Fructose consumption increases risk factors for heart disease

A recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) found that adults who consumed high fructose corn syrup for two weeks as 25 percent of their daily calorie requirement had increased blood levels of cholesterol and triglycerides, which have been shown to be indicators of increased risk for heart disease.

31 july 2011--The American Heart Association recommends that people consume only five percent of calories as added sugar. The Dietary Guidelines for Americans 2010 suggest an upper limit of
25 percent or less of daily calories consumed as added sugar. To address this discrepancy in recommended consumption levels, researchers examined what happened when young overweight and normal weight adults consumed fructose, high fructose corn syrup or glucose at the 25 percent upper limit.

"While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting," said the study's senior author, Kimber Stanhope, PhD, of the University of California, Davis. "Our findings demonstrate that several factors associated with an elevated risk for cardiovascular disease were increased in individuals consuming 25 percent of their calories as fructose or high fructose corn syrup, but consumption of glucose did not have this effect."

In this study, researchers examined 48 adults between the ages of 18 and 40 years and compared the effects of consuming 25 percent of one's daily calorie requirement as glucose, fructose or high fructose corn syrup on risk factors for cardiovascular disease. They found that within two weeks, study participants consuming fructose or high fructose corn syrup, but not glucose, exhibited increased concentrations of LDL cholesterol, triglycerides and apolipoprotein-B (a protein which can lead to plaques that cause vascular disease).

"These results suggest that consumption of sugar may promote heart disease," said Stanhope. "Additionally our findings provide evidence that the upper limit of 25 percent of daily calories consumed as added sugar as suggested by The Dietary Guidelines for American 2010 may need to be re-evaluated."

Provided by The Endocrine Society

REM sleep behavior disorder is a risk factor for Parkinson's disease

Patients suffering REM sleep behaviour disorders dream nightmares in which they are attacked and pursued, with the particularity that they express them by screaming, crying, punching and kicking while sleeping. Lancet Neurology has published the third consecutive work in five years about the relationship between this disorder and Parkinson's disease.

30 july 2011--The first work¹ showed in 2006 that 45% of patients who suffer this sleep disorder develop Parkinson's disease and other neurodegenerative diseases caused by a lack of dopamine in the brain. The second article² discovered that neuroimaging tests that measure dopamine in the brain, such as the brain SPECT, are useful to identify patients with REM sleep disorders with increased risk of developing a neurodegenerative diseases such as Parkinson's disease.

The new study applied brain SPECT to conclude that the levels of dopamine in the brain are quickly lowering over the years in patients with REM sleep behaviour disorder. This neuroimaging technique becomes the first tool to detect the disease progression at an early stage. The first author of the three articles is Dr. Àlex Iranzo, doctor from the Neurology Service at the Hospital Clínic of Barcelona, researcher at the Biomedical Research Institute of August Pi i Sunyer (IDIBAPS) and member of the Multidisciplinary Sleep Disorders Unit , and the senior authors were to Dr. Joan Santamaria and Dr. Eduard Tolosa, from the same institution.

The study involved comparing for three years the evolution of brain SPECT in 20 patients with REM disorder and 20 healthy controls. The neuroimaging technique measures the presence of dopamine in the substantia nigra, a part of the brain associated with learning and harmony of body movements. In Parkinson's disease a deficiency of dopamine in the substantia nigra causes tremor, stiffness and movement slowness in patients. Results show that after 3 years of monitoring the production of dopamine in the control group was reduced by 8% due to age, while the group of REM sleep disorder patients experienced a reduction of 20%. Once the 3 year follow-up ended, 3 of 20 patients in the REM sleep disorder group had developed Parkinson's disease and their dopamine reduction was around 30%.

The three works led by the IDIBAPS - Hospital Clínic of Barcelona team conclude that more efforts are needed to create neuroprotective drugs that prevent the progression from REM sleep behavior disorders to Parkinson's disease. For the first time scientists have a technique, brain SPECT, to evaluate whether these drugs are effective. Authors of the study suggest that,to be considered effective, a neuroprotective drug should significantly prevent the dopamine concentration from dropping in these patients.

More information: ¹ Lancet Neurol. 2006 Jul;5(7):552-3.² Lancet Neurol. 2010 Nov;9(11):1040-2.

Provided by IDIBAPS - Institut d'Investigacions Biomčdiques August Pi i Sunyer

Low income, poor diet linked to accelerated aging

A new study of the DNA of people living in Glasgow suggests that earning less than the average wage and eating an unhealthy diet could accelerate the ageing process.

29 july 2011--The study, conducted by the University of Glasgow in collaboration with the Glasgow Centre for Population Health, compared the length of telomeres in blood samples taken from 382 Glaswegians from the most and least deprived parts of the city. Telomeres, the tails on the ends of chromosomes, shorten throughout a person’s life and can be used as a measure of the ageing process.

Over a 10-year period, telomeres shortened by 7.7% in people whose household incomes were less than £25,000, but only 0.6% in people with greater incomes. In those living in rented accommodation, telomere length was reduced by 8.7% compared to 2.2% in those who owned their homes. The telomeres of people with the poorest diets were shortened by 7.7%, compared to 1.8% in those with a better diet.

It is hoped that the findings will help to create a test which can be used for faster feedback on the effects of public health improvement measures. Currently, these effects can take decades to become apparent.

However, due to natural variation in telomere length from person to person, the test is only effective at a population level, and will not provide useful information on how long an individual can expect to live.

Dr. Paul Shiels of the University of Glasgow’s Institute of Cancer Sciences, who led this aspect of the research, said: “Glasgow’s population has one of the most extreme socioeconomic gradients in the world, which makes it an ideal place to conduct a study such as this.

“This study is a first for the city in that it provides a link between how adverse social conditions can influence the biology of ageing and hence disease. What we’ve shown is that social status and deprivation play a major part in how quickly people age and develop disease.

“Eating poorly and earning less than average is likely to increase the rate you age, and can lead to increased inflammation and risk for cardiovascular disease, which is endemic in the city.”

The results are published in the journal PLoS one by the Glasgow Centre for Public Health, a consortium of health and local authorities, the Scottish Government and the University of Glasgow.

Provided by University of Glasgow

Trouble with sentences may predict Alzheimer's

28 july 2011-- Having trouble finding the right word to say is a known side effect of healthy aging. But older adults with early Alzheimer's disease may find it especially difficult not only to find words but also to construct complex sentences, finds a Cornell pilot study.

Such language problems can make daily communication difficult and may be an early marker for Alzheimer's disease or other cognitive impairments, says Barbara Lust, professor of human development and director of the Cornell Language Acquisition Laboratory, who led the study in collaboration with neuropsychologist Janet Cohen Sherman at Massachusetts General Hospital and Professor Suzanne Flynn at the Massachusetts Institute of Technology. Its results have been presented at several conferences, most recently at the May 26-29 American Psychological Society convention in Washington, D.C., and at a May 11 Alzheimer's Association conference in Boston.

"There is a distinct gap in the research on language decline in those with clinical and prodromal (early symptom) conditions," said Lust. "Several studies have raised the possibility that very early Alzheimer's disease may be associated with deterioration in written language as seen in the works of popular authors such as Iris Murdoch. One unique contribution of our project is that we are looking at what is happening in spoken language. Another is that we are looking at sentence formation."

Lust and the other researchers in the Cornell Language Acquisition Lab and the Virtual Center for Language Acquisition at Cornell and colleagues are comparing language and cognitive abilities in three groups: healthy aging adults, adults with signs of mild cognitive impairment and young college-aged controls. Participants are asked to repeat a series of sentences that are experimentally designed and are tested on the accuracy of their repetition. So far they have tested 40 participants, and they plan to test more.

Preliminary results show that the declines found in language abilities may be separate from declines in overall cognition (e.g., memory). Specifically, those with mild cognitive impairment show particular challenges not only with vocabulary (e.g., word-finding difficulties, word substitutions) but also in certain types of complex sentence formation.

Results from this research may shed light on the mechanisms of language decline and lead to techniques for early diagnosis and interventions for both healthy and cognitively impaired older adults.

The researchers also plan to compare their findings in older adults to language development in young children to better determine how language decline is likely to occur with older adults and people with Alzheimer's disease relative to how language is first acquired.

This research is supported in part by the Cornell Bronfenbrenner Center for Life Course Development, Cornell Institute for Translational Research on Aging, Cornell Cognitive Science program, Cornell Institute for Social Sciences and Hatch Grant/Federal Formula Funds.

