Depression can lead to heart disease

Depression may have more far-reaching consequences than previously believed. Recent data suggests that individuals who suffer from a mood disorder could be twice as likely to have a heart attack compared to individuals who are not depressed.

29 nov 2011--This process has been poorly understood — until now. A new study led by Concordia University has found that depressed individuals have a slower recovery time after exercise compared to those who are non-depressed.

These findings suggest that a dysfunctional biological stress system is at play among depressed individuals. Published in the journal Psychophysiology, the research warns of the importance of testing for cardiovascular disease among people suffering from major depression.

"There have been two competing theories as to why depression is linked to cardiovascular disease," says first author Jennifer Gordon, who is a PhD candidate at McGill University. "Depressed people may have poorer health behaviors, which may in turn lead to heart problems. The other possibility is physiological: a problem with the stress system known as the fight or flight response. Our study was the first to examine the role of a dysfunctional fight or flight response in depression in a large population."

Heart rate recovery is a powerful diagnostic tool

A total of 886 participants, who were on average 60 years old, took part in the study conducted by Concordia in association with the Montreal Heart Institute, McGill University, the Hôpital Sacré-Coeur de Montréal, the Université du Québec à Montréal and the University of Calgary.

Approximately 5 per cent of participants were diagnosed with a major depressive disorder. All individuals were asked to undergo a stress test after which their heart rate and blood pressure were recorded. Recovery heart rates and blood pressure levels were compared between depressed and non-depressed individuals.

"We found that it took longer for the heart rate of depressed individuals to return to normal," says senior author, Simon Bacon, a professor in the Concordia University Department of Exercise Science and a researcher at the Montreal Heart Institute. "Heart rate recovery from exercise is one way to measure the fight or flight stress response. The delayed ability to establish a normal heart rate in the depressed individuals indicates a dysfunctional stress response. We believe that this dysfunction, can contribute to their increased risk for heart disease."

"The take-home message of this study is that health care professionals should not only address the mental disorder, but also the potential for heart disease in patients who are suffering from major depression," adds Bacon. "Both of these health issues should be treated to minimize risk of severe consequences."

More information: http://onlinelibra … .01232.x/pdf

Fruit fight: Kiwi tops apple in blood pressure study

ORLANDO,28 nov 2011-- An apple a day may keep the doctor away, but three kiwis could lower your blood pressure.

A study presented at the American Heart Association scientific meeting in Orlando on Tuesday found that eating the fuzzy-skinned fruit with the tart green flesh three times a day lowered blood pressure more than an apple.

The eight-week study, led by Mette Svendsen, a registered dietitian at Oslo University Hospital in Norway, involved 118 subjects with an average age of 55 and mildly high blood pressure.

One group added three kiwis to their daily diet, while the other half added the proverbial apple a day. Kiwis contain lutein, which has antioxidant properties.

After eight weeks, researchers found the kiwi group's 24-hour systolic blood pressure was 3.6 mm Hg lower than that of the apple eaters, on average.

The diastolic blood pressure was also lower in the kiwi group, but that association to the fruit was not as clear, researchers said. They recommended that the findings be confirmed with a larger study.

Perhaps the most surprising thing about the kiwi fruit study was that it was conducted in Norway and not in New Zealand.

Drugs ID'd in Most Older Adult Emergency Hospitalizations

Warfarin, insulin, oral antiplatelets, hypoglycemics implicated in most emergency hospitalizations

27 nov 2011-- Adverse drug events from commonly used medications, including warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents, account for the majority of emergency hospitalizations in older adults in the United States, according to a study published in the Nov. 24 issue of the New England Journal of Medicine.

Daniel S. Budnitz, M.D., M.P.H., from the Division of Healthcare Quality Promotion at the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues estimated the frequency and rates of emergency hospitalization after emergency department visits for adverse drug events in adults aged 65 years or older. Adverse event data were collected for 5,077 cases identified from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project from 2007 to 2009, and were used to assess the contribution of specific medications to hospitalizations.

The investigators identified approximately 99,628 emergency hospitalizations for adverse drug events in older adults each year. Adults aged 80 years or older accounted for 48.1 percent of these hospitalizations, and almost two-thirds of the hospitalizations (65.7 percent) resulted from unintentional overdoses. Sixty-seven percent of the hospitalizations involved four medications or medication classes, alone or in combination: warfarin (33.3 percent), insulin (13.9 percent), oral antiplatelet agents (13.3 percent), and oral hypoglycemic agents (10.7 percent). In 1.2 percent of hospitalizations, high-risk medications were implicated.

"Most emergency hospitalizations for recognized adverse drug events in older adults resulted from a few commonly used medications, and relatively few resulted from medications typically designated as high-risk or inappropriate," the authors write.

How cancer cells get by on a starvation diet

MIT researchers have found that when deprived of oxygen, cancer cells can engage an alternate metabolic pathway that allows them to use glutamine (seen above) as the starting material for synthesizing lipids.

Cancer cells usually live in an environment with limited supplies of the nutrients they need to proliferate — most notably, oxygen and glucose. However, they are still able to divide uncontrollably, producing new cancer cells.

26 nov 2011--A new study from researchers at MIT and the Massachusetts General Hospital (MGH) Cancer Center helps to explain how this is possible. The researchers found that when deprived of oxygen, cancer cells (and many other mammalian cells) can engage an alternate metabolic pathway that allows them to use glutamine, a plentiful amino acid, as the starting material for synthesizing fatty molecules known as lipids. These lipids are essential components of many cell structures, including cell membranes.

The finding, reported in the Nov. 20 online edition of Nature, challenges the long-held belief that cells synthesize most of their lipids from glucose, and raises the possibility of developing drugs that starve tumor cells by cutting off this alternate pathway.

Lead author of the paper is Christian Metallo, a former postdoc in the lab of Gregory Stephanopoulos, the William Henry Dow Professor of Chemical Engineering and Biotechnology at MIT and a corresponding author of the paper. Othon Iliopoulos, an assistant professor of medicine at Harvard Medical School and MGH, is the paper’s other corresponding author.

Alternate pathways

Much of the body’s supply of oxygen and glucose is carried in the bloodstream, but blood vessels often do not penetrate far into the body of tumors, so most cancer cells are deficient in those nutrients. This means they can’t produce fatty acids using the normal lipid-synthesis pathway that depends mostly on glucose.

In prior work, Stephanopoulos’ lab identified a metabolic pathway that uses glutamine instead of glucose to produce lipids; the new paper shows that this alternate pathway is much more commonly used than originally thought. The researchers found that in both normal and cancerous cells, lack of oxygen — a state known as hypoxia — provokes a switch to the alternate pathway.

In a normal oxygen environment, 80 percent of a cell’s new lipids come from glucose, and 20 percent from glutamine. That ratio is reversed in a hypoxic environment, Stephanopoulos says.

“We saw, for the first time, cancer cells using substrates other than glucose to produce lipids, which they need very much for their rapid growth,” Iliopoulos explains. “This is the first step to answering the question of how new cell mass is synthesized during hypoxia, which is a hallmark of human malignancies.”

The glutamine may come from within the cell or from neighboring cells, or the extracellular fluid that surrounds cells.

“There’s protein everywhere,” says Matthew Vander Heiden, the Howard S. and Linda B. Stern Career Development Assistant Professor of Biology at MIT and a co-author of the Nature paper. “The new pathway allows cells to conserve what glucose they do have, perhaps to make RNA and DNA, and then co-opt the new pathway to make lipids so they can grow under low oxygen.”

The switch from glucose to glutamine is triggered by low oxygen and allows cancer cells to thrive and proliferate in an environment with minimal glucose, though it is not clear how this is done. “Elucidating the molecular mechanism regulating this switch would be important in understanding regulation of cancer metabolism,” Stephanopoulos says. “This could be important not only for cancer cells but also other cells growing in hypoxic environments, such as stem cells, placenta and during embryonic development.”

New insights into old models

The researchers are now looking into what other unexpected sources might be diverted into lipid-synthesis pathways under low oxygen. “We had to revise models of metabolism that had been established over the past 50 years. This opens up the possibility for more exciting discoveries in this field that may impact strategies of therapy,” Metallo says.

A better understanding of metabolic pathways and their regulation raises the possibility of developing new drugs that could selectively disrupt key metabolic pathways for cancer cell survival and growth. One possible target is the enzyme isocitrate dehydrogenase, which performs a critical step in the transformation of glutamine to acetyl CoA, a lipid precursor.

“While this target is not new, our findings point to a new function and, hence, generate new ideas for drug development,” Iliopoulos says. “The better we understand the molecular basis of these phenomena, the more optimistic we can be about efforts to translate these basic results into effective treatments of cancer.”

