Brain Bleed Risk Puts Safety of Low-Dose Aspirin in Doubt

Amy Norton wrote . . . . . . . .

Let’s say you’re one of the millions of older adults who takes a low-dose aspirin religiously, in the belief that it will guard against heart disease and heart attacks.

Now, a new review suggests your risk of a brain bleed outweighs any heart benefit that a daily aspirin might bring you.

Researchers said the findings support a recent change to guidelines on low-dose aspirin: The blood thinner should now be reserved for people at high risk of heart attack or stroke.

Others can skip it.

The change was issued in March by the American College of Cardiology (ACC) and the American Heart Association (AHA). The groups said that while the bleeding risk with aspirin has always been known, it now appears the risk is not worth it for most people.

Instead, the average person should focus on controlling their blood pressure, blood sugar and cholesterol, eating a healthy diet, getting regular exercise and not smoking.

“All of those things are more important than taking low-dose aspirin in preventing future heart attacks and strokes,” said Dr. Meng Lee, one of the authors of the new report.

“Our findings do support the latest change to the ACC/AHA guidelines,” said Lee, of Chang Gung University College of Medicine, in Taiwan.

For the study, the investigators pooled the results from 13 clinical trials testing low-dose aspirin in older adults with no history of heart problems or stroke. On average, aspirin raised the risk of bleeding in or around the brain by 37%, the findings showed.

The risk was still small: The researchers estimate that a daily aspirin would cause an additional two brain bleeds for every 1,000 people.

But for people at lower risk of heart attack or stroke, that’s a chance they probably should not take, according to the new guidelines.

And, based on two trials, people of Asian ethnicity might be at particular risk of brain bleeding. Patients in those studies saw their risk rise by 84%.

It’s not clear why, according to Lee — but other studies have found the same pattern.

The latest finding was published online in JAMA Neurology.

If it has long been known that aspirin carries a bleeding risk, why is the advice changing now?

Research in recent years has shown that the balance of risks versus benefits has changed, explained Dr. Eugene Yang, a member of the ACC’s Prevention Section and Leadership Council.

Earlier studies did suggest that the bleeding risks with aspirin were generally outweighed by its ability to curb the odds of a first-time heart attack and stroke.

But things are different today, Yang explained. People are smoking less and there have been improvements in controlling high blood pressure and cholesterol. That means for lower-risk people, the heart benefit of aspirin has diminished — making the bleeding risk more of a concern.

Yang stressed, however, that the guideline change applies only to people without “overt” cardiovascular disease. For people with a history of heart attack or stroke, or significant narrowing in the arteries supplying the heart, brain or legs, the advice stays the same.

“In those cases, you’re trying to prevent further complications,” said Yang, who is also a clinical associate professor of medicine at the University of Washington, in Seattle.

In addition, he pointed out, aspirin is not an absolute “no” for preventing first-time complications, either.

The guidelines say people over age 70 should avoid aspirin if they do not have overt cardiovascular disease. But it may still be considered for certain people ages 40 to 70 who are at heightened risk of cardiovascular complications.

“It’s not a simple, black-and-white decision,” Yang said.

If you are currently taking aspirin and wondering if you should stop, talk to your doctor first, Yang advised.

“There could be other reasons it was prescribed, such as lowering the risk of colon cancer or to prevent blood clots,” he said.

Source: HealthDay


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A Nutty Solution for Improving Brain Health

Long-term, high nut consumption could be the key to better cognitive health in older people according to new research from the University of South Australia.

In a study of 4822 Chinese adults aged 55+ years, researchers found that eating more than 10 grams of nuts a day was positively associated with better mental functioning, including improved thinking, reasoning and memory.

Lead researcher, UniSA’s Dr Ming Li, says the study is the first to report an association between cognition and nut intake in older Chinese adults, providing important insights into increasing mental health issues (including dementia) faced by an ageing population.

“Population aging is one of the most substantial challenges of the twenty-first century. Not only are people living longer, but as they age, they require additional health support which is placing unprecedented pressure on aged-care and health services,” Dr Li says.

“In China, this is a massive issue, as the population is ageing far more rapidly than almost any other country in the world.

“Improved and preventative health care – including dietary modifications – can help address the challenges that an aging population presents.

“By eating more than 10 grams (or two teaspoons) of nuts per day older people could improve their cognitive function by up to 60 per cent– compared to those not eating nuts – effectively warding off what would normally be experienced as a natural two-year cognition decline.”

China has one of the fastest growing aging populations. In 2029, China’s population is projected to peak at 1.44 billion, with the ratio of young to old dramatically imbalanced by the rising ranks of the elderly. By 2050, 330 million Chinese will be over age 65, and 90.4 million will be over age 80, representing the world’s largest population of this most elderly age group.

More broadly, the World Health Organization says that by 2020, the number of people aged 60 years and older will outnumber children younger than five years old.

The UniSA study analysed nine waves of China Health Nutrition Survey data collected over 22 years, finding that 17 per cent of participants were regular consumers of nuts (mostly peanuts). Dr Li says peanuts have specific anti-inflammatory and antioxidant effects which can alleviate and reduce cognitive decline.

