Nearly 7 million Americans are living with Alzheimer’s disease, the fifth leading cause of death among those 65 and older. The disease will carry an estimated $360 billion in health care costs this year alone, according to the Alzheimer’s Association.

Researchers led by Duke Han, professor of psychology and family medicine at USC Dornsife, aimed to better understand the link between early Alzheimer’s disease and financial vulnerability by using high-powered MRI to examine the brains of 97 study participants over age 50.

The scientists focused on the entorhinal cortex, a region that acts as a relay station between the hippocampus — the brain’s learning and memory center — and the medial prefrontal cortex, which regulates emotion, motivation and other cognitive functions. It is often the first region to show changes in Alzheimer’s disease, typically becoming thinner as the disease progresses.

None of the study participants, age 52 to 83, showed clinical signs of cognitive impairment, but all underwent MRI scans to measure the thickness of their entorhinal cortex.

In addition, the researchers used a standardized tool called a Perceived Financial Exploitation Vulnerability Scale (PFVS) to assess the participants’ financial awareness and their susceptibility to poor financial decisions, which they term “financial exploitation vulnerability,” or FEV.

By comparing the adults’ FEV with the thickness of their entorhinal cortex, Han and the team found a significant correlation: Those more vulnerable to financial scams had a thinner entorhinal cortex.

This was especially true for participants age 70 and older. Previous research has linked FEV to mild cognitive impairment, dementia and certain molecular brain changes associated with Alzheimer’s disease.

Han, who holds a joint appointment at Keck School of Medicine of USC, says the findings provide crucial evidence supporting the idea that FEV could be a new clinical tool for detecting cognitive changes in older adults — changes that are often difficult to detect.

“Assessing financial vulnerability in older adults could help identify those who are in the early stages of mild cognitive impairment or dementia, including Alzheimer’s disease,” Han said. He added, however, that financial vulnerability alone is not a definitive indicator of Alzheimer’s disease or other cognitive decline. “But assessing FEV could become part of a broader risk profile,” he said.

Han also noted several limitations of the study. Most participants were older, white, highly educated women, making it difficult to generalize the findings to a more diverse population. Additionally, while the study found a link between entorhinal cortex thickness and FEV, it does not prove one. Finally, the study does not include specific measures of Alzheimer’s disease pathology.

These limitations leave open the possibility that the relationship between FEV and entorhinal cortex thinning could be explained by other factors. Accordingly, Han said that more research, including long-term studies with diverse populations, is needed before FEV can be considered a reliable cognitive assessment tool.

The method, leveraging a solvent of sodium hydroxide and urea in water, can significantly lower the production cost of nanocellulosic fiber — a strong, lightweight biomaterial ideal as a composite for 3D-printing structures such as sustainable housing and vehicle assemblies. The findings support the development of a circular bioeconomy in which renewable, biodegradable materials replace petroleum-based resources, decarbonizing the economy and reducing waste.

Colleagues at ORNL, the University of Tennessee, Knoxville, and the University of Maine’s Process Development Center collaborated on the project that targets a more efficient method of producing a highly desirable material. Nanocellulose is a form of the natural polymer cellulose found in plant cell walls that is up to eight times stronger than steel.

The scientists pursued more efficient fibrillation: the process of separating cellulose into nanofibrils, traditionally an energy-intensive, high-pressure mechanical procedure occurring in an aqueous pulp suspension. The researchers tested eight candidate solvents to determine which would function as a better pretreatment for cellulose. They used computer models that mimic the behavior of atoms and molecules in the solvents and cellulose as they move and interact. The approach simulated about 0.6 million atoms, giving scientists an understanding of the complex process without the need for initial, time-consuming physical work in the lab.

The simulations developed by researchers with the UT-ORNL Center for Molecular Biophysics, or CMB, and the Chemical Sciences Division at ORNL were run on the Frontier exascale computing system — the world’s fastest supercomputer for open science. Frontier is part of the Oak Ridge Leadership Computing Facility, a DOE Office of Science user facility at ORNL.

