Nine factors you can control may be key to Alzheimer's risk

Healthy lifestyle important but no guarantee against most common form of dementia, researchers find.

21 aug 2015—Up to two-thirds of Alzheimer's cases worldwide may stem from any of nine conditions that often result from lifestyle choices, a broad research review suggests.
Those include obesity (specifically, high body mass index, an indication of obesity, in midlife); carotid artery disease, in which plaque buildup narrows major neck arteries and slows blood supply to the brain; high blood pressure; depression; being frail; being poorly educated; having high levels of a naturally occurring amino acid known as homocysteine; and (specifically among those of Asian descent) being a smoker and/or having either type 2 diabetes.
The implication: Taking steps to minimize or eliminate such conditions might reduce the long-term risk for developing Alzheimer's, a brain disorder that affects memory and thinking. It is the most common form of dementia among seniors.
"The current evidence from our study showed that individuals would benefit from [addressing] the related potentially modifiable risk factors," said study lead author Dr. Jin-Tai Yu, an associate specialist in neurology at the University of California, San Francisco, and senior editor of the Journal of Alzheimer's Disease.
But Yu cautioned that "what is what is seen here is an association rather than a direct cause-and-effect relationship between any one factor and Alzheimer's risk." And that, he said, means it's impossible to determine exactly how much protection against Alzheimer's would be gained by the elimination of any one condition.
Yu and his colleagues discuss their findings in the Aug. 20 online issue of the Journal of Neurology, Neurosurgery & Psychiatry.
In all, investigators reviewed the findings of 323 studies completed between 1968 and 2014. Collectively, the studies involved more than 5,000 patients and looked at 93 conditions with the potential to affect Alzheimer's risk.
The team set out to determine which factors appeared to offer some protection against developing Alzheimer's.
On that score, the strongest evidence suggested that coffee, vitamins C and E, folate, NSAIDS (anti-inflammation drugs), statins (cholesterol-lowering drugs), blood pressure medications, and estrogen supplementation all appeared to reduce Alzheimer's risk.
Patients battling several serious health conditions also seemed to see their risk fall, including those with arthritis, heart disease, metabolic syndrome and/or cancer.
Those who were light or moderate drinkers of alcohol similarly saw their Alzheimer's risk dip, alongside current smokers (apart from those of Asian descent), those struggling with stress, and seniors with high body mass index.
By contrast, a complex statistical analysis enabled the research team to zero in on the nine factors that appeared to elevate Alzheimer's risk among 66 percent of those who ultimately get the disease.
But Dr. Anton Porsteinsson, a professor of psychiatry and director of the Alzheimer's Disease Care, Research and Education Program at the University of Rochester School of Medicine in Rochester, N.Y., suggested that to his mind, "there's not a lot of surprise here."
"It's an interesting paper," he said. "And certainly this review validates a number of individual studies that have previously shown an association between Alzheimer's and the factors they're identifying." But it doesn't improve understanding of the causes, he added.
The take-away, Porsteinsson said, is that a healthy lifestyle matters. Paying attention to blood pressure and cholesterol levels as well as exercise are all beneficial, and the other factors studied may make a difference, he added, but it doesn't mean there is a simple way to reduce Alzheimer's risk. Large clinical trials have looked at behavior modifications that might help, but those kind of simple interventions have failed.
"So reducing risk is probably not going to happen by just taking a pill or a food supplement or a single medication," he added. "That kind of a shortcut answer just doesn't have a lot of support."
More information: There's more on preventing Alzheimer's at U.S. National Institute on Aging.

Baby boomers reeling in the years

People in their 60s are the group most likely to feel younger than their age. Credit: Thinkstock

It's long been said that you're as old as you feel. Now a group of researchers is looking at how the concept of "subjective" age might be used to manage the wellbeing of the baby boomer generation.

