How’s my driving? GPS tracking spots Alzheimer’s with 86% accuracy

 Diagnosing Alzheimer’s disease is still a challenge, particularly in its earliest stages, but a new study suggests that subtle changes in behaviour whilst driving could serve as an early warning system.

The researchers used GPS logging devices and machine learning as “digital biomarkers” to compare the driving of people who have preclinical Alzheimer’s but are still cognitively normal to a control group of normal age-matched drivers over the course of a year.

They found that there were characteristic behaviours in the preclinical Alzheimer’s group – who show subtle changes in the brain precede cognitive problems – which meant they could be distinguished from the normal controls with 86% accuracy.

The results suggest it may be possible to screen people for signs of dementia very early on, perhaps 20 years before the cognitive symptoms become apparent.

That could present a window of opportunity to try to introduce changes to lifestyle such as physical exercise or non-drug therapies like memory or cognitive training that – in theory at least – could help slow down progression to symptomatic Alzheimer’s. It could potentially also help to select patients for drug therapies.

At the moment, diagnosing Alzheimer’s relies on molecular biomarkers detected using PET imaging or lumbar punctures to collect cerebrospinal fluid (CSF), and access to these can be limited by cost, availability and the willingness of people to undergo an invasive procedure.

After the follow-up period, the scientists found a number of driving behaviours that were more common among the preclinical Alzheimer’s group, including a tendency to take shorter trips in general and avoiding driving at night.

Other signals for preclinical Alzheimer’s were driving too slowly, abrupt changes in braking or acceleration (jerking), and sticking to fewer destinations, which could imply they preferred well-known routes. The most important driving feature was jerk, according to the scientists, led by Sayeh Bayat of the Toronto Rehabilitation Institute in Canada.

GPS trackers are already being used for applications like proving careful driving patterns in order to secure cuts to insurance premiums, so it isn’t a big stretch to envisage a scenario where devices are fitted for health monitoring.

The approach could provide “a non-invasive, unobtrusive, and low-cost solution” for identifying people with preclinical Alzheimer’s, write the authors of the study, which is published in the journal Alzheimer’s Research & Therapy.

Adding in genotype testing for ApoE4 – a well-established diagnostic biomarker for Alzheimer’s pushed the accuracy of the diagnosis up, but only a little to 90%, showing that the GPS monitoring was remarkably effective on its own.

The next stage will be to carry out randomised studies of GPS monitoring that include larger numbers of subjects from a broad demographic spectrum.

https://pharmaphorum.com/news/hows-my-driving-gps-tracking-spots-alzheimers-with-86-accuracy/

Dementia Comes 5 Years Later for Some

 A cognitively active lifestyle that involves reading and processing information in old age may delay the onset of dementia in Alzheimer's disease by as much as 5 years, a longitudinal study suggested.

Older adults who had the highest level of late-life cognitive activity had a mean onset age of Alzheimer's dementia of 94, reported Robert Wilson, PhD, of Rush University Medical Center in Chicago, and colleagues.

In contrast, those with the lowest late-life cognitive activity levels developed dementia at age 89, they wrote in Neurology.

"Our study shows that people who engage in more cognitively stimulating activities may be delaying the age at which they develop dementia," Wilson said in a statement.

"It is important to note, after we accounted for late-life level of cognitive activity, neither education nor early-life cognitive activity were associated with the age at which a person developed Alzheimer's dementia," he continued. "Our research suggests that the link between cognitive activity and the age at which a person developed dementia is mainly driven by the activities you do later in life."

"This study provides further support for the concept of cognitive reserve, where genetic and life exposures allow some people to cope better than others with age- or disease-related brain changes," noted Yaakov Stern, PhD, of Columbia University in New York City, who wasn't involved with the research.

"Previous work has suggested many exposures that can contribute to cognitive reserve, including education, aspects of occupational attainment, and late-life leisure activities, along with IQ," Stern told MedPage Today.

"What is interesting here is that this paper suggests that late-life cognitive activity can contribute to this reserve," he added. "Further, their autopsy data indicates that the late-life cognitive activity does not influence the pathology itself, making it more likely that it influences cognitive reserve -- the ability to cope with the pathology."

The study involved 1,903 older adults from the longitudinal Rush Memory and Aging Project who were dementia-free at enrollment. Participants had annual clinical evaluations to diagnose dementia and Alzheimer's disease. Those who died had a neuropathologic examination.

Mean age at baseline was 79.7. Participants had completed an average of 15 years of formal education; most were women (74.9%) and white (89.1%). They had a median of one of seven chronic medical conditions such as cancer or heart disease, and a median income between $35,000 and $49,999.

At baseline, participants reported how frequently they participated in seven specific cognitively stimulating activities on a 5-point scale. The activities emphasized seeking or processing information: daily reading, or time spent each year visiting a library, reading newspapers, reading magazines, reading books, writing letters, or playing games like puzzles, cards, and board games. Scores ranged from 1 (no time) to 5 (every day or almost every day).

