Tag: health and medical

Making the case for an underappreciated but full-of-flavor ingredient | CNN

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CNN
 — 

Among foods that spark a strong reaction, anchovies are at the top of the food chain.

Whether they’re adored or abhorred, it’s difficult to find someone who doesn’t have a strong opinion about these small silvery swimmers.

Food writer Alison Roman wants the haters to think differently. Anchovies are more versatile than most people think and deserve to be approached with an open mind, according to Roman.

She might be biased — anchovies are one of her all-time favorite foods — but she has a strategy to change cooks’ minds.

“They’re more of a condiment than an ingredient,” Roman said. “To cook with them, you don’t need to eat them whole.” She incorporates anchovies into many of her dishes in the same way that she would add garlic, herbs or other flavorful aromatics. “Most of the time when I’m eating (anchovies), I can’t even see them.”

Even if you think your taste buds will rebel if you try an anchovy, your brain and heart will be happier if you do. “Anchovies are a small but mighty fish,” said Michelle Dudash, registered dietitian, nutritionist and author of “The Low-Carb Mediterranean Cookbook.”

“They’re packed with the omega-3 fatty acids DHA and EPA, which are important for brain, cardiovascular and skin health,” she added. Anchovies are on par with salmon and tuna as one of the fish with the highest amounts of omega-3s per serving, and are a good source of protein, niacin and vitamin B12.

Following Roman’s lead of using anchovies as one of many elements in a dish instead of as the spotlight ingredient, cooks who want to incorporate anchovies into meals “can start small,” Roman suggested. “They don’t have to dump a whole jar into their salad.”

Here are three ways Roman likes to introduce anchovies to the wary but curious. Ready to change your “anchoview”? Read on.

Move over, ranch dressing — there’s another dip in town. Bagna cauda, the Italian dipping sauce made from anchovies, garlic, butter and olive oil, is traditionally served with crudités as an appetizer.

Roman loves using bagna cauda as a vehicle to introduce unsuspecting dinner guests to anchovies because it hits the taste trifecta of “salty, buttery, garlicky” flavors. “It’s mostly about garlic and vegetables,” Roman said. In addition to the traditional accompaniment of raw, crunchy vegetables, she likes to include steamed artichoke hearts and tender cooked potato slices.

Bagna cauda is also an answer to the ever-present question about anchovies: What about the bones? “They are so tiny, they mostly all melt” and dissolve into the dish when heat is applied, Roman said. “They’re not going to choke you.”

“High-quality anchovies shouldn’t have many bones,” she added, and they should not be noticeable like they would be in larger fish, such as a salmon fillet. If you happen to see many bones in your anchovies, “spring for a more expensive tin,” Roman said.

If the presence of whole anchovies resting atop a bed of romaine in a Caesar salad has been historically too much to handle, Roman’s Caesar-adjacent salad will be a refreshing revelation.

Roman likes to pair bitter greens from the chicory family, such as radicchio, with a dressing that can stand up to their strong flavors. “I put anchovies in my salads all the time,” she said, but when hidden in the dressing, they add body and nuance without overpowering any of the other ingredients with which they’re paired.

Anchovies in a dressing can add body and nuance to a salad without overpowering other ingredients.

Her preferred dressing blends finely chopped anchovies and capers with lemon, whole grain or Dijon mustard, and good quality olive oil. “It’s anchovy-heavy but more about the mustard and the garlic,” Roman explained, which she finds “meatier and saltier and more interesting” than the usual Caesar dressing.

Finally, the same strategy of dissolving the umami flavors of anchovies in a sauce comes into play when making a rich and comforting pasta. Based on the Venetian dish bigoli in salsa, in which long strands of thick bigoli pasta are tossed with slow-simmered onions and anchovies, Roman’s version can be used with any long, thin pasta.

Pasta alla puttanesca features garlic, olives, capers, tomatoes and anchovies.

Roman adds whole anchovies and chopped dried chili pepper to a skillet of sliced onions, garlic and fennel caramelized in olive oil. The whole fillets might look intimidating, but as with the bagna cauda, the anchovies melt and dissolve as the sauce simmers, leaving only a rich and meaty undertone. Finishing the dish with freshly squeezed lemon juice and parsley brightens up the intense sauce.

