What’s for Dinner?

Seafood Set Dinner at Rose Terrace Restaurant in Ibaraki, Japan

The price is 3,600 yen plus tax.

Time Until Dementia Symptoms Appear Can be Estimated Via Brain Scan

Tamara Bhandari wrote . . . . . . . . .

Researchers at Washington University School of Medicine in St. Louis have developed an approach to estimating when a person with no cognitive symptoms will start showing signs of Alzheimer’s dementia based on data from brain scans and the person’s age.

Researchers at Washington University School of Medicine in St. Louis have developed an approach to estimating when a person who is likely to develop Alzheimer’s disease, but has no cognitive symptoms, will start showing signs of Alzheimer’s dementia.

The algorithm, available online in the journal Neurology, uses data from a kind of brain scan known as amyloid positron emission tomography (PET) to gauge brain levels of the key Alzheimer’s protein amyloid beta.

In those who eventually develop Alzheimer’s dementia, amyloid silently builds up in the brain for up to two decades before the first signs of confusion and forgetfulness appear. Amyloid PET scans already are used widely in Alzheimer’s research, and this algorithm represents a new way of analyzing such scans to approximate when symptoms will arise. Using a person’s age and data from a single amyloid PET scan, the algorithm yields an estimate of how far a person has progressed toward dementia — and how much time is left before cognitive impairment sets in.

“I perform amyloid PET scans for research studies, and when I tell cognitively normal individuals about positive results, the first question is always, ‘How long do I have until I get dementia?’,” said senior author Suzanne Schindler, MD, PhD, an assistant professor of neurology. “Until now, the answer I’d have to give was something like, ‘You have an increased risk of developing dementia in the next five years.’ But what does that mean? Individuals want to know when they are likely to develop symptoms, not just whether they are at higher risk.”

Schindler and colleagues analyzed amyloid PET scans from 236 people participating in Alzheimer’s research studies through Washington University’s Charles F. and Joanne Knight Alzheimer Disease Research Center. The participants were an average of 67 years old at the beginning of the study. All participants underwent at least two brain scans an average of 4½ years apart. The researchers applied a widely used metric known as the standard uptake value ratio (SUVR) to the scans to estimate the amount of amyloid in each participant’s brain at each time point.

The researchers also accessed over 1,300 clinical assessments on 180 of the participants. The assessments typically were performed every one to three years. Most participants were cognitively normal at the start of data collection, so the repeated assessments allowed the researchers to pinpoint when each participant’s cognitive skills began to slip.

Schindler spent years trying to figure out how to use the data in amyloid PET scans to estimate the age at which symptoms would appear. The breakthrough came when she realized that amyloid accumulation has a tipping point and that each individual hits that tipping point at a different age. After this tipping point, amyloid accumulation follows a reliable trajectory.

“You may hit the tipping point when you’re 50; it may happen when you’re 80; it may never happen,” Schindler said. “But once you pass the tipping point, you’re going to accumulate high levels of amyloid that are likely to cause dementia. If we know how much amyloid someone has right now, we can calculate how long ago they hit the tipping point and estimate how much longer it will be until they are likely to develop symptoms.”

People in the study who reached the tipping point at younger ages took longer to develop cognitive symptoms than those who reached it later in life. Participants who hit the tipping point at age 50 typically took nearly 20 years to develop symptoms; those who hit it at age 80 took less than 10 years.

“When we look at the brains of relatively young people who have died with Alzheimer’s, they typically look pretty healthy, other than Alzheimer’s,” Schindler said. “But older people more frequently have damage to the brain from other causes, so their cognitive reserves are lower, and it takes less amyloid to cause impairment.”

The power of this new technique is that it requires just one brain scan, plus the person’s age. With that data, the model can estimate the time to symptom onset, plus or minus several years. In this study, the correlation between the expected age of symptom onset and the true age at diagnosis was better than 0.9 on a scale of 0 (no correlation) to 1 (perfect correlation).

After age, the genetic variant APOE4 is the strongest risk factor for Alzheimer’s dementia. People who carry one copy of the variant are two to three times more likely to develop Alzheimer’s dementia than the general population, and people who carry two copies are 10 times more likely. In this study, people with the high-risk variant hit the tipping point younger, but once that point was passed, they followed the same trajectory as everyone else.

“APOE4 seems to have a seeding effect,” Schindler said. “At very low levels, below the tipping point, you see amyloid rising in people with APOE4 while it’s not changing in people without APOE4. That means APOE4 carriers are going to hit the tipping point sooner. People with two copies of APOE4 hit the tipping point about 10 years earlier than people with no copies. But after that point, we see no difference between the APOE4 carriers and noncarriers.”

With an out-of-pocket cost of around $6,000, amyloid PET brain scans may be financially out of reach for many people. However, this algorithm could help accelerate the pace of drug development by streamlining clinical trials.

“Most participants in clinical trials designed to prevent or slow Alzheimer’s symptoms do not develop symptoms during the trials,” Schindler said. “That’s a lot of time and effort — for the participants as well as the researchers — that doesn’t yield useful data. If we could do trials only on people who are likely to develop symptoms in the next few years, that would make the process of finding therapies much more efficient.”

Source: Washington University School of Medicine

Is a Combo COVID/Flu Shot on the Way?

Dennis Thompson wrote . . . . . . . . .

