Fever Burden Reduced by Automated Temperature Management Device in Stroke

 Didn't your competent? doctor start using this research a decade ago? NO? So you don't have a functioning stroke doctor, do you?

Reducing fever after a stroke June 2013

And this was followed up by your competent? doctor with EXACT PROTOCOLS  also!

Impact of Fever Prevention in Brain-Injured Patients (INTREPID): Study Protocol for a Randomized Controlled Trial March 2021

Do you prefer your doctor and hospital incompetence NOT KNOWING OR NOT DOING?

The latest here:

Fever Burden Reduced by Automated Temperature Management Device in Stroke

The use of an automated surface temperature management device reduced fever burden, but did not improve functional outcomes among patients with acute vascular brain injury.

An automated surface temperature management device effectively reduced fever burden among patients with acute vascular brain injury, but did not improve functional outcomes, according to results published in JAMA.

Researchers conducted an open-label randomized clinical trial with blinded outcome assessment (INTREPID; ClinicalTrials.gov Identifier: NCT02996266) between March 2017 and April 2020 to assess the effectiveness of an automated surface temperature management device (ArcticSun Temperature Management System) in the prevention of fever in patients with acute vascular brain injury and determine whether the device vs standard fever care improves functional outcomes. Critically ill patients with stroke at 43 intensive care units (ICUs) in 7 countries were randomly assigned 1:1 to receive fever prevention or standard care. In the fever prevention group, the target temperature was 37.0^oC for 14 days or until ICU discharge. Fever was defined as a temperature of at least 38^oC. The primary outcome was daily mean fever burden (^oC-hour) through day 14 or until ICU discharge. Fever burden was calculated as the area under the temperature curve over 37.9°C divided by the number of hours in the acute phase multiplied by 24 hours. The principal secondary outcome global disability at day 90 by modified Rankin Scale (mRS) score, with a good outcome defined as an mRS score of 0 to 3.

Fever prevention in patients with acute vascular brain injury using an automated surface temperature management device reduced fever burden but did not improve functional outcomes.”

A total of 677 patients comprised the primary analysis population, of whom 339 (mean age, 61; women, 52.2%; White, 60.2%; ischemic stroke, 37.8%) were randomly assigned to fever prevention and 338 (mean age, 60.4; men, 50.3%; White, 55.9%; ischemic stroke, 37.3%) to standard care.

Overall, daily mean fever burden was lower in the fever prevention (0.37^oC-hour) vs standard care (0.73^oC-hour) group (risk difference, -0.35; 95% CI, -0.51 to -0.20; P <.001).

By stroke subtype, daily mean fever burden was also lower in the fever prevention vs standard care group for the following subtypes:

• Ischemic stroke: 0.37^oC-hour vs 0.47^oC-hour (difference, -0.10^oC-hour; 95% CI, -0.35 to 0.15);
• Intracerebral hemorrhage: 0.29^oC-hour vs 0.79^oC-hour (difference, -0.50^oC-hour; 95% CI, -0.78 to -0.22); and,
• Subarachnoid hemorrhage: 0.47^oC-hour vs 0.99^oC-hour (difference, -0.52^oC-hour; 95% CI, -0.81 to -0.23).

Positive fever burden was lower in the fever prevention vs standard care group for ischemic stroke (relative risk [RR], 0.69; 95% CI, 0.54-0.88; P <.001), intracerebral hemorrhage (RR, 0.70; 95% CI, 0.57-0.85; P <.001), and subarachnoid hemorrhage (RR, 0.79; 95% CI, 0.68-0.93; P <.001) in a supportive analysis.

At 3 months, the median mRS was 4.0 for both cohorts (odds ratio [OR] for a favorable shift in functional outcome, 1.09; 95% CI, 0.81-1.46; P =.54). A good outcome was achieved by 39.2% and 42.8% of participants in the intervention and standard care cohorts, respectively (RR, 0.92; 95% CI, 0.76-1.12).

Study limitations include the variation in standard care across regions and centers, lack of clinician blinding, and reduced generalizability of results to sites with poorer expertise in ICU treatment of patients with stroke and targeted temperature management.

“Fever prevention in patients with acute vascular brain injury using an automated surface temperature management device reduced fever burden but did not improve functional outcomes,” the study authors concluded.

Disclosure: This research was supported by Becton, Dickinson and Company. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Drinking non-fermented milk may increase the risk of heart disease in women

 Your competent? doctor will need to reconcile these conflicting research pieces. Do you really think your doctor can do that?

Dairy fat from milk, butter, and cheese could actually PREVENT a heart attack September 2021

The latest here:

Drinking non-fermented milk may increase the risk of heart disease in women

Researchers analyzed data from over 100,000 Swedish adults over 33 years, though the study couldn't confirm a direct cause-and-effect link.

Study: Non-fermented and fermented milk intake in relation to risk of ischemic heart disease and to circulating cardiometabolic proteins in swedish women and men: Two prospective longitudinal cohort studies with 100,775 participants. Image Credit: Katarzyna Hurova/Shutterstock.com

In a recent study published in BMC Medicine, Swedish researchers explored the link between fermented and non-fermented milk consumption and heart health, specifically ischemic heart disease and myocardial infarction risk. Using data from two large Swedish cohort studies, the study examined the association between milk consumption and cardiometabolic protein patterns in the blood.

Background

Ischemic heart disease results primarily from restricted blood flow to the heart and is a significant global health issue and a major cause of early mortality. Although research indicates that cardiovascular health is influenced by multiple factors, including diet, the role of dairy products, especially milk, remains ambiguous.

Furthermore, different types of milk products, such as non-fermented fresh milk or fermented milk products such as yogurt, may affect heart health in distinct ways, possibly due to variations in the microbial content or bioactive compounds formed during fermentation.

Although milk is widely recommended as part of a balanced diet for its calcium, vitamin D, and protein content, studies on its cardiovascular impact have reported conflicting results. Some research suggests that high milk consumption might increase cardiovascular risks, while others find no link or even protective effects.

About the study

In the present study, the researchers aimed to clarify the impact of milk consumption on cardiovascular health, focusing on fermented and non-fermented milk intake and their potential effects on specific blood proteins related to heart disease. They analyzed data from two Swedish cohort studies, the Cohort of Swedish Men (COSM) and the Swedish Mammography Cohort (SMC), which cumulatively involved over 100,000 participants who were monitored for up to 33 years.

The participants were required to complete dietary and lifestyle questionnaires, which included details on milk consumption, categorized into non-fermented and fermented types. Additionally, blood samples were taken to assess cardiometabolic proteins. The researchers excluded participants who had a history of ischemic heart disease or cancer, and the final dataset consisted of over 40,000 men and close to 60,000 women.

