Tuesday, December 29, 2009

Over 85s Function Well Despite Disease and Disability

'Oldest old' are fastest growing segment of the global population

29 dec 2009-- Elders over the age of 85 report good health and functional ability despite the fact that they have to contend with a range of diseases and disabilities; however, as the fastest growing segment of the world's population, the health needs of future generations of over 85s represent a profound challenge, according to a study published online Dec. 22 in BMJ.

Joanna Collerton, of Newcastle University in the United Kingdom, and colleagues conducted a study of 1,453 people aged 85 and above. They conducted health assessments of a maximum of 853 patients and reviewed records for a maximum of 1,030 patients.

Hypertension and osteoarthritis were the two most common diseases, found in 57.5 and 51.8 percent of cases, respectively. Hearing impairment affected 59.6 percent of patients, 37.2 percent were visually impaired, and 21.3 percent had profound urinary incontinence, the researchers found. Despite this, 77.6 percent of respondents rated their health as good, very good, or excellent.

"Our study shows the opportunities available to intervene to improve health further in this age group," the authors write. "If the data are extrapolated to the future, much larger, populations of 85 year olds in developed countries, implications for health and social care and the resources needed to provide these are profound."

Full Text

Course and Aging director publishes book examining impact of natural disasters on lifespan

Book focuses on aftermath of Hurricane Katrina and survivors' longevity

BATON ROUGE, 29 dec 2009 – Director of LSU's Life Course and Aging Center, or LCAC, Katie Cherry, along with several LSU colleagues, has published a book titled, "Lifespan Perspectives on Natural Disasters: Coping With Katrina, Rita and Other Storms," through Springer Publishing.

"I am very excited about this edited volume which is unique in that provides a glimpse of psychological reactions to the storms across the lifespan, from the preschool period to the oldest-old adults aged 90 and over," said Cherry. "I imagine that this book would be of interest to a very diverse audience, spanning the science to the service ends of the continuum. Given the complex and tragic nature of Katrina, the worst natural disaster in our nation's history, this book may also appeal to the general public."

The book explores problems that could develop at all stages of life: children and youth, middle aged adults, older adults and very old adults. It also analyzes risks and dangers inherent in different aspects of an individual's life, such as in the workplace, as a volunteer, in the medical field and more.

"It is very important to me that I indicate the truly collaborative nature of the book. All of the contributing authors are top notch scholars in their own rights and each worked hard to ensure that their chapters were not only of the highest possible quality but also integrated with the each other's work," said Cherry. "To me, an indication of the overall value of the book is sheer number of cross-references indicating the complexity and scope of the topic as well as the range of experiences."

In addition to Cherry, other researchers affiliated with the LSU LCAC who have contributed to the book include:

  • Priscilla Allen, LSU School of Social Work
  • Teresa Buchanan, LSU Department of Educational Theory, Policy and Practice
  • Jennifer Baumgartner, LSU School of Human Ecology
  • Renee Casbergue, LSU Department of Educational Theory, Policy and Practice
  • Thompson E. Davis III, LSU Department of Psychology
  • Betsy Garrison, LSU School of Human Ecology and LSU AgCenter
  • Yoshinori Kamo, LSU Department of Sociology
  • Mary Lou Kelley, LSU Department of Psychology
  • Loren Marks, LSU School of Human Ecology
  • Stacy Overstreet, Tulane University Department of Psychology and LSU LCAC
  • Diane Sasser, LSU School of Human Ecology and LSU AgCenter
  • Carl Weems, UNO Department of Psychology and LSU LCAC
  • Tracey Rizzuto, LSU Department of Psychology

"I know that I speak for all of the contributing authors when I tell you that my hat goes off to Dr. Cherry," said Betsy Garrison, contributing author and member of LSU's School of Human Ecology and LSU's AgCenter. "She has put together a truly noteworthy, comprehensive and moving book. A book that, in a scientifically rigorous way, uniquely captures the experiences of people of all ages and walks of life, including those of us who have led parallel lives for several years now, that of both survivors and scholars. This book demonstrates to the world the collective excellence of life course and aging scholarship at LSU and is a harbinger for the future."

According to the Springer Web site, the book examines "human strengths and vulnerabilities during large-scale devastation and crisis." The panel of authors, the majority of whom are from Louisiana, along with chapter contributors from Virginia Tech and University of Michigan, have targeted the book toward both to mental health care providers and to others involved in developing disaster preparedness strategy, intervention and recovery programs at the community, state and regional levels.

"Examining the impact of the 2005 hurricanes through scholarship was an important part of the LSU response and in this book Dr. Cherry has gathered together the work that was completed as part of that response," said Teresa Buchanan, contributing author and member of LSU's Department of Educational Theory, Policy and Practice. "It was difficult to do this research under those trying times and conditions that personally challenged us as community and family members. I'm proud of my research team and glad to be one of the Louisiana scholars who made the effort to continue LSU's mission of generating knowledge in the midst of such crisis, and I'm very grateful to Dr. Cherry for providing this outstanding forum for the dissemination of our scholarship."


For more information on "Lifespan Perspectives on Natural Disasters: Coping With Katrina, Rita and Other Storms," visit http://www.springer.com/psychology/psychology+general/book/978-1-4419-0392-1.

For more details about LSU's Life Course and Aging Center, visit http://www.lsuagingstudies.com/.

Contact Ashley Berthelot

Saturday, December 26, 2009

High Blood Pressure Treatment For The Over 80s Too Aggressive, Warns Expert

People over 80 years are being treated too aggressively for high blood pressure, warns an expert in an editorial in BMJ Clinical Evidence this week.

26 dec 2009--According to Dr James Wright, the latest evidence suggests that less aggressive drug therapy may be more effective at reducing mortality in this age group. Based on this evidence, he suggests clinicians change what they are presently doing and move towards a more conservative approach for people aged over 80.

Despite limited evidence about high blood pressure (hypertension) treatment in the over 80s, UK and US guidelines recommend that people over 80 should receive the same treatment as people of any other age. This means using combinations of drugs to reach a target blood pressure of 140/90 mmHg.

But could this be doing more harm than good, asks Wright?

He points to the results of a recently updated Cochrane review which suggest that our present approach may be "excessively aggressive."

This review includes data from two new trials which looked specifically at the effect of antihypertensive drugs in people over the age of 80. Interestingly, the only trial that found a significant reduction in mortality was the most conservative in terms of number of drugs and dose of drugs allowed. The treatment regime involved three easy steps, with a target blood pressure of 150/80 mmHg.

Using this approach would require little adjustment of drug doses and would markedly simplify and reduce the cost of managing these patients, says Wright.

However, he points out that only half of the people on this regimen would achieve a target blood pressure of 150/80 mmHg. This is below recommendations set out for UK GPs in the Quality and Outcomes Framework (QOF), which suggest that 70% of all patients should meet treatment targets.

Trials are now needed to compare this conservative approach with the more aggressive treatment strategies in common use today, he writes. In the meantime, clinicians should change what they are presently doing and move towards a more conservative approach for people aged over 80.

British Medical Journal

Pollution linked to hospitalizations for pneumonia in older adults

Older adults with long-term exposure to higher levels of pollution are at higher risk for hospitalization for pneumonia, according to researchers in Canada.

26 dec 2009--"Our study found that among older individuals, long-term exposure to traffic pollution independently increased their risk of hospitalization for pneumonia," said principal investigator, Mark Loeb, M.D., of McMaster University.

The research will be published in the January 1 issue of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Pneumonia is a leading cause of sickness and death among older adults, and rates of hospitalizations for pneumonia among patients 65 and older have been increasing in recent years.

In addition to traffic pollution associated with roads, Hamilton has a large industrial steel-making complex in the north end of the city, creating a large exposure zone for residents. The researchers recruited 365 older adults from Hamilton, Ontario, who had been hospitalized with radiologically confirmed pneumonia in one of Hamilton's four emergency departments between 2003 and 2005. Control subjects from the same catchment areas as the patients were enrolled contemporaneously, and then compared their exposures to nitrogen dioxide (NO2), sulfur dioxide (SO2), and fine particulate matter less that 2.5 μm (PM2.5) using data from air-quality monitoring stations and land use regression models.

