Apathy is the forgotten symptom of dementia

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Apathy is the most common neuropsychiatric symptom of dementia, with a bigger impact on function than memory loss – yet it is under-researched and often forgotten in care.

A new study has found that apathy is present in nearly half of all people with dementia, with researchers finding it is often distinct from depression.

Although common, apathy is often ignored as it is less disruptive in settings such as care homes than symptoms like aggression.

Defined by a loss of interest and emotions, it is extremely distressing for families and it is linked with more severe dementia and worse clinical symptoms.

Now, research led by the University of Exeter and presented at the Alzheimer’s Association International Conference in LA has analysed 4,320 people with Alzheimer’s disease from 20 cohort studies, to look at the prevalence of apathy over time.

At the start of the study, 45% presented with apathy, and 20% had persistent apathy over time. Researchers found that a proportion had apathy without depression, which suggests that the symptom might have its own unique clinical and biological profile when compared to apathy with depression and depression only.

Dr Miguel de Silva Vasconcelos, of the University of Exeter and King’s College London, said: ‘Apathy is an under-researched and often ignored symptom of dementia. It can be overlooked because people with apathy seem less disruptive and less engaging, but it has a huge impact on the quality of life of people living with dementia, and their families. Where people withdraw from activities, it can accelerate cognitive decline and we know that there are higher mortality rates in people with apathy. It’s now time this symptom was recognised and prioritised in research and understanding.’

Professor Clive Ballard, of the University of Exeter Medical School, said: ‘Apathy is the forgotten symptom of dementia, yet it can have devastating consequences. Our research shows just how common apathy is in people with dementia, and we now need to understand it better so we can find effective new treatments. Our WHELD study to improve care home staff training through personalised care and social interaction included an exercise programme that improved apathy, so we know we can make a difference. This is a real opportunity for interventions that could significantly benefit thousands of people with dementia.’

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Rye is healthy, thanks to an interplay of microbes

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Eating rye comes with a variety of health benefits. A new study from the University of Eastern Finland now shows that both lactic acid bacteria and gut bacteria contribute to the health benefits of rye. Published in Microbiome, the study used a metabolomics approach to analyse metabolites found in food and the human body.

Rye sourdough used for the baking of rye bread is rich in lactic acid bacteria. In addition to fermenting the dough, these bacteria also modify bioactive compounds found in rye. They produce branched-chain amino acids and amino acid-containing small peptides, which are known to have an impact on insulin metabolism, among other things.

Many of the compounds found in rye are processed by gut bacteria before getting absorbed into the body. The study found that gut microbes and microbes found in sourdough produce compounds that are partially the same. However, gut microbes also produce derivatives of trimethylglycine, also known as betaine, contained in rye. An earlier study by the research group has shown that at least one of these derivatives reduces the need for oxygen in heart muscle cells, which may protect the heart from ischemia or possibly even enhance its performance. The findings can explain some of the health benefits of rye, including better blood sugar levels and a lower risk of cardiovascular diseases.

The study used metabolomics as the primary method to carry out an extensive analysis of metabolites found in food and the human body. The effects of gut microbes were studied in mice and in an in vitro gastrointestinal model, mimicking the function of the human gut. Using these two models, the researchers were able to eliminate naturally occurring differences in the gut microbiome between different individuals, making it easier to detect metabolites actually originating from rye.

Rye can be traced back to what is now known as present-day eastern Turkey, from where it has spread to many cuisines across the world. In Finland, for example, rye has been consumed for thousands of years, and it was recently selected as the country’s national food.

Although the health benefits of rye are long known, the underlying mechanisms are still poorly understood. For instance, the so-called Rye Factor refers to the lower insulin response caused by rye than, for example, wheat bread. Eating rye makes blood sugar levels fall slower, which leads to beneficial effects on the health – for a reason that remains unknown.

A significant factor contributing to the health benefits of rye are its bioactive compounds, or phytochemicals, which serve as antioxidants. In addition, gut microbes seem to play an important role in turning these compounds into a format that can be easily absorbed by the body, making it possible for them to have a greater effect.

“The major role played by gut microbes in human health has become more and more evident over the past decades, and this is why gut microbes should be taken very good care of. It’s a good idea to avoid unnecessary antibiotics and feed gut microbes with optimal food – such as rye,” Researcher Ville Koistinen from the University of Eastern Finland notes.