Dietary intake was assessed through validated food frequency questionnaires, with milk intake specified by fat content (0.5%, 1.5%, or 3%) and type (non-fermented versus fermented). The total milk intake was calculated by combining the servings across types and fat contents. High-throughput immunoassays were used to measure the protein concentrations in blood, focusing on 276 proteins related to cardiometabolic health.

The study employed Cox proportional hazards regression models to evaluate the association between milk intake and the risk of ischemic heart disease or myocardial infarction, adjusting for factors such as age, physical activity, dietary habits, alcohol intake, and socioeconomic status. The analysis also assessed dose-response relationships for milk intake, with stratified analyses to explore potential modifiers like sex and lifestyle. Sensitivity analyses excluded the participants with comorbidities and assessed impacts across different intake levels and fat contents.

Results

The study found that increased consumption of non-fermented milk was associated with an elevated risk of ischemic heart disease and myocardial infarction in women but not in men. Specifically, women who consumed more than 300 mL of non-fermented milk (equating to 2 or more glasses) daily showed a significant increase in ischemic heart disease risk, with the hazard ratio increasing progressively with higher intake.

Furthermore, this association was consistent across all milk fat percentages (0.5%, 1.5%, and 3%) and was significant even after adjusting for lifestyle and dietary factors. In contrast, fermented milk intake was not linked to ischemic heart disease or myocardial infarction risk in either sex.

The study also found that women who consumed high amounts of non-fermented milk exhibited distinct patterns in cardiometabolic proteins. Higher intake of non-fermented milk was found to correlate with elevated levels of angiotensin-converting enzyme 2 (ACE-2), a protein that was associated with cardiovascular risks.

Additionally, the levels of fibroblast growth factor 21 (FGF21), a protein that is protective against cardiometabolic conditions, were found to be lower in women who consumed non-fermented milk in large amounts. These protein changes may reflect underlying biological pathways affected by non-fermented milk consumption, potentially explaining the higher ischemic heart disease risk observed in women.

Moreover, substitution analysis indicated that replacing non-fermented milk with fermented milk or fermented milk products such as yogurt could potentially lower the risk of ischemic heart disease, although further research is needed to confirm this possibility.

Conclusions

Overall, the study suggested that non-fermented milk, irrespective of fat content, may contribute to higher ischemic heart disease risk in women through pathways involving ACE-2 and FGF21.

The findings highlighted a potential sex-specific risk of ischemic heart disease associated with non-fermented milk intake, with a greater risk in women who consume large amounts of fresh milk. The study warranted further investigation into fermented milk products as a potentially safer dairy alternative.

Journal references:

• Michaëlsson, K., Lemming, E. W., Larsson, S. C., Höijer, J., Melhus, H., Svennblad, B., Baron, J. A., Wolk, A., & Byberg, L. (2024). Non-fermented and fermented milk intake in relation to risk of ischemic heart disease and to circulating cardiometabolic proteins in swedish women and men: Two prospective longitudinal cohort studies with 100,775 participants. BMC Medicine, 22(1), 483. doi:10.1186/s12916024036511, https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03651-1

   

A systematic review of techniques and clinical evidence to adopt virtual reality in post-stroke upper limb rehabilitation

 Where is the protocol on this located so survivors can deliver it to their therapists to implement? Not creating a protocol is a complete fucking failure of the mentors and senior researchers involved!

A systematic review of techniques and clinical evidence to adopt virtual reality in post-stroke upper limb rehabilitation

• V. Mani Bharathi,
• P. Manimegalai,
• S. Thomas George,
• D. Pamela,
• Mazin Abed Mohammed,
• Karrar Hameed Abdulkareem,
• Mustafa Musa Jaber &
• Robertas Damaševičius 

• 27 Accesses

• Explore all metrics

Abstract

Recognizing the limitations of traditional therapy can be tedious and demotivating, we explore VR’s dynamic and immersive environment to potentially improve patient engagement and motivation. This approach promises accelerated recovery by integrating real-time feedback and progress monitoring. This study aims to compare various VR training techniques employed for upper limb rehabilitation in stroke survivors. We have followed the PRISMA guidelines for systematic reviews. Articles were filtered with title words such as “virtual reality rehabilitation”, “rehabilitation”, “upper limb”, “lower limb”, “interactive gaming system”, and “VR based games” were searched in databases (LILACS, PUBMED, IEEE, WoS, and Scopus). Articles published between 2005 and 2021 were analyzed. There were 820 articles found, but only the most relevant 96 papers were analyzed. Most of the studies were randomised controlled trials (RCTs) that were submitted in 2014 or beyond. The sample size ranged from 5 to 96 persons with chronic stroke, or adults and seniors. There were no samples analyzed for those under the age of 18. Nintendo Wii® and Microsoft’s Kinect were the most popular video gaming systems. In most of the publications, the intervention took place 2–3 sessions per week, for about 2–12 weeks, with each session lasting 30 to 60 min. The most assessed outcomes were body steadiness, upper extremity motor capabilities, daily tasks, and quality of life. The Fugl–Meyer Assessment was one the commonly used tool for measuring outcomes. After VR therapy, the research found that quality of life, dynamic steadiness, and upper extremity movement function improved. To achieve dynamic equilibrium, VR proved more beneficial than traditional treatments. The most important outcomes, the researchers focused, were day-to-day activity and physical movements of the patients. Some studies investigated the early consequences of VR on daily activities and social involvement.

From Stroke to Strength: Building Mental Resilience

 Survivors shouldn't need resilience if your competent? doctor and hospital had 100% recovery protocols. This is just trying to dump responsibility on the patient as your stroke medical 'professional' runs away!

From Stroke to Strength: Building Mental Resilience

SALT LAKE CITY, Utah. (Ivanhoe Newswire) - Stroke — 800,000 people in the U.S. will suffer from one this year. It’s the leading cause of long-term disability.

It can impact a person’s speech, movement and memory. When treating patients who have had their life changed by a stroke, there are limits to what medicine can do(Well, solve those limits! Leaders would get to work and solve stroke to 100% recovery! There are NO LEADERS in stroke!). That’s why new interventions are being used that help promote resilience after a stroke.

“I felt like a pulsing all the way in the back of my head,” described Quincy Taylor.

That was the moment Quincy’s life changed forever.

“It was the worst pain that I’ve experienced so far in my life,” he said.

Quincy suffered a stroke. And like many survivors, he faced months of rehab working on his balance and coordination. But that’s not all survivors struggle with.

