Interaction of these 2 factors contributes 17% of overall risk, study findings suggest 

Concurrent physical frailty and depression likely boost the risk of dementia in older people, with the interaction of these 2 factors alone contributing around 17% of the overall risk, suggest the findings of a large international study, published in the open access journal General Psychiatry.

Globally, some 57 million people are living with dementia—a figure that is expected to triple by 2050, note the researchers.

Previously published research has primarily focused on the individual associations between physical frailty or depression and dementia risk, despite the fact that both have physiological and pathological factors in common, they explain.

To explore the potential interaction between these two factors on dementia risk in older adults,  the researchers tracked the diagnosis of any type of dementia in 220,947 participants (average age: 64; 53% women) from 3 large study groups.

These were the UK Biobank, the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study.

Physical frailty was assessed using modified versions of the Fried frailty criteria, in which a person is considered to be frail if they have 3 or more of the following indicators: unintentional weight loss; self-reported exhaustion; low physical activity; slow walking speed; and weak grip strength.

Depression was evaluated through responses to mental health questionnaires or combined with hospital admission records.

Compared with those in good physical health, frail participants across all 3 groups were older, more likely to be female, weigh more, have more long term conditions and lower educational attainment.

During an average tracking period of nearly 13 years, 9088 people (7605 in the UK Biobank, 1207 in the Health Retirement Study and 276 in the ELSA) were diagnosed with dementia of any type.

Analysis of the data revealed that compared with those in good physical health, those who were frail were more than 2.5 times as likely to be diagnosed with dementia, while depression was associated with a 59% heightened risk.

And participants who were both physically frail and depressed were more than 3 times as likely to be diagnosed with dementia as those in good physical and mental health.

What’s more, a significant additional interaction between physical frailty and depression was observed, with around 17% of the overall dementia risk attributable to these two factors combined.

“These results underscore the complex relationship between frailty, depression, and cognitive function,” write the researchers.

“Lower levels of frailty may allow the health system to partially offset the cognitive burden of depression and, similarly, lower levels of depression may enable the system to mitigate the burden of frailty,” they suggest.

“However, once both factors exceed a certain threshold, this compensatory ability may be compromised, leading to a sharp increase in the risk of dementia,” they add.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers sound a note of caution in the interpretation of the findings, primarily because the definitions of physical frailty, depression, and dementia varied across the three cohorts.

Nevertheless, the researchers conclude: “Given that physical frailty and depression are modifiable, concurrent interventions targeting these conditions could significantly reduce dementia risk.”

16/12/2025

Notes for editors
Research: Associations of physical frailty, depression and their interaction with incident all- cause dementia among older adults: evidence from three prospective cohorts Doi: 10.1136/ gpsych-2025-102172
Journal: General Psychiatry

External funding: National Key Research and Development Program of China

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

About the journal
General Psychiatry is one of 70 journals published by BMJ Group. The title is owned by the Shanghai Mental Health Center.
https://gpsych.bmj.com/

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Concurrent frailty + depression likely boost dementia risk in older people first appeared on BMJ Group.

Certain types may boost or lower risk; and insomnia may alter abundance of certain types

There seem to be reciprocal links between certain groups of gut bacteria and the risk of insomnia, suggests a Mendelian randomisation study, published in the open access journal General Psychiatry.

Certain types of bacteria seem to boost or lower the risk of the sleep disorder while insomnia itself seems to alter the abundance of certain types of bacteria, the findings indicate.

Several studies have explored the effects of the gut microbiome on various sleep characteristics, but it’s not yet clear how different groups of gut bacteria might affect the risk of insomnia, which affects an estimated 1 in 10  to 1 in 5 people, say the researchers.

To strengthen the evidence base, they deployed Mendelian randomisation analysis, a technique that uses randomly selected genetic variants as proxies for a particular risk factor to obtain genetic evidence in support of a particular outcome.

They drew on data for 386,533 people with insomnia from a previously published genome wide analysis study and gut microbiome data for 18,340 people from the MiBioGen alliance, and for 8208 people from the Dutch Microbiome Project (71 groups of bacteria in common).

The analysis revealed associations between specific gut microbes and insomnia. In all, a total of 14 groups of bacteria were positively associated (1-4% higher odds), and 8 groups negatively associated (1-3% lower odds), with insomnia.

And insomnia was itself associated with a reduction of between 43% and 79% in the abundance of 7 groups of bacteria, and a 65% to a more than fourfold increase in the abundance of 12. The Odoribacter class of bacteria, in particular, was significantly associated with the risk of insomnia. 

