Wednesday, July 29, 2020

Breakthrough Test for Alzheimer's

New blood test shows great promise in the diagnosis of Alzheimer's disease



Date:

July 29, 2020

Source:

Lund University


Summary:

A new blood test demonstrated remarkable promise in discriminating between persons with and without Alzheimer's disease and in persons at known genetic risk may be able to detect the disease as early as 20 years before the onset of cognitive impairment, according to a large international study.



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FULL STORY


A new blood test demonstrated remarkable promise in discriminating between persons with and without Alzheimer's disease and in persons at known genetic risk may be able to detect the disease as early as 20 years before the onset of cognitive impairment, according to a large international study published today in the Journal of the American Medical Association (JAMA) and simultaneously presented at the Alzheimer's Association International Conference.


For many years, the diagnosis of Alzheimer's has been based on the characterization of amyloid plaques and tau tangles in the brain, typically after a person dies. An inexpensive and widely available blood test for the presence of plaques and tangles would have a profound impact on Alzheimer's research and care. According to the new study, measurements of phospho-tau217 (p-tau217), one of the tau proteins found in tangles, could provide a relatively sensitive and accurate indicator of both plaques and tangles -- corresponding to the diagnosis of Alzheimer's -- in living people.


"The p-tau217 blood test has great promise in the diagnosis, early detection, and study of Alzheimer's," said Oskar Hansson, MD, PhD, Professor of Clinical Memory Research at Lund University, Sweden, who leads the Swedish BioFINDER Study and senior author on the study who spearheaded the international collaborative effort. "While more work is needed to optimize the assay and test it in other people before it becomes available in the clinic, the blood test might become especially useful to improve the recognition, diagnosis, and care of people in the primary care setting."




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Researchers evaluated a new p-tau217 blood test in 1,402 cognitively impaired and unimpaired research participants from well-known studies in Arizona, Sweden, and Colombia. The study, which was coordinated from Lund University in Sweden, included 81 Arizona participants in Banner Sun Health Research Institute's Brain Donation program who had clinical assessments and provided blood samples in their last years of life and then had neuropathological assessments after they died; 699 participants in the Swedish BioFINDER Study who had clinical, brain imaging, cerebrospinal fluid (CSF), and blood-based biomarker assessments; and 522 Colombian autosomal dominant Alzheimer's disease (ADAD)-causing mutation carriers and non-carriers from the world's largest ADAD cohort.


In the Arizona (Banner Sun Health Research Institute) Brain Donation Cohort, the plasma p-tau217 assay discriminated between Arizona Brain donors with and without the subsequent neuropathological diagnosis of "intermediate or high likelihood Alzheimer's" (i.e., characterized by plaques, as well as tangles that have at least spread to temporal lobe memory areas or beyond) with 89% accuracy; it distinguished between those with and without a diagnosis of "high likelihood Alzheimer's" with 98% accuracy; and higher ptau217 measurements were correlated with higher brain tangle counts only in those persons who also had amyloid plaques.


In the Swedish BioFINDER Study, the assay discriminated between persons with the clinical diagnoses of Alzheimer's and other neurodegenerative diseases with 96% accuracy, similar to tau PET scans and CSF biomarkers and better than several other blood tests and MRI measurements; and it distinguished between those with and without an abnormal tau PET scan with 93% accuracy.

In the Colombia Cohort, the assay began to distinguish between mutation carriers and non-carriers 20 years before their estimated age at the onset of mild cognitive impairment.


In each of these analyses, p-tau217 (a major component of Alzheimer's disease-related tau tangles) performed better than p-tau181 (another component of tau tangles and a blood test recently found to have promise in the diagnosis of Alzheimer's) and several other studied blood tests.


In the last two years, researchers have made great progress in the development of amyloid blood tests, providing valuable information about one of the two cardinal features of Alzheimer's. While more work is needed before the test is ready for use in the clinic, a p-tau217 blood test has the potential to provide information about both plaques and tangles, corresponding to the diagnosis of Alzheimer's. It has the potential to advance the disease's research and care in other important ways.


"Blood tests like p-tau217 have the potential to revolutionize Alzheimer's research, treatment and prevention trials, and clinical care," said Eric Reiman, MD, Executive Director of Banner Alzheimer's Institute in Phoenix and a senior author on the study.


"While there's more work to do, I anticipate that their impact in both the research and clinical setting will become readily apparent within the next two years."


