A study published in Nature Scientific Reports has found that minuscule snippets of genetic material called microRNA can help detect Alzheimer's and other neurodegenerative diseases early, reports United Press International . Indiana University Professor Hui-Chen Lu's team discovered that changes in microRNA are identifiable in mice long before they start to manifest symptoms of neurodegenerative conditions. The researchers analyzed microRNA and messenger RNA in a group of healthy rats and in another group genetically modified to develop symptoms of dementia. The highest level of "dysregulation," or deviation from normal levels, was detected in the microRNA of the dementia group before their physical symptoms developed. "Higher levels of pre-symptomatic microRNA dysregulation are significant because it strongly suggests that it may have a role in changes in the brain in later stages," says Hui-Chen. MicroRNA can better predict neurodegenerative diseases than regular "messenger RNA," which directs cells to produce specific proteins. Hui-Chen's team compared the microRNA changes to the messenger RNA changes to detect biological pathways impacted by microRNA dysregulation, suggesting such changes affected pathways linked to immunity in the dementia-prone model. Additional tests were held to study a specific type of microRNA, microRNA 142, that they noticed more of in the dementia model; microRNA 142 is known to significantly contribute to inflammation. Introducing microRNA 142 into the brain caused significant neuroinflammation, and many other studies have demonstrated that chronic inflammation plays a role in neurodegeneration.

The liaison council of the Dementia Supporter Caravan estimates that more than 10 million persons have received training to assist people with dementia in Japan, reports the Japan Times . Because about 7 million people are projected to have dementia by 2025, Japan's government is considering the development of 12 million dementia care aides by the end of fiscal 2020 as part of a national push to build supportive communities. Such aides must complete a 60- to 90-minute training session offered by local governments, schools, and companies. As of the end of March, nearly 10.2 million people had completed the mandatory sessions, including instructors and those who have taken the course more than once. About 9.6 million in that group participated in sessions held by local governments, while the others were trained by private entities, including financial institutions and operators of supermarkets, where workers may regularly meet people with dementia. There is no age restriction for becoming a volunteer, and about 2.1 million volunteers are 19 or younger. Many local governments provide advanced sessions in which volunteers can learn more specialized knowledge about dementia and further enhance their skills.

The Centers for Medicare and Medicaid Services (CMS) wants to roll out a demonstration to test the concept of waiving Merit-Based Incentive Payment System (MIPS) mandates for clinicians who participate in certain Medicare Advantage plans that involve assuming risk, reports Health Data Management . The Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act stipulates that clinicians currently participate in the QPP either via MIPS, which adjusts Medicare payments based on combined performance on measures of quality, cost, improvement activities, and advancing care information; or via Advanced Alternate Payment Models (APMs), which requires clinicians to assume risk for what is spent for their beneficiaries' healthcare. CMS says certain Medicare Advantage plans are developing innovative arrangements that resemble Advanced APMs, but without undertaking the agency's proposed Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration, doctors are still subject to MIPS even if they participate extensively in such arrangements. "The MAQI demonstration aligns with the agency's goal of moving to a value-based healthcare system, and aims to put Medicare Advantage on a more equal playing field with Fee-for-Service Medicare," says CMS Administrator Seema Verma. "CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes."

A study published in Science found that while Medicare spending is concentrated among people who die, there is very little spending on those whose death within the year is highly likely, reports ScienceDaily . "Very little money is spent on people who we know with high probability are going to die in a short amount of time," says Massachusetts Institute of Technology Professor Amy Finkelstein. She also notes to the extent that such cases exist, "they're just not the drivers of bulk spending." The researchers examined a random sample of nearly 6 million Medicare enrollees who were in the program as of Jan. 1, 2008. For survivors, the study analyzed healthcare spending for all of 2008; for people who died in 2008, it examined spending over the year before death. The researchers demonstrated that fewer than 10 percent of people who die in a given year have a predicted 12-month mortality rate over 50 percent. Even when people are hospitalized in what turns out to be their final year, fewer than 4 percent have a predicted 12-month mortality rate of 80 percent or higher at the time of hospitalization. The analysis indicates the apparent focus of spending on last-year-in-life persons is a byproduct of the fact that even relatively low-mortality health scenarios for seniors will include a certain number of deaths, not that the individual treatment decisions represent longshots. Furthermore, the fact that we spend more money on sick people represents 30 percent to 50 percent of the concentration of spending on people in their last year of life.

A study published in J AMA Ophthalmology suggests vision deficits may influence cognitive decline in older adults, reports MedPage Today . The researchers linked visual impairment with reduced cognitive function cross-sectionally and over time, with worsening vision having a stronger connection with declining cognition than vice-versa. The team studied 2,520 community-residing adults in Salisbury, Md., who were 65 to 84 years old at enrollment in 1993-1995 with a Mini-Mental State Examination (MMSA), tracking them for eight years. They assessed 2,240 people at the two-year follow-up point, 1,504 at the six-year point, and 1,250 at the eight-year point, with more than 50 percent of the loss being due to death. The segment of participants with MMSE scores indicating cognitive impairment rose from 11 percent at baseline to 20.6 percent in the fourth round. Visual acuity (VA) also got worse over time. Comparing the impact of VA at the start of the study on cognitive function to years later versus the reverse revealed that the standardized regression coefficient of VA to MMSE score was almost double that of MMSE score to VA. If visual impairment has a negative association with future cognition, "the tacit assumption is that improving (or protecting) visual function may be a viable intervention to prevent or control cognitive decline in older age," Notes Paul Foster of Moorfields Eye Hospital in the U.K.

