Wednesday, August 31, 2011

Cycling fast: vigorous daily exercise recommended for a longer life

A study conducted among cyclists in Copenhagen, Denmark1 showed that it is the relative intensity and not the duration of cycling which is of most importance in relation to all-cause mortality and even more pronounced for coronary heart disease mortality. The study presented today at the ESC Congress 2011, concluded that men with fast intensity cycling survived 5.3 years longer, and men with average intensity 2.9 years longer than men with slow cycling intensity. For women the figures were 3.9 and 2.2 years longer, respectively (see Figures below). The groups were adjusted for differences in age and conventional risk factor levels.

31 aug 2011--Current recommendations prescribe that every adult should accumulate 30 minutes or more of moderate physical activity in leisure time, preferably every day of the week. The optimal intensity, duration and frequency still have to be established.

According to Prof Schnor, "this study suggests that a greater part of the daily physical activity in leisure time should be vigorous, based on the individuals own perception of intensity. "Our group has already published similar results for all-cause mortality in relation to walking."2

The following tables show hazard ratios for all-cause and coronary heart disease death in relation to duration and intensity of cycling adjusted for age, gender, number of other sports activities, BMI, systolic blood pressure (including antihypertensive medication), HDL-cholesterol, smoking, income, alcohol-intake and diabetes. Within all three duration groups, there was an inverse association between cycling intensity and all-cause mortality, this was even more pronounced for coronary heart disease.

Provided by European Society of Cardiology

Tuesday, August 30, 2011

Study suggests people with neurotic personality traits do not enjoy growing older as much as peers, may need extra help

LinkWhile most adult Americans report feeling more cheerful, content and other positive emotions as they reach their middle and later years, a subset who have more neurotic personality traits do not share in that trend toward greater satisfaction with age, according to a recent analysis by psychology researchers at the University of Massachusetts Amherst and Purdue University.

30 aug 2011--Led by Rebecca Ready, UMass Amherst assistant professor of psychology, and her graduate student Anna Akerstedt, with Daniel Mroczek at Purdue, the analysis suggests that neuroticism may be a liability for older adults not only because they are less content but because their "negative affect" is associated with poorer mental health.

The researchers suggest that psychological theories about emotional change over time and clinical practice could do more to help enrich adults’ lives by taking into account individual personality differences such as neuroticism. Results appear in the current issue of the journal Aging and Mental Health.

Ready and colleagues analyzed data collected at two points about 10 years apart from 1,503 men and women who participated in the Midlife in the United States (MIDUS I and II) studies. "People who score high on a neuroticism scale had less mental well-being over time and this pattern was stronger for older and midlife adults than for younger persons. We feel further study may yield a better understanding of how to intervene in this process. This might provide tools to guard against late-life depressive symptoms," Ready says.

Psychology views neuroticism as a fairly stable personality trait that occurs on a continuum. People who score higher describe themselves more often as nervous, sad, upset and feeling hopeless or worthless. By contrast, people who score low in neuroticism report less often feeling tense, sad or worried. They don’t say they are happier, but they do say they feel calm, satisfied and not stressed.

Ready and her colleagues point out that despite the wealth of data available on neuroticism, emotion and aging, little is known about how these variables interact over time, as people grow older. They set out to address this gap in understanding and to explore whether an individual’s neuroticism score at baseline predicted emotional complexity and emotional well-being 10 years later.

Participants were selected from among 2,257 people 25 to 74 years old who took part in the MIDUS I study in 1995-1996 as well as the follow-up study in 2004-2006. Respondents completed two mail-in questionnaires and a 30-minute phone interview at each time point. Those with missing data or who didn’t answer the questions needed for this analysis were excluded, leaving 1,503 in the final sample. They were 90 percent white, 55 percent female and most, 68.7 percent, were married at baseline.

The researchers assessed the trait of neuroticism with a four-item scale at MIDUS I and II. It asked how often subjects felt moody, worried or nervous, for example. Ten years later, different items were used to code individuals as having positive or negative emotions by asking how often they felt sad, restless/fidgety, hopeless, everything was an effort, worthless, afraid, jittery, irritable, ashamed and upset as well as attentive, proud and active.

Overall, using moderated multiple regressions, Ready and colleagues found that neuroticism was significantly and negatively associated with emotional well-being while age was significantly and positively associated with emotional well-being. The interaction between age and neuroticism in predicting emotional well-being was significant.

A major finding was that "neuroticism is more strongly linked to emotion outcomes for older than younger persons," they add. On average, neuroticism tends to decrease during adult development, but not at the same rate for everyone, Ready points out. "Such decreases may result in better, broader and richer emotional experiences in later life. This hypothesis is supported by results of the current study."

Older and midlife adults who are as high on the neuroticism scale as younger people might be helped by early interventions to improve emotional well-being, Ready adds. "We did not assess risk for future depressive disorders but it is reasonable to speculate that older and midlife adults high in neuroticism are at greater risk for depressive symptoms in the future than are persons lower in neuroticism. They may also experience less well-being and may have less tolerance for complex emotions."

The authors say more research is needed to explore how and why some older adults do not conform to normative developmental trajectories to provide a fuller understanding of emotional development and how to help people achieve optimal outcomes as they mature.

Provided by University of Massachusetts Amherst

Monday, August 29, 2011

Lower socioeconomic status linked with heart disease despite improvements in other risk factor

People with lower socioeconomic status are much more likely to develop heart disease than those who are wealthier or better educated, according to a recent UC Davis study. Published online in BMC Cardiovascular Disorders, the outcomes also show that this risk persists even with long-term progress in addressing traditional risk factors such as smoking, high blood pressure and elevated cholesterol.

29 aug 2011--"Being poor or having less than a high school education can be regarded as an extra risk when assessing a patient's chances of developing cardiovascular disease," said Peter Franks, a UC Davis professor of family and community medicine and lead author of the study. "People with low socioeconomic status need to have their heart-disease indicators managed more aggressively."

Using data from the Atherosclerosis Risk in Communities Study, authors of the current study included information on more than 12,000 people aged 45 to 64 years living in North Carolina, Mississippi, Minnesota and Maryland. Participants reported their education and income levels in 1987, and then over the course of 10 years were periodically evaluated for heart-disease diagnoses and changes in their risk factors, including cholesterol, blood pressure and smoking.

The results indicated that people with lower socioeconomic status had a 50 percent greater risk of developing heart disease than other study participants.

According to Franks, although it is known that people with low socioeconomic status have a greater risk for developing heart disease and other health problems, the reason is often attributed to reduced health-care access or poor adherence to treatments such as smoking cessation or medication. This study showed for the first time that the increased risk endured despite long-term improvements in other risk factors, indicating that access and adherence could not account for the differences.

"Low socioeconomic status is a heart-disease risk factor on its own and needs to be regarded as such by the medical community," Franks said.

According to Franks, previous studies could help explain the link between low socioeconomic status and increased heart-disease risk. Social disadvantages and adversity in childhood may result in lasting adaptations to stress that take a bigger toll on the heart. Cumulative effects of social disadvantage throughout the lifespan could also cause more "wear and tear" on the cardiovascular system.

Franks advocates for including socioeconomic status in the Framingham risk assessment, a tool based on outcomes from the Framingham Heart Study, which is commonly used to determine treatments for heart-disease prevention. He points out that health-care providers in the United Kingdom already consider socioeconomic status in determining care plans.

"Doctors could, for instance, moderately increase the dosage of cholesterol-lowering drugs to reflect the higher risk imposed by socioeconomic status," said Franks, whose research focuses on addressing health-care disparities. "Changes like this would be easy to implement, and the benefits could be significant."

More information: The study "Do Changes in Traditional Coronary Heart Disease Risk Factors Over Time Explain the Association between Socio-Economic Status and Coronary Heart Disease?" is available online at http://www.biomedc … 1-2261/11/28

Provided by University of California - Davis

Saturday, August 27, 2011

A lifetime of physical activity yields measurable benefits as we age

The benefits of physical activity accumulate across a lifetime, according to a new study published in the October issue of the American Journal of Preventive Medicine. Researchers in England and Australia examined the associations of leisure time physical activity across adulthood with physical performance and strength in midlife in a group of British men and women followed since birth in March 1946.

27 aug 2011--"Maintaining physical performance and muscle strength with age is important given that lower levels in older populations are associated with increased risk of subsequent health problems, loss of independence, and shorter survival times," commented lead investigator Rachel Cooper, PhD, Medical Research Council (MRC) Unit for Lifelong Health and Ageing. "As the global population ages, there is a growing need to identify modifiable factors across life that influence physical performance and strength in later life. We found that there are cumulative benefits of physical activity across adulthood on physical performance in mid-life. Increased activity should be promoted early in adulthood to ensure the maintenance of physical performance in later life. Promotion of leisure time activity is likely to become increasingly important in younger populations as people's daily routines become more sedentary."