“Half of all stroke survivors will experience post-stroke depression at some point in time after their stroke,” explained Alexandra Terrill, PhD, Clinical Psychology at University of Utah Health.

Post-stroke depression can impact a patient’s motivation for rehab and can lead to social isolation. Studies show rates of hospitalization increase and relationships can suffer. Prof. Terrill led a study using positive psychology to help stroke survivors and their caregivers.

“Positive psychology is really something that’s focused on the strengths or resources that an individual has and that can be built upon,” she told Ivanhoe.

The eight-week program helps couples practice goal setting, communication strategies, gratitude, finding meaning and fostering connections with each other and those in their social circles.

“We saw a dramatic increase in resilience for the person who had the stroke,” said Prof. Terrill.

Resilience is a person’s ability to adapt and cope when faced with the challenges both mentally and physically after a stroke – and building resilience is just as important for the caregiver.

“Right now I’m feeling like I’m doing a little bit better than what I was before.”

The NIH reports that people who suffer post-stroke depression are more likely to be dependent for life on caregivers and have a higher risk of having another stroke. Prof. Terrill believes positive psychology can be a simple, cost-effective and life-saving solution to post-stroke depression. A larger NIH funded study is being conducted now across the United States.

CSP responds to RCOG and Stroke Association call for better access to rehab - UK

 WRONG, WRONG, WRONG! Survivors want recovery you blithering idiots, not 'access'! Does no one in the stroke medical world have two functioning neurons to rub together for a spark of intelligence? This is why survivors need to be in charge, even with damaged brains we know more about what survivors need than these idiots!

CSP responds to RCOG and Stroke Association call for better access to rehab

Two reports published this week highlight issues with accessing rehabilitation and specialist services, echoing our calls for long-term, ring-fenced funding.http://

The Royal College of Obstetricians and Gynaecologists (RCOG) has published a report stating that waiting times for gynaecology services have increased across the UK, with more than three quarters of a million women now waiting for treatment for non-cancer related conditions. 

At the same time, the Stroke Association has published latest figures from the Sentinel Stroke National Audit Programme (SSNAP) which covers England, Wales and Northern Ireland highlighting that fundamental aspects of acute stroke care have deteriorated compared to a decade ago. It points to health inequality created by inconsistent access to rehab across different regions.

Both reports echo CSP calls for protected funding for community services as part of the government’s ten-year plan to transform the NHS. The RCOG specifically references the need for specialist support, such as pelvic health physiotherapy, to help women waiting for care to manage their symptoms. 

The Stroke Association is calling for greater investment for in-hospital and community rehabilitation services. The CSP underscored the urgency of stroke rehab staffing across acute and community sectors being expanded to meet current NICE recommendations.

Sara Hazzard, CSP assistant director and co-chair of the Community Rehabilitation Alliance (CRA), said: 

It’s striking to see both of these reports released on the same day, each shining a light on the hundreds of thousands of people who are denied the care and support they need to live their lives to the fullest.

The latest SSNAP report shows a rise in people receiving integrated community-based rehabilitation, which is a step forward. 

'However, the more troubling trend is the significant decline allocated to essential therapies, including physiotherapy, over the past five years. Teams are typically seeing patients for 35 minutes of physiotherapy a day, falling short of the target of 45 minutes per day for those that need it. This reduction is a stark setback for patient care.'

Dr Kate Lough, chair of the Pelvic Obstetric and Gynaecology Physiotherapy (POGP) professional network, echoes the CSP call for protected long-term funding: 

Recent reports have highlighted the importance of connected and multidisciplinary care. It is key that women’s needs are identified and met by services that are available and these are prioritised for funding.

 Long term commitment will enable optimal service provision including developing appropriate resources that are accessible and cost-effective. 

'Physiotherapy training and postgraduate experience needs to include earlier access to skills development in key rehabilitation areas to ensure that workforce gaps in the NHS do not compromise healthcare.'

It is important that governments in all four UK countries fulfil policy commitments and act on these issues highlighted in both reports. Physiotherapy is essential to delivering the government’s ambitions to shift from ‘sickness to prevention’. 

Covid's Long-term Impact on Stroke Rehab Unveiled - Australia

 Why would you want to return to pre COVID levels? They were a complete failure at getting 100% recovered anyways! Your tyranny of low expectations is showing. Nothing will get better in stroke until survivors are in charge, so start scaling the walls. Or you could wait until these persons become the 1 in 4 per WHO that has a stroke : they'll want 100% recovery then and by then it will be too late.

Covid's Long-term Impact on Stroke Rehab Unveiled

A Stroke Foundation audit of Australian hospitals has highlighted the 'concerning' long-term impact of COVID-19 on inpatient stroke rehabilitation services.

Released today, the 2024 audit found that structures and resourcing at one in five audited services have still not returned to pre-pandemic levels, four years on.(And those levels were complete failures in getting to 100% recovery, weren't they?)

Stroke Foundation Chief Executive Officer, Dr Lisa Murphy, says this needs to change.

"Appropriate resourcing on inpatient rehabilitation wards is critical to delivering the best possible care(NOT RECOVERY!) to all survivors of stroke across Australia so they can make the best recovery possible after stroke."

The audit looked at various ways COVID-19 impacted rehabilitation services, such as: a relocation, or reduction, in the number of rehabilitation beds, changes in the format of ward rounds and redeployment of staff.

Of the hospitals audited, 60 per cent recorded a reduction in the number of rehabilitation beds, 96 per cent recorded staff shortages, and 63 per cent recorded staff being redeployed to other duties, at the time of the pandemic.

"The pandemic was hugely demanding and put a significant strain on Australia's health system. While this led to a rapid innovation in services such as use of telehealth. We cannot accept that there are still stroke rehabilitation services that have not yet returned to optimal resources. We should not have the continued crisis within the rehabilitation services that this data suggests," Dr Murphy said.

The report highlights areas of improvement and will inform conversations and recommendations to government and health care providers.

"This will allow us to set priorities for governments, health care administrators and health care professionals as we move forward in the post-pandemic era and strive for equitable access to appropriate, specialised and adequately resourced rehabilitation services for stroke."

"It is time to fill the critical gaps, view rehabilitation as an important next step in the patient's treatment journey and shift the focus from surviving to thriving."

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.           

Fitness Level May Offset Genetic Dementia Risk

 

 3 years post stroke at a physical I had a resting heart rate of 54 at age 53, level of an athlete. My doctor asked what exercises I was doing; 'I've done no exercises for the past 3 years'.  And now 18 years past the stroke my fitness has declined a bit, ALL BECAUSE MY STROKE MEDICAL 'PROFESSIONALS' COMPLETELY FAILED AT GETTING ME 100% RECOVERED!

