According to a study published in the November 6, 2024, online issue of Neurology, the medical journal of the American Academy of Neurology, older people who are sleepy during the day or lose interest in activities due to sleep issues may be more likely to develop a syndrome that can lead to dementia.

People with the syndrome walk slowly and report memory problems, but they do not have a mobility handicap or dementia. Motoric cognitive risk syndrome is a condition that can develop before dementia.

What The Study Found?

The study found that people with excessive daytime sleepiness and a lack of enthusiasm to get things done were more likely to develop the syndrome than people without those sleep-related issues. The study does not prove that these sleep-related issues cause the syndrome, it only shows an association.

“Our findings emphasize the need for screening for sleep issues,” said study author Victoire Leroy, MD, PhD, of Albert Einstein College of Medicine in the Bronx, New York. “There’s potential that people could get help with their sleep issues and prevent cognitive decline later in life.”

How Was It Conducted?

The study included 445 participants, with an average age of 76, who did not have dementia. Participants completed sleep surveys at the beginning of the trial. They were queried about memory problems, and their walking pace was measured on a treadmill at the beginning of the study and then once a year for the next three years.

The sleep assessment included questions about how frequently people had difficulties sleeping because they woke up in the middle of the night, couldn't fall asleep within 30 minutes, or felt too hot or cold, as well as whether they used sleep aids. The question to assess excessive daytime drowsiness asks how frequently people have had problems remaining awake when driving, eating meals, or were engaged in any other activity.

The Findings

In total, 177 participants fit the category of bad sleepers, whereas 268 satisfied the definition of good sleepers.

At the outset of the trial, 42 participants had motoric cognitive risk syndrome. Throughout the trial, 36 more persons got the condition.

35.5% of patients who experienced extreme daytime sleepiness and a lack of enthusiasm developed the syndrome, compared to 6.7% who did not. After accounting for other factors that could influence the risk of the syndrome, such as age, depression, and other health conditions, researchers discovered that people with excessive daytime sleepiness and a lack of enthusiasm were more than three times more likely to develop the syndrome than those who did not have those sleep-related issues.

“More research needs to be done to look at the relationship between sleep issues and cognitive decline and the role played by motoric cognitive risk syndrome,” Leroy said. “We also need studies to explain the mechanisms that link these sleep disturbances to motoric cognitive risk syndrome and cognitive decline.”

A limitation of the study is that participants reported their own sleep information, so they may not have remembered everything accurately.

The study was supported by the National Institute on Aging.

The common perception about varicose veins is that they are merely an aesthetic or cosmetic problem. Varicose veins are indeed enlarged, twisted blood vessels that many people believe are not life-threatening. But the reality is that the condition may be a symptom of something more serious.

The disease manifests itself through insufficient blood supply in the body caused by faulty valves. As the blood vessels cannot effectively move the blood from the veins back to the heart, the blood tends to accumulate in the veins themselves. Other symptoms may include pain, heaviness, swelling, and skin sores in severe cases.

What Are The Causes Of Varicose Veins?

Varicose veins don’t develop overnight; they are usually the result of multiple underlying factors that gradually affect vein health and blood flow:

1. Valve dysfunction and poor circulation: Healthy veins rely on tiny valves to prevent backflow. When these valves weaken, blood starts collecting in the veins, leading to increased pressure and visible swelling.

2. Prolonged standing or sitting: These days, occupations require long hours of standing, which can hinder proper blood circulation and increase the risk.

3. Hormonal changes: Hormonal fluctuations during pregnancy, menopause, or while using hormonal therapies can relax vein walls, making them more prone to dysfunction.

4. Genetics: A family history of varicose veins significantly raises the likelihood of developing them, indicating a hereditary component in vein wall strength and valve efficiency.

5. Obesity and lack of physical activity: Excess body weight puts additional pressure on veins, while a sedentary lifestyle reduces the efficiency of blood circulation, leading to vein damage over time.

6. Ageing: As people age, veins lose elasticity, and valves may wear out, making older adults more susceptible to developing varicose veins.