The researchers found that long-term (more than 12 months) exposures to NO2 and PM2.5 were each associated with a more than doubled risk of hospitalization from pneumonia. Individuals with long-term exposure to NO2 had 2.3 times the risk for hospitalization with pneumonia; for PM2.5, the odds ratio was 2.26.

"We postulate that long-term exposure to air pollution may have increased individuals' susceptibility to pneumonia by interfering with innate immune defenses designed to protect the lung from pathogens; this may have included epithelial cell damage, reductions in bronchial macrophages, or reductions in natural killer cells," said Dr. Loeb.

Exposure to SO2 was not associated with increased risk of hospitalization.

"Given the large population exposure to ambient air pollution, the results of this study highlight the important health impact that long-term exposure to ambient air pollution can have on respiratory infections," wrote Dr. Loeb. "It also emphasizes the need to monitor emissions from vehicles, given that ground level NO2 is derived predominantly from traffic."

"While we don't know what is increasing the rates of pneumonia, we felt that studying air pollution was a good idea. Assessing if there is a correlation between rising pneumonia rates and increasing air pollution would be of interest," said Dr. Loeb.

In future research, Dr. Loeb hopes to examine whether there is a genetic component to susceptibility to the health effects of pollution. "Examining genetic variants to see if there is interaction between genetic basis and air pollution in the causal pathway of pneumonia would be very interesting," he said.

Thursday, December 24, 2009

Alzheimer's May Stave Off Cancer, and Vice Versa

24 dec 2009-- Researchers have uncovered a bittersweet relationship between two major illnesses: cancer and Alzheimer's disease.

People who have had cancer are less likely to get Alzheimer's disease, just as having Alzheimer's disease reduces the risk for cancer, their study found.

"Alzheimer's was associated with a rather dramatic reduction in cancer risk," said Dr. Richard Lipton, an attending neurologist at Montefiore Medical Center and professor of neurology at Albert Einstein College of Medicine in New York City. "From my perspective, the strengths of the findings are very striking and somewhat unexpected."

There was no link between Alzheimer's and vascular dementia, however, suggesting that the association has to do with neurodegenerative factors. Vascular dementia is attributed to damage to the brain's blood supply.

"Parkinson's and Alzheimer's are both neurodegenerative diseases, where specific populations of cells die without clear reason," Lipton said. "In cancer, specific populations of cells begin dividing wildly and out of control so, very broadly, it makes sense that a condition associated with selective cell death may be associated with a condition associated with proliferation. The biological factors that predispose one to neurodegenerative disease may protect against wild division."

A number of previous studies had hinted at a similar relationship but were subject to the usual limitations of early research.

For example, said Catherine M. Roe, lead author of the new study, published Dec. 23 in Neurology, earlier research could not pinpoint whether cancer patients died before they had a chance to be diagnosed with Alzheimer's. Roe is an instructor in neurology at Washington University in St. Louis School of Medicine.

As the accompanying editorial pointed out, the main reason older people with advanced brain tumors don't get Alzheimer's is that they just don't live long enough.

In Roe's study, 3,020 people 65 and older enrolled in a cognition sub-study of the large Cardiovascular Health Study were followed for an average of five years for dementia and eight years for cancer.

Among white participants, those who had Alzheimer's at the start of the study were 69 percent less likely to be hospitalized for cancer. Having cancer meant a 43 percent reduced risk for Alzheimer's.

Among minority participants, the researchers found an opposite trend, but it was not statistically significant, they noted.

There appeared to be no link either way between vascular dementia and cancer.

Next, Roe said, the research team would like to see whether there's an association between Alzheimer's disease and specific types of cancer.

More information

The Alzheimer's Association has more on Alzheimer's disease.

"Good" cholesterol less protective with diabetes

CHICAGO, 24 dec 2009– Diabetes may lower the heart-protective benefits of high-density lipoprotein, or HDL, the so-called "good" cholesterol, but giving diabetics niacin, a drug that raises HDL levels, might restore the benefit, researchers said on Tuesday.

HDL lowers heart risks because it clears "bad" low-density lipoprotein, or LDL cholesterol, away from arteries and back to the liver, where it is passed out of the body. Several recent studies also suggest HDL protects arteries by promoting cell healing and repair.

But in people with diabetes, HDL may be less protective, researchers at the University Hospital Zurich and the Medical School of Hannover in Germany reported in the journal Circulation.

The team compared the vessel-protecting action of HDL samples from 10 healthy adults with that of 33 patients who had type 2 diabetes and metabolic syndrome, a condition that includes having low levels of HDL. All of the people with diabetes were taking drugs called statins to lower their bad cholesterol.

In the lab, the team found that the protective benefits on blood vessels were "substantially impaired" in HDL taken from the diabetic patients compared with that taken from healthy people.

Next, they divided up the diabetics and gave half a placebo and treated half with extended-release niacin, a drug that raises HDL levels in the blood.

After three months, patients who got the niacin had increased HDL levels, and markedly improved protective functions of HDL in laboratory testing as well as improved vascular function.

Because it was a small study, the team said more research is needed to see if diabetics will benefit from getting extended-release niacin, such as Niaspan made by Abbott Laboratories Inc.

In the United States, about 11 percent of adults have diabetes. Most have type 2 diabetes, the kind closely linked to obesity.

Wednesday, December 23, 2009

CT: The first-line imaging choice of physicians for the diagnosis of pulmonary embolism

23 dec 2009--Computed tomography (CT), a highly accurate, readily available medical imaging technique, is the overwhelmingly preferred technique of emergency physicians and radiologists for the diagnosis of pulmonary embolism (PE), according to a study in the January issue of the American Journal of Roentgenology.

PE, the formation of a blood clot in the lung, is a life-threatening condition that requires prompt diagnosis and treatment. Medical imaging techniques such as CT, lung scintigraphy, and MRI are currently available to physicians to diagnose PE. "The purpose of our study was to assess the diagnostic approach to PE practiced by emergency physicians and advised by radiologists," said Saurabh Jha, MD, lead author of the study.

Questionnaires were sent to emergency physicians and radiologists in Pennsylvania. The questions covered diagnostic strategies for the detection of PE. "Emergency physicians nearly uniformly (96 percent) chose CT as the preferred first-line investigation. They cited accuracy as one of the major determinants of their choice, followed by overall access to CT, availability of 24-hour interpretation, and capability for alternative diagnosis. Ninety percent of radiologists reported that the first-line medical imaging technique for excluding pulmonary embolism at their hospital was CT," said Jha.

"The results of our study indicate that by a large margin, both emergency physicians and radiologists prefer CT in the diagnosis of PE. In imaging of pregnant patients to whom radiation is of concern, approaches differed," he said.

"CT is the nearly universal first-line imaging choice for the diagnosis of PE. This is not surprising considering its accuracy is well established," said Jha.


This study appears in the January issue of the American Journal of Roentgenology. For a copy of the full study, please contact Heather Curry via email at hcurry@acr-arrs.org or at 703-390-9822.

Pelvic Fracture May Increase Trauma Patients' Risk of Death

But it is only one variable among many, and some are more strongly associated with mortality

23 dec 2009-- In trauma patients, pelvic fracture is significantly associated with death, but its effect should be considered in relation to other variables, according to a study in the Dec. 1 issue of the Journal of Bone & Joint Surgery.

Ashoke K. Sathy, M.D., of the University of Texas Southwestern Medical Center in Dallas, and colleagues performed a regression analysis on 63,033 patients to compare mortality associated with pelvic fracture with other variables such as age, shock, head injury, abdominal or chest injury, and extremity injury. They also conducted a second analysis to see whether the impact of a pelvic fracture on mortality varied when combined with other known risk factors for mortality.

The researchers found that pelvic fracture was significantly associated with mortality, with an odds ratio (approximately 2) similar to that of an abdominal injury. However, they found that the odds ratio for mortality was slower for pelvic fracture than for other variables such as hemodynamic shock, severe head injury, and an age of 60 years or above.

"Presumably, for patients with severe head injury and shock, the mortality risk is so high that the pelvic fracture adds little to the overall risk," the authors conclude. "This does not mean pelvic fractures can be ignored in such patients. However, in our opinion, it seems advisable to exclude patients with severe head injury and shock from analyses of the effectiveness of treatment strategies that seek to lessen mortality after pelvic fracture, since it appears that pelvic fracture has little impact on the risk of death for such patients."