People in the 90th percentile of cognitive activity scored an average of 4.0, indicating they were involved with these activities several times per week. Those with the lowest cognitive activity -- the 10th percentile -- had an average score of 2.1, indicating activities several times per year.

Over a mean of 6.8 years of annual followup evaluations, 457 people were diagnosed with incident Alzheimer's dementia at a mean age of 88.6 (range 64.1-106.5). In an extended accelerated failure time model, a higher level of baseline cognitive activity (mean 3.2) was associated with older age at Alzheimer's dementia onset (estimate 0.026, 95% CI 0.013-0.039).

An activity score of 2.1 (10th percentile) was linked with an average dementia onset age of 88.6. A activity score of 4.0 (90th percentile) was associated with an average onset age of 93.6. Cognitive activity continued to be related to age of Alzheimer's dementia onset after adjusting for sex, education, APOE4 status, and baseline social activity and loneliness. The association persisted even when people who had mild cognitive impairment at baseline were excluded.

In the 695 participants who died and had a neuropathologic examination, cognitive activity was unrelated to postmortem markers of Alzheimer's and other dementias, including amyloid burden and tau.

Overall, the bases of observed associations between cognitive activity and age of Alzheimer's dementia onset are uncertain, Wilson and colleagues noted.

"One possibility is that low cognitive activity is an early sign of Alzheimer's disease (reverse causality hypothesis)," they wrote. "In the present analyses, however, postmortem markers of Alzheimer's disease and other dementias were unrelated to the self-report measure of cognitive activity, consistent with prior research in this cohort."

"We think a more likely possibility is that cognitive activities lead to changes in brain structure and function that enhance cognitive reserve," the researchers added.

The main limitation of the study is that analyses are based on a selected group of mainly white, well-educated participants. "Further research will be needed to establish whether the findings will generalize to more diverse cohorts with a wider range of age and cognitive experiences," they wrote.

Disclosures

This study was supported by grants from the National Institute on Aging.

The researchers had no disclosures to report.

Primary Source

Neurology

Source Reference: Wilson RS, et al "Cognitive Activity and Onset Age of Incident Alzheimer Disease Dementia" Neurology 2021; DOI: 10.1212/WNL.0000000000012388.

https://www.medpagetoday.com/neurology/alzheimersdisease/93576

First Look at 2022 Cost-Of-Living Adjustments and Maximum Contribution Base

 The BLS reported yesterday morning:

The Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) increased 6.1 percent over the last 12 months to an index level of 266.412 (1982-84=100). For the month, the index rose 1.1 percent prior to seasonal adjustment.

CPI-W is the index that is used to calculate the Cost-Of-Living Adjustments (COLA). The calculation dates have changed over time (see Cost-of-Living Adjustments), but the current calculation uses the average CPI-W for the three months in Q3 (July, August, September) and compares to the average for the highest previous average of Q3 months. Note: this is not the headline CPI-U, and is not seasonally adjusted (NSA).

• In 2020, the Q3 average of CPI-W was 253.412.

The 2020 Q3 average was the highest Q3 average, so we only have to compare Q3 this year to last year.

Click on graph for larger image.

This graph shows CPI-W since January 2000. The red lines are the Q3 average of CPI-W for each year.

Note: The year labeled for the calculation, and the adjustment is effective for December of that year (received by beneficiaries in January of the following year).

CPI-W was up 6.1% year-over-year in June, and although this is very early - we need the data for July, August and September - my current guess is COLA will probably be around 5.5% this year, the largest increase since 5.8% in 2008 - and it is possible this will be the largest increase since 1982 (7.4%).

Contribution and Benefit Base

The contribution base will be adjusted using the National Average Wage Index. This is based on a one year lag. The National Average Wage Index is not available for 2020 yet, but wages probably increased again in 2020. If wages increased the same as in 2019, then the contribution base next year will increase to around $148,200 in 2022, from the current $142,800.

Remember - this is an early look. What matters is average CPI-W, NSA, for all three months in Q3 (July, August and September).

https://www.calculatedriskblog.com/2021/07/first-look-at-2022-cost-of-living.html

Fed Chair Powell: Semiannual Monetary Policy Report to the Congress

 From Fed Chair Powell: Semiannual Monetary Policy Report to the Congress. An excerpt on inflation:

Inflation has increased notably and will likely remain elevated in coming months before moderating. Inflation is being temporarily boosted by base effects, as the sharp pandemic-related price declines from last spring drop out of the 12-month calculation. In addition, strong demand in sectors where production bottlenecks or other supply constraints have limited production has led to especially rapid price increases for some goods and services, which should partially reverse as the effects of the bottlenecks unwind. Prices for services that were hard hit by the pandemic have also jumped in recent months as demand for these services has surged with the reopening of the economy.

https://www.calculatedriskblog.com/2021/07/fed-chair-powell-semiannual-monetary.htm

Microsoft taps Teladoc to integrate telehealth into Teams app

 Teladoc Health is partnering with Microsoft to integrate telehealth into the Teams app for hospitals and health systems.

The combination of communications, collaboration and workflows in Microsoft Teams with Teladoc Health’s virtual care delivery technology will simplify the way care providers work by streamlining the technology and administrative processes associated with providing virtual care, according to the companies.