The study, conducted by investigators from the MRC Unit for Lifelong Health, London, United Kingdom, and the School of Population Health, University of Queensland, Australia, used data from about 2400 men and women from the UK Medical Research Council National Survey of Health and Development. They analyzed self-reported leisure time physical activity (LTPA) levels at 36, 43 and 53 years of age. During the 53-year investigation, grip strength, standing balance, and chair rise times were measured as indicators of strength and physical performance.

Grip strength is a measure of upper-body muscle condition. Chair-rise times are associated with lower body strength and power, as well as cardiorespiratory fitness. Standing balance requires mental concentration and subtle motor control and measures a number of neurophysiological and sensory systems.

Participants who were more active at all three ages showed better performance on the chair-rise test. Persons more active at ages 43 and 53 had better performance on the standing balance test, even after adjusting for covariates. However, physical activity and grip strength were not associated in women and, in men, only physical activity at age 53 was associated with grip strength.

Dr. Cooper added that the findings in relation to chair rising and standing balance performance suggest that promotion of leisure time physical activity across adulthood would have beneficial effects on physical performance later in life and hence the functional health and quality of life of the aging population, especially as the size of the differences in performance detected may be clinically relevant.

More information: The article is "Physical Activity Across Adulthood and Physical Performance in Midlife: Findings from a British Birth Cohort" by Rachel Cooper, PhD, Gita D. Mishra, PhD, and Diana Kuh, PhD. (doi: 10.1016/j.amepre.2011.06.035). It appears in the American Journal of Preventive Medicine, Volume 41, Issue 4 (October 2011).

Provided by Elsevier

Friday, August 26, 2011

Obesity linked to cognition

New research suggests obese individuals often perform poorly in reasoning and planning tasks and, likewise, those with poor cognitive function are more vulnerable to excessive weight gain.

26 aug 2011--The controversial findings, published this week in the international journal Obesity Reviews, suggests that obesity should be treated, at least in part, as a brain condition, similar to anorexia nervosa.

This could mean introducing cognitive remediation therapy used to treat anorexia to support other lifestyle interventions for people with obesity. Cognitive remediation therapy aims at improving executive function via cognitive training and increases awareness of cognitive style.

Australia is one of the most overweight developed nations in the world, according to the Federal Government’s Preventative Health Task Force, with over 60% of adults and one in four children overweight or obese.

Reviewing 38 recent studies into obesity and cognition, researchers from UNSW’s School of Psychiatry found there was a likely “vicious cycle” relationship between cognition and obesity, with low performance in planning, reasoning and problem solving exacerbating weight gain, which in turn compounds negative influence on the brain via biological mechanisms.

This relationship was not explained by other factors such as medical problems or social status, and was apparent in children, adolescents and adults, but not in the elderly whose situation is more complex. However the research does support existing studies that show mid-life obesity is a risk factor for dementia in later life.

The reviewers said obesity is, at least in part, a brain condition, not only a so-called “lifestyle” disorder. There is evidence of a common genetic vulnerability for both obesity and impairments in thinking style which could be triggered by lifestyle factors.

Review lead author Dr Evelyn Smith said the finding was controversial, but what it didn’t mean was that all obese people have cognitive deficiencies. “However, on average they do have more problems with problem solving and other ‘executive’ brain or cognitive functions than normal weight individuals,” she said.

“Executive function is the most common cognitive deficiency found in obese individuals. It encompasses a diverse range of processes that facilitate initiation, planning and achievement of complex goals, all of which may impact on eating behaviour and activity.”

Cognitive remediation therapy similar to that used to treat individuals with anorexia could be an effective intervention for obesity, by improving certain cognitive processes and in turn helping individuals maintain a healthy lifestyle long term, Dr Smith said.

Dr Smith is now piloting the therapy as a way to help the obese lose weight and keep it off long term, in collaboration with Kings College London and University of Western Sydney (UWS).

“Because current strategies for treating obesity are not successful long-term, there’s an urgency to invest in new obesity research,” Dr Smith said.

“Additional investigations are required to further understand the biological mechanisms and bi-directional relationship between cognition and obesity, and also to confirm whether executive function in children and adolescents can predict obesity in adults,” she said.

Dr Smith’s review was supported by a grant from the National Health & Medical Research Council of Australia, and was carried out in collaboration with Professor Phillipa Hay (UWS), Conjoint Professor Lesley Campbell (UNSW), and Associate Professor Julian Trollor (UNSW).

Provided by University of New South Wales

Thursday, August 25, 2011

Sexual satisfaction tied to overall 'successful aging' as reported by women age 60 to 89

A study by researchers at the Stein Institute for Research on Aging at the University of California, San Diego finds that successful aging and positive quality of life indicators correlate with sexual satisfaction in older women. The report, published online in the August edition of the Journal of the American Geriatric Society, also shows that self-rated successful aging, quality of life and sexual satisfaction appear to be stable even in the face of declines in physical health of women between the ages of 60 and 89.

The study looked at 1,235 women enrolled at the San Diego site of the Women's Health Initiative (WHI) study, a major ongoing research program funded by the National Institutes of Health which, since 1993, has addressed causes of death, disability and quality of life in more than 160,000 generally healthy, post-menopausal women.

25 aug 2011--As the researchers expected, sexual activity and functioning (such things as desire, arousal and ability to climax) were negatively associated with age, as were physical and mental health. However, in contrast to sexual activity and functioning, satisfaction with overall sex life was not significantly different between the three age cohorts studied: age 60 to 69; 70 to 70; and 80 to 89. Approximately 67 percent, 60 percent, and 61 percent of women in these three age groups, respectively, reported that they were "moderately" to "very satisfied" with their sex lives.

"Contrary to our earlier hypothesis, sexual satisfaction was not significantly associated with age," said Wesley K. Thompson, PhD, assistant professor of psychiatry with the Stein Institute for Research on Aging at the UC San Diego School of Medicine, and co-lead author along with UC San Diego medical student Lindsey Charo, BA. "Although the levels of sexual activity and functioning did vary significantly, depending on the woman's age, their perceived quality of life, successful aging and sexual satisfaction remained positive."

Sexual activity was significantly lower in older age cohorts. Of the women who were married or in an intimate relationship, 70 percent of those aged 60 to 69, 57 percent of those aged 70 to 79, and 31 percent of those aged 80 to 89 reported having had some sexual activity in the previous six months. While women who were married or living in an intimate relationship engaged in higher rates of sexual activity than those who were not in such a relationship, sexual activity still decreased across age cohorts.

The findings of this study confirm earlier published research from the UCSD Stein Institute suggesting that self-rated health changes little with age even when objective health indicators show age-associated decline.

"What this study tells us is that many older adults retain their ability to enjoy sex well into old age," said Thompson. "This is especially true of older adults who maintain a higher level of physical and mental health as they grow older. Furthermore, feeling satisfied with your sex life - whatever your levels of sexual activity - is closely related to your perceived quality of life." He added that "while we cannot assess cause and effect from this study, these results suggest that maintaining a high level of sexual satisfaction may positively reinforce other psychological aspects of successful aging."

Provided by University of California - San Diego

Tuesday, August 23, 2011

Older adults with too much salt in diet and too little exercise at greater risk of cognitive decline

Older adults who lead sedentary lifestyles and consume a lot of sodium in their diet may be putting themselves at risk for more than just heart disease.

23 aug 2011--A study led by researchers at Baycrest in Toronto – in collaboration with colleagues at the Institut Universitaire de Gériatrie de Montréal, McGill University and the Université de Sherbrooke – has found evidence that high-salt diets coupled with low physical activity can be detrimental to cognitive health in older adults.

The finding, which appears online today in the journal Neurobiology of Aging, ahead of print publication, may have significant public health implications, emphasizing the importance of addressing multiple lifestyle factors that can impact brain health.

The study followed the sodium consumption and physical activity levels of 1,262 healthy older men and women (ages 67 – 84) residing in Quebec, Canada, over three years. The adults were recruited from a large pool of participants in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge).

While low sodium intake is associated with reduced blood pressure and risk of heart disease, this is believed to be the first study to extend the benefits of a low sodium diet to brain health in healthy older adults.

"We have generated important evidence that sodium intake not only impacts heart health, but brain health as well," said Dr. Alexandra Fiocco, a scientist with Baycrest's Kunin-Lunenfeld Applied and Evaluative Research Unit (KLAERU) and the study's lead investigator.

