New research suggests that psychological resilience, ie having attitudes and behaviours that help people bounce back after stressful challenges, may help older individuals with type 2 diabetes to experience fewer hospitalisations and have better physical functioning, lower disability, better mental quality of life, and a lower likelihood of becoming frail.
The study, published in published in theJournal of the American Geriatrics Society, recruited 3199 participants, average age 72.2 years, 61% female, 61% white, and followed them for 14 years. The association of resilience with some metrics (grip strength and self-reported disability) varied based on recent hospitalisation history, and results suggested that some associations may differ based on race/ethnicity.
“This study suggests that individuals who report being psychologically resilient also report fewer aging-related concerns,” said lead author KayLoni L. Olson, PhD, of the Warren Alpert Medical School of Brown University. “This study is preliminary but points to the potential role of psychological resilience in helping individuals feel better mentally and physically, which can ultimately enhance their later years of life.”
For certain patients with vomiting and nausea in the emergency department (ED), haloperidol may be a better alternative to the usual ondansetron, according to a small study presented at the American College of Emergency Physicians annual meeting.
“[Haloperidol] is definitely a drug that’s going to help young patients with benign abdomens who come in with vomiting and generalised abdominal pain,” study presenter Jessica McCoy, MD, told MedPage Today.
Dr McCoy presented data showing that, at 90 minutes, median abdominal pain Visual Analogue Scale (VAS) score fell from 5 to 0 in the patients who received haloperidol compared with a VAS score drop from 6 to 3.5 in the ondansetron group.
Also at 90 minutes, median nausea VAS score fell from 7 to 0.5 in the haloperidol group versus 6 to 3.5 in the ondansetron group.
Of 48 patients (ages 18-55) who were included and completed the study, 22 were randomised to receive 2.5mg of intravenous haloperidol (half the usual dose) and 26 to receive 4mg of IV ondansetron.
Dr McCoy said despite concern over haloperidol prolonging the QT interval, no sign of a difference between the drugs was found. Among the 29 cannabis users in the study, haloperidol was not found to be superior at 90 minutes post-treatment, she said.
Halving the dose of haloperidol seemed to prevent common side effects of anxiety, sedation, and restlessness, Dr McCoy noted.
Adverse effects, which resolved by the time of discharge from the ED, included three cases of anxiety/restlessness and one case of tongue swelling in the haloperidol group and single cases of restlessness, sleepiness, and irritated throat in the ondansetron group.
Nausea and vomiting is commonly reported by ED patients, one of the top five complaints in the ED, and a diagnosis may be elusive if urgent treatment is not needed, she explained. “There’s this whole list of things it could be that make you feel lousy for a little bit but get better on their own.”
Increased chronic cannabis use, meanwhile, has caused more cases of nausea and vomiting, she said.
ED physicians often use ondansetron, developed for nausea in chemotherapy patients, Dr McCoy said. However, ondansetron “doesn’t work great. And it really wasn’t developed for people who were actively vomiting.”
The new study follows on from Dr McCoy’s previous research demonstrating the benefit of haloperidol for severe benign headache. She noted that the new study is small and was halted at the interim analysis due to COVID. At that time, ED waits were six or seven hours long, she said, and some patients with nausea and vomiting gave up and went home.
Dr McCoy noted that the ED physicians at her institution continue to turn to alternatives to ondansetron such as haloperidol in appropriate cases, especially in patients with anxiety. Haloperidol, however, is not appropriate, she cautioned, for more complex cases such as patients with rigid abdomens, possible dissections, or who have a need for surgery.
Like ondansetron, haloperidol is inexpensive, she added. “I hope [the new research] spurs more interest in studying this drug and its pain-relieving properties.”
A study published in the Journal of Orthopaedic Research showed that physical activity levels may impact adolescents’ and young adults’ leg alignment during development, as measured by magnetic resonance imaging (MRI) scans.
The study included 57 elite male soccer players compared with 34 male and 34 female controls aged 11–21 years. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length MRI scans, and a physical activity questionnaire score.
Using magnetic resonance imaging scans, physical activity levels were associated with the development of varsus or ‘knock knees’, an abnormal leg alignment, which may represent a physiological adaptation to load where the shin bone meets the knee.
“Our study suggests that abnormal leg alignment, a risk factor for future injury and osteoarthritis, develops in early adolescence due to high activity levels,” said corresponding author Scott Fernquest, DPhil, of the University of Oxford. “Modifying activity levels during this critical period of growth may prevent the development of abnormal leg alignment. We hope our findings lead to further research investigating this possibility.”
