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Association of Joint Pain and Depressive Symptoms with Accelerated Cognitive Decline in the Elderly

Older adults exhibiting symptoms of depression coupled with moderate to severe joint pain are likely to experience an accelerated decline in cognitive functions, particularly memory. This finding emerges from a study supported by FAPESP and published in the journal Aging & Mental Health, which draws on data from 4,718 participants aged 50 and above, tracked over 12 years. The research team includes experts from the Federal University of São Carlos (UFSCar) in Brazil and University College London (UCL) in the UK.

The study suggests that pain and depressive symptoms impact brain regions, notably the hippocampus, which are crucial for cognitive processes. This dual burden potentially leads to a ‘clogging’ of cognitive functions, forcing the brain to redistribute tasks to manage both pain and depressive symptoms, adversely affecting memory formation and overall cognitive performance. According to Patrícia Silva Tofani, a researcher in the Gerontology Program at UFSCar and a professor at the Federal University of Sergipe, this cognitive overload progressively leads to a swifter decline in cognitive abilities over time.

The study’s participants are part of the English Longitudinal Study of Ageing (ELSA Study), which forms a component of the International Collaboration of Longitudinal Studies of Ageing (InterCoLAgeing), a global consortium headed by Tiago da Silva Alexandre, a professor in UFSCar’s Department of Gerontology. Tofani conducted this research during her postdoctoral studies, focusing on the correlation between memory decline and the co-occurrence of chronic pain and depressive symptoms.

Analysis from the study indicates that individuals suffering concurrently from pain and depression exhibited a more rapid deterioration in both memory and overall cognitive function over the 12-year follow-up compared to those with neither condition. Interestingly, those experiencing only one of these issues did not face an accelerated decline, which was an unexpected discovery. Alexandre noted that while they anticipated a more significant cognitive decline in individuals with both depressive symptoms and chronic joint pain compared to those with only one of these conditions, the compounded impact of both was notably more detrimental than anticipated.

The study identifies six cognitive domains affected: executive function, language, attention, memory, perceptomotor functions, and social cognition. Despite observing a decline in global cognition and memory, the researchers did not detect a decrease in executive function, which Tofani highlights as crucial for maintaining independence in elderly individuals, allowing them to manage daily living tasks effectively.

Both depressive symptoms and joint pain are prevalent among older adults, often underreported, and commonly misattributed to normal ageing processes. This misattribution can lead to inadequate assessment and management in primary care settings, emphasizing the need for greater awareness and targeted care for these conditions. Chronic joint pain is typically linked to conditions like osteoarthritis, which is prevalent among older adults.

The study’s findings underscore the critical need for primary care practitioners to better recognize and address depressive symptoms and joint pain in older adults. Overlooking these conditions can adversely affect not only the mood and physical mobility of the elderly but also their cognitive functions. Alexandre stresses the importance of not dismissing these symptoms as mere effects of ageing, as doing so can prevent the identification and treatment of conditions that, while familiar, are modifiable with appropriate medical intervention.

More information: Patrícia Silva Tofani et al, Does the coexistence of pain and depressive symptoms accelerate cognitive decline? Aging & Mental Health. DOI: 10.1080/13607863.2024.2392737

Journal information: Aging & Mental Health Provided by Fundação de Amparo à Pesquisa do Estado de São Paulo

The Impact of Depression on the Occupational and Recreational Activities of Young Adults in Finland

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According to a comprehensive study conducted by the University of Eastern Finland, the Finnish Social Insurance Institution (Kela), and Monash University in Australia, depression and other mental health conditions significantly reduce productivity-adjusted life years (PALYs) more than musculoskeletal and cardiovascular diseases. This groundbreaking research marks the first time the loss of PALYs due to chronic conditions has been assessed at the population level in Finland. The findings were reported in the prestigious journal Value in Health, known for its contributions to the field of health economics.

PALYs, an innovative metric devised at Monash University, measures the impact of diseases on work and functional ability, accounting for the requirements of both professional and domestic life. The metric reflects a year lived in complete working and functional health.

The recent findings reveal that annually, depression and other mental health disorders account for a loss of 99,570 PALYs in the workplace and 256,086 in domestic and volunteer activities among Finnish individuals aged 18–79. This significant toll is particularly pronounced in women aged 18–34. In comparison, musculoskeletal conditions lead to 67,945 PALYs lost annually in professional settings and 198,544 in leisure activities. Cardiovascular diseases cause a loss 55,329 in the workplace and 143,453 in leisure activities yearly. The study also looked at other chronic conditions, including asthma, diabetes, gastrointestinal diseases, migraines, and thyroid disorders.

In Finland, mental health issues have historically been the leading cause of sick leave among individuals aged 16–34, as reported by Kela. Since 2017, these conditions have also topped the list for those aged 35–49. Although an increase in mental health-related sick leave is observed in those aged 50–67, musculoskeletal diseases remain predominant in this older age bracket.