A free-form pasta sauce such as this lets you adjust the flavor balance based on what you like best. If you love lemon, squeeze more on. If fennel isn’t your favorite, use more onions instead. If you like it spicy? Amp it up with more chili pepper. “Gauge your own personal preferences,” Roman recommended.

When choosing a tin or jar of anchovies, Roman said to make sure the anchovies are oil-packed, salt-cured anchovy fillets, not brined, pickled or whole anchovies. The former is the most common style of jarred or canned anchovies on the market, but it always pays to double-check the label.

Second, “always try a bunch of brands. They really are all different,” Roman said. Though the ingredients in each container should be the same — anchovies, salt and olive oil — the fillets will vary in saltiness, taste and texture. “Ortiz and Cento are available nationally,” she said, and many other brands are available in brick-and-mortar and online specialty food stores.

One note on the salt-curing: “The only downside of anchovies is the sodium,” Dudash noted, since they are packed in salt during the curing process. “If you are concerned about your sodium intake or if you simply prefer less salty food, briefly rinse the anchovies and pat dry with a paper towel” before using them.

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Home delivery of medications can help improve access, especially when time is tight | CNN

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CNN
 — 

Covid-19 hospitalizations are on the rise in the United States, with more than 34,000 new admissions last week, but millions of vaccines and doses of antiviral treatments that could help prevent severe outcomes from the virus remain unused.

Research has found that many who could benefit most from the Covid-19 medication Paxlovid – including the elderly and Black and Hispanic people, groups that have disproportionately had the most severe illness – are less likely to take it.

As the supply of Paxlovid has grown, efforts have been made to improve timely, equitable access to the treatment.

“The driving distance to the nearest site or the geographic accessibility of the places where Paxlovid is being offered doesn’t seem to be the primary driver of why these populations are not getting the treatments they need,” said Dr. Rohan Khazanchi, a resident at Harvard Medical School and health equity consultant for the New York City health department.

Transportation is one significant barrier to health care access for many people, experts say, but creating equitable outcomes will involve a much more comprehensive approach.

In response to the White House’s call for pharmacies to help make this winter a healthier one for Americans, Walgreens launched a program Thursday in partnership with DoorDash and Uber Health that offers free home delivery of Paxlovid for those with a prescription. The initiative is meant to increase access to Covid-19 treatment, particularly for those in socially vulnerable or medically underserved communities.

Millions of Americans get prescriptions through the mail, a service that research has shown is used more frequently among seniors, adults with poor health and others who are also at high risk of severe outcomes for Covid-19.

But Paxlovid is most effective when taken within five days of symptoms starting, making timely treatment a critical piece of the puzzle and traditional mail-order delivery too slow.

Walgreens also plans to expand the service to include HIV treatment – in line with the Biden administration’s goals to accelerate efforts to end the HIV/AIDS epidemic in the US.

As with Paxlovid, early uptake is key with HIV treatment. And people who miss doses of HIV treatment risk developing drug resistance, making it crucial that they stick with the prescription.

“There are places across the patient journey that would divert a patient from being able to get treated and back to feeling better. But that’s where our teams have been working on really understanding that patient journey and then offering and identifying solutions to help address that,” said Rina Shah, vice president of pharmacy strategy at Walgreens.

Rite Aid adopted a prescription delivery program during the Covid-19 pandemic through a partnership with ScriptDrop. Service fees are currently waived for all eligible prescriptions, which excludes controlled substances and refrigerated medications but includes Paxlovid.

CVS also has one- or two-day delivery in most locations and on-demand delivery at some, which is provided free to people enrolled in the membership program.

In March, the Biden administration launched a federal Test-to-Treat initiative that streamlined access to Paxlovid for people who had Covid-19, with testing and prescribing all happening in one visit. In May, the program was broadened to specifically reach more vulnerable communities.

Khazanchi was author of a study published last month that found that Black and Hispanic people were more likely to live closer to Test-to-Treat sites than White people. But despite the physical proximity, these groups were less likely to get outpatient Covid-19 therapeutics – even though they’re at elevated risk of infection and severe disease.

Even if someone has a car or another way to get to the doctor’s office, pharmacy or other Test-to-Treat location, they’re often challenged by the time required to make that trip, said Dr. Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

“It’s a combination of things that prevent access to care,” said Werner, whose research has focused on health equity. “Often, people have to take time off of work to do that, and they don’t always have paid sick leave. Everyone’s lives are complicated, and sometimes it’s hard to balance competing priorities.”