“These simulations, looking at every single atom and the forces between them, provide detailed insight into not just whether a process works, but exactly why it works,” said project lead Jeremy Smith, director of the CMB and a UT-ORNL Governor’s Chair.

Once the best candidate was identified, the scientists followed up with pilot-scale experiments that confirmed the solvent pretreatment resulted in an energy savings of 21% compared to using water alone, as described in the Proceedings of the National Academy of Sciences.

With the winning solvent, researchers estimated electricity savings potential of about 777 kilowatt hours per metric ton of cellulose nanofibrils, or CNF, which is roughly the equivalent to the amount needed to power a house for a month. Testing of the resulting fibers at the Center for Nanophase Materials Science, a DOE Office of Science user facility at ORNL, and U-Maine found similar mechanical strength and other desirable characteristics compared with conventionally produced CNF.

“We targeted the separation and drying process since it is the most energy-intense stage in creating nanocellulosic fiber,” said Monojoy Goswami of ORNL’s Carbon and Composites group. “Using these molecular dynamics simulations and our high-performance computing at Frontier, we were able to accomplish quickly what might have taken us years in trial-and-error experiments.”

The right mix of materials, manufacturing

“When we combine our computational, materials science and manufacturing expertise and nanoscience tools at ORNL with the knowledge of forestry products at the University of Maine, we can take some of the guessing game out of science and develop more targeted solutions for experimentation,” said Soydan Ozcan, lead for the Sustainable Manufacturing Technologies group at ORNL.

The project is supported by both the DOE Office of Energy Efficiency and Renewable Energy’s Advanced Materials and Manufacturing Technologies Office, or AMMTO, and by the partnership of ORNL and U-Maine known as the Hub & Spoke Sustainable Materials & Manufacturing Alliance for Renewable Technologies Program, or SM2ART.

The SM2ART program focuses on developing an infrastructure-scale factory of the future, where sustainable, carbon-storing biomaterials are used to build everything from houses, ships and automobiles to clean energy infrastructure such as wind turbine components, Ozcan said.

“Creating strong, affordable, carbon-neutral materials for 3D printers gives us an edge to solve issues like the housing shortage,” Smith said.

It typically takes about six months to build a house using conventional methods. But with the right mix of materials and additive manufacturing, producing and assembling sustainable, modular housing components could take just a day or two, the scientists added.

The team continues to pursue additional pathways for more cost-effective nanocellulose production, including new drying processes. Follow-on research is expected to use simulations to also predict the best combination of nanocellulose and other polymers to create fiber-reinforced composites for advanced manufacturing systems such as the ones being developed and refined at DOE’s Manufacturing Demonstration Facility, or MDF, at ORNL. The MDF, supported by AMMTO, is a nationwide consortium of collaborators working with ORNL to innovate, inspire and catalyze the transformation of U.S. manufacturing.

Other scientists on the solvents project include Shih-Hsien Liu, Shalini Rukmani, Mohan Mood, Yan Yu and Derya Vural with the UT-ORNL Center for Molecular Biophysics; Katie Copenhaver, Meghan Lamm, Kai Li and Jihua Chen of ORNL; Donna Johnson of the University of Maine, Micholas Smith of the University of Tennessee, Loukas Petridis, currently at Schrödinger and Samarthya Bhagia, currently at PlantSwitch.

The research, led by scientists at Stanford Medicine and the University of California, San Francisco, is part of a larger effort to identify low-risk, low-cost ways to treat one of the most common health problems women face as they age.

After 12 weeks of a low-impact yoga program, study participants had about 65% fewer episodes of incontinence. Women in a control group doing stretching and strengthening exercises experienced a similar benefit over the same time period. The benefits are on par with the effects of medications used to address incontinence, the researchers said.

“Our study was testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” said the study’s senior author, Leslee Subak, MD, chair of obstetrics and gynecology at Stanford Medicine. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor and accessible wherever you live.” Because the trial was conducted partly during the COVID-19 pandemic, many participants received their yoga or exercise instruction via online meetings, exercising in their own homes, she noted.