“We’ve been looking, as a field, for almost 90 years for a metabolic pathway that could truly be used to differentiate malignant tumors from normal tissues,” says Ralph DeBerardinis, an assistant professor of pediatrics and genetics at the University of Texas Southwestern Medical Center, who was not involved in this research. He adds that more study is needed, but “if this could be exploited, that could have significant therapeutic potential.”

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This story is republished courtesy of MIT News (http://web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

Provided by Massachusetts Institute of Technology

Doctors could learn from Shakespeare's deep understanding of mind-body connection

Shakespeare was a master at portraying profound emotional upset in the physical symptoms of his characters, and many modern day doctors would do well to study the Bard to better understand the mind-body connection, concludes an analysis of his works, published in Medical Humanities.

25 nov 2011--Kenneth Heaton, a medical doctor and extensively published author on William Shakespeare's oeuvre, systematically analysed 42 of the author's major works and 46 of those of his contemporaries, looking for evidence of psychosomatic symptoms.

He focused on sensory symptoms other than those relating to sight, taste, the heart, and the gut.

He found that Shakespeare's portrayal of symptoms such as dizziness/faintness, and blunted or heightened sensitivity to touch and pain in characters expressing profound emotions was significantly more common than in works by other authors of the time.

Vertigo/giddiness/dizziness is expressed by five male characters in "Taming of the Shrew", "Romeo and Juliet", "Henry VI" part 1, "Cymbeline" and "Troilus and Cressida". The nearest approximation in contemporaries' works was one incident in John Marston's "The Malcontent".

There are at least 11 instances of breathlessness associated with extreme emotion in "Two Gentlemen of Verona", "The Rape of Lucrece", "Venus and Adonis", and "Troilus and Cressida", compared with just two in the works of other writers.

Fatigue/weariness as a result of grief or distress is a familiar sensation among Shakespeare's characters, most notably in "Hamlet", "The Merchant of Venice", "As You Like It", "Richard II" and "Henry IV" part 2. This crops up twice as frequently as in other contemporaries' works, argues Dr Heaton.

Disturbed hearing at a time of high emotion occurs in "King Lear", "Richard II" and "King John" while blunted/exaggerated senses are portrayed in "Much Ado about Nothing", "Venus and Adonis", "King Lear", "Love's Labour's Lost" and "Coriolanus".

"Shakespeare's perception that numbness and enhanced sensation can have a psychological origin seems not to have been shared by his contemporaries, none of whom included such phenomena in the works examined," writes Dr Heaton.

The Bard also uses coldness - for example, "Romeo and Juliet" - and faintness to convey shock, including in "Titus Andronicus", "Julius Caesar", "Love's Labour's Lost", and "Richard III", significantly more frequently than other writers of the period.

Dr Heaton concludes that his data show that Shakespeare "was an exceptionally body-conscious writer," suggesting that the technique was used to make his characters seem more human and engender greater empathy or raise the emotional temperature of his plays and poems.

And his findings should encourage doctors to remember that physical symptoms can have psychological causes, he suggests.

"Many doctors are reluctant to attribute physical symptoms to emotional disturbance, and this results in delayed diagnosis, overinvestigation, and inappropriate treatment," he writes.

"They could learn to be better doctors by studying Shakespeare. This is important because the so-called functional symptoms are the leading cause of general practitioner visits and of referrals to specialists," he says.

Provided by British Medical Journal

People with early Alzheimer's disease may be more likely to have lower BMI

Studies have shown that people who are overweight in middle age are more likely to develop Alzheimer's disease decades later than people at normal weight, yet researchers have also found that people in the earliest stages of Alzheimer's disease are more likely to have a lower body mass index (BMI). A current study examines this relationship between Alzheimer's disease and BMI.

24 nov 2011--The study, published in the November 22, 2011, print issue of Neurology, the medical journal of the American Academy of Neurology, examined 506 people with advanced brain imaging techniques and analyses of cerebrospinal fluid to look for biomarkers for Alzheimer's disease, which can be present years before the first symptoms begin. The participants, who were part of the Alzheimer's Disease. Neuroimaging Initiative, included people with no memory problems, people with mild cognitive impairment, or mild memory problems, and people with Alzheimer's disease.

The study found that in people with no memory or thinking problems and in people with mild cognitive impairment, those who had the Alzheimer's biomarkers were also more likely to have a lower BMI than those who did not have the biomarkers.

For example, 85 percent of the people with mild cognitive impairment who had a BMI below 25 had signs of the beta-amyloid plaques in their brains that are a hallmark of the disease, compared to 48 percent of those with mild cognitive impairment who were overweight. The relationship was also found in people with no memory or thinking problems.

"These results suggest Alzheimer's disease brain changes are associated with systemic metabolic changes in the very earliest phases of the disease," said study author Jeffrey M. Burns, MD, MS, of the University of Kansas School of Medicine in Kansas City and a member of the American Academy of Neurology. "This might be due to damage in the area of the brain called the hypothalamus that plays a role in regulating energy metabolism and food intake. Further studies should investigate whether this relationship reflects a systemic response to an unrecognized disease or a long-standing trait that predisposes a person to developing the disease."

Provided by American Academy of Neurology

A study looks at the nature of change in our aging, changing brains

23 nov 2011 -- As we get older, our cognitive abilities change, improving when we’re younger and declining as we age. Scientists posit a hierarchical structure within which these abilities are organized. There’s the “lowest” level— measured by specific tests, such as story memory or word memory; the second level, which groups various skills involved in a category of cognitive ability, such as memory, perceptual speed, or reasoning; and finally, the “general,” or G, factor, a sort of statistical aggregate of all the thinking abilities.

What happens to this structure as we age? That was the question Timothy A. Salthouse, Brown-Forman professor of psychology at the University of Virginia, investigated in a new study appearing in an upcoming issue of Psychological Science, a journal published by the Association for Psychological Science. His findings advance psychologists’ understanding of the complexities of the aging brain.

“There are three hypotheses about how this works,” says Salthouse. “One is that abilities become more strongly integrated with one another as we age.” That theory suggests the general factor influences cognitive aging the most. The second—based on the idea that connectivity among different brain regions lessens with age—“is almost the opposite: that the changes in cognitive abilities become more rather than less independent with age.” The third was Salthouse’s hypothesis: The structure remains constant throughout the aging process.

Using a sample of 1,490 healthy adults ages 18 to 89, Salthouse performed analyses of the scores on 16 tests of five cognitive abilities—vocabulary, reasoning, spatial relations, memory, and perceptual speed. The primary analyses were on the changes in the test scores across an interval of about two and a half years.

The findings confirmed Salthouse’s hunch: “The effects of aging on memory, on reasoning, on spatial relations, and so on are not necessarily constant. But the structure within which these changes are occurring does not seem to change as a function of age.” In normal, healthy people, “the direction and magnitude of change may be different” when we’re 18 or 88, he says. “But it appears that the qualitative nature of cognitive change remains the same throughout adulthood.”

The study could inform other research investigating “what allows some people to age more gracefully than others,” says Salthouse. That is, do people who stay mentally sharper maintain their ability structures better than those who become more forgetful or less agile at reasoning? And in the future, applying what we know about the structures of change could enhance “interventions that we think will improve cognitive functioning” at any age or stage of life.

Provided by Association for Psychological Science

Older adults in home health care at elevated risk for unsafe meds

Older adults receiving home health care may be taking a drug that is unsafe or ineffective for someone their age. In fact, nearly 40 percent of seniors receiving medical care from a home health agency are taking at least one prescription medication that is considered potentially inappropriate to seniors, a new study in the Journal of General Internal Medicine has revealed.

22 nov 2011--The study's researchers, led by Dr. Yuhua Bao, assistant professor of public health at Weill Cornell Medical College, found that home health care patients aged 65 and over are prescribed Potentially Inappropriate Medications, or PIMs, at rates three times higher than patients who visit a medical office. The researchers' data shows that home health care patients are taking 11 medications on average, and that the concurrent use of multiple medications is a strong indicator of the presence of PIMs.

"Elderly patients receiving home health care are usually prescribed medications by a variety of physicians, and it's a great challenge for home health care nurses to deal with prescriptions from many sources," says Dr. Bao.

Still, she sees the home health care model offering potential for improving this situation. "Having a medical professional enter an elderly patient's home is an opportunity to do a proper medication review and reconciliation," Dr. Bao explains.

The study used data from the National Home and Hospice Care Survey, conducted in 2007 by the Centers for Disease Control and Prevention (CDC), which is the most recent nationally representative epidemiological survey of home health patients. The 2002 Beers Criteria, an expert-panel-generated list that itemizes 77 medications or groups of medications considered inappropriate for elderly people, was the basis for the PIMs chosen.

