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Gitlin LN, Arthur P, Piersol C, Hessels V, Wu SS, Dai Y, Mann WC. Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial. J Am Geriatr Soc 2017; 66:339-345. [PMID: 29192967 DOI: 10.1111/jgs.15194] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES Dementia-related behavioral symptoms and functional dependence result in poor quality of life for persons with dementia and their caregivers. The goal was to determine whether a home-based activity program (Tailored Activity Program; TAP-VA) would reduce behavioral symptoms and functional dependence of veterans with dementia and caregiver burden. DESIGN Single-blind (interviewer), parallel, randomized, controlled trial (Clinicaltrials.gov: NCT01357564). SETTING Veteran's homes. PARTICIPANTS Veterans with dementia and their family caregivers (N = 160 dyads). INTERVENTION Dyads in TAP-VA underwent 8 sessions with occupational therapists to customize activities to the interests and abilities of the veterans and educate their caregivers about dementia and use of customized activity. Caregivers assigned to attention control received up to 8 telephone-based dementia education sessions with a research team member. MEASUREMENTS Primary outcomes included number of behaviors and frequency of their occurrence multiplied by severity of occurrence; secondary outcomes were functional dependence, pain, emotional well-being, caregiver burden (time spent caregiving, upset with behaviors) and affect at 4 (primary endpoint) and 8 months. RESULTS Of 160 dyads (n = 76 TAP-VA; n = 84 control), 111 completed 4-month interviews (n = 51 TAP-VA; n = 60 control), and 103 completed 8-month interviews (n = 50 TAP-VA; n = 53 control). At 4 months, compared to controls, the TAP-VA group showed reductions in number (difference in mean change from baseline = -0.68, 95% CI = -1.23 to -0.13) and frequency by severity (-24.3, 95% CI = -45.6 to -3.1) of behavioral symptoms, number of activities needing assistance with (-0.80, 95% CI = -1.41 to -0.20), functional dependence level (4.09, 95% CI = 1.06, 7.13), and pain (-1.18, 95% CI = -2.10 to -0.26). Caregivers of veterans in TAP-VA reported less behavior-related distress. Benefits did not extend to 8 months. CONCLUSION TAP-VA had positive immediate effects and no adverse events. Because TAP-VA reduces behavioral symptoms, slows functional dependence, and alleviates pain and caregiver distress, it is a viable treatment option for families.
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Affiliation(s)
- Laura N Gitlin
- Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Paul Arthur
- Department of Occupational Therapy, St. Catherine University, Minneapolis, Minnesota.,Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida
| | - Catherine Piersol
- Department of Occupational Therapy and Jefferson Elder Care, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Virginia Hessels
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Yunfeng Dai
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - William C Mann
- Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System, Department of Veterans Affairs, Gainesville, Florida.,Department of Occupational Therapy, University of Florida, Gainesville, Florida
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Levine GN, Lange RA, Bairey-Merz CN, Davidson RJ, Jamerson K, Mehta PK, Michos ED, Norris K, Ray IB, Saban KL, Shah T, Stein R, Smith SC. Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2017; 6:e002218. [PMID: 28963100 PMCID: PMC5721815 DOI: 10.1161/jaha.117.002218] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.
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53
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Forbes TA, Gallo V. All Wrapped Up: Environmental Effects on Myelination. Trends Neurosci 2017; 40:572-587. [PMID: 28844283 PMCID: PMC5671205 DOI: 10.1016/j.tins.2017.06.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022]
Abstract
To date, studies have demonstrated the dynamic influence of exogenous environmental stimuli on multiple regions of the brain. This environmental influence positively and negatively impacts programs governing myelination, and acts on myelinating oligodendrocyte (OL) cells across the human lifespan. Developmentally, environmental manipulation of OL progenitor cells (OPCs) has profound effects on the establishment of functional cognitive, sensory, and motor programs. Furthermore, central nervous system (CNS) myelin remains an adaptive entity in adulthood, sensitive to environmentally induced structural changes. Here, we discuss the role of environmental stimuli on mechanisms governing programs of CNS myelination under normal and pathological conditions. Importantly, we highlight how these extrinsic cues can influence the intrinsic power of myelin plasticity to promote functional recovery.
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Affiliation(s)
- Thomas A Forbes
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC 20010, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's Research Institute, Children's National Medical Center, Washington, DC 20010, USA; The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.
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Buric I, Farias M, Jong J, Mee C, Brazil IA. What Is the Molecular Signature of Mind-Body Interventions? A Systematic Review of Gene Expression Changes Induced by Meditation and Related Practices. Front Immunol 2017; 8:670. [PMID: 28670311 PMCID: PMC5472657 DOI: 10.3389/fimmu.2017.00670] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/23/2017] [Indexed: 12/22/2022] Open
Abstract
There is considerable evidence for the effectiveness of mind–body interventions (MBIs) in improving mental and physical health, but the molecular mechanisms of these benefits remain poorly understood. One hypothesis is that MBIs reverse expression of genes involved in inflammatory reactions that are induced by stress. This systematic review was conducted to examine changes in gene expression that occur after MBIs and to explore how these molecular changes are related to health. We searched PubMed throughout September 2016 to look for studies that have used gene expression analysis in MBIs (i.e., mindfulness, yoga, Tai Chi, Qigong, relaxation response, and breath regulation). Due to the limited quantity of studies, we included both clinical and non-clinical samples with any type of research design. Eighteen relevant studies were retrieved and analyzed. Overall, the studies indicate that these practices are associated with a downregulation of nuclear factor kappa B pathway; this is the opposite of the effects of chronic stress on gene expression and suggests that MBI practices may lead to a reduced risk of inflammation-related diseases. However, it is unclear how the effects of MBIs compare to other healthy interventions such as exercise or nutrition due to the small number of available studies. More research is required to be able to understand the effects of MBIs at the molecular level.
