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Heart failure: An Important link with cognitive impairment.

Heart failure: An Important link with cognitive impairment.

Heart failure affects more than 64 million people globally. One of the most frequent complications in heart failure patients is cognitive impairment.

Heart failure may cause cognitive decline because, according to Columbia University researchers, there is a little calcium leak inside the brain’s neurons.

Additionally, researchers have created an investigational medication that aims to ‘plug’ the calcium leak and halt the course of heart failure.

Heart failure, an incurable cardiovascular disorder where the heart cannot effectively pump blood throughout the body, affects about 64 million people globally.

Complications include shortness of breath, arrhythmia, and kidney problems. Also, fluid retention in the lungs, belly, feet, and legs is more common in those with heart failure.

Additionally, one frequent complication in persons with heart disease is cognitive impairment.

A little calcium leak inside the brain’s neurons, according to Columbia University researchers, may be the reason heart failure can result in cognitive impairment.

In addition, researchers have created an experimental medication to “plug” the calcium leak and perhaps reduce the development of heart failure.

What is cognitive dysfunction?

Cognitive impairment is also known as mild cognitive impairment. It happens when a person struggles to perform routine tasks that call for mental abilities like memory and thought.

Cognitive disability examples include:

  • forgetfulness
  • missing events on the calendar
  • not knowing how to travel to frequented locations
  • difficulty understanding a talk
  • decision-making challenges
  • failure to follow through on commitments or directions

People who have modest cognitive impairment could also go through emotional changes like despair, anxiety, and rage.

Cognitive impairment can be brought on by a variety of conditions, including infections, prescription drugs, and other diseases.

A increased chance of developing other types of dementia, such as Alzheimer’s disease, exists in those with mild cognitive impairment.

How does brain dysfunction may affect cognition?

The team decided to investigate a potential link between heart failure and cognitive decline. Based on what they already knew about the ryanodine receptor type 2 (RyR2)/intracellular Ca2+ (calcium release channel), Dr. Andrew R. Marks, chair of the Department of Physiology & Cellular Biophysics at Columbia University Vagelos College of Physicians and Surgeons and lead researcher of this study explained.

Both the heart and the brain have the RyR2 channel, thus he said, “I reasoned that since the channel is leaky in the heart due to systemic stress of heart failure it might also be leaky in the brain.”

In heart muscle, there is an encoded protein called RyR2. It contributes to the delivery of that specific mineral to the cardiac muscles as a component of the intracellular calcium channel.

Calcium is essential for both heart and brain function, Dr. Marks noted. “Calcium is required to activate muscle contraction in the heart and for signaling in the brain.”

Testing the theory of the heart-brain relationship

Dr. Marks and his team tested their theory in this study using a mouse model. Researchers discovered that calcium leakage in the brain’s neurons caused cognitive impairment in rats with heart failure.

Scientists also looked at the brains of heart failure victims who had passed away. They looked at those brains and discovered leaky calcium channels, which may have contributed to cognitive impairment in those people.

Since heart failure is progressive, clinicians may want to closely examine their heart failure patients for cognitive impairment and keep track of this, according to Dr. Marks’ research. “The doctors could determine whether their patient’s cognitive impairment is affecting their capacity to comply with medical advice and take their medications.”

Are calcium leaks treatable by doctors?

Dr. Marks and his team discovered throughout the study that an investigational medication called Rycals created by Marks’ group. It could be used to “plug” the calcium leak and possibly delay the onset of heart failure.

Rycals fix the leak in RyR channels and are in clinical trials at the Mayo Clinic and at the AMC in Amsterdam for an inherited form of exercise-induced sudden death,” stated Dr. Marks. In a year or two, depending on the outcome of this experiment, they might be available.

A broad unifying hypothesis?

About this study, Dr. Richard Wright, a cardiologist at Providence Saint John’s Health Centre in Santa Monica, California, who was not involved in the study, remarked.

He applauded the researchers for finally developing a comprehensive, all-encompassing theory of various disease states after years of research.

