Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: A systematic review

A prolonged preclinical phase of more than two decades before the onset of dementia suggested that initial brain changes of Alzheimer’s disease (AD) and the symptoms of advanced AD may represent a unique continuum. Given the very limited therapeutic value of drugs currently used in the treatment of AD and dementia, preventing or postponing the onset of AD and delaying or slowing its progression are becoming mandatory. Among possible reversible risk factors of dementia and AD, vascular, metabolic, and lifestyle-related factors were associated with the development of dementia and late-life cognitive disorders, opening new avenues for the prevention of these diseases. Among diet-associated factors, coffee is regularly consumed by millions of people around the world and owing to its caffeine content, it is the best known psychoactive stimulant resulting in heightened alertness and arousal and improvement of cognitive performance. Besides its short-term effect, some case-control and cross-sectional and longitudinal population-based studies evaluated the long-term effects on brain function and provided some evidence that coffee, tea, and caffeine consumption or higher plasma caffeine levels may be protective against cognitive impairment/decline and dementia. In particular, several cross-sectional and longitudinal population-based studies suggested a protective effect of coffee, tea, and caffeine use against late-life cognitive impairment/decline, although the association was not found in all cognitive domains investigated and there was a lack of a distinct dose-response association, with a stronger effect among women than men. The findings on the association of coffee, tea, and caffeine consumption or plasma caffeine levels with incident mild cognitive impairment and its progression to dementia were too limited to draw any conclusion. Furthermore, for dementia and AD prevention, some studies with baseline examination in midlife pointed to a lack of association, although other case-control and longitudinal population-based studies with briefer follow-up periods supported favourable effects of coffee, tea, and caffeine consumption against AD. Larger studies with longer follow-up periods should be encouraged, addressing other potential bias and confounding sources, so hopefully opening new ways for diet-related prevention of dementia and AD

The BDNF Val66Met polymorphism moderates the relationship between cognitive reserve and executive function

The concept of cognitive reserve (CR) has been proposed to account for observed discrepancies between pathology and its clinical manifestation due to underlying differences in brain structure and function. In 433 healthy older adults participating in the Tasmanian Healthy Brain Project, we investigated whether common polymorphic variations in apolipoprotein E (APOE) or brain-derived neurotrophic factor (BDNF) influenced the association between CR contributors and cognitive function in older adults. We show that BDNF Val66Met moderates the association between CR and executive function. CR accounted for 8.5% of the variance in executive function in BDNF Val homozygotes, but CR was a nonsignificant predictor in BDNF Met carriers. APOE polymorphisms were not linked to the influence of CR on cognitive function. This result implicates BDNF in having an important role in capacity for building or accessing CR

Managing chronic myeloid leukemia for treatment-free remission: A proposal from the GIMEMA CML WP

Several papers authored by international experts have proposed recommendations on the management of BCR-ABL11 chronic myeloid leukemia (CML). Following these recommendations, survival of CML patients has become very close to normal. The next, ambitious, step is to bring as many patients as possible into a condition of treatment-free remission (TFR). The Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA; Italian Group for Hematologic Diseases of the Adult) CML Working Party (WP) has developed a project aimed at selecting the treatment policies that may increase the probability of TFR, taking into account 4 variables: the need for TFR, the tyrosine kinase inhibitors (TKIs), the characteristics of leukemia, and the patient. A Delphi-like method was used to reach a consensus among the representatives of 50 centers of the CML WP. A consensus was reached on the assessment of disease risk (EUTOS Long Term Survival [ELTS] score), on the definition of the most appropriate age boundaries for the choice of first-line treatment, on the choice of the TKI for first-line treatment, and on the definition of the responses that do not require a change of the TKI (BCR-ABL1 ≤10% at 3 months, ≤1% at 6 months, ≤0.1% at 12 months, ≤0.01% at 24 months), and of the responses that require a change of the TKI, when the goal is TFR (BCR-ABL1 >10% at 3 and 6 months, >1% at 12 months, and >0.1% at 24 months). These suggestions may help optimize the treatment strategy for TFR

Fatal injuries in cyclists: analysis of the epidemiological and medico-legal aspects and of the protective role of the helmet in a post-mortem case record in the territory of milan from 1995 to 2010

Introduction : The involvement of the bicycle in traffic accidents is growing, especially in large urban conglomerates, such as, for instance, the Milanese one. The use of this form of transport is aimed for sports or recreational activities and its diffusion is due to logistic expediency. and ease of use. However, bicycle crashes are responsible for significant morbidity and mortality, due to simple falls and involvement of motor vehicles. In either event, the effect is often represented by head-brain injuries, which could be significatively reduced, if not even avoided, as reported by numerous studies, with the use of a suitable protective helmet. In Italy, despite the amendments to the legislative Decree of 30 April 1992, n\ub0 285, introduced by the Law of 29 July 2010 n.120, the use of helmet is optional, as it is not mandatory even for children under 14. The purpose of this report is to demonstrate the efficacy of helmets, especially as regards lethal head-brain injuries. Materials and methods A retrospective study was performed using a post-mortem case record, collected between 1995 and 2005 at the Section of Legal Medicine of the University of Milan, relating to all cases of death due to road traumatism, with significant involvement of a bicycle. The analysis of the available necroscopic documents allowed to investigate the kind of the found lesions, the circumstances of the accident, and, if present, the protective efficacy of helmets. Results The number of cases was equal to 269 (1.6% of total), examined considering various parameters: sex (male in 81% of cases), age bracket (52% of cases between 60 and 79 years), survival (64%), seasonal trend of the events (oftener during spring and summer) and crash site (urban roads). The accidents happened in three ways: direct impact (231 cases), running down of the cyclist (31 cases), and impact followed by projection against obstacle (7 cases). The protective helmet was worn by only one victim. In most cases (84%), the pathological lethal found was head-brain injuries, related with non-use of helmet. Conclusions The high number of helmetless cyclists, who died from injuries sustained in the cephalic region, would require legislative implementation of proper measures of prevention, such as the obligation to wear helmet, required for all two-wheelers, and the creation of special cyclists-reserved lanes. This in order to reduce both the number of accidents and the frequency and severity of injuries suffered by road cyclist user