Physical Ability Measures Predict Death Risk in Elderly

Poor grip strength, walking speed, chair rising, and standing balance predict higher mortality

30 sept 2010 -- Community-dwelling elderly people with poor performance on objective measures of physical capability are at higher risk of death than those who perform better, according to a meta-analysis published online Sept. 9 in BMJ.

Rachel Cooper, Ph.D., of the University College London, and colleagues screened the medical literature and identified studies that examined the associations of four objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality. The researchers pooled the data and assessed mortality risks for each of the four measures.

Generally, the meta-analysis confirmed that mortality risk increased for those who performed less well on any or all of the four physical capability measures. Comparing the lowest performance quartile to the highest, mortality risks were as follows: for grip strength, hazard ratio (HR), 1.67 (P from Q statistic < p =" 0.25);">

"Objective measures of physical capability are predictors of all-cause mortality in older community-dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death," the authors write.

Two authors disclosed financial relationships with pharmaceutical companies.

Abstract
Full Text

Look AHEAD Results Favor Intensive Lifestyle Intervention

At four years, this diabetes intervention beats education for CVD risk factor reduction

29 sept 2010 -- Intensive lifestyle intervention (ILI) for patients with type 2 diabetes can result in sustained improvements in cardiovascular risk factors and in fitness, according to a report published in the Sept. 27 issue of Archives of Internal Medicine.

Rena R. Wing, Ph.D., of Brown Medical School in Providence, R.I., and other members of The Look AHEAD Research Group reported four-year results of the ongoing trial, which was designed to obtain long-term data on the effects of ILI compared to diabetes support and education (DSE; the control group) on changes in weight, fitness, and cardiovascular disease risk factors.

Averaged across the four years, the researchers found that ILI patients had significantly greater improvements in weight, treadmill fitness, hemoglobin A1c level, high-density lipoprotein cholesterol, triglycerides, and blood pressure. Low-density lipoprotein cholesterol was more improved in the DSE group, a finding related to greater use of lipid-lowering medications in the DSE group.

"ILI can produce sustained weight loss and improvements in fitness, glycemic control, and cardiovascular disease risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in cardiovascular disease events will ultimately be addressed by the Look AHEAD trial," the authors write.

One author disclosed serving on a scientific advisory committee for Free & Clear and financial relationships with BodyMedia Inc., UPMCHealth Plan, and Proctor & Gamble.

Abstract

Friends, family detect early Alzheimer's signs better than traditional tests

Family members and close friends are more sensitive to early signs of Alzheimer's dementia than traditional screening tests, according to researchers at Washington University School of Medicine in St. Louis.

28 sept 2010--Doctors often evaluate a person who is having memory problems by testing them with a variety of cognitive tasks, such as recalling a list of words or comparing shapes of objects. Washington University researchers developed a different approach. The two-minute Ascertain Dementia 8 (AD8) questionnaire relies on a friend or family member who knows the person well, known as an informant, to evaluate whether cognitive changes have caused the individual to have difficulties in performing everyday activities.

In the new study, published online in the journal Brain, scientists validated the AD8 by checking to see if it could highlight individuals who had biological indicators, or biomarkers, for Alzheimer's disease, such as abnormal levels of certain factors in the spinal fluid or positive brain scans for Alzheimer's plaques. The AD8's results corresponded with biomarker results more consistently than traditional cognitive tests.

"It's not economically feasible to screen everyone for Alzheimer's disease biomarkers," says John C. Morris, MD, director of the Charles F. and Joanne Knight Alzheimer's Disease Research Center at Washington University School of Medicine. "The AD8 gives us a brief and very low-cost alternative that takes a few minutes of the informant's time to screen for dementia and thus identify those individuals who need follow-up evaluations to determine if there truly are signs of Alzheimer's."

According to Morris, the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology, the difficulty with traditional early-stage dementia screening tools is that they only give a snapshot of a person's cognitive abilities at one point in time — when they're being tested. Asking the individual if his or her mental abilities have changed doesn't necessarily produce accurate results either, Morris says, because persons with early-stage dementia often lack insight into their problem.

