Research demonstrates benefits of medical cannabis as a treatment for chronic pain

31 aug 2010--The medicinal use of cannabis has been debated by clinicians, researchers, legislators and the public at large for many years as an alternative to standard pharmaceutical treatments for pain, which may not always be effective and may have unwanted side effects. A new study by McGill University Health Centre (MUHC) and McGill University researchers provides evidence that cannabis may offer relief to patients suffering from chronic neuropathic pain. The results of the groundbreaking study are published in the latest issue of the Canadian Medical Association Journal.

"This is the first trial to be conducted where patients have been allowed to smoke cannabis at home and to monitor their responses, daily," says Dr. Mark Ware, lead author of the study, who is also Director of Clinical Research at the Alan Edwards Pain Management Unit at the MUHC and an assistant professor of anesthesia in McGill University's Faculty of Medicine, and neuroscience researcher at the Research Institute of the MUHC.

In this study, low doses (25mg) of inhaled cannabis containing approximately 10% THC (the active ingredient in cannabis), smoked as a single inhalation using a pipe three times daily over a period of five days, offered modest pain reduction in patients suffering from chronic neuropathic pain (pain associated with nerve injury) within the first few days. The results also suggest that cannabis improved moods and helped patients sleep better. The effects were less pronounced in cannabis strains containing less than 10% THC.

"The patients we followed suffered from pain caused by injuries to the nervous system from post-traumatic (e.g. traffic accidents) or post-surgical (e.g. cut nerves) events, and which was not controlled using standard therapies" explains Dr. Ware. "This kind of pain occurs more frequently than many people recognize, and there are few effective treatments available. For these patients, medical cannabis is sometimes seen as their last hope."

"This study marks an important step forward because it demonstrates the analgesic effects of cannabis at a low dose over a shot period of time for patients suffering from chronic neuropathic pain," adds Dr. Ware. The study used herbal cannabis from Prairie Plant Systems (under contract to Health Canada to provide cannabis for research and medical purposes), and a 0% THC 'placebo' cannabis from the USA.

However, larger-scale studies with a longer time frame and higher doses of THC are needed to further evaluate the efficacy and long-term safety of medical cannabis. "Our challenge as researchers is to continue to conduct rigorous clinical studies on the medical use of cannabis with strict attention to details such as quality and dosage," says Dr. Ware. "This will allow us to move the debate forward by providing reliable scientific clinical data."

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About the Study

The article "Smoked cannabis for chronic neuropathic pain," is published in the Canadian Medical Association Journal (www.cmaj.ca) and was made possible by grants from the Canadian Institutes of Health Research (CIHR).

Click here for online access: http://www.cmaj.ca/embargo/cmaj091414.pdf

Click here for the related commentary: http://www.cmaj.ca/embargo/cmaj100799.pdf

Omega-3 margarines fail to help in heart study

STOCKHOLM, 30 aug 2010 - Giving patients with a history of heart attacks a margarine enriched with omega-3 oils in addition to standard drugs appears to make no difference to their chances of having a repeat attack.

A 40-month study of more than 4,800 patients showed taking low doses of omega-3 fatty acids in margarine did not significantly reduce rates of serious heart attacks and other cardiovascular events, Dutch researchers said on Sunday.

The finding raised questions about the benefits of omega-3, which has been shown in previous studies to make for healthier hearts. The margarines used in the study were developed for the researchers by food and consumer goods giant Unilever.

Doctors, however, are unlikely to rush to change clinical practice. Many already prescribe omega-3 fish oil capsules, including GlaxoSmithKline's Lovaza, to reduce triglycerides, a type of blood fat linked to clogged arteries.

"It will be viewed as a largely negative study and people who are enthusiasts for omega fatty acids will continue to be enthusiasts and people who are skeptics will continue to be skeptics," said Scott Wright of the Mayo Clinic in the United States, who was not involved in the research.

Daan Kromhout of Wageningen University, who led the study, told the European Society of Cardiology the lack of efficacy might reflect the good background drug treatment patients were receiving, with 85 percent on cholesterol-lowering statins, as well as blood pressure and blood-thinning tablets.

"We found the cardiovascular mortality rate in the study population was only half that expected, probably because of their excellent treatment," he said.

"This may also be why the rate of major cardiovascular events during follow-up was no lower in the fatty acid groups than in the placebo group."

All the men and women in the Dutch study were aged between 60 and 80 and had suffered a heart attack roughly four years previously.

They were randomly assigned use of one of four margarines on bread instead of their regular spread -- one containing no extra omega-3 fatty acids; one with 400 milligrams a day of extra eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); one with 2 grams of alpha-linolenic acid (ALA); and one with a combination of EPA-DHA and ALA.

Fish like salmon, herring and sardine are a common source of EPA-DHA, while ALA is found in vegetables including soybeans, flax seeds and walnuts.

Despite the overall negative results, researchers did find there was a reduction in repeat heart attacks and other cardiovascular events in women who took ALA margarine, although this was not statistically significant. Diabetes patients also showed a possible benefit.

Unilever, whose margarine brands that contain omega-3 include Flora and I Can't Believe It's Not Butter, said the lack of benefit seen with EPA and DHA was surprising, considering the weight of evidence published to date.

"The results indicate that more investigation is required into the efficacy of vegetable omega 3, but do not question the current authoritative dietary recommendations and advices for omega 3 intakes on which our products are based," the company said in a statement.

The results of the study, which was supported by the Netherlands Heart Foundation, the National Institutes of Health, and Unilever, were also published in the New England Journal of Medicine.

Doctors' Religious Beliefs Strongly Influence End-of-Life Decisions, Study Finds

28 aug 2010— Atheist or agnostic doctors are almost twice as willing to take decisions that they think will hasten the end of a very sick patient's life as doctors who are deeply religious, suggests research published online in the Journal of Medical Ethics.

And doctors with a strong faith are less likely to discuss this type of treatment with the patient concerned, the research shows.

The findings are based on a postal survey of more than 8500 UK doctors, spanning a wide range of specialties, which was designed to see what influence religious belief -- or lack of it -- had on end of life care.

The specialties included those in which end of life decisions would be particularly likely to arise, such as neurology, elderly care, palliative care, intensive care and hospital specialties, and general practice.

The doctors were asked about the care of their last patient who died, if relevant -- including whether they had provided continuous deep sedation until death and whether they had discussed decisions judged likely to shorten life with the patient -- their own religious beliefs, ethnicity, and their views on assisted dying/euthanasia.

Nearly 4000 doctors responded (42% of the total surveyed), and almost 3000 reported on the care of a patient who had died.

Specialists in the care of the elderly were somewhat more likely to be Hindu or Muslim, while palliative care doctors were somewhat more likely than other doctors to be Christian, white, and agree that they were "religious."

But, overall, white doctors, who comprised the largest ethnic group among the respondents, were the least likely to report strong religious beliefs.

Ethnicity was largely unrelated to rates of reporting ethically controversial decisions, although it was related to support for assisted dying/euthanasia legislation.

Specialty was strongly related to whether a doctor reported having taken decisions, expected or partly intended to, end life. Doctors in hospital specialties were almost 10 times as likely to report this as palliative care specialists.

But irrespective of specialty, doctors who described themselves as "extremely" or "very non-religious" were almost twice as likely to report having taken these kinds of decisions as those with a religious belief.

