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Five minute dementia screening iPad app debuts

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An iPad app developed in the United States could help doctors screen for a wide range of neurological diseases, such as Parkinson’s and dementia, in five minutes or less.

Developed at Northwestern Medicine in Chicago, the NIH (National Institutes of Health) Toolbox V3 iPad app allows time-strapped clinicians to quickly but thoroughly assess patients, from young children who need screening ahead of school to older people who may be concerned about dementia.

The developers claim that tests that would once have taken two or three hours to complete can now be reliably done in under 30 minutes.

Project leader Richard Gershon, vice chair for research in the department of medical social sciences at Northwestern University’s Feinberg School of Medicine, said: “The problem in clinical care today is nobody has time for long tests for everything; we need very brief tests.”

While some clinical screening tools require expensive custom hardware, this app = which can be downloaded from the Apple App Store – allows anyone with an iPad to access the full assessment suite of more than 50 tests spanning four areas – cognition, motor, sensation (hearing, smell, pain, vision and taste) and emotion.

COVID-19 patients complaining of “brain fog,” for instance, can now take several brief tests to determine what areas could be the target for cognitive rehabilitation.

Or someone who has recently lost their sense of smell can take the Toolbox’s olfactory test – and any others as need via the – to better understand if it could be an early sign of Parkinson’s disease.

Parts of the Toolbox are already being used at Northwestern to help detect dementia. And researchers are working on developing a self-administered version of the tests that could be taken in the waiting room before a patient’s visit with the results being sent straight into their electronic health record.

One example of a test to measure episodic memory is a series of pictures displayed on the screen describing a trip to the park. After they’ve been scrambled, the patient has to put the pictures back in order.

The NIH Toolbox has been in development for more than a decade. It was first launched in 2012 with a more portable iPad app unveiled three years later.

This newest version was originally intended solely for researchers. But it was decided to release it for clinical use following appeals from physician-scientists and psychologists looking for a way to improve patient care by allowing access to a wide variety of easily administered tests.

As an example, the researchers say it could be used for an older adult presenting to their neurologist with complaints of cognitive decline.

The examiner could assess the patient’s cognitive abilities as well as emotional functioning, such as depression and anxiety, which can also contribute to those complaints.

The NIH Toolbox has been developed by more than 250 scientists and sponsored by 15 institutes of the Maryland-based National Institutes for Health, that make up the NIH Neuroscience Blueprint, a collaborative framework supporting research on the nervous system.

Because the app is being distributed through the Apple App store, Richard Gershon and his colleagues don’t always know everyone who is using the Toolbox, but by tracking analytics detailing how often and where it’s purchased, they know it is currently in 21 countries.

The earlier V2 version of the app has been used by 3,000 researchers from 1,200 institutions globally and has been authenticated in 300 separate validation studies.

Dr Igor Koralnik, chief of neuro-infectious disease and global neurology at Feinberg, said: “The NIH Toolbox cognitive tests are extremely useful for testing the cognitive function of our neuro covid-19 clinic patients complaining of ‘brain fog,’ The results are adjusted according to age, education and other demographics, allowing us to tell our patients immediately of their performance, and if they may benefit from cognitive rehabilitation.”

Additionally, a Northwestern-led National Institute on Aging cohort study examining midlife determinants of later-life cognitive decline and dementia, is using the Toolbox to capture a range of conscious mental abilities.

Michael Wolf, associate vice chair for research in the department of medicine at Feinberg, commented: “Patients find the tests easy to use and are more engaged than with other standard measures we have deployed previously. Overall, this is an incredibly important research assessment tool that will help our work be more translatable to other studies.”

The app has been made available in both English and Spanish. Hebrew and Arabic versions are set to be released in late 2023. Additionally, numerous studies in Africa are using the Toolbox and have incorporated a translation app to communicate in Swahili, Dholuo and Twi.

Many of the streamlined tests are accomplished through computer adaptive testing. This means the app is constantly adjusting the questions to meet the level of the person being tested, eliminating irrelevant questions.

Richard Gershon said: “We zero in on that person’s individual level of functioning and don’t waste their time asking questions far above or below their ability.”

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Study reveals link between cheese and dementia

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A 25-year Swedish study links higher cheese intake to lower Alzheimer’s risk in people without known genetic risk, with cream also tied to lower dementia risk.

However, researchers emphasise that the results should be interpreted with caution.

