A study published in the Journal of Affective Disorders found late-life depression is predictive of cognitive decline in older adults, and cortisol is not only an independent predictor of this decline in seniors with and without Alzheimer's, but also is associated with a risk for cognitive decline in late-life depression, reports Psychiatry Advisor . The researchers evaluated global cognition over 12 months in older adults with and without late-life depression. Nineteen people in the late-life depression cohort exhibited global cognitive decline, while elevated serum cortisol levels at baseline were predictive of cognitive decline in the adjusted model. Older age also was associated with higher risk for cognitive decline, while education level, age at depression onset, and baseline Mini-Mental State Examination scores were not significantly associated with global cognition outcome. The team observed that baseline serum cortisol levels were gauged only in the morning and may not have been reflective of cortisol dysregulation in subjects overall. Nevertheless, the data indicates that cortisol levels may contribute to the cognitive decline observed in seniors with late-life depression.

A study published in the Journal of Experimental Medicine reveals that soluble versions of a protein or toll-like receptors (TLR) called TLR5 can reduce the accrual of amyloid plaques in the brains of Alzheimer's disease model mice and prevent the peptide forming these plaques from killing neurons, reports EurekAlert . The researchers theorized that untethering some of these TLRs from the surface of microglia could reduce amyloid plaque formation, perhaps functioning as "decoy receptors" that bind to ß-amyloid and constrain its aggregation without initiating cellular signaling pathways that could cause inflammation. The team demonstrated that soluble TLR5 could bind to ß-amyloid aggregates and augment their uptake into microglia, while also reducing the ability of ß-amyloid to destroy neurons cultured in the laboratory. "This mouse model is well recognized as a primary model for Alzheimer-type amyloid plaque deposition, but it does not recapitulate the entire Alzheimer's neurodegenerative cascade," says the University of Florida's Paramita Chakrabarty. "Therefore, the potential of soluble TLR5 in dampening immune activation and related neurotoxic pathways needs to be further explored in multiple models of Alzheimer's disease."

A report from the Centers for Medicare & Medicaid Services (CMS) determined Medicare's Next Generation model of accountable care organization (ACO) appears to be saving money for participating ACOs, according to MedPage Today . The 18 ACOs that participated in the Next Generation program saved Medicare an average of $18.20 per beneficiary per month (PBPM) in the program's first year. CMA said this decrease "is similar to the decrease noted in the first two years of the Pioneer ACO model, and larger than the decrease noted for Medicare Shared Savings Program ACOs in the early years. However, there was wide variation in spending across ACOs. Seven ACOs showed Medicare cost savings of $30 PBPM, while two showed cost increases of $30 PBPM." The report noted the new ACO model assigns ACOs "nearly complete financial risk sharing (either 80 percent or 100 percent risk) and must take on downside risk ... unlike predecessor ACO models including the Medicare Shared Savings Program and Pioneer models. In addition, there are no minimum savings or loss requirements." In general, CMS estimated a net savings for Medicare of $62.12 million, or 1.1 percent, versus what Medicare would have spent on the same beneficiaries without the ACO.

The U.S. Senate has approved additional funding for Alzheimer's research, reports Alzforum . Lawmakers stipulated a 2019 fiscal year budget that, if signed into law, would include $2.34 billion for such research, exceeding 2018's research budget by $425 million. The bill also allocates a $2 billion boost in funding for the National Institutes of Health to $39.1 billion. The research budget was part of an overarching $857 billion appropriations bill, which outlined spending for the Departments of Defense, Labor, Health and Human Services, and Education. Sen. Roy Blunt (R-Mo.) said the proposed 2019 budget is far less than the $277 billion in annual U.S. dementia care costs, and the Alzheimer's Association noted these costs include $186 billion in Medicare and Medicaid payments. The University of Indiana School of Medicine's Bruce Lamb said the budget proposal tops the $2 billion in annual funding proposed in 2011, when the National Alzheimer's Project Act was first approved and the National Plan was developed. "Given some of the recent disappointments in the AD clinical trials, we likely will need to further increase investments to help speed the process of identifying new drug targets, to improve the drug-discovery pipeline, to redesign clinical trials that target specific ... populations, and to discover lifestyle interventions that slow or prevent dementia," Lamb noted.

HP's Biohacker technology is working with the Centers for Disease Control and Prevention (CDC) on a pilot program to "print" and test antibiotics in an effort to retard the spread of antimicrobial-resistant superbugs, reports TechCrunch . The HP D300e Digital Dispenser BioPrinter technology uses the same setup as a conventional ink printer, but instead dispenses any combination of drugs in volumes from picoliters to microliters for research purposes. "To save lives and protect people, it is vital to make technology accessible to hospital labs nationwide," says the CDC's Jean Patel. "We hope this pilot will help ensure our newest drugs last longer and put gold-standard lab results in healthcare providers' hands faster." Superbugs spread rapidly often due to misuse of antibiotics, allowing the bacteria to develop a resistance to the drugs available. The CDC aims to give hospital providers access to the technology across the country to mitigate the problem. The HP BioPrinter is presently employed by labs and pharmaceutical companies such as Gilead, which tests for drugs used against the Ebola virus. It also is being used in various CRISPR applications. HP says the CDC will use these printers in four regional areas spread throughout the United States within the Antibiotic Resistance Lab Network to develop antimicrobial susceptibility test methods for new drugs.