Fitness Level May Offset Genetic Dementia Risk

      In middle-age and older adults, high cardiorespiratory fitness was linked with better cognition

by Judy George, Deputy Managing Editor, MedPage Today November 19, 2024

Key Takeaways

• High fitness was associated with lower dementia risk, even in people with genetic predisposition.
• Across all age groups between 39 and 70, higher fitness was tied to better cognitive function.
• Cardiorespiratory fitness may a predictor of cognitive health, the researchers suggested.

Genetic risk for Alzheimer's disease and dementia appeared to be partly offset by high levels of cardiorespiratory fitness, U.K. Biobank data suggested.

Overall, high cardiorespiratory fitness was associated with better global and domain-specific cognitive functions and lower risk of dementia in both middle-age and older adults, reported Weili Xu, PhD, of the Karolinska Institute in Stockholm, and co-authors.

The incidence rate ratio (IRR) of all-cause dementia was 0.60 (95% CI 0.48-0.76) for high versus low cardiorespiratory fitness. Dementia onset was delayed by 1.48 years (95% CI 0.58- 2.39) in the high fitness group.

Among people with moderate or high genetic dementia risk scores, high cardiorespiratory fitness attenuated dementia risk by 35% (IRR 0.65, 95% CI 0.52-0.83) compared with low fitness, Xu and colleagues said in the British Journal of Sports Medicine.

"Cardiorespiratory fitness may be used as a predictor of cognitive health," the researchers stated. "Enhancing cardiorespiratory fitness could be a strategy for the prevention of dementia, even among people with a high genetic predisposition for Alzheimer's disease."

No study to date has explored the combined effect of cardiorespiratory fitness and genetic risk on dementia, Xu and colleagues pointed out. "Open questions remain regarding whether and to what extent favorable cardiorespiratory fitness may reduce dementia risk, even in those with a high genetic predisposition for dementia," they noted.

In this analysis, the researchers followed 61,214 dementia-free U.K. Biobank participants ages 39-70 for a median of 11.72 years. Mean baseline age was 56 and 52% of participants were female.

A 6-minute submaximal exercise test on a stationary bike was completed at study enrollment (from 2006 through 2010) to estimate cardiorespiratory fitness. Fitness scores were divided into low, moderate, and high tertiles, standardized by age and sex.

Global and domain-specific cognitive function was evaluated at baseline. Dementia was identified over the follow-up period using medical history and medical records. Genetic predisposition for dementia was estimated using polygenic risk scores for Alzheimer's disease derived from genome-wide association studies.

During the follow-up period which spanned to 12 years, 553 people (0.9%) received a diagnosis of dementia. High cardiorespiratory fitness was associated with a lower risk of dementia and a delay in the onset of dementia across middle and older ages.

In multi-adjusted linear regression models, higher cardiorespiratory fitness was associated with better global cognitive function, prospective memory, verbal/numeric memory, and processing speed in all participants. The association between cardiorespiratory fitness and cognitive function was consistent in different age and genetic risk groups.

"Future research on the relationship between cardiorespiratory fitness and brain health, especially in older adults, is warranted, and the mechanisms by which cardiorespiratory fitness modifies the relationship between genetic risk and dementia deserve further investigation," Xu and colleagues observed.

"As the measurement of cardiorespiratory fitness in clinical settings becomes both important and feasible, cardiorespiratory fitness may be used as a routine health monitoring tool or an indicator of health conditions," they added.

The study was observational and cannot determine causality. Also, U.K. Biobank participants often are healthier than the general population, the researchers acknowledged.

U.K. Biobank participants with certain health conditions -- such as chest pain at rest, high weight, high blood pressure, or a pacemaker -- were excluded from the exercise test, which may have influenced outcomes. The submaximal exercise test used in this study is considered less accurate than maximal exercise testing which requires participants to exercise to exhaustion, Xu and co-authors said.

In addition, incident dementia cases were determined through register information, which might have led to an underestimation. Most participants did not have repeated cardiorespiratory fitness measurements, and relationships between changes in cardiorespiratory fitness and dementia risk could not be determined.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

This research was supported by the Swedish Research Council, the Swedish Council for Health Working Life and Welfare, and the Karolinska Institutet Research Foundation.

Xu and co-authors reported no conflicts of interest.

Primary Source

British‌ ‌Journal‌ ‌of‌ ‌Sports‌ ‌Medicine‌‌

Source Reference: Wang S, et al "Association of cardiorespiratory fitness with dementia risk across different levels of genetic predisposition: a large community-based longitudinal study" Br J Sports Med 2024; DOI: 10.1136/bjsports-2023-108048.

Combining cyproheptadine hydrochloride with targeted muscle activation training to treat upper extremity stroke: A randomized, placebo-controlled trial

So I guess this is why this drug is being used. Spasticity reduction. Only two years for your competent? doctor to figure how to treat your spasticity. Is your doctor competent at all?

Use of cyproheptadine hydrochloride (HCl) to reduce neuromuscular hypertonicity in stroke survivors: A Randomized Trial: Reducing Hypertonicity in Stroke October 2022

The latest here:

 Combining cyproheptadine hydrochloride with targeted muscle activation training to treat upper extremity stroke: A randomized, placebo-controlled trial

Archives of Physical Medicine and Rehabilitation. Volume 105(10), Pgs. 1938-1945.

NARIC Accession Number: J94231. What's this?
Author(s): Kamper, Derek, Bansal, Naveen, Barry, Alexander, Seo, Na J., Celian, Courtney, Vidakovic, Lynn, Stoykov, Mary E., Roth, Elliot.
Publication Year: 2024.
Abstract: Study evaluated a treatment for upper-extremity impairment in stroke survivors that combines administration of cyproheptadine hydrochloride with repetitive practice focused on control of muscle activation patterns. Participants received either a placebo or cyproheptadine hydrochloride in identical pill form. The daily dosage of cyproheptadine/placebo was gradually increased from 8 to 24 milligrams per day over 3 weeks and then maintained over the next 6 weeks while participants completed 18 therapy sessions. Therapy consisted of either: (1) active practice of muscle activation patterns to play "serious" computer games or control a custom hand exoskeleton or (2) passive, cyclical finger stretching imposed by the exoskeleton. Ninety-four stroke survivors with severe, chronic hand impairment were randomly assigned to 1 of 4 treatment groups (cyproheptadine-active, cyproheptadine-stretching, placebo-active, or placebo-stretching). The primary outcome was time to complete the Graded Wolf Motor Function Test (GWMFT); secondary outcome measures included finger strength and spasticity. Across the 88 participants who completed the study, a repeated-measures analysis of variance revealed a significant effect of group-by-evaluation interaction on GWMFT. The 3 groups receiving cyproheptadine and/or actively practicing muscle activation pattern control exhibited significant reduction in mean time to complete the GWMFT tasks; roughly one-third of these participants experienced at least a 10 percent reduction in completion time. Gains were maintained at the 1-month follow-up evaluation. The group receiving placebo and passive stretching did not show improvement. No significant differences among groups were observed in terms of changes in strength or spasticity.
Descriptor Terms: DEXTERITY, DRUGS, EXERCISE, LIMBS, MOTOR SKILLS, MUSCULAR IMPAIRMENTS, PHARMACOLOGY, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE, THERAPEUTIC TRAINING.


