Tag: Aging

As the world’s population ages, health experts are bracing for higher rates of age-related diseases, including Alzheimer’s.

Finding new ways to diagnose the condition is more of a priority than ever, since new treatments work best earlier in the course of disease. But currently, the two primary ways to diagnose Alzheimer’s—PET imaging or a lumbar puncture—are either too expensive or invasive for most people, leaving too many cases undiagnosed.

In a study published in JAMA Neurology, researchers report on a promising, more accessible test using blood, which could make more widespread screening and monitoring of the neurodegenerative condition possible. Researchers at the University of Gothenburg in Sweden worked with ALZPath, a company that developed a blood-based Alzheimer’s test used in research studies, to determine how well the test measured up to the current gold standards of PET imaging and cerebrospinal fluid (CSF) tests from lumbar punctures. The researchers analyzed scans or CSF and blood samples from nearly 800 people in three different patient populations in the U.S., Canada, and Spain.

In the comparison, the blood test performed as well as CSF in detecting Alzheimer’s—an encouraging finding, since CSF performs as well as PET scans in diagnosing the condition.

“This test showed that blood and CSF performed exactly the same,” says Nicholas Ashton, associate professor of neurochemistry at the University of Gothenburg and lead author of the study. “The blood test performed excellently—it was almost 95% accurate—and in that regard, it could eventually replace CSF.”

The test measures a substance called phosphorylated tau, a protein that has emerged as a strong indicator of Alzheimer’s. Levels of phosphorylated tau tend to rise as clumps of amyloid protein, the hallmark of Alzheimer’s, begin to form in the brain, often years before symptoms of memory loss and cognitive decline occur. The blood-based test takes advantage of proprietary technology that makes it very sensitive to even low levels of the protein, which could make it a useful tool for screening for the disease.

Ashton says doctors in Sweden are beginning to incorporate the blood test into an overall program for diagnosing and managing Alzheimer’s. They are beginning to conduct a real-world study and collect blood samples to determine what proportion of patients, for example, could be reliably diagnosed from the blood test alone, and which might need additional confirmatory tests like CSF. “We hope that everyone who is suspected of having dementia could access this test, which reveals the underlying pathology of what might be causing their symptoms,” says Ashton.

If people do have Alzheimer’s, the blood test could also become a tool to identify patients who could benefit from the new anti-amyloid treatments, such as lecanemab, as well as help doctors monitor how well they are responding the medication. In order to qualify for the drug in the U.S., patients need to prove that they have amyloid in the brain, and a simple blood test could be a way to quickly identify those who might benefit. “Rather than wait for a CSF test or PET scan, everyone [who is suspected of having dementia] could at least get a blood exam to see if they are eligible for the drug or now,” says Ashton.

For now, the ALZPath test is available only for scientists to purchase for research studies through select partner labs. But later this month, doctors in the U.S. will be able to order the test for use with patients. (Some laboratory-developed tests performed by certain certified labs don’t require clearance from the U.S. Food and Drug Administration.) Andreas Jeromin, chief scientific officer of ALZPath, expects that in the next two to three years, large hospital and regional labs could start performing the test themselves as demand increases.

Kathryn Clancy wrote an entire book about menstrual cycles. But even she was surprised by some of the pre-menopausal symptoms she recently began to experience at age 44.

“A lot of things that have to do with my uterus, ovaries, and breasts, I have been massively underprepared for as a Ph.D.-level expert in this field,” says Clancy, a professor at the University of Illinois Urbana-Champaign. “That should tell you how even more underprepared most people are.”

Most people who menstruate will experience symptoms including hot flashes, brain fog, and changes to mood, sleep, and sexual function as they approach menopause, defined as the point in time a year after their last period. But that transition, which typically begins between the ages of 45 and 55, is so rarely discussed in society—and at the doctor’s office—that people often know nearly nothing about it in advance. One 2023 study of post-menopausal women found that almost none of them had learned about menopause in school, and about half of them “did not feel informed at all” about the life stage.

But there are signs that menopause is finally going mainstream, as both the medical and business worlds get serious about the needs of the million-plus people in the U.S. who reach menopause every year. The U.S. Food and Drug Administration (FDA) in 2023 approved Astellas Pharma’s drug to treat menopausal hot flashes, and pharmaceutical giant Bayer is currently developing a similar medication. Some companies are beginning to offer menopause benefits to their employees. Lawmakers have pushed for more research on menopause. And a flurry of menopause-focused startups have launched in recent years to supplement traditional care, since studies suggest a significant portion of people going through menopause are not treated. The company Alloy, for example, connects patients to menopause specialists via telehealth and sells wellness products targeted toward those going through the transition.

“I have really noticed, thankfully, a new attention and interest in taking care of people during this transition,” says Dr. Ghazaleh Moayedi, a Texas-based ob-gyn who provides menopause care. She attributes that shift to growing numbers of women holding positions of power in business, tech, and medicine, and to social media’s ability to spread information among patients.

But fixing the problem will take more than well-branded startups, or even new FDA-approved therapies, which not all patients are able to get. Experts believe a meaningful shift will only take place once the core issues change: how research is conducted and disseminated, how doctors are trained, and how seriously practitioners take women’s pain.

For Dr. Sharon Malone, chief medical advisor to Alloy, the medical system’s problems with menopause go back to 2002. That’s when a major study was published, linking hormone therapy —which can ease menopause symptoms by boosting levels of hormones that have dropped off—to increased risks of breast cancer and other serious conditions. After that, hormone therapy use plummeted in the U.S.

But, Malone says, there’s a crucial caveat to the data: the study participants’ average age was 63, older than that of a typical patient receiving hormone therapy for menopause. Later analyses, and statements from researchers involved in the study, clarified that the risk of breast cancer may have been overstated, particularly for younger people.

