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**Key Points from the *Lancet* Review on RSV in Adults (2024):**

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### **1. Epidemiology & Disease Burden**

- **Hospitalizations**: RSV accounts for **4–11% of adult hospitalizations** for respiratory infections, with **6–15% requiring ICU care**.

- **Mortality**: **1–12% of hospitalized adults die**, rising to **6–9% in older adults (≥60 years)**.

- **Incidence**: Yearly community infection rate in older adults: **3–7%** (higher in those with comorbidities).

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### **2. High-Risk Groups**

- **Older adults** (≥60/65 years) and those with **chronic conditions** (COPD, heart failure, diabetes, immunosuppression).

- **Immunocompromised adults** (e.g., transplant recipients): Risk of prolonged infection, bronchiolitis obliterans, and death.

- **Long-term care residents**: Overrepresented in severe RSV cases.

---

### **3. Clinical Challenges**

- **Diagnosis**:

- PCR is the gold standard, but lower viral loads in adults reduce sensitivity.

- Testing multiple samples (sputum, saliva) improves detection.

- **Symptoms**: Often nonspecific (cough, dyspnea) or masked by underlying conditions (e.g., heart failure exacerbation).

---

### **4. Complications**

- **Short-term**: Respiratory failure, bacterial co-infections, acute cardiovascular events (20% of hospitalized cases).

- **Long-term**: Decline in lung/cardiac function, loss of independence, increased medication use, and higher mortality within 1 year post-hospitalization.

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### **5. RSV vs. Influenza**

- RSV patients are **older**, have **more comorbidities**, and experience:

- Longer hospital stays.

- Higher rates of respiratory support (e.g., oxygen therapy).

- Worse 1-year survival (74% vs. 81% for influenza).

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### **6. Prevention**

- **Vaccines**:

- **3 licensed vaccines** (2023): Two protein-based (Abrysvo, Arexvy) and one mRNA (mRESVIA).

- **Efficacy**: 66–85% against severe RSV lower respiratory tract illness.

- **Recommendations**: Targeted for adults ≥60–75 years (varies by country).

- **Non-pharmacological**: Masking, hand hygiene, avoiding crowded settings.

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### **7. Treatment Gaps**

- **No RSV-specific antivirals** are widely effective; supportive care remains standard.

- **Ribavirin** (nebulized/oral) is used off-label but lacks robust evidence outside immunocompromised groups.

- **Antibiotic misuse** is common despite low bacterial co-infection rates.

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### **8. Economic Impact**

- Annual U.S. cost: **$6.6 billion** (direct + indirect).

- Hospitalization costs: **$16,034 per RSV admission** (vs. $15,163 for influenza).

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### **9. Future Priorities**

- **Vaccines**: Real-world effectiveness data in high-risk subgroups (e.g., immunocompromised).

- **Antivirals**: Develop therapies targeting viral entry/replication.

- **Diagnostics**: Improve point-of-care testing sensitivity.

- **Global data**: Address gaps in low/middle-income countries.

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### **Takeaway**

RSV is a **major, underrecognized threat** to older and high-risk adults, with burdens comparable to influenza. Vaccines offer hope, but equitable access, better diagnostics, and targeted therapies are urgently needed.

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*Source: Wildenbeest et al. (2024). Lancet Respir Med.*

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Retaining all memories would lead to decision paralysis, crippling emotions, habit crossover, hallucinating memories, and neural fatigue. The brain needs to forget information to function properly.

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:Tired of dry and scratchy tissues when your nose is raw from a cold or allergies? CR’s José Amézquita tested 10 bestselling facial tissue brands for softness, absorbency, tensile strength (how resistant they are to breakage), and abrasion resistance (how much friction a tissue can handle). The results surprised us: Some less expensive store-brand tissues beat out pricier household names like Kleenex, Puffs, and Scotties. What follows: our top picks—and some tissues to leave on the shelf.

1. EDITOR’S PICK

Member’s Mark Ultra Soft (Sam’s Club)

1.5¢ per tissue

These unscented three-ply tissues were some of the softest we tested, but they were surprisingly strong and absorbent, making them an excellent choice.