The study’s lead author is Alison Huang, MD, professor of medicine, urology, and epidemiology and biostatistics at UCSF.

Urinary incontinence, which affects more than half of middle-aged women and up to 80% of 80-year-olds, can lead to a variety of other problems, from social isolation to bone fractures caused by falls. But there is help.

“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Subak, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor III. “Or we hear folklore about this being normal when you get older. In fact, it’s very common but it’s not inevitable, and we have very effective ways of treating it.”

Addressing a common problem

Incontinence deserves good treatment because of the many ways it interferes with people’s lives.

“It takes away independence,” Subak said. “My patients will say, ‘I can’t stay with my kids or grandkids because I’m afraid I’ll wet the bed, and I can’t talk about it; it’s too embarrassing.'”

Patients may avoid activities that could boost their well-being, such as exercising and seeing friends. They are more likely to be admitted to a nursing home and to suffer certain serious medical problems such as hip fractures.

“Incontinence and overactive bladder are among the biggest risk factors for falls and fractures among older women,” Subak said. “You’re rushing to the bathroom at night — with the lights off — tripping and falling, and breaking a hip.”

Some factors that contribute to risk for incontinence can’t be changed, such as aging or having had children. But others are modifiable.

“A lot of my research has focused on weight loss and physical activity, which in fact are effective treatments,” Subak said. She became interested in studying yoga as a treatment after some of her patients told her it helped them.

Being active helps

The study compared two 12-week exercise programs: 121 participants were randomly assigned to yoga, and 119 to a physical conditioning control group. The participants were women with urinary incontinence that caused symptoms at least once a day. They were 45 to 90 years old, with a mean age of 62.

In the yoga program, participants learned 16 hatha yoga poses intended to strengthen the pelvic floor, via two 90-minute sessions per week. The pelvic floor consists of the muscles that form the base of the pelvis and hold its organs — including the bladder and urethra — in place. Participants were also asked to practice yoga for at least one hour per week outside of class and to maintain a practice log.

Participants in the control group spent an equal amount of time in exercise classes, but their classes focused on nonspecific stretching and strengthening exercises that did not engage the pelvic floor. They were also asked to practice for an additional hour per week and keep a practice log.

The study began with in-person classes, then transitioned to a videoconference format when the COVID-19 pandemic lockdowns began.

Participants recorded when they leaked urine and classified whether each episode was urgency incontinence, when an overactive bladder causes a person to feel the need to urinate more often than usual, or stress incontinence, in response to pressure in the abdomen, such as from coughing or sneezing. They also answered standard questionnaires about their bladder function.

At the beginning of the study, the participants had an average of 3.4 episodes of urinary incontinence per day, including 1.9 urgency-type episodes and 1.4 stress-type episodes.

By the end of the 12-week programs, participants in the yoga group were experiencing 2.3 fewer episodes of incontinence per day, on average. Those in the physical conditioning group were experiencing 1.9 fewer episodes per day.

The two treatments are about equally effective, with both approaches reducing episodes of incontinence by around 60%, and the benefits from both treatments are meaningful, Subak said. Patients who would like to try these approaches can search for low-impact Iyengar yoga or low-impact exercise classes in their communities or online, she said, adding that instructors should be able to adapt the activity to participants’ physical limitations.

“I’m impressed that exercise did so well and impressed that yoga did so well,” Subak said. “One of the take-home messages from this study is ‘Be active!'”

Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, she noted.

If a patient asked whether yoga could help with incontinence, “I would say that I think it’s a great idea to try it if you’re interested,” Subak said. “It’s very low risk, and there’s potential for benefit not only for incontinence but also for your general well-being.”

The study was funded by the National Institutes of Health (grants R01AG050588, R01DK116712-04S1 and K24AG068601). Researchers from Yale University and San Francisco State University also contributed to the study.