20/08/2015--The researchers, from Australia and the US, have developed a model for measuring age that takes into account social, mental and biological factors, not only how many birthdays have passed.
Individuals, potentially with the help of their GPs, may one day be able to measure themselves against this subjective age index.
If it reveals weakness in any of the three key elements – you may be more socially isolated than the average 60-year-old, say – steps could be taken to improve that area of your life. The aim is to "time bend" to achieve a lower subjective age than your birth certificate shows.
"We see this as becoming a great aid in healthcare, as a diagnostic tool that can assist a move away from reparative medicine to rejuvenative medicine," says Dr Bruce Perrott, a senior lecturer in marketing with the Business School at the University of Technology Sydney (UTS).
"Within the next three decades, Australia, like other Western countries, will experience a lift in the numbers of people in older age brackets," Dr Perrott says. "Many healthcare systems will strain to keep up. Insights into subjective age have the potential to help us improve quality of life for an ageing population and ease that burden."
As specialists in the science of consumer behaviour, Dr Perrott and researchers from the University of Massachusetts Amherst are interested in how people's values affect their decisions, including their choices about how they manage ageing.
"One value among baby boomers is that they want to be forever young, and they'll do absolutely everything they can to stay young," says Professor Charles Schewe of the University of Massachusetts.
"One of the things they can do is keep their mind thinking that they are younger. So the question for us, as marketers, as healthcare providers, is how can we provide mechanisms for them to get to that end?"
Studies have shown that lowering your subjective age improves quality of life, reducing health issues and even adding to lifespan, the researchers say. "In one longitudinal study, it was shown to add 7.5 years to life," Professor Schewe says.
The chief executive of the Council on the Ageing NSW, Ian Day, says his 90-year-old father regularly used the line that the only thing wrong with his retirement village was the number of old people there.
"It's that concept of, 'my body may say I'm 75 but I'm going to keep trying to behave like I'm 25'. It's when you finally say, 'I'm going to start acting like a 75-year-old' that you really start to age," Day says.
The research team, which includes Professor George Milne and doctoral students David Agogo and Fatima Hajjat of Massachusetts, broke down the factors of subjective age into how old you feel, how old you look, and how "old" your interests are.
They then developed an extensive questionnaire that asks things such as how often you walk briskly for 20 minutes, how often you carry out physical tasks you believe others your age cannot do (biological factors), how often you forget appointments, how often you wonder whether you've used a word correctly (mental factors), how often you speak to more than one person at a social gathering, and how often you introduce or connect people (social factors).
This subjective ageing index has been tested in the US and Dr Perrott plans to replicate it in Australia. Among the findings so far are:

• Only about 1 per cent of people feel their actual age
• The average person feels about 13.5 years younger than their chronological age
• People aged in their 60s are the group most likely to feel younger than their actual age.

Dr Perrott is particularly interested in the concept of "self-balancing" behaviour, the theory being that older people who lose something – such as a degree of manual dexterity – will compensate in another area, by doing something else that makes them feel younger.
"It's been observed – though not empirically proven – that people considered by others to be ageing successfully tend to take up as many activities as they give up," he says.
Dr Perrott hopes that, as well as potentially providing a diagnostic tool, the research will inspire policymakers to create programs that encourage healthy lifestyles at each of the critical life stages.
Day says the research underlines the fact that there is great diversity among older people, including how "old" different people of the same age feel. "They are regularly bunched together as a homogenous group but they definitely are not."

Provided by University of Technology, Sydney

USPSTF draft recommendation urges against COPD screening

The U.S. Preventive Services Task Force (USPSTF) has found no net benefit for chronic obstructive pulmonary disease (COPD) screening in asymptomatic adults and consequently recommends against screening. These findings form the basis of a draft recommendation statement published online Aug. 17 by the USPSTF.

19 aug 2015--Janelle M. Guirguis-Blake, M.D., from the Kaiser Permanente Center for Health Research in Portland, Ore., and colleagues conducted a systematic review to update USPSTF recommendations on screening for COPD.
The researchers found no evidence that COPD screening with questionnaires or spirometry improves health outcomes in asymptomatic individuals. There was no indication that COPD screening before symptom development affected treatment decisions, altered the course of disease, or improved patient outcomes. There was inadequate evidence on the harms of screening; the cost associated with screening asymptomatic individuals may be large, given the lack of benefit of early detection and treatment. These findings form the basis of a draft recommendation statement which will be available for comment until Sept. 14.
"The Task Force found that there is no evidence that screening for COPD in adults without symptoms results in improved health outcomes," Task Force member William Phillips, M.D., M.P.H., said in a statement. "The most important step you can take to prevent COPD is to avoid smoking. People who smoke should talk with their doctors about ways to quit."
More information: Evidence Review
Draft Recommendation Statement
Comment on Recommendation

Study reveals benefits of clinical medication reviews for improving medication management

Structured and collaborative medication reviews performed by pharmacists and general practitioners are beneficial in improving the quality use of medicines, according to a groundbreaking new review published by Monash University.