No pleiotropy—the production by a single gene of two or more apparently unrelated effects—was identified, strengthening the integrity of the findings and implying causation, note the researchers.

The findings agree with those of many previously published studies that have suggested an interplay between insomnia and the gut microbiome, but certain limitations should be borne in mind, caution the researchers.

All the study participants were of European descent, so the results may not be more widely applicable as the make-up of the microbiome varies among different ethnicities and geographies, they point out. And factors, such as diet and lifestyle, all of which affect the microbiome and the interplay between genes and the environment, weren’t accounted for.

“Overall, the intertwined effects of insomnia on gut microbiota, and vice versa, represent a complex bidirectional relationship involving immune regulation, inflammatory response, release of neurotransmitters, and other molecular and cellular pathways,” they explain.

And they conclude: “Our study offers preliminary evidence supporting a causal effect between insomnia and gut microbiota, providing valuable insights for the future development of microbiome-inspired treatment plans for insomnia.”

These might include the use of probiotics, prebiotics, or faecal microbiota transplantation, they suggest.

12/08/2025

Notes for editors
Research: Investigating bidirectional causal relationships between gut microbiota and insomnia Doi: 10.1136/gpsych-2024-101855
Journal: General Psychiatry

Externally peer reviewed? YesPreview (opens in a new tab)
Evidence type: Mendelian randomisation
Subjects: People

The post Reciprocal links likely between certain groups of gut bacteria and insomnia risk first appeared on BMJ Group.

Including a non-invasive eye test in the preoperative assessment for older patients might be a useful predictor of vulnerability to this debilitating postoperative complication, authors suggest

Thickening of the macular layer of the eye’s retina is associated with a greater risk of postoperative delirium for older patients undergoing surgery under general anaesthetic, reveals a study published online in the open access journal General Psychiatry.

Postoperative delirium is one of the most common complications for older patients after surgery and can have profound implications for long-term health and wellbeing.

Patients with postoperative delirium require longer hospital stays and are more likely to require support at home to help with daily tasks such as washing, dressing, and eating or be discharged into a nursing home. They also face a greater risk of cognitive decline and dementia.

Although there are no simple tests to identify patients at risk of developing postoperative delirium, visual impairment is a risk factor, so the authors set out to determine whether a thickened retinal layer called the macular might be a potential biomarker of the condition.

The study included 169 patients aged 65 years or more scheduled for hip or knee replacements, kidney or prostate surgery under general anaesthetic at Shanghai 10th People’s Hospital who received an eye imaging test called optical coherence tomography (OCT) as part of their preoperative assessment to measure the thickness of the macular of the retina. Patients were screened for delirium using the Confusion Assessment Method (CAM) algorithm each day for the first three days post-surgery.

Severity of any delirium was measured using the CAM-Severity (CAM-S) rating of ten delirium features, including inattention, disorganised thinking, disorientation, reduced quality and amount of sleep, inability to sit still accompanied by anxiety, or slowed movement and thought processes.

Forty patients (24%) developed postoperative delirium, and these patients had displayed a greater mean macular thickness (283.35 µm) of the right eye at their preoperative assessment than the patients who did not experience postoperative delirium (273.84 µm). After adjusting for age, sex and mental state, greater preoperative macular thickness of the right eye was associated with 1.593 higher odds of developing postoperative delirium and the delirium experienced was of greater severity.

Thickness of the macular in patients with postoperative delirium was greater in the right eye, and thickening of the macular of the left eye was not associated with a greater risk of postoperative delirium.

The reasons for the differences in association observed between the right and left eye are unclear, the authors say, but are consistent with findings from previous studies. Studies of healthy individuals have found the mean macular thickness of the right eye to be thicker than that of the left eye, and studies of neurodegeneration have reported asymmetrical neurodegeneration of both the retina and brain.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. The authors also acknowledge that the study has some limitations, including its small size and that potential confounding factors, such as pre-existing eye dominance, were not examined.

The authors conclude, “Our findings suggest that macular thickness measured by OCT may serve as a non-invasive marker and identify individuals vulnerable to developing postoperative delirium after anaesthesia and surgery among geriatric patients.”

They add, “Further large-scale validation studies should be performed to confirm these results.”

02/04/2025

Notes for editors
Research: Association between retinal layer thickness and postoperative delirium in older patients Doi: 10.1136/gpsych-2024-101740
Journal: General Psychiatry

Funding: National Natural Science Foundation of China

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Thickening of the eye’s retina associated with greater risk and severity of postoperative delirium in older patients first appeared on BMJ Group.