In a review of data of 3,124 home health patients 65 years of age or older, the researchers found 38 percent were taking at least one PIM. Senior patients taking 15 or more medications were five to six times as likely to be prescribed PIMs as patients taking seven or fewer medications. Of those seniors taking at least one PIM, 21 percent were taking 15 or more medications.

According to Dr. Bao, the study, if anything, underestimates the prevalence of PIMs taken by home health patients: The researchers were not able to look at potentially problematic drug-to-drug interactions or drug-and-disease interactions because data were not available.

There is no one reason why PIMs are prevalent in home health care settings. "Anecdotal evidence shows that many physicians are not aware of what is on the PIM list," says Dr. Bao. "In our fragmented health care system, we generally don't have an electronic reference for a patient that lists all medications from different physicians, and there isn't a readily available means for professionals to share essential information. Enhanced physician communication with home health care nurses may help to address the problem, as well as better communication among physicians."

Dr. Bao sees incentives for improvement in communication and care coordination in the implementation of the Patient Protection and Affordable Care Act passed by the U.S. Congress in 2010. "The current payment system doesn't provide incentives to optimize coordination of care," says Dr. Bao. "But when providers in different settings as a group are held responsible for outcomes and costs of care through, for example, an accountable care organization -- a concept promoted in the Affordable Care Act -- this could create an impetus to break the communication barriers that currently exist."

Provided by New York- Presbyterian Hospital

Study finds sex a significant predictor of happiness among married seniors

The more often older married individuals engage in sexual activity, the more likely they are to be happy with both their lives and marriages, according to new research presented in Boston at The Gerontological Society of America's (GSA) 64th Annual Scientific Meeting.

21 nov 2011--This finding is based on the 2004-2006 General Social Surveys, a public opinion poll conducted on a nationally representative sample of non-institutionalized English and Spanish-speaking person 18 years of age or older living in the U.S. The data analysis was conducted by Adrienne Jackson, PT, PhD, MPA, an assistant professor at Florida Agricultural and Mechanical University.

"This study will help open the lines of communication and spark interest in developing 'outside the box' approaches to dealing with resolvable issues that limit or prevent older adults from participating in sexual activity," said Jackson. "Highlighting the relationship between sex and happiness will help us in developing and organizing specific sexual health interventions for this growing segment of our population."

Based on the survey responses of 238 arried individuals age 65 years or older, Jackson discovered that frequency of sexual activity was a significant predictor of both general and marital happiness. The association even remained after accounting for factors such as age, gender, health status, and satisfaction with financial situation.

Whereas only 40 percent of individuals who reported no sexual activity in the last 12 months said they were very happy with life in general, almost 60 percent who engaged in sexual activity more than once a month said they were very happy. Similarly, while about 59 percent of individuals who reported no sexual activity in the last 12 months said they were very happy with their marriage, almost 80 percent who had sex more than once a month said they were very happy. To assess frequency of sexual activity, respondents were asked the following question: "About how many times did you have sex during the last 12 months? By 'sex' we mean vaginal, oral, or anal sex." To assess general happiness, respondents were asked the following question: "Taken all together, how would you say things are these days — would you say that you are very happy, pretty happy, or not too happy?" To assess marital happiness, respondents were asked the following question: "Taking things all together, how would you describe your marriage? Would you say that your marriage is very happy, pretty happy, or not too happy?"

GSA's meeting — the country's largest interdisciplinary conference in the field of aging — is taking place at the John B. Hynes Veterans Memorial Convention Center and Sheraton Boston Hotel from November 18 to 22.

Provided by The Gerontological Society of America

Elderly hospital patients with delirium more likely to die within a year

Hospital patients over 65 who are referred for a psychiatric consultation and found to have delirium are more likely than those without delirium to die within one year following diagnosis, according to a new study published in the journal General Hospital Psychiatry.

20 nov 2011--“Clinical physicians should pay close attention to delirious patients,” says lead author Jian-An Su, M.D., a psychiatrist at Chang Gung Memorial Hospital in Taiwan. “Early psychiatric consultation could decrease mortality.”

Delirium is a sudden change in mental status associated with physical illness and related medications. A delirious patient may experience bouts of confusion, lethargy, agitation, or hallucinations alternating with periods of lucidity.

The new study is based on records for more than 600 patients over 65 years of age examined by psychiatrists in a Taiwanese hospital between 2002 and 2006. Of these, 172 were diagnosed with delirium. The researchers later reviewed state records to find out how many of the patients had subsequently died. The findings were compared to those for a similar group of patients who had not experienced delirium.

Elderly inpatients who were diagnosed with delirium had significantly higher death rates than other patients in the first year after delirium onset, found the authors. The results held regardless of patients’ gender, physical illnesses, or treatment with antipsychotic medications.

In the elderly, delirium is often characterized by “quiet” symptoms, such as confusion and lethargy. “These patients are frequently overlooked, under-diagnosed, or misdiagnosed as having depression, dementia, or severe illness,” note the authors.

“Primary physicians -- whether intensivists, hospitalists, surgical teams, or others -- must first be attuned to a patient’s behavior and cognitions in order to request a psychiatric consultation for a complete evaluation,” says Ian Cook, M.D., of the Resnick Neuropsychiatric Hospital at the University of California, Los Angeles.

Cook suggests that a brief series of questions such as, “Can you tell me the name of where we are? What day is it? Why are you here in the hospital?” could help attending physicians recognize patients with delirium more consistently, along with observing behaviors such as agitation or excessive sleepiness. Many resources on delirium also advise family members to alert providers immediately if their loved one displays sudden changes in mental status while in the hospital.

More information: Tsai, M-C. et al. Three-year mortality of delirium among elderly inpatients in consultation–liaison service. General Hospital Psychiatry In Press.

Provided by Health Behavior News Service

Study affirms 'mediterranean diet' improves heart health

19 nov 2011-- A team of Johns Hopkins researchers has uncovered further evidence of the benefits of a balanced diet that replaces white bread and pasta carbohydrates with unsaturated fat from avocados, olive oil and nuts — foods typical of the so-called “Mediterranean diet.”

In a report prepared for the American Heart Association’s scientific sessions in Orlando next week, the Johns Hopkins investigators say swapping out certain foods can improve heart health in those at risk for cardiovascular disease, even if the dietary changes aren’t coupled with weight loss.

“The introduction of the right kind of fat into a healthy diet is another tool to reduce the risk of future heart disease,” says Meghana Gadgil, M.D., M.P.H., a postdoctoral fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine who will be presenting the research.

Gadgil and her colleagues analyzed data from the OmniHeart Trial, which studied the cardiovascular effects of three different balanced diets on 164 people with mild hypertension but no diabetes. The researchers compared the body’s ability to regulate blood sugar and maintain healthy insulin levels while on a carbohydrate-rich diet, a protein-rich diet and a diet rich in unsaturated fats. People whose bodies fail to effectively use insulin usually develop type 2 diabetes, which is a major risk factor for heart disease.

The researchers found that a generally balanced diet higher in unsaturated fats such as those in avocados, olive oil and nuts improves insulin use significantly more than a diet high in carbohydrates, particularly such refined carbs as white bread and pasta. The preferred diet is very similar to the Mediterranean diet, inspired by the foods of southern Italy and Greece and emphasizing healthy fats, fruits and vegetables.

Each participant in the study was fed each of the three diets for six weeks in a row, with two to four weeks off in between. Blood samples were collected after fasting periods in weeks four and six of each diet, and used to monitor insulin and glucose levels. The study was designed to keep participants at their starting weights. “A lot of studies have looked at how the body becomes better at using insulin when you lose weight,” Gadgil says. “We kept the weight stable so we could isolate the effects of the macronutrients. What we found is that you can begin to see a beneficial impact on heart health even before weight loss.”

Provided by Johns Hopkins University

Protecting our brains: Tackling delirium

A new national plan of action provides a roadmap for improving the care of patients with delirium, a poorly understood and often unrecognized brain condition that affects approximately seven million hospitalized Americans each year.

18 nov 2011--"Delirium: A Strategic Plan to Bring an Ancient Disease into the 21st Century," written on behalf of the American Delirium Society, appears in the supplement to the Nov. 2011 issue of the Journal of the American Geriatrics Society. Publication of the supplement, "Advancing Delirium Science: Systems, Mechanisms and Management" was supported by the John A. Hartford Foundation.

Delirium is a sudden alteration in mental status -- brain failure in a vulnerable individual, often an older adult with multiple health issues, caused by something else such as medications, urinary tract infection, lack of sleep, excessive light or noise or pain. In the United States, an estimated 80 percent of patients in intensive care units experience delirium during their hospital stay, however delirium is unrecognized in 60 percent of patients who experience it.