Provided by Cornell University

Exercise has numerous beneficial effects on brain health and cognition, review suggests

It's no secret that exercise has numerous beneficial effects on the body. However, a bevy of recent research suggests that these positive effects also extend to the brain, influencing cognition. In a new review article highlighting the results of more than a hundred recent human and animal studies on this topic, Michelle W. Voss, of the University of Illinois at Urbana-Champaign, and her colleagues show that both aerobic exercise and strength training play a vital role in maintaining brain and cognitive health throughout life. However, they also suggest that many unanswered questions remain in the field of exercise neuroscience—including how various aspects of exercise influence brain physiology and function and how human and animal studies relate to each other—and issue the call for further research to fill in these gaps.

27 july 2011--The article, "Exercise, Brain and Cognition Across the Lifespan," is published in the online edition of the Journal of Applied Physiology.

Methodology

Using the findings from 111 recent studies, the researchers write a brief review showcasing the effects of aerobic exercise and strength training on humans ranging in age from children to elderly adults. They relate these findings to those in lab animals, such as rats and mice, which provide a window on the pathways through which exercise may enhance brain function.

Results

The review suggests that aerobic exercise is important for getting a head start during childhood on cognitive abilities that are important throughout life. For example, physical inactivity is associated with poorer academic performance and results on standard neuropsychological tests, while exercise programs appear to improve memory, attention, and decision-making. These effects also extend to young and elderly adults, with solid evidence for aerobic training benefiting executive functions, including multi-tasking, planning, and inhibition, and increasing the volume of brain structures important for memory. Although few studies have evaluated the effects of strength training on brain health in children, studies in older adults suggest that high-intensity and high-load training can improve memory.

Animal studies, primarily models that test the influence of aerobic exercise, suggest a variety of mechanisms responsible for these effects. For example, exercise appears to change brain structure, prompting the growth of new nerve cells and blood vessels. It also increases the production of neurochemicals, such as BDNF and IGF-1, that promote growth, differentiation, survival, and repair of brain cells.

Though this collection of studies clearly reveals the beneficial effects of exercise on the brain, it also highlights gaps in the scientific literature. For example, the review authors note that more research is needed on how exercise type might promote different effects on brain health and cognition. Similarly, they say, future research that integrates human and animal work will be necessary, such as studies that incorporate exercise over animals' life spans to understand the effects of exercise at different time points, or human studies that include measures of BDNF, IGF-1, or other neurobiological markers.

Importance of the Findings

The reviewed studies suggest that both aerobic exercise and strength training can have significant positive effects on brain health and function, but more research is needed to better elucidate these effects.

"It is increasingly prevalent in the print media, television, and the Internet to be bombarded with advertisements for products and programs to enhance mental and physical health in a relatively painless fashion through miracle elixirs, computer-based training, or gaming programs, or brief exercise programs," the authors say. "Although there is little convincing scientific evidence for such claims, there have been some promising developments in the scientific literature with regard to physical activity and exercise effects on cognitive and brain health."

Provided by American Physiological Society

Small hippocampus associated with depression in the elderly: Risk factor or shrinkage?

Imaging studies have repeatedly found that people with depression have smaller hippocampal volumes than healthy individuals. The hippocampus is a brain region involved in learning and memory, spatial navigation, and the evaluation of complex life situations or "contexts". However, because in prior studies hippocampal volume was only measured in people once they became depressed, it has been unclear whether a small hippocampus renders a person vulnerable to developing depression, or whether it is a consequence of depression.

26 july 2011--A new study published in Biological Psychiatry has approached that problem by following a large population of elderly individuals over a 10 year period.

Researchers performed an initial imaging scan on subjects to obtain a baseline measurement of their hippocampal volume and then performed follow-up scans 5 and 10 years later. During this time, they also repeatedly assessed the individuals for both depressive symptoms and depressive disorders.

Corresponding author Dr. Tom den Heijer explains their findings: "We found that persons with a smaller hippocampus were not at higher risk to develop depression. In contrast, those with depression declined in volume over time. Our study therefore suggests that a small hippocampal volume in depressed patients is more likely an effect of the depression rather than a cause."

"The principal importance of this type of research is that it may provide insight into age-related impairments in the function of the hippocampus," reflected Dr. John Krystal, Editor of Biological Psychiatry. "For example, in Alzheimer's disease, memory problems and disorientation are prominent symptoms, reflecting among other things the impaired function of the hippocampus."

Future studies will be needed to better understand whether current treatments protect the hippocampus and hippocampal function.

More information: The article is "A Study of the Bidirectional Association Between Hippocampal Volume on Magnetic Resonance Imaging and Depression in the Elderly" by Tom den Heijer, Henning Tiemeier, Hendrika J. Luijendijk, Fedde van der Lijn, Peter J. Koudstaal, Albert Hofman, and Monique M.B. Breteler. The authors are affiliated with Erasmus Medical Center, Rotterdam, the Netherlands. den Heijer is also from Sint Franciscus Gasthuis, Rotterdam, the Netherlands. Luijendijk is also from Bavo, Europoort, the Netherlands. The article appears in Biological Psychiatry, Volume 70, Number 2 (July 15, 2011)

Provided by Elsevier

Studies evaluate the association between physical activity and lower rates of cognitive impairment

Engaging in regular physical activity is associated with less decline in cognitive function in older adults, according to two studies published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals. The articles are being released on July 19 to coincide with the International Conference on Alzheimer's Disease in Paris and will be included in the July 25 print edition.

25 july 2011--According to background information provided in the articles, previous research has suggested that physical activity is associated with reduced rates of cognitive impairment in older adults. However, much of this research has apparently been conducted among individuals who are generally in good health. Further, many of these studies rely on self-reports of physical activity, which are not always accurate; and focus on moderate or vigorous exercise, instead of low-intensity physical activity. The two articles being presented today seek to fill in these gaps in the research.

In one article, Marie-Noël Vercambre, Ph.D., from the Foundation of Public Health, Mutuelle Generale de l'Education Nationale, Paris, and colleagues examined data from the Women's Antioxidant Cardiovascular Study, which included women who had either prevalent vascular disease or three or more coronary risk factors. The researchers determined patients' physical activity levels at baseline (1995 to 1996) and every two years thereafter. Between 1998 and 2000, they conducted telephone interviews with 2,809 women; the calls included tests of cognition, memory and category fluency, and followed up the tests three more times over the succeeding 5.4 years.

The researchers analyzed data to correlate cognitive score changes with total physical activity and energy expenditure from walking. As participants' energy expenditure increased, the rate of cognitive decline decreased. The amount of exercise equivalent to a brisk, 30-minute walk every day was associated with lower risk of cognitive impairment.

In another report, Laura E. Middleton, Ph.D., from the Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Research Institute, Toronto, and colleagues utilized data from the Health, Aging, and Body Composition study, an ongoing prospective cohort study. The researchers measured participants' total energy expenditure by using doubly labeled water, a technique that provides evidence of how much water a person loses and thus serves as an objective measure of metabolic activity. The authors calculated participants' activity energy expenditure (AEE), defined as 90 percent of total energy expenditure minus resting metabolic rate. The 197 participants, with an average age of 74.8 years, had no mobility or cognitive problems when the research began in 1998 to 1999. At that time, researchers assessed participants' cognitive function, and followed up two to five years later with the Modified Mini-Mental State Examination (MMMSE).

The authors adjusted the data for baseline MMMSE scores, demographics, fat-free mass, sleep duration, self-reported health and diabetes mellitus. When these variables were accounted for, participants who had the highest AEE scores tended to have lower odds of incident cognitive impairment. The authors also noticed a significant dose response between AEE and incidence of cognitive impairment.

The authors of both articles suggest that there is more to be learned about the relationship between physical activity and cognitive function. "Various biologic mechanisms may explain the positive relation between physical activity and cognitive health," write Vercambre and colleagues. Middleton and co-authors state, "The mechanisms by which physical activity is related to late-life cognition are likely to be multifactorial." Both groups of researchers note that studies such as theirs point toward some possible answers. As Vercambre and co-authors comment, "If confirmed in future studies, physical activity recommendations could yield substantial public health benefits given the growing number of older persons with vascular conditions and their high risk of cognitive impairment." And Middleton and colleagues conclude, "We are optimistic that even low-intensity activity of daily living may be protective against incident cognitive impairment."

Commentary: Brains and Aging

In a commentary accompanying the articles, Eric B. Larson, M.D., M.P.H., from Group Health Research Institute, Seattle, notes that these studies serve to "buttress growing evidence that habitual physical activity and fitness are associated with age-related changes in cognition and risk of dementia." The key finding of the Vercambre and colleagues study, he writes, "is that older women with high levels of vascular risk constitute a major risk group and that vascular risk is linked to cognitive decline." Of the work published by Middleton and colleagues, Larson observes, "The fact that the study used a validated measurement of energy expenditure, not just self-report, makes the results of further importance." Such research, he states, is increasingly needed as the population ages and the health care field attempts to cope with higher rates of cognitive decline.