Sweet spot seems to be 0.68 mg/day among healthy older people to ward off decline
Optimal maintenance dose seems to be 0.6 to less than 1 mg/day 

There seems to be a J-shaped curve between dietary thiamine (vitamin B1) and worsening mental acuity among cognitively healthy older people, suggests research published in the open access journal General Psychiatry.

The sweet spot seems to be a daily intake of 0.68 mg, below which there is relatively little impact. But higher daily intake was strongly associated with cognitive decline, with the optimal maintenance dose 0.6 to less than 1 mg/day, the findings show.

Thiamine is an essential water-soluble B vitamin involved in energy metabolism and brain neurotransmitter activity. Good dietary sources include whole grains, fortified breakfast cereals, legumes, liver, and salmon.

Small previously published studies suggest that high doses can improve cognitive function in people with mild cognitive impairment or early stage dementia. But it’s not clear if usual dietary intake is associated with slowing, or speeding up, cognitive decline.

To explore this further, the researchers used publicly available data from the China Health and Nutrition Survey (CHNS), a long term multipurpose study which began in 1989, and which included nearly half the country’s population by 2011.

In 1997, 2000, 2004 and 2006, mental acuity was repeatedly assessed for cognitively healthy participants aged 55 and above. The current study is based on 3106 participants, with an average age of 63, and at least two rounds of survey data.

Information on diet was collected in each survey round, supplemented by detailed data on personal dietary intake over 24 hours on 3 consecutive days of the week, and collected in person by trained investigators. Nutrient intake was calculated using the Chinese food composition tables.

Three tests of immediate and delayed recall of a 10-word list, counting backwards from 20, and serial subtraction of 7 five times from 100, taken from the Telephone Interview for Cognitive Status–modified (TICS-m), were used to evaluate verbal memory, attention, and numerical fluency, respectively.

A higher score for each item (including verbal memory [0-20 points], attention [0-2 points] and calculation [0-5 points]) indicates better cognitive function, with a global cognitive score ranging from 0 to 27 points and also a composite score ranging from -1.82 to 1.67 standard units.

The average monitoring period was nearly 6 years, during which time a J-shaped association emerged between dietary thiamine intake and the pace of decline in cognitive function over 5 years.

Average thiamine intake was 0.93 mg/day, but the threshold seemed to be a daily intake of 0.68 mg. There was no significant association with cognitive decline below this level.

But above 0.68 mg/day, each daily unit (1 mg/day) increase in thiamine intake was associated with a significant fall of 4.24 points in the global cognitive score and 0.49 units in the composite score within 5 years. Since the global cognitive score ranges from 0 to 27 points, a decline of about 4 points means a decline in cognitive function of at least 15%

These associations were stronger among those who were obese, had high blood pressure or who were non-smokers, although after further in depth analysis, the modifying effect of high blood pressure and smoking became statistically insignificant,

To further explore the optimal range of dietary thiamine for maintaining cognitive function, intake was further divided into 0.4, 0.6, 0.8, 1, 1.2 and 1.4 mg/day.

This showed that the lowest risk was associated with a thiamine intake of 0.6 to less than 1 mg/day. Similar patterns were also observed after accounting for daily intake of other B vitamins (riboflavin and niacin) and other foods, such as red or processed meat.

None of the other variables, including age, sex, alcohol consumption and dietary intake of fat, protein or carbohydrate, significantly changed the findings.

This is an observational study, and as such, can’t establish cause, acknowledge the researchers. And 24-hour dietary recall only captures information on specific days and may not be completely accurate. The study also focused on older people in China, so the findings may not be applicable to other nationalities and age groups, they add.

“Thiamine deficiency may lead to an insufficient supply of energy to the neurons of the brain and decreased acetylcholine signalling in the brain, which may impair cognitive function,” suggest the researchers, by way of an explanation for their findings.

“If substantiated by further research, our study highlights the importance of maintaining optimal dietary thiamine intake levels in the general older population to prevent cognitive decline.”

21/02/2024

Notes for editors
Research: J-shaped association between dietary thiamine intake and the risk of cognitive decline in cognitively healthy, older Chinese individuals doi: 10.1136/gsych-2023-101311
Journal: General Psychiatry

Funding: National Key Research and Development Program of China; National Natural Science Foundation of China

Link to Academy of Medical Sciences Press releases labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

The post J-shaped curve apparent between dietary thiamine and worsening mental acuity first appeared on BMJ Group.

Findings might help personalise music therapy and evaluate effectiveness of existing ones 

There are three potentially unique acoustic features of healing music that transcend musical genres, suggests research published in the open access journal General Psychiatry.