"Having delirium prolongs the length of a hospital stay, increases the risk of post-hospitalization transfer to a nursing home, doubles the risk of death, and may lead to permanent brain damage," said Regenstrief Institute investigator Malaz Boustani, M.D., M.P.H., associate professor of medicine at the Indiana University School of Medicine and director of the Healthy Aging Brain Center at Wishard Health Services. Dr. Boustani is an IU Center for Aging Research center scientist and president-elect of the American Delirium Society.

"Statistically having delirium is as serious as having a heart attack. Once delirium occurs, the same percentage of individuals die from it as die from a heart attack," said James Rudolph, M.D., president of the American Delirium Society.

Delirium, which occurs suddenly, is not the same as dementia, although individuals with dementia are more susceptible to developing delirium during hospitalization than individuals without dementia.

Delirium has plagued the ill and vulnerable with increased risk of death for centuries, at least since Hippocrates described the condition in the fourth century B.C. Today, as much as $152 billion is spent annually in the U.S. on delirium related costs such as hospitalization, rehabilitation services, or nursing homes residency.

The new framework outlines four broad goals and details steps to achieve them:

Goal 1: Improve clinical care related to delirium including screening patients for delirium risk and developing non-toxic treatments for delirium.

Goal 2: Improve delirium education especially improving public understanding that a change in mental status in an older patient is a medical emergency and correcting the misconception among health care providers that delirium is a 'normal' feature of hospitalization in older patients.

Goal 3: Invest in delirium science by funding research at levels comparable to diseases with similar outcomes. In 2009, NIH funding for delirium was only $12 million compared to $392 for pneumonia/influenza.

Goal 4: Develop a network of delirium professionals to advance the first three goals.

"Delirium may be averted or resolved but we are missing it because we are not focused on preventing, diagnosing or managing it. We need to improve inputs into the brain, create healing environments that do not overload their brains, and cautiously use medications tha act in the brain. Most importantly, we need to make sure we are alert to signs of delirium and address it as soon as possible," said Dr. Rudolph.

Ultimately the patient and his or her caregivers bear the burdens of delirium and the consequences thereafter. The focus of this call to action puts the patient at the forefront.

"Patients, family members, doctors, nurses, pharmacists and everyone involved in delivery of care need to be told about the short term and the long term impact of delirium in our society so we can have a delirium-free century," said Dr. Boustani.

More information: Delirium: A Strategic Plan to Bring an Ancient Disease into the 21st Century. James L. Rudolph, Malaz Boustani, Barbara Kamholz, Marianne Shaughnessey, and Kenneth Shay, on behalf of the American Delirium Society. J Am Geriatr Soc 2011;59(Suppl. 2):S237-S240.

Provided by Indiana University School of Medicine

New study links excessive amounts of vitamin D to onset of atrial fibrillation

While previous studies have linked vitamin D deficiency to an increased risk for cardiovascular disease, new research at the Intermountain Medical Center Heart Institute shows that too much vitamin D can lead to the onset of a dangerous heart condition known as atrial fibrillation.

17 nov 2011--Researchers at Intermountain Medical Center, the flagship facility for the Intermountain Healthcare system, studied more than 132,000 patients and found the risk of developing atrial fibrillation was two and a half times greater in those with excess levels of vitamin D compared to patients with normal levels.

Results of the study will be presented on Wednesday, Nov. 16, at the American Heart Association Scientific Sessions in Orlando, Fla.

Atrial fibrillation is a condition in which the heart's upper chambers quiver instead of beating rhythmically, which can cause blood to pool and clot. Atrial fibrillation has been linked to an increased risk of stroke, heart failure, heart attack, dementia and even Alzheimer's disease.

T. Jared Bunch, MD, a heart rhythm specialist at the Intermountain Medical Center Heart Institute and lead investigator on the study, says the findings are significant because so many Americans use vitamin supplements to promote their health.

"There are both benefits and harm to taking vitamin supplements of all kinds," says Dr. Bunch. "Our goal is to determine a safe dose and usage range so patients can understand what amount is healthy, and what amount may be toxic."

To determine if there is a correlation between too much vitamin D and increased heart risk, Dr. Bunch and his colleagues examined blood tests from 132,000 patients in the Intermountain Healthcare database at Intermountain Medical Center.

Patients did not have any known history of atrial fibrillation, and all had previously received a vitamin D assessment as part of their routine care. Patients were then placed into categories to compare levels of vitamin D: low (less than 20 nanograms per decilter), low/normal (21-40 ng/dl), normal (41-80 ng/dl), high/normal (81-100 ng/dl), and excess (more than 100).

Patients with vitamin D levels in the normal range were compared with other groups to assess their risk of developing atrial fibrillation. In patients with low, low-normal, normal and high-normal levels of vitamin D there was no increased risk of atrial fibrillation. However, in those with excess levels of vitamin D there was a significant increased risk of atrial fibrillation. Atrial fibrillation risk was two and a half times greater in patients with excess levels of vitamin D compared to those with normal levels.

The Institute of Medicine currently advises that healthy adults should be able to take as much as 4000 IU (international units) of vitamin D daily. But the reality is that doctors don't yet know how much vitamin D causes toxicity, which is why Dr. Bunch says communication between a patient and their healthcare provider is critical.

Vitamin D, which is synthesized by the body with exposure to sun, is used to regulate calcium and phosphate concentrations in the blood and is essential for growth and development, cellular health, and bone remodeling, a process where mature bone tissue is removed from the skeleton and new bone tissue is formed.

In regions where sun exposure may be limited, supplemental vitamin D may be required to maintain normal blood levels. The exact amount of vitamin D to achieve normal levels is unknown and usage varies in different regions and communities, which can cause problems, say the researchers.

Dr. Bunch stresses that patients need to tell their doctors about all of the vitamins and supplements they take, as well as all medications, in order to ensure they get the best care possible. He says this research also suggests that checking blood levels of vitamin D in patients that develop atrial fibrillation may help uncover the cause of the abnormal heart rhythm disorder.

"Patients don't think of vitamins and supplements as drugs," says Dr. Bunch. "But any vitamin or supplement that is touted as 'healing' or 'natural' is a drug and will have effects that are both beneficial and harmful. Just like any therapy, vitamins need to be taken for the right reasons and at the right doses."

More than two millions Americans suffer from atrial fibrillation. The risk of developing atrial fibrillation increases as people age. About five percent of people over the age of 80 will develop the heart disorder during their lifetime.

Provided by Intermountain Medical Center

1 in 10 adults could have diabetes by 2030

16 nov 2011-- The International Diabetes Federation predicts that at least one in 10 adults could have diabetes by 2030, according to its latest statistics.

In a report issued on Monday, the advocacy group estimated that 552 million people could have diabetes in two decades' time based on factors like aging and demographic changes. Currently, the group says that about one adult in 13 has diabetes.

The figure includes both types of diabetes as well as cases that are undiagnosed. The group expects the number of cases to jump by 90 percent even in Africa, where infectious diseases have previously been the top killer. Without including the impact of increasing obesity, the International Diabetes Federation said its figures were conservative.

According to the World Health Organization, there are about 346 million people worldwide with diabetes, with more than 80 percent of deaths occurring in developing countries. The agency projects diabetes deaths will double by 2030 and said the International Diabetes Federation's prediction was possible.

"It's a credible figure," said Gojka Roglic, head of WHO's diabetes unit. "But whether or not it's correct, we can't say."

Roglic said the projected future rise in diabetes cases was because of aging rather than the obesity epidemic. Most cases of diabetes are Type 2, the kind that mainly hits people in middle age, and is linked to weight gain and a sedentary lifestyle.

Roglic said a substantial number of future diabetes cases were preventable. "It's worrying because these people will have an illness which is serious, debilitating, and shortens their lives," she said. "But it doesn't have to happen if we take the right interventions."

More information: http://www.idf.org

http://www.who.int

Medical researchers decoding the aging process

Scientists are beginning to decode the complex biology of aging and are optimistic that recent advances in research may lead to treatments that can slow or even reverse degeneration and disease.

15 nov 2011--"We are seeing a major change, very important developments and real therapeutic efforts to try to treat age-related illnesses," said Norman Sharpless, professor of medicine and genetics at the University of North Carolina.

"It's a very exciting time in aging research," said Sharpless, of the Lineberger Comprehensive Cancer Center in the university's school of medicine, citing recent studies in France and the United States.

The French research, led by Jean-Marc Lemaitre at the Functional Genomics Institute, published in October, shows cells from elderly donors can be rejuvenated as stem cells, erasing the ravages of age and proving that aging is reversible.