In this context, Larson suggests that articles such as the ones presented here "highlight a gradual but steady change in current thinking about risk factors for late-life dementias." Vascular risk factors such as limited physical activity may be modifiable and represent a way to reduce the incidence of cognitive impairment among older adults. Physical activity, growing scientific evidence suggests, could be one such avenue.

"I believe that these findings can inform practice and the advice that we give our aging patients," comments Larson. "We can tell them that ongoing maintenance of physical activity is definitely worthwhile and likely of increasing benefit as they advance into old age." In addition, Larson stresses the need for research into "programs that promote ongoing physical activity, especially in late life."

More information: Arch Intern Med. Published July 19, 2011. doi:10.1001/archinternmed.2011.282 ; doi:10.1001/archinternmed.2011.277

Commentary: Arch Intern Med. Published online July 19, 2011. doi:10.1001/archinternmed.2011.273

Provided by JAMA and Archives Journals

Falls may be early sign of Alzheimer's

Falls and balance problems may be early indicators of Alzheimer’s disease, researchers at Washington University School of Medicine in St. Louis report July 17, 2011, at the Alzheimer’s Association International Conference on Alzheimer’s Disease in Paris.

24 july 2011--Scientists found that study participants with brain changes suggestive of early Alzheimer’s disease were more likely to fall than those whose brains did not show the same changes. Until now, falls had only been associated with Alzheimer’s in the late stages of dementia.

“If you meet these people on the street, they appear healthy and have no obvious cognitive problems,” says lead author Susan Stark, PhD, associate professor of physical therapy and neurology. “But they have changes in their brain that look similar to Alzheimer‘s disease, and they have twice the typical annual rate of falls for their age group.”

Stark and her colleagues recruited 119 volunteers from studies of aging and health at Washington University’s Knight Alzheimer’s Disease Research Center. All the participants were 65 or older and cognitively normal.

Brain scans showed that 18 participants had high levels of amyloid plaques, a hallmark of Alzheimer's. The other 101 volunteers had normal amyloid levels in the brain.

Participants were given a journal and asked to note any falls. When they did so, the researchers followed up with a questionnaire and a phone interview about the falls. This follow-up allowed researchers to gather information for future analyses that will compare and contrast the nature of the falls.

About one in three adults age 65 or older typically fall each year. But in the 18 participants with high amyloid levels in the brain, two-thirds fell within the first eight months of the study. High levels of amyloid in the brain were the best predictor of an increased risk of falls.

“Falls are a serious health concern for older adults,” Stark says. “Our study points to the notion that we may need to consider preclinical Alzheimer’s disease as a potential cause.”

Provided by Washington University School of Medicine in St. Louis

Inherited Alzheimer's detectable 20 years before dementia

Inherited forms of Alzheimer's disease may be detectable as many as 20 years before problems with memory and thinking develop, scientists will report July 20, 2011, at the Alzheimer's Association International Conference on Alzheimer's Disease in Paris.

23 july 2011--Identifying Alzheimer's in its earliest stages is a top priority for researchers. Many think that by the time symptoms become apparent, Alzheimer's disease has already damaged the brain extensively, making it difficult or impossible to restore memory and other mental abilities.

"We want to prevent damage and loss of brain cells by intervening early in the disease process — even before outward symptoms are evident, because by then it may be too late," says Alzheimer's researcher and physician Randall Bateman, MD, of Washington University School of Medicine in St. Louis and an associate director of the Dominantly Inherited Alzheimer's Network (DIAN), an international study of inherited forms of Alzheimer's.

Initial DIAN results confirm and expand upon earlier insights from studies of the more common sporadic forms of Alzheimer's, including data suggesting that changes in the levels of biological markers in the spinal fluid can be detected years before dementia.

Scientists say the results demonstrate the feasibility of clinical trials to prevent Alzheimer's in DIAN participants. Planning for those trials, which may start as early as next year, is currently under way.

"New treatments may have risks, so to treat patients prior to symptoms we must sure that we have a firm grasp on who will develop Alzheimer's dementia," says DIAN director John C. Morris, MD, Harvey A. and Dorismae Hacker Friedman Professor of Neurology at Washington University. "If we can find a way to delay or prevent dementia symptoms in DIAN participants, that would be a tremendous success story and very helpful in our efforts to treat the much more common sporadic form of the illness."

DIAN researchers are studying members of families who have mutations in one of three genes: amyloid precursor protein, presenilin 1 or presenilin 2. Participants with these mutations are certain to develop Alzheimer's disease early, with symptoms beginning in their 50s, 40s, or, in some rare cases, 30s.

DIAN, which includes research centers in the United States, the United Kingdom and Australia, is the largest study yet of these rare forms of dominantly inherited Alzheimer's. To date, 184 participants have been enrolled, nearly half the overall recruitment goal. This has allowed initial comparisons among participants who carry a genetic mutation for Alzheimer's but are still asymptomatic, those who have a mutation and have Alzheimer symptoms, and those who do not have a mutation and thus are unaffected.

By looking at the age of symptom onset in a parent who passed an Alzheimer's mutation to a DIAN participant, scientists can establish an estimated age of onset for a study participant. If a parent developed dementia at the age of 50, they would expect a child who inherited the mutation to develop dementia at roughly the same age. As a result, scientists can start amassing a detailed chronology of disease progression that covers the many years Alzheimer's is active in the brain but still before the onset of dementia.

"Based on what we see in our population, brain chemistry changes can be detected up to 20 years before the expected age of symptomatic onset," Bateman says. "These Alzheimer's-related changes can be specifically targeted for prevention trials in patients with inherited forms of Alzheimer's."

Washington University researchers, including Bateman, Morris and Anne Fagan, PhD, research professor of neurology, will report initial results from DIAN, including confirmation of the value of disease indicators from cerebrospinal fluid analyses. Participants who carry the mutations but are still asymptomatic have significantly lower levels of amyloid beta and higher levels of tau protein in their cerebrospinal fluid than participants without the mutations.

Amyloid beta normally is cleared from the brain and into the spinal fluid. Scientists theorize that decreases in spinal fluid levels of amyloid beta reflect a buildup of this sticky protein fragment in the brain, where it forms Alzheimer's plaques. Tau protein is a structural component of central nervous system cells. Its increase in cerebrospinal fluid is thought to be a byproduct of damage to brain cells.

Provided by Washington University School of Medicine

Progress is seen on a blood test for Alzheimer's

Researchers are working on an experimental blood test that appears very accurate at revealing how much of the telltale Alzheimer’s brain deposits a patient has, and they hope it might be a much-needed first step to see who needs definitive testing for the disease.

Scientists are closing in on a long-sought goal: A blood test to screen people for Alzheimer's disease.

22 july 2011--An experimental test did a good job of indicating how much of the telltale Alzheimer's plaque lurks in people's brains, Australian researchers reported Wednesday. If the test proves accurate in larger studies, it could offer a way to check people having memory problems to see who needs more definitive testing for the disease.

Many blood tests are being developed and a few are used in research settings now, but only the Australian one has been validated against brain scans and other accepted diagnostic tests with good accuracy in large groups of people, said Maria Carrillo, senior director of medical and scientific relations for the Alzheimer's Association.

The results, reported Wednesday at the Alzheimer's Association International Conference in France, "give us hope that we may be able to use a blood test in the near future," although that doesn't mean next year, she said.

More than 5.4 million Americans and 35 million people worldwide have Alzheimer's, the most common form of dementia. It has no cure and drugs only temporarily ease symptoms. Finding it early allows patients and their families to prepare, and ruling it out could lead to diagnosing a more treatable cause of symptoms, such as sleep problems.

Brain scans can show signs of Alzheimer's - sticky clumps of a protein called beta amyloid - a decade or more before it causes memory and thinking problems, but scans are too expensive and impractical for routine use. Doctors and patients need simple ways to screen people for the disease.

Samantha Burnham and others at Australia's national science agency, CSIRO, working with several universities, used a long-running study of more than 1,100 people - some healthy, some impaired - to develop the blood test.

They started with blood samples from 273 study participants and identified nine hormones and proteins that seemed most predictive of amyloid levels in the brain. A cutoff level was set for what was considered high.

"The belief is that people above that point will go on to get Alzheimer's disease, and the lag is about 8 to 10 years," Burnham explained.

When researchers used the nine-marker blood test on these same participants, they found that it separated healthy people from those with mild cognitive impairment or Alzheimer's as verified by their brain scans. The test correctly identified 83 percent of people with high amyloid levels and correctly ruled out 85 percent of people without this condition.

"That's pretty high," the Alzheimer's Association's Carrillo said of the test's accuracy.

More importantly, she said, the Australian researchers validated the test's accuracy in two additional groups: the other 817 folks in the Australian study and 74 people in a big U.S.-led study aimed at finding novel Alzheimer's disease biomarkers.

The test performed well in those situations, too, Burnham said.