The findings might help to personalise playlists for patients, using artificial intelligence to analyse individual physiological and psychological responses, and help to evaluate the effectiveness of existing music therapies, suggest the researchers.

Despite evidence of the therapeutic effects of music for mental health issues, such as anxiety, depression, and post traumatic stress disorder, there’s no consensus on what defines healing music, note the researchers.

They therefore wanted to find out if healing music shares certain acoustic features, irrespective of genre, and if these features are distinct from those found in regular music.

To compile a healing music library they drew on the recommendations of 35 therapists all of whom had several years of experience in music therapy practice and/or research.

This produced a collection of 165 different pieces of music that the experts frequently used in their daily practice or believed to be helpful for emotional and other mental health issues.

These were compared with 330 classical music pieces written by 10 composers and played on 11 instruments; 50 pieces of traditional 5-element Chinese music; 100 Jazz recordings; and 300 emotional music recordings from the Chinese affective music system. 

Traditional Chinese five-element music comprises five different tones or pitches, each of which connects to the liver, heart, spleen, lungs, and kidneys, corresponding to the five elements of wood, fire, metal, earth, and water.

The Chinese affective music system covers seven distinct emotional states: happiness; calm; sadness; fear; disgust; anger; and surprise. Each clip is accompanied by a set of indicator data, two of which were used in this study: valence, which describes the ability of music to evoke feelings of happiness or sadness; and arousal.

The pieces included 9 different genres: classical; electronic; rhythm and blues (R&B); fim scores (soundtrack); folk; jazz; military (marching) music; New Age; and pop.

Classical music accounted for the largest proportion (28.5%) of recommendations, followed by pop music (18%). None of the remaining genres accounted for more than 15% of the total. Five participants nominated Castle in the Sky by Japanese musician Joe Hisaishi.

The researchers then used a tool (Mirtoolbox) specifically designed for the extraction of musical features from audio files for statistical analysis, segmentation, and clustering.

This produced 370 acoustic features which were grouped into five dimensions: (1) energy, volume, and loudness; (2) rhythm (tempo and beat); (3) timbre; (4) pitch (frequency and harmonicity); and (5) key (tonal field). 

Around 1 in 4 (25.5%) of these features were specifically associated with their genre, but the rest were shared among all the genres.

To find out if these commonalities contributed to the healing properties of the music, they were compared with the healing classical music pieces and traditional 5-element Chinese music. 

This showed that more than a quarter (26%+) of the acoustic features differed significantly between the ‘healing’ pieces of classical music (47) and the regular classical music pieces.

And there was strong evidence that all the healing music pieces and traditional Chinese music shared nearly 10% of their acoustic features.

Based on this, three potentially distinctive acoustic features of healing music were identified that were independent of genre, differed from regular music of the same genre, and were consistent across various different types of healing music.

These three features significantly predicted both subjective valence and arousal ratings in the Chinese affective music system.

These were the standard deviation (SD) of the roughness, mean (average), and period entropy of the third coefficient of the mel-frequency cepstral coefficients (MFCC3).

The SD of the roughness describes the extent to which perceived irregularity or harshness of a sound deviates from the average; the MFCC captures the amount of energy in different frequency ranges, with mean referring to the average, and period entropy referring to the randomness or predictability in patterns of frequency components over time.  

Given the ability of roughness to create different moods and emotional responses in listeners, this is an essential perceptual feature of music, say the researchers.

“For example, dissonant intervals in music with a high roughness can evoke feelings of tension or suspense, whereas consonant intervals in music with smoother sounds can evoke a sense of relaxation or resolution,” they explain.

The findings were validated when the acoustic features of the jazz pieces in the healing music collection were compared with those of regular jazz music.

And they echo those of previous research indicating that music is a universal language that transcends culture and genre, say the researchers. This includes traditional music forms, such as pilgrimage songs in Nigeria, high-life drumming in Ghana, singing bowl music in India, and five-element music in China.

They acknowledge that they relied on a relatively small number of experts to create their healing music collection and that cultural factors may limit the wider applicability of their findings.

But they suggest that incorporating the three acoustic features into music could enable healthcare professionals to personalise therapeutic playlists for patients, by harnessing AI algorithms to analyse physiological and psychological responses in real time. 

“The implications of these findings can be applied in diverse contexts, such as music therapy for stress reduction, mental health and chronic pain management,” they conclude.