Senior Researcher Piia Lavikainen from the University of Eastern Finland highlights that the rising number of PALYs lost due to depression and mental health concerns among young adults could reflect better disease diagnosis and decreasing stigma. However, it may also signify the escalating work pressures and social media’s influence.

The study utilised a representative sample of 2,187 individuals from the Finnish adult population in 2022, stratified by age, gender, and hospital district. Participants were surveyed about their health conditions and their perceived work and functional capacity. Using Statistics Finland’s demographic data, these responses were extrapolated to estimate PALYs across the adult population, considering the prevalence of chronic conditions and their impact on work and life functionalities.

Professor Janne Martikainen from the University of Eastern Finland, who led the study, emphasised that the PALY metric not only illuminates the burden of various diseases but also aids in evaluating the societal advantages of preventive strategies and treatments. This approach promises to enhance future healthcare policies by focusing on the practical capacities affected by illnesses.

More information: Piia Lavikainen et al, The Impact of Chronic Conditions on Productivity-Adjusted Life-Years in Both the Workplace and Household Settings in the General Adult Population in Finland, Value in Health. DOI: 10.1016/j.jval.2024.09.017

Journal information: Value in Health Provided by University of Eastern Finland

Even Moderate Exercise Can Lower the Risk of Common Heart Conditions

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A new study spearheaded by researchers at NYU Langone Health has demonstrated that incorporating just an additional hour of physical activity each week may diminish the likelihood of developing the most prevalent type of arrhythmia, atrial fibrillation, by 11%.

Atrial fibrillation is characterised by an erratic and rapid beating of the heart’s upper chambers, which, if not managed, can lead to severe complications such as stroke and heart failure. Previous research has consistently indicated a correlation between physical exercise and a decreased risk of this heart condition. However, these studies typically depended on self-reported participant data, which can often be unreliable.

To overcome this limitation, the research team turned to data from Fitbit devices to objectively quantify the physical activity of over 6,000 individuals across the United States. Their findings revealed that higher weekly physical activity levels correlate with a reduced likelihood of developing atrial fibrillation. It is particularly noteworthy that even modest amounts of moderate-to-vigorous physical activities — which could include activities as simple as brisk walking, household chores, swimming, or jogging — were linked to a decreased risk.

The study outlined specific findings: Participants who engaged in 2.5 to 5 hours of exercise per week—aligning with the minimum guidelines suggested by the American Heart Association—experienced a 60% lower risk of developing atrial fibrillation. Those who exercised for more than 5 hours weekly saw an even more significant risk reduction, estimated at 65%.

Preventive cardiologist Sean Heffron, MD, the study’s senior author and an assistant professor at NYU Grossman School of Medicine, emphasised that significant health benefits could be achieved through moderate activity without engaging in extreme fitness routines like marathon running. Dr Heffron, who also directs the cardiovascular fitness and nutrition at NYU Langone’s Center for the Prevention of Cardiovascular Disease, highlighted the study’s unique use of activity monitors over a prolonged period, contrasting it with previous studies that only followed participants for a short duration, potentially failing to capture habitual exercise patterns.

This research, the largest of its type thus far, monitored participants for an entire year using Fitbits they already owned and continued to track their health for an additional five years. This study forms part of the National Institutes of Health’s All of Us program, which aims to enhance the representation of historically underrepresented groups in medical research, including racial minorities, women, and rural populations.

Lead author Souptik Barua, PhD, also noted the importance of tools like Fitbits in research for providing an objective measure of exercise over extended periods. This capability allows researchers to gain more nuanced insights into how different activity patterns influence health outcomes. However, he also mentioned that despite the study’s strengths, it primarily included college-educated white women, thus reflecting a less diverse cohort than the overall All of Us population. Plans are underway to include more diverse groups in future studies by providing free devices to participants from underrepresented communities.

Lastly, while the findings strongly suggest a link between physical activity levels and reduced risk of atrial fibrillation, the study was not designed to prove causation definitively prove causation or explore the mechanisms behind this association or other influencing factors such as socioeconomic status.

More information: Souptik Barua et al, Fitbit-measured physical activity is inversely associated with incident atrial fibrillation among All of Us participants, medRxiv. DOI: 10.1101/2024.06.27.24308221

Journal information: medRxiv Provided by NYU Langone Health / NYU Grossman School of Medicine

The Concealed Impact of Air Pollution on Cognitive Deterioration

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Air pollution has traditionally been regarded as an external environmental concern, primarily threatening respiratory health. However, burgeoning research is now illuminating its detrimental effects on brain health. Fine particulate matter, or PM2.5, is a particularly insidious form of air pollution composed of tiny particles that can be deeply inhaled into the lungs and even absorbed into the bloodstream. Historically, the focus has been on the immediate physical impacts of PM2.5, such as tissue damage and lung inflammation. Only recently has the spotlight shifted to its potential implications for cognitive decline, an area that is just beginning to be understood.