During the next few weeks or months, you might find yourself dropping by the doctor’s office or pharmacy to get your annual flu shot along with a dose of COVID vaccine.

Unfortunately, you’ll have to get two individual jabs. Though at least two drug companies are working on a combo flu/COVID booster, the single-dose shot won’t be ready for this flu season.

But rest assured that it’s perfectly safe to get your flu shot and COVID vaccination during the same visit, infectious disease doctors say.

Getting several vaccinations at once has been standard medical practice for decades now, and these combos have never caused any harm, said Dr. William Schaffner, medical director of the Bethesda, Md.-based National Foundation for Infectious Diseases.

“It certainly hasn’t inhibited the armed forces,” said Schaffner, a professor of infectious disease and preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tenn. “When you’re a recruit, you get needled. You get a whole bunch of vaccines simultaneously.”

It doesn’t overwhelm your immune system, he said.

“And the CDC [U.S. Centers for Disease Control and Prevention] has said explicitly you can get your first, second or — if they’re recommended — booster COVID vaccines at the same time that you get your flu shot,” Schaffner added.

Anticipating that annual COVID boosters will be needed in the future, the pharmaceutical companies Moderna and Novavax both have announced that they are developing a combination flu/COVID vaccine.

Moderna told investors last week it hopes eventually to build an annual combo vaccine that protects against a variety of respiratory viruses, including influenza, COVID and respiratory syncytial virus (RSV).

Meanwhile, Novavax said it has initiated early-stage clinical trials to test a combined flu/COVID vaccine.

Don’t go looking for either combo shot this flu season, said Dr. Amesh Adalja, senior scholar with the Johns Hopkins Center for Health Security in Baltimore.

“I do not think that this is going to be something available in the short term, especially not for this flu season as flu vaccinations have already become available,” he said.

Schaffner agreed.

“They’re looking to the future,” Schaffner said of the drug companies. “They think COVID boosters will be necessary, and they’re even laying their bet this might be a good idea on an annual basis, because that would be the schedule in which you would need to get flu vaccine. They’re thinking about that pretty seriously and have invested a bunch of science in it.”

Adalja says the combo COVID/flu shot could be a smart idea, if it turns out we do need boosters against COVID.

“The more vaccines that can be packed into one shot the better, as it makes getting vaccinated and staying on schedule convenient,” he said. “Whether this is a vaccine everyone needs depends upon the data supporting the need for booster COVID vaccinations, which has not been fully presented.”

Lots of other combination vaccines are already on the market, like the tetanus/diphtheria/pertussis (Tdap) and the measles/mumps/rubella (MMR) shots, Adalja said.

Whether a COVID/flu combo would be safe and effective will depend on the immune reaction that’s produced by a single jab, Adalja said.

He noted that the MMR and varicella (chickenpox) vaccines are separated for the first dose, and then combined into a single MMRV shot for a person’s second dose.

That’s because when the combo MMRV is given as one shot for the first dose, it produces more adverse reactions than breaking it into two separate jabs, Adalja said.

Either way, infectious disease doctors like Schaffner and Adalja are bracing for a flu season that could be worse than last year. According to the CDC, flu cases were at an all-time low in 2020-2021 as pandemic protections such as masking and social distancing also served to keep influenza at bay.

“People are concerned because we’re doing exactly the opposite of what we did last year,” Schaffner said. “We’re going out instead of staying home. The kids are in school rather than learning virtually. So we anticipate there will be influenza this year. We can’t tell you how much, but we think there will be influenza, so we’re going to have to reintroduce everyone to this other respiratory virus which is also nasty — influenza.”

Schaffner is also worried that public health experts will be promoting flu shots “at a time of vaccine fatigue,” during which people might also be touting COVID booster shots among some groups.

But it’s still anyone’s guess what will happen this flu season, Adalja noted.

“It’s unclear whether influenza will be a major factor this season because there has not been much flu circulating even in the Southern Hemisphere, and there are some residual COVID-19 mitigation measures that people are taking,” Adalja said. “But influenza has a special status, and it is very important to be prepared for whatever the season may hold.”

Source: Health

Tiger Shrimp with Pinot Grigio, Fresh Tomato, & Basil Sauce

Ingredients

3 tablespoons olive oil
8 oz raw tiger shrimp, thawed if frozen
1 small onion or 2 shallots, very finely chopped
1 garlic clove, crushed
about 1/2 cup Pinot Grigio or other crisp, dry white wine
12 oz vine-ripened tomatoes, peeled, then roughly chopped
a small pinch of sugar
8 fresh basil leaves, torn
sea salt and freshly ground black pepper
boiled rice, to serve

Method

  1. Heat 2 tablespoons oil in a skillet or wok, add the shrimp, and sauté briefly until they turn pink. Remove them from the pan with a slotted spoon and set aside.
  2. Add the remaining oil to the pan, then add the onion or shallots and sauté for 1 to 2 minutes until softened but not browned. Stir in the garlic, then pour in the wine and cook until it has almost evaporated.
  3. Add the tomatoes and their juice and cook for 4 to 5 minutes, breaking them up with a fork or spatula to make a thick sauce.
  4. Add the sugar, season to taste with salt and pepper, then stir in the basil leaves.
  5. Return the shrimp and any accumulated juices to the pan and heat through gently.
  6. Serve immediately with boiled rice.

Makes 2 servings.

Source: Cooking with Wine


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