The U.S. Department of Heath and Human Services' Office of Inspector General (OIG) has disclosed details about its involvement in the biggest healthcare fraud takedown in history this year. In June, more than 600 defendants in 58 federal districts were accused of participating in fraud schemes involving roughly $2 billion in losses to Medicare and Medicaid. Since the last takedown, OIG also released exclusion notices to 587 doctors, nurses, and other providers based on conduct related to opioid diversion and abuse, shielding Medicare and Medicaid and deterring fraud. OIG says for every $1 spent on healthcare-related fraud and abuse investigations in the last three years, more than $4 has been recovered. More information on the takedown is available here . OIG also has issued three studies on opioid use in Medicare Part D, the use of data analysis to estimate opioid levels and identify individuals at risk of misuse or overdose, and how entities complied with the Federal Select Agent Program Internal Inspection Requirement, respectively. The first report is accessible here , the second here , and the third here .

Scientists worldwide are exploring ways in which robots might help care for people with Alzheimer's disease, reports HealthDay News . One machine known as Silbot3 has shown promise in this field, says Elizabeth Broadbent with the University of Auckland in New Zealand. "It is designed to enable people to stay at home for longer before needing to go into a care home," she notes. "While a human could help with these things, the burden on caregivers of people with dementia is very high. Some people do not have a caregiver at home and caregivers often need a break during the day to get other things done. Robots can help provide extra care." Other teams are concentrating on using robots to counter the loneliness and isolation that some people with Alzheimer's feel. The National University of Ireland-Galway's School of Nursing and Midwifery is experimenting with MARIO, a robot designed to "provide companionship and support the person with dementia to connect and/or remain connected to their family and friends, and stay engaged in activities and events that interest them," says Professor Dympna Casey. "Caregivers of people with dementia carry a really heavy burden," notes the Alzheimer's Association's James Hendrix. "If there's a way we can lighten that burden for folks a little bit, make it a little easier for them, that's going to help the person with dementia as well. Their care partner is just going to be that much more rested, that much more healthy, and that much more happy."

Sixty percent of workers feel they are doing a good job preparing for retirement, up from 56 percent last year, but only half feel confident they know how much to save in order to live comfortably when that time comes, according to the 28th annual Retirement Confidence Survey released Thursday by the Employee Benefit Research Institute and Greenwald & Associates. The survey also found that 59 percent of workers feel at least somewhat stressed about preparing for retirement, and just 23 percent of workers within five years of retirement are very confident they know how much they will need to live comfortably, reports Pensions & Investments .

Champlain College in Vermont has just halved tuition for career-focused online degrees, in keeping with the trend of adult students comprising the majority of degree seekers in the United States, reports Champlain Provost Laurie Quinn in Next Avenue . "Even in your 50s or 60s, there can be a significant economic upside to earning, or completing, that college degree," she notes. Quinn also cites a national Champlain poll's findings that 60 percent of U.S. adults age 23 to 55 without a bachelor's degree have considered returning to school, but were blocked by costs and student debt. "While going back to school later in life isn't the right choice for everyone, it's becoming an increasingly attractive option, as more adults choose to delay retirement, the workforce becomes even more competitive, and career shifts become more common," she writes. Reasons Quinn provides for adults 50 and older returning to school include the desire for a second-chapter career, the need to remain competitive and relevant in the workforce, the hunger for new challenges and new knowledge, and meeting a long-cherished goal. "Some colleges have longstanding experience serving working adults with high-quality online programs dedicated to ensuring that the decision to go back to school pays off," Quinn notes. "And many such schools are creating new pathways to make this a viable option for even more people, including the over-50 crowd."

Sen. Lisa Murkowski (R-Alaska) is leading a push to ascertain how Congress could curb excessive out-of-network billing, as her state's attempted correction has only served to further hike healthcare costs, reports Modern Healthcare . Alaska in 2004 released a little-known rule to check exorbitant bills for people with commercial insurance needing out-of-network treatment. The rule stipulated insurers pay 80 percent of the reasonable market rate of the treatment, but was mostly ineffective because unregulated specialists ran up prices. Murkowski said other rural states could face similar problems with too few specialists. As hospitals cannot afford to employ these doctors full-time, their services typically are out of network. This problem narrowed debate at a Senate Health, Education, Labor, and Pensions Committee hearing on Sen. Lamar Alexander's (R-Tenn.) push to find policies to reduce healthcare costs. The Harvard Global Health Institute's Dr. Ashish Jha suggested in Alaska's case, linking benchmark prices to a national average instead of the local specialists' costs could drive incentives the other way. Panel witnesses called on lawmakers to weigh other transparency measures beyond out-of-network billing rules, criticizing the industry because beneficiaries are largely kept unaware in terms of cost of care and the coverage they can expect when they enter hospitals. Jha also noted the Federal Trade Commission and other agencies responsible for monitoring antitrust issues as the industry consolidates need congressional support.