Full Text (subscription or payment may be required)

Tuesday, December 22, 2009

Older adults may have a higher risk of complications and death after abdominal surgery

The risk of complications and early death after commonly performed abdominal surgical procedures appears to be higher among older adults, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.

22 dec 2009--It is estimated that one in six Americans will be age 65 or older by 2020 and that 15 percent of this population will be older than age 85, according to background information in the article. "Approximately 2 million older Americans undergo abdominal surgical operations each year," the authors note. "For clinicians, patients and families considering abdominal surgical procedures, informed decision making is challenging because of limited data regarding the risks of adverse perioperative events associated with advancing age."

Nader N. Massarweh, M.D., and colleagues at University of Washington School of Medicine, Seattle, examined complication and death rates of 101,318 adults age 65 or older who underwent common abdominal procedures such as cholecystectomy (gall bladder removal), hysterectomy and colectomy from 1987 to 2004. Complications were recorded within 90 days of discharge and deaths were recorded within 90 days of hospital admission.

The 90-day complication rate was 17.3 percent and the 90-day death rate was 5.4 percent. "Advancing age was associated with increasing frequency of complications (65 to 69 years, 14.6 percent; 70 to 74 years, 16.1 percent; 75 to 79 years, 18.8 percent; 80 to 84 years, 19.9 percent; 85 to 89 years, 22.6 percent; and 90 years or older, 22.7 percent) and mortality (65 to 69 years, 2.5 percent; 70 to 74 years, 3.8 percent; 75 to 79 years, 6 percent; 80 to 84 years, 8.1 percent; 85 to 89 years, 12.6 percent; and 90 years or older, 16.7 percent)," the authors note. "After adjusting for demographic, patient and surgical characteristics as well as hospital volume, the odds of early postoperative death increased considerably with each advance in age category. These associations were found among patients with both cancer and noncancer diagnoses and for both elective and nonelective admissions."

"Older adults may be less able to adapt to the stress of surgery or to the added stress of any postoperative complication, greatly increasing their risk of early mortality," the authors conclude. "These effects appear to be additive, highlighting the need for interventions to both prevent decline among older patients and avoid postsurgical complications."


(Arch Surg. 2009;144[12]:1108-1114. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This research was supported by a National Institutes of Health Roadmap Multidisciplinary Clinical Research Career Development Award Grant from the National Institutes of Health and the Hartford/American Federation for Aging Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Resistance Exercise Benefits Elderly Overweight Men

Researchers analyze energy costs and blood chemistry to pinpoint metabolic effects of exercise

22 dec 2009-- A regimen of resistance exercise two or three times a week appears to be an effective approach to weight management and metabolic control in elderly overweight men, according to a study in the December issue of Diabetes Care.

Ioannis G. Fatouros, Ph.D., of the Democritus University of Thrace in Komotini, Greece, and colleagues randomized 40 inactive, overweight men (aged 65 to 82 years) to one of the following four exercise groups: low-intensity resistance, moderate-intensity resistance, high-intensity resistance, and a control group. The researchers assessed exercise energy cost, resting energy expenditure and blood chemistry at baseline, immediately after exercise, and during a 72-hour recovery period.

The authors note that lactate, glucose, non-esterified fatty acids, and glycerol concentrations increased with exercise and returned to baseline afterwards. Resting energy expenditure increased in all groups at 12 hours and returned to baseline after 48 hours in the moderate-intensity and low-intensity groups and 72 hours in the high-intensity group. In all exercise groups, cortisol peaked with exercise and remained elevated for 12 hours. In the high-intensity group, adiponectin concentration increased after 12 hours and remained elevated for 24 hours.

"These findings indicate that overweight older men may benefit from training with a frequency of two to three resistance exercise sessions per week. In addition, it appears that all resistance exercise schemes induce marked energy expenditure," Fatouros and colleagues conclude.

Full Text (subscription or payment may be required)

Sunday, December 20, 2009

Heart Disease Risk Factors May Increase With Menopause

Researchers advocate increased surveillance of woman's risk factors before and after last period

20 dec 2009-- The risk factors for coronary heart disease increase in women in the year before and the year after their final menstrual period (FMP), making that transition a crucial time to monitor lipid profiles and lifestyle risk factors, according to a study in the Dec. 15/22 issue of the Journal of the American College of Cardiology.

Karen A. Matthews, Ph.D., of the University of Pittsburgh, and colleagues used data on 1,054 minority (African-American, Hispanic, Japanese, or Chinese) and Caucasian women from the Study of Women's Health Across the Nation (SWAN) to compare models for coronary heart disease risk assessment within a year before and after the occurrence of their FMP.

Across all ethnic groups, the researchers found that total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B showed substantial increases in the year before and the year after FMP, which is consistent with menopause-induced changes. Other risk factors were in line with a linear model, which was indicative of chronological aging.

"This study underscores the need to closely monitor lipid profiles of premenopausal and perimenopausal women, and the importance of emphasizing proven lifestyle measures and therapeutic interventions before the menopause transition to counter and possibly prevent this adverse change in lipids associated with menopause itself," the authors write.

Full Text (subscription or payment may be required)

Researchers ID traits of people with rare accelerated aging syndrome

DALLAS 20 dec 2009– UT Southwestern Medical Center researchers have provided the most extensive account to date of the unique observable characteristics seen in patients with an extremely rare premature aging syndrome.

The findings, reported online and in the December issue of the Journal of Clinical Endocrinology and Metabolism, suggest that patients with atypical progeroid syndrome (APS) should not be lumped together with those diagnosed with two similar but more well-defined accelerated aging disorders called progeria and mandibuloacral dysplasia (MAD).

"Before this paper, APS was not recognized as a distinct disease," said Dr. Abhimanyu Garg, professor of internal medicine in the Center for Human Nutrition at UT Southwestern and the study's lead author. "Although APS is extremely rare, we believe it should be a distinct entity, particularly since it seems to be less severe than either of the related disorders, and the patients show unique clinical features and metabolic abnormalities."

There are currently 24 reported cases of APS worldwide, including the 11 evaluated in the recent UT Southwestern study.

UT Southwestern is considered a leading center in the world for the study of accelerated aging disorders MAD and APS. Patients come to UT Southwestern's Clinical and Translational Research Center from around the world to be evaluated and participate in various clinical trials.

"A few other centers have reported one or two patients, but our findings on 11 patients are the most extensive to date, by far," said Dr. Garg, chief of nutrition and metabolic diseases at UT Southwestern. "The challenge was that no one had spelled out the physical characteristics unique to the atypical syndrome."

Prior research has shown that APS, MAD and progeria are all caused by mutations in the LMNA gene. Mutations in this gene also are linked to muscular dystrophies, cardiomyopathies and a body-fat disorder called familial partial lipodystrophy.

Five males and six females participated in the recent UT Southwestern study, undergoing numerous diagnostic tests. Most of the participants were short for their ages, had beaked noses, thin lips and thin, shiny skin with abnormal pigmentation, frequent markers of accelerated aging disorders. Some had gray hair at a young age. In addition, eight of the 11 participants had lipodystrophy (abnormally low body fat), four had diabetes and five exhibited heart valve problems. The female participants all had poorly developed breasts.

Unlike most individuals diagnosed with either MAD or progeria, patients evaluated in the UT Southwestern report displayed only slight evidence of scalp hair loss; their jaws were more fully developed; and only a few showed minimal resorption of fingertips or clavicles. The onset of other clinical symptoms also seemed to be delayed, potentially explaining why those with APS often live longer.

Dr. Garg said the findings suggest that the variations between the clinical presentations of APS, MAD and progeria are largely due to unique mutations or blips in the LMNA gene linked to each disorder. "Based on our findings, we believe that using a one-size-fits-all approach to therapy will probably not work," he said.

The next step, Dr. Garg said, is to begin clinical trials to find novel therapies that may help slow the aging process.


Other UT Southwestern researchers involved in the research were Dr. Lalitha Subramanyam, former fellow in endocrinology; Dr. Anil Agarwal, associate professor of internal medicine; Dr. Vinaya Simha, clinical assistant professor of internal medicine; and Dr. Benjamin Levine, professor of internal medicine. Researchers from Tor Vergata University in Rome and St. James's University Hospital in Leeds, U.K., also contributed to the report.