Government services such as myGov and myagedcare increasingly rely on individuals having access to computers and the Internet and the knowledge of how to use them, and seniors who lack these skills may miss out on the services and support they need, reports The Conversation . Small, social, community-run programs that let seniors share learning on their own terms have proved effective. Although Australia's score on the Australian Digital Inclusion Index improved last year from the year before, seniors still lag younger people in their capacity to access and use the Internet. A person in their 60s is more likely to be familiar with and use the Internet than someone in their 70s, 80s, or older, mainly because of the likelihood that younger cohorts would have used such technology in their working lives. Other factors can include gender, education, employment status/type, social and economic background, language skills, and current health and/or disability. For older Australians who are not yet online but who want to be, there are community and online programs that can assist them. One program is Telstra's Tech Savvy Seniors program, which contains a number of self-paced and self-directed learning modules and includes step-by-step videos and instruction guides that provide seniors with the basic skills to use computers, the Internet, and smartphones. Home and community care organizations have recently recognized the benefits technology can offer their clients, with one provider deploying its own technology program to help promote connection and relieve social isolation for its home, community, and residential care recipients.

A study published in Proceedings of the National Academy of Sciences ties pollution to a significant decline in cognition that worsens with age, reports National Public Radio . The researchers investigated the effects of air pollution over multiple years on more than 25,000 people in 162 Chinese counties, and matched those results with pollution conditions at the time of each test. They observed both short-term and cumulative effects of air pollution on cognitive performance. Pollution's effect on verbal test performance worsened as people got older, particularly among men and people with less education. Yale School of Public Health Professor Xi Chen says persons with less education are likely to experience more harm because they work outside more often and are exposed to higher pollution levels. He also says exposure to pollution could make seniors less effective in making major financial and medical decisions. Chen suggests pollution may have a damaging impact on the white matter in the brain, which could vary between men and women. "If the air pollution improves from China's level to the American EPA standard level, that means that would improve everyone's education by around one year," Chen notes.

A study published in BJGP Open found a machine-learning based model using data routinely accumulated in primary care identified individuals with dementia in such settings, reports Healio . "Such a tool could be used to select high-risk persons who could be invited for targeted screening," note the researchers. The team used Read codes, a set of clinical terms employed in Britain to summarize data for general practice, to develop the model. The Read codes were chosen based on their significant association with individuals with dementia, and included codes for risk factors, symptoms, and behaviors that are collected in primary care. To test the model, researchers collected Read-encoded data from 26,483 persons living in England 65 and older. They determined the model achieved a sensitivity of 84.47 percent and a specificity of 86.67 percent for recognizing dementia. "With the expected growth in dementia prevalence, the number of specialist memory clinics may be insufficient to meet the expected demand for diagnosis," the team says. "Furthermore, although current 'gold standards' in dementia diagnosis may be effective, they involve the use of expensive neuroimaging (for example, positron emission tomography scans) and time-consuming neuropsychological assessments which is not ideal for routine screening of dementia." The model will be assessed with other datasets, and have its validation tested "more extensively" at general practitioner practices in the future, the team says.

Ten Republican senators last week introduced a bill to shield Affordable Care Act (ACA) provisions for people with pre-existing conditions, reports The Hill . The proposal is an attempt to counter Democratic attacks on Republicans' alleged ties to the Trump administration's decision not to defend some ACA provisions in a federal lawsuit filed by red states. "There are strong opinions on both sides when it comes to how we should overhaul our nation's broken healthcare system, but the one thing we can all agree on is that we should protect healthcare for Americans with pre-existing conditions and ensure they have access to good coverage," said Sen. Thom Tillis (R-N.C.). "This legislation is a common-sense solution that guarantees Americans with preexisting conditions will have healthcare coverage, regardless of how our judicial system rules on the future of the ACA." Senate Republicans claimed their bill would revise federal law to guarantee the availability of health insurance to all Americans, including those with pre-existing conditions, regardless of the lawsuit's outcome. It also would prevent insurers from hiking premiums due to pre-existing conditions, but health experts said insurers would be permitted to exclude coverage of pre-existing conditions. "This legislation is needed now more than ever to give ... all Americans, the certainty they need that protections for those with pre-existing conditions will remain intact," said Sen. Lisa Murkowski (R-Alaska).

Caregivers for aging parents are concerned that the brokers managing their savings may not have their clients' best interests in mind, an allowance permitted because brokers are not necessarily fiduciaries, reports the New York Times . Brokers usually are only required to recommend investments that are "suitable." The Financial Industry Regulatory Authority (Finra) notes excessive and unauthorized trading are some of the leading complaints in customer arbitration cases. The agency estimates there were 166 cases of unauthorized trading in 2017, 209 in 2016, and 145 in 2015, while 142 complaints of excessive trading were submitted in 2017. There also are suspicions that Finra's numbers of complaints raised with brokerage firms are conservative, and securities lawyers say many investors who settle such cases sign confidentiality clauses. Commission-based accounts can make economic sense for investors who do not require many changes to their portfolios but brokers are only compensated each time they conduct a transaction, which means their interests are not necessarily in alignment with those of their clients. Large brokerage and financial services firms have been reducing the potential for conflicts of interest by switching to accounts that charge a flat annual fee for management services. The Securities and Exchange Commission in April proposed a new rule requiring brokers to prioritize their clients' interests, which consumer advocates have opposed, claiming it does not go far beyond what is already required of brokers.