Eve Bender

TOPLINE:

Exposure to more traffic-related air pollution is associated with greater levels of amyloid plaques in the brain, with exposure in the 3 years before death having the greatest risk, a new postmortem study showed.

METHODOLOGY:

• Investigators examined the brain tissue of 224 people living in the Atlanta area who agreed to donate their brains after death (average age of death, 76 years) for the presence of amyloid plaques and tau tangles.
• They also studied the amount of fine particulate matter < 2.5 microns (PM2.5) from traffic-related air pollution at participants’ home addresses at 1, 3, and 5 years before death.
• The presence of the APOE e4 gene was examined for evidence of any effect on the relationship between air pollution and evidence of Alzheimer’s disease (AD).

TAKEAWAY: 

The average level of exposure in the year before death was 1.32 µg/m³ and 1.35 µg/m³ in the 3 years before death.

People with 1 µg/m³ higher PM2.5 exposure in the year before death were nearly twice as likely to have higher levels of plaques (odds ratio [OR], 1.92; 95% CI, 1.12-3.30), while those with higher exposure in the 3 years before death were 87% more likely to have higher levels of plaques (OR, 1.87; 95% CI, 1.01-3.17).

A little more than half (56%) of the sample were positive for the APOE e4 genotype, but the strongest association between pollution and neuropathology markers was for noncarriers of the genotype, although this relationship did not reach statistical significance.

IN PRACTICE:

“More research is needed to establish causality for the association between PM2.5 and AD, including epidemiologic and mechanistic studies. Future studies should also investigate the association between PM2.5 and other dementia-related pathologies, including cerebrovascular pathology,” the study authors wrote. 

SOURCE:

Anke Hüls, PhD, of Emory University in Atlanta, led the study, which was published online on February 21, 2024, in Neurology.

LIMITATIONS:

The sample was not population-based but a convenience sample composed mostly of highly educated White participants.

DISCLOSURES:

The study was funded by the National Institute of Environmental Health Sciences, the Goizueta Alzheimer’s Disease Research Center, the National Institute on Aging, and the National Institutes of Health. There were no relevant disclosures. 
 

A version of this article appeared on Medscape.com.

TOPLINE:

Exposure to more traffic-related air pollution is associated with greater levels of amyloid plaques in the brain, with exposure in the 3 years before death having the greatest risk, a new postmortem study showed.

METHODOLOGY:

• Investigators examined the brain tissue of 224 people living in the Atlanta area who agreed to donate their brains after death (average age of death, 76 years) for the presence of amyloid plaques and tau tangles.
• They also studied the amount of fine particulate matter < 2.5 microns (PM2.5) from traffic-related air pollution at participants’ home addresses at 1, 3, and 5 years before death.
• The presence of the APOE e4 gene was examined for evidence of any effect on the relationship between air pollution and evidence of Alzheimer’s disease (AD).

TAKEAWAY: 

The average level of exposure in the year before death was 1.32 µg/m³ and 1.35 µg/m³ in the 3 years before death.

People with 1 µg/m³ higher PM2.5 exposure in the year before death were nearly twice as likely to have higher levels of plaques (odds ratio [OR], 1.92; 95% CI, 1.12-3.30), while those with higher exposure in the 3 years before death were 87% more likely to have higher levels of plaques (OR, 1.87; 95% CI, 1.01-3.17).

A little more than half (56%) of the sample were positive for the APOE e4 genotype, but the strongest association between pollution and neuropathology markers was for noncarriers of the genotype, although this relationship did not reach statistical significance.

IN PRACTICE:

“More research is needed to establish causality for the association between PM2.5 and AD, including epidemiologic and mechanistic studies. Future studies should also investigate the association between PM2.5 and other dementia-related pathologies, including cerebrovascular pathology,” the study authors wrote. 

SOURCE:

Anke Hüls, PhD, of Emory University in Atlanta, led the study, which was published online on February 21, 2024, in Neurology.

LIMITATIONS:

The sample was not population-based but a convenience sample composed mostly of highly educated White participants.

DISCLOSURES:

The study was funded by the National Institute of Environmental Health Sciences, the Goizueta Alzheimer’s Disease Research Center, the National Institute on Aging, and the National Institutes of Health. There were no relevant disclosures. 
 

A version of this article appeared on Medscape.com.

TOPLINE:

Exposure to more traffic-related air pollution is associated with greater levels of amyloid plaques in the brain, with exposure in the 3 years before death having the greatest risk, a new postmortem study showed.

METHODOLOGY:

• Investigators examined the brain tissue of 224 people living in the Atlanta area who agreed to donate their brains after death (average age of death, 76 years) for the presence of amyloid plaques and tau tangles.
• They also studied the amount of fine particulate matter < 2.5 microns (PM2.5) from traffic-related air pollution at participants’ home addresses at 1, 3, and 5 years before death.
• The presence of the APOE e4 gene was examined for evidence of any effect on the relationship between air pollution and evidence of Alzheimer’s disease (AD).

TAKEAWAY: 

The average level of exposure in the year before death was 1.32 µg/m³ and 1.35 µg/m³ in the 3 years before death.

People with 1 µg/m³ higher PM2.5 exposure in the year before death were nearly twice as likely to have higher levels of plaques (odds ratio [OR], 1.92; 95% CI, 1.12-3.30), while those with higher exposure in the 3 years before death were 87% more likely to have higher levels of plaques (OR, 1.87; 95% CI, 1.01-3.17).