Health Canada's sodium reduction strategy recommends that people 14 years of age and older consume no more than 2,300 mg of sodium per day in their diet. In the Baycrest study, senior participants were assessed as low, mid or high level sodium consumers based on a food frequency questionnaire they each completed. Low sodium intake was defined as not exceeding 2,263 mg/day; mid sodium intake 3,090 mg/day; and high sodium intake 3,091 and greater (this went as high as 8,098) mg/day.

Researchers used a modified Mini-Mental State Examination to measure cognitive function in participants at year one (baseline) and annually for three additional years. Physical activity levels were measured using the Physical Activity Scale for the Elderly.

"The results of our study showed that a diet high in sodium, combined with little exercise, was especially detrimental to the cognitive performance of older adults," said Dr. Fiocco.

"But the good news is that sedentary older adults showed no cognitive decline over the three years that we followed them if they had low sodium intake."

"These data are especially relevant as we know that munching on high-salt processed snacks when engaged in sedentary activities, such as watching TV or playing in front of the computer, is a frequent pastime for many adults," said Dr. Carol Greenwood, a senior author on the study and internationally-renowned scientist in the field of nutrition and cognitive function in late life.

"This study addresses an additional risk associated with lifestyles that are highly apparent in North American populations."

With brain failure rates expected to rise significantly as Canada's large boomer demographic ages, educating the public about lifestyle changes that can help delay or prevent normal, age-related cognitive decline – including adopting a healthier diet – is a way to give people some control over how their brain health will hold up in later years, said Dr. Greenwood, senior scientist with Baycrest's KLAERU and professor in the Department of Nutritional Sciences at the University of Toronto.

Provided by Baycrest Centre for Geriatric Care

Monday, August 22, 2011

At last, a reason why stress causes DNA damage

For years, researchers have published papers that associate chronic stress with chromosomal damage.

22 aug 2011--Now researchers at Duke University Medical Center have discovered a mechanism that helps to explain the stress response in terms of DNA damage.

"We believe this paper is the first to propose a specific mechanism through which a hallmark of chronic stress, elevated adrenaline, could eventually cause DNA damage that is detectable," said senior author Robert J. Lefkowitz, M.D., James B. Duke Professor of Medicine and Biochemistry and a Howard Hughes Medical Institute (HHMI) investigator at Duke University Medical Center.

The paper was published in the Aug. 21 online issue of Nature.

In the study, mice were infused with an adrenaline-like compound that works through a receptor called the beta adrenergic receptor that Lefkowitz has studied for many years. The scientists found that this model of chronic stress triggered certain biological pathways that ultimately resulted in accumulation of DNA damage.

"This could give us a plausible explanation of how chronic stress may lead to a variety of human conditions and disorders, which range from merely cosmetic, like graying hair, to life-threatening disorders like malignancies," Lefkowitz said.

P53 is a tumor suppressor protein and is considered a "guardian of the genome" – one that prevents genomic abnormalities.

"The study showed that chronic stress leads to prolonged lowering of p53 levels," said Makoto Hara, Ph.D., a postdoctoral fellow in the Lefkowitz laboratory. "We hypothesize that this is the reason for the chromosomal irregularities we found in these chronically stressed mice."

Lefkowitz earlier had proved the existence of isolated, and characterized the G-protein-coupled receptors (GPCRs) such as the beta adrenergic receptor. These receptors, which are located on the surface of the membranes that surround cells, are the targets of almost half of the drugs on the market today, including beta blockers for heart disease, antihistamines and ulcer medications.

Now he is continuing studies along another pathway,stemming from the GPCRs, that was discovered in his lab, which is known as the beta-arrestin pathway. At first, the theory was that beta-arrestin proteins turned off or desensitized the G-protein pathways, but evidence is accumulating that these proteins are also responsible for causing certain biochemical activities in their own right.

In the current study, the scientists found a molecular mechanism through which adrenaline-like compounds acted through both G-protein and the beta-arrestin pathways to trigger DNA damage.

The Nature publication showed that the infusion of an adrenaline-like compound for four weeks in the mice caused degradation of p53, which was present in lower levels over time.

The study also showed that the DNA damage was prevented in mice lacking beta-arrestin 1. Loss of beta-arrestin 1 stabilized cellular levels of p53 both in the thymus, an organ that strongly responds to acute or chronic stress, and in the testes, where paternal stress might affect an offspring's genome.

Future studies planned by the Lefkowitz laboratory include studying mice that are placed under stress (restrained), thus creating their own adrenaline or stress reaction to learn whether the physical reactions of stress, rather than an influx of adrenaline in the lab as was done in the current study, also leads to accumulation of DNA damage.

Provided by Duke University Medical Center

Sunday, August 21, 2011

Switch in cell's 'power plant' declines with age, rejuvenated by drug

Researchers at the Johns Hopkins University School of Medicine have found a protein normally involved in blood pressure regulation in a surprising place: tucked within the little "power plants" of cells, the mitochondria. The quantity of this protein appears to decrease with age, but treating older mice with the blood pressure medication losartan can increase protein numbers to youthful levels, decreasing both blood pressure and cellular energy usage. The researchers say these findings, published online during the week of August 15, 2011, in the Proceedings of the National Academy of Sciences, may lead to new treatments for mitochondrial–specific, age-related diseases, such as diabetes, hearing loss, frailty and Parkinson's disease.

21 aug 2011--"We've identified a functional and independently operated system that appears to influence energy regulation within the mitochondria," explains Jeremy Walston, M.D., professor of geriatric medicine at Hopkins. "This mitochondrial angiotensin system is activated by commonly utilized blood pressure medications, and influences both nitric oxide and energy production when signaled."

Previous research showed that manipulating angiotensin in the body's cells had unexpectedly affected mitochondrial energy production, so Walston and Peter Abadir , M.D., an assistant professor of geriatric medicine, decided to examine the role of angiotensin within the mitochondria. Using high-powered microscopy, they and their collaborators found evidence within the mitochondria of angiotensin as well as one of the protein receptors that bind to and detect it. They also pinpointed the angiotensin receptor's exact locations within the mitochondria of mouse kidney, liver, neuron and heart cells as well as in human white blood cells.

The team then treated mitochondria with a chemical known to activate the angiotensin receptors and measured the cell's response. This resulted in a decrease in oxygen consumption by half and a small increase in nitric oxide production—indicating less energy made by the mitochondria and lowered blood pressure, respectively. Explains Walston, "Activating angiotensin receptors within the mitochondria with these agents led to lowered blood pressure and decreased cellular energy use."

But they found even more than just an energy-regulating mechanism; after testing the angiotensin system in mitochondria of both young and old mice, they noticed a decrease by almost a third of the amount of the angiotensin receptor type 2 in the mitochondria in older mice, meaning that cells in older mice were unable to control energy use as well. The researchers then tried treating these older mice with the blood pressure lowering drug losartan daily for 20 weeks and found that the number of these receptors increased. "Treatment of the old mice with losartan resulted in a marked increase in the number of receptors that are known to positively influence blood pressure and decrease inflammation," says Walston.

Declining mitochondria are known to influence chronic diseases in older adults, explains Walston, whose next step is to translate studies from cell culture and animal based studies to human studies in hopes of developing new therapies. "Our findings will help us determine if the drugs that interact with this receptor will also lead to improvement of mitochondrial function and energy production. This, in turn, could facilitate the treatment of a number of chronic diseases of older adults."

Provided by Johns Hopkins Medical Institutions

Saturday, August 20, 2011

Moderate drinking protects against Alzheimer's and cognitive impairment

Moderate social drinking significantly reduces the risk of dementia and cognitive impairment, according to an analysis of 143 studies by Loyola University Chicago Stritch School of Medicine researchers.

20 aug 2011--Researchers reviewed studies dating to 1977 that included more than 365,000 participants. Moderate drinkers were 23 percent less likely to develop cognitive impairment or Alzheimer's disease and other forms of dementia.

Wine was more beneficial than beer or spirits. But this finding was based on a relatively small number of studies, because most papers did not distinguish among different types of alcohol.

Results are reported in the journal Neuropsychiatric Disease and Treatment. The authors are Edward J. Neafsey, PhD. and Michael A. Collins, PhD., professors in the Department of Molecular Pharmacology and Therapeutics.

Heavy drinking (more than 3 to 5 drinks per day) was associated with a higher risk of cognitive impairment and dementia, but this finding was not statistically significant.

"We don't recommend that nondrinkers start drinking," Neafsey said. "But moderate drinking -- if it is truly moderate -- can be beneficial." Moderate drinking is defined as a maximum of two drinks per day for men and 1 drink per day for women.