The research was funded by the National Institutes of Health and Southwestern Medical Foundation.

This news release is available on our World Wide Web home page at http://www.utsouthwestern.edu/home/news/index.html

Saturday, December 19, 2009

Study identifies those elderly most at risk for major depression

University of Rochester Medical Center researchers have pinpointed the prime factors identifying which elderly persons are at the highest risk for developing major depression.

19 dec 2009--The researchers, led by Jeffrey M. Lyness, M.D., professor of Psychiatry at the Medical Center, reported their findings in an article in the December issue of The American Journal of Psychiatry.

Preventive treatments for people in the high-risk group hold promise for providing the greatest health benefit at the lowest cost, the researchers concluded.

"People with low-level depressive symptoms, who perceive that they have poor quality social support from other people, and with a past history of depression, were at particularly high risk to develop new major depression within the one-to-four year time period of the study," Lyness said. "This is good news, as we in the field are just learning how to prevent depression in particular high-risk groups. Future work will be able to test whether any of a variety of treatments—perhaps psychotherapy, perhaps medication, perhaps other things such as exercise—will help to prevent depression in persons suffering from the risks we identified in this study."

More than 600 people who were 65 years of age or older took part in the study. They were recruited from private practices and University-affiliated clinics in internal medicine, geriatrics and family medicine in Monroe County, N.Y. Only participants without an active diagnosis of major depression were included in the analyses.

Annual follow-up in-person interviews were conducted for up to four years. Information obtained from telephone contacts and annual medical chart reviews supplemented the interviews. Thirty-three participants, or about 5.3 percent, developed an episode of major depression during the study period.

In their analysis, the researchers concluded the "number needed to treat," an epidemiological measure used in determining the effectiveness of a medical intervention, was five. This means the fully effective preventive treatment of five individuals presenting the indicators would prevent one new case of major depression.

In an editorial in the journal, Warren D. Taylor, M.D., associate professor of Psychiatry at Duke University Medical Center, agreed the number needed to treat was low and indicated cost effectiveness.

"Given the complications of depression in an elderly population, a preventive approach for this at-risk population may be quite important to not only prevent psychological suffering but to also avoid the deleterious effects of depression on comorbid medical illness," Taylor wrote.

The researchers concluded "the present study may inform current clinical practice by fostering early detection and intervention critical to improving patient outcomes for depression."


In addition to Lyness, authors of the article include: Wan Tang, Ph.D., research assistant professor of Biostatistics, Xin Tu, Ph.D., professor of Biostatistics and of Psychiatry, Yeates Conwell, M.D., professor of Psychiatry, and Qin Yu, Ph.D., research associate at the University of Pennsylvania.

For older adults, participating in social service activities can improve brain functions

19 dec 2009--Volunteer service, such as tutoring children, can help older adults delay or reverse declining brain function, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Using functional magnetic resonance imaging (fMRI), the researchers found that seniors participating in a youth mentoring program made gains in key brain regions that support cognitive abilities important to planning and organizing one's daily life. The study is the first of its kind to demonstrate that valuable social service programs, such as Experience Corps—a program designed to both benefit children and older adults' health—can have the added benefits of improving the cognitive abilities of older adults, enhancing their quality of life. The study is published in the December issue of the Journals of Gerontology: Medical Sciences.

About 78 million Americans were born from 1946 to 1964. Individuals of retirement age are the fastest-growing sector of the U.S. population, so there is great interest in preserving their cognitive and physical abilities, especially given the societal cost of the alternative.

"We found that participating in Experience Corps resulted in improvements in cognitive functioning and this was associated with significant changes in brain activation patterns," said lead investigator Michelle C. Carlson, PhD, associate professor in the Bloomberg School's Department of Mental Health and Center on Aging and Health. "Essentially the intervention improved brain and cognitive function in these older adults."

The study is the first of its kind to examine the effect of Experience Corps, a national volunteer service program that trains seniors to help children in urban public schools with reading and academic success in other areas. The study followed 17 women aged 65 and older. Half participated in existing Experience Corps programs in Baltimore schools, while the other half were wait-listed to enroll in Experience Corps the following year. Participants were evaluated at enrollment and again six months later, which included fMRI brain scans and cognitive function testing.

"While the results of this study are preliminary, they hold promise for enhancing and maintaining brain reserve in later life, particularly among sedentary individuals who may benefit most urgently from behavioral interventions like Experience Corps," said Carlson, who is now leading a larger fMRI trial as part of a large-scale randomized trial of the Baltimore Experience Corps Program.

"As life expectancies increase, it's important, from a public health standpoint, to delay the onset of diseases associated with aging," said senior author Linda P. Fried, MD, MPH, dean of the Mailman School of Public Health at Columbia University. "This study suggests that new kinds of roles for older adults in our aging society can be designed as a win-win—for addressing important societal needs, such as our children's success, and simultaneously the health and well-being of the older volunteers themselves."


Additional authors of "Evidence For Neurocognitive Plasticity In At-risk Older Adults: The Experience Corps Program" include Kirk I. Erickson, University of Pittsburgh; Arthur F. Kramer and Michelle W. Voss, University of Illinois at Urbana-Champaign; Sylvia McGill, The Greater Homewood Community Corporation, Baltimore, Md.; Teresa Seeman, University of California, Los Angeles; and Natalie Bolea, George W. Rebok and Michelle Mielke, Johns Hopkins University.

The research was co-funded by a Research and Career Development award to Dr. Carlson from the Johns Hopkins Claude D. Pepper Center and by a gift from S.D. Bechtel.

Friday, December 18, 2009

Link Between Sirtuins And Life Extension Strengthened By Study

A new paper from MIT biology professor Leonard Guarente strengthens the link between longevity proteins called sirtuins and the lifespan-extending effects of calorie restriction.

18 dec 2009--For decades, it has been known that cutting normal calorie consumption by 30 to 40 percent can boost lifespan and improve overall health in animals such as worms and mice. Guarente believes that those effects are controlled by sirtuins - proteins that keep cells alive and healthy in the face of stress by coordinating a variety of hormonal networks, regulatory proteins and other genes.

In his latest work, published Dec. 15 in the journal Genes and Development, Guarente adds to his case by reporting that sirtuins bring about the effects of calorie restriction on a brain system, known as the somatotropic signaling axis, that controls growth and influences lifespan length.

"This puts SIRT1 at a nexus connecting the effects of diet and the somatropic signaling axis," says Guarente. "This is a major shot across the bow that says sirtuins really are involved in fundamental aspects of calorie restriction."

Guarente and others believe that drugs that boost sirtuin production could help fight diseases of aging such as diabetes and Alzheimer's, improving health in later life and potentially extending lifespan. Drugs that promote sirtuin production are now in clinical trials in diabetes patients, with results expected next year.

How they did it: The researchers genetically engineered mice whose ability to produce the major mammalian sirtuin SIRT1 in the brain was greatly reduced. Those mice and normal mice were placed on a calorie-restricted diet. The normal mice showed much lower levels of circulating growth hormones, demonstrating that their somatotropic signaling system was impaired, but calorie restriction had no effect on hormone levels of mice that could not produce SIRT1.

Next steps: In future work, Guarente plans to investigate the mechanism by which sirtuins regulate the somatotropic axis. The work could also help researchers and companies in their search for small molecules that modulate sirtuins for maximum benefit.

"Neuronal SIRT1 regulates endocrine and behavioral responses to calorie restriction," Dena Cohen, Leonard Guarente et al. Genes and Development, Dec. 15, 2009.
Funding: CHDI Inc., the Hereditary Disease Foundation, the American Parkinson's Disease Association, the National Institutes of Health, and the Paul F. Glenn Foundation.
Written by Anne Trafton, MIT News Office

Source: Jen Hirsch
Massachusetts Institute of Technology

For Older Adults, Participating In Social Service Activities Can Improve Brain Functions

18 dec 2009--Volunteer service, such as tutoring children, can help older adults delay or reverse declining brain function, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. Using functional magnetic resonance imaging (fMRI), the researchers found that seniors participating in a youth mentoring program made gains in key brain regions that support cognitive abilities important to planning and organizing one's daily life. The study is the first of its kind to demonstrate that valuable social service programs, such as Experience Corps a program designed to both benefit children and older adults' health can have the added benefits of improving the cognitive abilities of older adults, enhancing their quality of life. The study is published in the December issue of the Journals of Gerontology: Medical Sciences.

