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Older people in good shape have fitter brains

Seventy- to eighty-year-olds who train for better fitness are better at solving cognitive tasks and are less likely to suffer cognitive impairment.

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“Our findings suggest that being fit can protect against mild cognitive impairment in older people,” says Ekaterina Zotcheva.

Just before Christmas, Zotcheva defended her doctoral dissertation on exercise and brain health at the  Norwegian University of Science and Technology, NTNU. The day before the defence, the last study for her doctoral degree was published in the highly regarded Sports Medicine journal.

The article is just one of three recent research articles from NTNU that show how important it is for the brain to stay in good physical shape as you get older. Common to all three articles is that they are based on data from the world’s largest training study for older adults, the Generation 100 study from the Cardiac Exercise Research Group.

Dementia risk

“The Generation 100 study has been going on for almost ten years now. After the study participants had been exercising for five years, we tested the cognitive function of almost 1000 of them.”

“The men and women who had maintained or increased their physical fitness during the study had better brain health than those whose fitness had declined over the five years,” says Zotcheva.

The cognitive test that the participants took is the same one that is often used to check whether people are at risk of developing dementia.

The test assesses short-term memory, execution function and the ability to orient oneself in time and space. Scoring below a certain number indicates a risk of mild cognitive impairment.

“We know that mild cognitive impairment can lead to dementia for some individuals. The greater the increase in a participant’s fitness level during the five years of the study, the lower their probability was of developing mild cognitive impairment,” says Zotcheva.

Better at problem solving

Good conditioning appears to be an important prerequisite for good brain function in the elderly in the other two research articles as well. In both of these studies, the researchers tested the brain health of more than 100 of the participants in the Generation 100 study at start-up and after one, three and five years of training.

“Participants who were in good shape, both when the study started and later in the study, had a faster reaction time. The ones who improved their fitness level gained a somewhat better working memory,” says NTNU professor Asta Håberg.

The ability to solve cognitive problems was tested using the web-based Memoro platform, which Håberg developed in collaboration with neuropsychologist Tor Ivar Hansen.

Less brain atrophy

Håberg has been involved in the work with all three recent research articles. In the third study, the researchers performed MRI scans of the participants’ brains to see how the brain volume and thickness of the cerebral cortex changed throughout the study. Here, too, the most energetic participants came out best.

“Participants who were in good shape when the study started had a thicker cerebral cortex after one, three and five years, as compared with those who had lower maximum oxygen uptake. But we didn’t find any effect from increasing fitness during the study,” says Håberg.

The cerebral cortex is the outermost layer of the brain and is important for several important brain functions, such as attention, ability to make choices, working memory, abstract thinking and memory. This part of the brain becomes thinner with age, and thinning of the cerebral cortex in different areas is linked to different types of dementia, such as Alzheimer’s disease and frontotemporal dementia.

Fitness more important than type of exercise

All 70- to 77-year-olds in Trondheim were invited to the Generation 100 study in 2012. Those who agreed to participate were randomly assigned to five years of exercise of various kinds. One group would primarily do high intensity intervals, a second group would mainly go for walks or do other exercise with moderate intensity, and the last group would try to follow the activity recommendations of the health authorities to be physically active for at least 150 minutes each week.

The first two groups were followed up most closely by the researchers, and were offered two organized training sessions each week. The NTNU researchers looked beyond the connection between fitness and brain health and also investigated whether the type of training follow-up that participants received made a difference.

“Our results show that organized training follow-up may have given older men, but not older women, better cognitive function and lowered the probability of mild cognitive impairments. But all in all, it seems that the most important thing is that you actually train in a way that increases your fitness, regardless of whether you get organized help to be physically active or not,” says Zotcheva.