CSIRO has patented the test and is talking with major companies about making it commercially available.

"It sounds like the Australians do have good clinical data" and that the markers they are testing for track with cases of the disease, said Creighton Phelps, a neuroscientist with the U.S. National Institute on Aging.

The next step is wider validation work and ensuring it can be standardized to give reliable results regardless of what lab or doctor would use it, he said.

International survey highlights great public desire to seek early diagnosis of Alzheimer's

Results of an international survey reveal that over 85% of respondents in the five countries surveyed say that if they were exhibiting confusion and memory loss, they would want to see a doctor to determine if the cause of the symptoms was Alzheimer's disease. Over 94% would want the same if a family member were exhibiting the symptoms. The findings were presented today at the Alzheimer's Association International Conference 2011 (AAIC 2011).

21 july 2011--The survey of the U.S. and four European countries – France, Germany, Spain and Poland – was designed and analysed by Alzheimer Europe and the Harvard School of Public Health.

In four of the five countries, Alzheimer's disease was the second biggest health fear after cancer. The public were asked to choose which disease they were most afraid of getting from a list of seven diseases including cancer, heart disease and stroke. Around a quarter of adults in four of the five countries say they most fear getting Alzheimer's disease.

Fear of Alzheimer's gets worse with age, but even young adults are concerned, with approximately one in seven 18- to 34-year-olds reporting Alzheimer's as the disease they are most afraid of getting from the list provided.

The survey found a large proportion of the public has had some experience with Alzheimer's disease. Majorities in all five countries say that they know or have known someone with Alzheimer's disease, including about seven in ten in France (72%), Germany (73%), Spain (77%), and in the U.S. (73%), and 54% in Poland. In addition, about three in ten have personal experience with a family member with Alzheimer's disease. Experience with a family member ranges from 19% in Poland to 42% in the U.S.

This high level of contact with Alzheimer's disease is likely to have contributed to the wide recognition of common symptoms such as confusion and getting lost, which were recognised by at least 86% and 88%,respectively.

Few people recognised the severity of Alzheimer's disease with approximately 40% knowing that it is a fatal condition (33-61%). In fact, Alzheimer's is the seventh-leading cause of death in high income countries and the only cause of death among the top 10 that cannot be prevented or cured.[ii]

Many of the respondents believe there is now an effective medical or pharmaceutical treatment to slow the progression of Alzheimer's disease and make the symptoms less severe (27%-63%). Also, nearly half believe there is a reliable medical test to determine if a person suffering from confusion and memory loss is in the early stages of Alzheimer's disease (38%-59%).

The survey also found public interest in predictive testing. Approximately two thirds of respondents said that, they would get a medical test which would tell them whether they would get Alzheimer's disease before they had symptoms.

Heike von Lützau-Hohlbein, Chairperson of Alzheimer Europe, said: "The results demonstrate the importance of being honest with patients when diagnosing Alzheimer's disease. As a former carer myself, I recognise how valuable it is for people to have first-of-all a name for all the uncertainties of their condition and then have the time to get their affairs in order. It will always be difficult to receive such a diagnosis but doctors need to empower patients and their loved ones to take the appropriate steps. The findings also show there is high awareness of Alzheimer's disease, which is a testament to the success of the many awareness campaigns coordinated by Alzheimer societies."

Dr. Robert Blendon, Professor of Health Policy and Political Analysis from the Harvard School of Public Health said: "Many of the public have high expectations about the possibilities of treatment alternatives and medical testing. It is important for doctors to talk to patients about what treatment and testing options are or are not available."

Florence Lustman, Coordinator of the French Alzheimer Plan, said: "Alzheimer's is a fatal condition that affects most people's lives at some time. One of the key priorities of the French Alzheimer's Plan is early diagnosis, and the survey results support this focus. The findings demonstrate overwhelming public support for receiving diagnosis."

Provided by Harvard School of Public Health

Lifestyle changes may cut Alzheimer's risk: study

PARIS, 20 july 2011– Up to half of worldwide cases of Alzheimer's disease could be due to modifiable lifestyle risk factors, according to a study released Tuesday based on a mathematical model.

The theoretical analysis suggests that seven known behaviour-related risk factors, taken together, account for 50 percent of the more than 35 million cases of dementia worldwide.

The findings "suggest that relatively simple lifestyle changes such as increasing physical activity and quitting smoking could have a dramatic impact" on the number of Alzheimer's cases over time, said lead researcher Deborah Barnes, a professor at the University of California in San Francisco.

The study, presented at an international Alzheimer's conference in Paris, is among the first attempts to link risk factors with the degenerative brain disease, which causes memory loss, disability and eventually death.

Only a tiny percentage of cases -- about one percent -- are clearly caused by genetic factors.

Otherwise, while the process by which the disease attacks nerve cells in the brain is well known, its origins remain poorly understood.

Barnes and colleagues used a statistical method to measure the percentage of cases which might be attributable, at least in part, to each of the risk factors assessed.

Worldwide, they found that a low level of education was linked to 19 percent of cases, smoking to 14 percent, physical inactivity to 13 percent, depression to 11 percent, mid-life hypertension and obesity to five and two percent, respectively, and diabetes to two percent.

When combined, these seven modifiable risk factors contribute to as many as 17 million Alzheimer's cases worldwide, and about three million in the United States, the study found.

While eliminating harmful lifestyle habits entirely is likely to remain a theoretical exercise, the more realistic goal of reducing them by a quarter would cut the number of cases globally by three million, the researchers calculated.

"The next step is to perform large-scale studies with people to discover whether changing these lifestyle factors will actually lower Alzheimer's risk," Barnes said in a statement.

The number of people afflicted by Alzheimer's is expected to more than triple by 2050 as populations across the planet age.

The disease is characterised by unwanted proteins that form plaque in some areas of the brain, ultimately destroying neurons and leading to irreversible brain damage.

Typical symptoms are memory loss, erratic behaviour and extreme agitation.

Alzheimer's affects 13 percent of people over 65, and up to 50 percent of those over 85.

For dementia, common painkillers may work best: study

Ordinary painkillers such as paracetamol may work better than the risky antipyschotic drugs often prescribed to calm agitation in people with dementia, according to a study released Monday.

19 july 2011--Patients with severe dementia showed significantly less agitation when taking ordinary pain medicines than a control group given standard treatment, showed the study, published online by the British Medical Journal.

Extreme aggression and agitation are common symptoms of advanced dementia, including Alzheimer's disease.

Such behaviour is distressing both for patient and family members, and a serious challenge to professional caregivers.

The condition is usually compounded by pain, and the frequent inability of the persons afflicted to clearly express the nature of their discomfort.

Powerful antipsychotics and antidepressants are often the drugs of first choice and, in many countries, are prescribed for agitation to around half of dementia patients in nursing homes.

Such treatment can be dangerous: In a population of about 180,000 dementia patients in Britain given antipsychotics, for example, there are 1,620 excess strokes and 1,800 excess deaths per year, according to a recent study.

"These figures emphasise the importance of finding safe and effective ways to reduce agitation and aggression in people with dementia," the researchers said.

Remarkably, little research has explored the effectiveness of off-the-shelf pain pills and other proven pain-relief drugs in quelling these common and debilitating symptoms.

To find out just how well they might work, a team of scientists led by Dag Aarsland, a professor at the Karolinska Institute in Stockholm, treated 352 patients from 16 Norwegian nursing homes -- all with severe dementia, most in their mid-to-late 80s -- with one of four pain-relief medications.

Over a period of eight weeks, 70 percent took a large daily dose of paracetamol and 20 percent were given buprenorphine, a semi-synthetic opioid used to treat addiction and moderate-to-acute pain.

The other 10 percent took stronger painkillers, either morphine or pregabalin, an anti-convulsant.

A control group continued their usual treatment, including certain antipsychotics or anti-depressants.

Experts who did not know which patients had taken which drugs did interviews during the trial and a four-week follow up.

"The intervention produced a clinically and statistically significant reduction in agitation and pain," note Paul Rosenberg and Constantine Lyketsos, professors at John Hopkins University, in a commentary also published in the British Medical Journal.

The treatment "should give clinicians a new strategy for tackling agitation in subgroups of patients," they said.

Aarsland urged other researchers to confirm the findings in further studies.

Thirty-five million people worldwide have dementia, a number expected to more than triple by 2050 as populations across the planet age.

In Alzheimer's, the most common form of dementia, unwanted proteins form plaque in some areas of the brain, ultimately destroying neurons and leading to irreversible brain damage.

Typical symptoms are memory loss, erratic behaviour and, in advanced stages, extreme agitation.

Alzheimer's affects 13 percent of people over 65, and up to 50 percent of those over 85.