18 aug 2015--Researchers from the Faculty of Pharmacy and Pharmaceutical Sciences' Centre for Medicine Use and Safety found that clinical medication reviews (CMRs) resulted in identification of medication-related problems, improved medication adherence and reduced hospitalisations.
Published in respected pharmaceutical research journal Research in Social and Administrative Pharmacy, the comprehensive review titled 'Clinical medication review in Australia: a systematic review' demonstrated the value of medication review models that incorporate inter-professional collaboration.
The Pharmaceutical Society of Australia (PSA) highlighted the importance of the research in a recent announcement, with National President Joe Demarte saying, "This review is landmark in that it provides an overview of the research to date and describes the clinical, humanistic, economic and qualitative benefits of medication reviews." Australia's Chief Medical Officer Professor Chris Baggoley AO also highlighted the research as part of his keynote address at the recent PSA 15 conference in Sydney.
The research team was led by Associate Professor Simon Bell and also included Ms Natali Jokanovic, Dr Edwin Tan, Professor Carl Kirkpatrick, Professor Michael Dooley, and Ms Denise van den Bosch.
"Our research showed that clinical medication reviews are capable of improving the quality use of medicines in older Australians. This is an important finding because up to 30 per cent of unplanned hospital admissions among people aged 75 years and older are medicines related," said Associate Professor Bell.
The review identified a lack of awareness of CMRs among eligible non-recipients, including people from indigenous and linguistically diverse communities, recipients of palliative care, people with poor medication adherence and those in rural and remote areas. Addressing these "access gaps" represents an opportunity to further improve the current model for CMRs in Australia, according to the review.
This was the first systematic review of CMR research undertaken in Australia.
More information: "Clinical medication review in Australia: A systematic review." DOI: dx.doi.org/10.1016/j.sapharm.2015.06.007

Provided by Monash University

Exercise-induced hormone irisin is not a 'myth'

Credit: Peter Griffin/Public Domain

Irisin, a hormone linked to the positive benefits of exercise, was recently questioned to exist in humans. Two recent studies pointed to possible flaws in the methods used to identify irisin, with commercially available antibodies. In Cell Metabolism on August 13, the Harvard scientists who discovered irisin address this contentious issue by showing that human irisin circulates in the blood at nanogram levels and increases during exercise.

17 aug 2015--Senior study author Bruce Spiegelman of Dana-Farber Cancer Institute and Harvard Medical School says that the confusion over irisin comes down to disagreement over how irisin protein is made in skeletal muscle cells and the detection limits of protocols. He and co-author Steven Gygi turned to state-of-the-art quantitative mass spectrometry techniques to show that the human hormone uses a rare signal ATA (start codon) to initiate its production (translation) rather than the usual ATG.
The use of the ATA, rather than the more common ATG, had led some investigators to conclude that the human gene was a pseudogene—a gene that serves no function. But alternative start codons account for a few of all genes and are usually an indication of complex regulation. The authors show that human irisin is similar to the mouse hormone and that it circulates in the range previously reported. Although irisin circulates at low levels (nanograms), this range is comparable to that observed for other important biological hormones such as insulin. Furthermore, the investigators developed a protocol, that does not rely on antibodies, to precisely measure how much irisin increases in people after exercise.
"The data are compelling and clearly demonstrate the existence of irisin in circulation," says endocrinologist Francesco Celi of the Virginia Commonwealth University Medical Center, who was not involved with the study. "Importantly, the authors provide a precise and reproducible protocol to measure irisin." He adds that further studies are necessary to fully understand how the hormone works in humans, specifically how it relates to brown and beige fat tissue and energy use.
Irisin's discovery in 2012 was exciting because scientists had potentially found one reason why exercise keeps us healthy. When irisin levels were increased in mice, their blood and metabolism improved. Results from human studies are still mixed as to what kinds of exercise raise irisin, but data suggest that high-intensity training protocols are particularly effective. The protocol described in the Cell Metabolism paper is likely to help such studies, as it is the most precise way to measure the hormone to date.
The authors point out one caveat in their methods—that some irisin is lost during sample preparation, and therefore the amount of irisin detected is, if anything, a slight underestimation. The technology is also expensive and requires specificmass spectrometry instruments. However, future refinement of this work should lead to more scalable protocols."Spiegelman and colleagues have unequivocally shown that the "mythical" irisin peptide is produced as a result of exercise," says chemical physiologist John Yates of The Scripps Research Institute, also not affiliated with the work. "This data should settle the controversy surrounding the existence of irisin and its increase in blood as a function of exercise."
More information: Cell Metabolism, Jedrychowski et al.: "Detection and Quantitation of Circulating Human Irisin by Tandem Mass Spectrometry" dx.doi.org/10.1016/j.cmet.2015.08.001

Provided by Cell Press

New, rapid dementia screening tool rivals 'gold standard' clinical evaluations

15 aug 2015--Determining whether or not an individual has dementia and to what degree is a long and laborious process that can take an experienced professional such as a clinician about four to five hours to administer, interpret and score the test results. A leading neuroscientist at Florida Atlantic University has developed a way for a layperson to do this in three to five minutes with results that are comparable to the "gold standard" dementia tests used by clinicians today.

