Gout in the Elderly Linked to Higher Risk of Dementia

The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2018) suggest that gout is associated with a 17-20% higher risk of dementia in the elderly.

Gout is a very common condition. It is caused by deposits of crystals of a substance called uric acid (also known as urate) in the joints, which leads to inflammation. Periods of time when patients are experiencing gout symptoms are called flares. Flares can be unpredictable and debilitating, developing over a few hours and causing severe pain in the joints. Guidelines for the treatment of gout recommend lowering uric acid levels, although maintaining too low levels is a concern because uric acid is thought to protect the brain.

“We welcome these results as they contribute to our understanding of the relationship between uric acid and dementia,” said Professor Robert Landewé, Chairperson of the Scientific Programme Committee, EULAR. “Previous studies have shown contradictory results with some indicating an increased risk of dementia, while others reporting the opposite.”

“Our study found a considerable increased risk of dementia associated with gout in the elderly,” said Dr. Jasvinder Singh, Professor of Medicine and Epidemiology at the University of Alabama at Birmingham, USA (study author). “Further study is needed to explore these relationships and understand the pathogenic pathways involved in this increased risk.”

The study included 1.23 million Medicare beneficiaries, of which 65,325 had incident dementia. In an analysis which was adjusted for various potential confounding variables including demographics, comorbidities and commonly used medications (HR 1.17, 95% CI 1.13-1.21), the results showed that gout is independently associated with a significantly higher risk of dementia.1 The association was larger in older age groups, females, black race, and people with higher medical comorbidity.

Subgroup analyses indicated that gout was associated with a significant 20-57% (p<0.0001) increase in dementia in patients without key comorbidities; coronary artery disease (CAD), hyperlipidemia, cardiovascular disease, diabetes, or hypertension. However, this was not the case in patients with each of these comorbidities, except in patients with CAD.

Source: EurekAlert!


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Opinion: Living Longer Not the Same as Living Healthy Longer

Blair Roblin wrote . . . . . . .

Of the terms used in the health-care lexicon, “compressed morbidity” is one of the more curious.

Though it sounds rather gruesome, it represents the optimal ending for beings of the mortal persuasion.

The term originated with Dr. James Fries, a professor at Stanford University School of Medicine. Compressing morbidity implies squeezing or compressing the length of time between the onset of chronic illness and death.

Let’s face the stark truth that nothing in life is more certain than our eventual death— taxes are a distant second, despite what Benjamin Franklin claimed.

Realistically, the best any of us can hope for is a long life with a relatively short period of morbidity at the end.

The glass-half-full corollary here is sometimes called “healthspan,” which is the healthy part of the lifespan. You can be excused for assuming that our healthspans have been increasing in lockstep with longer life expectancies in recent years.

Unfortunately, the evidence suggests we’ve been more successful at adding years of chronic illness to the end of life than adding years of health in themiddle.

Many jurisdictions track a healthspan statistic called “health-adjusted life expectancy” (HALE) which measures the average length of time people can expect to live in a healthy state, essentially without illnesses such as diabetes, heart disease and cancer. For Manitoba, Statistics Canada reports a HALE of 67 for males and 70 for females, more than 10 years short of life expectancy.

A quick history of life expectancy for homo sapiens is in order here. Long ago, humans often died rather early— and quickly — from childbirth (both mother and child), trauma caused by accidents or conflicts, infections, contagious diseases, bacteria, viruses and parasites.

As Thomas Hobbes might have put it, life tended to be “nasty, brutish and short.”

Early in the 20th century, worldwide advances occurred in public health, which included immunization, pasteurization and chlorination.

Big increases in life expectancy came simply from more people making it to middle age, never mind old age.

Today, the biggest threats to our health are chronic diseases, with onset typically occurring in adulthood.

These illnesses account for most deaths worldwide, but the incidence is even higher in developed countries such as Canada. Here, rates of chronic disease are now on the rise in the younger adult population as well, due to factors such as obesity.

So, is it feasible that we push out the onset of chronic illness?

The clear answer from the public health sector is that we can, with fitness, diet and lifestyle playing key roles. Most of us deal with these issues as daily challenges, though our success varies individually.

Amore complicated question is whether delaying chronic illness actually shortens it or just shifts it out in time. In other words, if we can forestall chronic illness until we are, say, 80, will we simply experience its full wrath later?

The implications here are profound, including for health economics. Fries and others have argued the lifespan has certain limits, as evidenced by mortality rates that naturally accelerate as we age. Therefore, if we can extend our healthspan, we will necessarily bump into these lifespan limits, thereby compressing the morbidity phase of chronic illness.

