A drug used to treat agitation in people with dementia is no more effec-tive than a placebo, and might even increase mortality, according to a new study.

The research, led by the University of Plymouth and published in the journal The Lancet, has shown that antidepressant mirtazapine offered no improvement in agitation for people with dementia – and was possibly more likely to be associated with mortality than no intervention at all. Agi-tation is a common symptom of dementia, characterised by inappropriate verbal, vocal, or motor activity, and often involves physical and verbal aggression. Non-drug patient-centered care is the first intervention that should be offered but, when this doesn’t work, clinicians may move to a drug-based alternative.

Antipsychotics have proven to increase death rates in those with demen-tia, along with other poor outcomes, and so mirtazapine has been rou-tinely prescribed. This study was designed to add to the evidence base around its effectiveness.

Funded by the National Institute for Health Research (NIHR), the study recruited 204 people with probable or possible Alzheimer’s disease from 20 sites around the UK, allocating half to mirtazapine and half to placebo. The trial was double-blind; meaning that neither the researcher nor the study participants knew what they were taking.

The results showed that there was no less agitation after 12 weeks in the mirtazapine group than in the control group. There were also more deaths in the mirtazapine group (seven) by week 16 than in the control group (only one), with analysis suggesting this was of marginal statistical significance.

Lead researcher Professor Sube Banerjee, Executive Dean of the Faculty of Health and Professor in Dementia at the University of Plymouth, ex-plained why the results were so surprising but important.

“Dementia affects 46 million people worldwide – a figure set to double over the next 20 years. Poor life quality is driven by problems like agita-tion and we need to find ways to help those affected,” he said.

This study shows that a common way of managing symptoms is not help-ful – and could even be detrimental. It’s really important that these results are taken into account and mirtazapine is no longer used to treat agita-tion in people with dementia.

“This study has added important information to the evidence base, and we look forward to investigating further treatments that may help to im-prove people’s quality of life,” Banerjee added.

WASHINGTON : Practice makes perfect, but sleep helps, too. Learning and executing a new motor skill can be enhanced if you can get additional memory pro-cessing during sleep, according to a recent study led by researchers at Northwestern University.

The study was published in the journal JNeurosci. Researchers com-pared how well participants performed a challenging motor task with and without the extra processing during sleep.

The participants played a computer game using a myoelectric computer interface, which enabled them to move a cursor by activating specific arm muscles. Each command to move the cursor in a particular direction was paired with a unique sound; after practicing, the participants played the game blindfolded and moved the cursor based on the sound cue alone.After completing a test round, the participants took a 90-minute nap.

The researchers played half of the sound cues during the nap, reactivat-ing the motor memories associated with each cue. After the nap, the participants performed the motions cued during sleep better than the uncued ones: it took less time to move the cursor, the cursor traveled a more direct route, and fewer superfluous muscles were activated. These results show we can improve the performance of new motor skills by reactivating memories during sleep.

Research from Regenstrief Institute and Indiana University School of Medicine has shown that the Patient-Reported Outcomes Measurement Information Systems (PROMIS) scale for depression developed by the National Institutes of Health can accurately measure depression symptoms and its severity.

The findings of the study were published in the ‘Journal of Psychosomatic Research’.

“Depression is treatable, that’s why routine screening is strongly recommended,” said study lead author Dr Kurt Kroenke, M.D., Regenstrief research scientist and IU School of Medicine professor of medicine.

“Measurement-based care is important to track a patient’s progress in order to make adjustments to care when needed. This study found that the PROMIS scales are an accurate measure of depression to aid in diagnosis and treatment,” added Dr Kroenke.

The research team analyzed data from three randomized clinical trials involving about 650 patients. It compared the results of the PROMIS scale, which is a survey where patients report their symptoms, to the results of a structured psychiatric interview.

They also compared the diagnostic performance of the PROMIS scale and Patient Health Questionnaire nine-item depression scale (PHQ-9), which has been validated and widely adopted around the world, to benchmark the PROMIS measures. The PHQ-9 was developed by Dr Kroenke.

Data analysis showed that PROMIS and PHQ-9 depression scales have similar accuracy when diagnosing depression. “PROMIS scales are already commonly in use, and both PROMIS and PHQ scales are accessible and free in the public domain. This research supports both as viable screening options,” said Kroenke.

“The pandemic has taken a substantial toll on mental health, and there will likely be a lingering effect. Screening has become all the more important because we must be able to diagnose and treat patients who are suffering. Monitoring depression is no different than monitoring blood pressure, so these scales are important tools that are proven to work,” he added.

If you have a throbbing headache, nausea and sensitivity to light and sound, then you aren’t going through those regular headaches. These are actually migraines, which not only makes you completely bed-ridden but also hamper your daily activities.

It’s a common condition, with an estimated global prevalence of 14.7% (that is around 1 in 7 people). When the migraine strikes, you will almost do anything to get rid of the excruciating pain. Medication can help manage the pain, and antidepressants and beta blockers might help prevent recurring episodes. However, all these methods have potential side-effects including nausea, insomnia, hypertension, and heart attacks. Clinical studies have shown that home remedies provide more effective pain relief when compared to usual care.