Alzheimer's is a debilitating and incurable disease that affects an estimated 5.8 million Americans age 65 and older. Without the discovery of successful prevention therapies, the number of U.S. cases is projected to reach nearly 14 million by 2050.




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Thursday, July 23, 2020

Covid-19 and the Brain

July 8, 2020

Source:

University of Liverpool


Summary:

Cases of brain complications linked to COVID-19 are occurring across the globe, a new review has shown. The research found that strokes, delirium and other neurological complications are reported from most countries where there have been large outbreaks of the disease.





    

FULL STORY

Cases of brain complications linked to COVID-19 are occurring across the globe, a new review by University of Liverpool researchers has shown.



Published in The Lancet Neurology, the study found that strokes, delirium and other neurological complications are reported from most countries where there have been large outbreaks of the disease.


COVID-19 has been associated mostly with problems like difficulty breathing, fever and cough. However, as the pandemic has continued, it has become increasingly clear that other problems can occur in patients. These include confusion, stroke, inflammation of the brain, spinal cord, and other kinds of nerve disease.


A recent Liverpool-led study of COVID-19 patients hospitalised in the UK found a range of neurological and psychiatric complications that may be linked to the disease.




To get a sense of the wider picture, the researchers brought together and analysed findings from COVID-19 studies across the globe that reported on neurological complications. The review, which included studies from China, Italy and the USA among others, found almost 1000 patients with COVID-19-associated brain, spinal cord and nerve disease.


Research Fellow, Dr Suzannah Lant, who was working on the project, said: "While these complications are relatively uncommon, the huge numbers of COVID-19 cases globally mean the overall number of patients with neurological problems is likely to be quite large."


One of the complications found to be linked to COVID-19 is encephalitis, which is inflammation and swelling of the brain.


Dr Ava Easton, CEO of the Encephalitis Society, and co-author on the paper said: "It is really important that doctors around the world recognise that COVID-19 can cause encephalitis and other brain problems, which often have potentially devastating, life-changing consequences for patients."


Professor Tom Solomon, senior author on the paper and Director of the Global COVID-Neuro Network, added: "Although such patients are being seen everywhere the virus occurs, many of the reports are lacking in detail. We are currently pooling data from individual patients all around the world, so that we can get a more complete picture. Doctors who would like to contribute patients to this analysis can contact us via the Global COVID-Neuro Network

website."






Wednesday, June 10, 2020

Unexpected uncertainty can breed paranoia



Date:
June 9, 2020
Source:
Yale University
Summary:
In times of unexpected uncertainty, such as the sudden appearance of a global pandemic, people may be more prone to paranoia, say researchers.

    
Silhouette of person, | Credit: © lassedesignen / stock.adobe.com
Silhouette of person, photo concept (stock image).
Credit: © lassedesignen / stock.adobe.com

In times of unexpected uncertainty, such as the sudden appearance of a global pandemic, people may be more prone to paranoia, Yale University researchers suggest in a new study published in the journal eLife.

Paranoia is a key symptom of serious mental illness, marked by the belief that other people have malicious intentions. But it also manifests in varying degrees in the general population. For instance, one previous survey found that 20% of the population believed people were against them at some time during the past year; 8% believed that others were actively out to harm them.

The prevailing theory is that paranoia stems from an inability to accurately assess social threats. But Corlett and lead author Erin Reed of Yale hypothesized that paranoia is instead rooted in a more basic learning mechanism that is triggered by uncertainty, even in the absence of social threat.

"We think of the brain as a prediction machine; unexpected change, whether social or not, may constitute a type of threat -- it limits the brain's ability to make predictions," Reed said. "Paranoia may be a response to uncertainty in general, and social interactions can be particularly complex and difficult to predict."



In a series of experiments, they asked subjects with different degrees of paranoia to play a card game in which the best choices for success were changed secretly. People with little or no paranoia were slow to assume that the best choice had changed. However, those with paranoia expected even more volatility in the game. They changed their choices capriciously -- even after a win. The researchers then increased the levels of uncertainty by changing the chances of winning halfway through the game without telling the participants. This sudden change made even the low-paranoia participants behave like those with paranoia, learning less from the consequences of their choices.

In a related experiment, Yale collaborators Jane Taylor and Stephanie Groman trained rats, a relatively asocial species, to complete a similar task where best choices of success changed. Rats who were administered methamphetamine -- known to induce paranoia in humans -- behaved just like paranoid humans. They, too, anticipated high volatility and relied more on their expectations than learning from the task.

