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Eye exam detects signs of Alzheimer’s disease
“Among the folks who had Alzheimer’s there was a significant reduction in the density of the blood vessels in the superficial layer of the retina compared to controls and those with mild cognitive impairment,” said Dr. Dilrag Grewal, an associate professor of ophthalmology at the Duke Eye Center. “We also found a reduction in the thickness of (of a specific layer of the retina) in Alzheimer’s patients compared to controls and those with mild cognitive impairment.”
The findings were reported in Ophthalmology Retina, a publication of the American Academy of Ophthalmology.
“The retina is an extension of the brain,” Grewal said. “And it’s thought that changes that occur in the brain are mirrored in the retina. With any neurodegenerative disease you lose nerve tissue. Along with a measurable loss of brain volume, there’s a loss of the vasculature that supplies the brain. And because the retina is part of the central nervous system, the same changes occur there.”
The new findings couldn’t have happened without a new scanning technology, called optical coherence tomography angiography (OCTA), that allows users to see in fine detail the structure of the back part of the eye. “With previous technology you were able to measure only the larger blood vessels in the back of the eye,” Grewal said. “Now we can look at blood vessels that are at the level of capillaries in the different layers of the retina. Therefore we are able to detect much smaller levels of change.”
Grewal and his colleagues used OCTA to peer into the eyes of 39 Alzheimer’s patients, 37 people with MCI and 133 cognitively healthy people, the controls. Not only were the researchers able to detect differences between the Alzheimer’s patients and the other two groups, but they were also able to see differences among the Alzheimer’s patients that appeared to be linked with the severity of the disease.
“The differences were proportional to the severity of the cognitive impairment,” Grewal said. “So, the folks with more severe Alzheimer’s had more severe loss of retinal blood vessels.”
In the past, some small studies have suggested that there would be differences “in both neuronal and microvascular retinal measures between those with and those without Alzheimer’s disease,” said Alison Abraham, an associate professor of ophthalmology and director of the Wilmer Eye Institute Biostatistics Center at the Johns Hopkins School of Medicine. “The current study gives weight to these past findings and informs our targets for future research given the large number of possible retinal parameters one could study.”
The new research is a “small step forward,” said Dr. Richard Isaacson, director of the Alzheimer’s Prevention Clinic at NewYork-Presbyterian/Weill Cornell Medicine.
“But future studies need to focus on earlier stages of the disease,” Isaacson said in an email. “We already have more definitive ways to diagnose dementia due to Alzheimer’s, but we need to see if OTCA can be a useful cost-effective screening test for pre-symptomatic Alzheimer’s.”
If scientists could find people who have brain changes, but no obvious symptoms yet, there could be an opportunity to intervene, Abraham said in an email. “But we are still a long way off,” she added.
SOURCE: http://bit.ly/2CflOBw Ophthalmology Retina, online March 11, 2019.
The United States is in the midst of a particularly rough – and deadly – flu season. According to the latest from the Centers for Disease Control and Prevention, the current flu outbreak is responsible for at least 53 child deaths so far this season.
High levels of flu-like illness are being reported in 42 states and hospitalizations for flu continue to rise across the country.
The flu is most dangerous for older adults age 65 and over, young children under the age of 5, and people with compromised immune systems. These groups of people are more likely to experience severe or even deadly complications from the flu.
Still, anyone can be affected by the flu and there are steps everyone can take to prevent its spread.
Get a flu shot
The absolute best protection against the flu is to get a flu shot, even though the vaccine is far from foolproof. The CDC recommends everyone age 6 months and older be vaccinated against the flu each year.
Last week, Canadian researchers reported that this year’s flu vaccine is less than 20 percent effectiveagainst the most dominant strain of the virus. However, experts emphasize that the vaccine still offers some protection and can reduce the severity of illness if you do get infected.
While it is best to get a flu shot before the start of flu season, experts say it’s still not too late to get vaccinated if you haven’t done so already.
Avoid contact with sick people
People who are sick with the flu can spread the virus to others up to about 6 feet away. Flu spreads mainly by microscopic droplets that go airborne when people who are infected cough, sneeze or talk. These droplets can get into the mouths or noses of people nearby or possibly be inhaled into the lungs, or linger on surfaces nearby.
To avoid getting sick, limit contact with sick people and stay home from work or school if you are ill. Also avoid touching your eyes, nose and mouth, as viruses enter the body this way.
Wash your hands frequently
Another important way to avoid getting sick with the flu or other bugs is to “wash your stinking hands,” as Florida nurse Katherine Lockler put it in a video that recently went viral. And wash them right: scrub your hands with soap and water for at least 20 seconds. If you need a timer, experts recommend humming the “Happy Birthday” song from beginning to end twice. Don’t forget to lather the backs of your hands, between your fingers, and under your nails.