Here, my thoughts turn to Ed Whitlock, whom I regarded as a modern-day hero.

Ed was the Canadian who rewrote the record book in masters distance running, most famously running a sub-three-hour marathon when hewas 73 — and then again at 74. Sadly, Ed died last year at the age of 86.

While his lifespan was not exceptionally long, his healthspan was impressive.

In fact, he set another world record for his age group in the Scotiabank marathon just six months before his death.

We can’t live forever — and perhaps don’t want to — but health research tells us that postponing chronic illness can bring important advances in quality of life, even without extending total lifespan.

Health researchers may never win any awards for the terms they introduce — there’s probably no market for “compressed morbidity” T-shirts and collectibles — but the concept itself may lead us to health care’s pot of gold.

Source : Winnipeg Free Press Newspaper

How Much Exercise Needed to Help the Aging Brain?

Maureen Salamon wrot . . . . . . . . .

It’s well-known that exercise benefits the brain as well as the heart and muscles, but new research pinpoints just how much — and what types — of exercise may promote thinking skills as you age.

Reviewing data from dozens of studies on older adults, scientists found that those who exercised an average of at least 52 hours over about six months — and for about an hour during each session — showed improvements in their thinking skills. The research didn’t show a link between a weekly amount of exercise and better brain function.

“The data seem to suggest … you have to keep exercise up for a while before you start to see these changes actually impact your life in a positive manner,” said study author Joyce Gomes-Osman. She directs the University of Miami Miller School of Medicine’s Neuromotor Plasticity Laboratory.

Study participants experienced specific, significant changes in mental sharpness, Gomes-Osman said. These included improvements in processing speed, or the amount of time needed to complete a task; and executive function, or the ability to manage time, pay attention and achieve goals.

“This is also super-encouraging, because these are the first two things that people, as aging progresses, start to have problems with,” said Gomes-Osman, who’s also a postdoctoral research scholar at Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center in Boston. “The study provides evidence that with exercise, you can actually turn back the clock of aging in your brain.”

Adults older than 60 will comprise 2 billion of the world’s population by 2050, and the highest priority of this age group is staying mentally sharp, according to the U.S. National Council on Aging. But while much scientific evidence has established positive effects in the brain from exercise, scant research has addressed just how much exercise is needed to promote brain health, according to the study authors.

Gomes-Osman and her team reviewed 98 studies involving more than 11,000 participants that analyzed various exercise “doses” and their relationship to improved brain performance. The researchers sought to identify consistent patterns of reported effects on thinking skills.

The reviewed studies all focused on older adults (average age 73) who were asked to exercise for at least four weeks. Their tests of thinking and memory skills were then compared to those of peers who did not start a new exercise routine.

Among all participants, 59 percent were categorized as healthy adults, while 26 percent had mild cognitive impairment, which can precede the development of Alzheimer’s disease. Another 15 percent had diagnosed dementia. A total of 58 percent of participants did not exercise regularly before being enrolled in a study.

Of those who exercised, aerobic exercise was the most common type, with walking the most common form. Some studies incorporated a combination of aerobic exercise along with strength or resistance training; a small number used mind-body exercises such as yoga or tai chi.

Ultimately, any form of exercise was found to be beneficial to thinking skills in older adults, including aerobic exercise, strength training, mind-body exercise or combinations of these. Notably, these effects extended to those with established dementia, the researchers said.

How does exercise work to help the brain? Dr. Ajay Misra, chairman of neurosciences at NYU Winthrop Hospital in Mineola, N.Y., said physical activity improves blood circulation “all over the body — that includes the brain.”

Additionally, exercise produces endorphins, natural “feel-good” chemicals that promote increased motivation and enjoyment, said Misra, who wasn’t involved in the new research.

“That improves your overall view of life, which is beneficial in terms of cognition,” he added. “It improves your outlook on life, so you keep on exercising.”

Gomes-Osman’s advice to people of any age — especially those concerned about brain health — is simple.

“I tell people to get moving,” she said. “We’re not made to be sitting around — we need movement. I encourage people to make an appointment with themselves to get moving and to keep it up for a while.”

The study was published online in the journal Neurology: Clinical Practice.

Source: HealthDay


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Even at ‘Safe’ Levels, Air Pollution Puts Seniors at Risk

For older people, breathing in dirty air puts them at risk of being hospitalized with a dangerous respiratory disease, a new study suggests.

Among U.S. seniors, hospital admissions for acute respiratory distress syndrome (ARDS) rose as levels of both ozone and fine particulate matter increased — even when the pollutants were within levels now considered safe, the researchers said in a news release from the American Thoracic Society.

