A study published in Alzheimer's & Dementia has yielded new insights into how Alzheimer's develops at the molecular level, before extensive neuronal damage occurs and symptoms manifest, reports ScienceDaily . The researchers also found the drug memantine, currently used for alleviating the symptoms of moderate-to-severe Alzheimer's, could prevent or retard its progression if used before symptoms appear. At the onset of the disease, there is a long period, perhaps 10 years or more, when neurons affected by the disease attempt to divide, possibly to compensate for the death of neurons. A student of University of Virginia Professor George Bloom proved that excess calcium entering neurons via calcium channels on their surface drive those neurons back into the cell cycle, before a series of events that ultimately produce the plaques found in the Alzheimer's brain. Neurons exposed to toxic amyloid oligomers cause the channel, called the NMDA receptor, to open, allowing the calcium flow that drives neurons back into the cell cycle. Memantine blocks cell cycle reentry by sealing the NMDA receptor. "The experiments suggest that memantine might have potent disease-modifying properties if it could be administered to subjects long before they have become symptomatic and diagnosed with Alzheimer's disease," Bloom says.

A study published in Perspectives in Psychiatric Care found almost 92 percent of people caring for a family member with dementia sleep poorly, reports News-Medical . The researchers analyzed the sleep of 43 people serving as primary caregivers for a family member with dementia. All participants were older than 50 and resided in the Western New York area. The majority of participants experienced poor sleep quality, awoke often, and slept less than six hours a night. It was determined that poor sleep hygiene increased the amount of time it takes to fall asleep. Although caregivers self-reported taking an average of half an hour to fall asleep, data collected using actigraphy watches indicated a sleep latency of 40 minutes. "Understanding how well caregivers are sleeping and the variables that affect them is an important first step toward the development of tailored and effective treatment," says University at Buffalo School of Nursing Professor Yu-Ping Chang. "This would help the millions of caregivers receive the optimum sleep needed to protect their health and continue to provide quality care."

Many U.S. cities and states can no longer provide pensions for millions of public workers over many years, and they can only be saved if governments hike taxes, divert funds, or persuade workers to relinquish money they are owed, reports the Wall Street Journal . For public employees nearing retirement, median incomes, including Social Security and retirement fund receipts, have not risen in years. They are stuck with high average debt, and are often using savings for their children's educations and to care for their aging parents. A Pew study found state and local pensions lost about $35 billion in assets between 2008 and 2009 during the recession. Liabilities swelled by more than $100 billion annually. Such pension plans currently have less than 75 percent of the money they need to meet their promised payouts, while Moody's Investors Service calculates that the hole for state and local pensions is $5 trillion. Cities and states can either raise taxes, slash services, or more aggressively reduce retiree benefits.

Enso co-founder Sebastian Buck writes that the most critical current business challenge is work engagement by employees, reports Fast Company . "With a 21st-century business mindset ... an emotional commitment at work is essential," he argues. "An employee turning up for a paycheck in exchange for functional work will not create products that stand apart from functional low-cost versions, or create that magical customer experience, or that team ethic that urges each other on to their very best." Buck cites studies indicating that lower employee engagement encourages greater absenteeism, more errors, accidents and defects, reduced productivity and profitability, less job growth, and 65 percent lower share price over time. He thinks the key to remedying this state of affairs is to offer employees more meaningful work. "What really matters is transitioning organizations to a state where the impact they create has the people that know them best — their own people — waking up in the morning inspired to be part of the work," Buck says. "What we have seen work well is beginning with internal conversations about what people and teams stand for, and what really living up to that would look like," he writes.

The imminent mass-retirement of older federal employees from the baby boomer generation is spurring government agencies to prepare, reports Government Executive . According to the Housing and Urban Development (HUD) Department's Suzanne Tufts, HUD Secretary Ben Carson has "directed everyone in leadership to make the vibrancy and the succession planning of their workforce not only top of mind, but to start really thinking and cooperating together and working very carefully together to make that a reality." Such initiatives include weekly meetings by top officials and their staffs to discuss new vacancies and recruitment efforts. The department has assigned a human resources business partner to each program office to help hiring managers with organizational design and position management. Officials have collected information on both HUD's mission-critical and high-risk operations to form a hiring strategy. They also are pushing to incentivize the current workforce to stay longer by expanding a mentoring program to help junior employees learn from more senior peers and engaging in other "knowledge transfer and capture" strategies. Tufts notes HUD is using its growing function as a disaster response agency to motivate employees and diffuse expertise. "You can't have good programs without good people and without an adequate number of people," she stresses. "We don't deliver our services with robots and good people don't fall out of the trees."