Dr. Wright said, “People with chronic heart failure are weak and have respiratory problems; this has long been known. As this article noted, they frequently exhibit cognitive impairment in comparison to their classmates.”

Here, Dr. Marks’ team is attempting to develop a unified theory to account for all these many changes that take place in heart failure patients, and I believe they have done so. Dr. Richard Wright stated, “I believe this idea that calcium excess is a unifying mechanism to explain not only the heart’s dysfunction but skeletal muscle dysfunction, diaphragm dysfunction, and as the article’s main thesis, brain dysfunction as well.”

The beginning of a new era is upon us.

Dr. Wright remarked that he was thrilled to learn of a substance created in the lab of the study team that has been demonstrated to favourably effect these alterations.

We are at the beginning of a new era, which I would refer to as the period of designer molecules, he remarked. “We’ve seen it in hypertrophic cardiomyopathy and amyloidosis already, where you can design molecules that change pathologic changes of proteins.”

They have compounds created in their lab to prevent alterations that help prevent calcium excess in neurons, heart cells, and skeletal muscle cells. This could have a significant impact on the results of our research.

Dr. Wright did point out that additional research is still required because the majority of the results in this article came from a mouse model.

Humans are not mice, he continued, so “sometimes we get misled.” However, they’ve done a great job of avoiding that and gone to the bother of using chunks of autopsied brains to support their claim, which I think is quite real.”

Other study limitations include the tiny number of human brains examined by the researchers and the fact that the study’s control group consisted of participants who were significantly younger than those who had suffered from heart failure and cognitive deterioration.


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Detect the Cognitive ability by a test before its arrival.

Detect the Cognitive ability by a test before its arrival.

According to researchers, a quick card memory test can identify cognitive decline years before symptoms appear. According to experts, the test would make it possible for those who are more likely to develop dementia to receive treatment and preventative measures sooner.

One specialist advocates administering the test to everyone over 45. Researchers claim to have created an easy test that can forecast a person’s future risk of developing cognitive impairment.

The test only applies to persons without pre-existing cognitive and memory impairments, the researchers write in their study, which was just published in the journal Neurology.

The study’s lead author and clinical professor at the Albert Einstein College of Medicine in New York City, Ellen Grober, Ph.D., said in a statement that there is “increasing evidence” that some people who appear to be healthy and have no cognitive or memory issues may fact be displaying very mild indicators of early cognitive impairment. In our study, a quick and accurate memory test indicated the likelihood that individualsnormally thought to have normal cognition will experience cognitive impairment.

Cognitive impairment study

969 participants in the study, whose average age was 69, took a basic memory test and then underwent follow-up exams over ten years.

There were two phases of the test.

The participants were first instructed to examine four cards, each of which had four drawings of various objects.

Then, the respondents were required to identify each item as a member of a specific category. For instance, when asked to name a fruit, participants might respond “grape.”

In the following stage, participants were required to recall the things to gauge their memory capacity. They were given category cues, which calculated the amount of memory storage, for the items they couldn’t recall.

Result of the tests for cognitive impairment

Using the Stages of Objective Memory Impairment (SOMI) approach, researchers categorized the participants into five groups with stages zero through four based on their test results.

Stage 0 was for patients with no memory issues (47% of cases).

Memory retrieval problems, which researchers noted can occur five to eight years before dementia, were more difficult to recall in stages one (35%) and two (13%) of the disease. When given indications, these participants could recall information.

The individuals in the third and fourth stages (5% overall) had trouble remembering all the objects, even with hints. These stages, according to the researchers, occur 1 to 3 years before dementia.

234 of the 969 subjects experienced cognitive impairment in the end.

Subjects at stages one and two were twice as likely to experience cognitive impairment compared to those at SOMI stage zero, even after accounting for factors such as age, gender, education level, and the APOE4 gene, which affects a person’s chance of developing Alzheimer’s disease.

Cognitive impairment was three times as likely to develop in those in stages three and four.