What Are The Tips To Take Care Of?

People can manage or reverse varicose veins by:

• Making sure blood is circulating well in the body: An inactive lifestyle or standing for long periods can lead to increased risks of vein disease. Exercise and movement, along with raising the legs, will ensure that blood continues circulating well.

• Maintaining a healthy weight: Obesity can lead to increased pressure on the veins of the legs. Maintaining a healthy body weight is important to avoid and treat varicose veins.

• Wear compression stockings: Compression stockings apply gentle pressure to the veins, which enables them to circulate blood effectively and avoid swelling and other conditions.

• See a vein specialist if necessary: In cases of persistent pain, discoloration of skin, severe itching, or sores that don't heal, it is advised to see a vein specialist, as these symptoms could signal something worse.

How Can It Be Treated?

Varicose vein treatment procedures have become much easier in the modern world. Varicose veins can now be treated with minimally invasive procedures that address the problem at its root cause. These minimally invasive treatments include EVLT (Endovenous Laser Treatment), Radiofrequency Ablation (RFA), and glue ablation. A laser fibre is inserted into the varicose vein during this operation, where it effectively closes it off.

Blood is automatically redirected through other veins after this treatment, which is relatively quick and involves local anesthesia. Patients generally recover within one day. However, EVLT is much less painful, safer, and does not involve leaving scars behind.

Varicose veins are often a symptom of vein disease and thus not just a cosmetic problem. They can be a visible sign of an underlying circulatory issue. Paying attention to early symptoms and seeking medical advice can help prevent complications and improve overall vascular health. Preventing further problems is easy when one knows what to do.

Knee problems were once considered an issue associated with old age. However, an increasing number of Indians in their 30s are experiencing knee pain, stiffness, and cartilage damage similar to arthritis. Doctors are reporting more cases of young adults seeking treatment for knee-related issues that can affect mobility and quality of life.

Sedentary Lifestyle And Lack of Physical Activity

One of the biggest reasons behind early knee damage is a sedentary lifestyle. Many young professionals spend long hours sitting at desks, working on computers, or using mobile devices. Lack of regular movement weakens the muscles around the knees, reducing the support they provide to the joint.

At the same time, some individuals suddenly engage in intense workouts without proper conditioning. This puts excessive stress on the knees, increasing the risk of injuries and long-term wear and tear. Maintaining a balanced exercise routine with strength training and stretching can help protect knee health.

Rising Obesity And Excess Weight

India has witnessed a rise in obesity among young adults. Excess body weight places additional pressure on the knee joints, which are responsible for supporting most of the body’s weight. Even a small increase in weight can significantly increase stress on the knees during activities such as walking, climbing stairs, or running.

Over time, this extra pressure can lead to cartilage deterioration, inflammation, and chronic pain. Maintaining a healthy weight through proper nutrition and regular exercise can reduce the risk of developing arthritis-like symptoms at an early age.

Poor Posture And Nutritional Deficiencies

Poor posture while sitting, standing, or exercising can also contribute to knee problems. Improper movement patterns may cause uneven stress on the joints, leading to gradual damage. Additionally, untreated sports injuries or ligament tears can accelerate knee degeneration if not managed properly.

Nutritional deficiencies, particularly low levels of vitamin D and calcium, are another concern. These nutrients play a vital role in maintaining strong bones and joint health. Deficiencies can weaken the musculoskeletal system and make individuals more susceptible to knee-related issues.

Steps to Protect Knee Health

Preventing early knee damage requires a combination of healthy habits. Individuals should engage in regular low-impact exercises such as walking, swimming, or cycling to strengthen the muscles around the knee. Maintaining a healthy body weight can significantly reduce pressure on the joints.

It is also important to follow an ergonomic posture while working, take frequent breaks from prolonged sitting, and avoid sudden high-intensity workouts without proper preparation. A balanced diet rich in calcium, vitamin D, protein, and anti-inflammatory foods can support bone and joint health. Most importantly, persistent knee pain should not be ignored, and timely consultation with a healthcare professional can prevent minor issues from becoming serious conditions.