The study tracked 27,670 people over 25 years.

During that time, 3,208 participants were diagnosed with dementia.

Among individuals without a known genetic risk for Alzheimer’s disease, those who consumed more than 50 grams of full-fat cheese per day showed a 13 to 17 per cent lower risk of developing Alzheimer’s.

This association did not appear in participants who carried genetic risk factors for the disease.

People who consumed more than 20 grams of full-fat cream per day also showed a lower risk of dementia overall, ranging from 16 to 24 per cent.

No meaningful links were found for low-fat or high-fat milk, fermented or non-fermented milk, or low-fat cream.

The results stand out because public health guidance has long encouraged people to choose low-fat dairy to protect heart health.

This connection matters because cardiovascular disease (conditions affecting the heart and blood vessels) and dementia share many underlying risk factors, including high blood pressure, diabetes and obesity.

When evidence from previous studies is combined, analyses suggest that cheese consumption may also be linked to a lower risk of heart disease, and that full-fat dairy does not necessarily increase cardiovascular risk.

Several other studies have explored whether similar patterns apply to brain health, but the results are mixed.

Evidence overall suggests that studies conducted in Asian populations are more likely to report benefits of dairy consumption for cognitive health (the ability to think, remember and reason), while many European studies do not.

One possible explanation is that average dairy intake tends to be much lower in Asian countries, meaning modest consumption may have different effects than higher intakes.

For example, one Japanese study reported a reduced dementia risk among people who ate cheese, but overall consumption levels were very low and the research was sponsored by a cheese producer.

In contrast, another Japanese study funded by government grants found no protective effect of cheese.

Some long-term European studies have also reported benefits.

In a Finnish study of 2,497 middle-aged men followed for 22 years, cheese was the only food associated with a lower dementia risk, reduced by 28 per cent.

Other dietary factors also appear to matter.

Higher consumption of milk and processed red meat was associated with worse performance on cognitive tests, while fish intake was linked to better results.

A large study in the UK that followed nearly 250,000 people found lower dementia risk among those who ate fish two to four times a week, fruit daily and cheese once a week.

However, these studies have important limitations.

What people eat is usually self-reported, and changes in memory can affect both eating habits and how accurately people remember what they have eaten. To deal with this, the Swedish researchers took two extra steps.

First, they excluded anyone who already had dementia when the study began.

Then they repeated the same calculations after removing people who went on to develop dementia within the first ten years of the study.

This did not mean starting the study again or recruiting new participants. It simply meant re-checking the results using a smaller group of people who remained dementia-free for longer.

The reason for doing this is that the early stages of dementia can subtly change behaviour long before diagnosis.

People may eat differently, lose appetite or struggle to recall their usual diet. By focusing on participants who stayed cognitively healthy for many years, the researchers reduced the chance that these early changes were influencing the results.

Another important question is whether substitution played a role.

Some of the apparent benefits may reflect replacing red or processed meat with cheese or cream, rather than an effect of dairy itself.

Supporting this idea, the Swedish study found no association between full-fat dairy and dementia risk among participants whose diets remained stable over five years.

Most importantly, foods should not be considered in isolation.

Dietary patterns matter more than individual ingredients. Diets such as the Mediterranean diet, which is consistently associated with lower risks of both dementia and heart disease, include cheese alongside vegetables, fish, whole grains and fruit.

In the Swedish study, people who consumed more full-fat cheese and cream were also more educated, less likely to be overweight and had lower rates of conditions linked to dementia, including heart disease, stroke, high blood pressure and diabetes.

All of these factors independently reduce dementia risk.

This suggests that higher cheese intake tended to occur within healthier overall lifestyles, rather than alongside excess calorie consumption or poor metabolic health.

Overall, the evidence does not support the idea that full-fat dairy causes dementia, nor that fermented milk products reliably protect against it.

Full-fat cheese contains several nutrients relevant to brain health, including fat-soluble vitamins A, D and K2, as well as vitamin B12, folate, iodine, zinc and selenium.

These nutrients play roles in neurological function and may help support cognitive health.

That said, the data do not justify eating large amounts of cheese or cream as protective foods against dementia or heart disease.

The most consistent message remains that balanced diets, moderation and overall lifestyle matter far more than any single item on the cheese board.

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New obesity and diabetes drug set for Boots clinical trial

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Boots will run an obesity drug trial for a new type 2 diabetes medicine at selected stores in England, the chain has revealed.