Can this document be ordered through NARIC's document delivery service*?: Request Information.

Citation: Kamper, Derek, Bansal, Naveen, Barry, Alexander, Seo, Na J., Celian, Courtney, Vidakovic, Lynn, Stoykov, Mary E., Roth, Elliot. (2024.) Combining cyproheptadine hydrochloride with targeted muscle activation training to treat upper extremity stroke: A randomized, placebo-controlled trial. Archives of Physical Medicine and Rehabilitation., 105(10), Pgs. 1938-1945. Retrieved 11/20/2024, from REHABDATA database.

Finger-Prick Test Brings Alzheimer’s Detection Closer to Everyone

 With this your competent? doctor can implement the EXACT DEMENTIA PROTOCOLS as soon as this diagnosis comes in. At least if you have a competent doctor! Do you have one? NO? RUN AWAY!

 With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING THIS!

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

Finger-Prick Test Brings Alzheimer’s Detection Closer to Everyone

Summary: A new Alzheimer’s test collects just a few drops of blood from a finger prick, which can be mailed to a lab for analysis. The test measures biomarkers like pTau217 and has shown similar accuracy to traditional venous blood sampling.

Unlike conventional methods, this approach doesn’t require cold-chain transportation, making it highly accessible for regions with limited infrastructure. With early detection critical for treatments like lecanemab, this test could revolutionize Alzheimer’s diagnosis and research accessibility worldwide.

Key Facts:

• The finger-prick test for Alzheimer’s biomarkers is nearly as accurate as venous sampling.
• Blood samples are mailed to labs without requiring specialized transportation.
• Early detection is key for effective treatments and expanding global research.

Source: University of Gothenburgh

A quick finger prick and a few drops of blood on a card that can be sent in regular mail. This approach could soon make Alzheimer’s testing much more accessible worldwide. A European study led by researchers at the University of Gothenburg, Sweden, is paving the way for this method.

The biomarkers measured in this test have been developed over a long period and have shown strong performance – initially in cerebrospinal fluid, then in venous blood samples, and now in blood from superficial vessels in the finger.

The test could potentially be implemented within a few years. Credit: Neuroscience News

The new test involves collecting one or two drops of blood from a finger prick onto a special card, which immediately separates blood cells from the plasma. After approximately 15 minutes, once the card has dried, it is sent by regular mail to a laboratory, where modern high-sensitivity techniques are used to analyze it.

As effective as venous blood sampling

The current study includes capillary blood samples from 203 people who underwent the finger prick test at one of five memory clinics in Europe. The simple test kit was then mailed to the neurochemistry department at the University of Gothenburg, where established biomarkers for Alzheimer’s, such as pTau217, were analyzed.

The results were presented at the CTAD (Clinical Trials on Alzheimer’s Disease) conference in Madrid, Spain, on October 30, 2024, by Hanna Huber, a researcher at the University of Gothenburg’s Sahlgrenska Academy:

“The simple capillary blood test works almost as well as venous samples, but unlike traditional blood tests, this new test does not require transport on dry ice. This could significantly increase accessibility to Alzheimer’s testing in countries and regions lacking the infrastructure needed for high-sensitivity analyses,” says Hanna Huber.

The test could potentially be implemented within a few years. A new European study is already underway to examine whether the test can be self-administered, allowing individuals to prick their own finger and mail the sample to a lab without the need for healthcare personnel.

Early detection

The test comes at a fitting time alongside the development of Alzheimer’s treatments, with the drug lecanemab already approved in numerous countries outside the EU. These treatments require early disease detection to be effective.

The test opens up possibilities for new research breakthroughs on Alzheimer’s disease, including its genetic profile and its prevalence across global populations. However, researchers emphasize that the test is not intended for general screening of the population.

The World Health Organization (WHO) currently advises against general screening for Alzheimer’s disease, as treatment options have historically been limited, making such screening ethically unsubstantiated.

The study utilizes the blood collection cards Capitainer®SEP10 and Telimmune.

About this Alzheimer’s disease research news

Author: Margareta Gustafsson Kubista
Source: University of Gothenburg
Contact: Margareta Gustafsson Kubista – University of Gothenburg
Image: The image is credited to Neuroscience News

Original Research: The findings were presented at CTAD (Clinical Trials on Alzheimer’s Disease)

The resilient brain: psychological resilience mediates the effect of amplitude of low-frequency fluctuations in orbitofrontal cortex on subjective well-being in young healthy adults

 6 years for your competent? doctor to comes up with ways to restore your resilience since you're going to need it, because your doctor HAS COMPLETELY FAILED AT PROVIDING 100% RECOVERY PROTOCOLS!

The resilient brain: psychological resilience mediates the effect of amplitude of low-frequency fluctuations in orbitofrontal cortex on subjective well-being in young healthy adults

. 2018 Jun 25;13(7):755–763. doi: 10.1093/scan/nsy045

Feng Kong ^1,✉, Xiaosi Ma ¹, Xuqun You ¹, Yanhui Xiang ²

PMCID: PMC6121151  PMID: 29939335

Abstract

Psychological resilience reflects the capacity to bounce back from stress, which plays an important role in health and well-being. However, less is known about the neural substrate for psychological resilience and the underlying mechanism for how psychological resilience enhances subjective well-being in the healthy brain. To investigate these issues, we employed fractional amplitude of low-frequency fluctuations (fALFF) measured with resting-state fMRI in 100 young healthy adults. The correlation analysis found that higher psychological resilience was related to lower fALFF in the left orbitofrontal cortex (OFC), which is involved in reward-related processing and emotion regulation. Furthermore, the mediation analysis indicated that psychological resilience acted as a full mediator of the association between the fALFF in left OFC and subjective well-being indicators (i.e. life satisfaction and hedonic balance). Importantly, these results remained significant after controlling for the effect of gray matter volume and regional homogeneity in the region. Overall, the present study provides the further evidence for functional neural substrates of psychological resilience and reveals a potential mechanism that psychological resilience mediates the effect of spontaneous brain activity on subjective well-being.