The most religious doctors were significantly less likely to have discussed end of life care decisions with their patients than other doctors.

These attitudes were reflected in support for assisted dying/euthanasia legislation, with palliative care specialists and those with a strong faith more strongly opposed to it. Asian and white doctors were less opposed to such legislation than doctors from other ethnic groups.

The author concludes that the relationship between doctors' values and their clinical decision making needs to be acknowledged much more than it is at present.

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List Of Medications That Put Elderly Patients At Risk: The PRISCUS List

In the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2010; 107[31-32]: 543-51), Stephanie Holt, a clinical pharmacologist, and coauthors present the PRISCUS List: a list of medications that carry an increased risk of side effects when given to elderly patients.

27 aug 2010--The authors present the new list, which was developed specifically for Germany in the setting of a joint project entitled PRISCUS (Latin for "old and venerable"), and discuss its potential applications. Most patients take more medications as they grow older and thus run a greater risk of drug interactions and side effects. Medications that might cause side effects more frequently in elderly patients than they do in the overall population are called potentially inappropriate medications (PIM). A number of PIM lists already exist for countries other than Germany; these cannot be applied directly to the German situation because of differences between countries with respect to drug approval, prescribing practices, and treatment guidelines. The experts who created the PRISCUS list for Germany, proceeding on the basis of a literature search and a qualitative analysis of existing PIM lists from other countries, judged 83 medications to be potentially inappropriate for elderly patients. The authors of the article call the PRISCUS list an important aid in medical decision-making.

Source:
Prof. Petra A. Thuermann
Deutsches Aerzteblatt International

Vit D linked to cancer, autoimmune disease genes

LONDON,25 aug 2010- Scientists have found that vitamin D influences more than 200 genes, including ones related to cancer and autoimmune diseases like multiple sclerosis -- a discovery that shows how serious vitamin D deficiency can be.

Worldwide, an estimated one billion people are deficient in vitamin D, and a team of scientists from Britain and Canada said health authorities should consider recommending supplements for those at most risk.

"Our study shows quite dramatically the wide-ranging influence that vitamin D exerts over our health," said Andreas Heger of the Functional Genomics Unit at Britain's Oxford University, who led the study.

Vitamin D effects our DNA through something called the vitamin D receptor (VDR), which binds to specific locations of the human genome. Heger's team mapped out these points and identified more than 200 genes that it directly influences.

Vitamin D deficiency is a well-known risk factor for rickets, and some evidence suggests it may increase susceptibility to autoimmune diseases such as multiple sclerosis (MS), rheumatoid arthritis and type 1 diabetes, as well as certain cancers and even dementia.

With this is mind, the group looked at disease-associated regions of the gene map to see if they had higher levels of VDR binding. They found VDR binding was "significantly enriched" in regions linked to several common autoimmune diseases, such as MS, type 1 diabetes and Crohn's disease, as well as in regions associated with cancers such as leukemia and colorectal cancer.

"SUNSHINE VITAMIN"

Sreeram Ramagopalan, of the Wellcome Trust Center for Human Genetics at Oxford University, said the results, published on Monday in the journal Genome Research, showed "just how important vitamin D is to humans, and the wide variety of biological pathways that vitamin D plays a role in."

Most Vitamin D is made by the body as a natural by-product of the skin's exposure to sunlight. It can also be found in fish liver oil, eggs and fatty fish such as salmon, herring and mackerel, or taken as a supplement.

Some experts say that up to half the world's population has lower than optimal levels of vitamin D, and that about one billion people are actually vitamin D deficient. The problem is getting worse as people spend more time indoors.

A study published in March found that vitamin D is vital for activating the immune system's killer cells, known as T cells, which remain dormant and unaware of threats from infections if vitamin D is lacking in the blood.

Ramagopalan said the latest study suggested vitamin D played a role "in susceptibility to a host of diseases" and that health authorities should consider giving supplements to pregnant women and young children as a preventative measure.

"Vitamin D supplements during pregnancy and the early years could have a beneficial effect on a child's health in later life," he wrote. "Some countries such as France have instituted this as a routine public health measure."

There are no definitive studies on the optimal daily dose of vitamin D but some experts recommend 25 to 50 micrograms.

Urinary incontinence common in older men too

NEW YORK 24 aug 2010– It's not just women who suffer from urinary incontinence: Nearly one in twenty U.S. men have moderate to severe forms of the condition, which is as common as one in six among elderly men, a new study finds.

Research suggests that urinary incontinence affects women about twice as often as it does men. But the new findings, researchers say, underscore the fact that despite their relatively lower risk, men commonly deal with the condition as well.

The study found that among 5,300 U.S. men age 20 or older who participated in a government health survey, 4.5 percent reported symptoms of moderate to severe urinary incontinence -- defined as having leakage at least once a week, or once a month at volumes "more than drops."

Among men age 75 and older, 16 percent met that definition.

In all, that translates to an estimated 8.2 million U.S. men with moderate to severe urinary incontinence, the researchers report in the Journal of Urology.

"It's a common problem," said lead researcher Dr. Alayne D. Markland, of the Birmingham VA Medical Center and the University of Alabama at Birmingham.

Yet, she told Reuters Health, doctors and patients alike may not think to bring up urinary incontinence symptoms. "Older patients often think that it is just part of aging," Markland noted.

But she advised men to discuss any incontinence problems with their doctors, as there are a number of effective treatments.

The options include Kegel exercises -- a set of exercises that help strengthen the muscles of the pelvic floor -- as well as behavioral changes, such as scheduled bathroom trips and limiting fluids at certain times of the day. There are also a number of medications that help treat incontinence, and two of Markland's co-authors had relationships with companies that sell or research such drugs. In more severe cases, surgery may be an option.

Men with urinary incontinence will have the added step of needing a prostate check, because prostate-gland enlargement is a common cause of urinary symptoms.

Markland and her colleagues also found that several factors were linked to an increased risk of moderate to severe urinary incontinence.

One, not surprisingly, was older age. Another was major depression.

Among men who screened positive for major depression, about 11 percent had moderate to severe urinary incontinence, versus 4 percent of men who did not screen positive.

When the researchers accounted for other factors -- including age and the presence of chronic physical diseases -- depressed men had between two and three times the risk of moderate to severe urinary incontinence that non-depressed men had.

Other studies have seen a similar link between depression and urinary incontinence in both men and women, according to Markland. "But we don't know if that's a cause-and-effect relationship," she said.

On one hand, it's possible that serious problems with incontinence contribute to social isolation and depression in some people. Alternatively, there could be physiological effects connected to depression -- such as alterations in the brain chemical dopamine -- that impair bladder function.

Another possibility is that some of the medications used to treat depression cause incontinence as a side effect. Markland noted, however, that there is no evidence that the widely used SSRI antidepressants cause urinary incontinence.

In what Markland said was a rather surprising finding, the researchers also found that men with high blood pressure had an increased risk of incontinence. Roughly 9 percent had moderate to severe symptoms, versus 3 percent of men without high blood pressure. With other factors taken into account, high blood pressure was linked to a 30 percent increase in the risk of urinary incontinence.

As with depression, Markland said, the reasons for the connection between high blood pressure and incontinence are not yet clear. Again, she said it's possible that medications used to treat high blood pressure cause bladder control problems in some men, but that has yet to be shown.