Researchers at the Knight Alzheimer' s Disease Research Center, including first author James Galvin, MD, now at New York University, developed the AD8 from the Center's existing research tools. Informants are asked to rate whether there has been a change in the following areas:

• Problems with judgment, such as bad financial decisions;
• Reduced interest in hobbies and other activities;
• Repeating of questions, stories or statements;
• Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
• Forgetting the month or year;
• Difficulty handling complicated financial affairs, such as balancing a checkbook;
• Difficulty remembering appointments; and
• Consistent problems with thinking and memory.

Informants can respond yes or no to each item; each "yes" response is worth a point, and a score of two or more indicates a need for additional evaluation.

According to Morris, informants who have regular exposure to the individual provide the most accurate assessments.

"These informants can give us the retrospective perspective we need to know that a person's mental abilities have begun to meaningfully decline, indicating that additional testing is needed," Morris says.

For the new study, researchers gathered AD8 evaluations on 251 individuals and also tested them using the Mini Mental State exam, a traditional dementia screening test. They then evaluated biomarkers in the individuals, including spinal fluid assays and brain plaque scans.

"Based on our results, the AD8 appears to be superior to conventional testing in its ability to detect signs of early dementia," Morris says. "It can't tell us whether the dementia is caused by Alzheimer's or other disorders, but it lets us know when there's a need for more extensive evaluations to answer that question."

Since its development, the AD8 has been translated into several different languages and validated in those languages. It is currently in use in clinics around the world.

###

Galvin JE, Fagan AM, Holtzman DM, Mintun MA, Morris JC. Relationship of dementia screening tests with biomarkers of Alzheimer's disease. Brain, online Sept. 10, 2010.

Funding from the National Institute on Ageing and the National Institutes of Health supported this research.

Baby boomers raise midlife suicide rate

Unmarried, non-college graduates at particular risk

Baby boomers appear to be driving a dramatic rise in suicide rates among middle-aged people, a new study finds.

27 sept 2010--The suicide rate for middle-aged people – a group considered relatively protected from suicide and with historically stable suicide rates – took an upward jump between 1999 and 2005, according to research by sociologists Ellen Idler of Emory University and Julie Phillips of Rutgers University.

Their study has been published in the September/October issue of the journal Public Health Reports.

"The findings are disturbing, because they're a reversal of a long-standing trend," Idler says, noting that the suicide rate for the U.S. population overall has been declining for decades. And people aged 40-59, in particular, have long had a moderate suicide rate.

The baby boomers, people born between 1945 and 1964, have broken that pattern. "This is a striking new trend," says Phillips, a social demographer. "Since the 1930s and up to the 1990s, suicide rates among middle-aged people – people aged 40 to 59 – were declining or pretty stable. But after 2000, this picture changed dramatically."

By 2000, most people aged 40 to 59 were baby boomers and the suicide rate started climbing steadily for these middle-age ranges. Idler and Philips found significant increases of more than 2 percent per year for men, and more than 3 percent per year for women, from 1999 to 2005. (By 2005, all middle-aged people were baby boomers.)

The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree, the analysis showed. For example, from 2000 to 2005, the suicide rate jumped nearly 30 percent for men and women aged 50 to 59 with some college but no degree. Middle-aged people with a college degree appeared largely protected from the trend.

The baby boomers also experienced higher suicide rates during their adolescence and young adulthood, doubling the rate for those age groups at the time. Their suicide rate then declined slightly and stabilized, before beginning to increase again in midlife.

"You might think that the higher rates in adolescence would lead to lower rates later because the most suicide prone people would be gone but that doesn't appear to be the case," Idler says. "Clinical studies often show that knowing someone who committed suicide is considered a risk factor for later doing it yourself, and that may be one factor here. The high rates in adolescence could actually be contributing to the high rates in middle age."

Higher rates of substance abuse and the onset of chronic diseases are among other possible factors in the rising baby boomer suicide rate. "As children, the baby boomers were the healthiest cohort that had ever lived, due to the availability of antibiotics and vaccines," Idler says. "Chronic conditions could be more of a rude awakening for them in midlife than they were for earlier generations."

Traditionally, midlife has been considered a time when people are at their peak of social integration. "We need to pay attention to this new increase in suicides, during a period of life previously thought to be stable and relatively protected from suicide, and in an age group now occupied by extraordinarily large numbers of people," Idler says.

