SCREENING FOR OVARIAN CANCER DID NOT REDUCE DEATHS DURING STUDY - The Daily Guardian
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SCREENING FOR OVARIAN CANCER DID NOT REDUCE DEATHS DURING STUDY

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A large-scale randomised trial of annual screening for ovarian cancer, led by UCL researchers, did not succeed in reducing deaths from the disease, despite one of the screening methods tested detecting cancers earlier.

Results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) have been published in a report in the medical journal The Lancet. In the UK, 4,000 women die from ovarian cancer each year. It is not usually diagnosed until it is at a late stage and hard to treat. UKCTOCS was designed to test the hypothesis that a reliable screening method that picks up ovarian cancer earlier can save lives when treatments are more likely to be effective.

The latest analysis looked at data from more than 200,000 women aged 50-74 at recruitment who were followed up for an average of 16 years. The women were randomly allocated to one of three groups: no screening, annual screening using an ultrasound scan, and annual multimodal screening involving a blood test followed by an ultrasound scan as a second-line test.

The researchers found that, while the approach using multimodal testing succeeded in picking up cancers at an early stage, neither screening method led to a reduction in deaths.

Earlier detection in UKCTOCS did not translate into saving lives. Researchers said this highlighted the importance of requiring evidence that any potential screening test for ovarian cancer actually reduced deaths and detected cancers earlier.

Professor Usha Menon (MRC Clinical Trials Unit at UCL), the lead investigator of UKTOCS, said: “UKCTOCS is the first trial to show that screening can definitely detect ovarian cancer earlier. However, this very large, rigorous trial shows clearly that screening using either of the approaches we tested did not save lives. We therefore cannot recommend ovarian cancer screening for the general population using these methods.

“We are disappointed as this is not the outcome we and everyone involved in the trial had hoped and worked for over so many years. To save lives, we will require a better screening test that detects ovarian cancer earlier and in more women than the multimodal screening strategy we used.”

Women aged between 50 and 74 were enrolled in the trial between 2001 and 2005. Screening lasted until 2011 and was either an annual blood test, monitoring changes in the level of the protein CA125, or a yearly vaginal ultrasound scan. About 100,000 women were assigned to the no screening group, and more than 50,000 women to each of the screening groups.

Blood test screening picked up 39 per cent more cancers at an early stage (Stage I/II) while detecting 10 per cent fewer late-stage cancers (Stage III/IV) compared to the no screening group. There was no difference in the stage of cancers detected in the ultrasound group compared to the no screening group.

The initial analysis of deaths in the trial occurred in 2015, but there was not enough data at that time to conclude whether or not screening reduced deaths. By looking at five more years of follow-up data from the women involved, researchers are now able to conclude that the screening did not save lives.

Professor Mahesh Parmar, Director of the MRC Clinical Trials Unit at UCL and a senior author on the paper, said: “There have been significant improvements in the treatment of advanced disease in the last 10 years since screening in our trial ended. Our trial showed that screening was not effective in women who do not have any symptoms of ovarian cancer; in women who do have symptoms early diagnosis, combined with this better treatment, can still make a difference to the quality of life and, potentially, improve outcomes. On top of this, getting a diagnosis quickly, whatever the stage of cancer, is profoundly important to women and their families.”

Professor Ian Jacobs, from the University of New South Wales (UNSW Sydney), a co-investigator who has led the ovarian cancer screening research programme since 1985 and who was the lead investigator of UKCTOCS from 2001-2014, said: “My thanks to the thousands of women, healthcare professionals and researchers who made this trial possible. The multimodal screening strategy did succeed in the detection of ovarian cancer at an earlier stage, but sadly that did not save lives. This is deeply disappointing and frustrating given the hope of all involved that we would save the lives of thousands of women who are affected by ovarian cancer each year.”

Professor Jacobs noted: “Population screening for ovarian cancer can only be supported if a test is shown to reduce deaths in a future randomised controlled trial. I remain hopeful that a new effective screening test will be found eventually, but it will take many years to conduct a large trial of the test. Realistically, this means we have to reluctantly accept that population screening for ovarian cancer is more than a decade away.”

A huge wealth of samples and data from the trial has been donated by the participants for future research. This resource referred to as the UKCTOCS Longitudinal Women’s Cohort (UKLWC), is now being used by researchers worldwide, helping to improve understanding of ovarian cancer as well as other cancers and other diseases such as cardiovascular disease.