"It's a major advance," Sharpless said, noting that if many age-related diseases such as cancer, cardiovascular problems or Alzheimer's are to be defeated, regenerative medicine will be required.

But he stressed that "cellular therapy is very difficult to develop," and expectations must be kept in check.

"The way trials work, it is going to be a couple of years before that research is translated into human aging research because of the risk of cancer frankly," Sharpless warned.

"The worry is while those cells are great, there are some risks for the recipients."

At the end of 2010 an American study in Boston showed that aging could be reversed in mice that were treated with telomerase, a naturally occurring enzyme in the body that protects DNA sequences (telomeres) at the end of chromosomes and which shorten cellular aging.

A second US study conducted on genetically-modified mice, published in early November in the British journal Nature, showed that the removal of senescent cells, which cease to renew themselves and increase with age -- they represent 10-15 percent of an elderly person's cells -- would prevent or defer aging.

"By attacking these cells and what they produce, one day we may be able to break the link between aging mechanisms and predisposition to diseases like heart disease, stroke, cancers and dementia," said James Kirkland, head of the Mayo Clinic's Robert and Arlene Kogod Center on Aging.

"There is potential for a fundamental change in the way we provide treatment for chronic diseases in older people," he said.

The mice were treated with a substance that caused their senescent cells to self-destruct, causing a major improvement in their health which saw them not suffering the usual ills of aging such as a decrease in muscle mass or reductions in a layer of fat that can prompt the onset of wrinkles.

Judith Campisi, of the Buck Institute for Age Research at the University of California at Berkeley, said the recent research carried out in France and the United States bodes well for the future.

"Of course we are not there yet, there is still a long way to go," she said, noting the French study showed "aging is not as irreversible as we thought," but the Nature paper highlighted that "we also know that there is something about the aging organisms that will make stem cells not behave very well."

Dan Perry, president of the Alliance For Aging Research in Washington, said there was a lot of excitement within the scientific community at how research may lead to the development of therapies to combat aging and major diseases.

"But it will take more money and effort to bring these across the line into treatment," he noted.

"The hope here is not to extend life span but to extend the health span... in order to reduce the impact of diabetes, cardiovascular disease and cancer," allowing people in their 70s and 80s to enjoy better final years.

"The demographic moment of truth is upon us," he concluded.

Sugar-sweetened beverages may increase cardiovascular risk in women

Drinking two or more sugar-sweetened beverages a day may expand a woman's waistline and increase her risk of heart disease and diabetes, according to research presented at the American Heart Association's Scientific Sessions 2011.

14 nov 2011--In this study, researchers compared middle-aged and older women who drank two or more sugar-sweetened beverages a day, such as carbonated sodas or flavored waters with added sugar, to women who drank one or less daily. Women consuming two or more beverages per day were nearly four times as likely to develop high triglycerides, and were significantly more likely to increase their waist sizes and to develop impaired fasting glucose levels. The same associations were not observed in men.

"Women who drank more than two sugar-sweetened drinks a day had increasing waist sizes, but weren't necessarily gaining weight," said Christina Shay, Ph.D., lead author of the study and assistant professor at the University of Oklahoma Health Sciences Center in Oklahoma City. "These women also developed high triglycerides and women with normal blood glucose levels more frequently went from having a low risk to a high risk of developing diabetes over time."

The Multi-Ethnic Study of Atherosclerosis (MESA) included food frequency surveys in 4,166 African-American, Caucasian, Chinese-Americans and Hispanic adults 45 to 84 years old. At the beginning of the study the participants didn't have cardiovascular disease.

Researchers assessed risk factors in three follow-up exams spanning five years starting in 2002. Participants were monitored for weight gain, increases in waist circumference, low levels of high density lipoproteins (HDL "good" cholesterol), high levels of low density lipoproteins (LDL "bad" cholesterol), high triglycerides, impaired fasting glucose levels, and type 2 diabetes.

"Most people assume that individuals who consume a lot of sugar-sweetened drinks have an increase in obesity, which in turn, increases their risk for heart disease and diabetes," said Shay, formerly of Northwestern University's Department of Preventive Medicine in Chicago, where the study was conducted. "Although this does occur, this study showed that risk factors for heart disease and stroke developed even when the women didn't gain weight."

Women may have a greater chance for developing cardiovascular disease risk factors from sugar-sweetened drinks because they require fewer calories than men which makes each calorie count more towards cardiovascular risk in women, Shay said.

Researchers have yet to determine exactly how sugar-sweetened beverages influence cardiovascular risk factors such as high triglycerides in individuals who do not gain weight, Shay said, but further work is planned to try and figure that out.

Provided by American Heart Association

First large-scale study of pain reveals risk factors

Millions of Americans are affected by painful jaw problems known as TMD, temporomandibular disorders, but predicting who is at risk has been extremely difficult.

13 nov 2011--Now, for the first time, researchers in the University at Buffalo School of Dental Medicine are publishing a comprehensive set of clinical characteristics that they say will lead to the ability to identify individuals at risk for developing the painful conditions. Their new clinical assessments will help researchers and clinicians better understand TMD and other pain conditions, so as to find ways to better manage and treat them.

Published in the November issue of the Journal of Pain, the UB research results are part of the Orofacial Pain Prospective Evaluation and Risk Assessment (OPPERA) study, available at http://www.jpain.org/issues?issue_key=S1526-5900(11)X0013-5, which followed 3,200 initially pain-free individuals for three to five years. It is the largest clinical study of pain conditions and how they develop that has ever been done.

The UB researchers, led by Richard Ohrbach, DDS, PhD, associate professor of oral diagnostic sciences in the UB School of Dental Medicine, have been studying pain and TMD for several decades. Ohrbach is the lead author on the paper.

"The UB role in the project was to develop well-designed examination procedures to help dentists and other health care providers identify risk factors for TMD," says Ohrbach.

Ohrbach and his co-authors studied 71 different clinical variables in 1,633 controls -- individuals who never had TMD -- and in 185 people with chronic painful TMD. They assessed the individuals through lengthy questionnaires about health histories and current symptoms and through clinical exams. Participants were from Western New York, Maryland, North Carolina and Florida.

The UB researchers found that a very high rate of the variables they assessed, 59 out of 71, were significantly associated with painful TMD. "Our results indicate that individuals with TMD differ substantially from the controls across almost all of the variables we assessed," says Ohrbach.

TMD sufferers tended to have significantly higher levels of the following variables: trauma to the jaw, non-pain symptoms in the facial area, jaw locking and noises, and pain during such jaw movements as chewing, smiling or talking. Ohrbach notes that while the last two findings were clearly expected, very little has been known about the first two findings.

In particular, the UB researchers found that TMD sufferers reported a much higher rate of neural and sensory medical conditions, such as earaches, tinnitus or hearing loss, fainting and dizziness, as well as seizures due to epilepsy and other conditions.

Ohrbach said that the study also confirmed many findings that long have been associated with TMD but which have not, until now, been proven in a comprehensive, large-scale study.

Among these is the finding that any pain disorder, such as headache, backache and abdominal pain, is more likely to occur in TMD patients than in people who do not have TMD.

"Why are other pain disorders more common in people with TMD?" asks Ohrbach. "Is it because those pain conditions predispose them to develop TMD or do they develop TMD first and does TMD lead them to then develop other pain disorders?"

To answer these and other related questions, Ohrbach says he and his colleagues will next look at comorbidity.

"We'll be tracking these multiple pain disorders over time with particular variables," he says.

Ultimately, the findings of the UB researchers and their colleagues on the OPPERA study will be geared toward a better understanding of pain conditions in general.

"How do we understand the pain? How do we establish a reliable and clinically useful marker of pain so that significant pain can be more readily diagnosed?" asks Ohrbach. "To answer these questions, we need to have a model that puts all of the pieces together, that takes the findings from a clinical exam, puts it into a rigorous framework using the right assessment and diagnosis tools in order to chart the nature of multiple physical disorders so that we can ultimately understand how the pain is affecting the individual."

Provided by University at Buffalo

Elderly emergency patients less likely to receive pain medication than middle-aged patients

A new study finds that people 75 years old or older are less likely to receive any pain medication in hospital emergency departments than middle aged people – those between 35 and 54 years old.

12 nov 2011--And these differences remained even after researchers took into account how much pain the patients were having, said Timothy F. Platts-Mills, MD, lead author of the study and assistant professor of emergency medicine at the University of North Carolina at Chapel Hill School of Medicine.

For example, among older adults reporting severe pain, 67 percent received pain medication, compared to 79 percent of middle aged patients with severe pain.

"We're not exactly sure why this happens," Platts-Mills said. "It may be because physicians are more concerned about potential side effects in this population.