A little more than half (56%) of the sample were positive for the APOE e4 genotype, but the strongest association between pollution and neuropathology markers was for noncarriers of the genotype, although this relationship did not reach statistical significance.

IN PRACTICE:

“More research is needed to establish causality for the association between PM2.5 and AD, including epidemiologic and mechanistic studies. Future studies should also investigate the association between PM2.5 and other dementia-related pathologies, including cerebrovascular pathology,” the study authors wrote. 

SOURCE:

Anke Hüls, PhD, of Emory University in Atlanta, led the study, which was published online on February 21, 2024, in Neurology.

LIMITATIONS:

The sample was not population-based but a convenience sample composed mostly of highly educated White participants.

DISCLOSURES:

The study was funded by the National Institute of Environmental Health Sciences, the Goizueta Alzheimer’s Disease Research Center, the National Institute on Aging, and the National Institutes of Health. There were no relevant disclosures. 
 

A version of this article appeared on Medscape.com.

TOPLINE:

Scents that trigger specific, vivid autobiographical memories (AMs) could improve deficits in memory recall in patients with major depressive disorder (MDD), new research suggests. Investigators found that odor cues may be a stronger tool than word cues for improving memory, which could help reduce MDD symptoms.

METHODOLOGY:

• Participants included 32 individuals aged 18-55 years (mean age, 30 years; 26 females) with a diagnosis of MDD recruited from the community.
• Those with psychosis, bipolar I or II, neurological disorders, or drug or alcohol abuse were excluded.
• Participants were presented with a series of 12 words and 12 odors, such as cough syrup, tobacco ash, and Vicks VapoRub, and asked to recall a specific memory in response to each cue.
• AMs were rated in terms of vividness, frequency, and whether they were associated with positive or negative emotions.

TAKEAWAY:

• Although participants only guessed correct stimulus odors 30% of the time, they recalled more specific memories from odor cues than from word cues (68% vs 52%; P < .001).
• Odor-cued recall was more arousing and vivid (P < .001) than recall responses generated by word cues.
• Compared with the population mean for responses to word cues in healthy controls, study participants recalled fewer specific memories in response to words (P < .001), but the percentage of specific memories recalled in response to odor cues did not differ from the healthy control population mean.
• Investigators hoped to further their research by investigating the mechanisms underlying odor-cued AMs, particularly to test if the amygdala and hippocampus are activated during recall.

IN PRACTICE:

“This study suggests the potential for increasing autobiographical memory specificity in individuals with MDD, with the future goal of reducing depression symptoms for this population and informing a better understanding of the neural mechanisms influencing odor-based AM recall,” the authors wrote. “We hope this initial study spurs larger studies in more diverse samples that include healthy control participants to further investigate and explain these associations.”

SOURCE:

Kymberly D. Young, PhD, of the University of Pittsburgh, Pennsylvania, led the study, which was published online on February 13, 2024, in JAMA Network Open. 

LIMITATIONS:

Study limitations included the lack of a healthy control group and the small sample size. 

DISCLOSURES:

The study was funded internally by the University of Pittsburgh School of Medicine, Pennsylvania. No disclosures were reported.

A version of this article appeared on Medscape.com.

TOPLINE:

Scents that trigger specific, vivid autobiographical memories (AMs) could improve deficits in memory recall in patients with major depressive disorder (MDD), new research suggests. Investigators found that odor cues may be a stronger tool than word cues for improving memory, which could help reduce MDD symptoms.

METHODOLOGY:

• Participants included 32 individuals aged 18-55 years (mean age, 30 years; 26 females) with a diagnosis of MDD recruited from the community.
• Those with psychosis, bipolar I or II, neurological disorders, or drug or alcohol abuse were excluded.
• Participants were presented with a series of 12 words and 12 odors, such as cough syrup, tobacco ash, and Vicks VapoRub, and asked to recall a specific memory in response to each cue.
• AMs were rated in terms of vividness, frequency, and whether they were associated with positive or negative emotions.

TAKEAWAY:

• Although participants only guessed correct stimulus odors 30% of the time, they recalled more specific memories from odor cues than from word cues (68% vs 52%; P < .001).
• Odor-cued recall was more arousing and vivid (P < .001) than recall responses generated by word cues.
• Compared with the population mean for responses to word cues in healthy controls, study participants recalled fewer specific memories in response to words (P < .001), but the percentage of specific memories recalled in response to odor cues did not differ from the healthy control population mean.
• Investigators hoped to further their research by investigating the mechanisms underlying odor-cued AMs, particularly to test if the amygdala and hippocampus are activated during recall.

IN PRACTICE:

“This study suggests the potential for increasing autobiographical memory specificity in individuals with MDD, with the future goal of reducing depression symptoms for this population and informing a better understanding of the neural mechanisms influencing odor-based AM recall,” the authors wrote. “We hope this initial study spurs larger studies in more diverse samples that include healthy control participants to further investigate and explain these associations.”

SOURCE:

Kymberly D. Young, PhD, of the University of Pittsburgh, Pennsylvania, led the study, which was published online on February 13, 2024, in JAMA Network Open. 

LIMITATIONS:

Study limitations included the lack of a healthy control group and the small sample size. 

DISCLOSURES:

The study was funded internally by the University of Pittsburgh School of Medicine, Pennsylvania. No disclosures were reported.

A version of this article appeared on Medscape.com.

TOPLINE:

Scents that trigger specific, vivid autobiographical memories (AMs) could improve deficits in memory recall in patients with major depressive disorder (MDD), new research suggests. Investigators found that odor cues may be a stronger tool than word cues for improving memory, which could help reduce MDD symptoms.