Researchers say that the study has also generated insights into how best to design, conduct and analyse a large-scale randomised clinical trial particularly in individuals who have no signs of disease. These insights will be helpful to future trials in all areas of health. It has also contributed to advances in risk assessment, prevention and diagnosis of ovarian cancer.

The UKCTOCS trial was funded by the NIHR Health Technology Assessment (HTA) Programme and the charities Cancer Research UK and The Eve Appeal.

Michelle Mitchell, Cancer Research UK’s Chief Executive, said: “Trials don’t always find the result we had hoped for, but we need long-term studies like this to know whether new tests save lives. Cancer Research UK will continue to fund vital research into aggressive forms of ovarian cancer so we can reduce the impact of this disease.

“Screening is for people without symptoms, so it’s still important that if you notice unusual or persistent changes to talk to your doctor. Symptoms of ovarian cancer can be quite vague and similar to symptoms caused by less serious conditions, which can make spotting the disease tricky. Whether it’s needing to go to the toilet more often, pain, bloating, or something else, raise it with your GP – in most cases, it won’t be cancer but it’s best to get it checked out.”

Professor Nick Lemoine, Medical Director, NIHR Clinical Research Network, said: “These important findings from a large-scale trial, involving 200,000 participants, show that annual screening did not succeed in reducing deaths from ovarian cancer.

“However, it’s important to note that negative results can be as important as positive. The study has provided important new evidence and insights into how to conduct and analyse future large-scale randomised clinical trials into ovarian cancer, in the hope that this will prevent and diagnose this disease more effectively in the future.

“We thank every single person who took part.”

Athena Lamnisos, CEO, The Eve Appeal, said: “The threshold for introducing a national cancer screening programme is a mortality benefit. Of course, this is key – saving lives. It’s disappointing that this research programme did not show a reduction in mortality from ovarian cancer and so can’t be recommended as a national screening programme. However, the impact it had on earlier diagnosis is impressive and important.

“Ovarian cancer is so often diagnosed at stage 3 or 4 and shifting diagnosis one stage earlier makes a huge difference to both treatment options and quality of life. Earlier diagnosis will often reduce the amount and intensity of treatment, which makes all the difference to women and their families living with cancer. It may have also given them more precious time with their loved ones.”

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No health worries for children born to mothers given seasonal flu vaccine in pregnancy

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Correspondent,Ottawa

A population-based study, published in the Journal of the American Medical Association (JAMA), has found flu vaccination during pregnancy does not lead to an increased risk of adverse early childhood health outcomes.

Although pregnant people are not more susceptible to acquiring influenza infection, they are at an increased risk of severe illness and complications if they get the flu during pregnancy. For this reason, all pregnant people are advised to receive a flu shot each year, yet only 36% received it according to a study monitoring four flu seasons in Nova Scotia. Safety concerns are reportedly a leading reason women may not receive influenza vaccination in pregnancy.

Dr Deshayne Fell, an Associate Professor of Epidemiology in the Faculty of Medicine at the University of Ottawa and a Scientist at the CHEO Research Institute, a pediatric healthcare and research centre, led the study along with researchers in Ontario and at Dalhousie University in Nova Scotia. The study followed over 28,000 children from birth up to an average age of 3.5 years, with the results suggesting that maternal influenza vaccination during pregnancy was not associated with:

– Immune-related health conditions, such as asthma, ear infections or other types of infection.

– Non-immune-related health problems like neoplasms, sensory impairment.

– Nonspecific health needs such as Emergency Department visits and hospitalisations did not increase.

“This study adds to what we know from other recent studies showing no harmful effects of flu vaccination during pregnancy on the long-term health of children,” says Dr Fell, whose other recent work includes studying the effectiveness and safety of Covid-19 vaccines during pregnancy.

She added, “This is important because we know that getting the flu shot during pregnancy not only protects the pregnant person but has the added bonus of protecting newborn babies from getting the flu during their first few months of life, which is when they are most susceptible to respiratory infections but still too young to get the flu shot themselves.”

The study, Association of Maternal Influenza Vaccination During Pregnancy with Early Childhood Health Outcomes, is published in JAMA.

