Brain games linked to delayed cognitive decline in elderly

(Reuters Health) - Older people who engage in mentally stimulating activities later in life may have a lower risk of developing mild cognitive impairment than their peers who don't challenge their minds, a study suggests.

For adults 70 and older without cognitive problems, playing games was associated with a 22 percent reduced risk of what's known as new-onset mild cognitive impairment, a condition that can happen before age-related declines in brain function give way to full-blown dementia.

Working on crafts was tied to a 28 percent lower risk of mild cognitive impairment, computer use was linked to 30 percent smaller odds and social activities were associated with 23 percent decreased risk, the study also found.

"Mentally stimulating activities perhaps in combination with known healthy life styles such as exercise are simple and inexpensive activities that can potentially protect people against the development of mild cognitive impairment," said senior study author Dr. Yonas E. Geda, a psychiatry and neurology researcher at the Mayo Clinic in Scottsdale, Arizona.

To see how different activities might influence the odds of developing impairments, researchers examined data on 1,929 adults age 70 and older who didn't have any cognitive problems at the outset. They evaluated participants every 15 months. Half of their subjects stayed in the study for more than four years.

In surveys, participants reported how often they did various activities. Researchers then compared the risk of new-onset mild cognitive impairment based on whether people did activities at least once or twice a week or no more than two or three times a month.

At the start of the study, half of the participants were at least 77 years old.

By the end of the study, 456 people had developed new-onset mild cognitive impairment, according to a report in JAMA Neurology.

Researchers took a closer look at a subset of 512 people who had an increased risk of cognitive decline because they carried a version of the apolipoprotein E (APOE) gene that is a risk factor for mild cognitive impairment and Alzheimer’s dementia.

For carriers of the high-risk APOE gene, only computer use and social activities were associated with a decreased risk of mild cognitive impairment.

The study wasn't a controlled experiment designed to test whether or how different activities might directly prevent or delay the onset of cognitive decline, the authors note.

Some previous research has found that repeating familiar activities, even challenging ones, may not necessarily be enough to ward off cognitive decline, said Dr. Denise Park, a longevity researcher at the University of Texas in Dallas who wasn't involved in the current study.

Playing games or socializing at home may not protect the brain against decline, but devoting several hours a week over several months to learning new activities may be associated with better brain function, Park said by email.

"Our research suggests mentally demanding, novel tasks like quilting or learning photography are worthwhile," Park added. "Learning how to use a computer and many apps" also helped.

Her advice to elderly people who want to keep their mind sharp: "Do something that is engaging and fun for you that you want to spend time on."

SOURCE: bit.ly/2jRRFj1 JAMA Neurology, online January 30, 2017.

110-Year-Old World War II Veteran Gets to Stay in His Home After $117K Raised

Richard Overton, believed to be the nation’s oldest living World War II veteran, would see it as a “death sentence” if he was forced to leave his beloved Austin, Texas, home, according to his relative, Volma Overton Jr.

The prospect of Richard Overton, 110, being moved to an assisted living facility prompted Volma Overton Jr., the veteran’s third cousin, to start a GoFundMe campaign to raise money for around-the-clock in-home care.

“We all knew that if you move Richard out of his home, he’d die,” said Overton Jr. “That home is everything for him.”

The fundraising campaign has raised $117,000 since its launch last December, enough money to keep Overton in his home of around 70 years for another seven months.

“His front porch is a special place,” Volma Overton, 68, told ABC News. “He always sits there and waves to people and everyone just comes by and talks to him.”

It was the idea of Volma Overton’s 26-year-old daughter, Sarah, a graphic designer, to start a GoFundMe campaign. The family was unsure of what to do when Overton’s caretaker experienced aging issues of her own and was no longer able to care for him.

The closest heir to Overton, who was twice married but has no children of his own, is a 95-year-old cousin who lives a few doors down. Volma Overton is now Overton’s primary family caretaker, stopping by every day to check on him.

“His mind is really pretty sharp,” he said. “We just sit there and listen to him talk and just listening to him talk is something that’s really, really special.”

Volma Overton's wife, Shirley Overton, described Overton as of sound mind still and "very witty."

"We wanted him to be able to stay where he knows and loves," she said. "He still walks and talks and does everything. He’s so much fun to be around."

After his military service, Overton, who turns 111 in May, worked for a furniture company and then worked for the state of Texas at the capitol in Austin, according to Volma Overton.

“He knew many dignitaries, he said. “He worked for the treasurer of the state at one time and would drive a golf cart to the bank to deposit millions of dollars in checks.”