Among the studies reviewed, 74 papers calculated the ratios of risk between drinkers and non-drinkers, while 69 papers simply stated whether cognition in drinkers was better, the same or worse than cognition in nondrinkers. Neafsey and Collins did a meta-analysis of the studies that calculated risk ratios and found that moderate drinkers were 23 percent less likely to develop dementia or cognitive decline.

Other findings:

  • The protective effect of moderate drinking held up after adjusting for age, education, sex and smoking.
  • There was no difference in the effects of alcohol on men and women.
  • The beneficial effect of moderate drinking was seen in 14 of 19 countries, including the United States. In 3 of the remaining 5 countries, researchers also found a benefit, but it was not strong enough to be statistically significant.
  • The findings were similar across different types of studies (longitudinal cohort studies, case-control studies and cross-sectional studies).
It is unknown why moderate drinking can have a beneficial effect. One theory suggests that the well-known cardiovascular benefits of moderate alcohol consumption, such as raising good HDL cholesterol, also can improve blood flow in the brain and thus brain metabolism.

A second possible explanation involves "sick quitters." According to this theory, nondrinkers have a higher risk of cognitive impairment and dementia because the group includes former heavy drinkers who damaged their brain cells before quitting. But the analysis by Neafsey and Collins did not support this explanation. They found that in studies that excluded former heavy drinkers, the protective effect of moderate drinking still held up.

Neafsey and Collins suggest a third possible explanation: Small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia.

For people who drink responsibly and in moderation, there's probably no reason to quit. But because of the potential for alcohol to be abused, Neafsey and Collins do not recommend that abstainers begin drinking.

The researchers note that there are other things besides moderate drinking that can reduce the risk of dementia, including exercise, education and a Mediterranean diet high in fruits, vegetables, cereals, beans, nuts and seeds. Even gardening has been shown to reduce the risk of dementia.

Moreover, there are times when people should never drink, including adolescence, pregnancy and before driving, the researchers said.

Provided by Loyola University Health System

Friday, August 19, 2011

Time to clear up misconceptions about Alzheimer's

Time to clear up misconceptions about Alzheimer's

Many age-related changes that may lead to Alzheimer’s disease can be greatly minimized by lifestyle changes that favor healthy diets, physical exercise, reduced exposure to toxins, lowered psychosocial stress, purposeful social interaction, and better protection from and treatment of traumatic brain injuries.

19 aug 2011--The general perception of Alzheimer’s disease, including the dominant theory about what causes it, needs to shift, according to an editorial co-written by a Penn State College of Medicine faculty member. In “Changing Perspectives on Alzheimer’s Disease: Thinking Outside the Amyloid Box,” Penn State College of Medicine’s Daniel George, said the common belief that scientists will soon conquer the disease is a misconception.

“What people commonly hear about Alzheimer’s disease is that a classic American success story is destined to unfold,” George said. “They hear that in the near future, biotechnology will soon conquer this scourge of the elderly, this stealer of decades that has become a growing global epidemic. Unfortunately, the scientific story is a bit more complicated.”

The editorial was published in the July issue of Journal of Alzheimer’s Disease.

The current dominant scientific theory as to the causation of Alzheimer’s disease assumes that toxic amyloid protein plaques in the brain are the causes of neuronal death. But George and fellow study author Simon D’Alton, University of Florida say this theory is proving to be an unsustainable premise.

“There are many heavily age-related factors that affect the brain negatively and occur prior to the appearance of these so-called toxic plaques,” George explained. “What this means is that Alzheimer’s disease is not caused by one thing, like toxic proteins, but is multi-factorial and far more complicated than originally thought. We can’t continue to treat Alzheimer’s disease as if it were a singular condition, like a virus; this is not an honest portrayal.”

George said the reason for nearly 20 drug trial failures in the past decade is due to being trapped in the ‘amyloid box’— trying to remove ‘toxic’ proteins without addressing the real causes that precede them.

“This is like an oil company responding to a spill by having workers scrub petroleum off the shoreline rather than managing the upstream processes and procedures that could have slowed or prevented the spill and spread of oil,” he said. “We also don’t know what the role of amyloid is in the brain. There is much evidence to support amyloid actually being protective rather than just toxic.”

Since the processes leading to Alzheimer’s disease are not understood, it is unlikely that a profound therapy will be produced in the next 20 years, the scientists say. Instead, they say, a shift in approach that reflects the true nature of Alzheimer’s as a chronic, multifaceted, decades-long ‘syndrome’ caused by gradual dysfunction of the aging body is needed. Many of these age-related changes can be greatly minimized by lifestyle changes that favor healthy diets, physical exercise, reduced exposure to toxins, lowered psychosocial stress, purposeful social interaction, and better protection from and treatment of traumatic brain injuries.

“Individuals need to know that they can increase their chances of maintaining a healthy brain as they age by taking these steps across their life course, and that help in the form of a pill or vaccine is unlikely to be realized in the near future,” George said. “Such an understanding can help people protect their aging brain and the brains of those they love and live amongst. Moreover, as we are all susceptible to aging processes, we should feel greater solidarity with those more severely affected by the changes of brain aging, who we can help in finding purpose, valued social roles, and acceptance rather than the stigma, marginalization, and fear fomented by the fading disease model.”

Provided by Pennsylvania State University

Thursday, August 18, 2011

People fear cancer more than other serious illness

More than a third of people in the UK fear cancer more than other life-threatening conditions – such as Alzheimer’s, stroke and heart disease according to a Cancer Research UK survey.

And top of the list of cancers most feared is brain cancer followed by bowel and lung cancers.

18 aug 2011--Cancer Research UK commissioned a YouGov survey of more than 2000 people to find out the disease or condition feared by most people in the UK.

More than a third (35 per cent) said cancer was the disease they feared most and a quarter (25 per cent) said Alzheimer’s.

When asked which cancer they feared most 16 per cent said brain cancer. The main reasons for this were that they believed it was the cancer they were most likely to die from (57 per cent) or that it had the worst symptoms (47 per cent).

For men, bowel cancer is the second most feared (12 per cent) followed by lung (10 per cent) and prostate (10 per cent) cancers.

And just last week Radio Two presenter Chris Evans described his bowel cancer scare and said men were especially prone to fear of cancer.

For women, breast cancer (13 per cent) is the second most feared followed by bowel (8 per cent) and lung (7 per cent) cancers.

When asked about survival 21 per cent said they thought breast cancer had the best survival rate and 12 per cent thought testicular cancer had the best chance of survival.

Dr. Lesley Walker, director of cancer information at Cancer Research UK, said: “Cancer is a very emotive subject and it’s understandable why so many people fear it among other diseases. Yet people should be reassured that we are doing all we can to find new treatments for the disease. Our greatest achievement in brain tumor research has been temozolomide – a drug that Cancer Research UK created in the lab and developed through to the first treatment of patients. It’s now used to treat thousands of people all over the world with high grade glioma – an aggressive type of brain tumor.

“What’s heartening is that overall survival from all cancers has doubled over the last 40 years and this optimistic message is reaching the public who have rightly picked breast and testicular cancer which are both cancers with high survival rates.

“Our latest figures show more than 80 per cent of women now survive their breast cancer for five years or more. And our research – which has helped lead the way in treating bowel, prostate and lung cancer – has been at the heart of that progress. Our scientists helped to show the most effective way to use tamoxifen and paved the way for the development of Herceptin. Our work has also shown how radiotherapy can help prevent breast cancer coming back.

“All our research is directly funded by the generosity of the public. And we need to do all we can to maintain the level of cancer research in the UK so that we can continue making discoveries like these which have the potential to save thousands of lives every year.”

More information: When asked “Which ONE, if any, of the following conditions/ diseases do you MOST fear getting?” – the results were as follows:
All UK Adults 2056 in total

Heart disease 3%
Cancer 35%
Alzheimer’s 25%
Stroke 5%
Motor Neurone Disease 7%
Multiple Sclerosis 2%
Diabetes 1%
HIV 2%
Malaria 0%
Other 0%
Don’t know/ prefer not to say 8%
Not applicable – I don’t fear getting any condition/ disease 10%

When asked “And which ONE, if any, of the following types of cancer do you MOST fear getting?” – the results were as follows
All UK Adults 2056 in total

Breast 7%
Bowel 10%
Lung 9%
Prostate 5%
Malignant melanoma (skin) 2%
Cervical 2%
Ovarian 3%
Pancreatic 5%
Oesophageal (of the food pipe) 4%
Leukaemia 2%
Brain 16%
Testicular 3%
Other 1%
Don’t know/ prefer not to say 22%
Not applicable – I don’t fear getting any types of cancer 10%

The other questions asked what were the main reasons you picked the particular cancer you fear the most; and which of the following cancers (same list as above) do you think had the best survival rate.