“Nuts are known to be high in healthy fats, protein and fibre with nutritional properties that can lower cholesterol and improve cognitive health,” Dr Li says.

“While there is no cure for age-related cognition decline and neurogenerative disease, variations in what people eat are delivering improvements for older people.”

The World Health Organization estimates that globally, the number of people living with dementia is at 47 million.

By 2030, this is projected to rise to 75 million and by 2050, global dementia cases are estimated to almost triple. China has the largest population of people with dementia.

“As people age, they naturally experience changes to conceptual reasoning, memory, and processing speed. This is all part of the normal ageing process,” Dr Li says

“But age is also the strongest known risk factor for cognitive disease. If we can find ways to help older people retain their cognitive health and independence for longer – even by modifying their diet – then this absolutely worth the effort.”

Source: University of South Australia


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New Type of Dementia Identified

“Form of dementia that ‘mimics’ Alzheimer’s symptoms discovered,” reports The Guardian.

An international team of researchers has proposed a name for a type of brain disease that causes dementia symptoms: Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE.

The name brings together previously identified conditions linked to a protein that damages regions of the brain.

The damage causes memory and thinking problems, similar to those seen in Alzheimer’s disease and other types of dementia.

Alzheimer’s disease is thought to be caused by an accumulation of 2 types of protein, tau and amyloid beta, in the brain.

LATE is thought to be caused by another protein, TDP-43, which is usually present in the centre of nerve cells, but may change form and spread into the body of nerve cells as people get older.

It’s thought to affect around 20% of adults over 80. Some people may have both types of disease.

At present LATE can only be diagnosed by examining brain tissues after death.

Researchers say it may explain why some recent trials of treatments for Alzheimer’s disease have been unsuccessful.

They say treatments may have effectively treated the proteins that cause damage in Alzheimer’s disease, but LATE may have continued, masking any improvements to Alzheimer’s symptoms.

They’re calling for research to find markers that allow LATE to be diagnosed before death so clinical studies on its causes and potential treatments can begin.

But understanding of this condition is still in the early stages and as experts say, it’s not something that could be currently diagnosed in the clinic.

Why is this in the news?

A group of researchers working in this area came together to publish a consensus report in the peer-reviewed journal Brain.

It’s open access, so you can read the report for free online.

The researchers come from 22 universities and research institutes in the US, the UK, Sweden, Australia, Austria and Japan.

The consensus report:

  • describes the main features and effects of the disease on the brain
  • sets out proposed diagnostic criteria to diagnose and stage LATE in examination of the brain after death
  • sets out what’s known about the clinical effects of the disease
  • considers the possible effect of the disease on public health, now and in the future
  • sets out priorities for research

The working group members say they want to encourage more research into the disease, and hope that the criteria they propose for diagnosing LATE will help to focus and clarify research in the future.

What kind of research was this?

The consensus statement was based on a review of existing studies about TDP-43 brain diseases, Alzheimer’s disease and reports of dementia symptoms with no signs of Alzheimer’s disease.

The working group discussed the research they found and drew up a statement summarising what they thought previous research shows us, how it should be interpreted, and how the disease should be categorised and researched in future.

What’s the difference between LATE and other types of dementia?

Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning.

There are many types of dementia, including Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and LATE.

Dementia symptoms can include problems with:

  • memory loss
  • thinking speed
  • mental sharpness and quickness
  • language
  • understanding
  • judgement
  • mood
  • movement
  • difficulties carrying out daily activities

The differences between the types of dementia are in the causes. LATE seems to be caused by damage from one type of protein, while Alzheimer’s disease seems to be caused by other types of protein.

Vascular dementia happens when at some point there’s been a lack of oxygen to areas of the brain, causing damage.

But there may sometimes be overlap in conditions and it’s not always possible to give a single, definite cause of a disease. The results in terms of dementia symptoms may be broadly the same.

LATE is thought to mainly affect older people (aged 80 and over) and becomes more likely year on year, but again many people may not just have this one distinct type.

How does LATE affect you?

At present there’s no way to diagnose LATE while someone is still alive, but only by examining the brain at autopsy.

This is actually very similar to Alzheimer’s disease. While brain scans can indicate likely Alzheimer’s, examination of the brain tissue is needed to be sure of the diagnosis.

Nor is it possible to distinguish LATE from Alzheimer’s disease based on the symptoms.

There are no treatments for LATE. The main purpose of the new name and the consensus document is to guide researchers so they can better understand the disease.

Better understanding of the types of diseases that cause dementia may lead to better diagnosis and treatments. But that’s unlikely to happen for several years yet.

Source : NHS

Morning Exercise Kick-Starts Seniors’ Brains

Want a quick brain boost? A morning session of exercise and short walks throughout the day provide a number of brain benefits for older adults, a new study says.

The findings show that people should avoid uninterrupted sitting to maintain good mental function throughout the day. The study also indicates that moderate-intensity exercise such as brisk walking should be encouraged to maintain brain health, according to researcher Michael Wheeler.