According to a report from health analytics company IQVIA, 9% of all new prescriptions in 2019 were “abandoned” at pharmacies, representing a gap in physician-recommended care that was not received by the patient. But home delivery programs that have expanded throughout the Covid-19 pandemic may help.

“I think it may be important to think about other medications or conditions where the time to treatment really matters. And those may be the ones that I think would be ripe for this kind of home-based delivery system,” Werner said. “These are urgent things that people might otherwise show up to an urgent clinic or ER for and instead could just get a medication.”

With the expansion of things like telehealth and options for home care, experts say, the Covid-19 pandemic helped widen the picture of what health care can look like.

“For far too long, we’ve been bound by the idea that health care is something that occurs within the four walls of a hospital or clinic,” Werner said. “What the Covid pandemic really did, which is important, is it made people realize that health care should be accessible where and when people need it, and it doesn’t have to be delivered in the physical structure of a health care setting.”

Experts say that while it’s critical to break down barriers in terms of access to medication, it’s important to also address the issue of trust.

In the research about accessibility to Test-to-Treat sites, Khazanchi and his co-authors suggested that programs should leverage trusted community stakeholders like local health-care providers for in-person outreach and other “low-tech, high-touch” methods to ensure equitable use.

Dr. Kedar Mate, president and CEO of the Institute for Healthcare Improvement and assistant professor at Weill Cornell Medical College, thinks about it in terms of supply and demand.

“Getting treatments to people who need them is principally an issue around access and ensuring that the supply goes to where the people are,” he said. “There’s a different problem, though, on the demand side. Are patients willing or interested to get tested and then get treated if they are found to be positive? That has everything to do with a totally different set of challenges which have to do with trust, information, disinformation, misinformation and belief in the health system overall.”

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‘Living in despair and hopelessness’: A lack of affordable housing can put people’s health at risk | CNN

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KHN
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When Louana Joseph’s son had a seizure because of an upper respiratory infection in July, she abandoned the apartment her family had called home for nearly three years.

She suspected the gray and brown splotches spreading through the apartment were mold and had caused her son’s illness. Mold can trigger and exacerbate lung diseases such as asthma and has been linked to upper respiratory tract conditions.

But leaving the two-bedroom Atlanta apartment meant giving up a home that rented for less than $1,000 a month, a price that is increasingly hard to find even in the nation’s poorest neighborhoods.

“I am looking everywhere,” said Joseph, who is 33. “Right now, I can’t afford it.”

Since then, Joseph, her 3-year-old son, and infant daughter have teetered on the edge of homelessness. They have shuffled between sleeping in an extended-stay motel and staying with relatives, unsure when they might find a permanent place to live.

A nationwide affordable housing crisis has wreaked havoc on the lives of low-income families, like Joseph’s, who are close to the brink. Their struggle to stay a step ahead of homelessness is often invisible.

Rents soared during the pandemic, exacerbating an already-severe shortage of available housing in most U.S. cities. The result will be growing numbers of people stuck in substandard housing, often with environmental hazards that put them at higher risk for asthma, lead poisoning, and other medical conditions, according to academic researchers and advocates for people with low incomes. These residents’ stress levels are heightened by the difficulties they face paying rent.

“People are living in despair and hopelessness,” said Ma’ta Crawford, a member of the Human Relations Commission in Greenville County, South Carolina, who works with families living in extended-stay motels.

Housing instability — such as having trouble paying rent, living in crowded conditions, or moving frequently — can have negative consequences on health, according to the federal Office of Disease Prevention and Health Promotion.

In addition to potentially facing environmental risks, people who struggle with housing insecurity put off doctor visits, can’t afford food, and have trouble managing chronic conditions.

Losing a home can also trigger a mental health crisis. The suicide rate doubled from 2005 to 2010, when foreclosures, including those on rental properties, were historically high, according to a 2014 analysis, published in the American Journal of Public Health, that looked at 16 states.

Rents jumped 18% nationally from the first three months of 2021 to early 2022. And there is no county in the country where a minimum-wage worker could afford a two-bedroom rental home, according to an August report from the National Low Income Housing Coalition. Nationwide, only 36 affordable housing units are available for every 100 people in need, forcing many families to cobble together temporary shelter.