U.S. autopsy guidelines revised for Alzheimer's

17 july 2011– For many years, an autopsy done by a pathologist was considered the best way to confirm the presence of Alzheimer's disease.

But new guidelines proposed on Sunday by the U.S. National Institute on Aging and the Alzheimer's Association seek to distinguish between memory changes or dementia diagnosed by doctors when people are alive, and the changes pathologists can see in an autopsy.

The proposed guidelines will offer additional information about the disease that will help as scientists develop tests that measure biological changes in the brain, blood or spinal fluid to diagnose Alzheimer's at an earlier stage.

Several companies, including Eli Lilly and Co, Bayer and General Electric Co, are working on compounds to identify Alzheimer's-related brain changes on positron emission tomography scans.

Many other companies and researchers are working on other types of biomarkers as well.

"Someday biomarkers are probably going to replace pathology," Dr. Creighton Phelps of the National Institute on Aging's division of neuroscience, said in an interview at the Alzheimer's Association International Conference in Paris.

Pathologists now look in the brain for clumps of a protein called beta amyloid and a protein called tau to diagnose Alzheimer's disease.

But studies have shown that people can die with lots of plaques and tangles in their brain and still have normal cognitive function.

"We know people die with Alzheimer's changes in the brain but they had no dementia," Phelps said.

According to the proposed guidelines, patients who have memory problems caused by the disease will be diagnosed with Alzheimer's dementia, or in milder cases, mild cognitive impairment (MCI) due to Alzheimer's dementia.

The term Alzheimer's disease will be used to refer to the underlying changes in the pathology, Phelps said.

"Classically, it's all been one big pool but they are not equivalent," he said. "You might have something on a slide that doesn't match what the person was like in life."

Phelps said dementia can be caused by many diseases, including vascular disease, so it is important to be clear about what is causing the problem.

The proposed guidelines offer much more detail about how to test people's brains at autopsy, specifying tests that should be done and asking pathologists to quantify the amount of plaque in the brain.

Bill Thies of the Alzheimer's Association said knowing the location of the plaques in a person's brain may provide clues about why some people develop dementia and others do not.

If these protein deposits are clustered in memory centers of the brain, that could cause more problems than if they are in other parts, for example.

Earlier this year, the NIA, part of the National Institutes of Health, and the Alzheimer's Association issued new diagnostic criteria to help doctors better classify patients who are tested for signs of dementia.

The proposed pathology guidelines, which are part of that process, will be available for public comment until September 1. Phelps said he hopes final guidelines will published in January 2012.

Parkinson's Patients Still Prescribed Antipsychotics Despite Warning

16 july 2011-- Antipsychotic drugs are still prescribed to more than half of U.S. patients with Parkinson's disease and psychosis even though a warning that these drugs can worsen Parkinson's symptoms was issued six years ago, a new study reveals.

Many Parkinson's disease patients, including as many as 45,000 in the United States, eventually develop psychosis, meaning their thoughts are sometimes disconnected from reality. Parkinson's disease is also associated with dementia and complications of that condition, which may be exacerbated by antipsychotic drugs, according to the researchers.

In 2005, the U.S. Food and Drug Administration ordered antipsychotic drug packages to carry a "black box" warning about the risks the drugs pose to Parkinson's patients.

In the new study, published in the July issue of the journal Archives of Neurology, researchers analyzed Veterans Affairs data from 2002 to 2008 to assess antipsychotic drug prescription rates among 1,804 Parkinson's disease patients without dementia, 793 Parkinson's patients with dementia, and 6,907 patients with dementia and psychosis but no Parkinson's disease.

The investigators found that about half of the patients with Parkinson's disease and psychosis received an antipsychotic drug prescription. Use of the drugs was higher among patients with both Parkinson's disease and dementia than among those without dementia.

Between 2002 and 2008, the overall rate of antipsychotic prescriptions for Parkinson's patients was unchanged despite the warnings issued in 2005, but there was a decrease in the use of some antipsychotic drugs and an increase in the use of others, Dr. Daniel Weintraub, of the University of Pennsylvania, and colleagues noted in a journal news release.

"Approximately one-third of our Parkinson's disease sample had comorbid dementia, and many more likely had mild cognitive impairment," the authors wrote. "This has significant clinical implications in Parkinson's disease given the increased morbidity and mortality associated with typical and atypical [antipsychotic drug] use in dementia populations."

Even though prescribing habits appeared to shift toward antipsychotic drugs that are better tolerated by Parkinson's disease patients, those drugs are not necessarily safer or more effective, the researchers noted.

The researchers called for further studies to learn more about the factors that contribute to both overall and specific antipsychotic drug use in Parkinson's patients and to examine the effects of antipsychotic drug treatment on illness, death and disease progression in Parkinson's disease patients.

The secret to successful aging

Whether we choose to accept or fight it, the fact is that we will all age, but will we do so successfully? Aging successfully has been linked with the "positivity effect", a biased tendency towards and preference for positive, emotionally gratifying experiences. New research published in Biological Psychiatry now explains how and when this effect works in the brain.

15 july 2011--German neuroscientists studied this effect by using neuroimaging to evaluate brain engagement in young and old adults while they performed a specialized cognitive task that included supposedly irrelevant pictures of either neutral, happy, sad or fearful faces. During parts of the task when they didn't have to pay as much attention, the elderly subjects were significantly more distracted by the happy faces. When this occurred, they had increased engagement in the part of the brain that helps control emotions and this stronger signal in the brain was correlated with those who showed the greatest emotional stability.

"Integrating our findings with the assumptions of life span theories we suggest that motivational goal-shifting in healthy aging leads to a self-regulated engagement in positive emotions even when this is not required by the setting," explained author Dr. Stefanie Brassen. "In addition, our finding of a relationship between rostral anterior cingulate cortex activity and emotional stability further strengthens the hypothesis that this increased emotional control in aging enhances emotional well being."

"The lessons of healthy aging seem to be similar to those of resilience, throughout life. As recently summarized in other work by Drs. Dennis Charney and Steven Southwick, when coping with extremely stressful life challenges, it is critical to realistically appraise the situation but also to approach it with a positive attitude," noted Dr. John H. Krystal, the Editor of Biological Psychiatry.

Lifespan theories explain that positivity bias in later life reflects a greater emphasis on short-term rather than long-term priorities. The study by Dr. Brassen and colleagues now provides another clue to how the brain contributes to this age-related shift in priorities.

This makes aging successfully sound so simple – use your brain to focus on the positive.

More information: Anterior Cingulate Activation Is Related to a Positivity Bias and Emotional Stability in Successful Aging" Biological Psychiatry, Volume 70, Number 2 (July 1, 2011)

Provided by Elsevier

Parkinson's disease patients may benefit from virtual-reality-based therapies

In people with Parkinson's Disease (PD), the inability to make quick movements limits basic functioning in daily life. Movement can be improved by various cueing techniques, such as providing visual or auditory stimuli when movements are started. In a study scheduled for publication in the August issue of the Archives of Physical Medicine and Rehabilitation, researchers report that virtual reality (VR) and physical reality exercises can be used to provide effective stimuli to increase movement speeds in PD patients.

114 july 2011--Investigators from the Departments of Occupational Therapy, Neurology, and Mechanical Engineering, the Institute of Education, and Allied Health Sciences, the National Cheng Kung University, Tainan, Taiwan, studied a group of 13 women and 16 men with PD who were age-matched against 14 women and 11 men without PD. Each participant was asked to reach for and grasp a stationary ball as quickly as possible. Then, moving balls were rolled down a ramp and the participants were asked to catch them when they reached a particular point on the ramp. When trying to catch the moving balls, the targets were visible for periods from 1.1 to 0.5 seconds. These trials were done in both normal physical reality and in a virtual reality environment.

"This study contributes to the field of rehabilitation by providing evidence about how to manipulate task and environmental constraints to improve movement in persons with PD," commented lead investigator Hui-Ing Ma. "Specifically, this study shows how to manipulate VR scenarios to improve movement speed in persons with PD, while at the same time depicting their movement characteristics in VR. Our study extends the previous findings of the moving target effect in physical reality to VR. Our findings suggest that with an appropriate choice of cueing speed, VR is a promising tool for offering visual motion stimuli to increase movement speed in persons with PD."

The authors highlight three main findings. First, in both VR and physical reality, the PD group had longer movement time and lower peak velocity than the control group when reaching for a stationary ball at a self-determined maximum speed. Second, for both VR and physical reality, movement time was significantly shorter and peak velocity was higher in the faster cueing conditions. Third, when moving targets were provided, the PD group showed more improvement than the control group in movement time and peak velocity, thus reaching a performance level similar to that of the control group.