The significance of testing for cognitive impairment

The SOMI method continues to forecast an elevated risk of cognitive impairment even after accounting for indicators of Alzheimer’s disease including amyloid plaques and tau protein tangles.

According to research, 72% of people in the third and fourth stages will have cognitive impairment after ten years, compared to 57% of people in the second stage, 35% of people in the first stage, and 21% of people in stage zero.

Our findings confirm the SOMI system’s application in locating those most at risk for cognitive decline, according to Grober. “Researchers looking for remedies can benefit from spotting cognitive impairment early on. By working with their doctor and implementing strategies to support healthy brain aging, those persons who are discovered to be at elevated risk may also benefit.

Neura Health’s virtual headache and migraine clinic’s medical director, Dr. Thomas Berk, a neurologist, pointed out that present testing only reflect the brain’s current condition.

“Predicting neurological change years later is very difficult,” said Berk. When someone has neurological testing, “we are getting a snapshot of their current brain function, not what their brain will look like years later,”

“This does give some evidence for being able to assess the future risks of developing memory issues,” he continued.

There is unquestionably a need for “a simple and fairly rapid test,” particularly in light of the growing body of evidence that early intervention can have a positive impact, according to Dr. Dale Bredesen, head of the University of California Los Angeles’ Easton Centre for Alzheimer’s Disease Research.

Standard neurocognitive tests can take hours, making them impractical for screening, and common quick tests like the MMSE aren’t sensitive enough to catch these early alterations, according to Bredesen.

Using fresh memory tests

According to Bredesen, the subjects of present testing are those who already have cognitive problems.

“Simple tests like the one described in this report should be included for everyone over the age of 45, to identify those who should be evaluated further, and potentially treated,” he advised.

One physician claimed that the SOMI system made him think of a well-known kid’s game.

According to Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Centre in California, “I advise my patients to make a mental image of a scene with all three words to help in their recall when they have to recall the three words.” “I would suggest the same for this proposed card cognition exam. Currently used cognitive exams include additional memory tests.

“Go Fish,” which is utilised as a learning tool for children rather than a cognitive exam for senior people, is similar to the suggested test to be employed in my elderly population, which interests me as a parent and a practising adult neurologist, Segil added.

“When you start to worry that you might be losing your memory, you should be evaluated by a neurologist to see if your complaints are generally age-appropriate normal or something else,” he said.


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Faster cognitive decline linked with food insufficiency

Faster cognitive decline linked with food insufficiency

A recent study discovered that a lack of meals is linked to a quicker deterioration in cognitive function. Researchers examined information on thousands of people’s levels of food insecurity, cognitive health. Also, participation in the Supplemental Nutrition Assistance Program of the US federal government.

Those who don’t eat enough may have cognitive impairment due to poor nutrition or stress by significant financial difficulty. It prevents them from purchasing the food they require. Over the ten-year period from 2007 to 2016, the percentage of older persons in the United States who go without meals, frequently due to a lack of financial resources, more than doubled from 5.5% to 12.4%.

Number of young people going hungry has decreased because to initiatives like the U.S. Supplemental Nutrition Assistance Program (SNAP). According to study, older women who live alone in particular have had less success with their efforts than other senior people.

Age-related physical limitations and the risk of malnutrition and depression are more prevalent. This is among older adults who are food insecure. According to a recent review of SNAP data, there is also a link between older adults who are food insecure and cognitive impairment that happens more quickly.

A quicker rate of cognitive deterioration was observed in those who were SNAP qualified. It based on their income but did not take use of the programme. This pace was comparable to what would be anticipated if a person were 4.5 years older than they actually were.

Four years of brain ageing can be substantial for an older individual. When compared to individuals who had enough nourishment, those who did not showed a larger cognitive deterioration. This is equivalent to ageing by 3.8 years. The rate of mental decline was lowest in those who received enough meals.

Tying a lack of food to cognitive function

Data from 4,578 Medicare beneficiaries who were 65 years of age or older and took part in the National Health and Aging Trends Study (NHATS) from 2012 to 2020 were examined by the study’s authors.