Fear of falling linked to future falls in older people

Research: Determinants of disparities between perceived and actual fall risk in community living older people

23 aug 2010--Fear of falling is likely to lead to future falls among older people, irrespective of their actual fall risk, finds a study published on bmj.com today.

This indicates that measures of both actual and perceived fall risk should be included in fall risk assessments to help tailor interventions for preventing falls in older people, say the authors.

Fear of falling is common in older people and is associated with poor balance, anxiety, depression and falls. But the problem of irrational fear has been neglected in the scientific literature.

So a team of researchers from Australia and Belgium set out to improve their understanding of fear of falling and its impact on the risk of falls.

Five hundred people, aged 70 to 90 years, living in Sydney took part in the study and underwent an extensive medical and neuropsychological assessment. Actual and perceived fall risks were then estimated using recognised scoring scales and participants were followed up monthly over a one-year period.

The researchers found that both actual fall risk and perceived fall risk independently contribute to a person's future fall risk.

Further analysis was then used to split the sample into four groups based on the disparity between actual and perceived risk.

Most people had an accurate perception of their fall risk. Those in the "vigorous" group (low actual and low perceived fall risk) were considered at low risk of future significant falls, while those in the "aware" group (high actual and high perceived fall risk) were considered at high risk of future significant falls.

However, about one third of elderly people either underestimated or overestimated their risk of falls.

For example, the "anxious" group had a low actual but high perceived fall risk, which was related to depressive symptoms, neurotic personality traits and poor physical functioning. In contrast, the "stoic" group had a high actual but low perceived fall risk, which was protective for falling, and related to a positive outlook on life, physical activity, and community participation.

Overall, it seems that high levels of perceived fall risk are likely to result in future falls, irrespective of the actual risk, and the disparity between actual and perceived fall risk contributes to risk mainly through psychological pathways, say the authors.

The findings also suggest that reducing fear of falling is not likely to increase the risk of falls by making older people overly confident, they add.

And they conclude that measures of both actual and perceived fall risk should be included in fall risk assessments so as to tailor interventions for preventing falls in older people.

Moderate Chocolate Intake Tied to Lower Heart Failure Risk

However, protective association not observed with intake of one or more servings daily

22 aug 2010-- Regular, moderate chocolate consumption is linked to a lower rate of heart failure hospitalization or death, but no protective association is seen in individuals consuming one or more servings of chocolate daily, according to a study published online Aug. 16 in Circulation: Heart Failure.

In a prospective cohort study, Elizabeth Mostofsky, of Harvard Medical School in Boston, and colleagues followed 31,823 women, aged 48 to 83 years, without baseline diabetes or a history of heart failure or myocardial infarction from Jan. 1, 1998, through Dec. 31, 2006.

During nine years of follow-up, the investigators found that 419 women were hospitalized for incident heart failure (379) or died of heart failure (40). The multivariate adjusted rate ratio of heart failure was 0.74 for those consuming one to three servings of chocolate per month, 0.68 for those consuming one to two servings per week, 1.09 for those consuming three to six servings per week, and 1.23 for those consuming one or more servings per day, compared to those not regularly consuming chocolate.

"Further studies are needed to confirm or refute these findings and to determine the optimal dose and type of chocolate and to clarify the mechanisms involved," the authors write.

Abstract
Full Text

Moderate drinking, especially wine, associated with better cognitive function

21 aug 2010--A large prospective study of 5033 men and women in the Tromsø Study in northern Norway has reported that moderate wine consumption is independently associated with better performance on cognitive tests. The subjects (average age 58 and free of stroke) were followed over 7 years during which they were tested with a range of cognitive function tests. Among women, there was a lower risk of a poor testing score for those who consumed wine at least 4 or more times over two weeks in comparison with those who drink <>

It has long been known that "moderate people do moderate things." The authors state the same thing: "A positive effect of wine . . . could also be due to confounders such as socio-economic status and more favourable dietary and other lifestyle habits.

The authors also reported that not drinking was associated with significantly lower cognitive performance in women. As noted by the authors, in any observational study there is the possibility of other lifestyle habits affecting cognitive function, and the present study was not able to adjust for certain ones (such as diet, income, or profession) but did adjust for age, education, weight, depression, and cardiovascular disease as its major risk factors.

The results of this study support findings from previous research on the topic: In the last three decades, the association between moderate alcohol intake and cognitive function has been investigated in 68 studies comprising 145,308 men and women from various populations with various drinking patterns. Most studies show an association between light to moderate alcohol consumption and better cognitive function and reduced risk of dementia, including both vascular dementia and Alzheimer's Disease.

Such effects could relate to the presence in wine of a number of polyphenols (antioxidants) and other micro elements that may help reduce the risk of cognitive decline with ageing. Mechanisms that have been suggested for alcohol itself being protective against cognitive decline include effects on atherosclerosis ( hardening of the arteries), coagulation ( thickening of the blood and clotting), and reducing inflammation ( of artery walls, improving blood flow).

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Study source: Arntzen KA, Schirmer H, Wilsgaard T, Mathiesen EB. Moderate wine consumption is associated with better cognitive test results: a 7 year follow up of 5033 subjects in the Tromsø Study. Acta Neurol Scand 2010; Suppl 190:23-29.

Lung Cancer Patients Receiving Palliative Care Have Improved Quality of Life, Extended Survival, Study Finds

Aug. 20, 2010— Integrating palliative care early in the treatment of patients with advanced lung cancer not only improved their mood and quality of life, it also extended their lives. In the August 19 New England Journal of Medicine, Massachusetts General Hospital (MGH) investigators report that patients with metastatic non-small-cell lung cancer (NSCLC) who received early palliative care along with standard treatment lived more than two months longer than patients receiving standard care only. Metastatic NSCLC is difficult to treat, and patients typically are expected to survive less than one year.

"For me as an oncologist, results like this are incredibly exciting," says Jennifer Temel, MD, of the MGH Cancer Center, the paper's lead author. "We showed that adding the services of a care team focused on quality of life and not altering patients' cancer treatments could both enhance and extend life in patients with an incurable cancer diagnosis. These findings are very promising, and we are already taking steps to examine the impact of early palliative care in other situations."

"One of the most common misconceptions about palliative care is that it indicates treatment has failed -- that it means giving up," says Vicki Jackson, MD, MPH, acting chief of the MGH Palliative Care Service and a co-author of the NEJM study. "In this study the addition of palliative care early in the course of illness extended the survival of patients with incurable lung cancer. These patients not only lived longer, they also experienced improved quality of life and were better able to enjoy the time they had remaining."

Palliative care teams consist of physicians, nurses, social workers and chaplains specially trained to help patients facing serious illness cope with the psychological and spiritual aspects of their disease, as well as managing symptoms such as pain, nausea and shortness of breath. Cancer patients traditionally have been enrolled in palliative care late in the course of their illness, often when they are hospitalized and symptoms have become debilitating. A 2007 study by members of the MGH team found it feasible to integrate palliative care into the treatment of patients newly diagnosed with metastatic NSCLC, the leading cause of cancer death in the U.S. The current study was designed to evaluate the impact of early, continuing palliative care on patients' lives.