Less brain atrophy than expected

“In the groups that received follow-up with high-intensity training and training with moderate intensity, respectively, we found somewhat greater loss of brain volume in deep areas of the brain than among those who trained themselves. But we have to emphasize that everyone in the Generation 100 study – regardless of the form of exercise they did – had less brain loss than expected for people in their 70s. The group that trained on their own without organized follow-up had the least shrinkage in the hippocampus and thalamus,” Håberg says.

The training follow-up in Generation 100 was not decisive for the participants’ ability to solve cognitive tasks.

“The groups that were able to attend organized training didn’t perform any better than the group that trained on their own on various tasks, such as remembering where an object is located, memorizing words, processing information quickly or planning,” says Håberg.

Maintained good cognitive function

“It’s still worth noting that the 70-77-year-old participants on average had the same cognitive abilities after five years as at start-up, and that during the study period they even improved on some of the tests. The results show that being in good shape like the Generation 100 participants were, is important for maintaining good brain function,” Håberg says.

The training effect thus seems to be greatest for people who enter retirement age in good shape, and exercise that improves fitness can provide further benefits. So how should the elderly train to get in better shape?

“Several paths can lead to that goal, and the most important factor is to find an activity you enjoy and can continue with over time. In order to maintain or increase your fitness, you should in any case exercise regularly in a way that gets you out of breath and sweaty,” says Zotcheva.

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For people with migraine, feelings of stigma may impact disability, quality of life

For people with migraine, these feelings of stigma were linked to more disability, increased disease burden and reduced quality of life.

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Migraine can impact many aspects of a person’s life, but less is known about how feelings of stigma about the disease affect quality of life. For people with migraine, these feelings of stigma were linked to more disability, increased disease burden and reduced quality of life, according to new research published in the online issue of Neurology, the medical journal of the American Academy of Neurology.

“Stigma is common where the disease is not readily apparent to others, and there is indication that it could be especially relevant for those living with migraine,” said study author Robert Evan Shapiro, MD, PhD, of the University of Vermont and Fellow of the American Academy of Neurology. “This stigma may arise when a person with migraine recognizes negative stereotypes about the disease and experiences shame for having the disease, fear of experiencing stigma from others, or other negative emotions.”

For the study, researchers looked at 59,001 people with migraine with an average age of 41. Among all participants, 41% reported experiencing four or more headache days per month on average.

Participants answered 12 questions to assess two types of stigma: whether they felt others viewed migraine being used for secondary gain and whether they felt others were minimizing the burden of migraine. Questions included “How often have you felt that others viewed your migraine as a way to get attention?” “… as something that made things difficult for your co-workers or supervisor?” and “…with a lack of understanding of the pain and other symptoms?”

Researchers found that 32% of the participants experienced migraine-related stigma often or very often.

To assess migraine-related disability, participants reported the number of days they missed or had reduced productivity at work, home or social events over the previous three months. High scores on migraine-related stigma were linked with moderate to severe disability. Three-quarters of those who experienced stigma often or very often had moderate to severe disability, compared to 19% of those who never experienced stigma.

They also took a test assessing migraine-specific quality of life, which looked at the impact of migraine on social and work-related activities over the previous four weeks. Scores ranged from zero to 100 with higher scores meaning higher quality of life. Researchers found that those who experienced the highest rates of migraine-related stigma scored far lower in these tests, with an average score of 35 compared to those who did not experience stigma with an average score of 69.

The results remained the same after researchers adjusted for other factors that could affect disability and quality of life, such as age, employment status, other medical conditions and frequency of migraines.

They also found that the amount of stigma experienced increased with migraine severity. Those with 8-14 headache days or more than 15 monthly headache days were far more likely to report at least one form of stigma with 42% and 48%, respectively, compared to those with less than four monthly headache days with 26%.

“The social context of migraine may have a greater impact on quality of life than the number of monthly headache days,” said Shapiro. “However, it is possible that connecting with others with migraine may help decrease migraine-related stigma and stereotypes. More studies are needed to explore the mechanisms that link stigma to health outcomes.”