Conclusion

The growing incidence of arthritis-like knee damage among Indians in their 30s is a result of multiple lifestyle factors, including inactivity, obesity, poor posture, injuries, and nutritional deficiencies. While the problem is becoming more common, it is largely preventable. Regular exercise, maintaining a healthy weight, following a balanced diet, and seeking timely medical attention can help preserve knee health and reduce the risk of long-term joint damage.

(By Dr. Sanjeev Kapoor, Senior Consultant, Rheumatology, ISIC Multi-Speciality Hospital)

Prime Minister Narendra Modi proposed the idea of a dedicated yoga day during his address to the 69th session of the UN General Assembly in 2014. On December 11, 2014, all 193 UN member states unanimously agreed to observe the International Day of Yoga on June 21.

The primary objective of the International Day of Yoga is to raise awareness about yoga as a holistic practice for mental and physical well-being. Yoga originated in India, and it has a history of more than 5000 years. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes, hypertension, and chronic kidney disease.

The Challenges Faced by Dialysis Patients

Dialysis is a life-saving treatment for stage 5 CKD patients. It has to be done 2- 3 times/week. It has been seen that these patients become physically inactive, which leads to poorer outcomes. They also have a lot of comorbidities like hypertension and diabetes, besides stress. Over the last few years, scientific studies have shown that regular exercise in patients improves outcomes. These patients are a captive audience as they spend 8-12 hours in a dialysis unit every week.

Hence, many dialysis units have incorporated exercise into the dialysis sessions. Yoga has been purported to have multiple health benefits. Over the last few years, even Western science is starting to provide some concrete clues as to how yoga works to improve health, heal aches and pains, and keep sickness at bay.

Yoga: Benefits For Heart Health

Research studies have shown that Yoga lowers blood pressure and slows the heart rate. Two studies of people with hypertension, published in the leading scientific journal The Lancet, compared the effects of Savasana (Corpse Pose) with simply lying on a couch.

After three months, Savasana was associated with a 26-point drop in systolic blood pressure (the top number) and a 15-point drop in diastolic blood pressure (the bottom number), and the higher the initial blood pressure, the bigger the drop. A slower heart rate can benefit people with high blood pressure or heart disease, and people who've had a stroke. Yoga lowers LDL (“bad”) cholesterol and boosts HDL (“good”) cholesterol.

Yoga: Diabetes and Weight Management

In people with diabetes, yoga has been found to lower blood sugar in several ways: by lowering cortisol and adrenaline levels, encouraging weight loss, and improving sensitivity to the effects of insulin. If your blood sugar levels improve, there is a reduced risk of diabetic complications such as heart attack, kidney damage, and blindness.

Researchers have also found that people who practiced yoga for at least 30 minutes once a week for at least four years gained less weight during middle adulthood. People who were overweight actually lost weight. Overall, those who practiced yoga had a lower body mass index (BMI) compared with those who did not practice yoga. Researchers attributed this to mindfulness. Mindful eating can lead to a more positive relationship with food and eating.

Yoga also acts as a stress buster. It quells the fluctuations of the mind, according to it, slows down the mental loops of frustration, regret, anger, fear, and desire that can cause stress. And since stress is implicated in so many health problems—from migraines and insomnia to lupus, MS, eczema, high blood pressure, and heart attacks—if you learn to quiet your mind, you’ll be likely to live longer and healthier.

Yoga: Evidence For Dialysis Patients

There is a lack of good scientific data about the direct benefits of yoga in dialysis patients, but the absence of evidence does not mean evidence of absence. Some people regard it as a fashionable fitness, but it can be beneficial in various chronic diseases, including diabetes and hypertension. Diabetes and high blood pressure are among the commonest comorbidities in Dialysis patients. These patients are under great stress due to their kidney failure.

In another study, a 6-month yoga program was found to be a safe and effective measure as adjuvant therapy to conventional treatment modalities in reducing blood pressure, improving renal function, and improving QOL in these patients.