The best way to deal with it is to understand the root cause behind the trigger. Some of the prevalent triggers are related to dehydration, hypertension, stiff muscles in the neck or shoulder, emotional stress, certain medications, additives or reaction to some food items. Helicobacter pylori, commonly known as H-Pylori bacteria, is found to be one of the active reasons of migraine, ulcers and other gastric issues. Therefore, shifting to natural remedies is a drug-free way to evaluate migraine symptoms. These at-home treatments may help prevent migraines, or at least help reduce their severity and duration

HYDRATION IS THE KEY

The best way to treat migraine without medication is to drink loads of water or an electrolyte beverage. It has been seen that dehydration is the leading cause of headache. Ensure that the electrolyte beverage, which you are opting for, doesn’t have added sugar or colour in it as these can aggravate the headache. Taking a vitamin C drink is also a good option. One needs to check the sugar content of the drink if the individual has diabetes.

PERFORM YOGA REGULARLY

Research has shown that yoga can be effective for controlling headaches. Yoga is an ancient discipline that promotes a holistic approach to pain management through a combination of breathing techniques and postures. These asanas and pranayamas don’t have any side-effects. Practicing them twice every day under the guidance of a certified trainer will reduce the intensity of migraine pain and help prepare for future attacks.

TRY ACUPUNCTURE

Through this alternative medicine technique, pressure points are identified on the body to provide relieve from pain and other such symptoms. Studies have also credited acupuncture as one of the trusted alternative therapy for people suffering from chronic headaches. Even patients going through throbbing migraine pain, who have tried out sessions with acupuncturists, will also advocate acupuncture being one of the safest non drug options for pain relief during migraine.

MINDFUL MEDITATION

Mindful meditation involves focusing one’s attention at the current moment with a non-judgmental set of mind. This in a way helps to reduce the stress, which is one of the most common migraine triggers. Mind-body techniques like meditation and resting for sometime may relieve headaches by alleviating underlying stress.

EXERCISE

Regular exercise helps in reducing the frequency and intensity of migraine attack. But, don’t forget the fact that vigorous exercise can be detrimental to migraine. Exercise actually helps to ward off stress, which is a common migraine trigger. When we exercise we release feel good hormones, which are also considered as the body’s natural painkillers and anti-depressants. Don’t exercise if you are in the middle of a migraine pain as it will worsen your condition.

SELF-MASSAGE

Self-massage around the temples, shoulders and back of the head can help tension headaches. Massage, either self-massage or working with a massage therapist, can resolve chronic neck and shoulder tension that can cause headaches. It’s always advisable to put pressure on pressure point LI-4, also called Hegu, which is located between the base of your thumb and index finger. It will help to relieve pain and headache.

MANAGE GUT HEALTH

There is a strong connection between the gut and the brain. It signifies that if our gut is unhappy, its consequences can be experienced in the form of migraine. This is why GI disorders, such as irritable bowel syndrome and Inflammatory Bowel Disease, and migraine are often experienced together in a person. Unhealthy diet practices and excess consumption of antibiotics has caused a soaring population of H-Pylori bacteria in human body (inside human-gut) suppressing the good and vital bacterial population causing imbalance of intestinal fauna.

NATURAL MIGRAINE RELIEF KIT

After following these steps if still there is no relief, then, try out the Natural migraine relief kits. These kits are available online and provides 100% natural remedy to fight and cure migraines and headaches. These herbal probiotic kits made with indigenous herbs including black cumin, cumin, moon leaf, ginger and peppermint aims to resolve the headaches and pain by allowing intestinal flora to flourish in your gut.

The writer is a Senior Consultant at The Lifekart.in

Over the last few decades, scientists have discovered that long-term calorie restriction provides a wealth of benefits in animals: lower weight, better blood sugar control, even longer lifespans.

Researchers have largely assumed that reduced food intake drove these benefits by reprogramming metabolism. But a new study from the University of Wisconsin-Madison researchers finds that reduced calorie intake alone is not enough; fasting is essential for mice to derive full benefit. The team published their findings in the journal Nature Metabolism.

The new findings lend support to preliminary evidence that fasting can boost health in people, as trends like intermittent fasting continue to hold sway. These human and animal studies have added to the growing picture of how health is controlled by when and what we eat, not just how much.

The research further emphasizes the complexity of nutrition and metabolism and provides guidance to researchers trying to untangle the true causes of diet-induced health benefits in animals and humans.

The researchers discovered that combined with eating less, fasting reduces frailty in old age and extends the lifespan of mice. And fasting alone can improve blood sugar and liver metabolism. Surprisingly, mice that ate fewer calories but never fasted died younger than mice that ate as much as they wanted, suggesting that calorie restriction alone may be harmful.

The research was led by UW School of Medicine and Public Health metabolism researcher Dudley Lamming, his graduate student Heidi Pak and their colleagues at UW-Madison and other institutions.

Pak and Lamming were inspired to conduct the study because researchers began to realize that previous studies had unintentionally combined calorie restrictions with long fasts by providing animals with food just once a day. It was difficult, then, to distinguish the effects of one from the other.

