"Peter Pan Housing" is the idea that you choose a house you won't be able to use if you develop a mobility or other disability. You make your housing choice because you think, "I'll never grow up". This is a collection of articles about the concept....
Ever get chills listening to a particularly moving piece of music? You can thank the salience network of the brain for that emotional joint. Surprisingly, this region also remains an island of remembrance that is spared from the ravages of Alzheimer's disease. Researchers at the University of Utah Health are looking to this region of the brain to develop music-based treatments to help alleviate anxiety in patients with dementia. Their research will appear in the April online issue of The Journal of Prevention of Alzheimer's Disease.
"People with dementia are confronted by a world that is unfamiliar to them, which causes disorientation and anxiety" said Jeff Anderson, M.D., Ph.D., associate professor in Radiology at U of U Health and contributing author on the study. "We believe music will tap into the salience network of the brain that is still relatively functioning."
"When you put headphones on dementia patients and play familiar music, they come alive," said Jace King, a graduate student in the Brain Network Lab and first author on the paper. "Music is like an anchor, grounding the patient back in reality."
This is interesting.....
Biologic drugs for psoriasis were associated not only with improved skin condition but, as an added bonus, reduced atherosclerotic plaque burden, according to late-breaking data presented here.
Biologic therapy was associated with regressing coronary plaque burden over 1 year, Elnabawi told the audience, concluding that it may be of benefit to target proinflammatory cytokines related to cardiovascular disease.
"To see a reduction in coronary plaque after just 1 year of biologic therapy alone is incredible and very assuring. It's the first time we're seeing treatment of a skin disease with biologic therapy have an impact specifically on plaque in the coronary," according to principal investigator Nehal Mehta, MD, MSCE, of the National Heart, Lung, and Blood Institute, in a press release.
"Our study results further emphasize the importance of patients maintaining and treating psoriasis to decrease the risks of adverse cardiovascular events occurring. This also opens the door for us to look at other disease states and see how anti-inflammatory therapy options could impact coronary plaque over time."
Anticholinergic effects from OTC and prescribed medications have a powerful effect on cognition and it becomes more powerful as you get older. I've posted on this before, but we all need reminders that many, many drugs have anticholinergic effects....
The largest and most detailed study of the long-term impact of anticholinergic drugs, a class of drugs commonly prescribed in the United States and United Kingdom as antidepressants and incontinence medications, has found that their use is associated with increased risk of dementia, even when taken 20 years before diagnosis of cognitive impairment.
An international research team from the US, UK and Ireland analyzed more than 27 million prescriptions as recorded in the medical records of 40,770 patients over age 65 diagnosed with dementia compared to the records of 283,933 older adults without dementia.
The researchers found greater incidence of dementia among patients prescribed anticholinergic antidepressants, anticholinergic bladder medications and anticholinergic Parkinson’s disease medications than among older adults who were not prescribed these drugs.
Dementia increased with greater exposure to anticholinergic medications.
“Anticholinergic Medication and Risk of Dementia: Case-control Study” is published in BMJ (formerly the British Medical Journal) an international peer-reviewed medical journal.
“Anticholinergics, medications that block acetylcholine, a nervous system neurotransmitter, have previously been implicated as a potential cause of cognitive impairment,”
The disease is Hutchinson-Gilford Progeria, an ultra-rare condition – occurring in just 1 in 4 million births and characterized by premature aging.
The natural history of progeria is death, usually due to cardiac causes, in the early to mid-teen years. Until recently, there have been no known therapies.
Enter lonafarnib, an obscure little farnesyl transferase inhibitor that has seen some use in hepatitis delta virus infection and is being investigated for its anti-cancer properties.
The first trial of lonafarnib led to promising results -- kids treated with the drug had improved weight gain and less skeletal rigidity. But only now was there enough data collected to look at a hard outcome – all-cause mortality.
The researchers compared 63 patients treated with lonafarnib to 63 patients who were not treated with the drug. Again, this wasn't randomized. I think there's a good argument here that randomization would be unethical. That said, the researchers matched treated and untreated patients on a variety of factors to minimize bias. And the results were dramatic.
Among the treated patients, just four died over the two years of study, compared to 17 deaths in the untreated group. These results are unheard of in this disease. Results this strong are rarely seen in most diseases, actually.
Now most of these kids started taking the medication at around 9 or 10 years of age, and it didn't seem to have much effect on their physical appearance. But one wonders if earlier treatment would lead to even more dramatic results.
If you are on Pradaxa, this is worth reading....
Final Phase 3 study data had demonstrated that Praxbind immediately reversed the anticoagulant effect of Pradaxa
Boehringer Ingelheim announced that the Food and Drug Administration (FDA) has granted full approval for Praxbind (idarucizumab) for use in patients treated with Pradaxa (dabigatran etexilate mesylate) when reversal of anticoagulant effects is needed for emergency surgery/urgent procedures or in life-threatening or uncontrolled bleeding.