About 78 million Americans were born from 1946 to 1964. Individuals of retirement age are the fastest-growing sector of the U.S. population, so there is great interest in preserving their cognitive and physical abilities, especially given the societal cost of the alternative.

"We found that participating in Experience Corps resulted in improvements in cognitive functioning and this was associated with significant changes in brain activation patterns," said lead investigator Michelle C. Carlson, PhD, associate professor in the Bloomberg School's Department of Mental Health and Center on Aging and Health. "Essentially the intervention improved brain and cognitive function in these older adults."

The study is the first of its kind to examine the effect of Experience Corps, a national volunteer service program that trains seniors to help children in urban public schools with reading and academic success in other areas. The study followed 17 women aged 65 and older. Half participated in existing Experience Corps programs in Baltimore schools, while the other half were wait-listed to enroll in Experience Corps the following year. Participants were evaluated at enrollment and again six months later, which included fMRI brain scans and cognitive function testing.

"While the results of this study are preliminary, they hold promise for enhancing and maintaining brain reserve in later life, particularly among sedentary individuals who may benefit most urgently from behavioral interventions like Experience Corps," said Carlson, who is now leading a larger fMRI trial as part of a large-scale randomized trial of the Baltimore Experience Corps Program.

"As life expectancies increase, it's important, from a public health standpoint, to delay the onset of diseases associated with aging," said senior author Linda P. Fried, MD, MPH, dean of the Mailman School of Public Health at Columbia University. "This study suggests that new kinds of roles for older adults in our aging society can be designed as a win-win for addressing important societal needs, such as our children's success, and simultaneously the health and well-being of the older volunteers themselves."

Additional authors of "Evidence For Neurocognitive Plasticity In At-risk Older Adults: The Experience Corps Program" include Kirk I. Erickson, University of Pittsburgh; Arthur F. Kramer and Michelle W. Voss, University of Illinois at Urbana-Champaign; Sylvia McGill, The Greater Homewood Community Corporation, Baltimore, Md.; Teresa Seeman, University of California, Los Angeles; and Natalie Bolea, George W. Rebok and Michelle Mielke, Johns Hopkins University.

The research was co-funded by a Research and Career Development award to Dr. Carlson from the Johns Hopkins Claude D. Pepper Center and by a gift from S.D. Bechtel.

About Johns Hopkins Bloomberg School of Public Health

As a leading international authority on public health, the Johns Hopkins Bloomberg School of Public Health is dedicated to protecting health and saving lives. Every day, the School works to keep millions safe from illness and injury by pioneering new research, deploying its knowledge and expertise in the field, and educating tomorrow's scientists and practitioners in the global defense of human life.

About Columbia University Mailman School of Public Health

The only accredited school of public health in New York City and among the first in the nation, Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting millions of people locally and globally. The Mailman School is the recipient of some of the largest government and private grants in Columbia University's history. Its more than 1000 graduate students pursue master's and doctoral degrees, and the School's 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as infectious and chronic diseases, health promotion and disease prevention, environmental health, maternal and child health, health over the life course, health policy, and public health preparedness.

Source: Johns Hopkins Bloomberg School of Public Health

Thursday, December 17, 2009

Tarenflurbil Not Found to Reduce Declines in Alzheimer's

Amyloid-β-lowering drug not associated with less cognitive or functional loss in Alzheimer's patients

17 dec 2009-- Tarenflurbil, an amyloid-β-lowering treatment, isnt associated with reduced cognitive decline or functional loss in patients with mild Alzheimer's disease, according to research published in the Dec. 16 issue of the Journal of the American Medical Association.

Robert C. Green, M.D., of the Boston University School of Medicine, and colleagues analyzed data from 1,649 participants, aged 55 years and older, with mild Alzheimer's disease. They were randomized to receive 800 milligrams of tarenflurbil twice daily or placebo. Main end points included change in cognition measured by the Alzheimer Disease Assessment Scale -- Cognitive Subscale, and functional ability measured by the Alzheimer Disease Cooperative Studies -- activities of daily living scale.

Over 18 months of follow-up, the researchers found that tarenflurbil wasn't associated with improved outcomes. Patients taking the drug also reported more dizziness and anemia.

"This is yet another example among several drug candidates with demonstrated efficacy in transgenic mouse models of overproduction of cerebral amyloid-β peptides that failed to translate into demonstrated benefit for patients. There are many potential reasons for these failures. One is that the treatment did not achieve the expected pharmacologic effect of shifting amyloid-β peptide cleavage toward shorter peptides; there are no data on this critical point, just expectations based on experiments in mice," write the authors of an accompanying editorial.

The study was supported by Myriad Pharmaceuticals. The authors reported various relationships with pharmaceutical companies, including Myriad.

Full Text
Editorial (subscription or payment may be required)

Study finds significantly worse outcomes in cancer patients with cognitive impairment

Patients with mild cognitive impairment often survive several years

Athens, Ga.,17 dec 2009 – A new study published by researchers from the University of Georgia and the Moffitt Cancer Center in Tampa, Fla., has found that cancer patients with dementia have a dramatically lower survival rate than patients with cancer alone, even after controlling for factors such as age, tumor type and tumor stage.

But the study, published in the early online edition of the journal Critical Reviews in Oncology/Hematology, also argues that a diagnosis of dementia shouldn't discourage the use of cancer screenings and appropriate cancer treatments.

"As the population ages and as treatments improve, we're going to see more patients with both dementia and cancer," said lead author Claire Robb, assistant professor in the UGA College of Public Health. "And right now there are no guidelines for oncologists as to how to treat these patients."

Robb and her co-authors in the Senior Adult Oncology Program at Moffitt compared the outcomes of 86 cancer patients with cognitive impairment to a control group of 172 patients with cancer alone. They found that cancer patients with dementia survived an average of four fewer years.

Robb, who is also a researcher in the UGA Cancer Center, said that the reason for the disparity is unclear. She notes that the patients in both groups received similar treatment and that the survival gap persists even after controlling for age, tumor type and tumor stage.

But Robb pointed out that within the cognitively impaired group, there was a dramatic difference in survival time between those with mild cognitive impairment and those with moderate to severe impairment. People with mild cognitive impairment often have problems with thinking and memory yet can still live independently; those with moderate to severe dementia forget details about current events, lose awareness and have difficulty with basic tasks such as preparing meals or choosing proper clothing. The researchers found that while patients with moderate to severe dementia had an average survival time of eight months, those with mild dementia had an average survival time of nearly four and a half years.

"Some people would argue against treating patients with mild cognitive impairment because they're going to have a shorter survival," Robb said. "But, you know, 53 months—almost 4 and a half years—is a pretty significant amount of time to live."

The patients in the UGA/Moffitt study generally received the same treatment regardless of cognitive status, but other studies have found that patients with dementia often receive fewer cancer screenings and undergo less aggressive treatment. One study found that physicians were significantly less likely to recommend a mammogram for a woman with dementia than without, while another found that patients with dementia were twice as likely to have colon cancer reported only after death. Another study of breast cancer patients found that those with dementia were 52 percent less likely to have the tumor removed surgically, 41 percent less likely to undergo radiation therapy, 39 percent less likely to undergo chemotherapy and nearly three times more likely to receive no treatment.

"The fact that cognitively impaired patients seen in our Senior Adult Oncology Program received treatments similar to unimpaired patients while epidemiologic data show a marked difference in treatment provides food for thought," said study co-author Dr. Martine Extermann, associate faculty member at Moffitt. "Although this might reflect a referral bias in which those who volunteered to participate in the study are different from the general population, it might also indicate that such patients benefit from a specialized evaluation and management in a geriatric oncology program."

Robb emphasized that she does not advocate overly aggressive treatment for patients who are in the late stages of dementia, but urges the creation of guidelines to help ensure that cognitively impaired cancer patients receive appropriate treatment.

"People have thought about the impact of the aging population on rates of cancer and dementia, but not much attention has been paid to what happens when the diseases coincide," Robb said. "We're going to be seeing more cases like these, and, if anything, I hope our research raises awareness of this situation."

