with or resist CPAP therapy, many veterans report life-changing improvements once they begin using the device. He highlighted their increased energy levels and overall sense of well-being, suggesting that awareness of a possible reduction in Parkinson’s risk may encourage more individuals with sleep apnoea to consider trying CPAP.

More information: Lee Neilson et al, Obstructive Sleep Apnea, Positive Airway Pressure, and Implications of Early Treatment in Parkinson Disease, JAMA Neurology. DOI: 10.1001/jamaneurol.2025.4691

Journal information: JAMA Neurology Provided by Oregon Health & Science University

Study examines the potential for diet to ease the pace of normal brain ageing

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As the brain grows older, the cells that support its function become increasingly prone to metabolic strain and oxidative stress. This gradual shift disrupts the delicate energy balance required for healthy neural activity. It undermines the maintenance of the myelin sheath, the insulating layer that enables efficient communication between nerve fibres. As myelin quality declines, white matter becomes more vulnerable to age-related deterioration. Alongside this, microglia—the immune cells that protect the brain—tend to move into a state of chronic activation during ageing. Although this response is meant to safeguard neural tissue, its persistence can create a damaging inflammatory environment, and researchers still do not fully understand why microglia behave in this way as the brain ages or in conditions such as Alzheimer’s disease.

Against this biological context, a new study from the Boston University Chobanian & Avedisian School of Medicine offers long-term evidence that reducing calorie intake may slow specific aspects of brain ageing. The research examined the effects of consuming roughly 30% fewer calories than usual over more than twenty years, using an experimental model that closely resembles human physiology. While calorie restriction has already been shown to influence longevity and biological ageing in short-lived species, opportunities to study its long-term impact in a complex organism are rare. This makes the new findings particularly significant, as they provide insight into how sustained dietary habits may shape the ageing brain at a cellular level.

According to the corresponding author, Ana Vitantonio, a PhD student in pharmacology, physiology and biophysics, the study adds valuable long-duration evidence to what is already known about the effects of calorie restriction. She notes that while the intervention has been studied extensively in simpler organisms, observing similar protective patterns in a more sophisticated model strengthens the case that diet can meaningfully influence brain ageing beyond basic metabolic markers.

The project was first launched in the 1980s in collaboration with the National Institute on Aging. Participants were divided into two groups: one consumed a standard, balanced diet, while the other adhered to a long-term calorie-restricted regimen. They lived out their natural lifespans, after which researchers examined their brains postmortem. This allowed the team to evaluate the cumulative cellular and molecular effects of decades of differing dietary intake.

Using single-nucleus RNA sequencing, the researchers compared gene expression profiles in individual brain cells from both groups. Cells from the calorie-restricted group appeared metabolically healthier, with increased expression of genes linked to myelin formation and more robust activity in metabolic pathways—particularly glycolytic and fatty-acid biosynthesis pathways—that are essential for myelin maintenance. These enhancements suggest that long-term calorie reduction may help preserve white matter integrity as the brain ages.

Co-author Tara L. Moore, professor of anatomy and neurobiology, emphasises that these cellular shifts may have meaningful consequences for cognition and learning. The study highlights the possibility that long-term dietary patterns, when carefully managed, could influence the biological trajectory of brain ageing and support healthier cognitive function later in life.

More information: Ana Vitantonio et al, Calorie Restriction Attenuates Transcriptional Aging Signatures in White Matter Oligodendrocytes and Immune Cells of the Monkey Brain, Aging Cell. DOI: 10.1111/acel.70298

Journal information: Aging Cell Provided by Boston University School of Medicine

More than 90% of older people with dementia subjected to significant medical interventions in their final year, Duke-NUS reports

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A recent study by researchers at Duke-NUS Medical School has found that almost all older adults in Singapore living at home with advanced dementia undergo at least one potentially burdensome medical intervention during their final year. The findings highlight the pressing need for improved end-of-life support, particularly for families who often must make difficult decisions with limited guidance. While dementia prevalence is rising sharply across the Asia–Pacific region, most existing knowledge about the last stages of the illness comes from Western studies, underscoring the importance of region-specific research such as this.

Published in the Journal of Gerontology: Medical Sciences, the study examined the experiences of older adults with advanced dementia over the last year of life and found that ninety-two per cent received interventions such as feeding tubes or physical restraints. Experts note that such measures rarely improve comfort or survival and may, in fact, increase distress. The researchers identified several factors shaping these outcomes, beginning with an overreliance on taxing medical treatments. Nearly half of the older adults received antibiotics, more than one in five were given intravenous fluids, and almost three-quarters were tube-fed or restrained, with tube feeding far more common than in Western contexts despite clinical recommendations for careful hand feeding.

Hospitalisations were also frequent. Almost half of the individuals studied spent at least one night in hospital during their final year, and more than a third died there. In Singapore, where long-term care facilities are less commonly used for end-of-life care than in many Western countries, reliance on hospitals often led to interventions that added discomfort without clear clinical benefit.

The study highlighted the significant burden placed on informal caregivers, who provide the bulk of hands-on support. 42% provided at least 60% of total care, and 30% left their jobs to look after their loved ones. On average, caregivers dedicated forty-two hours of care per week, a workload comparable to full-time employment, with an estimated annual value exceeding S$32,000. Despite their efforts, many felt poorly informed, with almost two-thirds reporting inadequate guidance when making care decisions and only a small minority being told about life expectancy. This lack of communication left families struggling to prepare for the end of life.

The findings draw on data from the PISCES cohort, a longitudinal study that surveyed caregivers every four months between 2018 and 2023. However, nearly all caregivers agreed that comfort should be a primary goal, about a third—mostly adult children—prioritised prolonging life, reflecting cultural values around filial responsibility. The study’s authors, including Dr Ellie Bostwick Andres and Associate Professor Chetna Malhotra, emphasised the need for culturally informed education and better home-based palliative approaches to reduce avoidable interventions.