The "Quick Dementia Rating System" (QDRS), which uses an evidence-based methodology, validly and reliably differentiates individuals with and without dementia. When dementia is present, it accurately stages the condition to determine if it is very mild, mild, moderate or severe. QDRS has applications for use in clinical practice, to pre-qualify patients in clinical trials, prevention studies, community surveys and biomarker research.

James E. Galvin, M.D., M.P.H., is one of the most prominent neuroscientists in the country and a professor of clinical biomedical science in the Charles E. Schmidt College of Medicine and a professor in the Christine E. Lynn College of Nursing at Florida Atlantic University, and the QDRS is his brainchild. He recently published an article on his findings in Alzheimer's & Dementia, the journal of the Alzheimer's Association. Galvin has developed a number of dementia screening tools including the AD8, a brief informant interview to translate research findings to community settings that is used worldwide to detect dementia in diverse populations.

"After extensive testing and evaluation of the Quick Dementia Rating System, we have found it to be as effective as the gold standard used today to screen for the five stages of dementia," said Galvin. "This new tool gives you a lot of power to see the same results as a full screening in a fraction of the time it takes for a complete screening."

The QDRS is a 10-item questionnaire that can be completed by a caregiver, friend or family member, and is brief enough to be printed on one page or viewed as a single screenshot, maximizing its clinical utility. Scores range from 0 to 30 with higher scores representing greater cognitive impairment. The questionnaire covers: 1) memory and recall; 2) orientation; 3) decision-making and problem-solving abilities; 4) activities outside the home; 5) function at home and hobbies; 6) toileting and personal hygiene; 7) behavior and personality changes; 8) language and communication abilities; 9) mood; and 10) attention and concentration.

The total score is derived by summing up the 10 fields and each area has five possible answers increasing in severity of symptoms. The 10 areas capture the prominent symptoms of mild cognitive impairment, Alzheimer's disease, and non-Alzheimer's neurocognitive disorders including Lewy Body Dementia, frontotemporal degeneration, vascular dementia, chronic traumatic encephalopathy and depression.

A total of 267 individuals with various forms of dementia from Alzheimer's disease to Lewy Body Dementia participated in the study, which included 32 healthy controls. Study participants also included their spouses/significant others, adult children, relatives, friends and paid caregivers who completed the QDRS.

"Most patients never receive an evaluation by a neurologist, geriatric psychiatrist, or geriatrician skilled in dementia diagnoses and staging. Early detection will be important to enable future interventions at the earliest stages when they are likely to be most effective," said Galvin. "The QDRS has the potential to provide a clearer, more accurate staging for those patients who are unable to see these more specialized clinicians and get them the treatment, referrals and community services they so desperately need."

The Quick Dementia Rating System is copyrighted and permission to use this tool is required. QDRS is available at no cost to clinicians, researchers and not-for-profit organizations.

Galvin is working to improve clinical detection by combining biomarkers including high density EEG, functional and structural MRI, PET scans and CSF biomarkers to characterize and differentiate Lewy Body Dementia from healthy aging and other neurodegenerative diseases. He led efforts to develop a number of dementia screening tools in addition to the QDRS and AD8, and has done cross-cultural validation of dementia screening methods in comparison with Gold Standard clinical evaluations and biomarker assays. His team also developed sophisticated statistical models to explore transition points in clinical, cognitive, functional, behavioral and biological markers of disease in healthy aging, mild cognitive impairment, Alzheimer's disease and Parkinson's disease.

Provided by Florida Atlantic University

Low-fat diet results in more fat loss than low-carb diet in humans

Artistic depiction of a study investigating whether low-fat or low-carb diets lead to more fat burning and fat loss. 

14 aug 2015--A study from the US National Institutes of Health presents some of the most precise human data yet on whether cutting carbs or fat has the most benefits for losing body fat. In a paper published August 13 in Cell Metabolism, the researchers show how, contrary to popular claims, restricting dietary fat can lead to greater body fat loss than carb restriction, even though a low-carb diet reduces insulin and increases fat burning.

Since 2003, Kevin Hall, PhD—a physicist turned metabolism researcher at the National Institute of Diabetes and Digestive and Kidney Diseases—has been using data from dozens of controlled feeding studies conducted over decades of nutrition research to build mathematical models of how different nutrients affect human metabolism and body weight.

He noticed that despite claims about carbohydrate versus fat restriction for weight loss, nobody had ever measured what would happen if carbs were selectively cut from the diet while fat remained at a baseline or vice versa. His model simulations showed that only the carb-restricted diet would lead to changes in the amount of fat burned by the body, whereas the reduced-fat diet would lead to greater overall body fat loss, but he needed the human data to back it up.