Tuesday, December 15, 2009

Study: Looking young may mean living longer

LONDON, 15 dec 2009 – Those baby-faced people now have another reason to be smug: a new Danish study says looking young apparently means a longer life.

Research published online Monday in the British medical journal BMJ suggests that people who look younger than their years also live longer.

In 2001, Danish researchers conducted physical and cognitive tests on more than 1,800 pairs of twins over aged 70, as well as taking photos of their faces. Three groups of people who didn't know the twins' real ages guessed how old they were. The researchers then tracked how long the twins survived over 7 years.

The experts found that people who looked younger than their actual age were far more likely to survive, even after they adjusted for other factors like gender and environment. The bigger the difference in perceived age within any twin pair, the more likely it was that the older-looking twin died first.

They also found a possible biological explanation: people who looked younger also tended to have longer telomeres, a key DNA component that is linked to aging. People with shorter telomeres are thought to age faster. In the Danish study, the more fresh-faced people had longer telomeres.

The authors said that perceived age, which is widely used by doctors as a general indicator of a patient's health, is a good biomarker of aging that predicts survival among people over age 70.

Geriatricians Consult Using Videoconferencing, Australia

15 dec 2009--Having patient consultations conducted by geriatricians using telemedicine technology is an acceptable alternative to in-person consultations when hospitals are unable to employ a geriatrician to work on site, according to the authors of a study published in the Medical Journal of Australia.

Prof Leonard Gray, Professor of Geriatric Medicine at the University of Queensland, and his co-authors conducted an observational study in the geriatric ward of Toowoomba Base Hospital, where ward-based consultations with an off-site geriatrician are delivered by video conference.

"Weekly rounds are conducted by video conference. A web-based clinical support system enables the remote geriatrician to have accurate clinical information, particularly with reference to geriatric syndromes and functional and psychosocial problems," Prof Gray said.

"Interaction is achieved through a wireless, mobile video conferencing apparatus, which enables two-way vision and conversation between the geriatrician and the patient, accompanying nurse and junior house doctor. The camera is controlled remotely by the geriatrician and permits panning and a zoom capability sufficient to read 12-point text.

Of 15 patients who were interviewed, most found both the technical aspects and the medical consultation to be acceptable.

The video conferencing model limits the ability to perform hands-on clinical examination, although there is evidence that cognitive assessment and neurological examination can be performed reliably by video conferencing.

The potential loss of accuracy in these areas of assessment in geriatric practice requires further research. Nevertheless, in many communities, a telemedicine service will be the only viable means of having access to the expertise of a geriatrician.

The authors envisage the model being extended to other inpatient clinical situations, including geriatric consultation in non-geriatric wards in small rural hospitals where a geriatric ward configuration is not justified.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Australian Medical Association

Monday, December 14, 2009

A Nobel Prize For Better Understanding Of The Ageing Mechanism

14 dec 2009--This year's Nobel Prize in Physiology or Medicine was awarded to three American scientists Elizabeth Blackburn, Carol Greider and Jack Szostak for the discovery of "how chromosomes are protected by telomeres and the enzyme telomerase". The research contributed to the understanding of how telomeres protect chromosomes from degradation and identified telomerase, the enzyme that preserves telomere length and integrity.

Roughly speaking, telomeres are the tails of chromosomes; they are an indicator of history and replicative potential of the cell. Research in the last three decades indicates that telomeres are key factors in several biological fields such as cancer and ageing. Because of the long lifespan of humans and their short telomeres, attrition in telomere length may be a major determinant of human ageing not only at cellular level, but also at organ and perhaps systemic levels.

Recent studies, notably by the Nobel Prize winners have shown the existence of a specific enzyme, telomerase, capable of restoring the extremity of telomeres and thus keep the cell in "good shape". Professor Athanase BENETOS (Nancy, France), Member of the IAGG World Executive Committee explains: "Results of recent clinical studies suggest that subjects with shorter telomere length could have a more advanced biological age and an increased predisposition for the development of age-related diseases. These discoveries open new perspectives for the detection and prevention of the risk of age-related diseases."

A leap forward in Geriatric Medicine

"The ageing process remains a large domain of research and all mechanisms are not depicted yet. These recent discoveries are a real step forward to attract young scientist to the new fields of research and clinical practice in Geriatric Medicine and Gerontology", said Professor Baeyens, President International Association of Gerontology and Geriatrics (IAGG) for the European Region. He is available for interviews on the subject.

International Association of Gerontology and Geriatrics

Diabetic foot ulcers tied to earlier death

NEW YORK, 14 dec 2009 – Among people with diabetes, those who develop foot ulcers seem to die earlier than those without the complication, a new study finds.

Over time, diabetes can damage the blood vessels and nerves, especially if a person's blood sugar is poorly controlled. Poor circulation and nerve damage in the feet makes people vulnerable to sustaining cuts or other injuries that go unnoticed and progress into poorly healing ulcers, or sores. Severe cases can ultimately lead to amputation.

In the new study, researchers found that among more than 65,000 Norwegian adults, those with a history of diabetic foot ulcers had a higher death rate over 10 years.

Compared with other diabetic adults, those with a history of foot ulcers were 47 percent more likely to die during the study period. The risk was more than two-fold higher when foot ulcer patients were compared with non-diabetic adults.

People with a history of foot ulcers did tend to be older, have poorer blood sugar control and have higher rates of heart disease and stroke, depression and kidney dysfunction. But those factors only partly explained the higher death risk attributed to foot ulcers, the researchers report in the journal Diabetes Care.

"Our study revealed that a history of foot ulcer is a significant marker of higher risk of death not only for people in hospital settings but also in community health care," lead researcher Marjolein M. Iversen, of Bergen University College in Norway, told Reuters Health in an email.

That, she explained, underscores the importance of routine doctor visits -- both to monitor a diabetic patient's overall health, including heart disease risk factors and mental well-being, and for patients to learn how to prevent foot ulcers in the first place.

The findings are based on 65,126 adults taking part in a long-term health study; 1,339 had diabetes and no history of foot ulcers, while 155 had a history of the complication.

Over 10 years, half of those who'd suffered foot ulcers died, compared with 35 percent of diabetics without the complication and 10.5 percent of non-diabetic adults.

When the researchers factored in age, overall health, depression, education and lifestyle habits, the higher death risk in the foot-ulcer group persisted.

In general, experts recommend that people with diabetes take a number of measures to prevent foot ulcers -- with good blood sugar control being key to cutting the risk, as well as the risk of other diabetes complications.

Other recommendations include getting a complete foot exam at least once per year; regularly doing a self-check to spot any cuts, blisters or other abnormalities in the skin or toenails; and wearing socks and shoes at all times to cut the risk of foot injuries.

SOURCE: Diabetes Care, December 2009.

Sunday, December 13, 2009

Study Finds One Third Of American Adults Serves As A Caregiver

13 dec 2009--"A new study says almost one out of three adults in the U.S. currently serves as a caregiver," NPR reports. "The time and energy they put into caregiving becomes like an unpaid job. On average, they spend about 19 hours a week providing care, doing everything from bathing and dressing an elderly parent or loved one to balancing a checkbook or doing household chores."

The survey was sponsored by AARP and the National Alliance for Caregiving, with funding from the MetLife Foundation. Many results "are similar to those from earlier versions in 2004 and 1999. Two-thirds of caregivers are women. The average age is about 48. Almost all -- 86 percent -- care for a relative. Most often, 36 percent of the time, it's for a parent. On average, caregivers have been providing care for 4.6 years, and three in ten report doing so for five years or more" (Shapiro, 12/8).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

Irregular arm swing may point to Parkinson's disease

13 dec 2009--Irregular arm swings while walking could be an early sign of Parkinson's disease, according to neurologists who believe early detection may help physicians apply treatments to slow further brain cell damage until strategies to slow disease progression are available.

Parkinson's disease is an age-related disorder involving loss of certain types of brain cells and marked by impaired movement and slow speech.

"The disease is currently diagnosed by tremors at rest and stiffness in the body and limbs," said Xuemei Huang, associate professor of neurology, Penn State Hershey College of Medicine. "But by the time we diagnose the disease, about 50 to 80 percent of the critical cells called dopamine neurons are already dead."