20/12/2023 

Notes for editors
Research: Uncovering potential distinctive acoustic features of healing music doi 10.1136/gpsych-2023-101145
Journal: General Psychiatry

Funding: National Natural Science Foundation of China 

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Comparative study
Subjects: Acoustic features of healing music

The post 3 potentially unique acoustic features of healing music that transcend genre identified first appeared on BMJ Group.

Non-invasive technology (tDCS) may fire up brain’s plasticity, enabling new neural networks

Twice daily non-invasive electrical stimulation of the brain may boost mental processes (cognitive function) in people with Alzheimer’s disease, suggest the results of a small clinical trial published online in the open access journal General Psychiatry.

The technology, known as transcranial direct current stimulation, or tDCS for short, may help to fire up the brain’s plasticity, enabling ‘rewiring’ through the formation of new neural networks, the findings suggest. 

tDCS comes in the form of a device with two electrodes, placed over specific areas of a person’s head, which deliver a constant low intensity electrical current. It is starting to be used in many areas of medicine, including for the treatment of depression.

The researchers wanted to find out if tDCS might improve cognitive function in people with Alzheimer’s disease, and if so, whether this might be linked to their recovering some level of cortical plasticity–the brain’s capacity to form new neural networks. 

Some 140 patients with mild to moderate Alzheimer’s disease from four different hospitals were randomly allocated to receive either 2 daily sessions of active (constant low intensity 1-2 mA current) or sham tDCS, for 5 days of the week for a maximum period of 6 weeks.

The currents were applied to the prefrontal cortex, the region of the brain involved in higher order activities, such as planning, decision-making, working memory, moderating social behaviours, and controlling certain aspects of speech and language.

Participants were all aged over 65, had had their disease for more than 6 months, and had all scored below 26 on the Mini-Mental State Exam (MMSE). A score of 24 is regarded as abnormal and indicative of cognitive impairment. Both groups were comparable in terms of age, sex, and educational attainment.

The MMSE and the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) Test, which focuses on language and memory, were used to evaluate cognitive performance at the start of the trial, after 2 weeks, and again after 6 weeks.  

Readings of electrical signalling through the motor pathways of the nervous system, known as motor evoked potential or MEP, were used to indicate changes in neural plasticity.

In all, 133 patients completed the 2-week intervention and 124 completed the 6-week intervention. Reasons for withdrawal varied, but no one withdrew because of discomfort. 

The results showed that after 2 weeks there was no change in either group, but compared with baseline, 30 daily 20-minute sessions of tDCS significantly improved the cognitive function of those in the tCDS group, particularly their word recall, recall of test instructions, and word recognition. No such improvements were seen in the sham group.

The results also showed that in people with Alzheimer’s disease cortical plasticity is impaired, but that this improved after 6 weeks of tDCS.

In tandem with a decrease in MEP, word recall and word recognition got better among those in the tDCS group, but not among those in the sham group, suggesting that the improvement in cortical plasticity may reflect the degree of cognitive improvement, say the researchers.

But it’s still not clear how tDCS might exert its effects, they add, citing previous research,  indicating that the technology may alter ion activity, neurotransmitter release, and electrical activity in various areas of the brain.

The researchers acknowledge various limitations to their findings, including the small study size, the lack of MRI or electroencephalography scans to chart changes in brain structure, and the absence of cerebrospinal fluid and blood samples to monitor neurotransmitter changes.

But they nevertheless conclude: “The results of this study strongly indicate that tDCS treatment is a significant and promising intervention for improving cognitive function in [Alzheimer’s disease]. In addition, plasticity plays a vital role in cognitive change.” 

06/12/2023 

Notes for editors
Research: Impact of twice-a-day transcranial direct current stimulation intervention on cognitive function and motor cortex plasticity in patients with Alzheimer’s disease doi 10.1136/gpsych-2023-101166
Journal: General Psychiatry

Funding: Zhejiang Provincial Health Commission; Ningbo Public Welfare Projects 

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Clinical trial
Subjects: People

The post Twice daily electrical stimulation may boost mental processes in Alzheimer’s disease first appeared on BMJ Group.

Associated with smaller total and white matter brain volume; may be predictor of brain health

Shorter telomeres on the ends of white blood cell chromosomes may signal a heightened dementia risk, suggest the results of a large long term study, published online in the journal General Psychiatry.

They are associated with smaller total and white matter brain volume, which helps the body process information, and may be a predictor of future brain health, say the researchers.

A telomere–the equivalent of a shoelace cap—is intended to prevent the loss of coded DNA by a chromosome fraying or unravelling when it replicates.