"We will deliver what hospitals and health systems want: integrated, enterprise solutions that make the full breadth of virtual care available in their daily workflows,” said Joseph DeVivo, president of hospitals and health systems at Teladoc Health, in a statement. “Our collaboration will deliver a more seamless, unified experience for clinicians and patients that makes healthcare better, leveraging leading data, artificial intelligence and machine learning expertise from both companies.

During the COVID-19 pandemic, many hospitals and health systems adopted Microsoft Teams to connect clinicians and patients on video. Clinicians already have the ability to securely access clinical data included within their electronic health record system using Teladoc Health's Solo platform and will be able to do so without having to leave the Teams app, according to Teladoc.

“This collaboration is focused on taking our aligned strategies and delivering on the last mile in healthcare,” said Tom McGuinness, corporate vice president of global healthcare at Microsoft. “Together, we will bring new and innovative tools to market that will not only improve patient care but increase health system efficiency overall.”

The tech giant has been working to build a technology platform that is compelling for healthcare organizations.

In October, Microsoft announced its Cloud for Healthcare service that brings together existing services such as Microsoft Teams, Azure IoT and chatbots to help healthcare organizations manage operations.

In April, the tech giant also released the first update for its Microsoft Cloud for Healthcare, which included a new Microsoft Teams and Epic EHR integration.

Microsoft also worked with Nuance for the past two years on artificial intelligence software that helps doctors record conversations with patients and integrate them into electronic health records. Microsoft's acquisition of Nuance, announced in April, is the latest step in Microsoft’s industry-specific cloud strategy.

https://www.fiercehealthcare.com/tech/microsoft-taps-teladoc-to-integrate-telehealth-into-teams-app

FDA rescinds breakthrough tag for Axsome narcolepsy med

 Axsome Therapeutics - Notified by U.S. FDA That It is Rescinding Co’s Breakthrough Therapy Designation for Its Axs-12 Product Candidate.

Axsome - FDA Btd Rescindment Due to It Approving Additional Drug Product for Treatment of Cataplexy in Narcolepsy Subsequent to Granting Axs-12 Btd.
Axsome - Does Not Currently Anticipate Any Changes to Development Plans Or Associated Timelines for Axs-12 As a Result of FDA Btd Rescindment.

https://www.cmlviz.com/stocks/AXSM/news/b/2021/07/13/axsome-therapeutics---fda-is-rescinding-co-s-breakthrough-therapy-designation-for-its-axs-12-product-candidate

EU regulator weighing mixing COVID-19 vaccines, booster doses

 Europe's drug regulator on Wednesday refrained from making any recommendations on mixing schedules of COVID-19 vaccines with doses from different manufacturers, saying it was too early to confirm if and when an additional booster shot would be needed.

However, the European Medicines Agency (EMA) did say both doses of two-shot coronavirus vaccines,such as those from Pfizer (PFE.N), AstraZeneca (AZN.L) and Moderna (MRNA.O), are needed to protect against the fast-spreading Delta variant.

In a bid to tackle increasing infections and vaccine shortages, countries are testing whether giving a different second dose to the first could boost immunity in people and bridge the gap between vaccine availability.

EMA made no definitive recommendations on switching up doses, but advised countries to take several conditions into account.

"In order to respond to these needs and increase vaccination coverage, countries may adapt their strategies...based on the epidemiological situation and circulation of variants, and the evolving evidence on vaccine effectiveness against variants," EMA said in a statement.

NEED TO BE PREPARED

An Oxford study last month found that a mixed schedule of vaccines where a shot of Pfizer's (PFE.N) vaccine is given four weeks after an AstraZeneca (AZN.L) shot will produce better immune responses than giving another dose of AstraZeneca.

The European Centre for Disease Prevention and Control (ECDC) has estimated that the Delta variant will account for 90% of strains in circulation in the European Union by the end of August.

The variant, first identified in India, has led to a surge in cases worldwide and is setting back economic recovery plans.

"We always follow the science, and the expertise and evaluation from the ECDC and EMA. But we also need to be prepared and ready if (or) when booster shots may be required," a spokesperson for the European Commission said.

The World Health Organization said on Wednesday the Delta variant was likely to become the dominant variant globally over the coming months.

Its chief scientist on Tuesday advised individuals against mixing vaccines, saying such decisions should be left to public health authorities.

MONITORING SIDE-EFFECTS

EMA has also been actively monitoring rare but serious side-effects of COVID-19 vaccines, and on Wednesday disclosed it had assessed nine cases of immune thrombocytopenia (IT) following vaccination with Moderna's shot.

While it said no "clear causal relationship" could be established between the two, EMA would continue to monitor cases, stressing that benefits of the vaccine continues to outweigh risks. read more

EMA in March began a review of IT, an auto-immune condition with low blood platelet levels that can lead to bruising and bleeding in people who had received the AstraZeneca, Pfizer and Moderna shots.

https://www.reuters.com/world/europe/eu-says-90-virus-circulation-be-delta-variant-by-end-august-2021-07-14/