Data for the study were drawn from the National Center for Health Statistics and the U.S. Census Bureau. Preliminary data from 2006 and 2007, the latest time that statistics are available, indicate that the upward pattern in midlife suicide is continuing, Idler says.

Worldwide Dementia Price Tag $604 Billion: Report

26 sept 2010-- The global cost of Alzheimer's disease and related dementias in 2010 is an estimated $604 billion, according to a report released Tuesday by Alzheimer's Disease International.

The estimate includes direct costs of medical care in primary and secondary care settings, direct costs of social care provided in residential care settings and by community care professionals, and unpaid informal care offered by family caregivers and others.

The World Alzheimer Report 2010 found that the cost of Alzheimer's and related dementias is about 1 percent of the world's gross domestic product and that if dementia care were a country, it would be the world's 18th largest economy, ranking between Turkey and Indonesia.

Among the other findings:


If dementia care were a company, it would be the world's largest by annual revenue, ahead of such giants as Wal-Mart ($414 billion) and Exxon Mobil ($311 billion).
Worldwide costs of dementia will increase 85 percent by 2030. This is a conservative estimate that considers only increases in the number of people with dementia, said the report authors.
Costs in low- and middle-income countries are likely to rise much faster than in rich nations. This is because these countries will see a sharper rise in the numbers of people with dementia, and economic development will boost costs towards levels in rich countries.

Alzheimer's Disease International is a U.K.-based nonprofit federation of 73 national Alzheimer's organizations, including the Alzheimer's Association in the United States.

"This report clearly illustrates that dementia is already affecting health systems around the world, and for the families who are forced to face Alzheimer's the anguish is universal. The World Alzheimer Report 2010 urges all countries -- including the U.S. -- to develop national plans to deal with the disease," Harry Johns, president and CEO of the Alzheimer's Association, said in an association news release.

The group will present Congress with a 100,000-name petition Tuesday, urging lawmakers to make Alzheimer's disease a national priority.

"Given the magnitude and the impact of Alzheimer's, the U.S. federal government's response to this crisis has been stunningly neglectful," Johns said. "We know Alzheimer's will place a massive strain on an already overburdened health care system, especially Medicare and Medicaid. Substantial investment in Alzheimer research is required to avoid an even more painful future for American families and already overwhelmed state and federal budgets. Yet, the government has no national plan for how to deal with this crisis."

The rare aging disease, Progeria, linked to aging in the general population

Study results demonstrate progerin increases in blood vessels as we age

BOSTON, MA , 08 sept 2010– Progeria, also known as Hutchinson-Gilford Progeria Syndrome (HGPS), is a rare, fatal genetic disease characterized by an appearance of accelerated aging in children. All children with Progeria die of the same heart disease that affects millions of normal aging adults (atherosclerosis), but instead of occurring at 60 or 70 years of age, these children may suffer heart attacks and strokes even before age 10, and the average age of death is 13 years. Finding treatments and a cure for Progeria may provide clues to preventing or treating heart disease in the general population.

On August 26, 2010, Arteriosclerosis, Thrombosis, and Vascular Biology electronically published, ahead of print, the results of a study comparing Progeria, and typical cardiovascular aging, entitled "Cardiovascular Pathology in Hutchinson-Gilford Progeria: Correlation With the Vascular Pathology of Aging". The study found that progerin, the abnormal protein that causes Progeria, is also present in the vasculature of the general population and increases with age.

Researchers examined cardiovascular autopsies and progerin distribution in two patients with Progeria along with a group of 29 individuals without Progeria. Between the ages of one month and 97 years, researchers found that progerin in individuals without Progeria increased an average of 3.3 percent per year in the coronary arteries.

"We found similarities between many aspects of cardiovascular disease in both Progeria and the atherosclerosis that affects millions of people throughout the world" said Dr. Leslie Gordon, senior author of the study, and Medical Director of The Progeria Research Foundation. "We also found progerin in cardiac blood vessels of people without Progeria. The fact that progerin is present at all tells us that there may be a tie between the heart disease of Progeria and the heart disease that affects us all as we age. "

This study supports the possibility that progerin is a contributor to the risk of atherosclerosis in the general population, and merits examination as a potential new element influencing vascular health with aging.