As part of its yearly follow-up with participants, NHATS gathered data. Based on sociodemographic situation, social, physical, and technological settings, medical comorbidities, and cognitive function.

People’s responses to questionnaires about food insecurity were used as the basis for categorising them. As having enough food or not having enough, and their SNAP status was noted as part of NHATS. Participants in the new study were evaluated according to which of three groups they belonged to:

  • SNAP recipients
  • Non-participants who were SNAP-eligible, that is, non-participants who were making up to or less than 200% of the federal poverty threshold.
  • Non-participants who are SNAP-ineligible and make more over 200% of the federal poverty level.

Dr. Daniel P. Miller of Boston University, an expert on poverty and food insecurity who was not engaged in this study, clarified the critical distinction between “food insecurity” and “food insufficiency”.

Food insufficiency is just a statement about not having enough food to eat, as opposed to food insecurity, which is a condition of hardship where families struggle to put the correct kinds of food on the table due to a lack of money or other financial means.

He pointed out that, as opposed to food insecurity in the traditional sense, the focus of the current study was on food insufficiency.

Causes of food insecurity

According to Dr. Miller, economic hardship is mostly to blame for food insecurity. At an era of rising expenses for everything from food to health, he noted that older persons on fixed incomes are most at danger.

The definition of food insecurity according to the NHATS also included “non-financial constraints such as poor functional status, lack of social supports, and lack of access to food,” according to Dr. Colleen M. Heflin of Syracuse University, who was not engaged in this study.

Dr. Heflin stated that these access measures “are likely to be particularly significant for older persons who may need assistance acquiring food due to health restrictions, poor driving ability, and geographic isolation.”

Possible connection

Although the study found a link between dietary insufficiency and cognitive decline, because it was conducted over time, it was unable to determine whether a shortage of food causes cognitive impairment or the other way around.

Due to the challenging administrative procedures involved in proving programme eligibility, Dr. Heflin lamented that “my own data implies that cognitive impairment can function as a barrier to SNAP participation among older persons eligible for the programme.”

There are two likely causal mechanisms connecting food inadequacy to cognitive impairment, according to Drs. Heflin and Miller.

The first is a deficiency in crucial minerals and vitamins that support overall health, including brain function. Dr. Miller suggested that we should anticipate slower overall cognitive decline in elderly persons who are food insecure but instead expect greater reductions.

He did add, however, that research looking at the relationship between nutrition and cognitive decline have come to inconsistent results. Both experts agreed that long-term financial stress could be the second most likely causative mechanism. Dr. Heflin added that “stress exposure is linked to a higher rate of cognitive impairment.”

The importance of SNAP

A “electronic benefits transfer” card from SNAP allows users to make food purchases at approved retailers while also providing financial assistance. Dr. Heflin stated that SNAP participants consume more food at home and food of a higher quality than non-participants.

SNAP non-participation, according to Dr. Miller, is a “particularly important” indicator of future food insecurity. However, he continued, participation in the programme is lower than it could be, particularly among the elderly.

Dr. Miller pointed out that in 2020, just 47% of eligible older persons over the age of 60 joined in the programme, despite the fact that 78% of people of all ages who were eligible for SNAP did so.

A looming crisis?

Over 6 million Americans, according to the Centers for Disease Control and Prevention, suffer from Alzheimer’s and associated dementias. An estimated 14 million people will have Alzheimer’s by 2060, according to predictions.

The most vulnerable communities could be those of race. The number of cases among Latinos might rise seven times over current projections. There may be four times as many instances among African Americans as now anticipated.

In order to help prevent dementia, a new community-based programme in San Francisco will concentrate on established risk factors that may be changed. A model “Brain Health Program” being launched by Posit Science and the YMCA with funding from the National Institutes of Health.

Adults who are at risk for crime will be able to take classes through the initiative, which will launch in six months. The fundamentals of diet and nutrition the YMCA has been utilising in its Diabetes Prevention Program will be covered in some of the training.



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