A pivotal study conducted by researchers from Rostock, Bonn, and Luxembourg universities has shed light on a potential mechanism linking air pollution to cognitive impairment: systemic inflammation. This inflammation, spurred by an increase in monocytes — a type of white blood cell — may play a critical role in how PM2.5 contributes to the deterioration of cognitive functions. Their findings have been published in the esteemed scientific journal Alzheimer’s & Dementia, marking a significant advancement in our understanding of this issue.

PM2.5 particles are minuscule enough to bypass the body’s primary air filters and enter the lungs and bloodstream, posing substantial health threats. Long-standing exposure to these particles has been associated with an increased risk of developing neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease. Recent reports by the Lancet Commission on dementia prevention, intervention, and care have even listed air pollution as a modifiable risk factor, highlighting the urgent need for more comprehensive understanding and intervention strategies. Despite the growing recognition of these risks, the specific biological mechanisms by which PM2.5 affects cognitive functions remain largely unexplored.

The breadth of research on cognitive decline has predominantly concentrated on older populations, but current studies are expanding this focus to include the effects on younger adults. Evidence suggests that even chronic low-level exposure to PM2.5 during early and mid-life may influence long-term cognitive outcomes. In exploring this, the research team analysed data from over 66,000 participants in the Dutch Lifelines cohort. By correlating participants’ blood analyses and cognitive test results over a decade with air pollution data from their residential locations gathered through the ELAPSE project, researchers have begun to uncover the complex mechanisms at play.

The study identified a correlation between PM2.5 exposure and a decline in cognitive processing time (CPT), which reflects the brain’s speed in responding to stimuli. A noteworthy aspect of their findings is the significant role of an increased white blood cell count, mainly monocytes, in mediating this effect. According to Dr Benjamin Aretz, a research scientist at the University Hospital Bonn and the study’s first author, systemic inflammation may be a crucial intermediary connecting PM2.5 exposure to cognitive impairments. This marks the first large-scale study to directly associate changes in white blood cell count with the cognitive effects of delicate particulate matter.

While it’s known that PM2.5 can directly impact the brain by crossing the blood-brain barrier and inducing local inflammation, this study accentuates the broader systemic inflammation that occurs upon exposure. Prof. Gabriele Doblhammer, group leader at the DZNE in Rostock, hypothesised that pollutants might trigger an increase in white blood cells, disrupting immune functions in the brain and contributing to cognitive decline. The role of inflammation in the onset of neurodegenerative diseases is well-documented, making it a critical area of study for understanding how air pollution impacts cognitive health.

In an era marked by increasing urbanisation and an ageing population, comprehending and mitigating the effects of air pollution on neurodegenerative diseases is becoming increasingly critical. Prof. Michael Heneka, director of the Luxembourg Centre for Systems Biomedicine (LCSB) at the University of Luxembourg and senior author of the study, stresses the importance of further research to identify specific pollutants and their cellular mechanisms that mediate cognitive impairment. Insights from such studies could significantly influence public health policies to reduce the risks associated with long-term exposure to PM2.5, ultimately protecting brain health on a broader scale.

More information: Benjamin Aretz et al, The role of leukocytes in cognitive impairment due to long-term exposure to fine particulate matter: A large population-based mediation analysis, Alzheimer’s & Dementia. DOI: 10.1002/alz.14320

Journal information: Alzheimer’s & Dementia Provided by University of Luxembourg

Hidden Dementia: Research Reveals Widespread Undetected Cognitive Impairment in At-Risk Communities

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The delayed diagnosis of dementia carries profound consequences. Without prompt and accurate identification, individuals suffering from undiagnosed cognitive impairments face a myriad of risks, including medication discrepancies, falls, and escalated caregiver burden. Furthermore, such delays restrict access to vital resources and care services that could notably enhance their life quality.

A pioneering study conducted by Emory University School of Medicine in collaboration with Indiana University has uncovered a significant prevalence of undiagnosed cognitive impairments among older adults attending primary care at federally qualified health centers (FQHCs). These centres primarily cater to underprivileged groups, where findings particularly pointed out that African American patients had a higher likelihood — more than double that of their white counterparts — of having their cognitive issues go unnoticed. This research underscores a pivotal lack of early detection in marginalised communities that are inadequately served.

“Unrecognised cognitive impairments, including dementia, pose a formidable challenge both in the U.S. and globally, affecting not only patients but their families and the broader health care infrastructure,” remarked Ambar Kulshreshtha, MD, an associate professor at Emory University School of Medicine and the lead researcher of the study. He stressed that the ramifications of late diagnoses are severe, often resulting in the identification of patients at more advanced stages where symptoms have worsened, and medical care becomes substantially more complex. Early diagnosis is crucial as it opens the door to treatment options that can slow the progression of the disease.