"By examining one of the rarest diseases in the world, we are gaining crucial insight into a disease that affects millions of people worldwide. Ongoing research has the potential to have a significant impact on our understanding of heart disease and aging," said Dr. Gordon


###

The Progeria Research Foundation (PRF) was established in 1999 to find the cause, treatment and cure for Progeria – a rapid aging disease that causes children to die from heart disease or stroke at an average age of 13. In the past 10 years, research conducted in partnership with PRF has identified the gene that causes Progeria and possible treatments. PRF is now funding first-ever Progeria clinical drug trials, currently underway at Children's Hospital Boston. To learn more about Progeria and what you can do to help, please visit progeriaresearch.org

Memory problems more common in men?

ST. PAUL, Minn.,07 sept 2010–A new study shows that mild cognitive impairment (MCI) may affect more men than women. The research is published in the September 7, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Mild cognitive impairment is a condition in which people have problems with memory or thinking beyond that explained by the normal rate of aging. The study found that MCI was 1.5 times higher in men compared to women. MCI often leads to Alzheimer's disease.

"This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men," said study author Ronald Petersen, MD, PhD, with the Mayo Clinic in Rochester, Minn. "If these results are confirmed in other studies, it may suggest that factors related to gender play a role in the disease. For example, men may experience cognitive decline earlier in life but more gradually, whereas women may transition from normal memory directly to dementia at a later age but more quickly."

For the study, 2,050 people between the ages of 70 to 89 in Olmstead County, Minn. were interviewed about their memory and their medical history and tested on their memory and thinking skills.

The study found that nearly 14 percent of participants had mild cognitive impairment, about 10 percent had dementia and 76 percent of those tested had normal memory and thinking skills. A total of 19 percent of men had mild cognitive impairment, compared to 14 percent of women.

"Our results, showing combined rates of MCI and dementia at 22 percent highlight the public health impact these conditions have and the importance of finding treatments for them," said Petersen. People in the study who had a low level of education or were never married also had a higher rate of MCI.

###

The study was supported by the National Institute on Aging, as well as the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program of the Mayo Clinic.

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 epilepsy, dystonia, migraine, Huntington's disease, and dementia.

Healthy Lifestyle May Attenuate Short Telomere Associations

Appears to counterbalance link between shorter telomeres and coronary artery calcium

06 sept 2010-- Engaging in a healthy lifestyle might counterbalance the association between coronary artery calcium (CAC) and shorter telomeres in people who have the latter, according to research published in the Sept. 1 issue of the American Journal of Cardiology.

Vanessa A. Diaz, M.D., of the Medical University of South Carolina in Charleston, and colleagues studied the effect of healthy lifestyle behaviors (high fruit and vegetable consumption, low meat consumption, exercise, social support) on the association between telomere length and the presence of CAC in 318 subjects (aged 40 to 64) with no history of coronary heart disease, stroke, diabetes, or cancer.

After controlling for several factors, the researchers found that high social support, low meat consumption, and high fruit and vegetable consumption attenuated the relationship between shorter telomeres and the presence of CAC. Individuals with these healthy lifestyle characteristics and shorter telomeres did not differ significantly from those with longer telomeres. However, those with shorter telomeres and less healthy lifestyles were at a significantly higher risk for the presence of CAC (odds ratios, 3.30, 3.33, and 2.58 for low fruit and vegetable intake, high meat intake, and low social support, respectively). When individuals were stratified by gender, men had similar results, but only fruit and vegetable intake attenuated the shorter telomeres-CAC relationship in women.

"In conclusion, the results of the present study suggest that being involved in healthy lifestyle behaviors might attenuate the association between shorter telomere length and coronary atherosclerosis, as identified using CAC," the authors write.

Abstract

Over 50? You probably prefer negative stories about young people

COLUMBUS, Ohio, 05 sept 2010 – When given a choice, older people prefer to read negative news, rather than positive news, about young adults, a new study suggests.

In fact, older readers who chose to read negative stories about young individuals actually get a small boost in their self-esteem, according to the results.

And what about younger people? Well, they just prefer not to read about older people.