"A lot of people have very strong opinions about what matters for weight loss, and the physiological data upon which those beliefs are based are sometimes lacking," Hall says. "I wanted to rigorously test the theory that carbohydrate restriction is particularly effective for losing body fat since this idea has been influencing many people's decisions about their diets."

Studying the effects of diet on weight loss is often confounded by the difficulty in measuring what people actually eat—participants may not adhere to meal plans, misjudge amounts, or are not truthful in follow-up surveys. To counter this, Hall and colleagues confined 19 consenting adults with obesity to a metabolic ward for a pair of 2-week periods, over the course of which every morsel of food eaten was closely monitored and controlled.

To keep the variables simple, the two observation periods were like two sides of a balance scale: during the first period, 30% of baseline calories were cut through carb restriction alone, while fat intake remained the same. During the second period the conditions were reversed. Each day, the researchers measured how much fat each participant ate and burned and used this information to calculate the rate of body fat loss.

At the end of the two dieting periods, the mathematical model proved to be correct. Body fat lost with dietary fat restriction was greater compared with carbohydrate restriction, even though more fat was burned with the low-carb diet. However, over prolonged periods the model predicted that the body acts to minimize body fat differences between diets that are equal in calories but varying widely in their ratio of carbohydrate to fat.

"There is one set of beliefs that says all calories are exactly equal when it comes to body fat loss and there's another that says carbohydrate calories are particularly fattening, so cutting those should lead to more fat loss," Hall says. "Our results showed that, actually, not all calories are created equal when it comes to body fat loss, but over the long term, it's pretty close."

Hall does caution against making sweeping conclusions about how to diet from this study. The study's purpose was to explore the physiology of how equal calorie reductions of fat versus carbs affect the human body. The research is limited by its sample size; only 19 people could be enrolled due to the expense of such research and the restrictiveness of the carefully controlled protocol. However, this study clearly reaches statistical significance. In addition,, the menu that the participants followed does not emulate normal dieting and does not account for what diet would be easier to eat over extended periods.

"We are trying to do very careful studies in humans to better understand the underlying physiology that will one day be able to help generate better recommendations about day-to-day dieting," Hall says. "But there is currently a gap between our understanding of the physiology and our ability to make effective diet recommendations for lasting weight loss."

Hall recommends that for now, the best diet is the one that you can stick to. His lab will next investigate how reduced-carbohydrate and reduced-fat diets affect the brain's reward circuitry, as well as its response to food stimuli. He hopes these results might inform why people respond differently to different diets.

More information: Cell Metabolism, Hall et al.: "Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity" dx.doi.org/10.1016/j.cmet.2015.07.021 

Provided by Cell Press

High-dose vitamin D supplementation not associated with benefits for postmenopausal women

High-dose vitamin D supplementation in postmenopausal women was not associated with beneficial effects on bone mineral density, muscle function, muscle mass or falls, according to the results of a randomized clinical trial published online byJAMA Internal Medicine.

12 aug 2015--Low levels of vitamin D contribute to osteoporosis because of decreased total fractional calcium absorption (TFCA) and nearly half of postmenopausal women sustain an osteoporotic fracture. However, experts disagree on the optimal vitamin D level for skeletal health. Some experts contend that optimal serum 25-hydroxyvitamin D levels are 30 ng/mL or greater, while the Institute of Medicine recommends levels of 20 ng/mL or greater, according to study background.

Karen E. Hansen, M.D., M.S., of the University of Wisconsin School of Medicine and Public Health, Madison, and colleagues compared the effects of placebo, low-dose cholecalciferol (a form of vitamin D) and high-dose cholecalciferol on one-year changes on total TFCA, bone mineral density, sit-to-stand tests and muscle mass in 230 postmenopausal women (75 or younger) with vitamin D insufficiency.

Trial participants were divided into three groups: daily white and twice monthly yellow placebo, daily 800 IU vitamin D3 (low dose) and twice monthly yellow placebo, and daily white placebo and twice monthly 50,000 IU vitamin D3 (high dose). The high-dose regimen vitamin D regimen achieved and maintained 25-hydroxyvitamin D levels at greater than or equal to 30 ng/mL.

Results indicate that calcium absorption increased 1 percent in the high-dose group but decreased 2 percent in the low-dose group and 1.3 percent in the placebo group. The small increase in the high-dose group did not translate into beneficial effects because authors found no difference between the three study groups for changes in spine, average total-hip, average femoral neck or total-body bone mineral density, trabecular bone score, muscle mass or sit-to-stand tests. There also were no differences between the groups for numbers of falls, number of fallers, physical activity or functional status.

The authors note few African-American women participated in the study, which limits its ability to detect differential responses to cholecalciferol based on race. The study results also cannot be used to guide cholecalciferol therapy for young adults, men, or women older than 75, according to the authors. They point out individuals only participated for one year and perhaps longer exposure to high-dose cholecalciferol might yield greater effects on bone mineral density.