Volma Overton said the family has been blown away by the response to the GoFundMe campaign, which raised $50,000 in just the first two days after its launch.

Volma Overton said he has used the money to hire a in-home senior care provider to provide 24-7 support. He estimates one year of coverage will cost around $180,000.

Overton continues to have no major medical issues and still enjoys the daily cigars and shot of whiskey that he attributes, in part, to his longevity, according to Volma Overton.

“He knows it’s a gift of God,” he said of Overton’s outlook on his life.

Children Across the Country Spread Happiness With the Great Kindness Challenge

The founders of the Great Kindness Challenge, a grass-roots campaign aimed at spreading goodwill and happiness in schools across the country, appeared on "Good Morning America" today to share the work they are doing to make the world a better place.

Jill McManigal, 52, from Carlsbad, California, said that she originally started the Great Kindness Challenge in her backyard with her children, who were only seven and four years old at the time, and their neighborhood friends. Together, the group formed what became "Kids for Peace," an international non-profit that spearheaded the Great Kindness Challenge, a challenge taken by schools and youth groups to perform as many acts of kindness, form a list fifty acts, as possible over the course of the week.

"My inspiration is creating a world where everyone is loved and cared for and happy," McManigal told ABC News. "The mission of the Great Kindness Challenge is to create a school environments where all students thrive."

"We want all children and all students to recognize the goodness in others, and this gives them the platform to do that," McManigal said of the challenge.

In 2012, she brought the challenge to three local schools in her community, including the elementary school her children attended. The following year, 263 schools participated in the challenge. This year, more than 12,000 schools, and over 10 million students across the country, are participating in the challenge.

To participate in the Great Kindness Challenge, students receive a checklist of fifty simple, kind, acts that they can accomplish. Students are encouraged to try and complete all 50 random acts of kindness over the course of one week. Some of the items on the list are as simple as smiling at 25 people, while others might encourage students to step out of their comfort zones by sitting with someone new at lunch.

Richard Tubbs, the principal of Hope Elementary School in Carlsbad, Calif., which was one of the first schools to implement the Great Kindness Challenge, said in a statement that he believes "it’s very important that everyone is always thinking about ways to be kind."

"We just want everyone to be able to share that same kindness wherever they go in their community, around the world," Tubbs added.

The "Great Kindness Challenge," sponsored by the non-profit group "Kids for Peace," challenges children to perform as many acts of kindness, from a list of over fifty acts, as possible over the course of a week. more +

McManigal said the reaction to the challenge at schools has been overwhelmingly positive.

"I see that everyone is just a bit more or a lot more happier," McManigal said. "There is such a power in doing for others, and also from receiving."

McManigal added that teachers have also been very supportive of the Great Kindness Challenge in their schools because it "because they see their students reaching out to each other and being very conscious of their actions and words, so it makes for a happier and healthier learning environment."

The materials that educators need to implement the Great Kindness Challenge in their schools is all free, according to McManigal, who added that they have over 25,000 volunteers with their organization working to implement the challenge in local schools.

McManigal added that the joy that the program brings to schools and communities is "palpable."

"As the children are given permission to go out there and really exert their kindness," McManigal said. "It creates this joy that is palpable on campuses."

Eat Mediterranean diet for a healthier and younger brain, studies say

(CNN)As we age, our brains naturally shrink and our risk of having a stroke, dementia or Alzheimer's rise, and almost everyone experiences some kind of memory loss.

Scientists know that people who exercise regularly, eat a healthy diet, avoid smoking and keep mentally stimulated generally have healthier brains than people who aren't as careful about diet and exercise.

Now, a new study seems to confirm that eating an easy-to-follow Mediterranean diet can have lasting benefits for brain health. The study was published Wednesday in the journal Neurology.

For the study, researchers analyzed the diets of about 400 adults, 73 to 76 years old, in Scotland over a three-year period. During this same time, the researchers took MRI scans of the participants to analyze their overall brain volume and thickness of the brain's cortex.

The researchers found that those who closely followed a Mediterranean-like diet were less likely to lose brain volume as they aged, compared with those who didn't follow such a diet.

However, more research is needed to determine an association between a Mediterranean diet and a specific effect on risk for degenerative brain diseases, such as dementia.

High-fat Mediterranean diet has more benefits, says study

A 2015 study from the journal Neurology also suggests that a Mediterranean diet (which includes wine!) may help make your brain about five years younger.

Researchers figured this out by looking at the brains of 674 people with an average age of 80. They asked these elderly people to fill out food surveys about what they ate in the past year, and researchers scanned their brains. The group that ate a Mediterranean diet had heavier brains with more gray and white matter.