Each time a cell divides, chromosomes replicate, and telomeres shorten slightly, so telomeres have emerged as a promising marker for cellular ageing and the risk of age-related diseases, note the researchers. But studies looking at telomere length and brain health are few and far between. 

To explore this further, they drew on data from the UK Biobank to look at potential associations between the telomere length of leucocytes (white blood cells) and the risk of dementia, including Alzheimer’s disease and vascular dementia, and total and regional brain volumes.

The UK Biobank is a large biomedical database containing in-depth genetic and health information for around half a million people in the UK who were enrolled between 2006 and 2010. 

Leucocyte telomere length was measured by analysing blood samples taken at enrolment. These data were available for 439, 961 people aged 37 to 73 at the time (average age 56). 

During an average monitoring period of nearly 12 years, 1551 (0.4%) participants were diagnosed with Alzheimer’s disease; 767 (0.2%) with vascular dementia; and 5820 (1.3%) with other type of dementia.

Analysis of the data revealed a significant association between leucocyte telomere length and subsequent risk of dementia.

After accounting for sex and age, participants with the shortest leucocyte telomeres were 14% more likely to be diagnosed with dementia and 28% more likely to be diagnosed with Alzheimer’s disease than those with the longest leucocyte telomeres. 

The risk of  vascular dementia was also increased (18%), although this  wasn’t statistically significant.

Brain structure was visualised on MRI full body scans for 38,740 participants in 2014. This revealed a linear association between shorter leucocyte telomeres and smaller total brain volume, white matter, as well as brain structures including the hippocampus (involved in learning and memory), the thalamus (sensory processing centre), and the nucleus accumbens (the ‘pleasure centre’).

This is an observational study, and as such, can’t establish cause. The researchers also highlight several limitations: telomere length was measured only once so it was impossible to find out whether changes over time might have affected the chances of dementia, added to which telomere length was measured only in leucocytes. 

Measurement of telomere length in glial cells (non-neuronal cells in the central nervous system) might have been even more informative, they suggest, but these data weren’t available from the UK Biobank.

And dementia diagnoses were obtained only from electronic health records, which may not have been up to date and may not have mentioned milder forms.

Nevertheless, the researchers conclude, “We found that leucocyte telomere length acts as an aging biomarker associated with the risk of dementia. Furthermore, we also observed linear associations of leucocyte telomere length with total and regional brain structure. 

“These findings highlight telomere length as a potential biomarker of brain health.”

11/09/2023

Notes for editors
Research: Leucocyte telomere length, brain volume and risk of dementia: a prospective cohort study doi:10.1136/gpsych-2023-101120
Journal: General Psychiatry

Funding: The National Natural Science Foundation of China, Zhejiang Provincial Natural Science Foundation of China; Scientific Research Foundation for Scholars of HZNU

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Shorter white blood cell telomeres linked to higher dementia risk first appeared on BMJ Group.

And it’s lower for those assigned female sex at birth than those assigned male

The age of those who are distressed because of a mismatch between their biological sex and their gender identity—known as gender dysphoria—has been steadily falling, reveals research published in the open access journal General Psychiatry.

And it’s lower for those assigned female sex at birth than those assigned male, the findings indicate.

Recent studies suggest that gender dysphoria is becoming more common, particularly among those assigned female sex at birth. But these studies have been hampered by small sample sizes, short monitoring periods, or outdated datasets. 

In a bid to get round these limitations, the researchers drew on data submitted to the TriNetX database Research Network from 49 healthcare organisations between 30 April 2017 and 30 April 2022 inclusive.

This database holds the anonymised medical records of around 66 million people, most of whom (80%) live in the USA.

The researchers focused on 42 million 4-65 year olds, 66,078 of whom were diagnosed with gender dysphoria—equivalent to 155 people per 100,000 of the population.

Their average age was 26 (27 for those assigned female sex at birth; 30 for those assigned male sex). And they were more likely to have been assigned female sex at birth—58% vs 55%.

The estimated prevalence of gender dysphoria rose significantly between 2017 and 2021, while the average age of those diagnosed with it fell from 31 in 2017 to 26 in 2021. 

But the increasing trend of a gender dysphoria diagnosis among those assigned female sex at birth was significantly more rapid than that of those assigned male sex at birth, before the age of 22.

The estimated prevalence of gender dysphoria among those assigned female sex at birth rose sharply at the age of 11, peaked between the ages of 17 and19, and then fell below that of those assigned male sex at birth, by the age of 22. 

This compares with the estimated prevalence of gender dysphoria among those assigned male sex at birth which started to increase at the age of 13, peaked at the age of 23, and then gradually decreased.