With ANI inputs

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ALL YOU NEED TO KNOW ABOUT ALLERGIC SINUS INFECTIONS

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The incidence of Allergyis in 25% to 30% of the Indian population. Allergy can affect any geographical area. It involves primarily the younger population, affecting any age group. Men and women can both get affected almost equally by allergies. It is a type 1 hypersensitive reaction where eosinophil and IgE levels are raised. Asthma is the involvement of the lower respiratory tract. Allergic Rhinitis and Sinusitis is the involvement of the nose and sinuses. The nose being the main door to the respiratory system bears the brunt of allergic insult. Allergic Rhinitis is broadly classified into intermittent and persistent based on the duration of symptoms and mild, moderate or severe based on affecting working efficiency. The persistent and moderate to severe form of AR causes considerable morbidity by affecting working efficiency, sleep pattern, and school activities in the patients, especially in a young child or an adult of productive age. AR is caused by many aeroallergens (like tree, weed, and grass pollen), cat, dog, house dust mite (HDM), and moulds. HDM is the most common indoor allergen causing a persistent form of AR. 

The symptoms usually appear on exposure to the causative allergens and triggers. Excessive sneezing, recurrent nasal discharge, and nasal obstruction are the main symptoms of AR. Itching, hearing impairment, facial heaviness, and smell disturbances are the other symptoms. AR is generally undertreated and is neglected to an extent causing the disease to flood into surrounding structures like conjunctiva, sinuses, ear and then to the lower airways. Asthma is the condition when allergens reach the lower airways where symptoms are episodic cough, chest tightness, wheeze, and breathlessness. 

Skin prick allergen testing is the test of diagnosis but the detailed clinical history is quite revealing of the cause of symptoms. The raised eosinophils and immunoglobulin E is seen in the haematological and nasal fluid examination. Nasal endoscopy by ENT doctor reveal pale, swollen mucosa with rugosity and it will be boggy nasal septum and nasal turbinates. The hypertrophy of inferior turbinate is commonly stated by the patients as, “Naak me mass badh gaya hai”. The poorly handled disease can show polypoidal tissue in the nasal cavity. 

AR is a medical condition. Allergen avoidance and lifestyle modification are the commonly asked measures advised to the patients. Pet and food allergy is best managed by avoiding them. Pollen allergy is diagnosed by symptoms in particular season and it is managed by avoiding unnecessary outdoor activities, especially in early mornings and later in the evenings during the season. While going out, wearing a face mask can provide protection. The bedroom windows should be closed, preferably at night and morning hours. The correction of seepage and fungus infested corners and crevices, keeping the indoor environment clean and well ventilated are helpful methods in reducing fungal spore allergy. The presence of allergic symptoms while sleeping and cleaning the wardrobe is the indicator of HDM allergy. Corners, crevices must be cleaned properly. Regular hot sunlight exposure of pillows and mattresses and dust removal can be helpful. The cleaning of mattresses and pillows is possible with vacuum cleaner also. Regular changing of linens, use of synthetic covers over mattresses and pillows are the other measures to control HDM allergy. The deficiency of Vitamin D and Vitamin B12 predispose us to many diseases including allergy. The prevalence of Vitamin D deficiency is in 70% to 100% of the Indian population, according to hospital-based studies. The supplementation of vitamins is helpful in the control or elimination of allergy in selected cases. Regular physical activity and nasal douches (Jal Neti) help reduce allergy. Nasal douches can be done with a commercially available mixture or homemade mixture (mix baking soda and salt in water and flush the prepared liquid in the nasal cavity with a syringe).  Steroid based nasal sprays are the first line of medical management. The common myth regarding steroid spray is their side effects but medical literature is not reflecting the same. Steroid nasal sprays can be prescribed above two years of age. The other commonly employed pharmacotherapy are antihistamines, decongestant nasal drops, or spray. The patients show good and immediate response with nasal decongestants but it should be used for over seven days as it can revert the symptoms by the rebound effect of the drug. The prolonged use of nasal decongestants can induce systemic hypertension. Allergen immunotherapy involves the administration of a progressively increasing amount of an allergen perorally or subcutaneously reaching a dose that is effective in ameliorating the symptoms associated with subsequent exposure to the causative allergens. The selection of allergen is decided based on a skin prick test. Surgery has a very limited role in selected cases. Surgery is focused on the correction of persistent structural abnormality. 

AR is an autoimmune disease. A single course of treatment is generally not sufficient enough to control the disease. The course of medical treatment depends on the severity of the disease and it can be reduced significantly by lifestyle modification and allergen avoidance.