“It’s a vicious cycle,” Crawford said. “Every motel here has a school bus stop.”

In the Southeast, evictions are more common than anywhere else in the nation, says an analysis published this year in the Proceedings of the National Academy of Sciences.

Georgia has 19 evictions for every 100 renter households, according to data from the Eviction Lab at Princeton University. There are 23 evictions for every 100 renter households in South Carolina, and Virginia has 15 evictions per 100 renter households. The national rate is about eight evictions per 100.

Despite President Joe Biden’s promises to address the affordable housing shortage, researchers and activists say inflation — and Democratic deal-making — is only worsening the health threat.

Last year, the Biden administration included billions of dollars in the “Build Back Better” bill to increase the number of Housing Choice vouchers — a difficult-to-get benefit that helps people with low incomes pay rent. Under the voucher program, also known as Section 8, recipients put 30% of their income toward rent, and the federal government pays the remainder. Currently only 1 in 4 people who qualify receive the vouchers because of limited funding.

But lawmakers stripped out the provision that raised the number of vouchers, a compromise to pass the bill that became known as the Inflation Reduction Act.

About 2.3 million households rely on the program to help pay rent. Joseph applied years ago but has yet to receive any benefits.

The day before her son was born in September 2019, Joseph moved into an apartment complex in southwestern Atlanta, one of the poorest sections of the city. A year later, she upgraded to a two-bedroom unit in the same complex that cost $861 a month, far less than the typical apartment in metro Atlanta.

Recently, Joseph returned to the two-bedroom apartment to show KHN its condition. What appeared to be mold surfaced after a pipe burst and the air conditioning broke, but the complex owners did little to fix the situation, Joseph said.

The gray and brown splotches were on her mattress, sofa, and other plastic-wrapped belongings. They covered boxes of diapers stacked on dressers, an Elmo doll lying facedown, a child’s sneaker, and pink onesies.

After a pipe burst and the air conditioning broke in Louana Joseph's apartment, gray and black splotches covered a ventilation grille.

A property manager at Seven Courts Apartments, where Joseph lived, declined to comment when reached by phone. The management company did not respond to repeated requests for comment.

A few months after leaving the apartment, Joseph and her two children moved in with her sister in Orlando, Florida, with their remaining possessions — a car and some clothes.

A lack of affordable housing can force families with low incomes, like Joseph’s, to endure health risks such as mold, vermin, and water leaks, said Alex Schwartz, a housing expert at the New School in New York City. And the trauma of evictions, foreclosures, and homelessness can undermine physical and mental well-being, Schwartz said.

For five years, Nancy Painter lived in an apartment in Greenville, South Carolina, that had mold and cracks in the walls, ceiling, and floor. Sometimes, Painter said, she carried a can of bug killer in both hands to fend off roaches.

An autoimmune disease makes her extremely susceptible to colds and other respiratory illnesses, and arthritis causes her crippling pain. But she stayed in the apartment until last year because the rent was $325 a month. Painter moved out only after the landlord made plans to renovate the unit and raise the rent.

Painter, 64, now lives on about $1,100 in Social Security disability benefits. Her poor health left her unable to keep working in a fast-food job. She pays more than 70% of her income for a room in a house she shares with other adults who can’t find affordable housing.

Such renters should put no more than 30% of their income toward housing so they have enough left over for other basic needs, according to federal government formulas. “My options are so slim,” Painter said. “All I want is a small place where I can have a garden.”

In August, Louana Joseph's son, M.J., developed an upper respiratory infection that his mother suspects was caused by mold that was spreading in their apartment.

The problems are especially acute among Black people and other groups that have been denied good jobs, mortgages, and opportunities long beyond the Jim Crow era, said Dr. Steven Woolf, a professor of population health and health equity at Virginia Commonwealth University. Life expectancy can vary by 15 to 20 years between different neighborhoods in the same city, he said.

Federal lawmakers routinely fail to prioritize the nearly 50-year-old housing voucher program, said Kirk McClure, a professor emeritus of urban planning at the University of Kansas. The U.S. offers less help with housing than do other rich countries, like the United Kingdom and Australia, where voucher programs allow everyone who meets income requirements to get help, McClure said.