METHODOLOGY:

• Participants included 32 individuals aged 18-55 years (mean age, 30 years; 26 females) with a diagnosis of MDD recruited from the community.
• Those with psychosis, bipolar I or II, neurological disorders, or drug or alcohol abuse were excluded.
• Participants were presented with a series of 12 words and 12 odors, such as cough syrup, tobacco ash, and Vicks VapoRub, and asked to recall a specific memory in response to each cue.
• AMs were rated in terms of vividness, frequency, and whether they were associated with positive or negative emotions.

TAKEAWAY:

• Although participants only guessed correct stimulus odors 30% of the time, they recalled more specific memories from odor cues than from word cues (68% vs 52%; P < .001).
• Odor-cued recall was more arousing and vivid (P < .001) than recall responses generated by word cues.
• Compared with the population mean for responses to word cues in healthy controls, study participants recalled fewer specific memories in response to words (P < .001), but the percentage of specific memories recalled in response to odor cues did not differ from the healthy control population mean.
• Investigators hoped to further their research by investigating the mechanisms underlying odor-cued AMs, particularly to test if the amygdala and hippocampus are activated during recall.

IN PRACTICE:

“This study suggests the potential for increasing autobiographical memory specificity in individuals with MDD, with the future goal of reducing depression symptoms for this population and informing a better understanding of the neural mechanisms influencing odor-based AM recall,” the authors wrote. “We hope this initial study spurs larger studies in more diverse samples that include healthy control participants to further investigate and explain these associations.”

SOURCE:

Kymberly D. Young, PhD, of the University of Pittsburgh, Pennsylvania, led the study, which was published online on February 13, 2024, in JAMA Network Open. 

LIMITATIONS:

Study limitations included the lack of a healthy control group and the small sample size. 

DISCLOSURES:

The study was funded internally by the University of Pittsburgh School of Medicine, Pennsylvania. No disclosures were reported.

A version of this article appeared on Medscape.com.

TOPLINE:

Playing a musical instrument is associated with better working memory and executive function, and singing in a group is associated with better executive function, new study results showed.

METHODOLOGY:

• This was a nested study within PROTECT-UK, a longitudinal cohort study designed to examine aging and brain health. Participants completed three tests for working memory and one for executive function up to three times a year between 2019 and 2022.
• A group of 1107 participants (83% female; mean age 68 years) completed the Edinburgh Lifetime Musical Experience Questionnaire, which posed questions about playing musical instruments, singing, listening to music, and self-reported musical ability.
• Participants were split into two groups, namely, those who reported singing or playing a musical instrument (89%) or not (11%), and compared.

TAKEAWAY:

• Participants who reported playing a musical instrument performed significantly better on working memory (P < .0001) and executive function tasks (P < .0005) than those who didn’t play an instrument.
• The effect on working memory was the most heightened in those who reported playing keyboard (P < .0001), while those who played a woodwind instrument (P < .04) and/or sang (P < .014) showed significantly better performance on the executive function task.
• Nearly 90% of the sample had experience playing a musical instrument, with 44% playing currently. The majority of participants reported playing either one (28%) or two (23%) instruments.

IN PRACTICE:

Public health interventions might promote dementia risk reduction by incorporating music into programming, the authors concluded. “There is considerable evidence for the benefit of music group activities for individuals with dementia, and this approach could be extended as part of a health aging package for healthy older adults to enable them to proactively reduce their risk and to promote brain health,” they wrote.

SOURCE:

Gaia Vetere, MD, of the University of Exeter in Exeter, England, led the study, which was published online on January 28, 2024, in the International Journal of Geriatric Psychiatry.

LIMITATIONS:

The data were self-reported so may be subject to bias, and the size of the comparison group (those who didn’t play an instrument or sing) was much smaller.

DISCLOSURES:

The study was funded by the National Institute for Health and Care Research Exeter Biomedical Research Centre. Disclosures were noted in the original article.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Playing a musical instrument is associated with better working memory and executive function, and singing in a group is associated with better executive function, new study results showed.

METHODOLOGY:

• This was a nested study within PROTECT-UK, a longitudinal cohort study designed to examine aging and brain health. Participants completed three tests for working memory and one for executive function up to three times a year between 2019 and 2022.
• A group of 1107 participants (83% female; mean age 68 years) completed the Edinburgh Lifetime Musical Experience Questionnaire, which posed questions about playing musical instruments, singing, listening to music, and self-reported musical ability.
• Participants were split into two groups, namely, those who reported singing or playing a musical instrument (89%) or not (11%), and compared.

TAKEAWAY:

• Participants who reported playing a musical instrument performed significantly better on working memory (P < .0001) and executive function tasks (P < .0005) than those who didn’t play an instrument.
• The effect on working memory was the most heightened in those who reported playing keyboard (P < .0001), while those who played a woodwind instrument (P < .04) and/or sang (P < .014) showed significantly better performance on the executive function task.
• Nearly 90% of the sample had experience playing a musical instrument, with 44% playing currently. The majority of participants reported playing either one (28%) or two (23%) instruments.

IN PRACTICE:

Public health interventions might promote dementia risk reduction by incorporating music into programming, the authors concluded. “There is considerable evidence for the benefit of music group activities for individuals with dementia, and this approach could be extended as part of a health aging package for healthy older adults to enable them to proactively reduce their risk and to promote brain health,” they wrote.

SOURCE:

Gaia Vetere, MD, of the University of Exeter in Exeter, England, led the study, which was published online on January 28, 2024, in the International Journal of Geriatric Psychiatry.