A limitation of the study was that participants self-reported their migraines, based on a questionnaire or a diagnosis from a health care provider, and they may not have remembered all the information accurately.

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Alcohol raises heart disease risk, particularly among women

Young to middle-aged women who reported drinking eight or more alcoholic beverages per week—more than one per day, on average—were significantly more likely to develop coronary heart disease compared with those who drank less.

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Young to middle-aged women who reported drinking eight or more alcoholic beverages per week—more than one per day, on average—were significantly more likely to develop coronary heart disease compared with those who drank less, finds a study presented at the American College of Cardiology’s Annual Scientific Session. The risk was highest among both men and women who reported heavy episodic drinking, or “binge” drinking, and the link between alcohol and heart disease appears to be especially strong among women, according to the findings.

The study focused on 18- to 65-year-old adults and is among the largest and most diverse studies to date examining the links between alcohol and heart disease. Heart attacks and other forms of heart disease are on the rise in younger populations in the U.S., fueling concern about worsening health outcomes. At the same time, alcohol use and binge drinking have become more common among women than in previous decades.

“When it comes to binge drinking, both men and women with excess alcohol consumption had a higher risk of heart disease,” said Jamal Rana, MD, PhD, FACC, a cardiologist with The Permanente Medical Group, adjunct investigator in the Division of Research at Kaiser Permanente Northern California and the study’s lead author. “For women, we find consistently higher risk even without binge drinking. I wasn’t expecting these results among women in this lower age group because we usually see increased risk for heart disease among older women. It was definitely surprising.”

The researchers used data from more than 430,000 people who received care in the Kaiser Permanente Northern California integrated health organization, including nearly 243,000 men and 189,000 women. Participants on average were 44 years old and did not have heart disease at the start of the study. Information on participants’ alcohol intake was collected during primary care visits using the health organization’s standard “Alcohol as a Vital Sign” screening initiative, which includes visual reference posters to help patients estimate alcohol quantities according to standard measurements.

Researchers analyzed the relationship between the level of alcohol intake participants reported in routine assessments from 2014-2015 and coronary heart disease diagnoses during the four-year period that followed. Coronary heart disease occurs when the arteries that supply blood to the heart become narrowed, limiting blood flow. This condition can cause chest pain and acute events, such as a heart attack.

Based on self-report assessments, researchers categorized participants’ overall alcohol intake as low (one to two drinks per week for both men and women), moderate (three to 14 drinks per week for men and three to seven drinks per week for women), or high (15 or more drinks per week for men and eight or more drinks per week for women). They separately categorized each participant as either engaging in binge drinking or not. Binge drinking was defined as more than four drinks for men or more than three drinks for women in a single day in the past three months. People who reported no alcohol use were not included in the study. The researchers adjusted the data to account for age, physical activity, smoking and other known cardiovascular risk factors.

Overall, 3,108 study participants were diagnosed with coronary heart disease during the four-year follow-up period, and the incidence of coronary heart disease increased with higher levels of alcohol consumption. Among women, those who reported high alcohol intake had a 45% higher risk of heart disease compared with those reporting low intake and had a 29% higher risk compared with those reporting moderate intake. The difference was greatest among individuals in the binge drinking category; women in this category were 68% more likely to develop heart disease compared with women reporting moderate intake. Men with high overall intake were 33% more likely to develop heart disease compared with men who had moderate intake.

“Women feel they’re protected against heart disease until they’re older, but this study shows that even when you’re young or middle aged, if you are a heavy alcohol user or binge drink, you are at risk for coronary heart disease,” Rana said.

The results showed no significant difference in risk between people who reported moderate versus low alcohol intake, regardless of whether they also were categorized as binge drinking.

Alcohol has been shown to raise blood pressure and lead to metabolic changes that are associated with inflammation and obesity. Women also process alcohol differently than men. Researchers said the study calls attention to the health risks of alcohol consumption and underscores the importance of considering alcohol use in heart disease risk assessment and prevention efforts. 