“In the wealthiest society in the world, we could give every poor person a voucher,” McClure said. “This doesn’t require anything magical.”

Officials from the U.S. Department of Housing and Urban Development, which oversees the voucher program, did not respond when asked whether the administration planned to push for more housing vouchers.

Joseph’s prospects of finding another home remain dim as rents skyrocket.

The fair-market rent — which is determined annually by the federal government based on a rental home’s size, type, and location — for a two-bedroom home in the U.S. reached $1,194 a month, on average, in 2019, according to a 2020 report from the National Low Income Housing Coalition. A family of four living on poverty-level income could afford $644 a month, the report said. In the city of Atlanta, the median rent for apartments of all sizes is $2,200, up nearly 30% since January 2021, according to the real estate website Zillow.

A lack of child care has kept Joseph from pursuing full-time jobs. But she can’t qualify for one state child care assistance program since she doesn’t have full-time employment, and another state program she sought out won’t have openings until next year.

She sued the Seven Courts Apartments’ owner in small claims court in June for $5,219 to compensate her for the ruined belongings and rent she has already paid. A settlement could allow her to move into a new home.

“I am stuck because I have nowhere else to go,” Joseph said.

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New boosters add limited protection against Covid-19 illness, first real-world study shows | CNN

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CNN
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Updated Covid-19 boosters that carry instructions to arm the body against currently circulating Omicron subvariants offer some protection against infections, according to the first study to look at how the boosters are performing in the real world. However, the protection is not as high as that provided by the original vaccine against earlier coronavirus variants, the researchers say.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, called the new data “really quite good.”

“Please, for your own safety, for that of your family, get your updated Covid-19 shot as soon as you’re eligible to protect yourself, your family and your community,” Fauci said at a White House briefing Tuesday.

Uptake of the bivalent boosters, which protect against the BA.4/5 subvariants as well as the original virus strain, has been remarkably slow. Only 11% of eligible Americans have gotten them since they became available in early September.

The new study found that the updated boosters work about like the original boosters. They protect against symptomatic infection in the range of 40% to 60%, meaning that even when vaccine protection is its most potent, about a month after getting the shot, people may still be vulnerable to breakthrough infections.

That’s in about the same range as typical efficacy for flu vaccines. Over the past 10 years, CDC data shows, the effectiveness of the seasonal flu vaccines has ranged from a low of 19% to a high of around 52% against needing to see a doctor because of the flu. The effectiveness varies depending on how similar the strains in the vaccine are to the strains that end up making people sick.

The authors of the new study say people should realize that the Covid-19 vaccines are no longer more than 90% protective against symptomatic infections, as they were when they were first introduced in 2020.

“Unfortunately, the 90% to 100% protection was what we saw during like pre-Delta time. And so with Delta, we saw it drop into the 70% range, and then for Omicron, we saw it drop even lower, to the 50% range. And so I think what we’re seeing here is that the bivalent vaccine really brings you back to that sort of effectiveness that we would have seen immediately after past boosters, which is great. That’s where we want it to get,” said Dr. Ruth Link-Gelles, an epidemiologist at the US Centers for Disease Control and Prevention.

“This protection is not 100%, but it is something,” Link-Gelles said. “Especially going into the holidays where you’re likely to be traveling, spending time with elderly relatives, with vulnerable people. I think having some protection from infection and therefore some protection from infecting your loved one is better than having no protection at all.”

Link-Gelles says it also means that people should continue to adopt a layered approach to protection, utilizing rapid tests, good-quality masks and ventilation as a comprehensive approach, rather than relying on vaccines alone.

“This should be sort of one of the things in your toolbox for protecting yourself and your family,” she said. “Personally, we’re my family is all vaccinated up to date, but I think if we go to the airport tomorrow, we’ll be wearing our N95 [masks] because we’re seeing elderly relatives this weekend. And while we of course trust the vaccines, and I’m not super worried about a mild infection in myself or my healthy husband, we certainly would not want to infect his grandmother.”

Link-Gelles added that she expects that vaccine protection against severe outcomes from Covid-19, like hospitalization and death, will be higher, but that data isn’t in yet.

The study, which was led by CDC scientists, relied on health records from more than 360,000 tests given at nearly 10,000 retail pharmacies between Sept. 14 and Nov. 11, a period when the BA.4 and BA.5 subvariants were causing most Covid-19 infections in the US. The study included people ages 18 and up who had Covid-19 symptoms and were not immunocompromised.