"Study results do not justify the common and frequently touted practice of administering high-dose cholecalciferol to older adults to maintain serum 25(OH)D [25-hydroxyvitamin D] levels of 30 ng/mL or greater," the study concludes.

More information: JAMA Intern Med. Published online August 3, 2015. DOI: 10.1001/jamainternmed.2015.3874 

Provided by The JAMA Network Journals

The five things you didn't know about teaching empathy

The Drexel College of Medicine teaches empathy to its students to help doctors and patients better connect for more efficient care.

11 aug 2015--Though it seems like they may obscure a patient's medical issues at times, emotions can actually be the key to unlocking more about a person's condition.

At Drexel's College of Medicine, understanding and reading those emotions is a point of focus. Medical students take part in empathy training during their first year. In their second year, that training is reinforced. 

By the time they hit their third year, students take part in a webcam-based simulation developed at the College that uses actors portraying patients to test what the students have learned and determine how well they apply it.

That technology, created by Dennis Novack, MD, professor of medicine and associate dean of Medical Education, Christof Daetwyler, associate professor of Family, Community and Preventive Medicine, and Gregory McGee, web developer in the College of Medicine, was recently licensed by DecisionSim under the name CommSim. It will be used to train doctors across the country, potentially including the United States Department of Veteran Affairs.

But how do you actually train someone to be empathetic? Novack talked with DrexelNow about what you need to know.

You have to be careful about mixing empathy and sympathy.

"There are several definitions of empathy in the medical literature, but the most common is 'the ability to put yourself in somebody else's shoes,'" Novack said. "It's to have a, more or less, objective experience of what it must be like to be this person going through an illness. It's understanding."

Sympathy, in the meantime, is to "feel with," Novack said. It's a more subjective experience.

"If your friend's mother dies, you go over to their house and cry with them. You're feeling similar emotions," he said. "Sympathy is quite different, in that regard."

The training provided at the College of Medicine is about giving medical students the skills to understand what a person is going through.

When a doctor blurs the lines between empathy and sympathy, Novack said studies have shown that they order extra or unnecessary testing and procedures.

"The patient-physician relationship relies on boundaries," he said. "If a patient tells you something tragic, you don't want them to look up and see you crying."

Empathy is a skill-based quality.

"People have a different capacity for empathy going into medical school," Novack said. "People are just wired differently."

Brain scans show that some people simply have fewer brain cells designed for empathetic qualities, according to Novack.

So the training aims to develop listening skills that can be applied to demonstrating empathy.

They include skills like reflection, which means being able to comment or ask about a patients emotions; legitimization, which can be indicating recognition and normalizing  an emotional reaction ("most people would feel as you do in this situation"); partnership or support, which could be as simple as saying you'll do your best to work with them; and summarization, an accurate retelling and checking what a person has told you.

Personal biases need to be recognized and overcome.

"We're human beings. We're social animals. We all have judgments," Novack said. "You meet someone and 30 seconds later you have a judgment." 

The training at the College of Medicine encourages students to reflect on their own lives and also those of their parents and grandparents to trace back any biased attitudes or feelings they might have and where they originated.

Being aware of these biases or attitudes is crucial to overcoming them and seeing the world the way a patient might.

"If you don't seek the patients' perspective, you can get judgmental and that will get in your way when you're caring for a person."

Empathy is about being present in a situation, but that can be hard for a doctor.

Doctors whip back and forth from the mundane to the horrific, seeing the best moments of people's lives to the absolute worst.

"You go from death to the birth of a baby," Novack said.

As such, it's important to teach medical students to do their best to be present in each situation.

"You have to free yourself up. You can't completely do it but you can rely on the skills we're teaching you, even if you're not feeling it," Novack said. "If you can just get a glimmer of what that person is feeling, that will help them, even when you're not completely present."

Sharpening empathy skills can boost a doctor's overall performance.

"If you're not empathic, you're not going to get very far," Novack said. "Patients who feel understood are more willing to reveal important information and worries to their physicians."

The more information a doctor has, the easier it is to diagnose a condition and the more efficiently it can be treated.

"I remember seeing an interaction where the doctor was being completely clinical, didn't say one empathic thing but he listened very well and, if you watched this interaction, you would've said, 'That's not an empathic doctor,'" Novack said. "And then, at the end, he said, 'I think I know what's going on with you now.' And he said to this woman what he thought the emotional experience was. And she started to cry and said, 'Yes, that's exactly what I'm going through.'"

Two minutes of empathy was all it took to ensure the patient's trust.and form an agreement with a difficult diagnostic and therapeutic plan.