Regarding the impact on underserved communities, FQHCs serve as a critical healthcare resource for approximately 30 million patients in the U.S., most of whom live below 200% of the federal poverty level. This makes it challenging for them to afford specialised medical services typically covered by private insurance or require out-of-pocket expenses. Published in the JAMA Open Network, the study involved a detailed examination of 204 adults aged 65 and older from five FQHCs in Indianapolis between 2021 and 2023 who had no prior memory impairment diagnosis. Through a rigorous process including interviews, medical reviews, neurological exams, and neuropsychological tests, the interdisciplinary team diagnosed each participant with either normal cognition, mild cognitive impairment (MCI), or dementia. It was found that 75% of participants had undiagnosed mental issues, with 62% displaying MCI and 12.3% confirmed to have dementia.

The findings also shed light on significant racial disparities, with African Americans experiencing undiagnosed cognitive issues at more than double the rate of whites. This disparity persisted even after adjusting for variables such as age, gender, and educational level, emphasising the urgent need for improved early detection pathways in these vulnerable populations. The study suggests that higher rates of cognitive issues among African Americans are influenced more by social determinants like residential segregation, environmental pollution, racial discrimination, and disparities in education rather than biological differences.

The systemic issues, including limited time for screenings, inadequate training, and insufficient resources, exacerbate the problem of undetected cognitive impairments in African American communities. Kulshreshtha advocates for the removal of barriers to dementia screening, emphasising the necessity for timely screenings, especially among high-risk groups. He highlights the challenges faced by other minorities, such as those who do not speak English or live in rural areas, and the pervasive stigma and misconceptions surrounding dementia that need to be addressed through community education and healthcare system reform.

To facilitate early detection, experts recommend incorporating brief cognitive assessments during routine medical visits, which can serve as a practical approach to recognising early signs of dementia. In Atlanta, Dr. Kulshreshtha contributes to addressing this issue through his involvement with Georgia Memory Net, a state-funded initiative led by Emory that aims to promote early and accurate diagnosis of Alzheimer’s through primary care settings.

Moreover, recent advancements in dementia care have been exemplified by the introduction of the Centers for Medicare & Medicaid Services’ (CMS) new payment model, the Guiding an Improved Dementia Experience (GUIDE). This model, operational since July 2024 at Emory Integrated Memory Care in Atlanta—one of the nation’s leading nurse-practitioner-led primary care practices for dementia patients—aims to enhance care delivery and alleviate pressure on unpaid caregivers. Dr. Kulshreshtha’s dedication to improving dementia care is evident through his research and his active engagement in developing practical solutions to the challenges faced by patients and their families, as praised by Ted Johnson, MD, at Emory.

More information: Ambar Kulshreshtha et al, Prevalence of Unrecognized Cognitive Impairment in Federally Qualified Health Centers, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.40411

Journal information: JAMA Network Open Provided by Emory Health Sciences

Diets of Those Who Drink Only Beer Are Poorer Than Those of Wine Drinkers

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According to a study scheduled for presentation at The Liver Meeting, hosted by the American Association for the Study of Liver Diseases, individuals who primarily drink beer have notably poorer diets, are less active, and are more inclined to smoke compared to those who consume wine, spirits, or a combination of alcoholic beverages.

Madeline Novack, the chief resident at Tulane School of Medicine’s internal medicine residency program and the lead author of the study highlighted the significant health risks associated with excessive alcohol consumption. She pointed out that alcohol overuse is a primary cause of cirrhosis in the U.S., and metabolic dysfunction-associated steatotic liver disease (MASLD) is on the rise. Novack emphasised that both types of liver disease often co-occur and that making lifestyle adjustments is crucial for both managing and preventing these conditions. This begins with understanding how alcohol consumption correlates with poor nutritional choices.

The research surveyed a nationally representative sample of over 1,900 U.S. adults who reported current alcohol use to analyse diet quality. The groups compared included individuals who consume exclusively beer (38.9%), exclusively wine (21.8%), exclusively liquor (18.2%), or a mixture of alcohol types (21%). Their self-reported eating habits were evaluated against the Healthy Eating Index, a validated, standardised tool reflecting dietary guidelines.

Novack reported that none of the alcohol-consuming groups achieved a score close to 80 points, which is considered adequate on the 100-point Healthy Eating Index. Beer drinkers scored the lowest at 49, while wine drinkers scored slightly higher at 55. Those consuming only liquor and those who drank a combination of alcohol scored around 53.

She noted that beer-only drinkers are typically younger, male, smokers, and from lower income brackets. They also reported the highest daily caloric intake when adjusted for body weight and exhibited the lowest physical activity levels. While previous studies have shown that dietary quality diminishes with an increase in alcohol consumption regardless of the type, specific influences of different kinds of alcoholic beverages have been less explored.

The study suggests that the variation in diet quality among different types of drinkers could be related to the contexts in which food and alcohol are consumed together. For instance, in the U.S., beer is frequently chosen when the available food options are often low in fibre and high in carbohydrates and processed meats. Conversely, wine, particularly red wine, is typically consumed with meals that include meat, vegetables, and dairy.

Novack also proposed that the relationship could be inverse, where dietary preferences might dictate alcohol choice. For example, consuming fried or salty foods, which induce thirst, might lead people to choose beer.