The study looked at how effective the boosters were in two ways: Researchers calculated a value called absolute vaccine effectiveness, which compared the odds of symptomatic infection in people who received bivalent boosters with those who reported being unvaccinated. They also calculated relative vaccine effectiveness, which looked at the odds of symptomatic infection in people who received updated bivalent boosters compared with those who had two, three or four doses of the original single-strain vaccine.

Compared with people who were unvaccinated, adults 18 to 49 who had gotten bivalent boosters were 43% less likely to get sick with a Covid-19 infection. Older adults, who tend to have weaker immune function, got less protection. Those ages 50 to 64 were 28% less likely, and those ages 65 and up were 22% less likely to get sick with Covid-19 than the unvaccinated group.

The relative vaccine effectiveness showed the added protection people might expect on top of whatever protection they had left after previous vaccine doses. If a person was two to three months past their last vaccine dose, the bivalent boosters added an average of 30% protection for those who were ages 18 to 49, 31% more protection if they were 50 to 64, and 28% more protection if they were 65 or older. At 3 months after their last booster, people ages 50 and older still had about 20% protection from Covid-19 illness, CDC data show. So overall, the updated boosters got them to around 50% effectiveness against symptomatic infection.

If a person was more than eight months away from their last vaccine dose, they got more protection from the boosters. But Link-Gelles said that by eight months, there was little protection left from previous shots against Omicron and its variants, meaning the vaccine effectiveness for this group was probably close to their overall protection against infection.

Those ages 18 to 49 who were eight months or more past their last dose of a vaccine had 56% added protection against a Covid-19 infection with symptoms; adults 50 to 64 had 48% added protection, and adults over 65 had 43% added protection, on top of whatever was left from previous vaccinations.

John Moore, an immunologist and microbiologist at Weill Cornell Medicine, said it boils down to the fact that that boosters will probably cut your risk of getting sick by about 50%, and that protection probably won’t last.

“Having a booster will give you some additional protection against infection for a short term, which is always what we see with a booster, but it won’t last long. It’ll decline, and it will decline more as the more resistant variants spread,” said Moore, who was not involved in the new research.

The immunity landscape in the United States is more complex than ever. According to CDC data, roughly two-thirds of Americans have completed at least their primary series of Covid-19 vaccines. And data from blood tests shows that almost all Americans have some immunity against the virus, thanks to infection, vaccination or both.

A new preprint study from researchers at Harvard and Yale estimates that 94% of Americans have been infected with the virus that causes Covid-19 at least once, and 97% have been infected or vaccinated, increasing protection against a new Omicron infection from an estimated 22% in December 2021 to 63% by November 10, 2022. Population protection against severe disease rose from an estimated 61% in December 2021 to around 89%, on average, this November.

All of this means the US is in a better spot, defensively at least, than it ever has been against the virus – which is not to say that the country couldn’t see another Covid-19 wave, especially if a new variant emerges that is very different from what we’ve seen, if immunity continues to wane or if behavior shifts dramatically.



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New treatment for nightmares holds promise, study finds | CNN

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CNN
 — 

Heart pounding, I sit bolt upright in bed, flushed, sweaty and utterly panicked. My brain has snatched me from a nightmare — a dream so alarming I wake up.

I’ve only had one or two such night terrors, but for people suffering from trauma, post-traumatic stress disorder, depression or anxiety, frightening dreams may come night after night, ruining their sleep and ultimately their health.

Visions from nightmares can also creep like dark shadows into the light of the next day, disrupting a person’s ability to focus and think. Mood plummets, and anxiety rises. Days may be filled with an intense fear of falling asleep and trigger yet another terrifying dream.

Such symptoms can lead to a diagnosis of nightmare disorder, a sleep condition that affects about 4% of adults, according to the American Academy of Sleep Medicine.

Treatment can include stress reduction, counseling, gradual desensitization and medications, but the gold standard is imagery rehearsal therapy, a form of cognitive behavioral training that teaches people to reimagine their nightmares with positive endings. Still, not everyone with nightmare disorder responds to the treatment, experts say.