Provided by Cancer Research UK

Wednesday, August 17, 2011

Daily TV quota of 6 hours could shorten life expectancy by 5 years

Watching TV for an average of six hours a day could shorten the viewer's life expectancy by almost five years, indicates research published online in the British Journal of Sports Medicine.

17 aug 2011--The impact rivals that of other well known behavioural risk factors, such as smoking and lack of exercise, the study suggests.

Sedentary behaviour - as distinct from too little exercise - is associated with a higher risk of death, particularly from heart attack or stroke. Watching TV accounts for a substantial amount of sedentary activity, but its impact on life expectancy has not been assessed, say the authors.

They used previously published data on the relationship between TV viewing time and death from analyses of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), as well as Australian national population and mortality figures for 2008, to construct a lifetime risk framework.

AusDiab is a national survey of a representative sample of the population, starting in 1999-2000, and involving more than 11,000 adults aged 25 or older.

The authors then constructed a risk framework for the Australian population in 2008, based on the answers the survey participants had given, when quizzed about the total amount of time they had spent in the previous week watching TV or videos.

In 2008 the authors estimated that Australian adults aged 25 and older watched 9.8 billion hours of TV, which led them to calculate that every single hour of TV watched after the age of 25 shortened the viewer's life expectancy by just under 22 minutes.

Based on these figures, and expected deaths from all causes, the authors calculated that an individual who spends a lifetime average of six hours a day watching TV can expect to live just under five fewer years than someone who does not watch TV.

These figures compare with the impact of other well known lifestyle factors on the risk of death from cardiovascular disease after the age of 50, including physical activity and obesity.

For example, other research has shown that lifelong smoking is associated with the shortening of life expectancy by more than 4 years after the age of 50, with the average loss of life from one cigarette calculated to be 11 minutes - equivalent to half an hour of TV watching, according to the authors' risk framework.

Their findings "suggest that substantial loss of life may be associated with prolonged TV viewing," say the authors. And they add: "While we used Australian data, the effects in other industrialised and developing countries are likely to be comparable, given the typically large amounts of time spent watching TV and similarities in disease patterns."

They conclude: "If these [figures] are confirmed and shown to reflect a causal association, TV viewing is a public health problem comparable in size to established behavioural risk factors."

Provided by British Medical Journal

Tuesday, August 16, 2011

15 minutes of physical activity per day reduces risk of death by 14 percent, increases life expectancy by 3 years

A study published Online First by The Lancet shows that just 15 minutes of physical activity per day reduces a person's risk of death by 14% and increases life expectancy by 3 years compared with inactive people. The Article is by Dr Chi-Pang Wen, National Health Research Institutes, Taiwan, and China Medical University Hospital, and Dr Jackson Pui Man Wai, National Taiwan Sport University, and colleagues.

16 aug 2011--The health benefits of leisure-time physical activity are well known, but whether less exercise than the generally recommended 150 min a week can have life expectancy benefits is unclear. Thus the authors assessed the health benefits of a range of volumes of physical activity in a Taiwanese population.

The study included over 400 000 Taiwanese people who participated in a standard medical screening programme in Taiwan between 1996 and 2008, with an average follow-up of 8 years. On the basis of self-reported weekly exercise, participants were placed into one of five categories of exercise volumes: inactive, or low, medium, high, or very high activity. The authors calculated hazard ratios (HR) for mortality risks for every group compared with the inactive group, and calculated life expectancy for every group.

Compared with individuals in the inactive group, those in the low-volume activity group, who exercised for an average of 92 min per week (about 15 min a day) had a 14% reduced risk of all-cause mortality, a 10% reduced risk of all-cancer mortality, and on average a 3 year longer life expectancy. Every additional 15 min of daily exercise beyond the minimum amount of 15 min a day further reduced all-cause mortality by 4% and all-cancer mortality by 1%. These benefits were applicable to all age groups and both sexes, and to those with cardiovascular disease risks. Individuals who were inactive had a 17% increased risk of mortality compared with individuals in the low-volume group.

The authors say: "In Taiwan, if inactive individuals engage in low-volume daily exercise, one in six all-cause deaths could be postponed—mortality reductions of similar magnitude have been estimated for a successful tobacco control programme in the general population."

They conclude: "If the minimum amount of exercise we suggest is adhered to, mortality from heart disease, diabetes, and cancer could be reduced. This low volume of physical activity could play a central part in the global war against non-communicable diseases, reducing medical costs and health disparities."

In a linked Comment, Dr Anil Nigam and Dr Martin Juneau, Montreal Heart Institute and Université de Montréal, Quebec, Canada, conclude: "The knowledge that as little as 15 min per day of exercise on most days of the week can substantially reduce an individual's risk of dying could encourage many more individuals to incorporate a small amount of physical activity into their busy lives. Governments and health professionals both have major roles to play to spread this good news story and convince people of the importance of being at least minimally active."

More information: The Lancet paper: http://www.thelanc … 0140-6736(11)60749-6/abstract

Provided by Lancet

Monday, August 15, 2011

Patients Taking Antipsychotics Urged to Get Routine Physicals

15 aug 2011-- Patients who take antipsychotic medications aren't being adequately monitored for dangerous health complications, researchers have found.

Known as "metabolic complications," these conditions are common among patients taking antipsychotic drugs. For example, up to 60 percent have lipid (blood fat) abnormalities such as high cholesterol, 40 percent have high blood pressure and 30 percent have metabolic syndrome. It's believed that about 90 percent of patients who take antipsychotic drugs have at least one metabolic risk factor, the researchers said.

Metabolic syndrome is the name for a group of risk factors that raise the risk for heart disease, diabetes and stroke. The risk factors include abdominal obesity, high blood fat levels, high blood pressure and high levels of blood sugar.

The risk of metabolic complications is especially high in schizophrenia patients treated with antipsychotics, according to the report published in the Aug. 10 online edition of the journal Psychological Medicine.

Despite strong evidence of the need for regular monitoring of patients taking antipsychotic drugs, it's overlooked in many cases, the researchers from England, Belgium and the United States found.

The international team reviewed 48 studies conducted in five countries between 2000 and 2011. The studies included a total of nearly 300,000 patients.

Only blood pressure and triglycerides were checked in more than half of the patients, while cholesterol, blood sugar (glucose) and weight were checked in less than half.

"This study highlights that psychiatrists are not always considering the metabolic complications of prescribed medication," study author Dr. Alex Mitchell, of the University of Leicester, said in a university news release. "One explanation is that responsibility is often lost between psychiatry and general practice. We recommend that mental health providers schedule physical health checks as a mandatory part of routine care."

Sunday, August 14, 2011

Depression linked to increased risk of stroke in women

Depressed women may face an increased risk of stroke, according to new research reported in Stroke: Journal of the American Heart Association.

14 aug 2011--In six years of follow-up of women in the Nurses' Health Study, researchers found that a history of depression was associated with a 29 percent increased risk of total stroke – even after considering other stroke risk factors. Women who used anti-depressant medication — particularly selective serotonin reuptake inhibitors— had a 39 percent increased risk of stroke. Examples of these drugs are Prozac, Zoloft, and Celexa.

Anti-depressant medication use may be an indicator of depression severity, said Kathryn Rexrode, M.D., the study's senior author and Associate Physician at Brigham and Women's Hospital in Boston, Mass. "I don't think the medications themselves are the primary cause of the risk. This study does not suggest that people should stop their medications to reduce the risk of stroke."

Researchers followed 80,574 women 54 to 79 years old in the Nurses' Health Study from 2000-06 without a prior history of stroke. They assessed depressive symptoms multiple times with a Mental Health Index. Anti-depressant use was reported every two years beginning in 1996, and physicians diagnosed depression beginning in 2000.

Depression was defined as currently reporting or having a history of depression.

The reported prevalence of depression at baseline in the women was 22 percent, and 1,033 stroke cases were documented during six years of follow-up.

Compared to women without a history of depression, depressed women were more likely to be single, smokers and less physically active. They were also slightly younger, had a higher body mass index and more coexisting conditions such as high blood pressure, heart disease and diabetes.

"Depression can prevent individuals from controlling other medical problems such as diabetes and hypertension, from taking medications regularly or pursuing other healthy lifestyle measures such as exercise," said Rexrode, who is also Assistant Professor of Medicine at Harvard Medical School. "All these factors could contribute to increased risk."