2. RUNNER-UP

Walmart Great Value Ultra Soft

1.5¢ per tissue

Not a Sam’s Club member? These Walmart tissues offer the next best thing: a soft, absorbent three-ply that’s budget-friendly. While not as soft as Member’s Mark, they won’t irritate sensitive skin.

3. THIRD PLACE

Up & Up Ultra Soft Facial Tissue (Target)

2.6¢ per tissue

If you’re shopping at Target, look no further than the store’s own brand. It’s soft and absorbent but scored a bit below average in our strength test. These tissues are also nicely priced.

4. STRONG & ECO-FRIENDLY

Caboo Tree Free Facial Tissue

4.6¢ per tissue

Made from bamboo, these tissues impressed us with their strength and absorbency. One exception: The stiffer material felt distinctly rougher on our noses than other brands.

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**Mechanism of Migraine with Aura: Step-by-Step Brain Tissue Changes**

Migraine with aura involves a cascade of neurological events, primarily driven by **cortical spreading depression (CSD)** and subsequent activation of pain pathways. Here’s a breakdown of the process:

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### **1. Initiation of Cortical Spreading Depression (CSD)**

- **Trigger**: Neuronal hyperexcitability in the cortex (often genetic or due to ion channel dysfunction) leads to abnormal electrical activity.

- **Mechanism**: A sudden surge of neuronal depolarization (excessive firing) begins in a localized brain region, typically the **occipital lobe** (visual cortex).

- **Key Players**:

- **Glutamate**: Excess release of this excitatory neurotransmitter triggers depolarization.

- **Potassium (K⁺) ions**: Leak from neurons, propagating the wave.

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### **2. Wave of Depolarization Spreads**

- **Process**: The depolarization wave spreads across the cortex at ~3–5 mm/minute, temporarily disrupting normal brain activity.

- **Symptoms**:

- **Visual aura**: Flashing lights, zigzag patterns (scintillations) or blind spots (scotoma) as the wave affects the visual cortex.

- **Sensory aura**: Tingling/numbness (parietal lobe involvement) or speech difficulties (Broca’s area).

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### **3. Neurotransmitter & Ionic Shifts**

- **Glutamate Surge**: Sustained depolarization increases extracellular glutamate, overstimulating NMDA receptors and causing excitotoxicity.

- **Calcium Influx**: Neuronal calcium overload disrupts mitochondrial function, generating **reactive oxygen species (ROS)** and oxidative stress.

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### **4. Cerebral Blood Flow Changes**

- **Initial Hyperemia**: Brief increase in blood flow (due to vasodilation) during depolarization.

- **Oligemia**: Prolonged reduced blood flow (vasoconstriction) following the wave, potentially contributing to hypoxia-like symptoms.

- **Imaging**: fMRI studies show a "spreading oligemia" matching the aura’s progression ([*Annals of Neurology*](https://doi.org/10.1002/ana.410280502)).

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### **5. Trigeminovascular System Activation**

- **Trigeminal Nerve Stimulation**: CSD activates pain-sensitive trigeminal nerve terminals in the meninges (brain’s protective membranes).

- **Inflammatory Mediators**:

- **CGRP (Calcitonin Gene-Related Peptide)**: Released, causing vasodilation and neurogenic inflammation.

- **Substance P**: Enhances pain signaling and sensitizes blood vessels.

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### **6. Central Sensitization & Pain**

- **Pain Pathways**: Trigeminal signals reach the thalamus and cortex, perceived as throbbing headache (often unilateral).

- **Sensitization**:

- **Allodynia**: Normal touch becomes painful (due to hyperexcitable neurons).

- **Photophobia/Phonophobia**: Brainstem nuclei (e.g., locus coeruleus) amplify sensitivity to light/sound.

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### **7. Resolution & Postdrome**

- **Recovery**: Neurons repolarize, blood flow normalizes, and inflammatory mediators clear.