Keywords: resilience, subjective well-being, orbitofrontal cortex, amplitude of low-frequency fluctuations

Introduction

As an important personality trait, psychological resilience is defined as the capacity to bounce back from stress (Smith et al., 2010). It plays a protective role against disorders related to stress such as post-traumatic stress disorder (PTSD) (Agaibi and Wilson, 2005). Furthermore, psychological resilience is considered as a crucial concept in the field of positive psychology, and exhibits a beneficial effect on subjective well-being (Davydov et al., 2010; Hu et al., 2015). Subjective well-being reflects people’s cognitive (life satisfaction) and affective evaluations (hedonic balance) of their lives (Schimmack et al., 2002). A lot of research has found that psychological resilience is positively associated with hedonic balance and life satisfaction (Liu et al., 2012; Di Fabio and Palazzeschi, 2015; Kong et al., 2015d; Bajaj and Pande, 2016; Satici, 2016). In this study, we tried to investigate the neurobiological underpinnings of psychological resilience and the potential mechanism that how psychological resilience influences subjective well-being in the brain with resting-state fMRI (rs-fMRI).

Although psychological resilience is a hot topic in the field of positive psychology, limited work has used fMRI to explore the neurobiological underpinnings of resilience in healthy populations. For example, Waugh et al. (2008) used task-based fMRI (tfMRI) to probe this issue and found that, when facing with a threat, all of participants had prolonged activity in the insula to the aversive stimuli, but only low-resilient participants had prolonged activity in the insula to the neutral stimuli. Furthermore, Reynaud et al. (2013) found that high resilience was associated with increased activity in the amygdala and orbitofrontal cortex when responding to stress-related stimuli. However, these tfMRI results are limited to the regions that are activated by a certain task. Because psychological resilience is a complex construct, it should be related to different brain functions. Consistent with this view, evidence from studies on disorders related to stress has demonstrated that beyond the amygdala, insula and OFC, psychological resilience is also related to other regions within the prefrontal cortex (PFC) including anterior cingulate cortex (ACC) and medial PFC (mPFC) (Liberzon and Sripada, 2008; Milad et al., 2009; Sekiguchi et al., 2015).

Although psychological resilience has been defined as a dynamic process (Lutha and Cicchetti, 2000; Masten, 2001; Waugh and Koster, 2015), it has also often been considered as a stable trait (Jacelon, 1997; Waugh et al., 2011; Waaktaar and Torgersen, 2012), so its neural underpinnings might be related to the overall brain function under task-free conditions, which can be investigated by using the rs-fMRI based on measurements of low-frequency fluctuations (LFFs, 0.01–0.10 Hz) in the BOLD signal (Fox and Raichle, 2007; Biswal, 2012). Two increasingly popular measures of LFFs [e.g. regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF)] reflect local properties of spontaneous brain activity, but they characterize different aspects of the regional spontaneous activity. ReHo measures the temporal synchronization of the BOLD fluctuations in a given region (i.e. short range connectivity) that may reflect the interaction and integration among local voxels (Zang et al., 2004), whereas fALFF measures the amplitude of the BOLD fluctuations of each voxel (i.e. spontaneous brain activity intensity) (Zou et al., 2008). Importantly, the ReHo/fALFF measures have been used to identify the neural marker of mental disorders (Cheng et al., 2012; Dutta et al., 2014; Liu et al., 2014) and uncover the neural basis of individual differences in behavior in normal populations (Tian et al., 2012; Zou et al., 2013; Kong et al., 2015c, 2016a,b, 2018; Xiang et al., 2016). In addition, previous studies have found that the ReHo/fALFF could successfully predict task-evoked activations and behavioral performance (Mennes et al., 2011; Yuan et al., 2013; Zou et al., 2013). Therefore, these two measures can provide a useful tool to investigate neural correlates of psychological resilience.

Recently, Kong et al. (2015d) used the ReHo measure to explore neural correlates of trait resilience, and found that higher ReHo in the ACC and insula within salience network was associated with lower trait resilience. However, as Kong et al. (2015d) mentioned, this study failed to find an association of resilience with other PFC regions such as OFC, which has been demonstrated in studies on disorders related to stress, as well as studies on healthy populations (Liberzon and Sripada, 2008; Reynaud et al., 2013; Sekiguchi et al., 2015). Because both fALFF and ReHo reflect different aspects of the regional spontaneous activity (An et al., 2013; Tian et al., 2016; Zhao et al., 2016), so we wondered whether the association of psychological resilience with other PFC regions, especially OFC can be seen by using the measures on neuronal activity magnitude (i.e. fALFF). Recently, Wang et al. (2017) found a negative association between higher fALFF in the OFC and trait hope, which is a highly related construct to psychological resilience (Lloyd and Hastings, 2009; Satici, 2016). Thus, we speculated that the fALFF in the OFC could be negatively associated with psychological resilience.

Moreover, as we mentioned previously, behavioral studies have demonstrated that psychological resilience exhibits a beneficial effect on subjective well-being (Bajaj and Pande, 2016; Satici, 2016). Importantly, some regions with the PFC related to psychological resilience (e.g. OFC and ACC) are also found to be implicated in subjective well-being (Van Reekum et al., 2007; Kong et al., 2015a,c,d, 2016a;). Notably, Kong et al. (2015d) revealed that the ReHo in the ACC related to trait resilience could significantly predict the cognitive component of subjective well-being (i.e. life satisfaction), indicating that the ACC is an important site supporting the link between cognitive well-being and psychological resilience. However, there’re still several problems needing further research. On one hand, as mentioned earlier, this study did not find any association of other PFC subregions, especially OFC with psychological resilience and life satisfaction (Liberzon and Sripada, 2008; Reynaud et al., 2013; Sekiguchi et al., 2015; Kong et al, 2015c). On the other hand, this study focused on only the cognitive component of subjective well-being, but it is generally known that subjective well-being includes a cognitive component (i.e. life satisfaction) and an emotional component (i.e. hedonic balance).

To explore these issues, we used a standard instrument to measure psychological resilience in a sample of young healthy adults (N = 100). Then, we conducted a correlation analysis to investigate the relationship of psychological resilience with the fALFF across the brain. Based on previous neuroimaging studies on resilience, we speculated that the fALFF in the OFC would be negatively associated with psychological resilience. Finally, we conducted a mediation analysis to examine how the fALFF in these regions related to resilience, especially the OFC, affects two components of subjective well-being (e.g. hedonic balance and life satisfaction) through resilience. Based on previous behavioral and neuroimaging studies on resilience and well-being, we speculated that psychological resilience would mediate the relationship of the fALFF in the OFC with two components of subjective well-being.