LIMITATIONS:

The data were self-reported so may be subject to bias, and the size of the comparison group (those who didn’t play an instrument or sing) was much smaller.

DISCLOSURES:

The study was funded by the National Institute for Health and Care Research Exeter Biomedical Research Centre. Disclosures were noted in the original article.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Playing a musical instrument is associated with better working memory and executive function, and singing in a group is associated with better executive function, new study results showed.

METHODOLOGY:

• This was a nested study within PROTECT-UK, a longitudinal cohort study designed to examine aging and brain health. Participants completed three tests for working memory and one for executive function up to three times a year between 2019 and 2022.
• A group of 1107 participants (83% female; mean age 68 years) completed the Edinburgh Lifetime Musical Experience Questionnaire, which posed questions about playing musical instruments, singing, listening to music, and self-reported musical ability.
• Participants were split into two groups, namely, those who reported singing or playing a musical instrument (89%) or not (11%), and compared.

TAKEAWAY:

• Participants who reported playing a musical instrument performed significantly better on working memory (P < .0001) and executive function tasks (P < .0005) than those who didn’t play an instrument.
• The effect on working memory was the most heightened in those who reported playing keyboard (P < .0001), while those who played a woodwind instrument (P < .04) and/or sang (P < .014) showed significantly better performance on the executive function task.
• Nearly 90% of the sample had experience playing a musical instrument, with 44% playing currently. The majority of participants reported playing either one (28%) or two (23%) instruments.

IN PRACTICE:

Public health interventions might promote dementia risk reduction by incorporating music into programming, the authors concluded. “There is considerable evidence for the benefit of music group activities for individuals with dementia, and this approach could be extended as part of a health aging package for healthy older adults to enable them to proactively reduce their risk and to promote brain health,” they wrote.

SOURCE:

Gaia Vetere, MD, of the University of Exeter in Exeter, England, led the study, which was published online on January 28, 2024, in the International Journal of Geriatric Psychiatry.

LIMITATIONS:

The data were self-reported so may be subject to bias, and the size of the comparison group (those who didn’t play an instrument or sing) was much smaller.

DISCLOSURES:

The study was funded by the National Institute for Health and Care Research Exeter Biomedical Research Centre. Disclosures were noted in the original article.
 

A version of this article appeared on Medscape.com.

The number of state psychiatric hospital beds has hit a historic low with about 11 beds per 100,000 population, a new report showed.

More than half of those beds (52%) were occupied by forensic patients, individuals with serious mental illness (SMI) who were committed to the state hospital through the criminal legal system to help establish competency for trial.

“The shortage of psychiatric beds has real consequences for people with SMI — some will wait months in jail despite not yet being found guilty of a crime, others will be denied admission despite being critically ill, and others still will be discharged prematurely onto the streets to free up beds, where they may grow sicker and be at an elevated risk of mortality,” wrote report coauthors Shanti Silver of the Treatment Advocacy Center (TAC) in Arlington and Elizabeth Sinclair Hanq of the National Association of State Mental Health Program Directors in Alexandria, Virginia.

Published online on January 24, Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds recommends that state and local governments work together to open additional state psychiatric hospital beds for civil and forensic patients with SMI.

To obtain data about the availability of state psychiatric hospital beds, TAC surveyed state officials from April to August 2023. Official responses were provided by 41 states and the District of Columbia.

Information for the remaining states was gathered from state websites, media articles, preexisting reports, hospital admission staff, or personal contacts living in those states.

The median occupancy rate for state-run hospitals in the new report was 90%, well above the 85% level investigators say usually signals a bed shortage. Overall, 73% of states reported occupancy rates above that level, with 11 states operating at 95% capacity.

The proportion of state psychiatric beds occupied by forensic patients has increased by 12% since 2016, largely driven by the growing number of individuals awaiting a competency determination to stand trial. Before they occupy these beds, however, people with SMI can languish in jail for months or even years, waiting for a bed to open.

About 15% of all state hospital beds and 31% of forensic beds across 34 states were occupied by individuals who had been found not guilty of a crime by reasons of insanity.

“The prioritization of admission of forensic patients has effectively created a system where someone must be arrested to access a state hospital bed,” report coauthor Lisa Dailey, TAC executive director, told this news organization. “But there are not enough beds for forensic patients either; thousands of inmates are waiting in jail on any given day for a bed to open up.”

There are several factors contributing to the scarcity of beds, including an existing hospital staffing shortage made worse by the COVID-19 pandemic and a lack of appropriate discharge facilities.

Report authors offered a number of recommendations to federal, state, and local officials to increase the availability of state-run psychiatric hospital beds, including infrastructure changes involving recruiting and retaining staff for state hospitals and funding new discharge or step-down facilities so that patients have a place to recover when they leave the hospital.

Policy changes could also help, the report noted. Policymakers should consider “dismiss and transfer” procedures to address the backlog of nearly 6000 people with SMI waiting for a state hospital bed to achieve competency to stand trial. With “dismiss and transfer,” criminal charges are dismissed or suspended while an application for civil commitment is filed in the probate court. Once a civil commitment order has been issued, the individual is released to an outpatient commitment program for treatment.

“States must strive for prevention over punishment,” the report concluded.

There was no study funding reported, nor were disclosures available.
 

A version of this article appeared on Medscape.com.

The number of state psychiatric hospital beds has hit a historic low with about 11 beds per 100,000 population, a new report showed.

More than half of those beds (52%) were occupied by forensic patients, individuals with serious mental illness (SMI) who were committed to the state hospital through the criminal legal system to help establish competency for trial.