Novack emphasised the importance of healthcare providers discussing alcohol consumption types with their patients to promote healthier behaviours. For instance, the findings from this study could be leveraged to advise patients who primarily drink beer to increase their intake of fruits and vegetables and to enhance their physical activity levels as part of a broader strategy to prevent liver disease and other health complications.

More information: Madeline Novack et al, Convergence of Alcohol Consumption and Dietary Quality in US Adults Who Currently Drink Alcohol: An Analysis of Two Core Risk Factors of Liver Disease, Nutrients. DOI: 10.3390/nu16223866

Journal information: Nutrients Provided by American Association for the Study of Liver Diseases

Acknowledging Traumatic Brain Injury as a Persistent Condition Enhances Lifelong Care for Survivors

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A commentary published in the Journal of Neurotrauma advocates for traumatic brain injury (TBI) to be classified as a chronic condition, akin to diabetes, asthma, depression, and heart failure. This reclassification aims to shift care focus from addressing the immediate aftermath to embracing a lifelong care strategy.

The commentary authors suggest leveraging existing coordinated care models, which have been developed, tested, and implemented for various groups, including older adults and individuals with depression. By adapting these models, they aim to enhance the integration and communication between brain injury specialists, such as physical medicine and rehabilitation clinicians, and primary care physicians. This approach is expected to improve long-term patient outcomes, offering sustained support to TBI survivors and their families.

In the United States, the prevalence of TBI is increasing, with approximately 2.8 million Americans affected each year. Current healthcare and insurance systems focus on the acute phase of TBI, generally covering the first year following the injury. However, for many survivors, the impact of TBI is long-lasting and requires attention beyond this initial period. Unfortunately, options for post-acute care are often limited and inadequate.

TBIs are most frequently caused by falls, particularly among older adults, as well as by blunt trauma, often related to sports injuries, firearms, motor vehicles, and assaults. The damage may be localised to a specific brain area or more widespread. Various factors influence recovery, including the injury’s size, severity, and location, as well as the individual’s age and history of prior brain injuries.

The Centers for Disease Control and Prevention identify several populations at higher risk of TBI, including racial and ethnic minorities, military service members and veterans, homeless individuals, those in correctional and detention facilities, survivors of intimate partner violence, and residents of rural areas.

The commentary challenges clinicians’ common perception that TBI impairments are static after initial recovery has plateaued. Instead, the authors argue that the trajectory of TBI can involve fluctuations, suggesting that the condition is dynamic rather than static. Consequently, they advocate for TBI to be managed as a chronic condition.

Kurt Kroenke, M.D., the senior author of the commentary and a member of the Regenstrief Institute and the Indiana University School of Medicine, emphasises that recognising TBI as a chronic condition and providing coordinated care can significantly improve outcomes. This approach acknowledges that recovery extends beyond the first year and ensures ongoing patient monitoring and support over many years.

The commentary highlights the importance of self-management and the role of coordinated care models in fostering collaboration between the limited number of brain care specialists and primary care clinicians who oversee the care of TBI survivors throughout their lives. Such collaborative care models, developed by institutions like the Regenstrief Institute, offer essential support and coordinated care for patients with chronic conditions. Recently, Medicare acknowledged TBI as one of 18 chronic conditions, setting a precedent that may encourage further recognition and improved care standards.

Dr. Kroenke notes that Medicare’s designation of TBI as a chronic condition could significantly change how the condition is managed in the long term. It encourages better integration of brain injury specialists with primary care providers and may prompt health insurers to cover the extensive care needs of some survivors for many years.

Flora M. Hammond, M.D., co-author of the commentary and a leading figure in physical medicine and rehabilitation, advocates for a proactive, long-term approach to managing brain injury. She suggests that anticipating changes over time and incorporating strategies to promote healthy living through individualised, coordinated care can significantly enhance the quality of life for those with TBI.

The commentary concludes by asserting that recognising TBI as a chronic condition would not only direct more resources towards addressing the challenges associated with living with a brain injury but would also heighten public and professional awareness of optimising the health and well-being of individuals affected by TBI.

More information: John Corrigan et al, Recognition of Traumatic Brain Injury as a Chronic Condition: A Commentary, Journal of Neurotrauma. DOI: 10.1089/neu.2024.0356

Journal information: Journal of Neurotrauma Provided by Regenstrief Institute

Daytime Sleepiness May Be Linked to Early Dementia Syndrome

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Older individuals who experience daytime sleepiness or a diminished enthusiasm for daily activities due to sleep disturbances may be more susceptible to developing a syndrome that potentially precedes dementia, as revealed by a study published in the November 6, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.

This syndrome, known as motoric cognitive risk syndrome, is characterised by slow walking speeds and self-reported memory concerns, though not to the extent of having a mobility disability or diagnosed dementia. The condition represents a preliminary stage that could evolve into dementia.