The writer is an Associate Professor, Department of ENT, AIIMS, New Delhi.

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No health worries for children born to mothers given seasonal flu vaccine in pregnancy

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Vaccine

A population-based study, published in the Journal of the American Medical Association (JAMA), has found flu vaccination during pregnancy does not lead to an increased risk of adverse early childhood health outcomes.

Although pregnant people are not more susceptible to acquiring influenza infection, they are at an increased risk of severe illness and complications if they get the flu during pregnancy. For this reason, all pregnant people are advised to receive a flu shot each year, yet only 36% received it according to a study monitoring four flu seasons in Nova Scotia. Safety concerns are reportedly a leading reason women may not receive influenza vaccination in pregnancy.

Dr Deshayne Fell, an Associate Professor of Epidemiology in the Faculty of Medicine at the University of Ottawa and a Scientist at the CHEO Research Institute, a pediatric healthcare and research centre, led the study along with researchers in Ontario and at Dalhousie University in Nova Scotia. The study followed over 28,000 children from birth up to an average age of 3.5 years, with the results suggesting that maternal influenza vaccination during pregnancy was not associated with:

– Immune-related health conditions, such as asthma, ear infections or other types of infection.

– Non-immune-related health problems like neoplasms, sensory impairment.

– Nonspecific health needs such as Emergency Department visits and hospitalisations did not increase.

“This study adds to what we know from other recent studies showing no harmful effects of flu vaccination during pregnancy on the long-term health of children,” says Dr Fell, whose other recent work includes studying the effectiveness and safety of Covid-19 vaccines during pregnancy.

She added, “This is important because we know that getting the flu shot during pregnancy not only protects the pregnant person but has the added bonus of protecting newborn babies from getting the flu during their first few months of life, which is when they are most susceptible to respiratory infections but still too young to get the flu shot themselves.”

The study, Association of Maternal Influenza Vaccination During Pregnancy with Early Childhood Health Outcomes, is published in JAMA.

This study adds to what we know from other recent studies showing no harmful effects of flu vaccination during pregnancy on the long-term health of children.

With ANI inputs

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ALL YOU NEED TO KNOW ABOUT ALLERGIC SINUS INFECTIONS

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The incidence of Allergyis in 25% to 30% of the Indian population. Allergy can affect any geographical area. It involves primarily the younger population, affecting any age group. Men and women can both get affected almost equally by allergies. It is a type 1 hypersensitive reaction where eosinophil and IgE levels are raised. Asthma is the involvement of the lower respiratory tract. Allergic Rhinitis and Sinusitis is the involvement of the nose and sinuses. The nose being the main door to the respiratory system bears the brunt of allergic insult. Allergic Rhinitis is broadly classified into intermittent and persistent based on the duration of symptoms and mild, moderate or severe based on affecting working efficiency. The persistent and moderate to severe form of AR causes considerable morbidity by affecting working efficiency, sleep pattern, and school activities in the patients, especially in a young child or an adult of productive age. AR is caused by many aeroallergens (like tree, weed, and grass pollen), cat, dog, house dust mite (HDM), and moulds. HDM is the most common indoor allergen causing a persistent form of AR. 

The symptoms usually appear on exposure to the causative allergens and triggers. Excessive sneezing, recurrent nasal discharge, and nasal obstruction are the main symptoms of AR. Itching, hearing impairment, facial heaviness, and smell disturbances are the other symptoms. AR is generally undertreated and is neglected to an extent causing the disease to flood into surrounding structures like conjunctiva, sinuses, ear and then to the lower airways. Asthma is the condition when allergens reach the lower airways where symptoms are episodic cough, chest tightness, wheeze, and breathlessness. 

Skin prick allergen testing is the test of diagnosis but the detailed clinical history is quite revealing of the cause of symptoms. The raised eosinophils and immunoglobulin E is seen in the haematological and nasal fluid examination. Nasal endoscopy by ENT doctor reveal pale, swollen mucosa with rugosity and it will be boggy nasal septum and nasal turbinates. The hypertrophy of inferior turbinate is commonly stated by the patients as, “Naak me mass badh gaya hai”. The poorly handled disease can show polypoidal tissue in the nasal cavity. 