For the last 5 years, we have been celebrating World Yoga Day in our Dialysis unit and encouraging our Dialysis patients to regularly practice Yoga. Even after a kidney transplant, the better the blood pressure control, the longer the life of the transplanted kidney. Thus, there is enough indirect evidence that yoga is beneficial in patients with kidney diseases.

Yoga: Benefits for Kidney Disease Patients

However, it should be done under expert supervision. There are many other poses in yoga; you can choose those that are suitable for you under the guidance of a professional practitioner. In a word, practicing yoga can promote metabolism, blood circulation, and help discharge more metabolic wastes and toxins. It can improve endocrine functions and help repair damaged tissues.

It can strengthen physical fitness and enhance immunity. It can make the mind peaceful and ease pressure and chronic pains. They also assist in managing water retention in the body. This enables sound sleep schedules and hence better rest. A well-rested body is better able to perform functions such as regulating water in the body and stabilizing the heartbeat.

Precautions Before Practicing Yoga

Though yoga is safe, not every kidney failure patient can do all the poses. For example, if the patients have polycystic kidney disease, bending and other positions that can cause pressure on the abdomen and back should be avoided. If the patients have high blood pressure or lower back pain, leg lifts should be avoided. It is necessary to practice yoga under the guidance of a professional practitioner if you have kidney disease. Yoga asanas are known to increase relaxation.

There are many poses in yoga that are suitable for dialysis patients. Some of these could be done safely during dialysis sessions. However, special care should be taken to ensure that no arm movement on the side has an AV fistula where dialysis is taking place. For those patients who have a permacath (or permanent catheter), these restrictions are not that severe. Of these, I recommend the following, which can be done during the dialysis sessions, preferably before taking snacks and tea.

Yoga During Dialysis

1. Anulom vilom: A person needs to inhale through the left nostril and exhale through the right nostril, and then inhale through the right nostril and exhale through the left one. These alternate nostril breath exercises can promote blood circulation. All these are best done first thing in the morning

2. Kapaal Bhaarti: In this, the person exhales forcefully and then inhales passively. This is repeated a few times as per convenience, followed by a break and 3 – 5 sessions.

3. Bhastrika: In this, a person inhales deeply, followed by forceful exhalation. This is then reapted 3-5 times maximum.

4. Shavasana: In this one lies flat on the couch and is absolutely listless on the couch for a few minutes, with arms and legs lying loosely.

Yoga For Non-dialysis Days:

1. Vrikshaaasan: In this one stands straight and then places the right foot on the inner side of the left thigh, joins the hands, and raises them above the head. After a few minutes, the hands are brought down, and now the left foot is placed on the inner side of the left thigh, and the hands are joined and raised above the head.

2. Tada Asaan: In this, a person stands on his toes and stretches his arms above his head, and joins his hands. In this posture, he then breathes freely and holds as long as possible.

3. Cobra pose: In this, a person lies on his belly with hands flat on the floor on each side and inhales and extends the spine forward, lifts the chest and head off the floor. One needs to make sure that the legs and feet are parallel and hold this position for several breaths. This can help put mild pressure on the kidneys and revitalize the kidney functions.

4. Camel pose: In this asana, the person kneels on the floor, extends the spine, opens the chest, and reaches for the feet. One needs to make sure that the thighs are perpendicular to the floor and the toes are tucked. This posture can help improve blood circulation as well as the body’s circulatory system.

5. Paschimottanasana: In this asana, you bend forward and try to touch your toes.

6. Surya Namaskaar: It is one of the best Yogic aasanas as it involves a combination of 11 steps. You can see details on YouTube.

7. Kati chaakra aasan: in this one lies on the floor and stretches the hands on the sides and legs kept 3 feet apart. The head is turned to one side, and the knees are in the opposite direction

Thus, yoga keeps the internal organs healthy, balances the various systems in the body, and effectively controls the stress of the body and mind. Some of the yoga asanas and pranayamas facilitate internal cleansing rituals that ensure the flushing out of toxins from the body.