Study participants -- all of whom had recently been diagnosed with metastatic NSCLC -- were randomly assigned to receive either standard oncology care or early palliative care integrated with standard care. Those in the latter group met with members of the palliative care team within three weeks of study enrollment and then at least monthly throughout the course of their illness. Additional sessions could be scheduled as needed. The visits included assessing and treating symptoms, establishing goals of care, providing psychosocial support and coordinating care with other services. Participants receiving standard care who wished to access palliative services were free to do so at any point during the study.

Members of both groups completed standard questionnaires assessing mood and quality of life when they enrolled in the study and 12 weeks later. The research team collected data on the services and treatments participants received -- including hospital admission, hospice services, chemotherapy and other medications -- as well as whether patients' resuscitation preferences were documented in the medical record. A total of 151 patients enrolled -- 77 assigned to the palliative care group, and 74 to standard care -- during the three-year study period.

Responses to the quality-of-life questionnaire showed significant improvement from enrollment to 12-week assessment in the palliative care group but worsening quality of life in the standard care group. Depression symptoms in the palliative care group were about half those reported in the standard care group at 12 weeks, although the rates of new antidepressant prescriptions among both groups was similar. While more than half the palliative care participants had documented resuscitation preferences, essential to ensuring that patients' goals and end-of-life wishes are respected, fewer than 30 percent of standard care participants had documented preferences.

More than half the standard care participants received what the study protocol defined as aggressive end-of-life care -- chemotherapy within 14 days of death, a time when it is usually considered futile, and either no or late referral to hospice care -- compared with only a third of the palliative care group. Despite the lack of such aggressive end-of-life care, patients in the palliative care group lived an average of 11.6 months, while survival for standard care patients was less than 9 months.

Temel says, "Traditionally, cancer care has focused on treating the disease itself, but now we realize we must also focus on managing patient's symptoms and distress related to their diagnosis. We hypothesize that the increased survival was due to improved mood and quality of life, to early and more comprehensive management of symptoms and complications, and possibly to more appropriate end-of-life care. Similar studies in patients with other types of cancers and in other care settings will help us better understand the impact palliative care can have on the well-being and health of all patients with cancer." Temel is an assistant professor of Medicine, and Jackson an instructor in Medicine at Harvard Medical School.

The study was supported by grants from the American Society of Clinical Oncology, the Joanne Hill Monahan Cancer Fund and Golf Fights Cancer.

Discovery May Aid Search for Anti-Aging Drugs: Gene's Action May Help Explain Why Restricting Diet Lengthens Life in Animals

Ao-Lin Hsu. (Credit: Image courtesy of University of Michigan Health System)

Aug. 18, 2010 — A team of University of Michigan scientists has found that suppressing a newly discovered gene lengthens the lifespan of roundworms. Scientists who study aging have long known that significantly restricting food intake makes animals live longer. But the goal is to find less drastic ways to achieve the same effect in humans someday.

The U-M results offer promising early evidence that scientists may succeed at finding targets for drugs that someday could allow people to live longer, healthier lives.

In a study in the August issue of Aging Cell, U-M scientists found that a gene, drr-2, is an important component in a key cellular pathway, the TOR nutrient-sensing pathway, where many scientists are looking for potential drug targets. The U-M scientists then found that when they caused the drr-2 gene to be under- or over-expressed, they could lengthen or shorten lifespan in C. elegans, a worm widely used in research. Manipulating the drr-2 gene's action produced the same effects as reducing or increasing caloric intake.

"We showed that in C. elegans, drr-2 is one of the essential genes for the TOR pathway to modulate lifespan," says Ao-Lin Allen Hsu, Ph.D., the study's senior author and a scientist at the U-M Geriatrics Center. He also is an assistant professor in internal medicine and molecular and integrative physiology at U-M. The study also found that drr-2 appears analogous to a human gene, eIF4H, that controls similar cell functions.

Context

To find possible avenues for future anti-aging drugs, many scientists around the world are focusing on signaling pathways in cells that sense nutrients. The one Hsu examined, the target of rapamycin pathway or TOR pathway, is so named because its activity can be influenced by the drug rapamycin. Recent results from a large federal study being conducted at U-M and elsewhere have shown that in mice, rapamycin is effective at mimicking the anti-aging effects of dietary restriction.

Research in the last 25 years has shown that animals, including mammals, live longer and have lower levels of certain measures of age-related decline when scientists have restricted their food intake. No one has been able to show yet that the same effect happens in humans, though some studies are under way.

When calories or certain nutrients are restricted, scientists detect less oxidative damage in animal cells and a slower decline in DNA repair, a decline that normally occurs with age. It's thought that limiting oxidative damage and slowing the decline in DNA repair could help postpone or avoid many age-related diseases.

But scientists know relatively little about why reducing food intake causes these effects. In the last 10 years, they have made progress in identifying genes and associated proteins that are suppressed when diet is restricted. By learning more about the cell processes involved, they may be able to discover targets for future drugs that could delay aging without the need to restrict food intake.

Drugs tailored to block specific genes or proteins involved in nutrient-sensing pathways would have much more appeal than reducing what one eats. To achieve anti-aging benefits, it's thought that people would have to restrict food intake by 30 to 40 percent, a grim prospect. In addition, drugs might be designed to avoid other disadvantages of this level of dietary restriction, which include reduced fertility.

C. elegans is a tiny roundworm, a nematode whose two-week lifespan is a great advantage for scientists studying aging. The 1-millimeter-long transparent worms have other advantages, too. C. elegans exhibits many age-associated changes observed in higher organisms.

"Many genes identified in C. elegans to control the speed of aging turned out to be evolutionarily conserved, meaning that you can find them in other animals, too. And many are very similar to those found in humans," Hsu says.

Research details

Hsu and his team created different mutant strains of roundworms, some with drr-2 genes silenced and others in which the gene was over-expressed. They wanted to learn whether inactivating drr-2 is essential for TOR to influence longevity, and found that it was. Other newly discovered genes may affect TOR signaling as well. But Hsu's team has found a promising lead for anti-aging drugs of the future: They were able to show that silencing drr-2's action alone was sufficient to make worms live longer than wild-type C. elegans used as controls.

"It is known that reduction of TOR signaling in response to a change in the environment or genetic manipulation triggers a cascade of cellular signals that alter cell growth, metabolism, and protein synthesis, and decrease the pace of aging," says Hsu. "Our recent studies have shown that drr-2 might play a pivotal role in the TOR signaling network to control protein synthesis as well as longevity."

Additional U-M authors: Tsui-Ting Ching, Alisha B. Paal, Avni Mehta, and Linda Zhong, all of the Division of Geriatric Medicine, U-M Department of Internal Medicine Funding: Ellison Medical Foundation and the National Institutes of Health

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Journal Reference:

1. # Tsui-Ting Ching, Alisha B. Paal, Avni Mehta, Linda Zhong and Ao-Lin Hsu. drr-2 encodes an eIF4H that acts downstream of TOR in diet-restriction-induced longevity of C. elegans. Aging Cell, 2010;
   

Dysphagia found to increase length of hospital stay and mortality risk

Underdiagnosed swallowing condition causes complications in hospitalized patients

18 aug 2010--Researchers from Mount Sinai School of Medicine have found that hospitalized patients with dysphagia, or difficulty swallowing, averaged a 40 percent longer hospital stay than patients without the condition. They also had a generally poorer prognosis. The research is published in the August issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

The researchers evaluated more than 77 million hospital admissions during 2005-2006, 271,983 of which were associated with dysphagia, as indicated by the National Hospital Discharge Survey (NHDS). The median number of days in the hospital for patients with dysphagia was 4.04, compared to 2.40 days for patients without dysphagia. Mortality increased significantly in patients with dysphagia and disk disorders or heart disease, and those undergoing rehabilitation had a greater than 13-fold increased risk of mortality. Patients ages 75 and older were twice as likely to have dysphagia.