Scientists have developed a variety of games designed to boost older adults’ cognitive capacity. Co-creator Professor Adam Gazzaley, MD, PhD, said the games can be an “experiential medicine”. The games adapt to the players’ skill on the fly, and were shown to confer benefits on many important cognitive processes such as short-term memory, attention and long-term memory.
Each game uses adaptive closed-loop algorithms that Dr Gazzaley’s lab pioneered in the widely cited 2013 Neuroracer study published in Nature, which first demonstrated it was possible to restore diminished mental faculties in older people with just four weeks of training on a specially designed video game. The most recent game, which uses drumming, is described in in PNAS.
Watch a short video showing how the games Neuroracer and Body Brain Trainer, developed by the Neuroscape Center, improve cognitive function for multitasking and working memory, and can even be beneficial for conditions like ADHD, Parkinson’s, and multiple sclerosis.
These algorithms get better results than commercial games by automatically adjusting in difficulty according to the players’ skills. The games using these algorithms recreate common activities, such as driving, exercising and playing a drum, and use the skills each can engender to retrain cognitive processes that decline with age.
“All of these are taking experiences and delivering them in a very personalised, fun manner, and our brains respond through a process called plasticity,” said Prof Gazzaley at the UCSF Weill Institute for Neurosciences and who is founder and executive director of Neuroscape. “Experiences are a powerful way of changing our brain, and this form of experience allows us to deliver it in a manner that’s very accessible.”
The lab’s most recent invention is a musical rhythm game, developed in consultation with drummer Mickey Hart, that not only taught the 60 to 79-year-old participants how to drum, but also improved their ability to remember faces.
The eight-week program used visual cues to train people how to play a rhythm on an electronic tablet, with an algorithm matching difficulty to the player’s ability. The cues disappeared over time, forcing the players to memorise the rhythmic pattern.
When the participants were tested at the end to see how well they could recognise unfamiliar faces, electroencephalography (EEG) data showed increased activity in a part of the brain on the right side (the superior parietal lobule) that is involved both in sight reading music and in short-term visual memory for other tasks. The researchers said the data indicate that the training improved how people bring something into memory and then take it back out again when they need it.
A second game, the Body Brain Trainer, published recently in NPJ Aging, improved blood pressure, balance and attention in a group of healthy older adults with eight weeks of training, as well as a key signature of attention that declines with age. The game also included a feedback mechanism.
“We had people wearing a heart rate monitor, and we were getting that heart rate data and feeding it into the game,” said Joaquin A. Anguera, PhD, associate professor of neurology at UCSF and director of the Clinical Division at Neuroscape. “If they weren’t working hard enough, the game got harder.”
Neuroscape published the results of a third study last year in Scientific Reports on a virtual reality spatial navigation game called Labyrinth that improved long-term memory in older adults after four weeks of training.
“These are all targeting cognitive control, an ability that is deficient in older adults and that is critical for their quality of life,” Prof Gazzaley said. “These games all have the same underlying adaptive algorithms and approach, but they are using very, very different types of activity. And in all of them we show that you can improve cognitive abilities in this population.”
A world-first study published in the journal Diabetes, Obesity and Metabolism, has uncovered an association between metabolism and dementia-related brain measures, providing valuable insights about the disease.
Analysing UK Biobank data from 26 239 people, University of South Australia researchers found that those with obesity related to liver stress, or to inflammation and kidney stress, had the most adverse brain findings.
The study measured associations of six diverse metabolic profiles and 39 cardiometabolic markers, using MRI brain scan measures of brain volume, brain lesions, and iron accumulation, to identify early risk factors for dementia.
Participants with metabolic profiles associated with obesity were more likely to have adverse MRI profiles showing lower hippocampal and grey matter volumes, greater burden of brain lesions, and higher accumulation of iron.
UniSA researcher, Dr Amanda Lumsden, says the research adds a new layer of understanding to brain health.
“Dementia is a debilitating disease that affects more than 55 million people worldwide,” Dr Lumsden said.
“Understanding metabolic factors and profiles associated with dementia-related brain changes can help identify early risk factors for dementia.
“In this research, we found that adverse neuroimaging patterns were more prevalent among people who had metabolic types related to obesity.
“These people also had the highest Basal Metabolic Rate (BMR) -how much energy your body requires when resting in order to support its basic functions — but curiously, BMR seemed to contribute to adverse brain markers over and above the effects of obesity.”
Senior investigator Professor Elina Hyppönen said that the finding presents a new avenue for understanding brain health.
“This study indicates that metabolic profiles are associated with aspects of brain health. We also found associations with many individual biomarkers which may provide clues into the processes leading to dementia,” said Prof Hyppönen.
“The human body is complex, and more work is now needed to find out exactly why and how these associations arise.”