More at link.

Scientists restore some functions in a pig’s brain hours after death

 If your competent? doctor isn't excited about this and doesn't inform you of this immediately, I'd question your doctor's ability to treat stroke patients. 

Scientists restore some functions in a pig’s brain hours after death

New Yale research challenges long-held assumptions about the timing and irreversible nature of the cessation of some brain functions after death.

By Bill Hathaway

April 17, 2019

Immunofluorescent stains for neurons (green), astrocytes (red), and cell nuclei (blue) in a region of the hippocampus of a pig’s brain left untreated 10 hours after death (left) or subjected to perfusion with the BrainEx technology. Ten hours postmortem, neurons and astrocytes undergo cellular disintegration unless salvaged by the BrainEx system. (Image credit: Stefano G. Daniele & Zvonimir Vrselja; Sestan Laboratory; Yale School of Medicine)

Circulation and cellular activity were restored in a pig’s brain four hours after its death, a finding that challenges long-held assumptions about the timing and irreversible nature of the cessation of some brain functions after death, Yale scientists report April 17 in the journal Nature.

The brain of a postmortem pig obtained from a meatpacking plant was isolated and circulated with a specially designed chemical solution. Many basic cellular functions, once thought to cease seconds or minutes after oxygen and blood flow cease, were observed, the scientists report.

“The intact brain of a large mammal retains a previously underappreciated capacity for restoration of circulation and certain molecular and cellular activities multiple hours after circulatory arrest,” said senior author Nenad Sestan, professor of neuroscience, comparative medicine, genetics, and psychiatry.

However, researchers also stressed that the treated brain lacked any recognizable global electrical signals associated with normal brain function.

At no point did we observe the kind of organized electrical activity associated with perception, awareness, or consciousness.

Zvonimir Vrselja

“At no point did we observe the kind of organized electrical activity associated with perception, awareness, or consciousness,” said co-first author Zvonimir Vrselja, associate research scientist in neuroscience. “Clinically defined, this is not a living brain, but it is a cellularly active brain.”

Cellular death within the brain is usually considered to be a swift and irreversible process. Cut off from oxygen and a blood supply, the brain’s electrical activity and signs of awareness disappear within seconds, while energy stores are depleted within minutes. Current understanding maintains that a cascade of injury and death molecules are then activated leading to widespread, irreversible degeneration.

However, researchers in Sestan’s lab, whose research focuses on brain development and evolution, observed that the small tissue samples they worked with routinely showed signs of cellular viability, even when the tissue was harvested multiple hours postmortem. Intrigued, they obtained the brains of pigs processed for food production to study how widespread this postmortem viability might be in the intact brain. Four hours after the pig’s death, they connected the vasculature of the brain to circulate a uniquely formulated solution they developed to preserve brain tissue, utilizing a system they call BrainEx. They found neural cell integrity was preserved, and certain neuronal, glial, and vascular cell functionality was restored.

The new system can help solve a vexing problem — the inability to apply certain techniques to study the structure and function of the intact large mammalian brain — which hinders rigorous investigations into topics like the roots of brain disorders, as well as neuronal connectivity in both healthy and abnormal conditions.

“Previously, we have only been able to study cells in the large mammalian brain under static or largely two-dimensional conditions utilizing small tissue samples outside of their native environment,” said co-first author Stefano G. Daniele, an M.D./Ph.D. candidate. “For the first time, we are able to investigate the large brain in three dimensions, which increases our ability to study complex cellular interactions and connectivity.”

While the advance has no immediate clinical application, the new research platform may one day be able to help doctors find ways to help salvage brain function in stroke patients, or test the efficacy of novel therapies targeting cellular recovery after injury, the authors say.

The research was primarily funded by the National Institutes of Health’s (NIH) BRAIN Initiative.

“This line of research holds hope for advancing understanding and treatment of brain disorders and could lead to a whole new way of studying the postmortem human brain,” said Andrea Beckel-Mitchener, chief of functional neurogenomics at the NIH’s National Institute of Mental Health, which co-funded the research.

The researchers said that it is unclear whether this approach can be applied to a recently deceased human brain. The chemical solution used lacks many of the components natively found in human blood, such as the immune system and other blood cells, which makes the experimental system significantly different from normal living conditions. However, the researcher stressed any future study involving human tissue or possible revival of global electrical activity in postmortem animal tissue should be done under strict ethical oversight.

Everyone agreed in advance that experiments involving revived global activity couldn’t go forward without clear ethical standards...

Stephen Latham

“Restoration of consciousness was never a goal of this research,” said co-author Stephen Latham, director of Yale’s Interdisciplinary Center for Bioethics. “The researchers were prepared to intervene with the use of anesthetics and temperature-reduction to stop organized global electrical activity if it were to emerge. Everyone agreed in advance that experiments involving revived global activity couldn’t go forward without clear ethical standards and institutional oversight mechanisms.”

There is an ethical imperative to use tools developed by the Brain Initiative to unravel mysteries of brain injuries and disease, said Christine Grady, chief of the Department of Bioethics at the NIH Clinical Center.

 “It’s also our duty to work with researchers to thoughtfully and proactively navigate any potential ethical issues they may encounter as they open new frontiers in brain science,” she said.

Quick Dementia Screening Test Shows Promise for Primary Care

 You just might want to know the EXACT PARAMETERS of this test so you can practice passing it. Because even if the screening shows you will likely get dementia, there is NOTHING YOUR DOCTOR CAN DO TO PREVENT IT!

Quick Dementia Screening Test Shows Promise for Primary Care

SEATTLE — A novel, quick, and low-cost dementia screening test could significantly improve early detection of Alzheimer's disease in primary care settings, according to research presented at the Gerontological Society of America (GSA) 2024 Annual Scientific Meeting.

The test, called qBEANS — short for Quick Behavioral Exam to Advance Neuropsychological Screening — involves patients spooning raw kidney beans into small plastic cups in a specific sequence to assess motor learning, visuospatial memory, and executive function. It requires no technology or wearable sensors, making it accessible and easy to implement.

Previous research has shown qBEANS to be sensitive and specific to Alzheimer's disease pathology, as well as predictive of cognitive and functional decline, the researchers said.

However, the current version of the test takes around 7 minutes to administer, which is too long for use in primary care, according to study author Sydney Schaefer, PhD, associate professor in the School of Biological and Health Systems Engineering at Arizona State University, Tempe, Arizona.