These results come from a study of 276 Germans who were asked to read what they thought was a test version of an online magazine featuring carefully selected stories about younger and older people.

"Our results bolster the argument that people use the media to enhance their social identity," said Silvia Knobloch-Westerwick, lead author of the study and associate professor of communication at Ohio State University.

"Older people and younger people have different goals when they use the media, and it shows in what they choose to read."

Younger people, who are less certain about their own identity, prefer to read about other younger people to see how they live their lives, Knobloch-Westerwick said.

Older people, on the other hand, have greater certainty regarding their identity. However, living in a youth-centered culture, they may appreciate a boost in self-esteem. That's why they prefer the negative stories about younger people, who are seen as having a higher status in our society.

Knobloch-Westerwick conducted the study with Matthias Hastall of Zeppelin University Friedrichshafen in Germany. Their results appear in the September 2010 issue of the Journal of Communication.

The study included 178 younger adults (18 to 30 years old) and 98 older adults (50 to 65 years old). All came to a computer laboratory, where they were told they were testing an online magazine that was not yet available to the public.

The experimental magazine was created specifically for the study and contained 10 carefully pre-tested stories. Each story focused on one individual, but there were two different versions: one that had a negative spin and one with a positive spin (each participant was offered just one of the two versions).

For example, one positive article was headlined (translated here from German) "Visitation rights gained after daring protest – Demonstration at 100 feet high a success." The negative version had the headline, "Visitation rights denied despite daring protest – Demonstration at 100 feet high in vain."

The stories included a photo of the person involved: half were clearly an older person and half were clearly a younger person.

Participants in the study were told they would not have time to read all the stories and were asked to click on the stories that they found interesting. Each was given a random mix of positive and negative stories about younger and older people.

The computer secretly logged which stories each participant clicked on and how long they spent reading each article.

All of the stories were extensively pretested by other participants to ensure that the stories were clearly positive or negative, and that the photos were clearly differentiated by age and that the people pictured were similar in how likeable they appeared, Knobloch-Westerwick said.

Results showed that the older participants were more likely to select negative articles about younger people, but they did not show a strong preference for either positive or negative stories about people in their own age group.

Younger people showed low interest in articles about older individuals – regardless of whether the stories were positive or negative. They did choose to read more positive stories about their own age group than they did negative stories, she said.

After participants finished browsing and evaluating the online magazine, they were given a short questionnaire aimed at measuring their self-esteem.

Results showed that younger people showed no differences in self-esteem based on what they had read. However, the more that older people read negative stories about younger individuals, the higher the older people's levels of self-esteem tended to be.

This study came about because a previous study by the same researchers, using this same data, had produced unexpected results, Knobloch-Westerwick said. The original study had hypothesized that people prefer media messages that portray people like themselves – people of the same age and the same gender, in this case.

Overall, the original study found that was indeed true. However, the researchers were puzzled by the fact that older people in that first study seemed as equally interested in stories about younger people as they were in stories about older people like themselves.

"Now we know why older people liked reading about the younger people – they were looking for negative stories about them," she said.

"Our new results go along with other research showing that people's social identity helps shape what media messages we choose. Age is just one type of social identity which may affect our media choices."

Active Lifestyle May Help Counter Obesity Genes

04 sept 2010-- Exercise can reduce a person's genetic predisposition to obesity by 40 percent, finds a new English study.

Researchers looked at 20,430 people in Norwich and focused on genetic variants known to increase the risk of obesity. Most people had inherited 10 to 13 of these variants from their parents, but some had more than 17 while others had fewer than six.

The participants also provided information about their levels of physical activity.

Overall, each additional obesity-related genetic variant was associated with an increase in body mass index (BMI) equivalent to 445 grams (0.98 pounds) for a person 1.70 meters (5 feet, 6 inches) tall. BMI is a measurement that takes into account a person's height and weight.

However, this effect was greater in sedentary people than in active people, the researchers found. For those with a physically active lifestyle the increase was 379 grams (0.84 pounds) per genetic variant. That's 36 percent less than the increase of 592 grams (1.3 pounds) per genetic variant for inactive people.

The researchers also found that each additional obesity susceptibility variant increased the odds of obesity by 1.1-fold. But this risk was 40 percent lower for active people compared to inactive people, the findings revealed.