Nurse’s flu rant goes viral
If soap and water are not available, use an alcohol-based hand sanitizer.
Keep your environment clean
While experts believe the flu virus is mostly spread from person to person through droplets in the air, it is also possible to get the flu by touching a surface or object that has flu virus on it and then touching your mouth or nose. Doorknobs, countertops, airplane tray tables, computer keyboards and phones can silently transfer germs from one person to another.
To avoid this, clean and disinfect surfaces and objects that may be contaminated with germs like the flu. Household items like linens, eating utensils, and dishes belonging to those who are sick should not be shared with others without washing thoroughly first.
Cover coughs and sneezes properly. To avoid spreading germs, avoid coughing and sneezing directly into your hands. Instead, cough or sneeze into a tissue and then immediately throw the tissue away, or else cough or sneeze into your upper sleeve.
Wear a face mask when visiting a hospital
Though not 100 percent effective, wearing a surgical mask can help prevent the spread of the flu. Since hospital patients may have an illness that has compromised their immune system, taking steps to protect them from the flu — such as having visitors wear a mask and wash or disinfect their hands whenever they enter the room — is important. Healthy visitors can also benefit from the mask’s protection at a time when many hospitals report being swamped with flu patients.
Take antiviral drugs if your doctor prescribes them
If you get the flu, your doctor may prescribe an antiviral drug such as Tamiflu to treat it. These prescription medications are different than antibiotics, which treat bacterial infections and don’t work against the flu virus.
Antiviral drugs can make the illness milder and shorten the time you are sick, especially if taken soon after symptoms first arise. For people at high risk of complications from the flu — such as those 65 or older, young children, pregnant women, and people with other medical issues — it could mean the difference between having a milder illness versus a very serious illness that could result in hospitalization.
If you are prescribed antiviral drugs, follow your doctor’s instructions for taking them.
New adult vaccination recommendations published Monday feature a booster shot for mumps in case of outbreaks and the new and improved shingles vaccine.
People over 50 should get the new Shingrix vaccine, which protect both better and more safely than the older shingles vaccine, the Advisory Committee on Immunization Practices says. People who already had the old vaccine can get the new one, too.
Plus, adults should get a booster of MMR (measles, mumps and rubella) vacif they’re at risk during a mumps outbreak, ACIP says.
The recommendations, originally made in October, are published in the Annals of Internal Medicine and on the CDC website.
In 2017, more than 5,600 people got mumps, the Centers for Disease Control and Prevention says. The year before, in 2016, 6,366 cases were reported.
Studies have shown that vaccinating people during a mumps outbreak can help control it. Immunity from the MMR vaccine can wane over time in some people, and the booster dose brings it back up.
That’s why ACIP says people at high risk of catching mumps during an outbreak should get a booster dose, even if they’ve already been vaccinated twice.
And the official recommendation for the new shingles vaccine is in the Annals, also. The older vaccine, called Zostavax, is a “live” vaccine. It uses a weakened version of the virus that causes both shingles and chickenpox. The new vaccine doesn’t use the live virus, but a genetically engineered piece of the virus. It cannot cause “shedding” of virus and can be used in some people with weakened immune systems.
“Two doses of Shingrix is more than 90 percent effective at preventing shingles and post-herpetic neuralgia (the pain that follows an outbreak of shingles),” the CDC advises.
“Even people who have had shingles or previously got Zostavax can be vaccinated with Shingrix to prevent shingles and the complications caused by the disease.”
Separately Monday, a team at the Harvard School of Public health reported that vaccines could prevent up to 36 million deaths between about now and 2030.
Vaccination against measles will avert 22 million deaths between about now and 2030. Hepatitis B vaccines will prevent 6.6 million deaths and HPV (human papillomavirus) vaccines 2.5 million deaths, they reported in the journal Health Affairs.
“We looked at the effects of both routine and campaign immunization programs,” they wrote.
Consumed separately, almonds and chocolate have each been linked to lower blood sugar, blood pressure, cholesterol and hunger levels in previous studies. All of these things are risk factors for heart disease.
For the current study, researchers tested cholesterol levels in 31 overweight and obese people. For four weeks, all of them followed a typical American diet. Every day for another four weeks, they all added almost one-third of a cup of almonds to the typical diet. In another four-week period, participants added almost one-quarter cup of dark chocolateand about 2.5 tablespoons of cocoa powder per day. Everyone also had a four-week period of adding both the nuts and the dark chocolate with cocoa to their diet.
Adding just the almonds reduced participants’ levels of low-density lipoprotein (LDL) cholesterol – the bad kind that can build up in blood vessels and lead to clots and heart attacks – by 7 percent, the study found.
Combining almonds with dark chocolate and cocoa also reduced small, dense LDL particles that are a risk factor for cardiovascular disease, researchers report in the Journal of the American Heart Association.