“The shortage of psychiatric beds has real consequences for people with SMI — some will wait months in jail despite not yet being found guilty of a crime, others will be denied admission despite being critically ill, and others still will be discharged prematurely onto the streets to free up beds, where they may grow sicker and be at an elevated risk of mortality,” wrote report coauthors Shanti Silver of the Treatment Advocacy Center (TAC) in Arlington and Elizabeth Sinclair Hanq of the National Association of State Mental Health Program Directors in Alexandria, Virginia.

Published online on January 24, Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds recommends that state and local governments work together to open additional state psychiatric hospital beds for civil and forensic patients with SMI.

To obtain data about the availability of state psychiatric hospital beds, TAC surveyed state officials from April to August 2023. Official responses were provided by 41 states and the District of Columbia.

Information for the remaining states was gathered from state websites, media articles, preexisting reports, hospital admission staff, or personal contacts living in those states.

The median occupancy rate for state-run hospitals in the new report was 90%, well above the 85% level investigators say usually signals a bed shortage. Overall, 73% of states reported occupancy rates above that level, with 11 states operating at 95% capacity.

The proportion of state psychiatric beds occupied by forensic patients has increased by 12% since 2016, largely driven by the growing number of individuals awaiting a competency determination to stand trial. Before they occupy these beds, however, people with SMI can languish in jail for months or even years, waiting for a bed to open.

About 15% of all state hospital beds and 31% of forensic beds across 34 states were occupied by individuals who had been found not guilty of a crime by reasons of insanity.

“The prioritization of admission of forensic patients has effectively created a system where someone must be arrested to access a state hospital bed,” report coauthor Lisa Dailey, TAC executive director, told this news organization. “But there are not enough beds for forensic patients either; thousands of inmates are waiting in jail on any given day for a bed to open up.”

There are several factors contributing to the scarcity of beds, including an existing hospital staffing shortage made worse by the COVID-19 pandemic and a lack of appropriate discharge facilities.

Report authors offered a number of recommendations to federal, state, and local officials to increase the availability of state-run psychiatric hospital beds, including infrastructure changes involving recruiting and retaining staff for state hospitals and funding new discharge or step-down facilities so that patients have a place to recover when they leave the hospital.

Policy changes could also help, the report noted. Policymakers should consider “dismiss and transfer” procedures to address the backlog of nearly 6000 people with SMI waiting for a state hospital bed to achieve competency to stand trial. With “dismiss and transfer,” criminal charges are dismissed or suspended while an application for civil commitment is filed in the probate court. Once a civil commitment order has been issued, the individual is released to an outpatient commitment program for treatment.

“States must strive for prevention over punishment,” the report concluded.

There was no study funding reported, nor were disclosures available.
 

A version of this article appeared on Medscape.com.

The number of state psychiatric hospital beds has hit a historic low with about 11 beds per 100,000 population, a new report showed.

More than half of those beds (52%) were occupied by forensic patients, individuals with serious mental illness (SMI) who were committed to the state hospital through the criminal legal system to help establish competency for trial.

“The shortage of psychiatric beds has real consequences for people with SMI — some will wait months in jail despite not yet being found guilty of a crime, others will be denied admission despite being critically ill, and others still will be discharged prematurely onto the streets to free up beds, where they may grow sicker and be at an elevated risk of mortality,” wrote report coauthors Shanti Silver of the Treatment Advocacy Center (TAC) in Arlington and Elizabeth Sinclair Hanq of the National Association of State Mental Health Program Directors in Alexandria, Virginia.

Published online on January 24, Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds recommends that state and local governments work together to open additional state psychiatric hospital beds for civil and forensic patients with SMI.

To obtain data about the availability of state psychiatric hospital beds, TAC surveyed state officials from April to August 2023. Official responses were provided by 41 states and the District of Columbia.

Information for the remaining states was gathered from state websites, media articles, preexisting reports, hospital admission staff, or personal contacts living in those states.

The median occupancy rate for state-run hospitals in the new report was 90%, well above the 85% level investigators say usually signals a bed shortage. Overall, 73% of states reported occupancy rates above that level, with 11 states operating at 95% capacity.

The proportion of state psychiatric beds occupied by forensic patients has increased by 12% since 2016, largely driven by the growing number of individuals awaiting a competency determination to stand trial. Before they occupy these beds, however, people with SMI can languish in jail for months or even years, waiting for a bed to open.

About 15% of all state hospital beds and 31% of forensic beds across 34 states were occupied by individuals who had been found not guilty of a crime by reasons of insanity.

“The prioritization of admission of forensic patients has effectively created a system where someone must be arrested to access a state hospital bed,” report coauthor Lisa Dailey, TAC executive director, told this news organization. “But there are not enough beds for forensic patients either; thousands of inmates are waiting in jail on any given day for a bed to open up.”

There are several factors contributing to the scarcity of beds, including an existing hospital staffing shortage made worse by the COVID-19 pandemic and a lack of appropriate discharge facilities.

Report authors offered a number of recommendations to federal, state, and local officials to increase the availability of state-run psychiatric hospital beds, including infrastructure changes involving recruiting and retaining staff for state hospitals and funding new discharge or step-down facilities so that patients have a place to recover when they leave the hospital.

Policy changes could also help, the report noted. Policymakers should consider “dismiss and transfer” procedures to address the backlog of nearly 6000 people with SMI waiting for a state hospital bed to achieve competency to stand trial. With “dismiss and transfer,” criminal charges are dismissed or suspended while an application for civil commitment is filed in the probate court. Once a civil commitment order has been issued, the individual is released to an outpatient commitment program for treatment.