"The previous study only measured brain volume at a single time point, whereas we had longitudinal measurements: two measurements three years apart," said Michelle Luciano, a lecturer of psychology at the University of Edinburgh in Scotland and lead author of the latest study.

"The previous study was therefore not looking at brain volume change over time but differences in brain volumes at a single time point," she said. "We also looked at two components of the diet, meat consumption and fish consumption, and neither of these had an individual effect on brain volume loss. It might be that the diet as a whole is beneficial, and it is the combination of the foods and nutrients that protects against, for example, vascular disease and inflammation, which can cause brain atrophy," or volume loss.

Mediterranean diet wins again, helps bones

The Mediterranean diet is relatively simple to follow. It involves eating meals made up mostly of plants: vegetables, fruit, beans and cereals. You can eat fish and poultry at least twice a week. You don't have to keep away from carbs; in fact, you should have three servings of those a day, particularly of the whole grain variety.

A glass of wine a day is perfectly fine, too. What you do typically have to limit is the amount of meat, dairy and saturated fat you eat. Cook more with olive oil, as opposed to butter.

In the 2015 study, a higher consumption of fish was associated with keeping your brain young. But if you don't really like fish, scientists at Harvard and Rush University in Chicago created the MIND diet, a combination of the Mediterranean and DASH diets that may be a little bit easier to follow, as it requires you to eat less fish and fruit.

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People who ate a diet close to the MIND diet saw a 53% lower risk of developing Alzheimer's. Even people who ate the MIND diet "most" (as opposed to "all") of the time saw a 35% reduced chance of developing the disease. This is considered a significant result.

This latest Mediterranean diet research builds on other evidence that the diet is likely the way to go. It has also been shown as a key to helping you live longer. It helps you manage your weight better and can lower your risk for cancer, and cardiovascular diseases.

Bottom line: you'll likely be physically and mentally healthier long into old age if you stick with this diet.

The Dangers of Medication Mix-Ups at Home

At the beginning of the New Year, it's important for each of us to examine our health and lifestyle and plan for ways to improve in 2017. For better or worse, we are a society accustomed to taking multiple medications. As we age, we tend to accumulate a list of daily prescription medications; health care professionals and pharmacists call this practice "poly-pharmacy." It's common for the average American to see several different doctors for different conditions, and for each doctor to prescribe a particular remedy. In general, there's a real risk for poor coordination of care among primary care doctors and specialists due to the fragmentation of health care – and this can lead to having multiple drugs prescribed for similar ailments. In addition, the availability of over-the-counter therapies presents the opportunity for even more drug interactions. Your doctors might not be aware of all these, if they don't know you're taking a particular OTC medication in conjunction with prescription medications. Side effects can range from mild to severe and can even include death. With the ongoing epidemic of opioid painkiller use in the United States, the stakes have never been higher when it comes to understanding your medications and how they can interact.

How Big Is the Problem?

Recent data from the Centers for Disease Control and Prevention, published in the Journal of the American Medical Association, suggests four visits to the ER per 1,000 adults annually are for adverse drug effects. Currently, almost 60 percent of Americans are taking at least one prescription drug, and nearly 20 percent are taking more than five prescriptions medicines. Add in over-the-counter medicines, and you have a huge potential for side effects, drug-drug interactions and negative outcomes. While the study found that on average, 1 in every 250 ER visits was due to adverse drug events, rates among the elderly are even higher. This age group is at particularly high risk for drug mix-ups, as many of them take more than 10 drugs (both prescription and OTC) at a time. Many of the drugs they take can result in confusion; plus, dementia rates in this demographic are high and can contribute to medication errors at home. In fact, in the JAMA study, researchers found that nearly 30 percent of all ER visits due to adverse drug events were seen in elderly patients. Older Americans typically have more chronic medical problems and less reserve to deal with drug side effects and interactions.

[See: How to Help Aging Parents Manage Medications.]

What Are the Issues?

The most common types of drugs seen as the cause of negative side effects in the ER varied by the age of the patient. In children, antibiotics accounted for the most problems. In adults, blood thinners, diabetes medications and opioid pain medications were the most common culprits. Over the past 10 years, according to the CDC, the rate for medication-related ER visits has increased from 26 to 35 percent among people over age 65. The biggest issue is that Americans tend to self-treat for many common ailments and often take multiple OTC medications in conjunction with powerful prescription drugs. These interactions can result in damage to the liver, kidney and other organ systems. In addition, certain medications can interact in a way that can elevate or lower blood levels of important prescription drugs and make them less effective – or significantly enhance their effects in ways that can negatively affect our health.