“Almonds alone lowered LDL cholesterol levels and chocolate and cocoa did not, but they also did not increase LDL cholesterol levels, ”said senior study author Penny Kris-Etherton, a nutrition researcher at Penn State University.
The results don’t mean it’s wise for people to eat almonds and chocolate by the pound, however.
“We do have about 270 discretionary calories that we can include in our diet, and I tell people to use their discretionary calories wisely,” Kris-Etherton said by email. That means having almonds and chocolate in moderation, and instead of other sweets and treats, not in addition to cookies, candy and desserts.
Participants in the experiment ranged in age from 30 to 70 years, and all of them were overweight or obese.
During the study, people got roughly half their calories from carbohydrates, about 16 percent from protein and about 33 to 36 percent from fat.
The exact amount of calories in meals and snacks was calibrated to each participant’s current weight and designed to help them maintain that weight during the study period.
The study was small, and it’s possible results would be different with a larger group of people.
Kris-Etherton and other authors received funding from the Hershey Company and from the Almond Board of California.
Even so, the findings add to existing evidence that nuts and cocoa have health benefits, said Samantha Heller, a registered dietician and author in New York City who wasn’t involved in the study. These foods can help fight inflammation, provide fiber and healthy fats, among other things.
But moderation is key, Heller said by email.
“Eating nuts and dark chocolate in place of other less healthy foods such as chips, fast food, commercial candy or cookies, in appropriate portions, along with an overall healthy lifestyle, may offer health benefits,” Heller said.
SOURCE: http://bit.ly/2Avvk3L Journal of the American Heart Association, online November 29, 2017.
In one big company-funded study, Ozempic, on average, reduced long-term blood sugarlevels at least 2 ½ times as much as a popular daily diabetes pill, Merck & Co.’s Januvia. It also helped study participants lose two to three times as much weight as those in the comparison group.
Over 56 weeks, patients who got a lower dose of Ozempic lost an average of 9.5 pounds (4.3 kilograms) while those who got a higher dose lost 13.5 pounds (6.1 kilograms). The patients who took Januvia lost an average of 4 pounds (1.9 kilograms).
The 1,200 study participants were also taking one or two standard diabetes medicines.
Novo Nordisk, a leader in diabetes care, has also been testing the drug separately for weight lossalone.
Many Type 2 diabetes patients are overweight or obese, and losing significant weight usually helps them reduce their blood sugar and better control their diabetes. Over time, too high sugar in the blood can damage multiple organs and weaken circulation.
The new drug comes in injector pens and costs about the same as similar weekly drugs: $676 for a four- to six-week supply without insurance. Novo Nordisk already sells a similar once-a-day shot, Victoza.
Ozempic will compete with other popular once-a-week drugs in the same class, including Eli Lilly and Co.’s Trulicity and AstraZeneca PLC’s Bydureon, which don’t produce as much weight loss. However, they all carry warnings about possible serious side effects, including kidney damage and inflammation of the pancreas. They also may be linked to thyroid cancer, so people taking all drugs in the class are being followed via a patient registry.
Januvia is in a different drug class.
The new guidelines, from the American College of Physicians and the American Academy of Family Physicians and published in the Annals of Internal Medicine, are very similar to those that family physicians issued in 2014, calling for treatment of adults 60 and older when blood pressure is 150 or higher and aiming for less than 150, meaning a reading in the 140s is fine. (For people under 60, the goal was less than 140.) Those guidelines were controversial, and the new ones — coming in the wake of a high-profile 2015 study called SPRINT that argued for a lower target — are already, too.
“It seems like we’re back to 2014,” said Dr. Jackson Wright, director of the clinical hypertension program at University Hospitals in Cleveland and first author of the SPRINT study. “Even then, there was a lot of dissent and, since the SPRINT trial has come out since, I was surprised” by the new ACP/AAFP guidelines.
Even physicians who urged caution in adopting SPRINT’s aggressive, below-120 target in people at elevated risk of stroke and heart attack questioned the new, looser guidelines.
The “recommendations that clinicians initiate treatment in adults aged 60 or older with systolic blood pressure persistently at or above 150 are inappropriate,” said Dr. Franz Messerli, a cardiologist at the University of Bern in Switzerland. “Even less acceptable is a target … of less than 150 in this group. With such a elevated target there is substantial evidence of an increase in stroke risk.”
Last year, Messerli warned against embracing SPRINT’s aggressive blood pressure target, saying a goal of below 120 “clearly has to be considered absurd.” He believes that, for otherwise healthy patients, something in the 120s is OK.