“States must strive for prevention over punishment,” the report concluded.

There was no study funding reported, nor were disclosures available.
 

A version of this article appeared on Medscape.com.

Leading a healthy lifestyle, including regular exercise, eating fruits and vegetables, and minimal alcohol consumption, is associated with better cognitive function in older adults, new research showed.

The study, which combined longitudinal and cohort data with postmortem brain pathology reports, found that the association held even in those with Alzheimer’s disease (AD) pathology, suggesting that lifestyle factors may provide cognitive reserve and improve cognitive abilities in older age.

“While we must use caution in interpreting our findings, in part due to its cross-sectional design, these results support the role of lifestyle in providing cognitive reserve to maintain cognitive function in older adults despite the accumulation of common dementia-related brain pathologies,” Klodian Dhana, MD, of the Rush University Medical Center in Chicago, Illinois, and colleagues wrote.

The study was published online in JAMA Neurology.
 

Better Cognition

The study included 586 participants (71% female) who were followed from 1997 until 2022 as part of the Rush Memory and Aging Project longitudinal cohort study.

Investigators collected information on lifestyle and demographic factors at regular intervals, as well as information on diet, alcohol intake, and time spent participating in moderate or vigorous physical activity such as gardening, walking, calisthenics, biking, or swimming. Participants also received annual cognitive tests.

In later years, participants answered questions about whether they played card games or checkers, read, visited a museum, or did other cognitively stimulating activities.

Postmortem exams allowed the researchers to assess brain pathology (mean age at death, 91 years).

Participants were categorized as living a healthy lifestyle if they scored well in five categories: They exercised moderately or vigorously for 150 minutes per week, did not smoke, consumed one to two drinks per week, regularly played card games or did puzzles, and followed the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet.

For every one-point increase in the healthy lifestyle score, there were 0.120 fewer units of beta-amyloid load in the brain and a 0.22 standardized unit higher score in cognitive performance (P < .001).

After adjusting for the beta-amyloid load, phosphorated tau tangle, or other dementia-related brain pathologies, the healthy lifestyle score remained independently associated with cognition (P < .001).

More than 88% of a person’s global cognition score was a “direct association of lifestyle,” investigators noted, leaving slightly less than 12% affected by the presence of beta-amyloid.

“The mechanistic link between lifestyle and cognition could be attributed in part to the antioxidant and anti-inflammatory capacities of each lifestyle factor (eg, nutrition and physical activity) and cognitive reserve (eg, cognitive activities) that contribute to less inflammation and oxidative stress,” the authors wrote.

Further studies are necessary, they added, especially research investigating the association of lifestyle factors with markers for inflammation to understand the mechanisms of how lifestyle is associated with better cognitive scores in old age.

Study limitations include the reliance on self-reported data because cognitive impairment could interfere with inaccurate reporting. In addition, the authors noted that cognitive abilities may affect adherence to lifestyle factors.
 

‘Important Evidence’

In an accompanying editorial, Yue Leng, MD, and Kristine Yaffe, MD, of the University of San Francisco in San Francisco, California, noted that the new study adds “important evidence” to the debate over modifiable risk factors and reduction of AD risk.

“These interesting results add strength to the concept that health and lifestyle factors are important strategies for prevention and suggest that several mechanisms may be at work,” they wrote, adding that the study is “one of the first to harness brain pathology to investigate these mechanisms and is a crucial step forward in addressing these important questions.”

Still, critical questions remain regarding the mechanistic pathways linking modifiable risk factors and cognitive aging, Drs. Leng and Yaffe wrote.

“There is an urgent need for more well-designed randomized controlled trials to pave the way for dementia risk reduction in the era of precision medicine,” they wrote. “These strategies should be offered in conjunction with AD medications, similar to the approach in cardiovascular disease prevention and treatment in which medications along with lifestyle strategies are the standard of care.”

The study was funded by the National Institute on Aging. Dr. Dhana reported grants paid to his institution from the Alzheimer’s Association. No other disclosures were reported.

A version of this article appeared on Medscape.com.

Leading a healthy lifestyle, including regular exercise, eating fruits and vegetables, and minimal alcohol consumption, is associated with better cognitive function in older adults, new research showed.

The study, which combined longitudinal and cohort data with postmortem brain pathology reports, found that the association held even in those with Alzheimer’s disease (AD) pathology, suggesting that lifestyle factors may provide cognitive reserve and improve cognitive abilities in older age.

“While we must use caution in interpreting our findings, in part due to its cross-sectional design, these results support the role of lifestyle in providing cognitive reserve to maintain cognitive function in older adults despite the accumulation of common dementia-related brain pathologies,” Klodian Dhana, MD, of the Rush University Medical Center in Chicago, Illinois, and colleagues wrote.

The study was published online in JAMA Neurology.
 

Better Cognition

The study included 586 participants (71% female) who were followed from 1997 until 2022 as part of the Rush Memory and Aging Project longitudinal cohort study.

Investigators collected information on lifestyle and demographic factors at regular intervals, as well as information on diet, alcohol intake, and time spent participating in moderate or vigorous physical activity such as gardening, walking, calisthenics, biking, or swimming. Participants also received annual cognitive tests.

In later years, participants answered questions about whether they played card games or checkers, read, visited a museum, or did other cognitively stimulating activities.

Postmortem exams allowed the researchers to assess brain pathology (mean age at death, 91 years).