"If you can get to that moment where you accurately relate their experience back to them, that sets up a relationship where patients are now ready to listen to you and your recommendations," Novack said.

Provided by Drexel University

Many seniors overestimate their mobility

Many seniors who visit emergency departments require more assistance with physical tasks than they think they do, which may lead to hospital readmission later on. The results of the study were published online Friday in Annals of Emergency Medicine.

10 aug 2015--"Ensuring that older adults discharged from the emergency department are able to safely function in their home environment is important because those who are unable to function safely at home are at risk for falls and return ER visits," said lead study author Timothy Platts-Mills, MD, MSc, of the University of North Carolina Chapel Hill in Chapel Hill, N.C. "Accurately determining the ability of these patients to care for themselves at home is critical for emergency physicians as they make decisions about whether to discharge patients home or elsewhere. A patient who reports they can walk with an assistive device but actually requires human assistance to walk is likely to be bed-bound or to fall if they go home alone."

Overall, only 77 percent of patients in the study accurately assessed their ability to perform tasks. Of patients who said they could perform the assigned tasks without assistance, 12 percent required some assistance or were unwilling to complete the tasks. Of those who said they could perform the task with a cane or walker, 48 percent required either human assistance or were unable to perform the task. Of those who said they could perform the task with human assistance, 24 percent were unable to perform the task even with someone helping them.

The tasks assigned were getting out of bed, walking 10 feet and returning to bed. Twenty million people aged 65 and older visit emergency departments every year, and that number is expected to grow as the Baby Boomers continue to age.

"Emergency physicians are experts in deciding who can go home and who needs to come in the hospital," said Dr. Platts-Mills. "But we are not perfect and sometimes we make decisions based on patient statements about abilities, rather than direct assessments. Our results suggest that patient statements are sometimes inaccurate, and, particularly for older adults who need some assistance, directly observing the patient's ambulation can be informative. Of course being able to move around isn't the only determinant of whether an older adult can be safely sent home, but it is a critical piece of information and it's good to get it right."

More information: "Self-Reported vs. Performance-Based Assessments of a Simple Mobility Task Among Older Adults in the Emergency Department", www.annemergmed.com/article/S0196-0644(15)00584-3/fulltext 

Provided by American College of Emergency Physicians

Researchers claim modern living may contribute to dementia

09 aug 2015--Researchers at the University of Bournemouth have published research using death statistics from a group of Western countries suggesting that more people are dying with neurological conditions now than twenty years ago, particularly among the over 75s. Rates in the US appeared to be growing faster than other US countries. In contrast, deaths from cancer and heart disease had dropped. The findings are published in the journal Surgical Neurology International.

The team, led by Prof Colin Pritchard, used World Health Organisation mortality data to study differences in death rates over twenty countries between 1989-1991 and 2008-2010. While cancer mortality and deaths from circulatory diseases fell over that time period, total neurological deaths – which include those caused by Alzheimer's and other dementias as well as motor neurone disease, Parkinson's disease and CJD – showed increasing trends across countries.

The numbers of deaths resulting from neurological diseases, per million people in the population, varied from country to country. However, there was an average rise of 2% across 20 Western countries in men aged 55-74 and a 1% rise in female deaths in this age group. In the UK, death rates actually fell over the twenty year period in this age group – by 14% in men and 12% in women. In contrast, US rates appeared to increase by 82% in men and 48% in women.

In the over 75's, there were larger increases in death rates across the countries studied, including the UK, with the US showing the largest increase across the 20-year period. The researchers claimed that the increases could be caused by 'modern living' but there was no investigation in the research paper as to the reasons behind the observed trends. There was also no breakdown in the paper of the particular neurological diseases that could have been behind the observed increases.

Dr Simon Ridley, Head of Research at Alzheimer's Research UK, said:

"Dementia is a condition coming increasingly under the spotlight both in terms of growing public awareness and the realisation for a need to better understand the diseases that cause it. There is certainly greater awareness of young-onset dementias but that does not necessarily reflect an underlying increase in prevalence. This study suggests there may have been a disproportionately high rise in deaths from neurological diseases in the US over the last 21 years compared to other countries, but the reasons for this observation aren't clear. Neurological diseases encompass a whole range of conditions from Alzheimer's and other dementias to motor neurone disease and CJD and it would be interesting to drill down to see which of these diseases may be increasing the most.

"Comparing death rates across multiple countries in a consistent fashion is challenging, and the trends could be influenced by many different factors across countries such as increasing diagnosis rates or changing health policy. We know that ageing is the biggest risk factor for dementia, so with a growing elderly population, we would expect more people to die with the condition. Despite this, a much higher rise in neurological deaths in the US compared to other Western countries suggests it may also be important to explore environmental influencers.