“While there is growing evidence of the impact on lung health of numerous air pollutants, there have been few studies that have looked at acute respiratory diseases and air pollution across large populations,” said lead author Jongeun Rhee. She is an epidemiologist at Harvard’s T.H. Chan School of Public Health in Boston.

Rhee and her colleagues analyzed data from nearly 30 million Medicare beneficiaries who were discharged from U.S. hospitals from 2000 through 2012. Using ZIP codes, the investigators were able to calculate seniors’ annual exposure to fine particulate matter, or PM2.5, in the air as well as to ozone from April through September.

The researchers also developed models that allowed them to link pollution levels with hospitalizations due to ARDS. They found a significant link between changes in levels of fine particulate matter and ARDS admission rates among older people.

While the study found a connection between pollution and hospitalization for ARDS, it didn’t prove a link.

ARDS is a progressive, often fatal, disease that causes fluid to leak into the lungs, making breathing difficult or impossible, the study authors explained. Older people and those with serious health issues — such as sepsis, pneumonia or traumatic injury — are at greater risk.

“We highlighted the importance of air pollution as an environmental risk factor for ARDS, which has not been studied widely but contributed to a previous finding that was limited to ozone,” Rhee said in the news release.

The study also found that ARDS admissions increased even when older people were exposed to pollution levels that were within National Ambient Air Quality Standards.

The study’s senior author, Dr. David Christiani, is a professor of environmental genetics at T.H. Chan School of Public Health.

He said the “findings are unique in showing that the adverse health effects of air pollution on our senior citizens now include acute respiratory failure, and that an increase in hospitalization for ARDS in seniors occurs at the current U.S. air pollution standards.”

He went on to say that “these results add to the growing body of literature on various adverse health effects at current standards that demonstrate a need to lower our exposure limits.”

The study was scheduled for presentation Wednesday at the annual meeting of the American Thoracic Society, in San Diego. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

Source: HealthDay


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Exercise to Stay Young: 4-5 Days a Week to Slow Down Your Heart’s Aging

Participating in exercise 4-5 days per week is necessary to keep your heart young, according to new research published in The Journal of Physiology. These findings could be an important step to develop exercise strategies to slow down such ageing.

The optimal amount of exercise required to slow down ageing of the heart and blood vessels has long been a matter of vigorous debate. As people age, arteries – which transport blood in and out of the heart – are prone to stiffening, which increases the risk of heart disease. Whilst any form of exercise reduces the overall risk of death from heart problems, this new research shows different sizes of arteries are affected differently by varying amounts of exercise. 2-3 days a week of 30 minutes exercise may be sufficient to minimise stiffening of middle sized arteries, while exercising 4-5 days a week is required to keep the larger central arteries youthful.

The authors performed a cross-sectional examination of 102 people over 60 years old, with a consistently logged lifelong exercise history. Detailed measures of arterial stiffness were collected from all participants, who were then categorised in one of four groups depending on their lifelong exercise history: Sedentary: less than 2 exercise sessions/week; Casual Exercisers: 2-3 exercise sessions per week; Committed Exercisers: 4-5 exercise sessions/week and Masters Athletes: 6-7 exercise sessions per week. (NB: an exercise session was at least 30 minutes).

Upon analysing the results, the research team found that a lifelong history of casual exercise (2-3 times a week) resulted in more youthful middle sized arteries, which supply oxygenated blood to the head and neck. However, people who exercised 4-5 times per week also had more youthful large central arteries, which provide blood to the chest and abdomen, in addition to healthier middle sized ones.

The fact the larger arteries appear to require more frequent exercise to remain youthful will aid the development of long-term exercise programmes. They also enable the research team to now focus on whether or not ageing of the heart can be reversed by exercise training over a long period of time.

The research may have been limited by the fact that individuals were allocated to groups based on past exercise frequency, as opposed to other components of exercise programmes such as intensity, duration or mode, all of which could have large impacts on vascular adaptations. Furthermore, additional, unmeasured factors such as dietary intake and social background could influence arterial compliance indirectly through reduced adherence, or by non-exercise related means.

Benjamin Levine, one of the authors of the study, is excited to investigate this in the future:

“This work is really exciting because it enables us to develop exercise programmes to keep the heart youthful and even turn back time on older hearts and blood vessels. Previous work by our group has shown that waiting until 70 is too late to reverse a heart’s ageing, as it is difficult to change cardiovascular structure even with a year of training. Our current work is focussing on two years of training in middle aged men and women, with and without risk factors for heart diseases, to see if we can reverse the ageing of a heart and blood vessels by using the right amount of exercise at the right time”.

Source: EurekAlert!


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