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Action for happiness hopes we have an altruistic August

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Action for Happiness hopes to spread selfless goodwill next month, with its ‘Altruistic August’ action calendar.

The movement publishes monthly calendars, offering daily affirmations on the theme of the respective month. ‘Altruistic August’ follows other recent calendars, including ‘Jump Back July’, ‘Joyful June’, ‘Meaningful May’ and ‘Active April’.

Suggestions for this month include the following:

  • Decide to be kind to others (and yourself) all this month.
  • Offer your seat, give way, or hold the door open for others.
  • Take a friend on a spontaneous adventure.
  • Try to bring a smile to as many people as possible today.
  • Sign up to be an organ donor or give blood.

Download the calendar

College of Medicine announces dates for this year’s food conference

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Food on Prescription 2019 is the latest in a series of food conferences, run by the College of Medicine, that have become a leading UK event on food, lifestyle and medicine for all healthcare professionals, who want to create a healthier future for patients, communities and the nation.

Held on Thursday October 24 at the Royal Society of Medicine, the conference will focus on:

  1. The latest insight on the biome and the relationship of food to our major lifestyle conditions
  2. Supporting healthy eating throughout our communities and nation
  3. Transforming the clinician and patient relationship including the 10 min consultation
  4. Creating a stronger coalition of stakeholders to reverse the current situation whereby those who most need healthy food are the least likely to be able to either access it or want it.

The Conference will include presenters who represent some of the leading experts and leaders in food, lifestyle and medicine as well as senior politicians from the largest political parties.  As in previous years, it is a conference that will ‘walk the talk’ including a healthy lunch and positive interaction with the audience but with a sharp focus on bringing about effective change at every level.

Vist the College of Medicine website for more information and to book tickets

A small knee bone is making a comeback

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A small bone more common in clients with arthritis is making a comeback, according to an article published in the Journal of Anatomy.

The fabella is a small independent bone located behind the lateral femoral condyle that is common in non-human mammals. It is absent in many humans who have lost the bone through evolution.

However, a recent systematic review examining medical literature over the past 150 years has found an increase in its prevalence. The findings show that the fabella is now three times more common than it was 100 years ago and is present in 39% of people.

Scientists believe that this increase could coincide with the global increase in human weight and height due to improved nutrition over the past century. Increased weight and height leads to larger calf muscles and longer shinbones, putting more pressure on the knee, and in turn leading to the formation of the fabella.

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Diane Leopard discusses inspiring photo project on UK Health Radio

Diane Leopard 3.jpgFHT Fellow Diane Leopard was recently interviewed for UK Health Radio to discuss a photography project she has launched to raise cancer awareness and help support those affected.

Interviewed by UK Health Radio’s Jenni Russell for the Her Health and Happiness show, Diane told her how she had purchased a camera with prize money from winning an FHT Excellence Award in 2015.

She then joined an adult education class to learn how to use the camera and was required to complete a final project about ‘a journey’. Diane decided to use this opportunity to reflect on her own personal cancer journey, by taking outdoor photographs that were symbolic of the different stages of her cancer journey and the emotions she had experienced.

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Diagnosis – This picture of Dunstanburgh Castle, Northumberland represents how Diane felt when the consultant told her that she had breast cancer. In the foreground of this picture you can see people going about life as normal while Diane’s life came tumbling down.

After presenting the project to her classmates, Diane was overwhelmed by the response and felt compelled to expand the project, first taking it into a local hospice and Pink Sisters, a breast cancer support group. Diane has since given a talk at a Stoke-on-Trent FHT Local Group meeting and has spoken to hospice staff on several occasions about the emotional impact of cancer and how they can help to support clients/patients.

In the interview Diane goes on to talk about her journey with cancer, how her life became uncertain after a diagnosis, and discusses the meaning behind each photo.

Speaking about the project, Diane says, “As a complementary therapist working with cancer patients I thought I understood cancer but nothing had prepared me for the emotional impact of a diagnosis. Since then I have taken a series of nature photographs to represent the emotional impact of cancer called ‘Focus on Emotions’. This represents not only my story but also emotions and feelings that have been shared by many other cancer patients all with different stories to tell and my family.  The images are natural, unedited other than the occasional crop and not staged.  They are often everyday scenes for example sunrise, sunset, flowers, beaches things most of us have experienced.  During the presentation I explain at little bit about each image and why I chose it. I then let the  audience have a few moments to reflect on what the image means to them.