Depression may be associated with an increased risk of stroke through a variety of mechanisms. It may be linked to inflammation, which increases the risk of stroke as well as other conditions or underlying vascular disease in the brain, said An Pan, Ph.D., lead author of the study and a research scientist at the Harvard School of Public Health. "Regardless of the mechanism, recognizing that depressed individuals may be at a higher risk of stroke may help the physician focus on not only treating the depression, but treating stroke risk factors such as hypertension, diabetes and elevated cholesterol as well as addressing lifestyle behaviors such as smoking and exercise."

Among limitations of the study, the participants were predominantly white registered nurses, it excluded women without detailed information on depression measures and the participants with onset of stroke at a young age.

"We cannot infer cause or fully exclude the possibility that the results could be explLinkained by other unmeasured unknown factors," Pan said. "Although the underlying mechanisms remain unclear, recognizing that depressed women may be at a higher risk of stroke merits additional research into preventive strategies in this group."

Provided by American Heart Association

Saturday, August 13, 2011

Contrary to earlier findings, excess body fat in elderly decreases life expectancy

While some past studies have shown that persons carrying a few extra pounds in their 70s live longer than their thinner counterparts, a new study that measured subjects' weight at multiple points over a longer period of time reveals the opposite.

13 aug 2011--Research from Adventist Health Studies recently published in the Journal of the American Geriatrics Society showed that men over 75 with a body mass index (BMI) greater than 22.3 had a 3.7-year shorter life expectancy, and women over 75 with a BMI greater than 27.4 had a 2.1-year shorter life expectancy. Generally, a BMI between 18.5 and 24.9 is considered normal weight, and a BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

Previous work in this area by others found a protective association for a high body weight among the elderly. Pramil N. Singh, DrPH, lead author of the paper and an associate professor in the School of Public Health at Loma Linda University, says the data from many past studies is problematic because only a single baseline measure of weight was taken, which does not account for weight changes or how weight changes affect life expectancy. Additionally, most past studies had mortality surveillance of fewer than 19 years, which analyses have shown to be an inadequate amount of time to study risks associated with weight.

"We had a unique opportunity to do 29 years of follow-up with a cohort that was also followed for mortality outcomes," Dr. Singh said. "Across this long period of time, we had multiple measures of body weight, which provided a more accurate assessment."

The study looked at 6,030 adults who never smoked and who were free of major chronic diseases at enrollment. It then examined only those adults who maintained a stable weight. This was done in an effort to exclude individuals who, for example, were in the normal weight category because they experienced significant weight loss due to a disease. Therefore their death would not have been related to their normal weight, but rather to the disease that caused them to reach normal weight.

"When you control for confounding by disease-related weight loss, overweight and obesity remain a risk for persons over the age of 75," Dr. Singh said. "This suggests that elderly individuals of normal weight should continue to maintain their weight."

Researchers noted a difference between genders in that men had a higher sensitivity to body fat than women. Men started to experience a greater risk of mortality at a BMI of 22.3, while this risk did not appear for women until a BMI of 27.4. One possible reason for the difference between genders, Dr. Singh said, is that body fat is the primary source of estrogen in post-menopausal females, and a minimum level of estrogen in those years can be protective against heart disease and hip fractures.

"This is not to say that extra weight is good for women over 75," Dr. Singh said, "but rather that the negative effects of extra weight in women over 75 appear at a higher weight than in males."

The study population itself is unique in that all were Seventh-day Adventists, who, because of church recommendations, are lifelong non-smokers, consume little if any alcohol, are more physically active, and consume less meat than the general population. This means those who maintained a lower BMI did so intentionally with healthy lifestyle choices rather than as a result of smoking for weight control or as a result of poverty-related factors. Dr. Singh said further studies are needed to understand the positive and negative effects of lifestyle patterns that help individuals maintain low body weight over long periods of time.

Provided by Loma Linda University Adventist Health Sciences Center

Friday, August 12, 2011

New measurements prove it: Active older adults less likely to become cognitively impaired

Reaching over to make the bed or bending to get a grocery bag might not be the typical idea of being physically active. But all those everyday movements add up and could contribute to health benefits, especially among older adults — even if it’s not clear just how much energy seniors are exerting.

12 aug 2011--Previous research has been mostly based on error-prone self-reports of physical activity rather than actual measurements. Now, University of Florida researchers and colleagues have used laboratory-based methods to objectively measure the amount of energy older adults use up as they go about their daily activities, and linked that to cognitive performance.

The researchers found that older adults who expend relatively high amounts of energy in their daily activities are substantially less likely to become cognitively impaired than those who exert less energy. The findings are published in the July 25 issue of the Archives of Internal Medicine.

“There are millions and millions of people who don’t exercise, but we’re beginning to understand that a lot of these people do a lot during the day, and they are likely to accumulate more energy expenditure during the day than others who go out and exercise,” said study co-author Todd Manini, an assistant professor in the department of aging and geriatric research at the University of Florida College of Medicine and the UF Institute on Aging. “These studies are starting to shed light on the fact that accumulating activity during the day can potentially provide health benefits.”

A growing body of research points to the promise of physical activity as a way to prevent or even treat cognitive impairment. But to figure out what types of activities are necessary, and how much, researchers need better estimates of energy spent in various activities.

“That’s going to be a hard question to answer until we can get objective answers about physical activity,” said Kirk Erickson, an assistant professor in the department of psychology and the Center for the Neural Basis of Cognition at the University of Pittsburgh. “If we’re going to translate this research into a clinical setting, we need to provide a quantifiable metric or number for how much physical activity to get.” Erickson was not involved in the current study.

Previous studies have relied heavily on study participants to tell researchers how physically active they were.

“With self-report, we hear what people think they are getting, but it might not be accurate, and doesn’t tell us about energy expenditure the way that objective measures do,” said Erickson, whose imaging studies have shown that one year of participation in modest amounts of exercise can reverse Alzheimer’s-related atrophy in parts of the brain involved in memory formation.

In the new study, the research team, led by scientists at the Heart and Stroke Foundation Centre in Toronto, and at the University of California, San Francisco, moved a step closer to reliably identifying just how much energy people expend.

The researchers studied almost 200 older adults who on average were 75 years old to figure out how much energy people burn during daily activities. First, they calculated the total amount of energy used for the day, then subtracted the basic amount of energy the body needs while at rest.

Participants drank so-called “heavy” water, which has a slight chemical difference from regular water. That allowed researchers to track the body’s consumption of oxygen molecules over time and use that to calculate the number of calories burned.

To find out how much energy a person used while at rest, the researchers used a method called calorimetry to determine the levels of carbon dioxide in the breath.

For comparison, the researchers also collected self-reported activity data.

To assess cognitive function, patients were tested on memory, concentration, orientation, language and other categories.

The more energy spent, the lower the likelihood of cognitive impairment, the researchers found. Patients with the highest levels of activity energy expenditure were 90 percent less likely to become cognitively impaired than those with the lowest levels of expenditure.

The findings are consistent with what other researchers have found, but Manini and colleagues went a step beyond by pointing out the shortcomings associated with using self-reported activity.

Self-reports are highly biased because people might report participating in more activity than they actually do — or they might forget to mention something they did. Self-reports also often focus on sports-like activities and fail to capture movements such as walking around the house or pottering about in the garden.

The link between the onset of cognitive impairment and energy expenditure was stronger when laboratory measurements were used to measure activity than when self-report data was used. In addition, the relationship between the amount of energy spent and the amount of decline experienced was more pronounced for laboratory methods than for self-reports, possibly because of more accurate recording of low-intensity activity.

“The strength of the study was that the researchers didn’t have to just ask people how much physical activity they got — they could actually measure it,” Erickson said.

Provided by University of Florida

Thursday, August 11, 2011

Study: Alzheimer's disease symptoms more subtle in people over 80

A new study suggests that the relationship between brain shrinkage and memory loss in Alzheimer's disease changes across the age spectrum. The research is published in the August 10, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

11 aug 2011--"Those who are 85 and older make up the fastest growing population in the world," said study author Mark Bondi, PhD, with the University of California San Diego School of Medicine and VA San Diego Healthcare System. "Our study shows how age has a dramatic effect on the profile of brain atrophy and cognitive changes evident in Alzheimer's disease."

The study involved 105 people with Alzheimer's disease and 125 people who were free of dementia and recruited through the Alzheimer's Disease Neuroimaging Initiative. Participants were grouped into those who were between the ages of 60 and 75 and those age 80 years and older. All were given tests that measured language, attention and speed of processing information, executive function, and immediate and delayed ability to recall information.

Participants also underwent brain scans to measure the thickness of the outermost tissue layers in the cerebrum of the brain.

