White coat hypertension is associated with increased small vessel disease in the brain

Objective: Small vessel disease, as measured by white matter hyperintensity (WMH) in the brain, is known to be associated with increased stroke risk and cognitive impairment. This study explored the relationship between WMH on computerised tomography (CT) and white coat hypertension/effect (WCH/E) in patients with recent transient ischaemic attack (TIA) or lacunar stroke (LS). Design and method: Ninety-six patients recruited for the ASIST trial (Arterial Stiffness in Lacunar Stroke and TIA) underwent measurement of clinic blood pressure (BP) and ambulatory BP monitoring (APBM) within two weeks of TIA or LS. Twenty-three patients had normotension (clinic BP / = 140/90mmHg and day-time ABPM < 135/85mmHg). Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV) (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI) (VaSera VS-1500N®, Fukuda Denshi). CT images were scored for WMH using the four-point Fazekas visual rating scale. Patients were grouped into no-mild WMH (scores 0–1) or moderate-severe (scores 2–3) groups. The relationship between BP, vascular stiffness and WMH was explored with t-tests, chi-square and logistic regression accounting for known cardiovascular risk factors. Results: Forty-four percent of patients with WCH/E had moderate-severe WMH compared to 17% of normotensives (p = 0.047). The regression model with WMH as the dependent factor, and WCH/E and cardiovascular risk factors as independent factors showed WCH/E and either CAVI or PWV to be the only independent significant factor contributing to WMH (CAVI:p = 0.038, PWV:p = 0.043)

P104 White coat hypertension is associated with increased small vessel disease in the brain

Objective: Small vessel disease, measured by brain white matter hyperintensity (WMH), is associated with increased stroke risk and cognitive impairment. This study aimed to explore the relationship between WMH on computerised tomography (CT) and white coat hypertension (WCH) in patients with recent transient ischaemic attack (TIA) or lacunar stroke (LS). Methods: Ninety-six patients recruited for the ASIST trial (Arterial Stiffness in Lacunar Stroke and TIA) underwent measurement of clinic blood pressure (BP) and ambulatory BP monitoring (APBM) within two weeks of TIA or LS. Patients were grouped by BP phenotypes. Twenty-three patients had normotension (clinic BP 140/90 mmHg and day-time ABPM <135/85 mmHg). CT brain images were scored for WMH using the four-point Fazekas visual rating scale. Patients were grouped into no-mild WMH (scores 0–1) or moderate-severe (scores 2–3) groups. The relationship between BP and WMH was explored with chi-square and logistic regression accounting for known cardiovascular risk factors (age, gender, smoking, diabetes and hyperlipidaemia). Results: 44% of WCH patients had moderate-severe WMH compared to 17% of normotensives (p = 0.047). Logistical regression incorporating WCH as the independent factor and cardiovascular risk factors as independent variables showed WCH to be the only independent significant factor contributing to WMH (p = 0.024). Conclusion: Patients with WCH were more likely to have moderate-severe WMH on CT brain than normotensives. WCH was associated with increased WMH, independent of other cardiovascular risk factors. This study suggests that WCH is associated with increased small vessel disease in the brain and may benefit from treatment

Q351R MAPT mutation is associated with a mixed 3R/4R tauopathy and a slowly progressive cognitive, behavioural and parkinsonian syndrome

Alzheimer's Research UK; Alzheimer's Society; Brain Research UK; The Wolfson Foundation; UK DRI Ltd, funded by the UK Medical Research Council, Alzheimer's Society and Alzheimer's Research UK; Miriam Marks Brain Research UK Senior Fellowship; MRC Clinician Scientist Fellowship (MR/M008525/1); NIHR Rare Disease Translational Research Collaboration (BRC149/NS/MH); Alzheimer’s Society and by the NIHR UCLH Biomedical Research Centre; NIHR UCL/H Biomedical Research Centre; UK Dementia Research Institute which receives its funding from DRI Ltd, funded by the UK Medical Research Council, Alzheimer’s Society and Alzheimer’s Research UK

Las áreas marinas protegidas como asunto de política internacional: el escenario de la Comisión para la Conservación de los Recursos Vivos Marinos Antárticos