Participants were categorized as living a healthy lifestyle if they scored well in five categories: They exercised moderately or vigorously for 150 minutes per week, did not smoke, consumed one to two drinks per week, regularly played card games or did puzzles, and followed the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet.

For every one-point increase in the healthy lifestyle score, there were 0.120 fewer units of beta-amyloid load in the brain and a 0.22 standardized unit higher score in cognitive performance (P < .001).

After adjusting for the beta-amyloid load, phosphorated tau tangle, or other dementia-related brain pathologies, the healthy lifestyle score remained independently associated with cognition (P < .001).

More than 88% of a person’s global cognition score was a “direct association of lifestyle,” investigators noted, leaving slightly less than 12% affected by the presence of beta-amyloid.

“The mechanistic link between lifestyle and cognition could be attributed in part to the antioxidant and anti-inflammatory capacities of each lifestyle factor (eg, nutrition and physical activity) and cognitive reserve (eg, cognitive activities) that contribute to less inflammation and oxidative stress,” the authors wrote.

Further studies are necessary, they added, especially research investigating the association of lifestyle factors with markers for inflammation to understand the mechanisms of how lifestyle is associated with better cognitive scores in old age.

Study limitations include the reliance on self-reported data because cognitive impairment could interfere with inaccurate reporting. In addition, the authors noted that cognitive abilities may affect adherence to lifestyle factors.
 

‘Important Evidence’

In an accompanying editorial, Yue Leng, MD, and Kristine Yaffe, MD, of the University of San Francisco in San Francisco, California, noted that the new study adds “important evidence” to the debate over modifiable risk factors and reduction of AD risk.

“These interesting results add strength to the concept that health and lifestyle factors are important strategies for prevention and suggest that several mechanisms may be at work,” they wrote, adding that the study is “one of the first to harness brain pathology to investigate these mechanisms and is a crucial step forward in addressing these important questions.”

Still, critical questions remain regarding the mechanistic pathways linking modifiable risk factors and cognitive aging, Drs. Leng and Yaffe wrote.

“There is an urgent need for more well-designed randomized controlled trials to pave the way for dementia risk reduction in the era of precision medicine,” they wrote. “These strategies should be offered in conjunction with AD medications, similar to the approach in cardiovascular disease prevention and treatment in which medications along with lifestyle strategies are the standard of care.”

The study was funded by the National Institute on Aging. Dr. Dhana reported grants paid to his institution from the Alzheimer’s Association. No other disclosures were reported.

A version of this article appeared on Medscape.com.

Leading a healthy lifestyle, including regular exercise, eating fruits and vegetables, and minimal alcohol consumption, is associated with better cognitive function in older adults, new research showed.

The study, which combined longitudinal and cohort data with postmortem brain pathology reports, found that the association held even in those with Alzheimer’s disease (AD) pathology, suggesting that lifestyle factors may provide cognitive reserve and improve cognitive abilities in older age.

“While we must use caution in interpreting our findings, in part due to its cross-sectional design, these results support the role of lifestyle in providing cognitive reserve to maintain cognitive function in older adults despite the accumulation of common dementia-related brain pathologies,” Klodian Dhana, MD, of the Rush University Medical Center in Chicago, Illinois, and colleagues wrote.

The study was published online in JAMA Neurology.
 

Better Cognition

The study included 586 participants (71% female) who were followed from 1997 until 2022 as part of the Rush Memory and Aging Project longitudinal cohort study.

Investigators collected information on lifestyle and demographic factors at regular intervals, as well as information on diet, alcohol intake, and time spent participating in moderate or vigorous physical activity such as gardening, walking, calisthenics, biking, or swimming. Participants also received annual cognitive tests.

In later years, participants answered questions about whether they played card games or checkers, read, visited a museum, or did other cognitively stimulating activities.

Postmortem exams allowed the researchers to assess brain pathology (mean age at death, 91 years).

Participants were categorized as living a healthy lifestyle if they scored well in five categories: They exercised moderately or vigorously for 150 minutes per week, did not smoke, consumed one to two drinks per week, regularly played card games or did puzzles, and followed the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet.

For every one-point increase in the healthy lifestyle score, there were 0.120 fewer units of beta-amyloid load in the brain and a 0.22 standardized unit higher score in cognitive performance (P < .001).

After adjusting for the beta-amyloid load, phosphorated tau tangle, or other dementia-related brain pathologies, the healthy lifestyle score remained independently associated with cognition (P < .001).

More than 88% of a person’s global cognition score was a “direct association of lifestyle,” investigators noted, leaving slightly less than 12% affected by the presence of beta-amyloid.

“The mechanistic link between lifestyle and cognition could be attributed in part to the antioxidant and anti-inflammatory capacities of each lifestyle factor (eg, nutrition and physical activity) and cognitive reserve (eg, cognitive activities) that contribute to less inflammation and oxidative stress,” the authors wrote.

Further studies are necessary, they added, especially research investigating the association of lifestyle factors with markers for inflammation to understand the mechanisms of how lifestyle is associated with better cognitive scores in old age.

Study limitations include the reliance on self-reported data because cognitive impairment could interfere with inaccurate reporting. In addition, the authors noted that cognitive abilities may affect adherence to lifestyle factors.
 

‘Important Evidence’

In an accompanying editorial, Yue Leng, MD, and Kristine Yaffe, MD, of the University of San Francisco in San Francisco, California, noted that the new study adds “important evidence” to the debate over modifiable risk factors and reduction of AD risk.

