Get your sleep and treat depression to guard against Alzheimer’s disease

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The September International Psychogeriatrics Article of the Month is entitled “Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia” by Shanna L. Burke, Peter Maramaldi, Tamara Cadet and Walter Kukull. This blog piece was released by Florida International University and can be viewed here.

New research suggests that lack of sleep and untreated depression may increase the risk of Alzheimer’s disease, even for those who do not have a genetic predisposition for the disease.

Depression and sleeplessness have long been considered symptoms of Alzheimer’s disease. This study indicates that whether in combination with genetic risk factors or on their own, untreated depression and lack of sleep may lead to the onset of Alzheimer’s disease dementia later in life.

“Previous research has attempted to explore the relationship between depression, sleep disturbance and Alzheimer’s disease. Our research is significant in that it is the first to find an increased risk of Alzheimer’s disease due to insomnia and depression independently, as well as in combination with genetic risk factors,” said Shanna L. Burke, assistant professor of social work at the FIU Robert Stempel College of Public Health & Social Work.

Alzheimer’s disease currently affects more than 39.9 million people worldwide. In the United States, it is the most common form of dementia in the elderly, affecting 1 in 10 people over the age of 65.

Although treating the genetic risk factors for Alzheimer’s disease isn’t possible yet, these findings suggest that alleviating depression and sleep disturbance may decrease the chances of a person developing the disease.

Burke served as the primary investigator for the study. She and the other members of the research team—Peter Maramaldi, Tamara Cadet and Walter Kukull—present their findings in Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia, which was recently highlighted as “Paper of the Month” in the journal International Psychogeriatrics. Commentary and associated findings on the study were provided by Dr. David Steffens, chair of the department of psychiatry at the University of Connecticut.

“Future studies are needed to better understand the role of sleep in development of Alzheimer’s Disease, either as an independent risk factor or as a key depressive symptom that might further unlock the link between depression and Alzheimer’s,” said Steffens.

The full paper “Associations between depression, sleep disturbance, and apolipoprotein E in the development of Alzheimer’s disease: dementia” is available free of charge for a limited time here.

The commentary paper “J’accuse! depression as a likely culprit in cases of AD” by David C. Steffens is also available free of charge for a limited time here.

Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

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Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

A centenary of Robert T. Leiper’s lasting legacy on schistosomiasis and a COUNTDOWN on control of neglected tropical diseases

The latest Parasitology Paper of the Month is “A centenary of Robert T. Leiper’s lasting legacy on schistosomiasis and a COUNTDOWN on control of neglected tropical diseases” by J. Russell Stothard, Narcis B. Kabatereine, John Archer, Hajri Al-Shehri, Louis Albert Tchuem-Tchuenté, Margaret Gyapong and Amaya L. Bustinduy. This blog post was written for us by Professor Stothard.

Typically, biomedical research and disease control in general is forward looking in focus. This is often typified in the aspirational goals and targets set by international health agencies, as bundled within progress-specific indicators. In 2012, for example, the WHO formulated the Neglected Tropical Diseases (NTDs) Roadmap which helped to set out future progress to sustain the drive to overcome the global impact of NTDs by 2020. With later formulation of the sustainable development goals (SDGs), this NTD agenda has been expanded but now framed in a 2030 perspective.

While looking to the future, we should not forget to occasionally glance back at the past; for it is here where we review and contextualise previous successes and failures. Indeed, progress is rarely smooth and is often a stuttered march through time. Just over a hundred years ago, the then state-of-the-art biomedical research culminated in clarification of the lifecycle of the African schistosome. With it, precious knowledge was brought forth to the world, opening up a new vista on schistosomiasis, a terrifying waterborne illness, and signposting a cardinal era in future disease control. In some small celebration of this achievement, I thought it time to reflect upon this, placing its significance in today’s world.

I previously had some understanding of the stature that Robert T. Leiper had in parasitology when I was based at the Natural History Museum (NHM) and London School of Hygiene and Tropical Medicine (LSHTM). Although Leiper died the year before I was born, many times did I look at his portrait in oils hanging in the LSHTM’s main stairwell. His face often brought to life by an anecdote retold to me, often either tart or sweet in equal measure, when visiting a senior colleague on the 4th floor who had had first-hand dealings with him.

Upon more detailed investigations into his life, while searching the LSHTM and NHM archives, I was privileged to read his meticulous hand written notes. Moreover, viewing his black and white photographs transported me to China and Egypt of old and delving deeper, I became beset within the melancholies of Antarctic exploration and First World War tragedy. Without doubt, I strongly sensed Leiper’s fiery energy and dogged determination which enabled him to go the extra mile where others would not, and help him solidify the importance of fundamental parasitological research within tropical medicine.