“This overlap of treatment — both reducing calories and imposing a fast — was something that everybody saw, but it wasn’t always obvious that it had biological significance,” said Lamming, who has long studied the effect of restricted diets on metabolism. “It’s only been in the past few years that people started getting interested in this issue.”

To untangle these factors, Lamming’s group designed four different diets for mice to follow. One group ate as much as they wanted whenever they wanted. Another group ate a full amount, but in a short period of time — this gave them a long daily fast without reducing calories.

The other two groups were given about 30 per cent fewer calories either once a day or dispersed over the entire day. That meant that some mice had a long daily fast while others ate the same reduced-calorie diet but never fasted, which differed from most previous studies of calorie restriction. It turned out that many of the benefits originally ascribed to calorie restriction alone — better blood sugar control, healthier use of fat for energy, protection from frailty in old age and longer lifespans — all required fasting as well. Mice who ate fewer calories without fasting didn’t see these positive changes.

Fasting on its own, without reducing the amount of food eaten, was just as powerful as calorie restriction with fasting. Fasting alone was enough to improve insulin sensitivity and to reprogram metabolism to focus more on using fats as a source of energy. The livers of fasting mice also showed the hallmarks of a healthier metabolism. The researchers did not study the effect of fasting alone on lifespan or frailty as mice age, but other studies have suggested that fasting can provide these benefits as well.

While the mice that ate fewer calories without ever fasting did show some improved blood sugar control, they also died younger. Compared with mice who both ate less and fasted, these mice that only ate less died about 8 months earlier on average.

“That was quite surprising,” said Lamming, although other studies have also shown some negative effects from restricting calories. The team also measured frailty through metrics like grip strength and coat condition. “In addition to their shorter lifespans, these mice were worse in certain aspects of frailty, but better in others. So, on balance, their frailty didn’t change much, but they didn’t look as healthy.”

The primary studies were done in male mice, but Lamming’s lab also found similar metabolic effects of fasting in female mice. The research reveals how difficult diet studies are, even in a laboratory environment. That difficulty is magnified for human studies, which simply can’t match the level of control possible in animal models. The new study can provide direction to future work trying to answer whether fasting improves human health.

“We need to know whether this fasting is required for people to see benefits. If fasting is the main driver of health, we should be studying drugs or diet interventions that mimic fasting rather than those that mimic fewer calories.” Lamming said.

Patients with acute kidney injury who receive continuous renal replacement therapy (CRRT), a common dialysis method, have a high incidence of needing this dialysis method reinstituted after having it removed. This contributes to poor 90-day outcomes, according to recent research led by an international team of scientists.

The study was published in the journal Mayo Clinic Proceedings. Though CRRT is a common dialysis method for critically ill patients with acute kidney injury, little research has been performed to determine at what point in kidney function recovery the patient should be “liberated” from CRRT.

This study, by researchers at Mayo Clinic and Zhongnan Hospital of Wuhan University in China, is believed to be the first to investigate outcomes for patients with acute kidney injury who were not successfully liberated from CRRT.

The retrospective cohort study examined the records of 1,135 patients with acute kidney injury who were treated with CRRT at Mayo Clinic in Rochester between January 2007 and May 2018. Of those patients, 20 per cent were successfully liberated from CRRT. In 39 per cent of patients, CRRT had to be reinstituted within 72 hours, and 41 per cent of these patients died.

Successful CRRT liberation was marginally associated with fewer major adverse kidney events and improved kidney recovery at the time of 90-day follow-up, though the causal relationships could not be established.

“In current clinical practice, CRRT liberation is typically based on physicians’ personal experience because there has been only limited and inconsistent research available,” says Kianoush Kashani, M.D., a nephrology intensivist at Mayo Clinic and the study’s senior author.

Kianoush added, “Our study demonstrated a high occurrence of CRRT liberation failure, as well as poor 90-day outcomes. Thus, there is a critical need for identifying preventive measures to avoid the need for CRRT or interventions that lead to early liberation from CRRT among critically ill patients with advanced acute kidney injury.”

Acute kidney injury is a common complication for patients in ICUs. As many as 57 per cent of ICU patients have acute kidney injury. Dialysis is used to treat about 13 per cent of those patients, and this treatment is associated with 60 per cent mortality, according to research.

“There are limited data and little consensus on how and when to liberate patients from CRRT properly, the high rate of liberation failure observed in our study may reflect variations in clinical practices. Development of consistent approaches that can guide decision-making on when to remove CRRT should be a top priority of future research,” he added.

CRRT is frequently used as a dialysis mode for critically ill patients because it provides continuous control of fluid status during treatment and doesn’t interfere with the body’s normal blood flow while achieving uremic control.

But recent studies have found that prolonged CRRT may lead to adverse events and impede kidney function recovery, while premature CRRT liberation also can lead to complications.

Other dialysis options are associated with even lower changes in kidney recovery, says Dr. Kashani, the study’s senior author. The study clearly indicates that CRRT liberation, when successful, can be associated with improved clinical outcomes for critically ill patients and lower costs of care, he says.