The study shows that adopting a healthy lifestyle can benefit people at increased genetic risk of obesity, the authors explained.

"Our findings further emphasize the importance of physical activity in the prevention of obesity," Dr. Ruth Loos, of the Medical Research Council's epidemiology unit in Cambridge and colleagues wrote in the article published online this week in PLoS Medicine.

Older adults experience 'destination amnesia'
...and over-confidence with false beliefs


Older adults are more likely to have destination memory failures – forgetting who they've shared or not shared information with, according to a new study led by Baycrest's Rotman Research Institute.

03 sept 2010--It's the kind of memory faux pas that can lead to awkward or embarrassing social situations and even miscommunication in the doctor's office. Ironically, after making these memory errors older adults remain highly confident in their false beliefs.

The study appears online, ahead of print publication, in the Online First Section of Psychology and Aging.

"What we've found is that older adults tend to experience more destination amnesia than younger adults," said lead investigator and cognitive scientist Dr. Nigel Gopie, who led the study with internationally-renowned experts in memory and attention, Drs. Fergus Craik and Lynn Hasher.

"Destination amnesia is characterized by falsely believing you've told someone something, such as believing you've told your daughter about needing a ride to an appointment, when you actually had told a neighbour."

Why are older adults more prone to destination memory failures? The ability to focus and pay attention declines with age, so older adults use up most of their attentional resources on the telling of information and don't properly encode the context (ie. who they are speaking to) for later recall.

"Older adults are additionally highly confident, compared to younger adults, that they have never told people particular things when they actually had," added Dr. Gopie. "This over-confidence presumably causes older adults to repeat information to people."

A critical finding in the study is that destination memory is more vulnerable to age-related decline than source memory. Source memory is the ability to recall which person told you certain information.

In the research, 40 students from the University of Toronto (ages 18 - 30) and 40 healthy older adults from the community (ages 60 - 83) were divided into two experimental groups. The first experiment measured destination memory accuracy and confidence: requiring the individual to read out loud 50 interesting facts to 50 celebrities (whose faces appear on a computer screen), one at a time, and then remember which fact they told to which famous person. For example, "a dime has 118 ridges around it" and I told this fact to Oprah Winfrey.

The second experiment measured source memory accuracy and confidence: requiring the individual to remember which famous person told them a particular fact. For example, Tom Cruise told me that "the average person takes 12 minutes to fall asleep".

In the first experiment for destination memory accuracy, older adults' performance was 21% worse than their younger counterparts.

In the second experiment for source memory accuracy, older and younger adults performed about the same (60% for young, 50% for old) in recollecting which famous face told them a particular fact.


###

The study was funded by the Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, U.S. National Institute on Aging, and a Baycrest Jack and Rita Catherall Award.

The study follows an earlier one published last year in Psychological Science by Dr. Gopie (Baycrest's Rotman Research Institute) and Dr. Colin M. MacLeod (University of Waterloo). That one looked at disrupted destination memory in a single age group – university-aged students.

Mental 'exercise' linked to faster dementia progression

NEW YORK 02 sept 2010– While staying mentally active in old age has been linked to a delayed onset of dementia, seniors who engage in such brain "exercise" may actually have a faster rate of decline once Alzheimer's is diagnosed, researchers reported Wednesday.

The findings, published online in the journal Neurology, do not mean that a mentally stimulating lifestyle is a bad thing.

Instead, the researchers suspect that their findings may point to the "cost" of delaying Alzheimer's onset by keeping the mind active with hobbies, reading, crossword puzzles and the like.

That is, once these mentally active older adults are showing the signs of dementia and are ultimately diagnosed, they may have a more advanced stage of brain damage compared with less mentally active seniors.

This idea fits in with the "cognitive reserve" hypothesis of dementia. That theory basically holds that people who are mentally active can better withstand the gradual brain-cell damage that marks Alzheimer's disease and other forms of dementia. But once that damage reaches a certain threshold, dementia symptoms will become apparent.

So mentally active older adults may develop dementia later than those who "exercise" their brains less often. But once they do develop it, they are in a more extensive state of brain damage.

That, at least, is "the working hypothesis," said Dr. Charles B. Hall, a researcher at Albert Einstein College of Medicine in New York. Hall was not involved in the current study, but is researching the connection between cognitive activities and dementia.