In a 2022 position statement, the North American Menopause Society said hormone therapy has more benefits than risks for women younger than 60 and within 10 years of menopause, unless they have specific complicating health factors. But many doctors and health groups remain wary. The U.S. Centers for Disease Control and Prevention, for example, still cautions that hormone therapy may be associated with higher risks of breast cancer when taken for at least five years.

There has also been debate about whether hormone therapy is linked to a heightened risk of dementia—a risk that Dr. Kejal Kantarci, a professor of radiology at the Mayo Clinic, says her research has not borne out, at least among younger people. In a 2018 study, Kantarci and her colleagues compared a small group of women who used menopausal hormone therapy in their 40s and 50s with those who took a placebo. Three years later, they found no significant differences in cognitive function between the two groups. Other studies, however, have reached different conclusions.

The result of all this back-and-forth, Malone says, is that “we are now looking at a generation of doctors that really have not had formal or informal training in how to treat menopause. Women don’t know what to expect, and doctors don’t really know what to do.”

Moayedi says the problems in physician training go deeper than hormone therapy. “I don’t remember a single lecture from medical school about menopause,” she says. And after graduation, she, like many of her colleagues, worked in a clinic staffed by doctors finishing their medical training, which mostly served people who were uninsured or underinsured. Most of the patients Moayedi saw were lower-income pregnant people who qualified for Medicaid or older people on Medicare—which meant she hardly ever saw people who were going through menopause, despite training to become an ob-gyn.

Physicians who don’t specialize in obstetrics and gynecology likely know even less, she says, because women’s health is often (wrongly) considered “separate from the rest of medicine.” Moayedi says she often sees patients who have been misdiagnosed with other conditions, including ADHD, because their primary care doctor didn’t realize that symptoms like brain fog can be linked to menopause.

Another reason doctors are under-informed, Clancy says, is that most reproductive-science research looks at people at the peak of their childbearing years, which typically excludes adolescents and adults entering menopause. She says there’s a clear need for more studies—and more funding for studies—on people who fall outside those main reproductive years. A bill introduced in 2022 called for $100 million for menopause research in 2023 and 2024, but it hasn’t moved forward.

Even so, Malone says she’s encouraged by the fact that menopause is receiving renewed attention—and that people are noticing the need for that course correction at all.

“Women of a certain generation just assumed that suffering was just part of being a woman, our unfortunate lot in life,” she says. Now, she says, patients “are saying, ‘This is nonsense. You’re going to have to do better by us.’”

Aging is inevitable, but that doesn’t stop us from trying to slow it down. And the easier the intervention, the better.

In a study published in the American Journal of Clinical Nutrition, researchers report that taking a multivitamin that you can buy at the pharmacy can slow cognitive decline associated with aging by as much as two years.

The trial is part of a series led by scientists at Harvard Medical School and Brigham and Women’s Hospital that compared people 60 years or older taking Centrum Silver to those taking a placebo. It was funded by the National Institutes of Health and Mars Edge—a branch of the food company Mars, Inc.—and Haleon, the maker of Centrum, donated the vitamins. None of the sponsors or funders were involved in the design of the study or analysis of the results.

Two previous studies in the series had evaluated the participants over two to three years via phone or web interviews, and those results revealed that people taking a multivitamin daily scored higher on cognitive tests than those taking the placebo. In this latest study, which involved 573 people who were tested in person by the research team, the scientists saw the same benefit. Taken together, all three studies, which involved more than 5,000 volunteers, show that people taking a daily multivitamin for up to three years slowed cognitive brain aging by two years.

“These findings of consistent benefit of a multivitamin in three separate placebo-controlled studies are compelling and exciting,” says Dr. JoAnn Manson, professor of medicine at Harvard Medical School, chief of preventive medicine at Brigham and Women’s Hospital, and co-director of the study, which was conducted with scientists at Columbia and Wake Forest University. “They could even be considered stunning.”

Read More: What the Science Says About the Health Benefits of Vitamins and Supplements

Manson says that each of the three studies showed slightly different magnitudes of benefit on different cognitive tests, which included memory skills such as recalling word lists both immediately and after a delay, naming animals and vegetables, and subtracting numbers backwards. All three trials showed particularly strong benefits for memory.

The results are a first step toward better understanding how vitamins and nutrients—especially the 20 essential micronutrients included in most multivitamins—can keep brains healthy. But questions remain: for example, is the multivitamin supplementing already adequate levels of these vitamins and nutrients in older people, or is it addressing deficiencies? Manson says the research team has some health information on the participants’ diets, which ranged from poor to good, and are planning to investigate that issue further. “We have some indication that people with lower diet quality showed greater benefit, but we need to delve into those questions in more detail,” she says. “It’s possible that in study populations with lower diet quality, or lower educational levels and lower socioeconomic status, there would be greater benefit, because it’s likely that there are more nutritional deficiencies in those groups.”

They will also be exploring whether specific vitamins or nutrients are more important for the brain as people age, such as vitamin B12, vitamin D, vitamin E, lutein, and zinc. Other studies have reported that people tend to absorb less vitamin B12 as they get older, for example, and synthesize less vitamin D through the skin. And while the study only followed people for up to three years, future trials could also look at whether longer term use of multivitamins could lead to even greater benefits for the brain.

As encouraging as the results are, Manson says they don’t suggest that a vitamin can substitute for a healthy diet and lifestyle. “By no means does this say that people can be complacent about their diet and just pop a pill. But it is possible that a multivitamin could have a complementary role to a healthy diet and lifestyle because it includes a comprehensive array of essential vitamins and minerals, and if someone does have a deficiency in any of them, it can be of benefit.”