"To us, the gap we observe in pain management for older patients highlights the need to better understand how best to manage pain in older patients and understand the barriers to doing this. All patients, regardless of age, deserve to have relief from pain, especially when it is severe. Our group is actively investigating the side effects of commonly used pain medication and the impact of pain on functional outcomes after injury in older adults. We think that for most older emergency department patients providing effective treatment for acute pain is likely to result in a substantial net benefit," Platts-Mills said.

The study was published online ahead of print by the journal Annals of Emergency Medicine.

Emergency departments (EDs) are an important source of acute care for older adults, with over 20 million ED visits by patients 65 and older each year. Almost half of these visits are for the evaluation and treatment of pain.

Platts-Mills and study co-authors conducted a secondary analysis of data collected from U.S. emergency departments between 2003 and 2009 in order to test the hypothesis that older adults who come to the ED with a primary complaint of pain are less likely to receive pain medication than younger patients.

Their results show that 49 percent of patients 75 and older received an analgesic (such as morphine, oxycodone, or ibuprofen), compared to 68.3 percent of middle-aged patients. Similarly, 34.8 percent of the elderly patients received an opioid (such as morphine or oxycodone) compared to 49.3 percent among the middle-aged.

These differences persisted even after the statistical analyses were adjusted for sex, race/ethnicity, pain severity and other factors. Elderly patients were 19.6 percent less likely to receive an analgesic and 14.6 percent less likely to receive an opioid than middle-aged patients.

Platts-Mills said further research is needed to better understand the long-term impact of acute pain management for older emergency department patients, assess strategies to minimize adverse effects from pain medications, and examine the role of non-pharmacologic pain management for this population.

Provided by University of North Carolina School of Medicine

Researcher provides further evidence that slow eating reduces food intake

Two new studies by researchers at the University of Rhode Island are providing additional insights into the role that eating rate plays in the amount of food one consumes. The studies found that men eat significantly faster than women, heavier people eat faster than slimmer people, and refined grains are consumed faster than whole grains, among other findings.

11 nov 2011--Kathleen Melanson, URI associate professor of nutrition, along with graduate students Emily Ponte and Amanda Petty, presented their research at the annual meeting of The Obesity Society in Orlando this month.

In one laboratory study, which validated that self-reported eating rates reflect an individual's actual eating rate, Melanson and her lab team found that fast eaters consumed about 3.1 ounces of food per minute, medium-speed eaters consumed 2.5 ounces per minute, and slow eaters consumed 2 ounces per minute. This work is the first to validate self-reported eating rates that have been used in large population studies, which have shown relationships between eating rate and body weight.

The researchers also found what Melanson described as "very strong gender differences" in eating rates. At lunch, the men consumed about 80 calories per minute while the women consumed 52 calories per minute.

"The men who reported eating slowly ate at about the same rate as the women who reported eating quickly," said Melanson, director of the URI Energy Balance Laboratory.

The second study, which examined the characteristics associated with eating rates, found a close association between eating rate and body mass index (BMI), with those individuals with a high BMI typically eating considerably faster than those with a low BMI.

"One theory we are pursuing is that fast eating may be related to greater energy needs, since men and heavier people have higher energy needs," said Melanson.

In what Melanson called her favorite result, the study also found that the test subjects consumed a meal of whole grains – whole grain cereal and whole wheat toast – significantly slower than when eating a similar meal of refined grains.

"Whole grains are more fibrous, so you have to chew them more, which takes more time," she said.

According to Melanson, these studies have raised a number of additional questions that she intends to pursue with future research.

"When you talk about eating rate, you have to talk about eating techniques," she explained. "It's not just about how long it takes you to eat, but how you eat."

She plans to study specific slow-eating techniques to see how they may affect appetite and weight loss. She will also examine other factors that might influence eating rate in daily life.

"We also want to recruit fast-paced eaters with a high BMI, teach them how to eat slowly, and see what role that might play in weight management," Melanson said.

While the link between eating rate and obesity is still being studied, Melanson said that her research has demonstrated that eating slowly results in significantly fewer average calories being consumed.

"It takes time for your body to process fullness signals," she concluded, "so slower eating may allow time for fullness to register in the brain before you've eaten too much."

The latest research follows up on a landmark 2007 study conducted by Melanson that was the first to confirm the popular dietary belief that eating slowly reduces food intake. That study found that women who were told to eat quickly consumed 646 calories in nine minutes, but the same women consumed just 579 calories in 29 minutes when encouraged to pause between bites and chew each mouthful 15 to 20 times before swallowing.

Provided by University of Rhode Island

Cognitive reframing can help dementia caregivers with depression, stress

Family caregivers of people with dementia experience more burden and are at greater risk of developing depression than caregivers of people with a chronic illness. A new evidence review from the Netherlands finds that a psychotherapy technique called cognitive reframing can help reduce caregivers’ stress when they are caring for loved ones with dementia.

10 nov 2011--Cognitive reframing focuses on thinking differently by “reframing” negative or untrue assumptions and thoughts into ones that promote adaptive behavior and lessen anxiety and depression. Cognitive reframing can be offered by a trained primary health care provider or by a mental health care professional.

Several studies have focused on psychosocial intervention in dementia care, but this is the first review that focused on the effectiveness of cognitive reframing in particular. The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Led by Myrra Vernooij-Dassen Ph.D., of the Radboud University Nijmegen Medical Centre in the Netherlands, the review looked at whether caregivers benefited from various interventions to provide education about dementia and whether their beliefs about caregiving responsibilities and their own needs could be changed.

“We found that changing their thinking and understanding helps a lot to allow more positive feelings to emerge and to reduce distress,” Vernooij-Dassen said.

Caregivers who received a cognitive reframing intervention had fewer symptoms of anxiety and depression and felt less stress or distress related to their caregiving. While reframing helped caregivers manage their stress, it didn’t change the burden of being a dementia caregiver or their coping skills. However, reframing may also lead to a more positive relationship with the person who has dementia. “When a caregiver is able to reframe self-defeating cognitions into more constructive reasoning, it is a major change,” said Vernooij-Dassen.

The evidence review comprised eleven randomized controlled trials involving family caregivers of people with dementia. None of the trials focused solely on cognitive reframing, but they all used cognitive reframing as the main component in their intervention. Caregivers ranged in age from 19 to 84. The majority of participants—40.2 percent—were caring for a spouse.

Dementia symptoms include diminished reasoning, memory, social and language skills that can alter a person’s ability to function in daily life. Alzheimer’s disease is the most common form of advanced dementia.

“Alzheimer’s is a chronic, progressive, fatal disease and caregiving at home for someone with the disease is fraught with many challenges but also rewards,” said, Beth Kallmyer, M.S.W., senior director of constituent services for the Alzheimer’s Association, a non-profit advocacy organization.

Kallmyer said the Alzheimer’s Association encourages caregivers to reach out for assistance and take care of themselves. “Because of the progressive, debilitating nature of the disease and the extended length of the caregiving process, multiple services are needed to provide comprehensive support and education to dementia caregivers.”

Tools to decrease stress for family dementia caregivers will be even more important in years to come as people continue to live longer. Kallmyer said cognitive reframing is one among many appropriate interventions as part of a package of individual support for caregivers. “More research is needed overall for improving our knowledge of how to best support and educate caregivers.”

Vernooij-Dassen emphasized dementia caregivers don’t need to go it alone. “When they need support, reframing their thinking and understanding about dementia can yield positive results.”

More information: Vernooij-Dassen, M. et al. Cognitive reframing for carers of people with dementia. Cochrane Database of Systematic Reviews 2011. Issue 11.

Provided by Health Behavior News Service

Imaging technique IDs plaques, tangles in brains of severely depressed older adults

Brain images demonstrate higher FDDNP binding (yellow areas) and thus more abnormal proteins in a patient with major depressive disorder compared with a healthy control.

Depression is one of the most common mental disorders in the elderly, but little is known about the underlying biology of its development in older adults.

09 nov 2011--In a small study published in the November issue of the peer-reviewed journal Archives of General Psychiatry, UCLA researchers used a unique brain scan to assess the levels of amyloid plaques and tau tangles in older adults with a type of severe depression called major depressive disorder (MDD).

Previous research has suggested that plaque and tangle deposits in the brain -- hallmarks of Alzheimer's disease and many dementias -- are associated not only with memory loss but also with mild symptoms of depression and anxiety in middle-aged and older individuals. The team wanted to see what the brain-scanning technique developed at UCLA would find in older people with MDD.

UCLA researchers have created a chemical marker called FDDNP that binds to both plaque and tangle deposits, which can then be viewed through a positron emission tomography (PET) brain scan, providing a "window into the brain." Using this method, researchers are able to pinpoint where in the brain these abnormal protein deposits are accumulating.