The research indicated that those who suffer from excessive daytime sleepiness and a lack of motivation are more likely to develop this syndrome than those without such sleep-related problems. However, it’s crucial to note that the study did not establish a causal relationship but merely an association between these factors.

Dr. Victoire Leroy, MD, PhD, from the Albert Einstein College of Medicine in the Bronx, New York, stressed the importance of screening for sleep issues. Dr Leroy suggested that addressing sleep problems might help mitigate cognitive decline in later life.
The study involved 445 participants, the average age of whom was 76, none of whom had dementia. At the outset, participants underwent sleep questionnaires and were evaluated for memory issues and walking speed using a treadmill. These assessments were repeated annually over an average of three years.

The sleep assessment included questions about difficulties such as waking up during the night, inability to fall asleep within 30 minutes, discomfort due to temperature, and using sleep medications. The researchers also evaluated daytime sleepiness by asking participants about their ability to stay awake during activities such as driving, eating, or socialising. They also gauged enthusiasm levels by asking about difficulties maintaining sufficient motivation to complete tasks.

Of the participants, 177 were classified as poor and 268 as good. At the start of the study, 42 participants were identified with motoric cognitive risk syndrome, and another 36 developed the syndrome during the study’s duration.

The findings revealed that 35.5% of participants with excessive daytime sleepiness and a lack of enthusiasm developed the syndrome, in contrast to only 6.7% without these issues. After adjusting for other risk factors such as age, depression, and health conditions, the study found that individuals with these sleep-related problems were over three times more likely to develop the syndrome than those without them.

Dr. Leroy emphasised the need for further research to explore the relationship between sleep disturbances, motoric cognitive risk syndrome, and cognitive decline. The study calls for additional investigations to understand the mechanisms linking sleep disturbances with cognitive risks and the potential progression to cognitive decline.

More information: Victoire Leroy et al, Association of Sleep Disturbances With Prevalent and Incident Motoric Cognitive Risk Syndrome in Community-Residing Older Adults, Neurology. DOI: 10.1212/WNL.0000000000210054

Journal information: Neurology Provided by American Academy of Neurology

Enhancing Treatment Results for Adults with Congenital Heart Disease

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A recent article published in JAMA Network Open casts new light on the life quality and health outcomes of adults with congenital heart disease (CHD), offering essential revelations from the Congenital Heart Initiative (CHI) registry. The paper, with Ochsner Health’s paediatric cardiologist and adult congenital heart specialist, Thomas Young, MD, as one of its authors, brings critical data to the fore.

In the United States, the population of adults living with CHD exceeds 1.5 million, underlining an urgent requirement for detailed research and improved clinical practices. The CHI registry, a digital platform accessible online, plays a pivotal role in this area by gathering patient-reported outcomes (PROs). This initiative promotes multicentre research and provides critical insights that enhance the understanding and management of CHD in adults.

The study utilises data from over 4500 participants, making it the most significant US registry encompassing adults with CHD. It covers a broad array of CHD subtypes. The study showed that 84% of participants assessed their health-related quality of life as good or better despite the varying complexities of their CHD conditions. However, it was noted that those with more complex CHD forms were less likely to adhere to standard physical activity guidelines. The research also brought to light a high incidence of mood disorders among the cohort, though a majority still perceived their overall health-related quality of life positively.

Dr. Young commented on the historical progress in the field, noting, “Over several decades, we’ve observed substantial advancements in diagnostics and surgical techniques, resulting in many CHD patients now living into adulthood. Yet, the pace of research into long-term outcomes for this group hasn’t matched these advances, partly due to the absence of a dependable registry system.” He elaborated on how CHI is now filling this gap, providing deeper insights into clinical outcomes that will likely enhance the life quality and health results for more patients with CHD moving forward.

This research emphasises the value of patient-reported outcomes in comprehending and ameliorating the health and life quality of adults with CHD. The findings from this study will guide future research and targeted interventions, aiming to boost the health-related quality of life for this patient group further.

More information: Thomas Young et al, Patient-Reported Outcomes Among Adults With Congenital Heart Disease in the Congenital Heart Initiative Registry, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.39629

Journal information: JAMA Network Open Provided by Ochsner Health System

Excessive Intake of Ultra-Processed Foods Associated with Hastened Biological Ageing

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A recent study carried out by the Research Unit of Epidemiology and Prevention at the I.R.C.C.S. Neuromed in Pozzilli, in collaboration with LUM University of Casamassima, has revealed that consuming high amounts of ultra-processed foods is linked to accelerated biological ageing, irrespective of the overall nutritional quality of one’s diet. These findings were highlighted in the esteemed American Journal of Clinical Nutrition.

The study in question scrutinised data from over 22,000 participants enrolled in the Moli-sani Study, one of Europe’s most substantial population cohorts. Researchers employed more than thirty distinct blood biomarkers to determine the biological age of these individuals. It’s important to note that biological age, as opposed to chronological age based purely on one’s birth date, provides a more comprehensive reflection of the body’s physiological state, encompassing the health of organs, tissues, and systems. This biological age can vary significantly from the chronological age.