More information: The article is "Comparison of Virtual Reality Versus Physical Reality on Movement Characteristics of Persons With Parkinson's Disease: Effects of Moving Targets" by Ching-Yi Wang, MS, OT, Wen-Juh Hwang, MD, Jing-Jing Fang, PhD, Ching-Fan Sheu, PhD, Iat-Fai Leong, PhD, and Hui-Ing Ma, ScD, OT. It will appear in Archives of Physical Medicine and Rehabilitation, Volume 92, Issue 8 (August 2011). doi:10.1016/j.apmr.2011.03.014

Provided by Elsevier

PET Detection of Amyloid Levels Equal to Immunohistochemistry

Amyloid levels detected by florbetapir-PET standard uptake value ratio characterizes AD, MCI

13 july 2011-- Detection of amyloid levels by positron emission tomography (PET), measuring fluorine 18-labeled flutemetamol (florbetapir) uptake by the brain cortex, is in concordance with immunohistochemical estimation; and the florbetapir-PET standard uptake value ratios (SUVRs) help characterize amyloid levels in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI), according to two studies published online July 11 in the Archives of Neurology.

David A. Wolk, M.D., from the University of Pennsylvania in Philadelphia, and colleagues investigated the concordance of in vivo quantitative estimates of florbetapir brain uptake in PET scans with immunohistochemical estimates of amyloid levels in seven patients who had a previous cortical biopsy. They found a complete agreement between florbetapir-PET scans and histology. Taking time from biopsy as a covariate, they identified a significant relationship between florbetapir uptake and percentage of area of amyloid measured by a monoclonal antibody raised against amyloid.

Adam S. Fleisher, M.D., from the Banner Alzheimer's Institute in Phoenix, and colleagues characterized florbetapir-PET measurements of fibrillar β-amyloid (Aβ) burden and compared mean cortical florbetapir SUVRs in 68 patients with AD, 60 with MCI, and 82 older healthy controls (OHCs). Participants with probable AD and MCI, and OHCs differed significantly in mean cortical florbetapir SUVRs, in the percentage meeting SUVR criteria of levels of amyloid associated with AD (80.9, 40.0, and 20.7 percent, respectively), and in percentage meeting SUVR criteria for the presence of any identifiable Aβ (85.3, 46.6, and 28.1 percent, respectively).

"The findings of our analysis confirm the ability of florbetapir-PET SUVRs to characterize amyloid levels in clinically probable AD, MCI, and OHC groups using continuous and binary measures of fibrillar Aβ burden," the authors write.

Several authors from Wolk's study disclosed financial relationships with GE Healthcare, which also funded the study. Several authors from Fleisher's study disclosed financial ties to the pharmaceutical industry, including Avid Radiopharmaceuticals, a wholly owned subsidiary of Eli Lilly, which funded the study.

Abstract - Wolk
Full Text

Cutting down on salt doesn't reduce your chance of dying

Moderate reductions in the amount of salt people eat doesn't reduce their likelihood of dying or experiencing cardiovascular disease. This is the main conclusion from a systematic review published in the latest edition of The Cochrane Library.

12 july 2011--There is lots of evidence that reducing dietary salt intake reduces blood pressure and the researchers did see some indication of this occurring. "Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months," says lead author Professor Rod Taylor who works at the Peninsula College of Medicine and Dentistry at the University of Exeter.

"What we wanted to see was whether this dietary change also reduced a person's risk of dying or suffering from cardiovascular events," says Taylor.

An earlier Cochrane review of dietary advice published in 2004 could not find enough evidence to allow the researchers to draw any conclusions about the effects of reducing salt intake on mortality or cardiovascular events. In Taylor's newly published research, however, the team managed to locate seven studies that together included 6,489 participants. This gave a sufficiently large set of data to be able to start drawing conclusions. Even so, Taylor believes he would need to have data from at least 18,000 individuals before he could expect to reveal any clear health benefits.

Most experts are agreed that consuming too much salt is not good for you and that salt reduction is beneficial in people with normal and high blood pressure. "We believe that we didn't see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large," says Taylor. He believes that health practitioners need to find more effective ways of reducing salt intake that are both practicable and inexpensive.

Many countries have government-sanctioned recommendations that call for reduced dietary sodium. In the UK, the National Institute of Health and Clinical Guidance (NICE) has recently called for an acceleration of the reduction in salt in the general population from a maximum intake of 6g per day per adult by 2015 to 3g by 2025.

"With governments setting ever lower targets for salt intake, and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake," says Taylor.

Provided by Wiley

Satisfaction with the components of everyday life appears protective against heart disease

While depression and anxiety have long been recognised as risk factors for heart disease, there is less certainty over the beneficial effects of a 'positive' psychological state, Now, following a study of almost 8000 British civil servants, researchers say that a satisfying life is indeed good for the heart.

11 july 2011--The results of the study are published online today by the European Heart Journal.

The civil servants - who were all members of the Whitehall II study cohort in the UK with an average age of 49 years - were questioned about seven specific areas of their everyday lives: love relationships, leisure activities, standard of living, job, family, sex, and one's self. They were asked to rate their satisfaction in each domain on a scale of 1 ('very dissatisfied') to 7 ('very satisfied'). Ratings for each domain were also combined to provide an average satisfaction score for their overall lives.

The participants' health records were then examined for coronary related deaths, non-fatal heart attack, and clinically verified angina over a follow-up period of around six years.

Results of the investigation showed that higher levels of average life satisfaction were associated with a reduced (and statistically significant) risk of total coronary heart disease of 13% (HR 0.87; 95% CI: 0.78 – 0.98), after controlling for demographic and other health characteristics. An approximate 13% reduced risk of heart disease was also associated with satisfaction in four of the specific life domains - job, family, sex, and self (but not with love relationships, leisure activities, or standard of living). The reduced risk of total coronary heart disease was found in both men and women.

There was a 'dose response' in these associations such that those reporting the greatest average life satisfaction appeared to enjoy the greatest risk reduction in total coronary disease. However, when examining the association between average life satisfaction and fatal or non-fatal heart attack separately from angina, reduced risk was only evident with angina, which appeared to be driving the association between life satisfaction and total coronary heart disease. Such findings may be accounted for by the relatively young age of the study participants or by the possibility that life satisfaction may relate to a general risk of atherosclerosis but not to factors predisposing individuals to heart attack. Nevertheless, the authors propose that understanding the psychological profile of patients with angina may add predictive value to an assessment of their subsequent heart disease risk.

'Taken together,' say the investigators, 'this research indicates that being satisfied with specific life domains - in particular, one's job, family, sex life, and self - is a positive health asset associated with a reduction in incident coronary heart disease independently of traditional risk factors.'

Commenting on the results, investigator Dr Julia Boehm from the Department of Society, Human Development, and Health, at the Harvard School of Public Health, Boston, USA, said: 'Although conventional risk factors such as health behaviors, blood pressure, lipids and body mass index did not explain the relationship between life satisfaction and total coronary heart disease, other behavioural or biological mechanisms that promote resilience cannot be ruled out. Moreover, these findings suggest that interventions to bolster positive psychological states - not just alleviate negative psychological states - may be relevant among high-risk individuals.'

Provided by European Society of Cardiology

Aging boomers strain cities built for the young

10 july 2011 -- America's cities are beginning to grapple with a fact of life: People are getting old, fast, and they're doing it in communities designed for the sprightly.

To envision how this silver tsunami will challenge a youth-oriented society, just consider that seniors soon will outnumber schoolchildren in hip, fast-paced New York City.

It will take some creative steps to make New York and other cities age-friendly enough to help the coming crush of older adults stay active and independent in their own homes.

"It's about changing the way we think about the way we're growing old in our community," said New York Deputy Mayor Linda Gibbs. "The phrase `end of life' does not apply anymore."

With initiatives such as using otherwise idle school buses to take seniors grocery shopping, the World Health Organization recognizes New York as a leader in this movement.

But it's not alone.

Atlanta is creating what it calls "lifelong communities." Philadelphia is testing whether living in a truly walkable community really makes older adults healthier. In Portland, Ore., there's a push to fit senior concerns such as accessible housing into the city's new planning and zoning policies.

Such work is getting a late start considering how long demographers have warned that the population is about to get a lot grayer.

"It's shocking how far behind we are, especially when you think about this fact - that if you make something age-friendly, that means it is going to be friendly for people of all ages, not just older adults," said Margaret Neal of Portland State University's Institute on Aging.

While this fledgling movement is being driven by nonprofit and government programs, New York aims to get private businesses to ante up, too.

Last year, East Harlem became the city's first "aging improvement district." Sixty stores, identified with window signs, agreed to put out folding chairs to let older customers rest as they do their errands. The stores also try to keep aisles free of tripping hazards and use larger type so signs are easier to read. A community pool set aside senior-only hours so older swimmers could get in their laps without faster kids and teens in the way.

On one long block, accountant Henry Calderon welcomes older passers-by to rest in his air-conditioned lobby even if they're not customers. They might be, one day.