In 2016, the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) created a Marine Protected Area (MPA) in the Ross Sea. The purpose of this article is to know the United Kingdom, the United States and New Zealand stance on this decision, regarding the impacts global warming on the Antarctic geopolitics and the discussions on the establishment of new MPAs in the CCAMLR’s scope. A qualitative methodology was used for this purpose through an inductive approach. Documents and materials published by the CCAMLR and by the three countries were analyzed. Everything was supplemented by performing semi-structured interviews with key actors. The paper concludes that the stance of the United Kingdom, the United States and New Zealand on the CCAMLR, when a MPA was designated in the Ross Sea, requires understanding the context of the political impact of global warming on Antarctic geopolitics and the debates to designate new MPAs. It is also necessary to consider the strategic interests of these countries in the CCAMLR’s area of application, their views on the MPA debate, the geopolitical component of their relevant strategies for marine conservation of biodiversity and, finally, the impacts of changes in international policy on existing environmental commitments.Em 2016, a Comissão para a Conservação dos Recursos Vivos Marinhos Antárticos (CCRVMA), criou uma área marinha protegida (AMP) no Mar de Ross. Este artigo tem como objetivo conhecer o posicionamento do Reino Unido, Estados Unidos e Nova Zelândia diante dessa decisão, no contexto dos efeitos do aquecimento global na geopolítica antártica, e as discussões em torno do estabelecimento de novas AMPs no campo da CCRVMA. Por isso, foi utilizada uma metodologia qualitativa sob uma perspectiva indutiva. Os documentos e materiais publicados pela CCRVMA e pelos três Estados foram analisados. Tudo isso foi complementado por entrevistas semiestruturadas realizadas com os principais atores. O artigo conclui que o comportamento do Reino Unido, Estados Unidos e Nova Zelândia na CCRVMA, quando designaram uma AMP no Mar de Ross, precisa ser entendido no contexto do efeito político do aquecimento global na geopolítica antártica e dos debates para designar novas AMPs. Além disso, é necessário levar em conta nessa situação os interesses estratégicos desses Estados na área de atuação da CCRVMA, suas percepções sobre o debate das AMPs, o componente geopolítico de suas respectivas estratégias de conservação da biodiversidade marinha e, finalmente, os efeitos das mudanças na política internacional sobre os compromissos ambientais existentes.En 2016, la Comisión para la Conservación de los Recursos Vivos Marinos Antárticos creó un área marina protegida en Mar de Ross. Este artículo tiene como objetivo conocer el posicionamiento del Reino Unido, Estados Unidos y Nueva Zelanda ante esta decisión, en el contexto de los efectos del calentamiento global en la geopolítica antártica, y las discusiones en torno del establecimiento de nuevas AMP en el ámbito de la CCRVMA. Para tal efecto, se utilizó una metodología cualitativa a través de una perspectiva inductiva. Se analizaron documentos y materiales publicados por la CCRVMA y esto tres Estados. Se consideraron también entrevistas semi-estructuradas realizadas a actores claves. El trabajo concluye que el comportamiento estos tres Estados en la CCRVMA, cuando se designó una AMP en el Mar de Ross, requiere ser comprendido en el contexto del efecto político del calentamiento global sobre la geopolítica antártica y los debates para designar nuevas AMP. También es necesario tener en cuenta en esta situación los intereses estratégicos de estos Estados, sus percepciones sobre el debate acerca de las AMP, el componente geopolítico de sus estrategias de conservación marina de la biodiversidad y, por último, los efectos en política internacional sobre los compromisos ambientales existentes

Gender, Pain, and Function Associated With Physical Activity After Hospitalization in Persons Living With Dementia

Background: The purpose of this study was to identify factors that are associated with physical activity after hospitalization in persons living with dementia.Methods: Multiple linear regressions were conducted to test factors associated with objective activity levels (sedentary, low, moderate, and vigorous) among 244 patients living with dementia from a randomized controlled trial.Results: Within 48 hours of hospital discharge, time in sedentary behavior was associated with increased pain (beta = 0.164, P = 0.015). Time in low activity was associated with less pain (beta = -0.130, P = 0.049) and higher physical function (beta = 0.300, P = < 0.001). Time in moderate activity was associated with increased physical function (beta=0.190, P = 0.008) and male gender (beta = 0.155, P = 0.016). No significant associations of potential factors were found with time in vigorous activity.Conclusions: Our findings suggest that managing or reducing pain, encouraging individual functional level, and gender could influence time spent in physical activity after acute hospitalization in persons living with dementia

Neural markers of category-based selective working memory in aging

Working memory (WM) is essential for normal cognitive function, but shows marked decline in aging. The importance of selective attention in guiding WM performance is increasingly recognized. Studies so far are inconclusive about the ability to use selective attention during WM in aging. To investigate the neural mechanisms supporting selective attention in WM in aging, we tested a large group of older adults using functional magnetic resonance imaging whilst they performed a category-based (faces/houses) selective-WM task. Older adults were able to use attention to encode targets and suppress distractors to reach high levels of task performance. A subsequent, surprise recognition-memory task showed strong consequences of selective attention. Attended items in the relevant category were recognized significantly better than items in the ignored category. Neural measures also showed reliable markers of selective attention during WM. Purported control regions including the dorsolateral and inferior prefrontal and anterior cingulate cortex were reliably recruited for attention to both categories. Activation levels in category-sensitive visual cortex showed reliable modulation according to attentional demands, and positively correlated with subsequent memory measures of attention and WM span. Psychophysiological interaction analyses showed that activity in category-sensitive areas were coupled with non-sensory cortex known to be involved in cognitive control and memory processing, including regions in the prefrontal cortex and hippocampus. In summary, we found that older adults were able to recruit a network of brain regions involved in top-down attention during selective WM, and individual differences in attentional control corresponded to the degree of attention-related modulation in the brain

Imagining a brighter future: The effect of positive imagery training on mood, prospective mental imagery and emotional bias in older adults

AbstractPositive affect and optimism play an important role in healthy ageing and are associated with improved physical and cognitive health outcomes. This study investigated whether it is possible to boost positive affect and associated positive biases in this age group using cognitive training. The effect of computerised imagery-based cognitive bias modification on positive affect, vividness of positive prospective imagery and interpretation biases in older adults was measured. 77 older adults received 4 weeks (12 sessions) of imagery cognitive bias modification or a control condition. They were assessed at baseline, post-training and at a one-month follow-up. Both groups reported decreased negative affect and trait anxiety, and increased optimism across the three assessments. Imagery cognitive bias modification significantly increased the vividness of positive prospective imagery post-training, compared with the control training. Contrary to our hypothesis, there was no difference between the training groups in negative interpretation bias. This is a useful demonstration that it is possible to successfully engage older adults in computer-based cognitive training and to enhance the vividness of positive imagery about the future in this group. Future studies are needed to assess the longer-term consequences of such training and the impact on affect and wellbeing in more vulnerable groups