Praxbind was initially granted accelerated approval by the FDA in October 2015; continued approval was pending results from the Phase 3 RE-VERSE AD trial (N=503). The latest analysis included findings from patients requiring urgent procedures/emergency surgery (eg, surgery for an open fracture after a fall) or patients with either uncontrolled or life-threatening bleeding complications (eg, intracranial hemorrhage, severe trauma after car accident). The primary endpoint was the degree of reversal of the anticoagulant effect of Pradaxa achieved by Praxbind within 4 hours.
The final study data, published in July 2017, demonstrated that Praxbind immediately reversed the anticoagulant effect of Pradaxa. Complete reversal was seen within 4 hours in the majority of patients, as measured by ecarin clotting time (ECT 82%) or diluted thrombin time (dTT 99%). In addition, there was a low rate of thrombotic events and no new safety events were reported.
Real, thoughtful coordination is less expensive and more effective.....
Cantata, a Chicago-area senior housing and care provider, is achieving success with its Take2 home care model, increasing margins even as clients are paying less for services.
Take2 was piloted in 2014, rolled out on a wider scale in 2016, and now serves about 60 people after a record month for new sign-ups in March, Cantata CEO John Larson said last week at the LeadingAge Illinois annual meeting and expo near Chicago. Cantata is a not-for-profit organization that offers an array of senior services; its campus-based housing, located about 15 miles southwest of downtown Chicago, includes independent living, assisted living and enhanced care.
The cost of personal care is already steep for consumers, and rates are only going up as tightening labor markets and changing laws increase costs for providers. At the same time, turnover is rampant in home care and a worker shortage is set to get worse as the baby boomer generation ages.
Take2 is a neighborhood-based system, in which caregivers drive around a designated area for the duration of their shifts, dropping in on clients to provide services in short bursts of about 20 minutes. Some of these drop-ins are scheduled and others are done on-demand, as clients have needs that arise and they alert the Take2 staff.
Currently, the service area is roughly six square miles around the Cantata campus. The organization has two people handling the program logistics and six to eight roving caregivers. They work regularly scheduled shifts, around the clock.
Take2 provides a wide array of services, including bathing and dressing assistance, light housekeeping, medication reminders, home maintenance and pet care. It does not provide companion care, given that the caregivers come in to perform specific tasks and then leave, moving on to the next house.
At the outset, the Cantata team had some doubts about the model. For instance, some people feared that clients would constantly be calling for help, and caregivers would be frantically trying to field requests and get from house to house.
“Our team said, it’ll be like a video game,” Larson said.
Those fears did not come to pass. In fact, clients request on-demand services infrequently, and the care team has been able to keep visits brief while maintaining 95% customer satisfaction and good health outcomes. For instance, as of October 2016, with 125 clients served, there had been only three falls with injury and two 30-day hospital readmissions.
There is a learning curve, however. Explaining the system and setting client expectations are important.
“We rarely if ever say, you’ll have a bath at 9:30,” Larson said. “We say … you’ll get hygiene in the morning.”
Similarly, there was skepticism about helping people with toileting on a schedule, but that has also not been a stumbling block. It is not unusual to have a toileting schedule in an assisted living setting, Larson noted.
Beta thalassemia is one of the most common genetic diseases in the world, affecting an estimated three hundred thousand people, with another sixty thousand born every year. (Evolutionary biologists speculate that the gene has survived for so long because, like the sickle-cell mutation, it may confer resistance to malaria.) Beta thalassemia is prevalent in Africa, Asia, the Middle East, and, especially, the Mediterranean. Its name comes from the Greek words thalassa, meaning “sea,” and haema, meaning “blood.” In many countries, including England, Greece, Iran, Saudi Arabia, and Taiwan, couples are screened for the disorder before they conceive, so that they know the chances of their child inheriting it. Once a patient shows symptoms of beta thalassemia, treatment is essentially palliative, consisting of regular transfusions of red blood cells from healthy donors. But with these life-saving transfusions come large amounts of iron, which builds up in the liver, heart, and other organs, amplifying the damage of the disease itself. At Hadassah, few of the patients with the severe form of beta thalassemia lived into adulthood. The years before death were typically marked by broken bones, recurrent infections, and overwhelming fatigue.
Now, a little more than four decades after I cared for these young patients, science is on the cusp of curing the disease. This week, the New England Journal of Medicine published a landmark paper on beta thalassemia by researchers in the United States, France, Australia, and Thailand. Twenty-two patients with the condition, treated at six centers around the world, underwent so-called gene therapy, a process in which the normal variant of a gene is inserted into the patient’s DNA, compensating for the abnormal one. In this case, the researchers retrieved immature stem cells from each patient’s bone marrow—the body’s blood factory—and isolated them in the laboratory. Next, they used an otherwise harmless virus to infect the cells with a copy of the normal globin gene. They cleared the patient’s marrow of diseased cells using chemotherapy, then reintroduced the genetically altered cells into the bloodstream—what is known as an autologous transplant. The cells found their own way back into the marrow.
