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Healthy lifestyle linked to slower memory decline in older adults

Benefits were even seen for those with gene linked to Alzheimer’s disease.
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A healthy lifestyle, in particular a healthy diet, is associated with slower memory decline, finds a decade-long study of older adults in China.

Even for carriers of the apolipoprotein E (APOE) gene – the strongest known risk factor for Alzheimer’s disease and related dementias – a healthy lifestyle was found to slow memory loss.

Memory continually declines as people age, but evidence from existing studies is insufficient to assess the effect of a healthy lifestyle on memory in later life. And given the many possible causes of memory decline, a combination of healthy behaviours might be needed for an optimal effect.

To explore this further, researchers analysed data from 29,000 adults aged at least 60 years (average age 72; 49 per cent women) with normal cognitive function who were part of the China Cognition and Aging Study.

At the start of the study in 2009, memory function was measured using the Auditory Verbal Learning test (AVLT) and participants were tested for the APOE gene (20 per cent were found to be carriers). Follow-up assessments were then conducted over the next 10 years in 2012, 2014, 2016, and 2019.

A healthy lifestyle score combining six factors was then calculated: healthy diet, regular exercise, active social contact (eg. seeing friends and family), cognitive activity (e.g writing, reading, playing mahjong), non-smoking, and never drinking alcohol. 

Based on their score, ranging from 0 to 6, participants were put into favourable (4 to 6 healthy factors), average (2 to 3 healthy factors), or unfavourable (0 to 1 healthy factors) lifestyle groups and into APOE carrier and non-carrier groups.

After accounting for a range of other health, economic and social factors, the researchers found that each individual healthy behaviour was associated with a slower than average decline in memory over 10 years.

A healthy diet had the strongest effect on slowing memory decline, followed by cognitive activity and then physical exercise.

Compared with the group that had unfavourable lifestyles, memory decline in the favourable lifestyle group was 0.28 points slower over 10 years based on a standardised score (z score) of the AVLT, and memory decline in the average lifestyle group was 0.16 points slower.

Participants with the APOE gene with favourable and average lifestyles also experienced a slower rate of memory decline than those with an unfavourable lifestyle (0.027 and 0.014 points per year slower, respectively).

What’s more, those with favourable or average lifestyles were almost 90 per cent and almost 30 per cent less likely to develop dementia or mild cognitive impairment relative to those with an unfavourable lifestyle, and the APOE group had similar results. 

This is an observational study so can’t establish cause and the researchers acknowledge some limitations, such as the potential for measurement errors due to self-reporting of lifestyle factors, and the possibility of selection bias, as some participants did not return for follow-up evaluations.

But this was a large study with a long follow-up period, allowing for evaluation of individual lifestyle factors on memory function over time. And findings remained significant after further analyses, suggesting that they are robust.

As such, the researchers say their results provide strong evidence that adherence to a healthy lifestyle with a combination of positive behaviours is associated with a slower rate of memory decline, even for people who are genetically susceptible to memory decline. 

They suggest further research could focus on the effects of a healthy lifestyle on memory decline across the lifespan, acknowledging that memory problems can also affect younger people, not included in this study. “These results might offer important information for public health initiatives to protect older adults against memory decline,” they conclude.

“Prevention is important, given the absence of effective treatments for Alzheimer’s disease and related dementias,” say researchers in a linked editorial.

However, they point out that these results do not help to determine which among the six health behaviours included in the score (or specific combination) is the best target for dementia prevention, or when in the life course to focus prevention efforts. Further insight is also needed to determine whether the differences in memory decline observed in this study are clinically meaningful, they add.

They suggest a similar approach that led to a substantial reduction in cardiovascular disease should be taken with dementia prevention, “identifying not only the factors that matter most but also the threshold at which they matter, and the age when intervention is likely to be most effective.”

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ChatGPT shows promise as medication management tool

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Researchers have found that ChatGPT may hold promise as a tool to manage medication and polypharmacy—which could be particularly helpful in the care of older adults.