What Can We Do to Reduce Our Risk for Adverse Drug Events?

1. Communicate effectively with providers. It's essential that all your physicians know exactly what drugs you're taking (including both prescription and OTC medications). Carry a list with you in your wallet or on your mobile device, and verify meds at each visit. Make sure your doctor has a record of all your medications and that you discuss any concerns you have.

[See: 5 Common Preventable Medical Errors.]

2. Build a relationship with your pharmacist. Working with your local pharmacist can be an excellent way to ensure you're taking the right drugs at the right time. Your pharmacist is adept at spotting potential interactions and will often contact your doctor on your behalf to question anything that seems out of the ordinary. When in doubt, call and ask.

3. Always question the need for medications annually. When meeting with your health care provider, question the need for all the medications on your list at least annually. Make sure to ask why you're taking a particular drug and how long you'll need it. A good, healthy discussion about your meds can make you a more informed patient and help improve your health outcomes through engagement.

4. Verify all new prescription bottles for accuracy. While it's rare, pharmacies do occasionally make mistakes. Verify that the label reads exactly what you're expecting to get and that the product inside the bottle is what's on the label. Your pharmacist can help you with this as well.

What's Next: Tools and Technologies Available to Help Avoid Adverse Drug Effects

With nearly 70 percent of all Americans possessing a mobile device or tablet, there's a huge opportunity for organizing your medications online. There are many medication-tracking programs available and others in development that can help you keep your medication list organized. One new application that will be available soon on both iPhone and Android is called MyRxProfile and has several particularly unique features that can help keep patients safe.

Not only does MyRxProfile have the ability to list and track your medications, but it can also screen for potential drug-drug interactions (including prescription and OTC meds) and send users a real-time, immediate alert. The app can also scan bar codes and take pictures of bottles and serial numbers through the smartphone camera to enter medications into a patient profile quickly and effectively. While MyRxProfile is just now entering the market as a free download, developer Robert Baker says that "as a pharmacist, I realized drug interactions were becoming a medical crisis ... and I believe this app will greatly improve awareness of adverse drug interactions and ultimately save lives."

[See: 8 Questions to Ask Your Pharmacist.]

It will be important that as we work to improve patient safety, tools such as MyRxApp can be used in medical research and clinical trials to determine ways we can significantly impact the increasing rates of adverse drug events – particularly among the elderly. I expect that in the future, pharmaceutical medical applications for patients will be able to interface with electronic medical record systems and help synchronize medication lists at multiple physician appointments as well as with your pharmacist. By improving communication and engaging patients and providers together in common health care goals, these new digital tools are likely to make medication errors and drug interactions much less common in 2017.

Tech devices to treat chronic pain could curb opioid use

In 2014 radio producer Coy Dean was at a promotional event in Greenville, North Carolina, when he had a stroke. The 48-year-old couldn't move the left side of his body, and even as he started to recover, his joints were painful, especially his shoulder.

"I play ball, so I was used to pain, but this was a whole other type of pain," Dean said. He couldn't lift his left arm, and he was sleeping poorly because the pain would wake him every time he moved. His doctor prescribed painkillers, to which Dean says he became addicted, popping pills every 45 minutes. He once even broke the top of the bottle to get to the pills faster, he said.

Then Dean heard about a clinical trial for a device called the SPRINT Peripheral Nerve Stimulation (PNS) System, intended to reduce his shoulder pain without drugs. It took his new doctor only a few minutes to slip the thin wire into his arm and another few seconds to calibrate the small patch that controls it. When the device was on, it felt like a massage to his muscles, he said. After a few months Dean's shoulder pain evaporated. He said he still has morning stiffness in his shoulder and he still takes aspirin for the pain from his other joints, but he can now drink a cup of coffee with his left hand with ease.

The SPRINT PNS device is one of a growing class of FDA-approved devices that relieve chronic pain. They have fewer side effects than drugs and, if used in conjunction with other treatments, such as over-the-counter pain treatments and physical therapy, can eliminate patients' pain altogether. If their popularity continues among doctors and patients, the devices may soon become the standard of care to treat chronic pain.

An estimated 100 million Americans are suffering from chronic pain — pain that lasts more than three months and is caused by diseases such as arthritis or fibromyalgia, a remnant of an injury from an accident or surgery or from an unknown source.