The researchers’ hope was that the modified stem cells would mature into red blood cells and produce robust amounts of healthy hemoglobin. That hope was realized. Nine of the twenty-two patients suffered from severe beta thalassemia, and, after treatment, the number of blood transfusions they required fell by seventy-four per cent. Three of the nine no longer need any transfusions at all. The same is true of twelve of the thirteen patients with the less severe version of the disease. So far, the subjects of the trial have been observed for a maximum of forty-two months, but they will be monitored long into the future, to insure that the benefits of the therapy persist and cause no serious side effects. One early concern—that the procedure could disrupt the DNA of the stem cells, potentially triggering leukemia—has not, fortunately, come to fruition.
Thanks and a hat tip to RoAnne Chaney. Illuminating article; Completely altered my understanding of the issues.....
“He never got back to his cognitive baseline,” Cole continued, noting that his father was sharp as a tack before the operation. “He’s more like 80 percent.”
The old man likely has postoperative cognitive dysfunction (POCD) — a little-known condition that affects a substantial number of older adults after surgery, Cole said.
Some patients with POCD experience memory problems; others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.
“There is no single presentation for POCD. Different patients are affected in different ways,” said Dr. Miles Berger, a POCD specialist and assistant professor of anesthesiology at Duke University School of Medicine.
Unlike delirium — an acute, sudden-onset disorder that affects consciousness and attention — POCD can involve subtle, difficult-to-recognize symptoms that develop days to weeks after surgery.
Most of the time, POCD is transient and patients get better in several months. But sometimes — how often hasn’t been determined — this condition lasts up to a year or longer.
Mechanisms at work. What’s responsible for POCD? The drugs administered during anesthesia or the surgery itself? Currently, the evidence implicates the stress of surgery rather than the anesthesia.
“Most surgery causes peripheral inflammation,” Eckenhoff explained. “In young people, the brain remains largely isolated from that inflammation, but with older people, our blood-brain barrier becomes kind of leaky. That contributes to neuroinflammation, which activates a whole cascade of events in the brain that can accelerate the ongoing aging process.”
At Mount Sinai, Deiner has been administering two-hour-long general anesthesia to healthy seniors and evaluating its impact, in the absence of surgery. Older adults are getting cognitive tests and brain scans before and after. While findings haven’t been published, early results show “very good and rapid cognitive recovery in older adults after anesthesia,” Deiner said. The implication is that “the surgery or the medical conditions surrounding surgery” are responsible for subsequent cognitive dysfunction, she noted.
Advice. Currently, most patients are not told of the post-surgical risk of POCD during the process of informed consent. That should change, several experts advise.
“Beyond question, patients should be informed that the ‘safety step’ of not undergoing surgery is theirs to choose,” wrote Dr. Kirk Hogan, professor of anesthesiology at the University of Wisconsin-Madison School of Medicine and Public Health, in an article published earlier this year. “Each patient must determine if the proposed benefits of a procedure outweigh the foreseeable and material risks of cognitive decline after surgery.”
Research in clinical settings shows that some people with mental health problems experience extreme distress when hearing non-speech vocal sounds, like coughs and chewing noises, a phenomenon called “misophonia”. Now research from Amanda Seaborne at the University of California, Santa Barbara, and Logan Fiorella at the University of Georgia, published in Applied Cognitive Psychology, suggests that this issue exists in the broader population, and that people sensitive to these sounds perform poorly in their presence.
Seventy-two undergraduates sat in a cubicle and read a technical text about migraines for six minutes, before reporting what they remembered, answering questions on the text, and finally completing a questionnaire about their misophonia sensitivity (they rated how distressing they found sounds like “rustling papers, sneezing, chewing gum, tapping, eating crunchy foods, and heavy breathing”). For half the participants, a nearby cubicle contained a confederate working for the researchers who chewed gum loudly throughout the experiment. Participants in this condition who scored higher on the misophonia questionnaire performed worse at the comprehension measures than lower scorers.
Interestingly, the reverse pattern was found for the participants in the quiet control condition, with the more sound-sensitive students performing slightly better – perhaps because these conditions were the ones in which they naturally thrive. So misophonia seems to have an impact in non-clinical contexts (none of the rating scores reached clinical levels of sensitivity), although we can’t say whether its origin is in a subtle neurological difference or a psychological preoccupation. But it’s a good reminder that by honouring the expectations in designated quiet spaces, we may be helping others more than we know.