The research is now informing new caregiver support tools, including CareBuddy, a mobile application promoting healthy ageing, and decision aids to help families navigate complex choices. As noted by Professor Patrick Tan, Duke-NUS’ Dean-designate, the findings reveal the profound emotional and practical challenges of dementia care and the need to build systems that support both older adults and the families who sustain them.

More information: Ellie Bostwick Andres et al, The final year for community-dwelling older adults with dementia in an Asian setting: admissions, interventions, and caregiver burden, The Journals of Gerontology Series A. DOI: 10.1093/gerona/glaf227

Journal information: The Journals of Gerontology Series A Provided by Duke-NUS Medical School

New Nationwide Study Uncovers Regional Clusters of High Epilepsy Rates in Ageing Americans

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A newly published nationwide study has, for the first time, produced a detailed map of where epilepsy most affects older adults in the United States, revealing apparent regional disparities tied to environmental and social conditions. Featured in JAMA Neurology, the research is the result of a collaboration between the Houston Methodist Research Institute and Case Western Reserve University. By analysing Medicare records, the team found that adults aged sixty-five and older experience significantly higher rates of epilepsy in parts of the American South—particularly Louisiana, Mississippi, East Texas and central Oklahoma—than in other regions.

Epilepsy affects an estimated 3.3 million people across the country, according to the U.S. Centres for Disease Control and Prevention. In 2019 alone, health care spending related to epilepsy and seizures reached $24.5 billion. Against this backdrop, the study offers a clearer picture of how the condition is distributed among older adults and raises important questions about the factors that contribute to those differences.

Lead investigator Weichuan Dong, PhD, of the Houston Methodist DeBakey Heart & Vascular Centre and Case Western Reserve University, explained that the research provides the first comprehensive national view of where epilepsy is most prevalent in later life. By applying advanced geospatial mapping to Medicare data, the team identified concentrated “hot spots” of high incidence across several southern states—a pattern they describe collectively as the “epilepsy belt”. Dong noted that understanding where the burden is highest is a crucial step in learning why these patterns exist and how communities might better target prevention and care.

The study also identified several influential social and environmental factors linked to increased epilepsy incidence. Among them were insufficient sleep, defined as fewer than seven hours per night; frequent exposure to extreme heat, measured as days with a heat index above ninety-five degrees; low levels of physical activity; lack of health insurance among younger adults, which may delay diagnosis until Medicare coverage begins; and limited access to a household vehicle. These conditions, often shaped by local socioeconomic realities, were more common in regions with the highest case concentrations.

Co-author Siran Koroukian, PhD, of Case Western Reserve University School of Medicine, emphasised the strong association between extreme heat and new-onset epilepsy in older adults. She suggested that the finding highlights the growing relevance of climate-related risks to public health planning, especially given the ageing U.S. population.

Researchers used geospatial machine-learning methods to analyse data from 4.8 million Medicare beneficiaries between 2016 and 2019, drawing from the Medicare Master Beneficiary Summary File and the Agency for Healthcare Research and Quality. Alaska and Hawaii were excluded because of incomplete data. The analysis revealed previously unseen national patterns, showing how neighbourhood-level factors—from sleep habits and heat exposure to health care access and transportation—shape neurological health outcomes in later life.

More information: Weichuan Dong et al, Incidence and Risk Factors of Epilepsy Among Older Adults in the US Medicare Population, JAMA Neurology. DOI: 10.1001/jamaneurol.2025.4347

Journal information: JAMA Neurology Provided by Houston Methodist

Technion Faculty of Biology reports breakthrough findings on the mechanisms of immune system ageing

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Researchers at the Technion – Israel Institute of Technology’s Faculty of Biology have uncovered a distinctive process that contributes to immune system ageing, along with a potential strategy to strengthen immune responses in later life. The work, published in Nature Aging, was carried out by Assistant Professor Noga Ron-Harel and doctoral researcher David Ezuz.

As people grow older, their immune defences weaken, essentially because T cells—key white blood cells tasked with recognising and eliminating viruses and cancerous cells—gradually lose their capacity to function efficiently. The Technion team has shown that one of the central drivers of this decline lies in the ageing of the spleen, an organ crucial to the immune system. Beyond acting as the body’s primary reservoir of white blood cells, the spleen houses a specialised region that dismantles faulty red blood cells and recycles their iron-rich components. With age, this recycling machinery becomes increasingly ineffective, leading to the accumulation of iron deposits and harmful metabolic by-products. The result is an oxidative, damaging environment that compromises T-cell performance. Remarkably, the researchers demonstrated that even short-term exposure of young T cells to the conditions within an aged spleen is enough to blunt their effectiveness.

Faced with this stressful and toxic environment, T cells attempt to shield themselves by reducing their iron uptake and locking the iron they already contain in protective protein complexes that make it less available. While this response lessens potential oxidative damage, it comes at a high cost: readily accessible iron is indispensable for T-cell activation. By restricting it, T cells inadvertently undermine their own ability to mount a robust immune response.

Building on these observations, the researchers proposed and tested a practical way to counteract the decline in immune function associated with ageing. By providing controlled iron supplementation precisely at the time of T-cell activation, they improved the responsiveness of aged T cells. Experiments in older mice showed that this targeted intervention not only restored aspects of T-cell activation but also boosted the animals’ immune reactions to vaccination.

More information: David Ezuz et al, Heme and iron toxicity in the aged spleen impairs T cell immunity through iron deprivation, Nature Aging. DOI: 10.1038/s43587-025-00981-4

Journal information: Nature Aging Provided by Technion-Israel Institute of Technology