“Relatively simple changes to your daily routine could have a significant benefit to your cognitive health. [The study] also reveals that one day we may be able to do specific types of exercise to enhance specific cognitive skills such as memory or learning,” Wheeler added. He’s a doctoral student at the University of Western Australia’s Heart and Diabetes Institute.

The study included more than 65 men and women, aged 55 to 80, in Australia.

The researchers examined how moderate-intensity exercise on a treadmill in the morning with and without 3-minute walking breaks during an 8-hour day of extended sitting affected different kinds of mental function.

Decision-making throughout the day was improved when the participants did the morning exercise session, compared with uninterrupted sitting, according to the study.

It also found that the morning bout of exercise combined with a number of short light-intensity walking breaks throughout the day led to improvements in short-term memory, compared with uninterrupted sitting.

The findings show that different types of physical activity can improve specific areas of mental function, according to the study.

A key player in the exercise-linked brain benefits is a protein called brain-derived neurotropic growth factor, which is important in the survival and growth of information-transmitting neurons in the brain, the researchers said.

They found that levels of this protein were elevated when participants did either just the morning exercise or the morning exercise and short walking breaks throughout the day, compared with prolonged sitting.

“With an aging population which is looking to live healthier for longer, these studies are critical to people enjoying a productive and satisfying quality of life,” Wheeler said in a Baker news release.

The study was published in the British Journal of Sports Medicine.

Source: HealthDay


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Novel 5-minute Workout Improves Blood Pressure, May Boost Your Brain

Lisa Marshall wrote . . . . . . . . .

Could working out five minutes a day, without lifting a single weight or jogging a single step, reduce your heart attack risk, help you think more clearly and boost your sports performance?

Preliminary evidence suggests yes.

Now, with a new grant from the National Institute on Aging, CU Boulder researchers have launched a clinical trial to learn more about the ultra-time-efficient exercise known as Inspiratory Muscle Strength Training (IMST).

“It’s basically strength-training for the muscles you breathe in with,” explains Daniel Craighead, a postdoctoral researcher in the Integrative Physiology department. “It’s something you can do quickly in your home or office, without having to change your clothes, and so far it looks like it is very beneficial to lower blood pressure and possibly boost cognitive and physical performance.”

Developed in the 1980s as a means to wean critically ill people off ventilators, IMST involves breathing in vigorously through a hand-held device—an inspiratory muscle trainer—which provides resistance. Imagine sucking hard through a straw which sucks back.

During early use in patients with lung diseases, patients performed a 30-minute, low-resistance regimen daily to boost their lung capacity.

But in 2016, University of Arizona researchers published results from a trial to see if just 30 inhalations per day with greater resistance might help sufferers of obstructive sleep apnea, who tend to have weak breathing muscles, rest better.

In addition to more restful sleep and developing a stronger diaphragm and other inspiratory muscles, subjects showed an unexpected side effect after six weeks: Their systolic blood pressure plummeted by 12 millimeters of mercury. That’s about twice as much of a decrease as aerobic exercise can yield and more than many medications deliver.

“That’s when we got interested,” said Professor Doug Seals, director of the Integrative Physiology of Aging Laboratory.

Seals notes that systolic blood pressure, which signifies the pressure in your vessels when your heart beats, naturally creeps up as arteries stiffen with age, leading to damage of blood-starved tissues and higher risk of heart attack, cognitive decline and kidney damage.

While 30 minutes per day of aerobic exercise has clearly been shown to lower blood pressure, only about 5 percent of adults meet that minimum, government estimates show. Meanwhile, 65 percent of mid-life adults have high systolic blood pressure.

“Our goal is to develop time-efficient, evidence-based interventions that those busy mid-life adults will actually perform,” said Seals, who was recently awarded a $450,000 NIA grant to fund a small clinical trial of IMST involving about 50 subjects. “The preliminary data are quite exciting.”

With about half of the tests done, the researchers have found significant drops in blood pressure and improvements in large-artery function among those who performed IMST with no changes in those who used a sham breathing device that delivered low-resistance.

So far, the IMST group is also performing better on certain cognitive and memory tests.

It’s something you can do quickly in your home or office, without having to change your clothes, and so far it looks like it is very beneficial to lower blood pressure and possibly boost cognitive and physical performance.” –Daniel Craighead

When asked to exercise to exhaustion, they were also able to stay on the treadmill longer and keep their heart rate and oxygen consumption lower during exercise.

“We suspect that as you improve the function of your respiratory muscles, they don’t need as much blood to work and that blood can be redistributed to your legs so you exercise longer,” said Craighead.

Some cyclists and runners have already begun to use commercially-available inspiratory muscle trainers to gain a competitive edge.

But Seals and Craighead stress that their findings are preliminary, more research is necessary and curious individuals should ask their doctor before considering IMST.

That said, with a high compliance rate (fewer than 10 percent of study participants drop out) and no real side-effects, they’re optimistic.

“High blood pressure is a major risk factor for cardiovascular disease, which is the number one cause of death in America,” said Craighead. “Having another option in the toolbox to help prevent it would be a real victory.”

Source: University of Colorado Boulder