Reed, Corlett and their team then used a mathematical model to compare choices made by rats and humans while performing these similar tasks. The results from the rats that received methamphetamine resembled those of humans with paranoia, researchers found.

"Our hope is that this work will facilitate a mechanistic explanation of paranoia, a first step in the development of new treatments that target those underlying mechanisms," Corlett said.

"The benefit of seeing paranoia through a non-social lens is that we can study these mechanisms in simpler systems, without needing to recapitulate the richness of human social interaction," Reed said.




Source:

Materials provided by Yale University. Original written by Bill Hathaway. 

Thursday, June 4, 2020

Health Challenges of Social Distancing


Excerpted from the Dana Foundation, March 30, 2020.)


We are social creatures by nature, wired to connect with friends, family, and with other people within their communities (See In Sync: How Humans are Wired for Social Relationships). Yet, according to the U.S. Resources and Services Administration (HRSA), a large number of Americans report feeling lonely or socially isolated from others – so much so that many experts are calling it a “loneliness epidemic.” In response to the COVID-19 pandemic, many communities are facing work and school closures and shelter-in-place orders, which may be further isolating vulnerable populations from the social interactions that are so vital to mental health and well-being.


Here, Myrna Weissman, Ph.D., the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University’s College of Physicians and Surgeons, discusses the impact of loneliness on mental health, as well as ways to stay connected when circumstances dictate you must stay at home.


What do we know about the effect of social isolation on mental health?


Human attachments are a basic need. That’s why we live in families and communities where we can be connected to other people. It’s just part of the human condition. There is vast data to document that when these kind of attachments are disrupted in early life, like when a mother suffers from post-partum depression, which often disrupts the mother-infant bond, it can have long-term health consequences, ranging from low-birth weight to increased risk of depression, anxiety, substance abuse, or suicidal behavior later in life. Unfortunately, the studies also show that poor bonds early in life can also lead to more social isolation when you are older, as well as feelings of extreme loneliness.



We understand that attachments to others are very important. In fact, a lot of talk therapy focuses on dealing with disruptions to those attachments. You don’t need a lot of friends, but you need to have some people in your life that you can talk to and share your life with.


One of the things psychiatrists were seeing long before the COVID-19 pandemic is that loneliness and social isolation are huge factors in depression. Sometimes, a person has depression and they will avoid other people and become more isolated as their symptoms worsen. Other times, people are depressed because they are isolated from others and they don’t have people they can rely on. Maybe they are lonely because something has changed in their lives. Maybe something bad has happened and they’ve lost someone special. Maybe they don’t get along with their families or the people who should be closest to them. There are, unfortunately, many paths to loneliness....


Does it influence only depression?


No, it influences everything – including chronic medical illnesses like hypertension and diabetes. It’s also now been linked to dementia. People don’t just wake up one day with dementia, unless they’ve had a stroke. Rather, the lack of social interaction, the ability to talk and cooperate with others, leads to a graduate mental decline over time. These social interactions are an important part to health in general.


That said, some people have the opposite experience. They are living with people with whom they don’t get along. Being stuck at home makes things even more stressful as they no longer can do the activities that take them out during the day that can compensate for the underlying discord in the family. That’s of concern.


Then there are the people who live alone. They may be more used to a lowered level of social contact in general. But, on the other hand, many people who live alone have a large number of friends and family members who they see on a regular basis to compensate for that alone time. They could be made more vulnerable by what’s going on, too.


How can people best cope with this sort of forced isolation?


The good news is that human beings, in general, are very flexible and adaptable. There’s good evidence that when you can find ways to connect, it helps to reduce symptoms associated with isolation. Anecdotally, I’ve seen some very creative solutions over the past few weeks....


How can people recognize when the isolation may be becoming too much?


It may not always be easy to recognize it in yourself. It may be easier to see in others. From my experience over the past 10 days, I’d say to watch out for the following situations. First, if there’s someone in your life that you are never hearing from – you send an email or call them and they don’t answer, that’s worrisome. That may be the kind of person who requires more attention during this time. Keep reaching out. Make sure they are okay.


The other kind of situation that may be of concern is a friend or family member who are hyper-focused on the disasters. They are on social media or sending out emails about the number of people who are dying, who are in the hospitals, or the lack of respirators. They are dwelling on the bad things. There, too, it is worthwhile to reach out to them and try to help them focus on something else, to help them see the positives in the situation.