Even though the two groups had similar levels of overall cognitive impairment, researchers found that the pattern of changes associated with Alzheimer's disease appeared to be less noticeable in people over the age of 80 (very-old) compared to those between the ages of 69 and 75 (young-old). When compared to their healthy counterparts, executive function, immediate memory and attention/processing speed were less abnormal in those considered very old compared to those considered young-old. The very-old also showed less severe thinning of portions of cerebral cortex and the overall cerebrum than the young-old, as compared to their healthy counterparts. This is in part because these brain areas decrease in thickness due to age, so there are fewer differences between the healthy very-old brain and the very-old brain with Alzheimer's disease, Bondi said.

Provided by American Academy of Neurology

Wednesday, August 10, 2011

Deep brain stimulation effects may last for 10 years in patients with Parkinson's disease

One decade after receiving implants that stimulate areas of their brains, patients with Parkinson's disease (PD) appear to sustain improvement in motor function, although part of the initial benefit wore off mainly because of progressive loss of benefit in other functions, according to a report published Online First by Archives of Neurology, one of the JAMA/Archives journals.

10 aug 2011--According to background information in the article, several previous clinical studies have shown deep brain stimulation of the subthalamic nucleus (STN-DBS) for PD to be effective and safe. Studies have shown that the technique, which stimulates a part of the brain involved in motor function, may have advantages compared with other medical treatments in terms of controlling motor complications and improving quality of life. "The motor improvement induced by STN stimulation has been reported to be sustained for up to five to eight years after surgery, although part of the initial benefit progressively deteriorates, mainly because of worsening axial signs," write the authors. "To date, studies with postoperative follow-up for longer than eight years are lacking."

Anna Castrioto, M.D., from the Università degli Studi di Perugia, Perugia, Italy, and colleagues conducted a study of 18 patients with advanced PD who had received DBS implants for PD between 1996 and 2000. Motor assessments were conducted before implantation and at one, five and 10 years. All motor assessments were videotaped. Patients were assessed without medication, without stimulation, without either, and with both. At each assessment, the researchers recorded every patient's medications and dosages.

At 10 years, the combination of medication and STN-DBS was associated with significantly better motor, resting and action tremor, bradykinesia (slowed movement) and rigidity scores. Compared with baseline, reductions were also seen in the scores in the medication and no medication conditions, the dyskinesia (difficulty controlling movement) and motor fluctuation scores and the levadopa-equivalent daily dose. However, axial signs (such as posture, gait and balance) showed the most progressive decline in stimulation and medication response.

"Our findings further support the long-term response to STN stimulation in patients with advanced PD, showing a prolonged motor improvement up to 10 years," conclude the authors.

More information: Arch Neurol. August 8, 2011. doi:10.1001/archneurol.2011.18

Provided by JAMA and Archives Journals

Monday, August 08, 2011

Weakness in aging tied to leaky muscles

There is a reason exercise becomes more difficult with age. A report in the August Cell Metabolism, a Cell Press publication, ties the weakness of aging to leaky calcium channels inside muscle cells. But there is some good news: the researchers say a drug already in Phase II clinical trials for the treatment of heart failure might plug those leaks.

08 aug 2011--Earlier studies by the research team led by Andrew Marks of Columbia University showed the same leaks underlie the weakness and fatigue that come with heart failure and Duchenne muscular dystrophy.

"It's interesting, normal people essentially acquire a form of muscular dystrophy with age," Marks said. "The basis for muscle weakness is the same." Extreme exercise like that done by marathon runners also springs the same sort of leaks, he added, but in that case damaged muscles return to normal after a few days of rest.

The leaks occur in a calcium release channel called ryanodine receptor 1 (RyR1) that is required for muscles to contract. Under conditions of stress, those channels are chemically modified and lose a stabilizing subunit known as calstabin1.

"Calstabin1 is like the spring on a screen door," Marks explained. "It keeps the door from flopping open in the breeze."

Calcium inside of muscle cells is usually kept contained. When it is allowed to leak out into the cell that calcium itself is toxic, turning on an enzyme that chews up muscle cells. Once the leak starts, it's a vicious cycle. The calcium leak raises levels of damaging reactive oxygen species, which oxidize RyR1 and worsen the leak.

The researchers made their discovery by studying the skeletal muscles of young and old mice. They also showed that 6-month-old mice carrying a mutation that made their RyR1 channels leaky showed the same muscular defects and weakness characteristic of older mice.

When older mice were treated with a drug known as S107, the calcium leak in their muscles slowed and the animals voluntarily showed about a 50 percent increase in the amount of time spent wheel running. Now in clinical trials for patients with heart failure, the drug is known to work by restoring the connection between costabilin and RyR1.

Despite considerable effort to understand and reverse age-related muscle wasting, there are no established treatments available. The new work suggests there may be hope in approaching the problem from a different angle.

"Most research has focused on making more muscle mass," Marks said. "What's different here is that we are focused not on muscle mass but on muscle function. More muscle doesn't help if it is not functional."

Provided by Cell Press

Sunday, August 07, 2011

Study suggests increase in public health spending results in healthier people

A groundbreaking new study published in the journal, Health Affairs, suggests that increases in public health spending result in healthier people, especially in communities with fewer resources.

07 aug 2011--The study was co-authored by Glen P. Mays, the new F. Douglas Scutchfield Endowed Professor in Health Services and Systems Research at the University of Kentucky College of Public Health. At UK, Mays is affiliated with the National Coordinating Center for Public Health Services and Systems Research, funded by the Robert Wood Johnson Foundation. Sharla A. Smith, a research associate in the Department of Health Policy and Management, University of Arkansas for Medical Sciences, co-authored the study.

The study examined whether changes in spending by local public health agencies over a 13-year period contributed to changes in rates of community mortality from preventable causes of death, including infant mortality and deaths due to cardiovascular disease, diabetes and cancer.

The researchers found for every 10 percent increase in local public health spending, mortality rates from the four causes of death analyzed dropped anywhere from 1 percent to almost 7 percent.

"In light of the Affordable Care Act that authorized the largest expansion in federal public health spending in decades, coupled with an economic downturn that has precipitated large cuts in state and local government support for public health activities, it's critical to take a data-driven look at whether public health spending translates to improved health of our population," Mays said.

It's important to examine not only how much was spent, but also how it was spent, Mays said. "Our findings suggest that a connection between spending and health outcomes does exist, although it's important to note that resources must be successfully aimed at activities that target at-risk population groups to ensure that spending is resulting in positive outcomes."

Previously, little research has been done in the area of the impact of public health spending on population health. Mays and Smith analyzed changes in spending patterns and mortality rates within the service areas of the nation's nearly 3,000 local public health agencies over a 13-year period.

Increases in public health spending were associated most significantly with reductions in deaths for four of the six mortality rates, with the strongest effects for infant mortality and cardiovascular disease mortality.

After accounting for differences in demographic and socioeconomic characteristics, medical resources and other factors, communities that made the largest investments in public health spending experienced the most significant reductions in mortality from leading preventable causes of death.

"Although a definitive causal link between spending and mortality cannot be drawn, the study does provide compelling evidence that communities must pay attention to more than local medical resources and interventions, but also to the resources invested in local public health activities to truly make a difference in the health of their people," Mays said.

Public health spending varies widely around the country. For example, per capita state public health spending ranged from a low of less than $4 in Nevada to a high of more than $171 in Hawaii. Local public health spending varied even more significantly – ranging from less than $1 per capita to more than $200 per capita, with the median spent around $36 per person.

The study provides a foundation for further research, particularly in light of the ACA investment of a projected $15 billion in new spending over 10 years in federal public health spending and the continued reductions in state and local government spending for public health, Mays said.

Provided by University of Kentucky

Saturday, August 06, 2011

Valproate doesn't prevent Alzheimer's agitation, psychosis

NEW YORK , 06 aug 2011- Divalproex sodium (Depakote) does not delay the onset of agitation or psychosis in patients with Alzheimer's disease, nor does it slow the progression of dementia, recent data show.

The new findings, along with inconclusive results of preliminary studies and negative results in a large trial reported in 2005, "should discourage prophylactic or symptomatic use of valproate in dementia," the researchers wrote this month in Archives of General Psychiatry.

The drug is not formally approved for Alzheimer's disease, but it's often recommended. For example, guidelines from the American Academy of Family Physicians list it as a preferred chronic medication for managing anger or aggression in Alzheimer's patients.

For the current study, Dr. Pierre N. Tariot at the Banner Alzheimer's Institute in Phoenix, Arizona and colleagues enrolled 313 Alzheimer's patients in a randomized double-blind trial. None of them had yet developed agitation or psychosis.

For 24 months, participants received either placebo or valproate, at a target dose of 10-12 mg/kg/day. Ultimately, 122 subjects completed 24 months on study medication.