“The purpose of this study was to identify the minimum number of trials needed for reliability relative to the original longer version,” said Schaefer.

The study involved 48 participants without dementia, 77% of whom were women, and an average age of 75.4 years.

The researchers found that the shortened version of the qBEANS test takes only about 3.85 minutes on average — nearly 48% faster than the original version — while still maintaining high reliability (intraclass correlation of 0.85).

With its brevity and simplicity, the test could be easily administered by medical assistants during patient check-in, potentially increasing early dementia detection rates in primary care, said Schaefer.

While the shortened qBEANS test shows promise, further research is needed to assess its acceptability in primary care settings.

“The findings also warrant further development of the BEAN as a direct-to-consumer product, given its low cost and ease of administration,” said Schaefer.

However, Carla Perissinotto, MD, MHS, professor in the Division of Geriatrics at the University of California, San Francisco, cautioned that direct-to-consumer plans “could lead to participants not knowing what to do with the results out of context and without clinical input.”

“I'm not sure that we need to have a new evaluation tool, but instead, greater adoption of known and existing tools,” said Perissinotto, who was not involved in the study.

According to Perissinotto, existing cognitive screening tools Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are more commonly used to evaluate cognition and are also relatively quick to administer.

“If [qBEANS] is not benchmarked to other standard tools like the MMSE or MoCA, clinicians may have trouble interpreting results,” said Perissinotto.

Study co-authors Schaefer and Jill Love are co-founders and managing members of Neurosessments LLC, which developed the qBEANS test.

A New and Early Predictor of Dementia? Frailty

 

With your elevated chances of dementia post stroke, your competent? doctor and hospital are responsible for preventing that! Have they taken on that responsibility to prevent frailty by getting you 100% recovered? Or are they DOING NOTHING?

With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING THIS!

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

A New and Early Predictor of Dementia?

Signs of frailty may signal future dementia more than a decade before cognitive symptoms occur, in new findings that may provide a potential opportunity to identify high-risk populations for targeted enrollment in clinical trials of dementia prevention and treatment.

Results of an international study assessing frailty trajectories showed frailty levels notably increased in the 4-9 years before dementia diagnosis. Even among study participants whose baseline frailty measurement was taken prior to that acceleration period, frailty was still positively associated with dementia risk, the investigators noted.

"We found that with every four to five additional health problems, there is on average a 40% higher risk of developing dementia, while the risk is lower for people who are more physically fit," study investigator David Ward, PhD, of the Centre for Health Services Research, The University of Queensland, Brisbane, Australia, told Medscape Medical News.

David Ward, PhD

The findings were published online on November 11 in JAMA Neurology.

A Promising Biomarker

An accessible biomarker for both biologic age and dementia risk is essential for advancing dementia prevention and treatment strategies, the investigators noted, adding that growing evidence suggests frailty may be a promising candidate for this role.

To learn more about the association between frailty and dementia, Ward and his team analyzed data on 29,849 participants aged 60 years or above (mean age, 71.6 years; 62% women) who participated in four cohort studies: the English Longitudinal Study of Ageing (ELSA; n = 6771), the Health and Retirement Study (HRS; n = 9045), the Rush Memory and Aging Project (MAP; n = 1451), and the National Alzheimer’s Coordinating Center (NACC; n = 12,582).

The primary outcome was all-cause dementia. Depending on the cohort, dementia diagnoses were determined through cognitive testing, self- or family report of physician diagnosis, or a diagnosis by the study physician. Participants were excluded if they had cognitive impairment at baseline.

Investigators retrospectively determined frailty index scores by gathering information on health and functional outcomes for participants from each cohort. Only participants with frailty data on at least 30 deficits were included.

Commonly included deficits included high blood pressure, cancer, and chronic pain, as well as functional problems such as hearing impairment, difficulty with mobility, and challenges managing finances.

Investigators conducted follow-up visits with participants until they developed dementia or until the study ended, with follow-up periods varying across cohorts.

After adjusting for potential confounders, frailty scores were modeled using backward time scales.

Among participants who developed incident dementia (n = 3154), covariate-adjusted expected frailty index scores were, on average, higher in women than in men by 18.5% in ELSA, 20.9% in HRS, and 16.2% in MAP. There were no differences in frailty scores between sexes in the NACC cohort.

When measured on a timeline, as compared with those who didn't develop dementia, frailty scores were significantly and consistently higher in the dementia groups 8-20 before dementia onset (20 years in HRS; 13 in MAP; 12 in ELSA; 8 in NACC).

Increases in the rates of frailty index scores began accelerating 4-9 years before dementia onset for the various cohorts, investigators noted.

In all four cohorts, each 0.1 increase in frailty scores was positively associated with increased dementia risk.

Adjusted hazard ratios [aHRs] ranged from 1.18 in the HRS cohort to 1.73 in the NACC cohort, which showed the strongest association.

In participants whose baseline frailty measurement was conducted before the predementia acceleration period began, the association of frailty scores and dementia risk was positive. These aHRs ranged from 1.18 in the HRS cohort to 1.43 in the NACC cohort.

The 'Four Pillars' of Prevention

The good news, investigators said, is that the long trajectory of frailty symptoms preceding dementia onset provides plenty of opportunity for intervention.

To slow the development of frailty, Ward suggested adhering to the "four pillars of frailty prevention and management," which include good nutrition with plenty of protein, exercise, optimizing medications for chronic conditions, and maintaining a strong social network.

Ward suggested neurologists track frailty in their patients and pointed to a recent article focused on helping neurologists use frailty measures to influence care planning.

Study limitations include the possibility of reverse causality and the fact that investigators could not adjust for genetic risk for dementia.

Unclear Pathway

Commenting on the findings for Medscape Medical News, Lycia Neumann, PhD, senior director of Health Services Research at the Alzheimer's Association, noted that many studies over the years have shown a link between frailty and dementia. However, she cautioned that a link does not imply causation.

Lycia Neumann, PhD

The pathway from frailty to dementia is not 100% clear, and both are complex conditions, said Neumann, who was not part of the study.

"Adopting healthy lifestyle behaviors early and consistently can help decrease the risk of — or postpone the onset of — both frailty and cognitive decline," she said. Neumann added that physical activity, a healthy diet, social engagement, and controlling diabetes and blood pressure can also reduce the risk for dementia as well as cardiovascular disease.

The study was funded in part by the Deep Dementia Phenotyping Network through the Frailty and Dementia Special Interest Group. Ward and Neumann reported no relevant financial relationships.