“When it comes to heart disease, the number one thing that comes to mind is smoking, and we do not think about alcohol as one of the vital signs,” Rana said. “I think a lot more awareness is needed, and alcohol should be part of routine health assessments moving forward.”

One limitation of the study is that people tend to under-report their alcohol intake when asked by a health care provider. As a result, the study likely provides conservative estimates of the heart disease risk associated with alcohol consumption. The researchers also said the manner in which alcohol screening is performed in a health clinic can influence how patients and clinicians discuss the risks of alcohol consumption, and that further research could help determine optimal strategies.

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Aerobic exercise can help fight liver diseases

he Mfn-2 protein would regulate the curve of the mitochondrial membrane in promoting the oxidation of fat in a specific population of mitochondria, through its interaction and ability to form specific domains with membrane phospholipids.

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Aerobic exercise could help fight the non-alcoholic fatty liver disease, the most common liver disease worldwide: it affects nearly 24% of the global population and it usually causes a certain stigma among the affected people.

This is according to a study – “Mitofusin-2 induced by exercise modifies lipid droplet-mitochondria communication, promoting fatty acid oxidation in male mice with NAFLD” that appeared in the journal Metabolism. The study was led by Professor María Isabel Heràndez-Alvarez, in collaboration with Rodrigo Troncoso, and Víctor Cortés.  

When the liver accumulates large amounts of fat

One of the features of the fatty liver disease or non-alcoholic steatohepatitis (NAFLD) is the large concentration of lipid droplets (LD) that accumulate in the liver cells. “Our findings reveal that aerobic exercise, that is, moderate physical activity over time, helps metabolize the fats because it reduces the size of lipid droplets, and therefore, the severity of the disease”, notes the author. 

“Therefore, the energy demands induced by the exercise determine regulated changes in physical and functional relationships between fat droplets and mitochondria, the cell organelles that provide energy for the metabolism.”

This interaction may take place in a specific population of mitochondria known as peridroplet mitochondria (PDM). “As a result, there is a higher oxidation of lipids in this specific population of mitochondria, a process that helps prevent the progress of the disease”.

Discovering a previously unknown connection

“The interaction between the lipid droplets (LD) and the mitochondria is functionally important for the homeostasis of the fat metabolism. Exercise improves fatty liver disease, but to date, it was unknown whether the disease had a direct impact on the interactions between hepatic LDs and mitochondria,” noted María Isabel Hernàndez-Alvarez, Ramón y Cajal postdoctoral researcher at the UB’s Department of Biochemistry and Molecular Biomedicine.

The study also stresses that mitofusin 2 (Mfn-2) — a protein located in the external membrane of mitochondria — plays a decisive role in this process, since it modifies the communication between lipid droplets and the specific population of mitochondria.

“We found a decrease in the content related to saturated fatty acids in the hepatic mitochondrial membranes of animals that had done physical activity. This suggests that membrane fluidity increases in the mitochondria,” noted the researcher. “In the case of the mice without the Mfn-2 gene, exposed to physical activity, we did not observe changes in the saturation and the metabolism of fatty acids. These results show that the Mfn-2 protein takes part in the regulation of the composition of fatty acids of the mitochondrial membranes in response to exercise”.

According to the authors, the Mfn-2 protein would regulate the curve of the mitochondrial membrane in promoting the oxidation of fat in a specific population of mitochondria, through its interaction and ability to form specific domains with membrane phospholipids.

The study is a step forward to boosting research on mediators and molecular mechanisms that could promote new strategies to prevent the progression of NAFLD. “Considering the Mfn-2 functions in mitochondrial morphology and in the liver, the therapeutic manipulations of the levels and the activity of Mfn-2 could contribute to the improvement of the NAFLD-related inflammation and the fibrosis”, concluded the researcher.

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