"Our study shows that dysphagia has a significant impact on length of stay and prognostic indicators," said Kenneth W. Altman, MD, PhD, Associate Professor of Otolaryngology, lead author on the study. "Early identification of dysphagia and therapeutic intervention are critical to preventing further complications in these patients and reducing length of stay. These data indicate the necessity for health care providers to prevent or diagnose this condition early to reduce complications."

The impact of dysphagia on hospital resources was also substantial. Patients with dysphagia are often at risk of aspirating, which often requires antibiotic use and intubation. The increased mortality risk associated with the condition also increases end-of-life costs. Using a measurement tool previously developed for community-acquired pneumonia, the researchers estimated the cost of dysphagia at nearly $550 million over the two year period.

"With our country moving into a value-based health care system, we will truly feel the impact of the costs associated with dysphagia," said Dr. Altman. "As such, it's important to develop strategies to prevent and treat this debilitating condition to reduce those costs."

Dysphagia is present with a number of serious conditions, which may contribute to mortality risk. The most common conditions associated with dysphagia were stroke, aspiration pneumonia, urinary tract infection, esophageal disease, fluid or electrolyte disorder, and congestive heart failure. Patients with these conditions are especially susceptible to aspiration. The authors emphasize that dysphagia is severely underreported, due to minor cases not being documented, or clinicians seeing it as a side effect of another condition rather than a condition itself.

"Hospitals should implement assessment tools to identify dysphagia in high risk patients, including the elderly, stroke and rehabilitation patients, and patients with malnutrition, neurodegenerative disease, pneumonia, or heart disease," said Dr. Altman. "At Mount Sinai, we are making every effort to identify these patients early to prevent further complications."

Immune system gene linked with Parkinson's: study

CHICAGO, 17 aug 2010– A gene linked with the immune system may play a role in developing Parkinson's disease, researchers said on Sunday, marking a possible advance in the search for effective treatments.

They said a gene in the human leukocyte antigen region or HLA -- which contains a large number of genes related to immune system function -- was strongly linked with Parkinson's disease.

"That means the immune system probably plays a role in your body developing Parkinson's disease," said Dr. Cyrus Zabetian of the University of Washington and Veteran's Administration Puget Sound Health Care System, whose study appears in the journal Nature Genetics.

Zabetian said there had been hints that the immune system may be linked to Parkinson's disease, a neurodegenerative disease that affects 1 to 2 percent of people over age 65.

"This is the best evidence we've seen so far," Zabetian said in a telephone interview.

The finding came from a large, long-term study of more than 2,000 Parkinson's disease patients and 2,000 healthy volunteers from clinics in Oregon, Washington, New York and Georgia.

Parkinson's sufferers have tremors, sluggish movement, muscle stiffness and difficulty with balance.

Researchers looked at clinical, genetic and environmental factors that might contribute to the development and progression of Parkinson's disease and its complications.

"We found strong evidence that a gene within the HLA region is associated with Parkinson's disease," Zabetian said.

HLA genes play an important role in helping the body discern between foreign invaders and the body's own tissues.

"We don't know specifically which gene because there is a cluster of genes in that region, but it is the first really strong link that the immune system plays a role," he said.

That may mean infections, inflammation or an auto-immune response play some role in the development of Parkinson's disease, Zabetian said.

"What this allows us to do is to hone in on the immune system," he said.

Although current medical treatments may improve symptoms, none can slow or halt the progression of the disease.

The study was funded in part by the National Institute of Neurological Disorders and Stroke, one of the National Institutes of Health.

CHC/IHF: Two Newer BP Drugs Not Better Than Diuretic

Extended ALLHAT study shows lisinopril, amlodipine not superior to chlorthalidone

16 aug 2010-- The ACE inhibitor lisinopril and the calcium channel blocker amlodipine are no better than the older, cheaper diuretic chlorthalidone for lowering blood pressure and preventing cardiovascular disease, according to research presented at the China Heart Congress and International Heart Forum, held from Aug. 12 to 15 in Beijing.

Paul Whelton, M.D., of the Loyola University Health System in Maywood, Ill., and chairman of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), reported the findings from the trial, which used data from participants (initial results published in 2002) who were followed for an additional four to five years. The original ALLHAT data showed that chlorthalidone, which costs only $25 to $40 per year, was superior to the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure, and overall cardiovascular disease.

In the new study, the differences in treatment effect between the chlorthalidone group and the other two groups were smaller than they were previously, but there was no evidence of any superiority of the ACE inhibitor or the calcium channel blocker in terms of prevention of major cardiovascular disease events.

The researchers "are continuing to mine data that we collected during the trial," Whelton said in a statement.

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Brain fitness programs may help frail elderly walk faster

13 aug 2010– Computerized brain fitness programs are known to help seniors improve their memory and focus. Now, a study led by researchers at Albert Einstein College of Medicine of Yeshiva University has found preliminary evidence that such programs may help frail seniors walk faster, potentially preventing disability and improving quality of life. Results appear in the July 19 online edition of the Journal of Gerontology.

The researchers recruited 20 frail seniors (aged 70 or older) who were sedentary (exercised once a week or less) and walked slowly (a speed of one meter per second or less). Ten of the seniors (the intervention group) participated in the Mindfit brain fitness program three times weekly for eight weeks, with each training session lasting from 45 to 60 minutes. During the sessions, they carried out tasks aimed at sharpening cognitive abilities such as focusing, planning, organizing and problem solving. The other 10 seniors constituted the control group.

Compared with their speeds at the start of the study, the 10 seniors in the intervention group improved their normal-walking velocity, although the gain was not statistically significant. For walking while talking – which requires considerably more concentration than normal walking – the seniors who took computer training notably improved compared with their initial speeds. By contrast, no improvement in walking speed was observed for the control group.

"This was a small study – we're now preparing to do a larger clinical trial – but the results suggest that brain fitness programs show promise for helping the frail elderly walk better," says lead author Joe Verghese, M.D., professor in the Saul R. Korey Department of Neurology and the Murray D. Gross Memorial Faculty Scholar in Gerontology at Einstein.

The findings, if duplicated in a larger study, could have important implications since the frail elderly are often in poor health and unable to participate in exercises that build strength and improve balance. Intervening through brain fitness programs could provide a useful alternative.

Three Genotypes Confirmed as Alzheimer's Disease Risk Loci

CR1, CLU, and PICALM confer risk for AD; plasma β-amyloid associated with faster cognitive decline

12 aug 2010-- Three specific genotypes at CLU, PICALM, and CR1 confer risk for Alzheimer's disease (AD), and an apolipoprotein E genotype, APOE ε4, interacts synergistically in those who also have the PICALM variant, according to a study published online Aug. 9 in the Archives of Neurology. A related study in the same issue clarifies the association between plasma β-amyloid (Aβ) and various aspects of cognition.