Now a new study has added a twist — playing a sound the person’s memory has associated with a more positive outcome during REM (rapid eye movement) or the dream stage of sleep. The result was a fourfold reduction in nightmares over the basic therapy alone.

“As far as I know, this is the first clinical and therapeutic study that uses target memory activation to accelerate and enhance therapy,” said lead author Dr. Lampros Perogamvros, a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva.

“This is a promising development. It does appear that adding a well-timed sound during REM sleep augments the effect of image rehearsal therapy … which is a standard and perhaps one of the most effective non-pharmacologic therapies at this time,” said Dr. Timothy Morgenthaler, lead author of the most recent American Academy of Sleep Medicine guidelines on nightmares.

“The result should be replicated,” said Morgenthaler, who was not involved in the study. “But I was a bit excited at this new possibility.”

Imagery rehearsal therapy has four basic steps that can be taught in one day, experts say. First, people are asked to write down every detail of their nightmare. Next, each person rewrites the nightmare with a positive arch, making sure that it ends with a pleasant or empowering solution or resolution.

Now the practice begins. The reworked dream must be rehearsed five to 20 minutes each day until it’s woven into the memory circuits of the brain. Once that is in place, it’s time to put it into action by rehearsing the new dream just before bed.

In the new study, published Thursday in the journal Current Biology, researchers added a twist to the therapy. Eighteen people with nightmare disorder heard a neutral sound — a piano cord — while they reinvented their nightmares in more positive ways. A control group of 18 people who also had nightmare disorder heard no additional sound, while they reworked their dreams.

All 36 people were given a headband called an actimeter to wear at night for two weeks. In addition to monitoring the stages of sleep, the device delivered sound in a way that would not wake the sleeper — via bone conduction.

“One of the significant things about this study’s intervention is the use of relatively new technology that can more accurately time the stimulus to true REM sleep,” said Morgenthaler, a professor of medicine at Mayo Clinic School of Medicine.

“Most wearable devices do not accurately measure actual REM sleep,” he added. “Of course, further study might find that the timing is not that critical — but that remains to be determined.”

The sound was delivered to both groups every 10 seconds during the dream stage of sleep over a two-week period. In this case, “imagery rehearsal therapy worked for all of the participants, including the control group,” Perogamvros said.

“But in the experimental group, where the sound was positively associated, the decrease was significantly bigger — they had nearly four times fewer nightmares,” he added.

Imagery rehearsal therapy also lessened overall distress, measures of mood and sleep quality in both groups, but nightmare reduction happened faster in the experimental group and persisted at a three-month follow-up, Perogamvros said. In addition, members of the group who heard the sound reported more joyful dream experiences during their dreams than those in the control group.

Additional research is needed to verify these results and expand upon the concept, but Perogamvros said he hoped the technique might lead to breakthroughs for the about 30% of patients who are unresponsive to imagery rehearsal therapy, also called IRT.

“The ideas underpinning the hypothesis that targeted memory reactivation might boost the effects of IRT have merit,” Morgenthaler said, “and this elegant test of that hypothesis strengthens that theory.”



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1 in 10 Americans over 65 have dementia, study finds | CNN

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CNN
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One in 10 Americans over 65 had dementia, while 22% experienced mild cognitive impairment, the earliest stage of the slow slide into senility, according to a new study conducted between 2016 and 2017.

The research, which the authors said is the first nationally representative examination of cognitive impairment prevalence in more than 20 years, was able to measure prevalence of dementia and mild cognitive impairment by age, education, ethnicity, gender and race.

The results showed older adults who self-identified as Black or African American were more likely to have dementia, while those who identify as Hispanic were more likely to suffer from mild cognitive impairment. People who had less than a high school education were more likely to have both conditions.

“Dementia research in general has largely focused on college-educated people who are racialized as white,” lead study author Jennifer Manly said in a statement.

“This study is representative of the population of older adults and includes groups that have been historically excluded from dementia research but are at higher risk of developing cognitive impairment because of structural racism and income inequality,” said Manly, professor of neuropsychology at the Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University.

“If we’re interested in increasing brain health equity in later life, we need to know where we stand now and where to direct our resources,” Manly said.

The study, published Monday in the journal JAMA Neurology, analyzed data from in-depth neuropsychological tests and interviews with nearly 3,500 people over age 65 enrolled in the Health and Retirement Study, a long-term research project sponsored by the National Institute on Aging and the Social Security Administration.