The primary endpoint -- a score of 3 or more on at least one of the Neuropsychiatric Inventory (NPI) items assessing delusions, hallucinations, and agitation/aggression - was met by 29 patients receiving placebo and 25 taking valproate, a nonsignificant difference.

In addition, the change in Alzheimer Disease Assessment Scale-cognitive subscale scores at 12 months favored placebo treatment, according to the report.

Furthermore, the valproate group had higher rates of somnolence, gait disturbance, tremor, diarrhea, constipation, weakness, asthenia, and dyspnea.

Behavioral problems in Alzheimer's disease still await a solution. "Given the public health significance of the behavioral features of dementia and the limited safety and efficacy of available psychotropic agents, it is still appropriate to pursue the goal of secondary prevention of agitation and psychosis," the authors said. "Other agents may merit investigation with this type of trial design."


Arch Gen Psychiatry 2011;68:853-861.

Friday, August 05, 2011

Caregivers and their relatives disagree about care given, received

Caregivers and their relatives who suffer from mild to moderate dementia often have different perceptions regarding the amount and quality of care given and received. A study by researchers at Penn State and the Benjamin Rose Institute on Aging examined a major source of those differences -- caregivers do not understand the things that are important to their relatives with dementia.

05 aug 2011--"Family caregivers often become the surrogate decision makers of relatives who have dementia, so the two groups need to communicate well and to understand each other," said Steven Zarit, a professor and head of the Department of Human Development and Family Studies at Penn State and the study's leader. "Unfortunately, in our study we found that family caregivers and their relatives often do not understand each other well when it comes to the values they hold about giving and receiving care."

The team interviewed 266 pairs of people, each composed of an individual with mild to moderate dementia and his or her family caregiver. To participate in the study, caregivers had to be the primary family caregiver of the dementia patient and the dementia patient had to be living in his or her own home. The researchers interviewed members of the pairs separately, asking questions related to how much value they place on five core values: autonomy, burden, control, family and safety. For example, one question focused on the level of importance a dementia patient gave to the ability to spend his or her own money in the way he or she wants.

"Our results demonstrate that adult children underestimate the importance that their relatives with dementia placed on all five core values," said Zarit. "For example, the person with dementia might think it is very important to continue to be part of family celebrations, but his or her caregiver might not." The team's results will appear in the August issue of The Gerontologist.

According to Zarit, a major reason for differences in these perceptions is that caregivers come to view people with dementia as unable to make their own decisions about daily life. "That is something that does happen as the disease progresses, but the people in our study remained capable of making decisions for themselves and could express their values in a clear and direct way," said Zarit. "Caregivers who still saw the person with dementia as able to direct his or her daily life were also more in tune with that person's values and beliefs."

This lack of agreement about how care is provided has ominous implications for when the dementia worsens. "As people's cognitive abilities decline," Zarit said, "they can no longer express clearly what they want. Family members have to act as surrogate decision makers, but if they don't understand the dementia patients' preferences about care, they may not be able to make the best choices."

Zarit plans to continue this research by developing and evaluating protocols for improving communication between caregivers and their relatives to ensure that medical and social decisions are made in such a way that reflect dementia patients' actual values.

Provided by Pennsylvania State University

Thursday, August 04, 2011

Newer antidepressants not necessarily safest for older people

New generation antidepressants, known as selective serotonin reuptake inhibitors (SSRIs) are associated with an increased risk of several severe adverse outcomes in older people compared with older tricyclic antidepressants (TCAs), finds a study published on today.

04 aug 2011--The authors say the risks and benefits of different antidepressants should be carefully evaluated when prescribing these drugs to older people.

Depression is a common condition in older people, and antidepressants - particularly SSRIs - are widely used. Yet very little is known about the safety of these drugs in older people.

So a team of researchers at the Universities of Nottingham and East Anglia set out to investigate the association between antidepressant treatment and the risk of a number of potentially life threatening outcomes in older people.

They identified 60,746 UK patients aged 65 and over with a newly diagnosed episode of depression between 1996 and 2007. Many patients had other conditions, such as heart disease and diabetes, and were taking several medications.

Patients were tracked until the end of 2008. During this time, 54,038 (89%) received at least one prescription for an antidepressant: 55% of prescriptions were for SSRIs, 32% for TCAs, 0.2% for monoamine oxidase inhibitors (MAOIs), and 13.5% for other antidepressants.

Antidepressant use was then analysed against several adverse outcomes including all-cause mortality, attempted suicide or self harm, heart attack, stroke, falls, fractures, epilepsy or seizures, and hyponatraemia (high salt levels in the blood).

After adjusting for factors which could affect the results, including age, sex, severity of depression, other illnesses and use of other medications, the team found that SSRIs and drugs in the group of other antidepressants were associated with an increased risk of several adverse outcomes compared with TCAs.

SSRIs were associated with an increased risk of all-cause mortality, stroke, falls, fracture, epilepsy or seizures, and hyponatraemia compared with TCAs. The group of other antidepressants were associated with an increased risk of all-cause mortality, attempted suicide or self harm, stroke, fracture, and epilepsy or seizures.

Depressed patients who were not taking antidepressants at all had a 7% risk of dying (absolute risk of all-cause mortality) some time in the next year, while the comparable risks were 8.1% for those taking TCAs, 10.6% for SSRIs, and 11.4 % for the group of other antidepressants. For stroke, one-year risks were 2.3%, 2.6% and 3.0% (compared to 2.2% for those not on antidepressants) and for fracture they were 2.2%, 2.7% and 2.8% compared to 1.8%.

Among individual drugs, trazodone, mirtazapine and venlafaxine were associated with the highest risks for several outcomes.

Rates of most outcomes were highest in the first 28 days after starting an antidepressant, and also in the first 28 days after stopping.

The authors point out that TCAs were prescribed at lower doses than SSRIs and other antidepressant drugs, which they say "could in part explain our findings." They also warn that differences between patients prescribed different antidepressant drugs may account for some of the associations seen in the study and suggest that further research is needed to confirm these findings.

However, they conclude that the risks and benefits of different antidepressants should be carefully evaluated when prescribing these drugs to older people.

In an accompanying editorial, Professor Ian Hickie from the University of Sydney says that, despite some limitations, "the study has clear implications for more informed prescribing and enhanced clinical monitoring."

He adds: "Given the potential harms, the decision to prescribe for an older person with depression should not be taken lightly."

Provided by British Medical Journal

Wednesday, August 03, 2011

Managing communication around cancer diagnosis gives patients sense of control in an otherwise uncontrollable situation

Asserting control over how to communicate — or not communicate — about their illness helps cancer patients overcome feelings of helplessness in a traumatic situation, according to researchers at The University of Texas at Austin.

03 aug 2011--Erin Donovan-Kicken, assistant professor of communication studies, and graduate students Andrew C. Tollison and Elizabeth S. Goins, set out to examine the strategies people with cancer use to communicate with family, friends and colleagues, and explore what is meaningful about communication during cancer. Their report, "A Grounded Theory of Control Over Communication Among Individuals with Cancer," is in the August issue of the Journal of Applied Communication Research.

Donovan-Kicken and her colleagues interviewed cancer survivors about strategies they used in managing information about their illness, how they approached conversations about their cancer with various audiences, challenges they faced, and advice they received or recommendations they would make regarding communication around cancer. Research participants also were asked to evaluate existing patient literature on how to talk to family and friends about a cancer diagnosis.

The researchers found that communication is an important factor in coping with cancer in that it enables people to exert control during a highly stressful and turbulent time. However, despite best efforts to structure and control that communication, cancer patients cannot always predict or control other people's reaction.

"Our study suggests that the very act of taking steps to be protective when communicating about cancer may benefit people because doing so empowers them during a time characterized by so much helplessness," said Donovan-Kicken, who has also studied topic avoidance among breast cancer survivors.

The findings are worthwhile for oncologists and survivor advocacy groups who are counseling patients and designing interventions to distinguish between asking "Are you opening up to people?" and "Do you have people you can talk to if you want to open up?"

Based on this research, patient literature could be refined to emphasize what is meaningful about communication from patients' perspectives, including suggestions on how to manage — and withhold — cancer communication and establish conditions that enable patients to experience their cancer in a way that suits their sensibilities.

Research participants expressed benefits from telling well-meaning family and friends to give them the space to feel ill or fall apart in private, to focus on themselves without needing to support others and to avoid people who were sad or overly solicitous.

Communication as a control mechanism is a double-edged sword, however.

"As hard as one tries to manage their cancer communication, they cannot control the flow of information or predict other people's reaction, which ultimately places limits on survivors' control," said Donovan-Kicken.

More information: DOI:10.1080/00909882.2011.585398

Provided by News from The University of Texas at Austin