Gyungah Jun, Ph.D., of Boston University, and colleagues conducted a meta-analysis of studies on AD and the CLU, PICALM, CR1, and APOE genotypes. They included studies with 8,169 elderly cognitively normal controls and 7,070 cases with AD from four ethnic groups (whites, African-Americans, Israeli-Arabs, and Caribbean Hispanics). CLU, PICALM, and CR1 were associated with AD in whites, but not in other ethnicities. The Arab cohort and all except one small white cohort had significant associations between AD and APOE ε4. After adjustments for the presence of APOE ε4, age, and sex, there was reduced evidence for association of AD with PICALM but not CR1 or CLU.

In another study, Stephanie A. Cosentino, Ph.D., of the Columbia University Medical Center in New York City, and colleagues studied 888 ethnically diverse individuals who had two Aβ samples and were free of dementia at the first sample. The study subjects had three visits over about four and a half years; 481 stayed cognitively healthy, 329 were cognitively or functionally impaired but never demented, and 70 developed AD. The researchers found that high baseline plasma Aβ42 and Aβ40 were related to faster cognitive decline in several domains, as was decreasing or relatively stable Aβ42. In cognitively healthy subjects, high baseline plasma Aβ42 and relatively stable or decreasing Aβ42 were also related to faster decline, especially in memory.

"The association between plasma Aβ and multiple aspects of cognition more clearly specifies the previously documented downward trajectory of plasma Aβ with AD onset. The predominant association with memory seen only in healthy elderly individuals also suggests that plasma Aβ is linked with even earlier neurologic changes that may or may not culminate in dementia," Cosentino and colleagues write.

Authors of the first study disclosed financial ties to pharmaceutical and medical device companies.

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'Biomarkers' Could Spot Alzheimer's Disease Early, Studies Suggest

11 aug 2010-- The presence of three proteins in cerebrospinal fluid may spot Alzheimer's disease long before symptoms start and might also signal how fast the disease is progressing.

The findings, appearing in the August issue of the Archives of Neurology, support recently released diagnostic criteria touting the use of such proteins, also known as biomarkers, in aiding diagnosis of this form of dementia.

"This just reinforces the recommendation by [Alzheimer's working groups] saying that biomarkers can actually be incorporated today into clinical practice in order to add a certain piece to the diagnosis if patients are already presenting with something that looks like Alzheimer's," said Maria C. Carrillo, senior director of medical and scientific relations at the Alzheimer's Association.

An accompanying editorial echoed that thought, by "strongly commend[ing] CSF [cerebrospinal fluid] analyses of A1-42, T-tau, and P-tau in circumstances where having a definitive diagnosis of AD is important for counseling patients about such concerns as work, driving, and making other lifestyle changes."

Scientists have been busily trying to find physiological indications that can indicate if a person has Alzheimer's disease or is going to develop it. Right now, effective medications against Alzheimer's do not exist. However, the disease likely begins a decade or so before symptoms appear, experts say, so spotting it early might someday mean earlier (and therefore more effective) prevention and treatment.

These researchers measured levels of three proteins - total tau protein, phosphorylated tau and amyloid protein - in the cerebrospinal (CSF) of 102 people with Alzheimer's, 200 people with mild cognitive impairment and 114 "normal" individuals.

An "Alzheimer's disease signature" was present in 90 percent of the Alzheimer's patients, 72 percent of those with mild cognitive impairment (MCI) and 36 percent of those who had no cognitive impairments.

A signature consisting of low amyloid levels and high phosphorylated tau levels identified patients with MCI who progressed to Alzheimer's with 100 percent accuracy, the team said.

The fact that the signature was also found in individuals with no sign of cognitive impairment underlines the likelihood that Alzheimer's disease has started long before it is symptomatic, stated the authors.

Another research group, this one set to report its finding in the December print issue of the Archives of Neurology verified that blood levels of the beta-amyloid protein predict progression toward Alzheimer's -- another step towards identifying valid biomarkers for the disease.

Patients who started out with high levels of the protein that later tapered off, saw their cognitive health decline more rapidly, even if they did not end up with full-blown Alzheimer's.

"High baseline levels of amyloid beta in combination with declining levels over time was sort of a high-risk profile for the development of Alzheimer's disease," explained study first author Stephanie Cosentino, an assistant professor of neuropsychology at Columbia University's Taub Institute in New York City.

The findings support the "amyloid cascade" theory of Alzheimer's, "which points to the accumulate of amyloid in brain as primary trigger for Alzheimer's disease," Cosentino said.

"This paper, which replicated an [earlier] study on these three risk genes indicates that ultimately, genetic biomarkers may play a very strong role in the whole spectrum of biomarkers [involved in Alzheimer's]," stated Carrillo, who was not involved with either study.

But, Cosentino cautioned, "amyloid beta is not ready to be used as a disease biomarker. Not everyone who has high levels of plasma amyloid beta will demonstrate Alzheimer's disease or cognitive decline. Other factors need to be taken into account."

This marker may have more immediately utility in clinical trials, as a way to determine if drugs-in-process are actually effective, she said.

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Visit the Alzheimer's Association for more on this disease.

Chronic Pain Gene Discovery May Spark Treatments

10 aug 2010- Nearly 20 percent of American adults suffer from persistent, chronic pain, but a new genetic clue may aid in the understanding and treatment of the debilitating condition.

Chronic pain can affect all aspects of life, from sleep, to work, to exercise. Some individuals are more susceptible to pain than others, but the reason for this has not been understood. For example, the amount of pain two patients experience after the same surgery can differ greatly.

An international team of researchers sought to find out if there is a genetic basis for susceptibility to pain. Using animal models, they were able to link mouse chromosome 15 with pain. Using two fine-mapping approaches, they narrowed it down to one gene: Cacgn2, which was previously know to be associated with cerebral function and epilepsy. Before now, no other gene has ever been associated with pain.

To further test the gene, scientists used a mouse strain harboring the mutant gene, previously used for epilepsy research, and the findings were consistent; the mice experienced different behavioral and electrophysiological characteristics linking the chronic pain to Cacgn2.

Researchers wanted to know if the Cacgn2 gene is responsible for chronic pain in humans as well. To find out, they studied a cohort of breast cancer patients that had all or partial removal of the breast, and found genetic polymorphisms in Cacgn2 were significantly associated with chronic pain experienced after surgery.

"The immediate significance is the mere awareness that differences in pain perception may have a genetic predisposition," Ariel Darvasi of the Hebrew University of Jerusalem in Israel, was quoted as saying. "Our discovery may provide insights for treating chronic pain through previously unthought-of mechanisms."

SOURCE: Genome Research, published online August 4, 2010

Tests Help Predict Falls in Parkinson's Disease

09 aug 2010— A group of tests may help predict which people with Parkinson's disease are more likely to fall, according to a study published in the June 23, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Falls are a major problem for people with Parkinson's disease and can lead to injuries and reduced mobility, which can result in increasing weakness, loss of independence and increased use of nursing homes," said study author Graham K. Kerr, PhD, of Queensland University of Technology in Brisbane, Australia. "Despite these issues and their impact on the health care system and society, little research has been done to help predict which people with Parkinson's disease are more likely to fall so we can try to prevent these falls."

For the study, 101 people with Parkinson's disease who were able to walk without any aids took a variety of tests evaluating their Parkinson's symptoms, balance and mobility. The participants then reported any falls that occurred over a six-month period.