Polypharmacy, or the concurrent use of five or more medications, is common in older adults and increases the risk of adverse drug interactions. While de-prescribing unnecessary drugs can combat this risk, the decision-making process can be complex and time-consuming. Increasingly, there is a need for effective polypharmacy management tools that can support short-staffed primary care practitioners.

In a new study, researchers from the Mass General Brigham MESH Incubator found that ChatGPT, a generative artificial intelligence (AI) chatbot, showed promise as a tool to manage polypharmacy and de-prescription. The findings, published in the Journal of Medical Systems, demonstrate the first use case of AI models in medicine management.

To evaluate its utility, the investigators provided ChatGPT with different clinical scenarios and asked it a set of decision-making questions. Each scenario featured the same elderly patient taking a mixture of medications but included variations in cardiovascular disease history (CVD) and degree of impairment in activities of daily living (ADL).

When asked yes or no questions about reducing prescribed drugs, ChatGPT consistently recommended deprescribing medications in patients without a history of CVD. However, it was more cautious when overlying CVD was introduced, and more likely to keep the patient’s medication regimen unchanged. In both cases, the researchers observed that ADL impairment severity did not seem to affect decision outcomes.

The team also noted that ChatGPT had a tendency to disregard pain and favoured de-prescribing pain medications over other drug types like statins or antihypertensives. In addition, ChatGPT responses varied when presented with the same scenario in new chat sessions — which the authors suggest could reflect inconsistency in commonly reported clinical deprescribing trends on which the model was trained.

More than 40 per cent of older adults meet the criteria for polypharmacy. The rate of seniors on Medicare seeing more specialists on their care teams has increased in recent years, leaving primary care providers to oversee medication management. An effective AI tool could help aid this practice, according to the researchers.

“Our study provides the first use case of ChatGPT as a clinical support tool for medication management,” said senior corresponding author Marc Succi, MD, Associate Chair of Innovation and Commercialization at Mass General Brigham Radiology and Executive Director of the MESH Incubator.

“While caution should be taken to increase accuracy of such models, AI-assisted polypharmacy management could help alleviate the increasing burden on general practitioners. Further research with specifically trained AI tools may significantly enhance the care of aging patients.”

Arya Rao, lead author, MESH researcher and Harvard Medical student, added: “Our findings suggest that AI-based tools can play an important role in ensuring safe medication practices for older adults; it is imperative that we continue to refine these tools to account for the complexities of medical decision-making.”

Read more in the Journal of Medical Systems.

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Ageing fight revealed in new ‘muscle map’

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The first comprehensive cell atlas of ageing human muscle reveals the intricate genetic and cellular processes behind muscle deterioration and mechanisms to counteract it.

How muscle changes with ageing, and tries to fight its effects, is now better understood at the cellular and molecular level with the first comprehensive atlas of ageing muscles in humans.

Researchers from the Wellcome Sanger Institute and their collaborators at Sun Yat-sen University, China applied single-cell technologies and advanced imaging to analyse human skeletal muscle samples from 17 individuals across the adult lifespan. By comparing the results, they shed new light on the many complex processes underlying age-related muscle changes.

The atlas uncovers new cell populations that may explain why some muscle fibres age faster than others. It also identifies compensatory mechanisms the muscles employ to combat ageing.

The findings offer avenues for future therapies and interventions to improve muscle health and quality of life as we age.

This study is part of the international Human Cell Atlas initiative to map every cell type in the human body, to transform understanding of health and disease.

As we age, our muscles progressively weaken. This can affect our ability to perform everyday activities like standing up and walking. For some people, muscle loss worsens, leading to falls, immobility, a loss of autonomy and a condition called sarcopenia. The reasons why our muscles weaken over time have remained poorly understood.

In this new study, scientists from the Wellcome Sanger Institute and Sun Yat-sen University, China used both single-cell and single-nucleus sequencing techniques along with advanced imaging to analyse human muscle samples from 17 individuals aged 20 to 75.