Researchers compared the FDDNP brain scans of 20 older adults between ages 60 to 82 who had been diagnosed with MDD with the scans of 19 healthy controls of similar age, education and gender.

They found that in patients with MDD, FDDNP binding was significantly higher throughout the brain and in critical brain regions, including the posterior cingulate and lateral temporal areas, that are involved in decision-making, complex reasoning, memory and emotions.

"This is the first study using FDDNP to assess the abnormal protein levels in brains of older adults with severe depression," said the study's senior author, Dr. Gary Small, UCLA's Parlow-Solomon Professor on Aging and a professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA. "The findings suggest that the higher protein load in critical brain regions may contribute to the development of severe depression in late life."

Researchers also found that similar protein deposit patterns in the lateral temporal and posterior cingulate areas in patients were associated with different clinical symptoms. Some patients demonstrated indicators of depression only, while others displayed symptoms of mild cognitive impairment as well.

Dr. Small noted that previous research has shown that depression may be a risk factor for or a precursor to memory loss, such as mild cognitive impairment, which can later lead to dementia.

"We may find that depression in the elderly may be an initial manifestation of progressive neurodegenerative disease," said the study's first author, Dr. Anand Kumar, the Lizzie Gilman Professor and department head of psychiatry at the University of Illinois at Chicago. "Brain scans using FDDNP allow us to take a closer look at the different types of protein deposits and track them to see how clinical symptoms develop."

According to Kumar and Small, more follow-up over time is needed to evaluate the significance of the outcomes of the study's patient subgroups. Such research will help further assess if depression later in life might be a precursor to mild cognitive impairment and dementia.

In addition, the researchers said, FDDNP used with PET may also be helpful in identifying new treatments and in tracking the effectiveness of current antidepressant therapy and medications designed to help reduce abnormal protein build-up in the brain.

The team is planning larger studies involving investigators at UCLA and the University of Illinois that will address the impact of the genetic marker APOE-4, which is a risk factor for dementia and Alzheimer's disease.

Provided by University of California - Los Angeles Health Sciences

Researchers discover tactic to delay age-related disorders

Researchers at Mayo Clinic have shown that eliminating cells that accumulate with age could prevent or delay the onset of age-related disorders and disabilities. The study, performed in mouse models, provides the first evidence that these "deadbeat" cells could contribute to aging and suggests a way to help people stay healthier as they age. The findings appear in the journal Nature, along with an independent commentary on the discovery.

08 nov 2011--"By attacking these cells and what they produce, one day we may be able to break the link between aging mechanisms and predisposition to diseases like heart disease, stroke, cancers and dementia," says co-author James Kirkland, M.D., Ph.D., head of Mayo's Robert and Arlene Kogod Center on Aging and the Noaber Foundation Professor of Aging Research. "There is potential for a fundamental change in the way we provide treatment for chronic diseases in older people."

Five decades ago, scientists discovered that cells undergo a limited number of divisions before they stop dividing. At that point the cells reach a state of limbo -- called cellular senescence -- where they neither die nor continue to multiply. They produce factors that damage adjacent cells and cause tissue inflammation. This alternative cell fate is believed to be a mechanism to prevent runaway cell growth and the spread of cancer. The immune system sweeps out these dysfunctional cells on a regular basis, but over time becomes less effective at "keeping house."

As a result, senescent cells accumulate with age. Whether and how these cells cause age-related diseases and dysfunction has been a major open question in the field of aging. One reason the question has been so difficult to answer is that the numbers of senescent cells are quite limited and comprise at most only 10 to 15 percent of cells in an elderly individual.

"Our discovery demonstrates that in our body cells are accumulating that cause these age-related disorders and discomforts," says senior author Jan van Deursen, Ph.D., a Mayo Clinic molecular biologist and the Vita Valley Professor of Cellular Senescence. "Therapeutic interventions to get rid of senescent cells or block their effects may represent an avenue to make us feel more vital, healthier, and allow us to stay independent for a much longer time."

"Through their novel methodology, the research team found that deletion of senescent cells in genetically engineered mice led to improvement in at least some aspects of the physiology of these animals. So, with the caveat that the study involved a mouse model displaying accelerated aging, this paper provides important insights on aging at the cellular level," says Felipe Sierra, Ph.D., Director of the Division of Aging Biology, National Institute on Aging, National Institutes of Health.

How They Did It

Dr. van Deursen and colleagues genetically engineered mice so their senescent cells harbored a molecule called caspase 8 that was only turned on in the presence of a drug that has no effect on normal cells. When the transgenic mice were exposed to this drug, caspase 8 was activated in the senescent cells, drilling holes in the cell membrane to specifically kill the senescent cells.

The researchers found that lifelong elimination of senescent cells delayed the onset of age-related disorders such as cataracts and muscle loss and weakness. Perhaps even more importantly, they showed that removing these cells later in life could slow the progression of already established age-related disorders.

The findings support a role of senescent cells in the aging process and indicate that chemicals secreted by these cells contribute to age-related tissue dysfunction and disease.

Provided by Mayo Clinic

Physical activity reduces the effect of the 'obesity gene'

The genetic predisposition to obesity due to the 'fat mass and obesity associated' (FTO) gene can be substantially reduced by living a physically active lifestyle according to new research by a large international collaboration, led by Ruth Loos from the Medical Research Council Epidemiology Unit, in Cambridge, UK, and published in this week's PLoS Medicine. The researchers found that the effect of the FTO gene on obesity risk is nearly 30% weaker among physically active than in physically inactive adults.

07 nov 2011--This finding holds an important public health message relevant to health care professionals and the wider public as it challenges the widely-held view that obesity 'is in my genes' and not amenable to lifestyle changes. On the contrary, this study shows that even those genetically predisposed can reduce their risk of becoming obese by being physically active.

The authors performed a comprehensive literature search and invited all researchers who had reported on the FTO gene in the past to participate in their study. They used an extensive and innovative methodology to analyze data from over 218,000 adults, to show that, in general, carrying a copy of the FTO gene increases the risk of becoming obese. However, the effect of the FTO gene on obesity risk was 27% less pronounced in individuals who were physically active (1.22 fold) compared with those who were physically inactive (1.30 fold).

The authors say: "Our findings are highly relevant to public health. They emphasize that physical activity is an effective way of controlling body weight, particularly in individuals with a genetic predisposition towards obesity. Thus, they contrast with the determinist view held by many that genetic influences are unmodifiable." The researchers believe that these findings will bring them a step closer to more personalised healthcare by identifying people who will benefit most from a targeted treatment.

In an accompanying Perspective, J. Lennert Veerman from the School of Population Health at the University of Queensland in Australia says: "testing for genetic traits that are associated with obesity makes no difference in the advice to overweight persons: increased physical activity and a healthy diet are indicated regardless of the genes." Dr Veerman continues: "A focus on individual genetic traits is a mere distraction and reinforces the popular view of obesity as a problem that individuals have to deal with, rather than one that requires societal action."

More information: Kilpeläinen TO, Qi L, Brage S, Sharp SJ, Sonestedt E, et al. (2011) Physical Activity Attenuates the Influence of FTO Variants on Obesity Risk: A Meta-Analysis of 218,166 Adults and 19,268 Children. PLoS Med 8(11): e1001116. doi:10.1371/journal.pmed.1001116

Perspective: Veerman JL (2011) On the Futility of Screening for Genes That Make You Fat. PLoS Med 8(11): e1001114. doi:10.1371/journal.pmed.1001114

Provided by Public Library of Science

Alternate ending -- living on without telomerase

Scientists of the German Cancer Research Center have discovered an alternative mechanism for the extension of the telomere repeat sequence by DNA repair enzymes.

06 nov 2011--The ends of the chromosomes, the telomeres, are repetitive DNA sequences that shorten every time a cell divides during the process of duplicating its genome. Once the telomeres become very short the cell stops dividing. Thus, telomeres work like a cellular clock that keeps an eye on the number of cell divisions. And once the cell's time is over it can no longer divide. Circumventing this control mechanism is crucial for tumor cells in order to proliferate without limits.

In the majority of tumors this is accomplished by reactivating telomerase, an enzyme that normally extends the telomeres only in embryonic cells, and thus resets the cellular clock during development. However, a 10-15% fraction of tumors keeps on dividing without telomerase by making use of what is called the ALT-mechanism for "Alternative Lengthening of Telomeres". The hallmark of ALT cancer cells is a special type of complexes of promyelocytic leukemia (PML) protein at the telomeres that are termed ALT-associated PML nuclear bodies or APBs.