Most participants were in the early stage of the disease, with an average of six years since the disease was diagnosed. The majority of the participants (77 percent) had the type of Parkinson's that is mainly affected by difficulty with voluntary movements, while 20 percent had tremors as the central symptom of the disease.

A total of 48 percent of the participants had a fall during the study and 24 percent had more than one fall. A total of 42 percent reported that they had fallen in the year before the study started.

The tests that were the best predictors of whether a person was likely to fall included a test of overall Parkinson's symptoms, a questionnaire on how often people tended to "freeze" while walking, and a test of balance. When these tests were combined, the results produced a sensitivity of 78 percent and a specificity of 84 percent for predicting falls. Sensitivity is the percentage of actual positives that are correctly identified as positive, and specificity is the percentage of negatives that are correctly identified.

"These tests are easy to implement and take only a short time to complete," Kerr said. "Once we can identify those at risk of falling, we can take steps to try to prevent these falls." In the United States, it is estimated that about one million people have Parkinson's disease.

The study was supported by Parkinson's Queensland Inc., the Queensland University of Technology, and the Australian National Health and Medical Research Council.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.

Deep Brain Stimulation Shows Promise for Patients With Alzheimer's

08 aug 2010— In a world first, Dr. Andres M. Lozano and his team at Toronto Western Hospital has shown using Deep Brain Stimulation (DBS) on patients with early signs of Alzheimer's disease is safe and may help improve memory.

The phase one safety trial of six Ontario patients took place from 2005 to 2008. All patients left hospital within 2 to 3 days of surgery, and continue to participate in regular follow-up cognitive assessments.

Throughout these assessments, Dr. Lozano says half the patients continue to perform better than predicted -- that is -- their memory capacity has improved, or deteriorated less than expected.

"While the study was not looking for efficacy, the results suggest that of the six patients, three may have done better than if the Alzheimer's disease was allowed to run its course," commented Lozano. "We showed that not only is this a safe procedure, but that the evidence is there to warrant a bigger trial. Any amount of time that extends quality of life and quality years to someone with Alzheimer's may be a benefit."

Dr. Lozano first discovered the potential for DBS to treat Alzheimer's disease while treating a patient for obesity using DBS back in 2003. While signaling areas of the brain, Dr. Lozano and his team triggered memories in the patient. In follow-up testing the patient's memory improved and Dr. Lozano set in motion the first ever DBS trial of patients with early signs of Alzheimer's disease.

"We've demonstrated this is safe, and that the evidence warrants more study. We're now planning a phase two, multi-centred trial -- we're just waiting on the funding," says Dr. Lozano.

Results of Dr. Lozano's trial are published in the August 4 issue of Annals of Neurology.

Healing Prayer or Proximity?

07 aug 2010-- Many have prayed for a loved ones health to be restored, but researchers say for best results, get close.

A new study shows praying for another person's health can benefit that person, especially if the person praying is close to the ill. The Study of The Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique," measured how people in poorer areas who don't have glasses and hearing aids readily available reacted to prayer.

Proximal prayer is often practiced by Pentacostal and Charismatic Christians. Pentacostals often pray for their own healing and ask others to do distant intercessory prayer, but they feel that proximal prayer is very important. They emphasize the importance of being close and physically touching the person for effective healing.

"When people feel that they have serious need for healing, they are willing to try almost anything," Candy Gunther Brown, an associate professor in the Department of Religious Studies at Indian University Bloomington, was quoted as saying. "If they feel that a particular religious or spiritual practice healed them, they are much more likely to become an adherent. This phenomenon, more than any other, accounts for the growth of these Christian subgroups globally."

The study was conducted in Mozambique and Brazil because of their reputation for being popular places for specialized prayer. Researvhers studied the effects of prayer on people with vision and hearing impairments. They decided on these to conditions because they are easily detectable with an audiometer and vision chart. The subjects were 14 Mozambican natives who were audibly impaired and 11 who were visually impaired. The subjects reported improvements in their vision and hearing. Two with hearing problems reported reducing the threshold at which they could hear by 50 decibels, and three visually impaired subjects went from 20/400 to 20/80 vision.

There is much controversy behind PIP because scientists and doctors argue that it is not clinically proven or scientific enough to be tested and used in clinical settings, but regardless, the medical community is committed to healing people any way necessary.

Source: Southern Medical Journal, September 2010

Eliminating diabetes and depression, and boosting education, most likely to ward off dementia

Research: Designing prevention programs to reduce incidence of dementia: Prospective cohort study of modifiable risk factors

06 aug 2010--Eliminating diabetes and depression, as well as increasing education and fruit and vegetable consumption, are likely to have the biggest impact on reducing levels of dementia in the coming years, should no effective treatment be found, concludes a study published on bmj.com today.

These findings suggest priorities for future public health interventions.

While the exact cause of dementia is still unknown, several modifiable risk factors have already been identified. These include vascular risk factors (heart disease, stroke, high blood pressure, obesity, diabetes, and high cholesterol), a history of depression, diet, alcohol consumption, and education level.

Based on this knowledge, a team of researchers based in France and the UK estimated which of these risk factors might be most effective in reducing the future burden of dementia, should no effective treatment be found.

Their analysis involved 1,433 healthy people aged over 65 years living in the south of France and recruited between 1999 and 2001. Participants underwent cognitive testing at the start of the study and again at two, four and seven years. A reading test (the Neale score) was also used as an indicator of lifetime intelligence.

Medical history and information on measures such as height, weight, education level, monthly income, mobility, dietary habits, alcohol consumption, and tobacco use was obtained. An individual's genetic risk of dementia was also measured: although it's not a factor that can be changed it served as a useful benchmark for dementia risk.

Results showed that eliminating depression and diabetes and increasing fruit and vegetable consumption were estimated to lead to an overall 21% reduction in new cases of dementia, with depression making the greatest contribution (just over 10%). However, the researchers point out that the direct (causal) relationship between depression and dementia remains unclear.

Increasing education would also lead to an estimated 18% reduction in new cases of dementia across the general population over the next seven years. By contrast, eliminating the principal known genetic risk factor from the general population would lead only to a 7% reduction in the number of new cases over the next seven years.

Given these findings, the authors suggest that public health initiatives should focus on encouraging literacy at all ages irrespective of ability, prompt treatment of depressive symptoms, and early screening for glucose intolerance and insulin resistance (early stages in the development of diabetes).

While these calculations can only provide a crude estimate of impact on incidence, they do make a significant statement about public health priorities in disease prevention in the face of current knowledge, conclude the authors. Further studies including younger adults are clearly needed to test the impact of intervention measures.

A second study, also published on bmj.com today, finds that death rates are more than three times higher in people with dementia than in those without dementia in the first year after diagnosis. The study also says that earlier and better detection of dementia in primary care is needed. An accompanying editorial suggests that key areas to focus on include better education and training in primary care, developing more integrated systems of care, and ensuring that policy makers and commissioners plan services that reflect the effects of dementia on primary care and other services.

Octogenarians have more heart surgery, live longer

NEW YORK , 05 aug 2010-- Heart surgery and the use of other invasive treatments have risen sharply in elderly people who've suffered a heart attack, Canadian researchers said Tuesday.