“These interesting results add strength to the concept that health and lifestyle factors are important strategies for prevention and suggest that several mechanisms may be at work,” they wrote, adding that the study is “one of the first to harness brain pathology to investigate these mechanisms and is a crucial step forward in addressing these important questions.”

Still, critical questions remain regarding the mechanistic pathways linking modifiable risk factors and cognitive aging, Drs. Leng and Yaffe wrote.

“There is an urgent need for more well-designed randomized controlled trials to pave the way for dementia risk reduction in the era of precision medicine,” they wrote. “These strategies should be offered in conjunction with AD medications, similar to the approach in cardiovascular disease prevention and treatment in which medications along with lifestyle strategies are the standard of care.”

The study was funded by the National Institute on Aging. Dr. Dhana reported grants paid to his institution from the Alzheimer’s Association. No other disclosures were reported.

A version of this article appeared on Medscape.com.

In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.

Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.

“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”

The findings were published online on January 10, 2024, in Addiction.
 

Not the Only Indicator of Success

To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.

The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.

Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.

Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.

Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.

Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).

Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).

However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.

“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”

Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.

Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.

The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
 

A version of this article appeared on Medscape.com.

In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.

Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.

“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”

The findings were published online on January 10, 2024, in Addiction.
 

Not the Only Indicator of Success

To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.

The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.

Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.

Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.

Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.

Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).

Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).

However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.

“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”

Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.

Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.

The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
 

A version of this article appeared on Medscape.com.

In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.

Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.

“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”

The findings were published online on January 10, 2024, in Addiction.
 

Not the Only Indicator of Success

To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.

The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.

Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.

Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.

Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.

Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).

Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).

However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.

“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”

Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.

Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.

The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.

METHODOLOGY:

• Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
• A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
• All participants completed questionnaires about how sleepiness affected their driving.

TAKEAWAY:

• Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
• Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
• Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
• Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).

IN PRACTICE:

“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”

SOURCE:

Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.

LIMITATIONS:

Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.

DISCLOSURES:

There was no information available about study funding, and study authors had no disclosures.

A version of this article appeared on Medscape.com.

TOPLINE:

Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.

METHODOLOGY:

• Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
• A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
• All participants completed questionnaires about how sleepiness affected their driving.

TAKEAWAY:

• Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
• Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
• Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
• Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).

IN PRACTICE:

“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”

SOURCE:

Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.

LIMITATIONS:

Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.

DISCLOSURES:

There was no information available about study funding, and study authors had no disclosures.

A version of this article appeared on Medscape.com.

TOPLINE:

Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.

METHODOLOGY:

• Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
• A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
• All participants completed questionnaires about how sleepiness affected their driving.

TAKEAWAY:

• Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
• Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
• Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
• Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).

IN PRACTICE:

“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”

SOURCE:

Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.

LIMITATIONS:

Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.

DISCLOSURES:

There was no information available about study funding, and study authors had no disclosures.

A version of this article appeared on Medscape.com.

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

TOPLINE:

Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.

METHODOLOGY:

• Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
• Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
• Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.

TAKEAWAY:

• More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
• During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
• in men vs women (aHR, 1.43 vs 1.12; P = .042).
• Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.

IN PRACTICE:

“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.

SOURCE:

Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.

LIMITATIONS:

Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.

DISCLOSURES:

There was no information about study funding nor disclosures from study authors.
 

A version of this article appeared on Medscape.com.

TOPLINE: 

Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.

METHODOLOGY:

• To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
• Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
• Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.

TAKEAWAY: 

• During the study period, 1143 hospitalizations occurred over 41,849 person-months.
• 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
• Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
• Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).

IN PRACTICE:

“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.

SOURCE:

Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.

LIMITATIONS:

The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.

DISCLOSURES:

The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.

A version of this article appeared on Medscape.com.

TOPLINE: 

Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.

METHODOLOGY:

• To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
• Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
• Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.

TAKEAWAY: 

• During the study period, 1143 hospitalizations occurred over 41,849 person-months.
• 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
• Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
• Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).

IN PRACTICE:

“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.

SOURCE:

Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.

LIMITATIONS:

The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.

DISCLOSURES:

The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.

A version of this article appeared on Medscape.com.

TOPLINE: 

Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.

METHODOLOGY:

• To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
• Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
• Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.

TAKEAWAY: 

• During the study period, 1143 hospitalizations occurred over 41,849 person-months.
• 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
• Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
• Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).

IN PRACTICE:

“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.

SOURCE:

Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.

LIMITATIONS:

The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.

DISCLOSURES:

The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.

A version of this article appeared on Medscape.com.

TOPLINE: 

Pet ownership is associated with slower cognitive decline in seniors who live alone, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.

METHODOLOGY:

• Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
• Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
• 35% of participants were pet owners, and 27% lived alone.

TAKEAWAY: 

• Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
• Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
• There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

IN PRACTICE:

“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote. 

SOURCE:

Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.

LIMITATIONS:

Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.

DISCLOSURES:

The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.

TOPLINE: 

Pet ownership is associated with slower cognitive decline in seniors who live alone, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.

METHODOLOGY:

• Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
• Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
• 35% of participants were pet owners, and 27% lived alone.

TAKEAWAY: 

• Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
• Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
• There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

IN PRACTICE:

“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote. 

SOURCE:

Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.

LIMITATIONS:

Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.

DISCLOSURES:

The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.

TOPLINE: 

Pet ownership is associated with slower cognitive decline in seniors who live alone, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.

METHODOLOGY:

• Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
• Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
• 35% of participants were pet owners, and 27% lived alone.

TAKEAWAY: 

• Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
• Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
• There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

IN PRACTICE:

“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote. 

SOURCE:

Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.

LIMITATIONS:

Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.

DISCLOSURES:

The investigators reported no disclosures.
 

A version of this article appeared on Medscape.com.