ALT-tumors can be identified by the presence of APBs on fluorescence microscopy images since normal cells do not have these structures. However, the function of APBs has remained mysterious. In a recent study, Inn Chung and Karsten Rippe from the German Cancer Research Center together with Heinrich Leonhard from the LMU in Munich applied a novel approach to study APBs. They succeeded in artificially making APBs in living cells by tethering PML and other APB proteins to the telomeres. In this manner they could not only trace the assembly of APBs but were able to investigate what happens after APB formation. They could show that the de novo formed APBs induced the extension of the telomere repeat sequence by a DNA repair synthesis mechanism.

This demonstrates for the first time that APBs have an important function for the alternative telomere lengthening mechanism, and suggests that disrupting APBs would stop proliferation of ALT-positive tumor cells once their telomeres become too short. This makes APBs a promising new target of cancer cells, in which the ALT mechanism is active.

More information: J. Cell Sci., doi: 10.1242/jcs.084681

Provided by Helmholtz Association of German Research Centres

Nutritional intervention helps in mild Alzheimer's disease

A second clinical trial of the medical food Souvenaid confirmed that daily intake of the nutritional intervention improves memory in people with mild Alzheimer's disease (AD). Results of the trial - called Souvenir II - were presented at the 4th International Conference on Clinical Trials in Alzheimer's Disease (CTAD) in San Diego, California on Friday, Nov. 4, 2011 by Philip Scheltens, MD, PhD, Professor of Cognitive Neurology and Director of the Alzheimer Center at the VU University Medical Center in Amsterdam.

05 nov 2011--CTAD is sponsored by the University of California, San Diego School of Medicine and the European Alzheimer's Disease Consortium (EADC).

Souvenaid contains a patented combination of nutrients (Fortasyn Connect) specifically designed to stimulate the formation of nerve connections called synapses. Loss of synapses is thought by many Alzheimer's experts to be the underlying cause of memory loss and cognitive dysfunction in AD. Preclinical studies showed that the nutrients in Fortasyn Connect promote the growth of new brain synapses. Subsequently, in a study called Souvenir I, Souvenaid taken once per day over 12 weeks was shown to improve scores on standardized memory tests.

"I'm encouraged by the results of this second trial, but we need to do more analyses and further studies to fully understand the findings," said Scheltens. "These positive results give me the energy to go forward."

Souvenir II, conducted at 27 centers in six European countries, was designed to confirm that the benefits seen in Souvenir I persist for 24 weeks. The study also used a more comprehensive measure of memory, as well as other measures of brain activity. Participants in the blind study were randomly assigned to drink 125 ml. of Souvenaid or a control drink. Of the 259 subjects enrolled in the trial, 238 (91.9%) completed the study. Souvenaid was well tolerated, with 97% compliance among those who completed the study and a very favorable safety profile.

Memory performance was evaluated at baseline, 12 weeks and 24 weeks. The memory domain score of a Neuropsychological Test Battery (NTB) was the primary outcome parameter. This memory composite score was derived from the Rey Auditory Verbal Learning Test (immediate recall, delayed recall and recognition performance) and the Wechsler Memory Scale verbal paired associates test (immediate and delayed recall). Secondary outcomes resulting from the NTB were the executive function domain, total composite score and individual item scores.

During 24 weeks, memory composite scores from the Souvenaid group were significantly better than those from the control group. The significant effect on memory performance was confirmed by individual tasks of the NTB memory domain. Detailed analyses of secondary outcomes are still ongoing, including electroencephalogram (EEG) data as a measure of brain function. The EEG analysis, along with data from a magnetoencephalogram (MEG) sub-study may provide further understanding of the effect of Souvenaid on functional connectivity, thus investigating the hypothesis that Souvenaid can support synapse formation and function in mild AD.

Provided by University of California - San Diego

Social media has role in delivery of healthcare but patients should proceed with caution

Social networking sites like Facebook and YouTube can be powerful platforms to deliver and receive healthcare information, especially for patients and caregivers who are increasingly going online to connect and share experiences with others with similar medical issues or concerns. However, these sites may lack patient-centered information and can also be sources of misleading information that could potentially do more harm than good, according to the results of two separate social media-related studies unveiled today at the American College of Gastroenterology's ACG) 76th Annual Scientific meeting in Washington, DC.

05 nov 2011--In the first study, "Social Media for Esophageal Cancer Survivors," researchers from the Mayo Clinic in Florida found that social media is an important resource for patients and their caregivers who are facing important treatment decisions after being diagnosed with esophageal cancer and managing difficult nutritional and lifestyle issues after esophageal surgery.

"We have successfully worked with a highly motivated group of 65 patients who have been diagnosed with and treated for esophageal cancer and Barrett's high grade dysplasia," said researcher Herbert Wolfsen, MD.

Few patient-centered resources are available for families and caregivers facing important treatment decisions after being diagnosed with esophageal cancer, according to Dr. Wolfsen. He said that the project goal was to establish an online community through a Facebook group to assist patients and families anticipate -- and cope with -- surgical and post-operative challenges after being diagnosed with esophageal cancer. The group also helps promote disease awareness and esophageal cancer research advocacy in the community.

"Connections facilitated through this group have often lead to more contact offline to share their personal experiences and information regarding diagnosis and treatment from the perspective of the patient and their family."

Since 2008 Dr. Wolfsen and his team recruited patients and their families to join and participate in the Mayo Clinic's interactive Facebook group, which was created to bring together a geographically diverse group of esophageal cancer survivors. "Many of these patients do not live close enough to attend the quarterly support group meetings held at Mayo in Jacksonville, so the online group has allowed patients who may otherwise not have the support they need to connect with others who share their medical concerns," said Dr. Wolfsen.

Much of the discussion and support revolves around strategies for coping with post-operative changes, especially with daily activities such as diet, nutrition, and swallowing and regurgitation problems, according to the study's findings. The group also provides members with many resources including access to new medical information via text postings and links to video content on the Mayo Clinic YouTube channel, schedules of group meetings, treatment options and advice and support for patients, family and caregivers during recovery.

In a second study, "YouTube: A Friend or Foe When You Are Taking Care of IBD Patients," researchers at the Cleveland Clinic Foundation analyzed the top 100 most viewed IBD-related videos for content, popularity and as a source of patient education information. They found that while YouTube can be a powerful tool for patient education and support, overall Inflammatory Bowel Disease (IBD) content posted on YouTube was poor.

"Clinicians and their patients need to be aware of misleading information posted by patients or particularly by pharmaceutical companies who often post videos to make it seem like they are coming from a patient when in actuality it is a company advertisement," said researcher Saurabh Mukewar, MD. "These sources are not transparent."

Crohn's disease and ulcerative colitis are the most common forms of IBD, which affect more than 1.4 million Americans. Both conditions inflame the intestines, leading to bouts of watery diarrhea, rectal bleeding, abdominal cramps and pain, fever, and weight loss. Crohn's disease can occur anywhere in the digestive tract, often spreading deep into the layers of the affected bowel wall. Ulcerative colitis usually affects only the innermost lining of the large intestine and rectum.

Patients with IBD respond differently to various treatments and inflammatory bowel diseases are life-long disorders, so from a healthcare standpoint, disease management is often challenging, according to Dr. Mukewar, who says many patients are constantly searching for new information and seek out the support of others with IBD -- and want the kind of first -- hand patient experience information that their doctors cannot provide.

"Recent reports state that 55 percent of IBD patients are not satisfied with the information provided at time of their disease diagnosis and more than 50 percent of IBD patients turn to the Internet as a source of information for IBD," said Dr. Mukewar.

Both Dr. Wolfsen and Dr. Mukewar agree that Internet and social media can benefit patients and enhance their care. But Dr. Mukewar said his findings are concerning to him since IBD patients may get misleading information via YouTube that could be harmful to their health.

"The success of Mayo's Esophageal Cancer Survivor Facebook group clearly demonstrates how social media can assist healthcare providers in providing patients with a way to connect and get the support they need that physicians cannot provide because we have not experienced the disease first hand," said Dr. Wolfsen. "We are also able to provide the latest Barrett's disease and esophageal cancer research information and emphasize high quality sources of online information such as the Mayo Clinic YouTube channel."

According to Dr. Mukewar, "one of the best resources for patients ideally would be physicians who also have health conditions and who can post a personal experience video on YouTube, for instance, that would not only be medically correct, credible and trustful but would also contain that first-hand experience that patients with a disease like IBD really crave and search for online."

"The Internet and social media are not going away -- YouTube is a powerful platform to deliver and receive healthcare information," said Dr. Mukewar. "But healthcare providers and professional societies need to provide more educational and efficient materials using this powerful tool to counteract misleading information."

Provided by American College of Gastroenterology