The timing of puberty might explain the different patterns of gender dysphoria by sex, suggest the researchers, as girls generally enter this before boys, and it’s at puberty that young people tend to seek medical help for gender issues.

Social attitudes may also have a role, they add, with school-age masculine girls with gender dysphoria more likely to be accepted by their peers and feminine boys in the same situation more likely to face bullying and rejection.

As to the increase in the numbers of those with gender dysphoria, wider availability of specialist clinics and growing awareness and acceptance of gender diversity might explain these trends, the researchers suggest.

“Gender identity development heavily leans on social processes, including exploration and experimentation with external feedback. There is now increasing acceptance of gender-neutral pronouns and gender-non-congruent chosen names,” they write.

But the researchers acknowledge that only 20% of participants came from countries other than the USA, which may limit the wider applicability of their findings.

26/06/2023

Notes for editors
Research letter: The mean age of gender dysphoria diagnosis is decreasing doi 10.1136/gpsych-2022-100972
Journal: General Psychiatry

Authors’ disclaimer: 
These research findings do not imply that all transgender people or those who identify as non-binary experience gender dysphoria. 

Funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Data analysis
Subjects: People

The post Age of those with gender dysphoria is falling first appeared on BMJ Group.

Satisfying mid-life relationships linked to lower multiple chronic disease risk in older age

Findings only partially explained by income, education, and health behaviours 

Satisfying relationships in mid-life with partners, friends, or work colleagues are linked to a lower risk of accumulating multiple long term conditions in older age—at least among women—suggests research published in the open access journal General Psychiatry.

The less satisfying these relationships were, the greater was the risk, with the findings only partially explained by influential factors, such as income, education, and health behaviours, the study shows.

Mounting evidence indicates a link between strong social networks and good health/wellbeing in older age, but it’s not known if these connections might lower the risk of multiple long term conditions (multimorbidity), which many older women, in particular, face. 

In a bid to assess to what extent a women’s level of satisfaction with their relationships—partner, family, friends, work colleagues, and other social connections—singly and collectively might influence this risk, the researchers drew on 13,714 participants of the Australian Longitudinal Study on Women’s Health (ALSWH).

The ALSWH is an ongoing population-based study looking at factors associated with the health and wellbeing of women who were aged 18–23, 45–50, and 70–75 in 1996.

All the women in the current study were aged 45-50 in 1996. Their health and wellbeing was tracked roughly every three years via questionnaire up to 2016.

They were asked to rank their levels of satisfaction with each of their 5 categories of  relationships on a 4-point scale, with each response scored up to a maximum of 3 points.

And they were asked to indicate if they developed any of the following: diabetes; high blood pressure; heart disease; stroke; chronic obstructive pulmonary disease (COPD); asthma; osteoporosis; arthritis; cancer; depression; and anxiety.

Accumulating 2 or more of these from a starting point of none, or additional conditions from just 1, or from 2 or more, was defined as having multiple conditions (multimorbidity).

Information was collected on potentially influential demographic, lifestyle and hormonal factors: country of birth, marital status, area of residence, educational attainment and the ability to manage income; weight (BMI), physical activity, alcohol intake and smoking; and menopausal status. 

The final analysis included 7694 women, 58% (4484) of whom accumulated multiple long term conditions over 20 years of monitoring.

Those who did so, were more likely to have lower educational attainment, find it difficult to live off their income, be overweight/obese, physically inactive, smokers and to have had a surgically induced menopause.

Overall, relationship satisfaction was associated with the accumulation of multiple long term conditions: the greater the levels of satisfaction, the lower were the risks.

Compared with women reporting the highest level of satisfaction (score of 15), those who reported the lowest (score of 5 or less) were more than twice as likely to accumulate multiple long term conditions after fully adjusting for potentially influential factors. 

The strength of the association was comparable with that of well established risk factors, such as overweight/obesity, physical inactivity, smoking and alcohol intake, say the researchers.

When all 5 types of relationship were included in the analysis, the association weakened, but still remained significant for all except friendships. Similar results were observed when individual conditions were analysed separately.

Well established risk factors, such as socioeconomic position, health behaviours, and menopausal status, together explained less than one-fifth of the observed association.

This is an observational study, and as such, can’t establish cause. It also relied on personal recall, and didn’t capture information on social relationships in early adulthood. And as it included only Australian women, the findings might not be applicable to men or other cultures, say the researchers.

Further research is needed to explore other specific effects of relationships on the accumulation of multiple long term conditions, such as intimacy, quantity, and emotional and practical support, they emphasise. 