Employers say they are abandoning preferences for college degrees and specific skill sets to accelerate hiring and broaden the pool of job candidates, reports the Wall Street Journal . This move is helping self-taught programmers secure software engineering roles at Intel and GitHub, and raising the chances for high-school graduates who aspire to be branch managers at Bank of America and elsewhere. "Candidates have so many options today," says Adecco Group's Amy Glaser. "If a company requires a degree, two rounds of interviews and a test for hard skills, candidates can go down the street to another employer who will make them an offer that day." Glaser says slashing job-credential requirements is more common in cities such as Dallas and Louisville, where unemployment is lowest, as well as in recruiting for roles at call centers and warehouses within retail logistics operations. An analysis by Burning Glass Technologies of 15 million ads on websites such as Indeed and Craigslist found the share of job postings requesting a college degree fell to 30 percent in the first half of this year from 32 percent in 2017. Minimum qualifications have been declining since 2012, when companies wanted college graduates for 34 percent of those positions. Recruiters say the tightest job market in many years has left employers looking to shrink hiring costs with three options — offer more money upfront, lower their standards, or retrain current staff in coding, procurement, or other necessary skills.

The Department of Veterans Affairs (VA) is looking for a team of developers to consolidate its agency websites into a single, user-friendly online portal, part of an agencywide effort to streamline online services and make it easier for veterans to navigate the benefits process. The vendor would lead a complete redesign of VA.gov, reports NextGov.com , and would also be responsible for mapping the site's new structure, optimizing its search functions, and working with agency officials to make regular improvements. "VA is committed to dramatically upgrading its user-facing digital tools, becoming the first federal agency to deliver a digital experience on par with the private sector," officials wrote in the request for information. Led by executive director Marcy Jacobs, the Digital Service at VA has in recent years revamped online applications, connected portals to vast troves of patient data, and given a thorough makeover to vets.gov, a site where veterans can apply for benefits and track claims. Now through the broader VA.gov redesign, the agency intends to bring all its veteran-facing sites under the umbrella of the main site.

The longitudinal Pittsburgh Cardiovascular Health Study-Cognition (CHS-CS) presented at the Alzheimer's Association International Conference 2018 demonstrated that among adults in their 70s at baseline, higher large-artery stiffness—measured by carotid-femoral pulse wave velocity (cfPWV)—independently anticipated higher dementia risk over 15 years, according to MedScape . The researchers examined 356 CHS-CS participants, mean age 78, without dementia at baseline who had annual cognitive exams through 2013 and cfPWV quantified between 1996 and 2000. A total of 212 developed dementia over 15 years, with four years the median time to onset. After adjusting for age, sex, education, race, APOE E4 genotype status, diabetes, and hypertension, higher cfPWV was linked to a 60 percent greater risk for incident dementia. Furthermore, white matter grade, ventricular grade, or large infarcts did not significantly strengthen this association, nor was dementia risk modified by baseline mild cognitive impairment (MCI), as indicated by similar hazard ratios for those with baseline normal cognition and MCI and the lack of a statistical interaction. Reduced physical activity intensity and higher systolic blood pressure, heart rate, and waist circumference measured about five years before cfPWV measurement were significantly connected to greater arterial stiffness. The implication is that preventive interventions targeting these risk factors may lower dementia risk by reducing arterial stiffness.

A research letter published in Diabetes Care says more than 25 percent of older U.S. adults with diabetes use some type of complementary and alternative medicine (CAM), reports HealthDay News . The researchers used data from the 2012 National Health Interview Survey for 1,475 adults aged 65 or older who reported having diabetes. They estimated that more than 2 million older adults with diabetes used some form of CAM in the past year in 2012. Average age among older CAM users with diabetes was 72.4 years, and 54.3 percent were women. Biologically-based therapies and manipulative body therapies were the most commonly used types of CAM, while the most commonly used individual therapies were herbal therapies, chiropractic, massage, acupuncture, and yoga. Significant prevalence differences existed for herbal therapies, chiropractic, and meditation by reason of use. "Older adults should be educated to proactively discuss their CAM use with their healthcare providers, so that ... care can be provided to meet the needs of older adults with diabetes," the researchers recommend.

The National Poll on Healthy Aging found only a small portion of older U.S. adults have talked with their healthcare providers about what to do with leftover prescription opioids, reports MedPage Today . Among 589 adults, ages 50 to 80, who had filled a pain medication prescription in the past two years, 90 percent reported discussing with their provider how often to take the medication, according to the Michigan Opioid Prescribing Engagement Network's Jennifer Waljee. However, just 37 percent said they talked about what to do with leftover pills. In addition, 50 percent of respondents with opioid prescriptions reported having pills leftover, and 86 percent noted they kept them for later potential use. Only 13 percent returned the additional pills to an approved location. The implication is that millions of older adults have opioids lingering in their homes, which is the most common source for misuse and may place loved ones at risk. Furthermore, 60 percent of the respondents reported discussing side effects with their healthcare provider, while 48 percent said the risk of addiction was covered, and 43 percent said the risk of overdose was addressed. Nearly all older adults sampled said they backed policies to improve opioid regulation, such as mandated review of prescription records and disclosure of prior opioid medication use. Seventy-four percent supported restrictions on the number of pills providers could prescribe at once, but only 47 percent said they would consent to regulations requiring unused medications to be returned.