During this exercise, I remembered that control of schistosomiasis in theory is relatively easy; it can be curtailed by very simple water hygiene measures that Leiper himself pioneered. Sadly, putting this into practice is still out of reach for millions in sub-Saharan Africa and in Uganda intestinal schistosomiasis is still rife within lakeshore communities where Leiper once worked. As Director of COUNTDOWN, an implementation research consortium funded by DFID, UK, I hope this article reminds us that ‘old’ advice still needs appropriate tailoring within the control practices of today, and to embellish the aspiration that everyone, child or adult, has the daily right to safe water.

Read the review paper “A centenary of Robert T. Leiper’s lasting legacy on schistosomiasis and a COUNTDOWN on control of neglected tropical diseases” which has been published Open Access here.

The road to depression: understanding the consequences of driving cessation in older women

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The August International Psychogeriatrics Article of the Month is entitled “Moderating effects of social engagement on driving cessation in older women” by Nancy A. Pachana, Janni K Leung, Paul A Gardiner and Deirdre McLaughlin. This blog piece was written for us by one of the paper’s authors, Nancy Pachana.

The ability to drive is considered an important functional skill, as well as a marker of independence, by people in most age groups, including older adults. A variety of physical and /or cognitive issues can require ceasing driving at any age, but this eventuality is perhaps both more common and more concerning later in life. For some older adults, having to cease driving can not only negatively impact participation in a range of activities but can also negatively impact emotional well-being.

A recent study at The University of Queensland examined this important relationship between driving cessation and depression in an older cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). It is important to examine this issue of the consequences of driving cessation in women, because international data suggests that older women are more likely to stop driving, more likely to stop driving pre-maturely, and are also more vulnerable to depression than older men.

Data from over 4000 older women aged 76-87 were analysed over a three year period. In the study driving cessation was indeed associated with poorer self-reported mental health in the sample, congruent with many studies of older men and women, published from a range of countries. However, in our study we were able to identify a protective factor, namely engagement in social activities. In our cohort, older women who remained engaged in social activities despite ceasing driving were able to maintain a higher level of mental health in the face of having ceased driving than those women who were less engaged in such activities.

This is an important finding from an intervention and policy perspective. Driving cessation programs (such as the CarFreeMe (http://carfreeme.com.au/) driving cessation intervention developed at UQ) which help to instruct older drivers about how to stay mobile via public transport, can assist in maintaining access to social activities for those who cease driving. Such interventions are being made available to increasing numbers of older adults who cease driving.

Interventions as well as policies to increase both ease of access as well as facilitate the provision of social engagement opportunities for older adults have an important role in maintaining emotional well-being, facilitating meaningful community engagement, and protecting against social isolation. From our study we suggest that social support acts as a buffer to declining mental health in those women who cease driving later in life. Attention on older women who cease driving is important, as some in this group will be widowed and unable to rely on a spouse for transport if they cannot drive themselves. The maintenance of social networks has been shown to have a wide range of benefits to emotional and physical well-being in later life, and our data shows this list includes well-being for older women who no longer drive.

The full paper “Moderating effects of social engagement on driving cessation in older women” is available free of charge for a limited time here.

The commentary paper “Giving up driving: does social engagement buffer declines in mental health after driving cessation in older women?” by George W. Rebok and Vanya C. Jones is also available free of charge for a limited time here.

 

Risk factors for dementia diagnosis

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The July International Psychogeriatrics Article of the Month is entitled “Risk factors for dementia diagnosis in German primary care practices” by Anke Booker, Louis EC Jacob, Michael Rapp, Jens Bohlken and Karel Kostev. This blog piece was written for us by one of the paper’s authors, Karel Kostev.

A number of factors are associated with the risk of developing dementia, for example, it is well known that the risk of developing this disease is higher in the elderly. Several previous works were controversial and partly focused on a low number of patients. We analyzed the association of different potential risk factors with the risk of developing dementia in German primary care practices.

Based on the large database with electronic medical records we selected 11,956 patients with an initial diagnosis of dementia between January 2010 and December 2014. To have a comparison group, 11,956 controls without dementia were also included and were matched with cases on the basis of age, sex, type of health insurance and physician.
For each patient we selected several disorders potentially associated with dementia based on primary care diagnoses. We used a multivariate regression model and could see that the risk of dementia increased significantly in connection with the following variables: diabetes, lipid metabolism, stroke, Parkinson’s disease, intracranial injury, coronary heart disease, mild cognitive impairment, and mental and behavioral disorders due to alcohol use. Conversely, the risk of dementia decreased with the use of statins, proton-pump inhibitors and antihypertensive drugs.

What are the main strengths of the study? We analyzed the ‘real life’ data from the clinical practice including all possible high risk patients who would be excluded from clinical trials. Further strengths are the high number of patients and the number of primary diagnoses included in the statistical analysis.