Huang and her colleagues are studying gait, or the manner in which people walk, to understand the physical signs that might be a very early marker for the onset of Parkinson's. They have confirmed Huang's clinical impression that in people with Parkinson's, the arm swing is asymmetrical. In other words, one arm swings much less than the other as a person walks.

"We know that Parkinson's patients lose their arm swing even very early in the disease but nobody had looked using a scientifically measured approach to see if the loss was asymmetrical or when this asymmetry first showed up," said Huang. Her team's findings appear in the current issue of Gait and Posture. "Our hypothesis is that because Parkinson's is an asymmetrical disease, the arm swing on one arm will be lost first compared to the other."

The researchers compared the arm swing of 12 people diagnosed three years earlier with Parkinson's, to eight people in a control group. The Parkinson's patients were asked to stop all medication the night before to avoid influencing the test results.

The team used special equipment to measure movement accurately, including many reflective markers on the study participants and eight digital cameras that captured the exact position of each segment of the body during a walk.

"Images from the cameras were sent to a computer where special software analyzed the data" explained Huang. "When a person walks, the computer was able to calculate the degree of swing of each arm with millimeter accuracy."

Analysis of the magnitude of arm swing, asymmetry and walking speed revealed that the arm swing of people with Parkinson's has remarkably greater asymmetry than people in the control group -- one arm swung significantly less than the other in the Parkinson's patients.

When the participants walked at a faster speed, the arm swing increased but the corresponding asymmetry between them remained the same.

"We believe this is the first demonstration that asymmetrical arm swings may be a very early sign of the disease," said Huang.

While slightly irregular arm swing occurs in people without Parkinson's, the asymmetry is significantly larger in those suffering from the disease.

"Our data suggests that this could be a very useful tool for the early detection of Parkinson's," noted Huang. "There are wide scale efforts to find drugs that slow cell death. When they are found, they could be used in conjunction with this technique to arrest or perhaps cure the disease because they could be given before great damage has occurred."


Other researchers in the study include Michael D. Lewek, assistant professor of exercise and sport science; Roxanne Poole, study coordinator; Julia Johnson, clinical fellow, and Omar Halawa, medical student, all at University of North Carolina.

Saturday, December 12, 2009

Coffee, Exercise Fight Prostate Cancer

12 dec 2009- Having a few more cups of coffee and running that extra mile each day can reduce a man's risk of dying of prostate cancer, two studies indicate.

The case for coffee and physical activity as prostate cancer preventatives is far from proven, according to the research reported Tuesday at an American Association for Cancer Research meeting in Houston. But data from the Health Professionals Follow-Up Study show a clear association with both daily activities.

"I wouldn't recommend that people change their coffee-drinking habits based on this study," said Kathryn M. Wilson, a research fellow in epidemiology at the Harvard School of Public Health, and lead author of one report. "But if you like coffee, there is no compelling reason to cut back at this point."

Her data on the nearly 50,000 men in the study showed how common a diagnosis of prostate cancer has become since widespread screening began. In the 20 years from 1986 to 2006, 4,975 cases of prostate cancer were diagnosed, affecting just about 10 percent of the men in the study.

But only 846 of those cancers were life-threatening, because they had spread beyond the prostate gland or were growing aggressively, Wilson said. And while the study found just a weak relationship between consumption of six or more cups of coffee a day and a reduced risk of all forms of prostate cancer (down about 19 percent), the reduction for the aggressive form was much more marked -- 41 percent.

And there was a clear relationship between the amount of coffee consumed and prostate cancer risk, Wilson said: "The more coffee you drank, the more effect we saw."

The caffeine in coffee doesn't seem to be the link, since the same reduction was seen for consumption of decaffeinated coffee, she said. Instead, "it has something to do with insulin and glucose metabolism," Wilson said. "A number of studies have found that coffee is associated with a reduced risk of diabetes."

This study is just a starting point for establishing a relationship between coffee and prostate cancer, Wilson stressed. "At this point, we would just like to confirm whether it exists in different populations," she said. "We hope that this study drives more research so that we really know what is going on."

The other study, by Stacey A. Kenfield, a research associate at the Harvard School of Public Health, looked at the levels of physical activity among 2,686 men in the study who were diagnosed with prostate cancer. It found, as many other studies have, that exercise is good for overall health, with a 35 percent lower death rate for men who reported three or more hours a week of vigorous physical activity, such as jogging, biking, swimming or playing tennis.

And the death rate from prostate cancer for men who exercised vigorously was 12 percent lower than for those who didn't -- a figure that did not quite reach the level of statistical significance because the numbers were small, Kenfield explained.

Nevertheless, "this is the first study to show an effect of physical activity not only on overall survival, but on prostate cancer survival," she said.

It's already well known how physical activity reduces overall mortality, Kenfield said. "It affects immune function and reduces inflammation, among the major processes involved. But it's not clear yet how it is related to prostate cancer and survival."

More information

Details on prostate cancer are provided by the U.S. National Cancer Institute.

U.S. panel to weigh safety of AstraZeneca's Crestor

WASHINGTON , 12 dec 2009 – U.S. regulators see benefits to using an AstraZeneca Plc cholesterol drug in a vast new group of patients but will ask outside advisers to probe various safety issues, documents released on Friday said.

AstraZeneca wants permission to promote the drug, Crestor, for preventing heart disease in people with normal cholesterol levels but other risk factors based on findings of a large study known as Jupiter.

A Food and Drug Administration reviewer, commenting on a higher number of diabetes cases reported with Crestor patients, said that, at the current time, the benefits seen in the Jupiter trial "outweigh the risk, but further clinical trials are needed to further define this benefit/risk ratio."

The Jupiter trial "was relatively short in duration" and "therefore the long-term complications are unknown," the reviewer said.

The reviewer also said the agency felt it was a "chance finding" that gastrointestinal-related deaths were higher in Crestor patients compared with a placebo.

The comments were included in documents the FDA released ahead of a meeting on Tuesday of a panel of outside advisers.

The advisory panel will be asked to comment on the diabetes and gastrointestinal findings before deciding whether to recommend approval for expanded use, according to a November 12 memo. The FDA also will seek input on a higher number of patients who reported a "confusional state" in the Crestor group, the memo said.

Barclays Capital analyst Brian Bourdot said he expects the advisory panel to support wider use of Crestor.

"Overall, the FDA review appears benign, with few safety concerns and little disagreement that Crestor shows a significant benefit" in the expanded group, Bourdot said in a note to clients.

The Jupiter study showed Crestor cut deaths, heart attacks and strokes in middle-aged people with healthy cholesterol, but elevated levels of C-reactive protein, which is associated with heart disease.

The FDA said it would ask the advisory panel to "keep in mind that an estimated 6 million middle-aged and older men and women in the United States" meet the criteria of people in the study.

AstraZeneca said in an analysis also released by the FDA that Crestor's risks in the Jupiter study were "consistent with the known safety profile." The company said potential side effects were outweighed by the benefits, including a 44 percent reduction in cardiovascular-related deaths, strokes, heart attacks and other problems.

An expanded label for Crestor would boost sales of the drug in the coming years, but industry analysts say the size of the opportunity is uncertain because of the looming arrival of generic versions of Pfizer Inc's Lipitor in late 2011.

Gbola Amusa of UBS believes the Jupiter results could expand the overall statin market by 20 percent to 50 percent in volume terms, lifting AstraZeneca's Crestor sales to some $8 billion in 2012 from $3.6 billion last year.

Others are more cautious, and the consensus forecast for 2012 is $6.75 billion, rising to $6.92 billion in 2013, according to Thomson Pharma.

AstraZeneca's partner Shionogi & Co Ltd also sells Crestor in Japan and recorded $172 million in revenue from the drug in 2008.

The dramatic reduction in heart attack risk seen in Jupiter already has helped boost prescriptions for Crestor since details were unveiled in November last year.

The FDA will make the final decision on whether to allow AstraZeneca to promote Crestor more widely, but it usually follows panel recommendations.

Crestor is a key driver for AstraZeneca as other drugs go off patent, but its exclusivity through to 2016 is being challenged by generic manufacturers in a case due to go to trial in February 2010. AstraZeneca has requested a summary judgment ahead of the trial to eliminate the most significant issue in the case and is awaiting the judge's decision.