The research was based on a randomly selected sample of people from the study that completed the core survey and underwent neurological testing between June 2016 and October 2017.

Fifteen percent of people who identified as Black tested positive for dementia, while 22% had mild cognitive decline, the study found. Ten percent of people who identified as Hispanic had dementia, but the rate of milder issues was higher — 28% tested positive for mild cognitive impairment. Nine percent of White people had dementia, while 21% had mild cognitive impairment.

Educational achievement, which experts consider to be protective against cognitive decline, showed a significant divide: Nine percent of people with a college degree tested positive for dementia, compared with 13% of those who never received a high school diploma. Twenty-one percent of people over 65 with college degrees had mild cognitive decline, compared with 30% of those with less than a high school degree.

The extreme elderly had the highest rates of dementia and mild cognitive impairment. Only 3% of adults between 65 and 69 tested positive for dementia, compared with 35% of those 90 and older.

In fact, every five-year increase in age was associated with higher risk of dementia and mild cognitive impairment, the report said. The study, however, found no differences between men and women in rates of either condition

Symptoms of mild cognitive impairment can include losing items, forgetting to do things or go to appointments, or struggling to come up with words. A loss of smell and taste and movement issues can also be symptoms, according to the National Institute on Aging.

People with mild cognitive impairment are fully capable of taking care of themselves, “but what they have to go through to do so is exhausting,” Laura Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told CNN in an earlier interview. She was not involved in the current study.

People with mild cognitive impairment may not remember where they are supposed to be, Baker said. ” ‘Let me check my calendar. Oh, I forgot to write on this calendar. Let’s check another calendar. Oh, I can’t find that calendar. I’ve lost my phone. Where is the key? I can’t find the key.’ They’re able to regroup in the early stages and accomplish things, but the toll is immense.”

Not everyone with mild cognitive impairment goes on to develop dementia, although many do, experts say. Lifestyle changes may be a key to reversing mental decline. A 2019 study found personalized lifestyle interventions -— such as diet, exercise, stress reduction and sleep hygiene — not only stopped cognitive decline in people at risk for Alzheimer’s, but actually increased their memory and thinking skills over 18 months. Women responded better than men, a follow-up study found.

A February study found about a third of women 75 years or older with mild cognitive impairment reversed their progression to dementia at some point during follow-up. All of the women, however, had high levels of education and academic performance and excellent written language skills, or what experts call “cognitive reserve.”

Signs of dementia can differ from one person to the next, and can include memory loss and confusion, difficulty speaking, understanding and expressing thoughts, or reading and writing, according to the National Institutes of Health.

People with dementia can act impulsively or show poor judgment, and they can have trouble paying bills or handling money responsibly. They may repeat questions, use strange words to refer to familiar objects and take longer than usual to complete daily tasks.

Wandering and getting lost in a familiar neighborhood is another sign of dementia, as is losing interest in daily activities or events or acting as if they don’t care about other people’s feelings. They may lose their balance or have other problems with movement. At times, people with dementia can hallucinate or experience delusions or paranoia.

Alzheimer’s disease is the most well-known cause of dementia, but cognitive issues can be caused by vascular problems that block the flow of blood to the brain or via ministrokes caused by tiny blood clots traveling to the brain. Frontal lobe dementia, a rare form thought to be associated with abnormal amounts of the proteins tau and TDP-43, often begins in people younger than 60. Another type of decline, called Lewy body dementia, is thought to be caused by abnormal deposits of the protein alpha-synuclein, which are called Lewy bodies.

A person with signs of cognitive decline or dementia needs a full workup by a neurologist to determine the underlying cause, the NIH said. Side effects from a number of medications can mimic dementia, as can certain diseases, such as Huntington’s disease.

If you’ve just been diagnosed with dementia, continue to meet with doctors and specialists and consider asking for a referral to a memory clinic, according to the National Institutes of Health. Reach out to your local Alzheimer’s Disease Research Center and consider joining a clinical trial.

The Alzheimer’s Association has detailed information on the differences between dementia and Alzheimer’s, and it offers many levels of support for both patients and caregivers.

Work on staying healthy — exercise helps with mood, balance and thinking, while eating a well-balanced diet and getting quality sleep can improve the brain’s ability to function.



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