Many of these factors are already known so why is this research important? We analyzed patients who visited primary care physicians. The study results clearly highlighted the importance of personalized follow-up by the physicians on patients not only with high risk diagnoses for dementia like mild cognitive impairment but also diabetes or cardiovascular diseases to try to prevent or delay dementia.

The full paper “Risk factors for dementia diagnosis in German primary care practices” is available free of charge for a limited time here.

The commentary paper “Clarifying dementia risk factors: treading in murky waters” by Halima Amjad and Esther S. Oh is also available free of charge for a limited time here.

Researchers find lifestyle link in depression

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Researchers following the progress of 1200 people for five years have found strong links between unhealthy lifestyles and depression.

Researchers at the University of Tasmania’s Menzies Institute for Medical Research studied the impact of lifestyle on depression and the impact of depression on lifestyle. This is the first time the association has been looked at from both sides.

The lead author of the study, Dr Seana Gall, said that people with healthier lifestyles at the beginning of the study were significantly less likely (22%) to develop a first episode of depression over the five years, while there was a tendency for those with a history of depression to lose points in a lifestyle assessment over the five years (46% more likely than those without a history of depression at the beginning of the study). Lifestyles were assessed through a score comprising body mass index, smoking, alcohol consumption, leisure time, physical activity and diet.

These associations occurred regardless of other predictive factors such as socio-economic position, parental and marital status, social support, major life events, cardiovascular disease history and self-rated physical health.

Participants were aged 26-36 years at the beginning of the study (2004-2006) and 31-41 years at follow-up (2009-2011).

Dr Gall said the study’s grouping of health behaviours (i.e. the overall lifestyle) rather than looking at individual risk factors was significant. “This is the first study to consider the association between this number of health behaviours and risk of developing depression over time,” Dr Gall said. “Studying individual risk factors and their relationship with depression ignores the fact that risk factors often cluster as unhealthy lifestyles.

“Our findings have implications for reducing the higher risk of cardiovascular disease that is seen in those with depression and also potentially reducing the risk of developing depression in young people” Dr Gall said. “The study highlights the need for holistic management of young adults in terms of their mental and physical health, including health behaviours.

Dr Gall said the results suggested that a healthier lifestyle may protect against the first onset of depression and therefore the findings were relevant for those managing the physical and mental health of younger adults.

 

via University of Tasmania – Researchers find lifestyle link in depression

 

The full paper, published in Psychological Medicine, “Bi-directional associations between healthy lifestyles and mood disorders in young adults: The Childhood Determinants of Adult Health Study” by S. L. Gall, K. Sanderson, K. J. Smith, G. Patton, T. Dwyer and A. Venn can be viewed here free of charge until 30th August 2016.

 

Personal music systems may be hazardous to hearing

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Improvements in digital technology have meant that an increasing number of people are listening to music via personal music systems such as MP3 players and mobile phones for prolonged periods of time. These music systems are increasingly small and lightweight with considerable storage capacity and improved sound quality – which has led to prolonged use at higher volume settings, particularly among young people.

A paper published in The Journal of Laryngology & Otology (JLO) finds, alarmingly, that large proportions of young adults are listening to personal music systems at levels higher than safety levels recommended by regulatory bodies. The study finds that listening to music through personal music systems at high volume through ear phones or ear buds may be potentially hazardous to hearing.

The paper’s co-authors – from the All India Institute of Speech and Hearing in Mysore, South India – recruited 60 participants between the ages of 15 and 30 years old for their study, which looked at regular users of personal music systems and non-users of personal music systems. The researchers also used manikins to measure the output of sound pressure levels of personal music systems.

Supported by India’s Department of Science and Technology, the study found that an alarming proportion of young adults were using personal music systems at levels that could potentially damage their hearing. The study found that people who listened to personal music systems at levels higher than 80 decibels had significantly poorer hearing thresholds in high frequencies when compared to other participants. The preferred range for listening to music among participants was 51 to 98 decibels – while workplace noise regulation in the UK, for example, limits the daily exposure levels to 80 decibels.

The study also found that 33 per cent of participants reached the maximum allowable noise level after listening to music for more than four hours, while 20 per cent reached the limit within one hour – with 30 per cent of used personal music systems at levels higher than the permissible limit.

People who listened to personal music systems at levels higher than 80 decibels also showed significant difficulty in perceiving speech in adverse listening conditions, compared to other participants in the study. The authors suggest that this reduced function may be linked to damage to the cochlear structure.

However, all the participants in the study had normal hearing in the conventional frequency range, the study found.

“Our results suggest that listening to music through personal music systems at higher volume levels (over 80 dB LAeq) may not result in clinically significant hearing loss, yet may cause subtle pre-clinical damage to the auditory system, and over the years such behaviour may be hazardous to hearing,” the authors conclude.

The full paper, published in The Journal of Laryngology & Otology, “Personal music systems and hearing” by U A Kumar and S R Deepashree, can be viewed free of charge until 31 August 2016 here.

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