AR is a medical condition. Allergen avoidance and lifestyle modification are the commonly asked measures advised to the patients. Pet and food allergy is best managed by avoiding them. Pollen allergy is diagnosed by symptoms in particular season and it is managed by avoiding unnecessary outdoor activities, especially in early mornings and later in the evenings during the season. While going out, wearing a face mask can provide protection. The bedroom windows should be closed, preferably at night and morning hours. The correction of seepage and fungus infested corners and crevices, keeping the indoor environment clean and well ventilated are helpful methods in reducing fungal spore allergy. The presence of allergic symptoms while sleeping and cleaning the wardrobe is the indicator of HDM allergy. Corners, crevices must be cleaned properly. Regular hot sunlight exposure of pillows and mattresses and dust removal can be helpful. The cleaning of mattresses and pillows is possible with vacuum cleaner also. Regular changing of linens, use of synthetic covers over mattresses and pillows are the other measures to control HDM allergy. The deficiency of Vitamin D and Vitamin B12 predispose us to many diseases including allergy. The prevalence of Vitamin D deficiency is in 70% to 100% of the Indian population, according to hospital-based studies. The supplementation of vitamins is helpful in the control or elimination of allergy in selected cases. Regular physical activity and nasal douches (Jal Neti) help reduce allergy. Nasal douches can be done with a commercially available mixture or homemade mixture (mix baking soda and salt in water and flush the prepared liquid in the nasal cavity with a syringe).  Steroid based nasal sprays are the first line of medical management. The common myth regarding steroid spray is their side effects but medical literature is not reflecting the same. Steroid nasal sprays can be prescribed above two years of age. The other commonly employed pharmacotherapy are antihistamines, decongestant nasal drops, or spray. The patients show good and immediate response with nasal decongestants but it should be used for over seven days as it can revert the symptoms by the rebound effect of the drug. The prolonged use of nasal decongestants can induce systemic hypertension. Allergen immunotherapy involves the administration of a progressively increasing amount of an allergen perorally or subcutaneously reaching a dose that is effective in ameliorating the symptoms associated with subsequent exposure to the causative allergens. The selection of allergen is decided based on a skin prick test. Surgery has a very limited role in selected cases. Surgery is focused on the correction of persistent structural abnormality. 

AR is an autoimmune disease. A single course of treatment is generally not sufficient enough to control the disease. The course of medical treatment depends on the severity of the disease and it can be reduced significantly by lifestyle modification and allergen avoidance.

The writer is an Associate Professor, Department of ENT, AIIMS, New Delhi.

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IT’S CRUCIAL TO MONITOR CASES, AND IF THEY GO BEYOND 5%, RESTRICTIONS MUST BE IMPLEMENTED: DR NAVEET WIG

Dr Naveet Wig, chairman of AIIMS Covid Task Force, exclusively spoke to us about the need to follow Covid guidelines, the reason behind the wastage of vaccines, how long the pandemic will last, and more.

AJEET SRIVASTAVA

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Q. How do you evaluate Unlock 2?

A. It’s a time of self-evaluation. The number of cases is still more than a lakh and the situation is grave. Unlock will only make the situation worse, and nothing will improve in this manner. I understand the economy is crucial but life is foremost. 

Q. We are witnessing massive crowding in markets. What precautions will you suggest for everyone?

A. The pandemic has taught so much to people like basic hygiene manners. A country like India is implementing social distancing; it was far stretched but now turning into reality. But still, when government eases the situation a little bit, people violate all the basic guidelines and that is terrible. People must wear a mask all the time, especially when they go out. The situation will get really bad if basic guidelines won’t be followed and the condition will be grave. It is important to understand that crowding and working in full strength will make things worse. So, people must decide voluntarily to work in half strength and maintain social distancing. 

Q. What are the basic things to follow to curb the spread of the virus?

A. Wearing a mask is foremost and forever. Working in half-strength is important. Don’t let your guards down. It’s important to monitor cases, and if it goes beyond 5% then restrictions must be implemented. Last time we waited till 20% to 25% and then considered implementing lockdown. We need to make proper arrangements in hospitals, sanitisation work and must keep the environment clean. 

Q. We are witnessing fear in society. Till when the situation will be like this? 

A. As per my study, 98% of infected people will recover but 2% to 3% will need ICU. We need to keep our locality, district, and society safe, and then the whole country will be safe. 

Representatives at the ground level will need to understand that it’s our and their responsibility to keep society safe by following basic Covid protocols. 