Researchers utilised a comprehensive food frequency questionnaire to approximate the consumption of ultra-processed foods among participants. These are foods either partially or wholly composed of substances not typically utilised in home cooking, such as hydrolysed proteins, maltodextrins, and hydrogenated fats. Furthermore, they often contain various additives, including dyes, preservatives, antioxidants, anticaking agents, flavour enhancers, and sweeteners. Ultra-processed foods span a broad spectrum, encompassing obvious choices like packaged snacks, sugary beverages, and seemingly innocuous items such as mass-produced bread, fruit yoghurts, some breakfast cereals, and certain meat substitutes.

The findings indicated a marked acceleration in the biological ageing of individuals who frequently consumed these ultra-processed foods. This means that people were found to be biologically older than their actual chronological age would suggest.

Biological ageing serves as an internal clock for our body, advancing at a pace that may not align with the passing years but instead mirrors the genuine health status of the individual.
Simona Esposito, a lead researcher at the Epidemiology and Prevention Research Unit and the study’s first author, pointed out that the high intake of ultra-processed foods not only detrimentally impacts health in a general sense but may also hasten the ageing process itself. This suggests that the effects of these foods extend beyond their basic nutritional deficiencies.

Marialaura Bonaccio, a nutritional epidemiologist at the same institution, elaborated on the potentially harmful mechanisms of ultra-processed foods. Despite their dietary shortcomings, characterised by high levels of sugar, salt, and unhealthy fats, these foods’ intense industrial processing fundamentally changes their food matrix. This alteration results in nutrient and fibre depletion, which can significantly affect various physiological functions, including glucose metabolism and the composition and functionality of the gut microbiota. Additionally, the prevalent use of plastic packaging in these products can lead to the ingestion of toxic substances.

Licia Iacoviello, director of the Research Unit of Epidemiology and Prevention at I.R.C.C.S. Neuromed and full professor of Hygiene at LUM University, emphasised that the study’s outcomes necessitate reevaluating current dietary guidelines. These should incorporate advisories to curb the intake of ultra-processed foods in everyday diets. She highlighted that even some nutrient-rich packaged foods fall under the ultra-processed category, underscoring the importance of guiding people towards making dietary choices that consider the extent of food processing. This shift in nutritional recommendations could be crucial in promoting better health outcomes and mitigating the premature advancement of biological ageing.

More information: Simona Esposito et al, Ultra-processed food consumption is associated with the acceleration of biological aging in the Moli-sani Study, American Journal of Clinical Nutrition. DOI: 10.1016/j.ajcnut.2024.10.006

Journal information: American Journal of Clinical Nutrition Provided by Istituto Neurologico Mediterraneo Neuromed I.R.C.C.S.

Dimmer Days and Brighter Nights May Hasten One’s Demise

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A comprehensive study encompassing over 13 million hours of data gathered from light sensors worn by 89,000 participants has uncovered a significant correlation between exposure to bright nocturnal environments and dark daytime conditions and an elevated mortality risk. The research assessed whether individual exposure to varying light conditions and the resultant disruption of circadian rhythms could predict mortality risks.

The findings, published in the prestigious journal Proceedings of the National Academy of Sciences, indicate a stark contrast in mortality risks associated with different light exposures. Specifically, individuals subjected to high levels of light during nighttime exhibited a 21–34% increase in the risk of death. Conversely, those who experienced high levels of natural daylight demonstrated a 17–34% decrease in mortality risk.

The study highlights the profound impact of light-induced disruption on circadian rhythms — the internal process that regulates the sleep-wake cycle and other physiological processes.
According to Professor Sean Cain of Flinders University, a senior author of the study and an expert in sleep research, disruptions to these rhythms are known to precipitate a range of health issues, including diabetes, obesity, cardiovascular diseases, and mental health disorders, all of which contribute to an increased mortality risk.

Professor Cain further explained that the study’s insights into the detrimental effects of inappropriate light exposure underscore the critical importance of managing personal light exposure for health preservation. Echoing his sentiments, Co-senior author Associate Professor Andrew Phillips pointed out that nighttime light exposure disrupts the body’s circadian rhythms by altering the timing (phase shift) and diminishing the strength (amplitude suppression) of signals from the central circadian ‘pacemaker’, which coordinates these rhythms across different body systems.

Associate Professor Phillips elaborated on the connections between circadian rhythm disruptions and the onset of metabolic syndrome, diabetes, obesity, and various cardiometabolic diseases, such as myocardial infarction, stroke, and hypertension. He suggested that the observed correlation between nocturnal light exposure and mortality risk could largely be attributed to these disruptions, which lead to adverse cardiometabolic outcomes.

The study’s practical implications were emphasized by the researchers, who advocate for avoiding artificial light at night and pursuing natural daylight as simple, accessible, and cost-effective strategies to foster optimal health and longevity. These recommendations stem from their analysis of data from the UK Biobank, involving middle-aged participants monitored over approximately eight years. During this period, all-cause and cardiometabolic mortality data was meticulously collected and analyzed, factoring in variables such as age, sex, ethnicity, photoperiod, and socio-demographic and lifestyle factors.