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Affiliation(s)
- Ivana Buric
- Brain, Belief, and Behaviour Lab, Centre for Psychology, Behaviour, and Achievement, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Miguel Farias
- Brain, Belief, and Behaviour Lab, Centre for Psychology, Behaviour, and Achievement, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Jonathan Jong
- Brain, Belief, and Behaviour Lab, Centre for Psychology, Behaviour, and Achievement, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Christopher Mee
- Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Inti A Brazil
- Brain, Belief, and Behaviour Lab, Centre for Psychology, Behaviour, and Achievement, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.,Forensic Psychiatric Centre Pompestichting, Nijmegen, Netherlands.,Collaborative Antwerp Psychiatric Research Institute, Antwerp University, Antwerp, Belgium
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55
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Cluckey TG, Nieto NC, Rodoni BM, Traustadóttir T. Preliminary evidence that age and sex affect exercise-induced hTERT expression. Exp Gerontol 2017; 96:7-11. [PMID: 28587932 DOI: 10.1016/j.exger.2017.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/04/2017] [Accepted: 06/02/2017] [Indexed: 12/22/2022]
Abstract
The ability to repair cellular damage is reduced with aging, resulting in cellular senescence. Telomeres shorten as cells divide but the rate of telomere attrition is modulated by telomerase, an enzyme that adds nucleotides to the chromosome. Shelterin is a protein complex that acts as a negative regulator of telomerase. The aim of the present study was to investigate age-related differences in telomerase and shelterin responses to acute exercise. We hypothesized that acute exercise would stimulate an increased activity of telomerase (measured by telomerase reverse transcriptase, hTERT) without an increase in activity of shelterin (measured by telomeric repeat binding factor 2, TRF2) in both young and older individuals and that hTERT response would be attenuated in older individuals. Young (22±2y, n=11) and older (60±2y, n=8) men and women performed 30min of cycling. Blood was collected pre-exercise and 30, 60, and 90-min post-exercise. The trial induced a significant hTERT response in the cohort as a whole (p<0.05) with greater increases in the young as compared to the older group (time-by-group interaction p<0.05). As expected, TRF2 did not change in response to the trial, however older individuals had a higher TRF2 response at 60min (p<0.05). There was an unexpected sex difference, regardless of age, where men had significantly greater hTERT and TRF2 responses to the acute exercise as compared to women (p<0.05). These data support the hypothesis that aging is associated with attenuated telomerase activation in response to high-intensity exercise; however, this was only evident in men.
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Affiliation(s)
- Travis G Cluckey
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Nathan C Nieto
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Bridger M Rodoni
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Tinna Traustadóttir
- Department of Biological Sciences, Northern Arizona University, Flagstaff, AZ, United States.
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Weeks J. Does Whole-Person, Time-Intensive, Integrative Care Raise the 10 Percent Portion in Determinants of Health Attributed to Clinical Services? J Altern Complement Med 2017; 23:153-154. [DOI: 10.1089/acm.2017.29021.jjw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Weeks
- Editor-in-Chief, The Journal of Alternative and Complementary Medicine
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The protective properties of Act-Belong-Commit indicators against incident depression, anxiety, and cognitive impairment among older Irish adults: Findings from a prospective community-based study. Exp Gerontol 2017; 91:79-87. [PMID: 28257931 DOI: 10.1016/j.exger.2017.02.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/31/2017] [Accepted: 02/27/2017] [Indexed: 01/30/2023]
Abstract
The Act-Belong-Commit campaign is the world's first comprehensive, population-wide, community-based program designed to promote mental health. The campaign targets individuals to engage in mentally healthy activities, while at the same time, encouraging community organizations that offer such activities, to increase participation in their activities. Using nationally-representative data from Ireland, the aim of this study was to prospectively assess the association between indicators of the Act-Belong-Commit behavioral domains and incident depression, anxiety, and cognitive impairment. Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The analytical sample consisted of 6098 adults aged ≥50years. Validated scales for depression, anxiety, and cognitive impairment were used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act-Belong-Commit and incident depression, anxiety, and cognitive impairment at two-year follow-up. The adjusted model showed that each increase in the number of social/recreational activities (Act) inversely predicted the onset of depression, anxiety, and cognitive impairment. The same was the case for social network integration (Belong); that is, being well integrated into social networks was a significant protective factor against all mental health outcomes. Finally, frequency of participation in social/recreational activities (Commit) significantly and inversely predicted the onset of depression and anxiety, while the protective effect against cognitive impairment was only marginally significant. Act-Belong-Commit indicators are shown to be protective against mental disorders and cognitive impairment among older Irish adults. This provides further evidence for the campaign's potential efficacy and has potentially wide-ranging implications for preventing the deterioration of mental health and cognitive decline in the aging community.
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