Q. How many active cases ring the alarm bell?

A. According to me, 5% is the threshold when the alarm bell must ring. For example, if 1,000 people are being tested and 50 are Covid positive then it is 5% of people infected and such patients need ICU bed and home isolation. Even the situation now is alarming and we must not take it lightly. 

Q. Many doctors have speculated that those who have recovered from Covid need no vaccination, how true is it?

A. The ones who never got infected are more prone to the virus compared to those who have recovered.  Covid recovered people should get vaccinated after three months.

Q. Centre is giving vaccines to states for free. How much the states need to stay careful to control Covid spread?

A. We need to have faith in the government. They are the only source of vaccines for us. Their distribution so far has been better but it needs to be more fluent. 

Q. We have witnessed wastage of vaccines too. What is the reason behind this?

A. We all need to stay united. There should be no space for blame-game. The wastage of vaccines is very unfortunate. We must ensure that everyone who is eligible and needs it must get vaccinated as early as possible. The vaccine will save you from dying and keep your immunity strong. You may feel feverish for a while but later on, it will be fine. 

Q. What will be your message to people?

A. You need to give two months for the vaccine to show effects. But nothing can ensure that a person will not get infected again. You need to wear a mask and maintain social distancing to stay safe. 

Q. Do you think we will have to wear a mask forever?

A. There is no reason to panic. As more people will be vaccinated, the situation and the immunity of citizens will improve. Researchers are working and they will improve the efficacy of the vaccine and that will eventually improve our health. 

Q. Will coronavirus behave like Swine Flue?

A. Predictions will make thing worse. So, we should act as per the behaviour of the virus. Wearing a mask, social distancing, and vaccination will only help us. 

Q. How long this will last?

A. Maybe two to five years. We need to keep our positive rates less and the rate of vaccination higher. We need to improve the vaccination process and may need immunity booster, and cocktail doses that will improve immunity for five to six years. 

Q. When will the country be Covid free. 

A. We need to take responsibility and accountability. With utmost sense and understanding, we will be able to overcome it.

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SECONDARY INFECTIONS INFLAME THE BRAIN, WORSENING COGNITION IN ALZHEIMER’S: STUDY

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A new research into Alzheimer’s disease (AD) suggested that secondary infections and new inflammatory events amplify the brain’s immune response and affect memory in mice and in humans – even when these secondary events occur outside the brain.

The study was published in Alzheimer’s and Dementia, the journal of the Alzheimer’s Association. Scientists believe that key brain cells (astrocytes and microglia) are already in an active state due to inflammation caused by AD and this new research shows that secondary infections can then trigger an over-the-top response in those cells, which has knock-on effects on brain rhythms and on cognition.

In the study, mice engineered to show features of AD were exposed to acute inflammatory events to observe the downstream effects on brain inflammation, neuronal network function and memory.

These mice showed new shifts in the output of astrocytes and microglia and displayed new cognitive impairment and disturbed ‘brain rhythms’ that did not occur in healthy, age-matched, mice. These new-onset cognitive changes are similar to acute and distressing psychiatric disturbances like delirium, which frequently occur in elderly patients.

Although it is difficult to replicate these findings in patients, the study additionally showed that AD patients who died with acute systemic infection showed heightened brain levels of IL-1b – a pro-inflammatory molecule that was important in causing the heightened immune response and the new-onset disruptions seen in the AD mice.

Colm Cunningham, Associate Professor in Trinity’s School of Biochemistry and Immunology, and the Trinity Biomedical Sciences Institute led the research.

He said, “Alzheimer’s disease is the most common form of dementia, affecting more than 5 per cent of those over 60 and this distressing, debilitating condition causes difficulties for a huge number of people across the globe. The more we know about the disease and its progression the better chance we have of treating those living with it. We believe our work adds to this knowledge base in a few ways. Primarily, we show that the Alzheimer’s-affected brain has a greater vulnerability to acute inflammatory events, even if they occur outside the brain.”

Cunningham added, “Placing this within the context of the slowly evolving progression of AD, we propose that these hypersensitive responses, now seen in multiple cell populations, may contribute to the negative outcomes that follow acute illness in older patients, including episodes of delirium and the accelerated cognitive trajectory that has been observed in patients who experience delirium before or during their dementia.”

The research was supported by the US National Institutes of Health (NIH) and by the Wellcome Trust.

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