- **Postdrome**: Fatigue, cognitive fog, or residual sensitivity due to lingering neurotransmitter imbalances.

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### **Key Factors Influencing Aura**

- **Genetics**: Mutations in ion channels (e.g., CACNA1A) increase neuronal excitability.

- **Hormones**: Estrogen fluctuations may modulate CSD susceptibility (common in women).

- **Triggers**: Stress, dehydration, or sleep changes lower the threshold for CSD.

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### **Clinical Implications**

- **Preventive Therapies**: CGRP inhibitors, beta-blockers, or antiepileptics (e.g., topiramate) target CSD or trigeminal activation.

- **Acute Relief**: Triptans constrict dilated meningeal vessels and block CGRP release.

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*Migraine with aura reflects a complex interplay of neuronal, vascular, and inflammatory processes. While CSD is central to aura, ongoing research aims to clarify genetic and molecular drivers.* 🧠⚡

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Here's a well-organized, evidence-based list of practical ways to boost neuroplasticity after 45, emphasizing safety and achievability:

### 1. **Engage in Regular Aerobic Exercise**

- Activities like brisk walking, swimming, or cycling increase blood flow to the brain and stimulate BDNF, a protein crucial for neuronal growth.

### 2. **Incorporate Strength Training**

- Resistance exercises improve cognitive function by enhancing insulin sensitivity and reducing inflammation.

### 3. **Learn New Skills**

- Challenge your brain with novel activities like learning a language, musical instrument, or craft to forge new neural pathways.

### 4. **Mental Stimulation**

- Solve puzzles, play strategy games, or use brain-training apps (e.g., Lumosity) to keep your mind sharp.

### 5. **Adopt a Brain-Healthy Diet**

- Follow a Mediterranean diet rich in omega-3s (fatty fish, walnuts), antioxidants (berries, leafy greens), and whole grains. Stay hydrated.

### 6. **Prioritize Quality Sleep**

- Aim for 7–9 hours nightly. Sleep hygiene practices (dark room, consistent schedule) support memory consolidation and toxin clearance.

### 7. **Practice Stress Management**

- Mindfulness, yoga, or deep breathing reduces cortisol levels, protecting the hippocampus from stress-related damage.

### 8. **Stay Socially Active**

- Engage in clubs, volunteer work, or regular social outings to boost cognitive resilience and emotional health.

### 9. **Seek Novel Experiences**

- Travel, explore new hobbies, or take alternate routes to stimulate adaptive thinking.

### 10. **Mindfulness and Meditation**

- Regular practice enhances gray matter density in areas linked to memory and emotional regulation.

### 11. **Avoid Harmful Habits**

- Limit alcohol and avoid smoking, both of which impair cognitive function and neuroplasticity.

### 12. **Continuous Learning**

- Enroll in courses, read widely, or attend lectures to maintain intellectual curiosity.

### 13. **Combine Physical and Mental Activities**

- Try dance, tai chi, or sports requiring coordination to engage body and mind simultaneously.

### 14. **Cultivate a Positive Mindset**

- Optimism and resilience reduce stress and encourage healthier lifestyle choices.

### 15. **Sensory Enrichment**

- Engage in music, art, or cooking to stimulate multiple senses and enhance cognitive flexibility.

### 16. **Consider Intermittent Fasting (With Caution)**

- Some studies suggest fasting may boost BDNF, but consult a healthcare provider before starting.

### 17. **Explore Cold Exposure (Limited Evidence)**

- Cold showers might increase norepinephrine, but research is preliminary. Proceed cautiously.

### 18. **Supplements**

- Omega-3s, curcumin, or vitamin D may support brain health, but discuss with a doctor first.

### 19. **Environmental Enrichment**

- Rearrange your living space or explore new environments to challenge spatial memory.

### 20. **Teach or Mentor Others**

- Sharing knowledge reinforces your own learning and cognitive engagement.

This list balances scientific support with practicality, ensuring accessibility for individuals over 45. Always consult healthcare professionals before starting new regimens.