"It's good for business but it's good for society," too, he said.

The size of the aging boom is staggering. Every day for the next few decades, thousands of baby boomers will turn 65. That's in addition to the oldest-old, the 85- to 90-somethings whose numbers have grown by nearly one-third in the past decade, with no signs of slowing.

By 2050, 1 in 5 Americans will be seniors. Worldwide, almost 2 billion people will be 60 or older, 400 million of them over 80.

That's almost always viewed as a health issue, preparing for the coming wave of Alzheimer's, or as a political liability, meaning how soon will Social Security go bust?

"We think this is something we should be celebrating," says Dr. John Beard, who oversees the World Health Organization's Global Network of Age-Friendly Cities. "They need to live in an environment that allows them to participate."

In East Harlem, a yellow school bus pulls up to a curb and 69-year-old Jenny Rodriguez climbs off. The bus had already dropped a load of kids at school. Now, before the afternoon trip home, it is shuttling older adults to a market where they flock to fresh fruits and vegetables.

Rodriguez usually goes shopping on foot, pulling along a small cart. It can be a hike. Supermarkets aren't too common in this lower-income part of the city, and there's less to choose at tiny, pricier corner bodegas.

"You can only buy so much. Some streets, the cracks are so bad, you're pushing the shopping cart and almost go flying," Rodriguez said, examining sweet potatoes that she pronounced fresher and cheaper than at her usual store. "This is so much easier."

More than 200 times, school buses have taken older adults from senior centers to supermarkets in different neighborhoods. It's just one of a variety of initiatives begun in 2009 by the New York Academy of Medicine and the city's government to address the needs of older residents. Already, they're showing results.

A city report found the number of crashes has dropped at busy intersections in senior-heavy communities where traffic signals now allow pedestrians a few more seconds to cross the street.

Benches have been placed in nearly 2,700 bus shelters to give waiting seniors a place to rest.

The city's aging taxi fleet is scheduled to be replaced by a boxier model designed to be easier for older riders and people with disabilities to open the doors and slide in and out.

On the Upper West Side, seniors snapped up a report card of grocery stores deemed age-friendly because they offer deliveries, have public bathrooms - a rarity in the city - and sell single portions of fresh meat, poultry or fish, important for people who live alone.

Artists volunteer to teach at senior centers in return for space to work on or display their own creations.

And a "Time Bank" is letting hundreds of people of different ages and with different skills essentially barter services. A retired English teacher may do some tutoring, for example, and use the credit she earns to get computer help from another volunteer.

Aging expert Andrew Scharlach of the University of California, Berkeley, sees a common thread in these changes and the work of other cities. Combat the social isolation that too easily sneaks up on older adults and it has a huge impact not just on how many years they will live, but how well they live them.

Cities and suburbs were designed for younger people, full of stairs and cars, he explained. As they become increasingly difficult to navigate, older people gradually retreat.

Revamping a lot of infrastructure may not happen in a tough economy. But some communities are building age-friendly changes into planned upgrades or maintenance, such as New York's street crossings, or into requirements for future development.

The WHO's Beard says some changes aren't that costly, noting that seniors around the world say more benches and access to bathrooms will help them get out and about.

Among other cities' work:

-The Atlanta Regional Commission's Lifelong Communities Initiative is pushing communities that help people age in place. Efforts are under way in six metro areas, including work to adapt zoning codes to allow more of a walkable mix of housing and retail. The Mableton community of suburban Cobb County is planning that kind of a town square, and has opened a farmers market - on a weekday morning when seniors preferred to shop - and intergenerational community garden. To the east, DeKalb County is building a library near a senior center, planned senior housing and a bus stop. One town pilot-tested a shuttle for seniors to supplement bare-bones public transit.

The Atlanta Housing Authority is working with the commission to retrofit high-rise apartments that house a lot of older residents, with the goal to improve access to the surrounding community. At one site under construction, changes include a ramp entrance, safer sidewalk to the bus stop and more time for pedestrians to cross the street.

The overall move isn't without controversy.

Sometimes younger residents misunderstand and say they don't want to live in a retirement community, said commission urban planner Laura Keyes.

She said boomers, who are classified as being born from 1946 to 1964, and millenials, the children of baby boomers who came of age in the new millennium, ultimately want the same things: access to shopping, green space, more freedom from the car. The idea is a mix of ages but where older residents don't need to move if their health fails.

Keyes became interested in age-friendly communities when visiting friends in nursing homes built in commercial districts - and saw that they had nowhere to take a walk.

-Philadelphia is the oldest of the nation's 10 largest cities, with 19 percent of its residents over age 60 - and lots of multi-story rowhouses where seniors are stuck on one floor. "They become prisoners in their homes," said Kate Clark of the nonprofit Philadelphia Corporation for Aging.

In redesigning the city's zoning code, proposals are being debated that would allow seniors to rent out their upper floors, and to require that a certain amount of new housing be what's called "visitable" - with such things as ramp entrances, wide hallways and at least a half-bathroom on the main floor, she said.

With funding from the National Institutes of Health, the aging group's Allen Glicksman is studying if seniors who live in a walkable neighborhood really are healthier as a result. He has found that social capital - think friendly neighbors, low crime and good sidewalks that encourage getting out - is as important to older residents as access to supermarkets, public transportation and good housing.

Also, there are calls for age-friendlier parks, with safer steps and places to walk apart from bikers.

To sustain momentum, Clark created GenPhilly, a network of 20- and 30-somethings interested in shaping the city they'll age in by raising senior issues in varying professions.

-Portland was part of WHO's initial study of what makes a city age-friendly, an initiative that helped bring about more handicapped-accessible cars for the city's light-rail system, Neal said.

Now, aging experts are among the advisers as the city develops a master plan for the next 25 years. One issue, Neal said, is how to develop more accessible housing when the city's anti-sprawl policy means a lot of narrow, multistory houses are being squeezed into empty city lots - near transportation but still not age-friendly with all the stairs.

Integrating senior-friendly changes into everyday city policies is less visible than, say, a new retirement home but it's ultimately the goal, says Scharlach, the aging expert.

New York also hopes for some economic return.

Consider La Marqueta in East Harlem. Fifty years ago, it was a bustling, five-block market, a weekly gathering spot for families. But economic downturn left the city-owned building mostly empty for years. Now, as part of a $1.5 million economic revitalization project, an industrial kitchen in the building will train low-income women to start their own food businesses. It joins the fish and butcher shop, a farmer's market, and a high-end food importer - and busing in the seniors once a month boosts the still thin customer traffic.

But it's more than a shopping day. A quick check from a health department nurse reassured 73-year-old Maria Ilarraza that her blood pressure was OK, and she sat to catch up with friends over coffee. In another corner, a crowd listened as a university nutritionist explained how to safely freeze and thaw meat.

Art teacher Piedad Gerena showed off some of the bold landscapes and modern images her students at a nearby senior center learned to paint, and, to her delight, sometimes sell for up to $200 apiece. "Many of these people have no families," Gerena said. "The art makes them feel happy."

More information:
World Health Organization's Global Network of Age-Friendly Cities: http://tinyurl.com/3kdkp6q

Portland State University's Institute on Aging: http://www.pdx.edu/ioa

New York City's Aging Improvement Districts: http://tinyurl.com/3h5fo7a

New York Academy of Medicine: http://www.nyam.org/urban-health/healthy-aging

Atlanta Regional Commission's Lifelong Communities Initiative: http://tinyurl.com/3gz9lfv

Philadelphia Corporation for Aging: http://www.pcacares.org

GenPhilly: http://www.genphilly.org

'Sundowning,' an anxiety syndrome in elderly dementia patients explained in a new study

New research provides the best evidence to date that the late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain.

08 july 2011--The findings could help explain "sundowning," a syndrome in which older adults show high levels of anxiety, agitation, general activity and delirium in late afternoon and evening, before they would normally go to bed.

"It's a big problem for caregivers. Patients can get aggressive and very disruptive," said Tracy Bedrosian, lead author of the study and a doctoral student in neuroscience at Ohio State University.

"There have been a few clinical studies documenting sundowning, but until now there hasn't been research in animals to see what's going on in the brain to explain this."

The new study found that aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice – just like sundowning in humans.

In these aged mice, the researchers found changes in parts of their brain associated with attention, emotions, and arousal, all of which could be associated with the behavior seen in sundowning.

In addition, mice that were genetically engineered to have an Alzheimer's-like disease also showed more anxiety before sleep than did other mice.

"Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn't communicate their needs over the course of the day, or by other factors," said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State.

"But our findings suggest there is a real phenomenon going on here that has a biological basis."

The study will appear in the online Early Edition of the Proceedings of the National Academy of Sciences.

In the first experiment, researchers compared middle-aged adult mice (7 months old) with aged mice (29 months old) that would resemble humans in their 80s.