Dr Daniel Windred, the study’s lead author, commented on the importance of maintaining dark conditions during the late night and early morning hours when the central circadian pacemaker is most receptive to light. He noted that exposure to bright light during daytime could significantly enhance circadian rhythm function. Dr Windred also stressed the potential benefits of protecting lighting environments, particularly in intensive care or aged-care facilities where individuals are more vulnerable to circadian disruptions and associated mortality risks.

In conclusion, the research offers compelling evidence that managing light exposure could drastically reduce the incidence of cardiometabolic diseases and enhance longevity across the general population. This groundbreaking study not only sheds light on the pivotal role of circadian rhythms in overall health but also provides actionable recommendations that could significantly reduce the burden of disease.

More information: Daniel Windred et al, Brighter nights and darker days predict higher mortality risk: A prospective analysis of personal light exposure in >88,000 individuals, Proceedings of the National Academy of Sciences. DOI: 10.1073/pnas.2405924121

Journal information: Proceedings of the National Academy of Sciences Provided by Flinders University

Extended sitting may undermine health, regardless of youth and activity levels

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In an era defined by lengthy commutes, workdays dominated by virtual meetings, and evenings dedicated to streaming and social media, millennials now spend over 60 hours per week seated, a habit that could increase their risk of heart disease and accelerate ageing signs. This insight comes from new research conducted by the University of Colorado Boulder and the University of California Riverside.

The investigation involved more than 1,000 individuals who were either current or former residents of Colorado, including 730 twins. It is one of the pioneering studies to examine the effects of prolonged sitting on health markers such as cholesterol levels and body mass index (BMI) among young adults.

The findings revealed that more than merely adhering to the minimum recommended physical activity guidelines, which suggest about 20 minutes per day of moderate exercise, is required to negate the risks associated with extensive daily sitting.

Chandra Reynolds, the study’s senior author and a professor in the Department of Psychology and Neuroscience and the Institute for Behavioral Genetics, emphasized the necessity of either reducing sitting time or engaging in more vigorous exercise or both to mitigate the risk of premature ageing in early adulthood.

The study, published in PLOS ONE, saw Reynolds collaborate with Ryan Bruellman, the lead author and a doctoral candidate at UC Riverside’s Department of Genetics, Genomics, and Bioinformatics. Post-COVID, Bruellman observed increased sitting habits among his peers, prompting a deeper exploration into its potential long-term effects.

Bruellman noted that young adults often overlook the impacts of ageing due to their robust metabolism, underestimating the significance of their lifestyle choices during these formative years.

Their analysis included participants aged between 28 and 49, with an average age of 33, from the Colorado Adoption/Twin Study of Lifespan Behavioral Development and Cognitive Aging (CATSLife), which tracks twins and adopted individuals from childhood.

On average, these individuals reported sitting for nearly nine hours daily, with some reporting as much as 16 hours. Their weekly exercise ranged from 80 to 160 minutes of moderate activity and less than 135 minutes of vigorous exercise. While seemingly active, these figures likely paint a healthier picture than the national average, buoyed by Colorado’s typically active lifestyle.

The research team focused on two primary indicators of heart and metabolic health: the ratio of total cholesterol to high-density lipoprotein and BMI. The study concluded that the more an individual sat, the “older” they appeared regarding these health metrics. Moreover, adding moderate activity to a predominantly sedentary day did little to alleviate these effects.
Interestingly, young adults who sat for approximately 8.5 hours a day and engaged in minimal to no exercise were at a “moderate to high risk” for cardiovascular and metabolic diseases, according to the study.

The team also discovered that vigorous physical activities, such as running or cycling for 30 minutes daily, could significantly improve cholesterol and BMI levels, making individuals appear five to ten years younger than their less active counterparts.

However, even vigorous activities couldn’t completely offset the adverse effects of prolonged sitting, suggesting that the combination of less sitting and more intense physical exercise was more beneficial.

The study particularly highlighted the utility of identical twins in isolating lifestyle factors from genetic influences, showing that replacing sitting time with exercise was more effective in improving health outcomes than merely adding exercises to a sedentary routine.
The findings underscore the importance of reducing sitting time—through measures like standing desks, taking regular breaks, and organizing walking meetings — and engaging in substantial vigorous exercise.

Bruellman hopes this research will prompt a reevaluation of physical activity guidelines to address excessive sitting. Meanwhile, Reynolds advises young adults to establish healthy habits to ensure long-term benefits, suggesting that the current moment is crucial for setting the foundations of lifelong health.

More information: Ryan Bruellman et al, A twin-driven analysis on early aging biomarkers and associations with sitting-time and physical activity, PLOS ONE. DOI: 10.1371/journal.pone.0308660

Journal information: PLOS ONE Provided by University of Colorado at Boulder