Boots has partnered with Civia Health to set up clinical research sites at four stores in Nottingham, Brighton, Peterborough and Birmingham, connecting communities to local research opportunities for obesity, diabetes and cardiovascular conditions.

Marc Donovan is director of healthcare development at Boots.

He said: “Clinical research plays a vital role in the development of new treatments and therapies, and we are proud to support increased clinical research participation to drive better health outcomes for all.”

The company said this is the first time dedicated clinical research units have been set up in high street pharmacies, enabling people to take part in convenient locations.

Boots said the first study to be conducted by Civia Health at its stores is a Phase 3 trial, a late-stage study that tests safety and effectiveness before approval, focused on a new obesity and type 2 diabetes medicine.

Customers at Boots stores will be able to join Civia Health’s longitudinal health registry, Thrive, which tracks participants’ health over time, and access free health screenings.

The screenings will include measurements such as height, weight, blood pressure and blood tests to help people understand their health and identify studies for which they may be eligible.

Civia will deploy its clinical teams, technology and operational standards to the participating Boots stores to screen and enrol participants, bringing research capability to the high street and providing convenient locations for study appointments.

As part of the partnership, Boots will also provide details of research opportunities to its customers to support recruitment.

Mark Campbell, chief executive of Civia Health, said: “For too long, clinical research sites have been in out-of-town and hard-to-find locations that can feel unfamiliar.

“Instead of relying on the small number of people who actively seek out studies, we’re bringing research to a broader, more diverse group – people who might benefit but would never have found us otherwise.”

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New study links Alzheimer’s memory loss to disrupted brain “replay” during rest

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Memory problems in Alzheimer’s may be linked to disrupted brain replay during rest, new research suggests.

The study, conducted in mice, points to a disrupted brain process that normally helps strengthen and preserve memories.

Researchers say the findings could inform future drugs that target this malfunctioning process and guide tools for earlier detection.

Scientists at University College London (UCL) found that replay events occurred as often in mice with amyloid plaques (protein deposits linked to Alzheimer’s) as in healthy mice, but the underlying patterns were no longer organised.

Instead of reinforcing memories, the coordinated activity of place cells became scrambled.

Dr Sarah Shipley, co-lead author from UCL Cell and Developmental Biology, said: “Alzheimer’s disease is caused by the build-up of harmful proteins and plaques in the brain, leading to symptoms such as memory loss and impaired navigation, but it’s not well understood exactly how these plaques disrupt normal brain processes.

“We wanted to understand how the function of brain cells changes as the disease develops, to identify what’s driving these symptoms.

“When we rest, our brains normally replay recent experiences, this is thought to be key to how memories are formed and maintained.

“We found this replay process is disrupted in mice engineered to develop the amyloid plaques characteristic of Alzheimer’s, and this disruption is associated with how badly animals perform on memory tasks.”

This replay activity takes place in the hippocampus, a region essential for learning and memory. During rest, specific neurons known as place cells activate in rapid sequences that mirror recent experiences.

Place cells, discovered by Nobel Prize-winning UCL neuroscientist Professor John O’Keefe, are neurons that correspond to particular locations.

As a person or animal moves through a space, different place cells fire in sequence. Later, during rest, those same cells typically reactivate in the same order, helping the brain store the experience as a memory.

To study this process, researchers tested how mice performed in a simple maze while recording brain activity at the same time.

Using specialised electrodes, they monitored roughly 100 individual place cells simultaneously as the animals explored and then rested.

This approach allowed the team to compare normal replay patterns with those seen in mice that had developed amyloid pathology associated with Alzheimer’s disease.

The researchers also observed that place cells in affected mice grew less stable over time. Individual neurons stopped reliably representing the same locations, especially after rest periods, which are normally when replay should strengthen memory signals.

These changes had clear behavioural effects.

Mice with disrupted replay performed worse in the maze, frequently revisiting paths they had already explored and appearing unable to remember where they had been.

Professor Caswell Barry, co-lead author from UCL Cell and Developmental Biology, said: “We’ve uncovered a breakdown in how the brain consolidates memories, visible at the level of individual neurons.

“What’s striking is that replay events still occur, but they’ve lost their normal structure. It’s not that the brain stops trying to consolidate memories, the process itself has gone wrong.”

Professor Barry added that the findings may help researchers identify Alzheimer’s earlier or develop treatments that focus on restoring normal replay activity.

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