The team discovered that genes controlling ribosomes, responsible for producing proteins, were less active in muscle stem cells from aged samples. This impairs the cells’ ability to repair and regenerate muscle fibres as we age. Further, non-muscle cell populations within these skeletal muscle samples produced more of a pro-inflammatory molecule called CCL2, attracting immune cells to the muscle and exacerbating age-related muscle deterioration.

Age-related loss of a specific fast-twitch muscle fibre subtype, key for explosive muscle performance, was also observed. However, they discovered for the first time several compensatory mechanisms from the muscles appearing to make up for the loss. These included a shift in slow-twitch muscle fibres to express genes characteristic of the lost fast-twitch subtype, and increased regeneration of remaining fast-twitch fibre subtypes.

The team also identified specialised nuclei populations within the muscle fibres that help rebuild the connections between nerves and muscles that decline with age. Knockout experiments in lab-grown human muscle cells by the team confirmed the importance of these nuclei in maintaining muscle function.

Veronika Kedlian, first author of the study from the Wellcome Sanger Institute, said: “Our unbiased, multifaceted approach to studying muscle ageing, combining different types of sequencing, imaging and investigation reveals previously unknown cellular mechanisms of ageing and highlights areas for further study.”

Professor Hongbo Zhang, senior author of the study from Sun Yat-sen University, Guangzhou, China, said: “In China, the UK and other countries, we have ageing populations, but our understanding of the ageing process itself is limited. We now have a detailed view into how muscles strive to maintain function for as long as possible, despite the effects of ageing.”

Dr Sarah Teichmann, senior author of the study from the Wellcome Sanger Institute, and co-founder of the Human Cell Atlas, said: “Through the Human Cell Atlas, we are learning about the body in unprecedented detail, from the earliest stages of human development through to old age.With these new insights into healthy skeletal muscle ageing, researchers all over the world can now explore ways to combat inflammation, boost muscle regeneration, preserve nerve connectivity, and more. Discoveries from research like this have huge potential for developing therapeutic strategies that promote healthier ageing for future generations.”

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UK body calls for more ageing research backing

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The British Society for Research on Ageing (BSRA) is calling for more public backing in the UK for research to help people stay healthier for longer, as an alternative to charities that support research on diseases.

The greatest risk factor for disease is ageing, but we have very little charitable support for research into how to slow ageing, the organisation warns.

Many diseases such as cancers and heart disease tragically shorten lives far too early, or like Alzheimer’s and arthritis, destroy quality of life for patients and carers. There is understandably huge public charitable support for more research. However, the greatest risk factor for those diseases, and even infectious diseases like COVID, is ageing.

Yet in comparison there is currently very little support for research to understand how we can slow ageing to prevent disease. This approach may be more productive in the long term to fight disease. Furthermore, keeping people healthier for longer, or avoiding chronic diseases all together, would be the most favourable outcome.

The UK population is ageing fast, putting pressure on the NHS and the economy. Despite this pressing problem all around us, there is no accessible way for people to support research into ageing in the UK. The BSRA aims to change that.

With a very small budget and almost completely run by volunteers, the BSRA has successfully funded several small research projects but progress needs to be accelerated. More funding is needed because it takes years to see the effects of ageing, so studies are long. Also ageing affects individuals in different ways, meaning that large numbers of people must be studied to make firm conclusions.

Therefore, there is an urgency to get studies funded and the BSRA has decided to launch an ambitious fundraising campaign to boost research into ageing. Initially, the Society aims to fund a series of one year research projects at the Masters degree level at universities across the UK and with plans to raise much more in the future to support longer and more ambitious projects that will impact the lives of the general public.

Chair of the BSRA, Prof David Weinkove from Durham University, says “The time is now to really get behind research into the biology of ageing. We have fantastic researchers across the country, but they are held back by a lack of funding. Evidence-based research is needed to understand how we people can stay healthier for longer, and to then we must make that knowledge available to as many people as possible”.

Dr Jed Lye says “This is a great opportunity for the public to help, for corporations to contribute, or philanthropists wanting a large impact with a relatively small donation; every £20,000 we raise can fund an entire year of research into ageing and longevity, and gets a budding scientist their research qualification.”

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