Nevertheless, they conclude: “Our findings have significant implications for chronic disease management and intervention. First, at the individual level, these implications may help counsel women regarding the benefits of starting or maintaining high quality and diverse social relationships throughout middle to early old age.

“Second, at the community level, interventions focusing on social relationship satisfaction or quality may be particularly efficient in preventing the progression of chronic conditions.

“Third, at the country and global levels, social connections (eg, social relationship satisfaction) should be considered a public health priority in chronic disease prevention and intervention.”

21/2/23

Research: Social relationship satisfaction and accumulation of chronic conditions and multimorbidity: a national cohort of Australian women doi 10.1136/gpsych-2022-100925

Journal: General Psychiatry

Funding: National Health and Medical Research Council; Australian Department of Health

Link to AMS press release labelling system 

http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Women

The post Satisfying mid-life relationships linked to lower multiple chronic disease risk first appeared on BMJ Group.

Gut microbes found in Buddhist monks linked to lower risks of anxiety, depression, heart disease in other studies

Regular deep meditation, practised for several years, may help to regulate the gut microbiome and potentially lower the risks of physical and mental ill health, finds a small comparative study published in the open access journal General Psychiatry.

The gut microbes found in a group of Tibetan Buddhist monks differed substantially from those of their secular neighbours, and have been linked to a lower risk of anxiety, depression, and cardiovascular disease.

Research shows that the gut microbiome can affect mood and behaviour through the gut–brain axis. This includes the body’s immune response, hormonal signalling, stress response and the vagus nerve—the main component of the parasympathetic nervous system, which oversees an array of crucial bodily functions.

The significance of the group and specimen design is that these deep-thinking Tibetan monks can serve as representatives of some deeper meditations. Although the number of samples is small, they are rare because of their geographical location.

Meditation is increasingly being used to help treat mental health disorders, such as depression, anxiety, substance abuse, traumatic stress, and eating disorders as well as chronic pain. But it’s not clear if it might also be able to alter the composition of the gut microbiome, say the researchers.

In a bid to find out, the researchers analysed the stool and blood samples of 37 Tibetan Buddhist monks from three temples and 19 secular residents in the neighbouring areas.

Tibetan Buddhist meditation originates from the ancient Indian medical system known as Ayurveda, and is a form of psychological training, say the researchers. The monks in this study had been practising it for at least 2 hours a day for between 3 and 30 years.

None of the participants had used agents that can alter the volume and diversity of gut microbes: antibiotics; probiotics; prebiotics; or antifungal drugs in the preceding 3 months.
Both groups were matched for age, blood pressure, heart rate, and diet.

Stool sample analysis revealed significant differences in the diversity and volume of microbes between the monks and their neighbours. 

Bacteroidetes and Firmicutes species were dominant in both groups, as would be expected. But Bacteroidetes were significantly enriched in the monks’ stool samples (29% vs 4%), which also contained abundant Prevotella (42% vs 6%) and a high volume of Megamonas and Faecalibacterium.

“Collectively, several bacteria enriched in the meditation group [have been] associated with the alleviation of mental illness, suggesting that meditation can influence certain bacteria that may have a role in mental health,” write the researchers.

These include Prevotella, Bacteroidetes, Megamonas and Faecalibacterium species, the previously published research suggests.

The researchers then applied an advanced analytical technique to predict which chemical processes the microbes might be influencing. This indicated that several protective anti-inflammatory pathways, in addition to metabolism—the conversion of food into energy—were enhanced in the meditation people.

Finally, blood sample analysis showed that levels of agents associated with a heightened risk of cardiovascular disease, including total cholesterol and apolipoprotein B, were significantly lower in the monks than in their secular neighbours by their functional analysis with the gut microbes.

Although a comparative study, it is observational and the numbers of participants were small, all male, and lived at high altitude, making it difficult to draw any firm or generalisable conclusions. And the potential health implications could only be inferred from previously published research.

But based on their findings, the researchers suggest that the role of meditation in helping to prevent or treat psychosomatic illness definitely merits further research.

And they conclude: “These results suggest that long-term deep meditation may have a beneficial effect on gut microbiota, enabling the body to maintain an optimal state of health.” 

Notes for editors
Research: Alteration of faecal microbiota balance related to long-term deep meditation doi 10.1136/gpsych-2022-100893
Journal: General Psychiatry

Funding: National Natural Science Foundation of China
Link to AMS press release labelling system 
http://press.psprings.co.uk/AMSlabels.pdf

The post Deep meditation may alter gut microbes for better health first appeared on BMJ Group.