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Tunnel of treatment, this is a poisonous laburnum arch with purple allium flowers standing tall and strong below. The laburnum represents chemotherapy and the allium are the medical staff who care for patients during treatment. The light at the end is where everyone hopes to be after treatment. Taken at the Dorothy Clive Gardens.

“I deliver the talk and exhibition to health care professionals, cancer patients, work colleagues and the general public. I want people to understand the devastating emotional impact cancer has on lives.  If people can have an insight to our emotions I am convinced that cancer patients will have an improved quality of treatment and recovery.  Cancer changes lives but that’s not always a bad thing.  I now see the beauty that surrounds us all yet many of us take for granted.

“The response from health care professionals, cancer patients and the public has been amazing, it has resonated with so many people.  Comments have included: – ‘that is one of the best presentations I have ever heard’ and ‘thank you, you’ve helped me to understand what my father must have gone through’.

“By looking at these images people seem to able to relate to their own emotions which may be cancer related or relate to other difficult life experiences such as bereavement, divorce and life changing illnesses.”

Listen to the full interview here

In addition, Diane has also published guest blogs on the project, highlighting her work on various websites, including Baba Baboon and Ticking Off Breast Cancer.

Protein reduces the risk of frailty in older women

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Adequate intake of protein is associated with a reduced risk of frailty and prefrailty in older women, according to a new study from the University of Eastern Finland and Kuopio University Hospital. Adequate protein intake was defined as at least 1.1 g per kg of body weight. The findings were published in European Journal of Nutrition.

Frailty is a multidimensional condition common in older adults, and those affected are at an elevated risk of dependence and mobility loss, fall, fracture, multimorbidity and mortality. Evidence shows a strong link between frailty and malnutrition, and protein may be the most important nutrient at play, mostly through its effect on muscle health. The Nordic Nutrition Recommendations (2012) suggest protein intake of 1.1-1.3 g per kg of body weight as adequate for preserving physical capacity in older adults. However, there is a paucity of data regarding the association of protein intake with frailty. The newly published study examined associations between protein intake and protein sources with frailty status in older women.

Participants were 440 women aged 65-72 years enrolled in the Osteoporosis Risk Factor and Prevention–Fracture Prevention Study. Their protein intake in g per kg of body weight was calculated using a three-day food record at baseline in 2003-2004. At the three-year follow-up in 2006-2007, frailty phenotype was defined as the presence of three or more, and prefrailty as the presence of one or two of the following criteria: low grip strength, low walking speed, low physical activity, exhaustion (defined using a low life satisfaction score), and weight loss of more than five per cent.

The study shows that getting the recommended amount of dietary protein was associated with a lower risk of frailty and prefrailty in older women. Moreover, the consumption of animal protein was associated with a lower likelihood of frailty. The recommended protein intake (1.1-1.3 g per kg of body weight) for an older person weighing 70 kg corresponds to a minimum intake of 77 g of protein. To illustrate, the protein content of a chicken breast per portion is 25 g, one boiled egg 6 g, and two slices of whole grain bread 6 g.

‘The public health recommendation is to eat an optimal diet with an adequate intake of protein. Adequate protein intake is important for muscle health and, according to the new results, may also prevent frailty. However, further research is still required in this area,’ Senior Lecturer Arja Erkkilä from the University of Eastern Finland concludes.

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Insomnia and loneliness may be reduced with physical education

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Physical education classes in school could reduce insomnia and feelings of loneliness in children, according to a study.

The above findings  were from a gender analysis of the impact of physical education on the mental health of schoolchildren in Brazil, published online by the open access journal, SSM – Population Health.

Scientists analysed data from more than 40,000 ninth grade (14-15-year-old) children from 3,160 schools across Brazil. The children were asked to complete a questionnaire, which included questions on whether they attend physical education classes, feel lonely and have difficulty sleeping.

The results showed that physical education reduced loneliness and insomnia in both boys and girls, but had a greater effect on boys. It has what the researchers call ‘a protective effect on mental health’.

Access the full study