Is there anything we can learn from this period of isolation that can help our mental health and well-being once the isolation from COVID-19 lifts so we can better connect with others in the future?


I’ve been thinking a lot about how the world might change after this is all over. What you take away from this experience will largely depend on your circumstances. Hopefully, you’ll learn something new about yourself. You’ll take stock of what is most vital to your wellbeing during this extraordinary period – both the things you need to be at your best and the things you need to avoid. My hope is that it will help people to reorder their priorities, examine what is important, and discover new ways to foster connections with others.



Thursday, March 5, 2020

Diabetes and Coronavirus, CO-VID19


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  • COVID-19 & diabetes




COVID-19 is a new and potentially serious coronavirus. There are many coronaviruses, ranging from the common cold to much more serious viruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). They are viruses that have been transmitted from animals to people. In severe cases, coronaviruses can cause infection in the lungs (pneumonia), kidney failure and even death.
The World Health Organization (WHO) has declared the COVID-19 outbreak to be a public health emergency of international concern. At present there is no vaccine against COVID-19.
Common signs are typical flu-like symptoms: a fever, cough, breathing difficulties, tiredness and muscle aches. Symptoms usually start within 3-7 days of exposure to the virus, but in some cases it has taken up to 14 days for symptoms to appear.
People of all ages can be infected. For many (more than 80% of cases), COVID-19 is mild, with minimal flu-like symptoms. Some have not shown symptoms or only very mild symptoms, more like a common cold. The majority of people who have caught the virus did not need to be hospitalised for supportive care. However, in approaching 15% of cases COVID-19 has been severe and in around 5% of cases it has led to critical illness. The vast majority (around 98%) of people infected to date have survived.

When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications.

Older people and people with pre-existing medical conditions (such as diabetes, heart disease and asthma) appear to be more vulnerable to becoming severely ill with the COVID-19 virus. When people with diabetes develop a viral infection, it can be harder to treat due to fluctuations in blood glucose levels and, possibly, the presence of diabetes complications. There appear to be two reasons for this. Firstly, the immune system is compromised, making it harder to fight the virus and likely leading to a longer recovery period. Secondly, the virus may thrive in an environment of elevated blood glucose.
Like any other respiratory disease, COVID-19 is spread through air-droplets that are dispersed when an infected person talks, sneezes or coughs. The virus can survive from a few hours up to a few days depending on the environmental conditions. It can be spread through close contact with an infected person or by contact with air droplets in the environment (on a surface for example) and then touching the mouth or nose (hence the common advice circulating on hand hygiene and social distancing).
What can people with diabetes and their loved ones do?
For people living with diabetes it is important to take precautions to avoid the virus if possible. The recommendations that are being widely issued to the general public are doubly important for people living with diabetes and anyone in close contact with people living with diabetes.
  • Wash hands thoroughly and regularly.
  • Try to avoid touching your face before you have washed and dried your hands.
  • Clean and disinfect any objects and surfaces that are touched frequently.
  • Don’t share food, glasses, towels, tools etc.
  • When you cough or sneeze, cover your mouth and nose with a tissue or use the crook of your arm if you don’t have a tissue to hand (dispose of the tissue appropriately after use).
  • Try to avoid contact with anyone showing symptoms of respiratory illness such as coughing.
  • Think whether you can make changes that will help protect yourself or loved ones. For example, can you avoid unnecessary business travel? Can you avoid large gatherings? Can you avoid public transport?
  • If you are ill with flu-like symptoms, stay at home.
If you have diabetes:
  • Prepare in case you get ill.
  • Make sure you have all relevant contact details to hand in case you need them.
  • Pay extra attention to your glucose control.
  • If you do show flu-like symptoms (raised temperature, cough, difficulty breathing), it is important to consult a healthcare professional. If you are coughing up phlegm, this may indicate an infection so you should seek medical support and treatment immediately.
  • Any infection is going to raise your glucose levels and increase your need for fluids, so make sure you can access a sufficient supply of water.
  • Make sure you have a good supply of the diabetes medications you need. Think what you would need if you had to quarantine yourself for a few weeks.
  • Make sure you have access to enough food.
  • Make sure you will be able to correct the situation if your blood glucose drops suddenly.
  • If you live alone, make sure someone you can rely on knows you have diabetes as you may require assistance if you get ill.
COVID-19 is a new coronavirus. The situation is not fully clear at this point, so keep informed of the latest developments. Look out for updates and advice from your government, national diabetes association and other reliable sources

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