Results showed that the aged mice were significantly more active than middle-aged mice in the two to three hours before they would normally go to sleep.

"The middle-aged mice had a distinct pattern of activity, with three peaks of activity during their waking hours," Bedrosian said.

"But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period."

That means that in the evening, when the middle aged mice would slow down compared to their peak activity levels, the aged mice kept going.

The mice were also tested for anxiety-like behaviors at two different times during their waking hours. The mice were placed in a maze where they were allowed to explore open areas – which are more anxiety-producing – or hide in enclosed areas.

The middle-aged mice showed consistent levels of anxiety at both times of the day. However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, Bedrosian said.

There were also differences in the brains of the aged mice when compared to the middle aged mice. The researchers looked specifically at the cholinergic system, because loss of function in that system is associated with dementia and many of the circadian changes associated with ageing.

Findings in aged mice showed greater expression of a certain enzyme – acetylcholinesterase – before sleep than earlier in the day. High levels of this enzyme are associated with anxiety and agitation.

However, in the middle-aged mice, there were no time-of-day differences in the expression of this enzyme.

Nelson noted that drugs used to control levels of acetylcholinesterase are sometimes used on dementia patients, although there has been no research evidence that it actually had an effect on sundowning.

"These drugs were prescribed for other purposes, but it also seemed to calm patients down. Now we have some evidence on why it works," Nelson said.

The researchers also found differences in expression of two other proteins in the brains of the aged mice that are also associated with behavioral disturbances.

"All of these results converge to suggest there are changes in the cholinergic systems of aged mice that may be contributing to the anxiety and agitation symptoms that we documented," Bedrosian said.

In another experiment, the researchers used mice that were genetically engineered to develop Alzheimer's-like disease in their brain. They were compared, at nine months of age, to similar wild-type mice of the same age.

The Alzheimer's-like mice showed more anxiety-type behaviors when tested before they would normally sleep than they did when tested earlier in their waking period. That is consistent with sundowning in humans, the researchers said.

However, the wild-type mice showed no differences in anxiety levels based on the time of day they were tested.

Nelson said one of the theories about sundowning is that it is tied to disruptions that often occur in the biological clocks of older people, where their sleep-wake cycles are fragmented.

To test this theory, the researchers also treated the aged mice with melatonin for four weeks in order to help consolidate their circadian rhythms. However, this treatment did not work to reduce anxiety issues in the mice.

Nelson said melatonin alone may not work because it doesn't deal with the disruptions in the cholinergic system that was identified in this study.

"We need to study whether treating cholinergic dysfunction alone or in combination with melatonin treatment will help deal with sundowning symptoms," he said.

Provided by The Ohio State University

Vitamin D can help elderly women survive

Giving vitamin D3 (cholecalciferol) to predominantly elderly women, mainly in institutional care, seems to increase survival. These women are likely to be vitamin D deficient with a significant risk of falls and fractures. This is the key conclusion in a systematic review published in the latest edition of The Cochrane Library.

06 july 2011--Up until now there has been no clear view on whether there is a real benefit of taking vitamin D. "A Cochrane meta-analysis published only a couple of years ago found that there was some evidence for benefit, but it could not find an effect on mortality. We were, however, aware that more trials had been published and wanted to assess the effects of vitamin D when you added all the data together," said Dr Goran Bjelakovic, who works at Department of Internal Medicine - Gastroenterology and Hepatology, at the University of Nis, in Serbia and at The Cochrane Hepato-Biliary Group at The Copenhagen Trial Unit in Copenhagen, Denmark.

The eight-strong international team of researchers identified 50 randomised trials that together had 94,148 participants. They had a mean age of 74 years, and 79% were women. "Our analyses suggest that vitamin D3 reduces mortality by about 6%. This means that you need to give about 200 people vitamin D3 for around two years to save one additional life," says Bjelakovic.

There were no significant benefits of taking other forms of vitamin D such as vitamin D2, and the active forms of the vitamin, alfacalcidol or calcitriol. However, the researchers point out that they could only find much less data relating to these types of vitamin D and so these conclusions should be taken with caution. "We need to have more randomised trials that look specifically to see whether these forms of vitamin D do or don't have benefits," says Bjelakovic. His team did conclude that alfacalcidol and calcitriol significantly increased the risk of hypercalcaemia, and vitamin D3 combined with calcium significantly increased the risk of kidney stones.

There have been reports and comments that taking vitamin D can reduce the risk of getting cancer, but this work showed no evidence that vitamin D reduced cancer-related mortality.

"Previous reviews of preventive trials of vitamin D have not included as much information and have not examined the separate influence of different forms of vitamin D on mortality. By taking data from a larger number of trials we have been able to shed much more light on this important issue," says Bjelakovic.

Provided by Wiley

Alcohol drinking in the elderly: Risks and benefits

The Royal College of Psychiatrists of London has published a report related primarily to problems of unrecognized alcohol misuse among the elderly. The report provides guidelines for psychiatrists and family physicians on how to find and how to treat elderly people with misuse of alcohol and drugs. Forum members consider it very important to identify abusive drinking among the elderly and this report provides specific and very reasonable recommendations to assist practitioners in both the identification and treatment of such problems.

04 july 2011--There is no question that, on average, very elderly people may be more sensitive to the effects of alcohol (especially those individuals with chronic diseases, lower muscle mass, a poor diet, etc.) It should be made clear, however, that 65-year-olds are healthier than people of that age a generation ago - age-specific disability rates are decreasing, not increasing.

The report also recommends lower "sensible limits" for older people in comparison with younger people The International Forum on Alcohol Research scientific reviewers point out inherent difficulties in providing guidelines for a very non-homogenous group of individuals whose only criterion for inclusion, in this paper, is being above the age of 65 years Such a group includes individuals varying from marathon runners to very sick, frail people.

The report was conspicuously lacking in a discussion of the important role that moderate drinking can play in reducing the risk of coronary heart disease, ischemic stroke, diabetes, dementia, and osteoporosis. Advising healthy people aged 65 years or older who are moderate, responsible drinkers to stop drinking or to markedly reduce their intake would not be in their best health interests, especially in terms of their risk of cardiovascular diseases. Forum reviewers thought that advice to lower limits of drinking for everyone in this age group is not based on reliable research, and would certainly not apply to all in this age group. Of more importance, the absolute risk for cardiovascular diseases increases markedly with age, and therefore the beneficial or protective effect of light to moderate drinking on cardiovascular diseases is greater in the elderly than in younger people.

Evidence is also accumulating that shows that the risk of Alzheimer's disease and other types of dementia is lower among moderate drinkers than among abstainers. Neurodegenerative disorders are key causes of disability and death among elderly people. Epidemiological studies have suggested that moderate alcohol consumption, may reduce the incidence of certain age-related neurological disorders including Alzheimer's disease. Regular dietary intake of flavonoid-rich foods and/or beverages has been associated with 50% reduction in the risk of dementia, a preservation of cognitive performance with ageing,a delay in the onset of Alzheimer's disease and a reduction in the risk of developing Parkinson's disease.

Further, scientific data are consistent in demonstrating that quality of life is better and total mortality is lower among moderate drinkers than among abstainers. For example, analyses by Simons et al from a large population-based patient population in New South Wales demonstrated clearly that regular moderate alcohol consumption increases life span and quality of life for men up to 80 years of age and for women indefinitely.

In another paper, by Kirchner et al of almost 25,000 American adults over age 65 seen in primary care, those reporting between 8 and 14 drinks/week (A US drink is 14g, against 8g in the UK) did not differ significantly in their characteristics from drinkers consuming 1-7 drinks/week.. Heavier drinkers and binge drinkers did not do as well.

A particular interesting paper by White et al showed a direct dose-response relation between alcohol consumption and risk of death in women aged 16-54 and in men aged 16-34, whereas at older ages the relation is U shaped. These investigators used statistical models relating alcohol consumption to the risk of death from single causes to estimate the all-cause mortality risk for men and women of different ages. The authors state that their data suggest that women should INCREASE their intake to 3 units a day over age 75, and men rise from 3 units a day up to age 54 to 4 units a day up to age 84.

Since the absolute effects of moderate drinking on cardiovascular disease are much greater in older people than in younger adults, the current limitations to intake for the elderly may not be appropriate. Attempting to persuade elderly people who currently drink moderately to decrease their current intake may not be advisable. For healthy moderate and responsible drinkers, advice to reduce or stop all alcoholic beverage intake would not be in the best health interests of such individuals.

More information: Royal College of Psychiatrists, London. Our invisible addicts. First Report of the Older Persons' Substance Misuse Working Group of the Royal College of Psychiatrists, College Report CR165. June 2011. http://www.bu.edu/ … 6-june-2011/

Provided by Boston University Medical Center