Thursday, December 10, 2009

WHO: Smoking kills 5 million every year

LONDON, 10 dec 2009 – Tobacco use kills at least 5 million people every year, a figure that could rise if countries don't take stronger measures to combat smoking, the World Health Organization said Wednesday.

In a new report on tobacco use and control, the U.N. agency said nearly 95 percent of the global population is unprotected by laws banning smoking. WHO said secondhand smoking kills about 600,000 people every year.

The report describes countries' various strategies to curb smoking, including protecting people from smoke, enforcing bans on tobacco advertising, and raising taxes on tobacco products. Those were included in a package of six strategies WHO unveiled last year, but less than 10 percent of the world's population is covered by any single measure.

"People need more than to be told that tobacco is bad for human health," said Douglas Bettcher, director of WHO's Tobacco-Free Initiative. "They need their governments to implement the WHO Framework Convention."

Most of WHO's anti-tobacco efforts are centered on the Framework Convention on Tobacco Control, an international treaty ratified by nearly 170 countries in 2003. The convention theoretically obliges countries to take action to reduce tobacco use, though it is unclear if they can be punished for not taking adequate measures, since they can simply withdraw from the treaty.

Other experts questioned how effective WHO's strategies were.

"It's like the well-intentioned blind leading the blind," said Patrick Basham, director of the Democracy Institute, a London and Washington-based think tank. He said WHO's policies were based more on hope than evidence.

Basham said measures like increasing taxes on tobacco products and banning advertising don't address the root causes of why people smoke. Smoking levels naturally drop off — as they have in Western countries — when populations become richer and better-educated.

Tobacco use is the leading preventable cause of death and WHO estimates that, unless countries take drastic action, tobacco could kill about 8 million people every year by 2030, mostly in developing countries.

Basham said officials should focus on anti-poverty measures to stem the smoking problem, though that is beyond WHO's mandate as a health agency.

"The cynical view is that the anti-tobacco lobby has itself now become an industry and we will never be able to do enough to stop smoking," Basham said. "Tobacco use will change, but it has very little to do with the kinds of things WHO is promoting."

Fast, accurate urine test for pneumonia possible, study finds

10 dec 2009--Doctors may soon be able to quickly and accurately diagnose the cause of pneumonia-like symptoms by examining the chemicals found in a patient's urine, suggests a new study led by UC Davis biochemist Carolyn Slupsky.

Pneumonia is a lung infection that annually sickens millions of people in the United States, resulting in approximately 500,000 hospitalizations and thousands of deaths. A rapid, accurate diagnostic test for pneumonia could save lives by enabling doctors to begin appropriate treatment earlier.

Using technology known as nuclear magnetic resonance spectroscopy, the researchers were able to identify a chemical "fingerprint" for the type of pneumonia caused by the bacterium Streptococcus pneumoniae, and compare this to the chemical fingerprints for other types of pneumonia and noninfectious lung diseases.

Findings from the study, conducted by Slupsky and colleagues in Canada and Australia, are discussed in a research profile in the December issue of the Journal of Proteome Research. A patent is pending on the diagnostic procedure.

"This is the first study to demonstrate that NMR-based analysis of metabolites in urine has the potential to provide rapid diagnosis of the cause of pneumonia," said Slupsky, an assistant professor in UC Davis' departments of Nutrition, and Food Science and Technology. She is also a faculty member in UC Davis' Foods for Health Institute.

"It also shows that we can use this technology to quickly and easily monitor patient recovery," Slupsky said. "The goal is a tool for rapid, accurate diagnosis so that patients can quickly begin treatment with the appropriate medication."

Currently, pneumonia is diagnosed by a combination of clinical symptoms, X-rays and analysis of a patient's blood or sputum by bacterial culture. Such tests usually take more than 36 hours to complete and tend to yield a high rate of false-positive results. Previous studies have shown that more than 80 percent of patients admitted to the hospital with pneumonia are misdiagnosed, leading to delays in treatment with the appropriate antibiotic.

About pneumonia

Pneumonia is an infection of the lower respiratory tract that causes symptoms such as difficulty in breathing, fever, chest pains and cough. It can be caused by bacteria, viruses, fungi and parasites, and is difficult to diagnose because other noninfectious ailments can mimic pneumonia.

Streptococcus pneumonia is the major cause of community-acquired, rather than hospital-acquired, pneumonia. It can become life threatening in anyone, but is particularly worrisome in elderly patients, smokers and people with weakened immune systems or chronic lung diseases.

Metabolomics study

In the new study, Slupsky and colleagues applied "metabolomics" — the study of the chemicals produced by the body's metabolic processes — to develop a profile for pneumonia as it appears in a patient's urine.

To do this, they analyzed hundreds of urine samples collected from both healthy individuals and patients with a variety of pulmonary diseases or infections. In the process, they measured 61 metabolites in urine samples using NMR spectroscopy.

They found that urine from patients infected with pneumonia caused by Streptococcus pneumoniae had a telltale chemical profile that clearly distinguished those people from healthy individuals or patients with other ailments.

"By analyzing urine samples collected at various intervals during the patient's hospitalization, we could actually observe sick patients recover because their recovery was reflected in the chemical composition of their urine," Slupsky said.

She noted that the research team was surprised to find that most of the changes in metabolites related to infection by Streptococcus pneumoniae were caused by the body's response to the infection rather than by the invading bacteria.

"In future studies, we hope to explore how bacteria and other microbes interact with the body of the individual they infect, and how these interactions alter metabolism in the body, resulting in unique metabolite profiles in the urine," she said.

Slupsky conducted this research while at the University of Alberta. She joined UC Davis in July 2008. Her research focuses on interactions between the human body and bacteria, as they relate to health and disease conditions.

She collaborated on the study with researchers at the University of Alberta, University of Toronto and Austin Health in Australia.


Funding for the study was provided by the Alberta Heritage Foundation for Medical Research, the Lung Association of Alberta and the Northwest Territories, Western Economic Development, and Alberta Advanced Education and Technology.

About UC Davis

For 100 years, UC Davis has engaged in teaching, research and public service that matters to California and transforms the world. Located close to the state capital, UC Davis has 31,000 students, an annual research budget that exceeds $500 million, a comprehensive health system and 13 specialized research centers. The university offers interdisciplinary graduate study and more than 100 undergraduate majors in four colleges — Agricultural and Environmental Sciences, Biological Sciences, Engineering, and Letters and Science — and advanced degrees from five professional schools — Education, Law, Management, Medicine and Veterinary Medicine.

Sunday, December 06, 2009

PSA value at 2 years post-treatment can predict long-term survival in prostate cancer patients

06 dec 2009--Prostate cancer patients who have a prostate-specific antigen (PSA) value of less than or equal to 1.5 at two years after external beam radiation therapy (EBRT) are less likely to have a cancer recurrence and cancer-related death, according to a study in the December 1 issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).

PSA levels in a prostate cancer patient are monitored after a patient's treatments, and after a successful course of EBRT the levels should decline gradually over the following 18 to 24 months. A continued rise in PSA can indicate relapsing disease.

Prior studies have attempted to categorize PSA response patterns after treatment in an effort to identify patients with an increased chance of a relapse earlier; however, most did not use a fixed point after treatment to predict outcomes.

Researchers at the Memorial Sloan-Kettering Cancer Center department of Radiation Oncology and Epidemiology and Biostatistics in New York, sought to determine the significance of a patient's reaching a certain PSA level at a specific point in time after EBRT.

The study authors found that patients with a PSA value of less than or equal to 1.5 at two years had a 2.4 percent incidence of distant metastases at five years after treatment and a 7.9 percent incidence at 10 years after treatment. Patients with a PSA value higher than 1.5 experienced a significantly higher rate of metastases at five and 10 years after treatment (10 percent and 17.5 percent, respectively).

"In the past, patients with a relapsing cancer after receiving radiation were not identified until several years after treatment and at that point it may be too late to effectively salvage their recurrence," Michael Zelefsky, M.D., lead author of the study and a radiation oncologist at Memorial Sloan-Kettering Cancer Center, said. "If we can catch these future instances of cancer recurrence earlier in prostate cancer patients, then we have a much higher chance of reducing the mortality associated with the cancer."


ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.