The new ACP/AAFP guidelines are stricter for patients who have had a stroke or a transient ischemic event (known as a mini-stroke), or who have risk factors such as high cholesterol, obesity, diabetes, or atherosclerosis. In those cases, people should reduce their blood pressure below 140, the groups said. That, too, raised eyebrows. “Wouldn’t it perhaps be better [to get below 140] before such a devastating complication has taken place?” Messerli asked.
The medical groups defended their new guidelines, which are based on the SPRINT study and 20 other randomized controlled trials.
That research showed that “any additional benefit from aggressive blood pressure control” — meaning reducing blood pressure below 140 — “is small,” said ACP president Dr. Nitin Damle.
The more lenient targets also reflect the harms of aiming lower. As people take more kinds of anti-hypertension drugs (three is not unusual) and higher does of them in an effort to drive down their numbers, they are more likely to have side effects like coughing and low blood pressure, which causes lightheadedness or fainting.
As a whole, the analysis of the 21 studies found, most of the evidence for the benefits of treating high blood pressure came from studies of patients who started out above 160 and got into the 140s. Studies that aimed for less than 140 “showed no statistically significant reduction in all-cause mortality or cardiac events,” the authors wrote in the Annals paper, though they did find a reduced risk for stroke.
For instance, a 2012 Cochrane Review concluded that in otherwise healthy adults with blood pressure of 140 to 159, blood-pressure-lowering drugs “have not been shown to reduce mortality or morbidity [death or disease] in randomized clinical trials.”
The SPRINT trial offered the strongest counterargument to that, finding benefits in reducing blood pressure to 120 or less. But it studied only people at high risk for cardiovascular disease. And it has been criticized for measuring blood pressure differently from how doctors usually do it, with the result that a reading of, say, 120 in SPRINT would be 128 or so in ordinary practice.
What’s indisputable is that the clashing, changing guidelines confuse both laypeople and doctors. The American Heart Association, for instance, says that in adults systolic blood pressure of 140 or more means “poor” cardiovascular health, 120 to 139 means intermediate cardiovascular health, and below 120 is “ideal.”
“For the public as well as practitioners, what the competing blood pressure guidelines illustrate is that there are different ways to interpret the same research,” said Dr. Vikas Saini, president of the Lown Institute, which warns against medical overtreatment. “The interpretation of the same data can be as different as half empty and half full.”
Changes to be aware of for 2017 include:
Medicare recipients reaching the donut hole will benefit from better prescription drug discounts. The gap in prescription drug coverage (the donut hole) starts when someone reaches the initial coverage limit ($3,700 in 2017), and ends when they have spent $4,950. Prior to 2011, Medicare Part D enrollees paid the full cost of their medications while in the donut hole. But the ACA has been steadily closing the donut hole, and it will be fully closed by 2020. At that point, enrollees will pay just 25 percent of the cost of their drugs all the way up to the catastrophic coverage threshold. For 2017, while in the donut hole, enrollees will pay 40 percent of the cost of brand name drugs (down from 45 percent in 2016) and 51 percent of the cost of generic drugs (down from 58 percent in 2016). The Medicare Part D deductible will be $400 in 2017.
Most Medicare beneficiaries should received their Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by Sept. 30. CMS will make information available to the public on Medicare.gov in October. The Medicare website is also a tremendous asset for individuals with questions about Medicare rules, timelines, Medicare Part D, etc.
It’s important to carefully review the information sent to you by your plan provider, since this will cover any possible changes. For example, increasing co-pays, changes to drug formularies or changes to treatment coverage. Once open enrollment gets underway, you can make changes that reflect your current health coverage needs.
Keeping a busy schedule may benefit the brain
One of the best ways to keep your brain sharp as you get older may be to stay busy, according to new research. While scientists have previously recommended engaging inmentally challenging activities, a new study suggests that keeping a packed schedule may offer similar benefits.
In a survey of over 300 people participating in the Dallas Lifespan Brain Study, study authors found that among adults over the age of 50, having a busy schedule was associated with better brain processing, improved memory, sharper reasoning and better vocabulary.
People in the study ranged from 50 to 89 years old, and the positive effect of busyness on the brain was consistent across age. This, the study authors conclude, suggests that keeping a busy lifestyle is important in middle age as well as old age.
And what about the stress that can come from maintaining a tight schedule? “We certainly considered that being very busy could hurt cognition,” says study author Denise Park, director of research at the Center for Vital Longevity at The University of Texas at Dallas. “Basically, the data suggest that the benefits of busyness outweigh the downside.”
Park says her team plans to further study the effects of busyness on the brain to hopefully further untangle the factors that improve or hamper cognition later in life.
Attention Seniors! Don’t miss out on our 17th Annual “Spotlight on Seniors” Health & Fitness Expo on Tuesday, April 26. Admission is free! Visit over 70 vendors from a variety of senior-oriented businesses, receive free health screenings and enter win a door prizes. Held at the Kentwood Activities Center (355 48th St. SE).