In addition, the number of deaths within one year of those heart attacks dropped by almost 10 percent between 1996 and 2006, data from Quebec hospital patients aged 80 and older show.

"Over the last decade we are doing procedures in patients once believed to be too old for these procedures," said chest surgeon Dr. Mark R. Katlic, of Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pennsylvania, who was not involved in the new study.

"It's my belief that this is a positive development," he said, cautioning that the study didn't prove the new treatment had reduced the number of deaths.

An earlier study found that U.S. heart patients of all ages are more likely to undergo procedures to clear blocked coronary arteries than are Canadians.

The current study, published in the Canadian Medical Association Journal, was carried out by Dr. Louise Pilote and colleagues of McGill University in Montreal.

Over a 10-year period, the researchers found that nearly 30,000 octogenarians in Quebec had suffered a heart attack.

In 1996, most of the patients received standard medications such as beta-blockers and cholesterol-lowering drugs, and only a few percent underwent invasive procedures.

Ten years later, however, that number had ballooned: A quarter of all patients were undergoing angioplasty, a procedure in which the doctor cleans out the blocked arteries that caused the heart attack.

Overall, almost half the patients died within a year of their heart attacks in 1996, while fewer than four in ten died in 2006.

The drop in mortality only occurred in patients who had undergone invasive procedures, suggesting those treatments might help patients survive longer. But it's possible that other changes in how doctors managed the patients could also have been involved.

Heart attacks kill more than 400,000 people in the U.S. every year according to the American Heart Association, and heart disease remains the leading cause of death.

Dr. Katlic, who wrote an editorial about the new study, said it was important to consider the cost of the procedures, which may amount to tens of thousands of dollars.

Medications are much less expensive, he told Reuters Health, but it's unclear if they are equally effective at preventing another heart attack.

"We should also study whether the quality of life is better after these procedures," he said.

SOURCE: link.reuters.com/ceh23n Canadian Medical Association Journal, online August 3, 2010.

Decreased Cardiac Function Linked to Faster Brain Aging

Bottom and middle cardiac index tertiles linked to significantly lower brain

04 aug 2010-- Reductions in cardiac function, as measured by cardiac index, may be associated with accelerated aging of the brain, according to a study published online Aug. 2 in Circulation.

Angela L. Jefferson, Ph.D., of the Boston University School of Medicine, and colleagues evaluated 1,504 individuals from the Framingham Heart Study Offspring Cohort who were free of clinical stroke, transient ischemic attack, or dementia (mean age, 61 years).

In multivariable-adjusted models, the researchers found that cardiac index was positively associated with total brain volume and information processing speed, as well as inversely associated with lateral ventricular volume. When excluding patients with clinically prevalent cardiovascular disease, the association between cardiac index and total brain volume remained. In post hoc analysis, the researchers found that participants in the bottom cardiac index tertile (values <2.54)>2.92).

"Whether lower cardiac index leads to reduced brain volumes and accelerates neurodegeneration on an eventual path to dementia is not yet clear," write the authors of an accompanying editorial. "What is known is that various vascular risk factors, including decrements in cardiac function, are determinants of dementia (both Alzheimer disease and variants of vascular cognitive disorders)."

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Exercise and caloric restriction rejuvenate synapses in lab mice

03 aug 2010-- Harvard University researchers have uncovered a mechanism through which caloric restriction and exercise delay some of the debilitating effects of aging by rejuvenating connections between nerves and the muscles that they control.
The research, conducted in the labs of Joshua Sanes and Jeff Lichtman and described this week in the journal Proceedings of the National Academy of Sciences, begins to explain prior findings that exercise and restricted-calorie diets help to stave off the mental and physical degeneration of aging.
"Caloric restriction and exercise have numerous, dramatic effects on our mental acuity and motor ability," says Sanes, a professor of molecular and cellular biology and director of the Center for Brain Science at Harvard. "This research gives us a hint that the way these extremely powerful lifestyle factors act is by attenuating or reversing the decline in our synapses."
Sanes says their research, conducted with mice genetically engineered so their nerve cells glow in fluorescent colors, shows some of the debilitation of aging is caused by deterioration of connections that nerves make with the muscles they control, structures called neuromuscular junctions. These microscopic links are remarkably similar to the synapses that connect neurons to form information-processing circuits in the brain.
In a healthy neuromuscular synapse, nerve endings and their receptors on muscle fibers are almost a perfect match, like two hands placed together, finger to finger, palm to palm. This lineup ensures maximum efficiency in transmitting the nerve's signal from the brain to the muscle, which is what makes it contract during movement.
As people age, however, the neuromuscular synapses can deteriorate in several ways. Nerves can shrink, failing to cover the muscle's receptors completely. The resulting interference with transmission of nerve impulses to the muscles can result in wasting and eventually even death of muscle fibers. This muscle wasting, called sarcopenia, is a common and significant clinical problem in the elderly.
The new work showed that mice on a restricted-calorie diet largely avoid that age-related deterioration of their neuromuscular junctions, while those on a one-month exercise regimen when already elderly partially reverse the damage.
"With calorie restriction, we saw reversal of all aspects of the synapse disassembly. With exercise, we saw a reversal of most, but not all," Sanes says.
Because of the study's structure -- mice were on calorie-restricted diets for their whole lives, while those that exercised did so for just a month late in life -- Sanes cautions against drawing conclusions about the effectiveness of exercise versus calorie restriction. He notes that longer periods of exercise might have more profound effects, a possibility he and Lichtman are now testing.
Though much of Sanes and Lichtman's work focuses on brain synapses, both have investigated neuromuscular synapses for many years. Neuromuscular junctions are large enough to be viewed by light microscopy, and can be a jumping-off point for brain study, highlighting areas of inquiry and potential techniques.
"These findings in neuromuscular synapses make us curious to know whether similar effects might occur in brain synapses," Sanes says.
While the changes to the synapses through caloric restriction and exercise were clear in the images the researchers obtained, Sanes cautioned that their work was structural, not functional, and they have not yet tested how well the synapses worked.
Provided by Harvard University

Social Relationships Linked to Improved Survival

Meta-analysis finds such relationships associated with 50 percent higher chance of survival

02 aug 2010-- Having stronger social relationships is associated with an increased likelihood of survival, with a magnitude of effect that's comparable to quitting smoking, according to research published online July 27 in PLoS Medicine.

Julianne Holt-Lunstad, Ph.D., of Brigham Young University in Provo, Utah, and colleagues performed a meta-analytic review of 148 studies with 308,849 participants that investigated the association between social relationships and mortality.

The researchers found a 50 percent increased likelihood of survival for participants who had stronger social relationships. The association was most prominent for complex measures of social integration (odds ratio, 1.91) and lowest for binary measures of residential status, such as living alone compared to living with others (odds ratio, 1.19). The authors write that the magnitude of the findings is comparable to quitting smoking and exceeds mortality risk factors such as obesity and physical inactivity.

"Physicians, health professionals, educators, and the public media take risk factors such as smoking, diet, and exercise seriously; the data presented here make a compelling case for social relationship factors to be added to that list. With such recognition, medical evaluations and screenings could routinely include variables of social well-being; medical care could recommend if not outright promote enhanced social connections; hospitals and clinics could involve patient support networks in implementing and monitoring treatment regimens and compliance, etc.," the authors conclude.

The study was partially funded by a grant from TP Industrial Inc.

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