In an interview, he said these latest findings confirm work by his research group and others finding a link between a mentally active lifestyle and a delayed onset of dementia, but also a faster decline once dementia is diagnosed.

The current study, led by Dr. Robert S. Wilson of Rush University in Chicago, included 1,157 older adults who were dementia-free at the outset and were evaluated for cognitive decline over roughly six years.

At the study's start, participants reported on how often they engaged in a number of activities that were considered mentally stimulating -- including reading, doing crosswords or other puzzles, playing games like cards or checkers, watching TV, listening to the radio and going to museums.

During the study period, 614 participants remained cognitively healthy, while 395 developed mild impairment in their thinking abilities, and 148 were diagnosed with Alzheimer's disease.

Wilson's team found that among the group who remained healthy, those who reported a greater number of cognitive activities showed a slower rate of decline in cognitive tests over six years. Test scores remained essentially unchanged among those in the top 10 percent for cognitive activities, but showed a gradual dip among those in the bottom 10 percent.

In contrast, among study participants who were diagnosed with Alzheimer's, those who were the most mentally active at the study's outset showed a quicker rate of decline over time than those who had been the least mentally engaged.

According to Wilson's team, all of this suggests that mentally stimulating activities in older age might "compress" the amount of time a person ultimately spends with dementia symptoms.

However, Hall pointed out that the key limitation of this and past studies on the issue is that they are observational studies. That is, they can show an association between mental activities and dementia onset and progression, but cannot prove cause-and-effect.

"The evidence from observational studies suggests that cognitive activities might delay the onset of dementia," Hall said, "but that has to be confirmed in intervention studies."

In an intervention-type study, participants would, for example, be randomly assigned to regularly perform some sort of mentally stimulating activity and then have their cognitive health followed over time and compared with that of a similar group who did not perform the activity.

If staying mentally active does delay dementia onset, evidence so far suggests the benefit would be modest.

In a study Hall and his colleagues published last year, they found that of older adults who developed dementia during the study period, the most mentally active ones were typically diagnosed just over a year later than the least mentally active men and women.

People in the most active group typically reported 11 "activity days" per week -- meaning, for example, they performed one activity, such as reading, writing or playing games, on all days of the week, and a second activity on four days of the week. The least active group reported four activity days per week.

"This doesn't prevent dementia. This doesn't prevent the (brain) pathology," Hall said. However, he added, if mental activities were found to delay dementia symptoms, or the need for nursing home care, by even a year, that would have a "tremendous public health impact."

"I'm not ready to tell everyone to do crossword puzzles," Hall said. On the other hand, he added, there would be little chance of harm in doing so.

SOURCE: http://link.reuters.com/bar78n Neurology, online September 1, 2010.

Biobehavioral Approach Linked to Benefits in Dementia

Intervention aimed at patients, caregivers includes visits with therapists, advance practice nurses

01 sept 2010-- A biobehavioral environmental intervention -- Care of Persons with Dementia in their Environments (COPE) -- is associated with better functioning in patients with dementia after four months, as well as benefits for caregivers, according to research published in the Sept. 1 issue of the Journal of the American Medical Association.

Laura N. Gitlin, Ph.D., of Thomas Jefferson University in Philadelphia, and colleagues analyzed data from 209 pairs of patients and their family caregivers. Participants were randomized to receive up to 12 contacts in the home or over the phone with occupational therapists and an advanced practice nurse who provided training to caregivers on matters such as modifying the home environment and daily activities. Control caregivers received educational materials and up to three calls from research staff.

The researchers found that the COPE group had less functional dependence at four months and less dependence in instrumental activities of daily living compared with controls. COPE patients also had improved engagement, and their caregivers had improved well-being and improved confidence using activities. At nine months, changes in outcomes were similar for patients in the two groups, but COPE caregivers reported greater benefits.

"Because most patients live at home with functional decline, a non-pharmacologic, biopsychosocial-environmental intervention may positively contribute to disease management. Future research needs to examine effects of underlying medical conditions, ways to boost treatment effects, cost-effectiveness, COPE in combination with pharmacologic treatments, and translational potential," the authors conclude.