In the past, doctors could only suggest that patients undergo physical therapy or cognitive-behavioral therapy to help them deal with their pain. For some patients, those techniques don't provide sufficient relief, so doctors often turn to opiate painkillers, which can cause addiction and long-term health problems, such as insomnia, digestive issues and even increased sensitivity to pain.

Scientists and entrepreneurs saw an opportunity in the $635 billion pain market to create an alternative in the form of devices. "Pain specialists are looking for new solutions to treat pain, for alternatives to opioids and to more invasive and expensive surgeries," said Maria Bennett, president, CEO and founder of SPR Therapeutics, the company that makes the SPRINT device that helped relieve Dean's shoulder pain.

The devices are coming to market now because the science and engineering are only recently advanced enough for this to be possible: "The technology wasn't available in the past, because the electronics weren't able to be made small enough," said Laura Perryman, the chairman and CEO of Stimwave, a company that manufactures a tiny implantable device to treat chronic pain, which was approved by the FDA in March. Thanks to technological advances in the cellphone industry, electronics in general are smaller and more sophisticated, she added, and more affordable.

Many of these devices are designed to specifically treat peripheral pain — pain in nerves that flow from every part of the body up through the spinal cord and into the brain. Some, such as the SPRINT PNS system, approved by the FDA in July to treat chronic pain in the back and extremities, have threadlike wires that need to be inside the body; the Stimwave device is implanted with a small needle. Others, such as Quell(approved in 2014 for all types of peripheral pain) or Cefaly (approved the same year to prevent migraines), treat pain from outside the body.

Fundamentally, each of these devices works by disrupting the pain signal as they move from nerves throughout the body to the brain. And there are advantages to treating pain this way. The devices are not permanent and often relieve pain after just a few weeks or months of use, with many fewer side effects than opiate painkillers; once the pain subsides, the device is removed.

The devices also don't interfere with most other health issues, which means that few patients are excluded from using them (though there are exceptions — people with pacemakers shouldn't use the SPRINT PNS system, for example). And clinical trials indicate that the devices are quite effective if placed properly, though sometimes patients will use the devices for multiple sessions if the pain comes back after the first round.

Risk and reward

The devices aren't completely without downsides. Since most devices are approved by the FDA, their cost is typically covered by most types of insurance and Medicare, but if someone should have to pay for one out of pocket, they could run tens of thousands of dollars.

The implantable devices run a small risk of infection and usually require that a patient carry a pagerlike gadget around with them; the Stimwave device, for example, is wireless but has an accompanying component that is battery-powered, so patients have to make sure they remember to charge and replace those. Some patients, such as those with pacemakers, are not eligible to use some of the devices, because the electricity involved may cause interference.

But to most patients and practitioners, the benefits of the devices outweigh their detriments. Since it was first available in June, the Stimwave device has been implanted in 500 patients, and demand is growing. "We can't make enough. We're sold out for months at a time. We just added three more manufacturing plants," Perryman said.

As more devices become commercially available, their manufacturers hope that devices will take over a larger part of the market to treat pain. "Our ultimate goal is to become treatment of choice," Bennett said. SPR Therapeutics will make its SPRINT device, the one Dean tried, available early this year. She adds that she hopes devices such as this one will improve the lives of many patients.

— By Alexandra Ossola, special to CNBC.com

Consumer Directed Personal Assistance Program (CDPAP)

• This Medicaid program provides services to chronically ill or physically disabled individuals who have a medical need for help with activities of daily living (ADLs) or skilled nursing services.
• Services can include any of the services provided by a personal care aide (home attendant), home health aide, or nurse.
• Recipients have flexibility and freedom in choosing their caregivers.
• The consumer or the person acting on the consumer's behalf (such as the parent of a disabled or chronically ill child) assumes full responsibility for hiring, training, supervising, and – if need be – terminating the employment of persons providing the services.

How do I find the Consumer Directed Personal Assistance Program?

Before a person can receive services, his or her doctor must send a completed Physician's Order for Services to the local social services district, which then completes a social and nursing assessment. A nurse assessor then determines whether the recipient can appropriately participate in CDPAP, and recommends the amount, frequency and duration of services.

Requirements of CDPAP

Recipients must be able and willing to make informed choices regarding the management of the services they receive, or have a legal guardian or designated relative or other adult able and willing to help make informed choices.

The consumer or designee must also be responsible for recruiting, hiring, training, supervising and terminating caregivers, and must arrange for back-up coverage when necessary, arrange and coordinate other services; and keep payroll records.

Click here if you think you have an immediate need for Consumer Directed Personal Assistance Services and would like more information on how to get your eligibility processed more quickly for these services.