"We know that Alzheimer's and other dementias can have a complex interplay of risk factors, including age, lifestyle and genetics, and continued investment in research is vital to understand more about them. The findings that neurological deaths in the over 75s have increased in almost all 20 countries studied highlights the growing impact of these conditions on the population but we can't conclude that modern life is causing these conditions at a younger age."

More information: "Neurological deaths of American adults (55–74) and the over 75's by sex compared with 20 Western countries 1989–2010: Cause for concern." Surg Neurol Int 23-Jul-2015;6:123 Available from:surgicalneurologyint.com/surgicalint_articles/neurological-deaths-of-american-adults-55-74-and-the-over-75s-by-sex-compared-with-20-western-countries-1989-2010-cause-for-concern/ 

Provided by Alzheimer's Research UK

Many older americans feel prepared for aging

But are concerned about physical, mental challenges, survey finds.

07 aug 2015—Most older Americans feel they are prepared for the process of aging, but many have concerns about maintaining their physical and mental health as they get older, a new survey finds.

The 2015 United States of Aging Survey of 1,000 adults 60 and older found that 86 percent felt prepared overall for the process of aging, and 42 percent said they are "very prepared" to age.

Forty percent said they are most concerned about maintaining their physical health, while more than one-third were concerned about maintaining their mental health and their memory as they get older.

More than two-thirds of respondents said the keys to good health include a healthy diet, having a good attitude and getting enough sleep. Fifty-eight percent said they had not changed residences in more than 20 years, and three-quarters said they intend to live in their current home for the rest of their lives.

The survey also included 150 professionals who support seniors, such as doctors, pharmacists, senior care specialists and credit union managers. They were less sure that older adults could maintain their quality of life.

While 43 percent of older respondents felt very confident they would be able to afford health care costs as they age, 62 percent of professionals were not confident that older adults can afford these costs.

Only 47 percent of older adults and 37 percent of professionals felt their communities were doing enough to prepare for the needs of retiring baby boomers.

The top aging-related concerns cited by the professionals included protecting seniors from financial scams, providing them with affordable housing, and memory loss.

"Both older adults and the professionals who support them offered strong but conflicting opinions on the top challenges older Americans face as they age," Dr. Rhonda Randall, chief medical officer of UnitedHealthcare Retiree Solutions, said in a news release from the company.

"The findings remind us of how valuable these different perspectives are and the importance of addressing many concerns simultaneously to ensure we all fully support the rapidly growing senior population," she added.

Each day, more than 10,000 American baby boomers turn 65, according to the news release.

The survey was conducted by the National Association of Area Agencies on Aging, the National Council on Aging, and UnitedHealthcare.

More information: The U.S. Centers for Disease Control and Prevention offers advice about healthy aging. 

Regular consumption of spicy foods linked to lower risk of death

Chile pepper (Capsicum annuum).

Eating spicy food more frequently as part of a daily diet is associated with a lower risk of death, suggests a new study published in The BMJ this week. The association was also found for deaths from certain conditions such as cancer, and ischaemic heart and respiratory diseases.

06 aug 2015--This is an observational study so no definitive conclusions can be drawn about cause and effect, but the authors call for more research that may "lead to updated dietary recommendations and development of functional foods."

Previous research has suggested that beneficial effects of spices and their bioactive ingredient, capsaicin, include anti-obesity, antioxidant, anti-inflammation and anticancer properties.

So an international team led by researchers at the Chinese Academy of Medical Sciences examined the association between consumption of spicy foods as part of a daily diet and the total risk and causes of death.

They undertook a prospective study of 487,375 participants, aged 30-79 years, from the China Kadoorie Biobank. Participants were enrolled between 2004-2008 and followed up for morbidities and mortality.

All participants completed a questionnaire about their general health, physical measurements, and consumption of spicy foods, and red meat, vegetable and alcohol.

Participants with a history of cancer, heart disease, and stroke were excluded from the study, and factors such as age, marital status, level of education, and physical activity were accounted for.

During a median follow-up of 7.2 years, there were 20,224 deaths.

Compared with participants who ate spicy foods less than once a week, those who consumed spicy foods 1 or 2 days a week were at a 10% reduced risk of death (hazard ratios for death was 0.90). And those who ate spicy foods 3 to 5 and 6 or 7 days a week were at a 14% reduced risk of death (hazard ratios for death 0.86, and 0.86 respectively).*

In other words, participants who ate spicy foods almost every day had a relative 14% lower risk of death compared to those who consumed spicy foods less than once a week.

The association was similar in both men and women, and was stronger in those who did not consume alcohol.

Frequent consumption of spicy foods was also linked to a lower risk of death from cancer, and ischaemic heart and respiratory system diseases, and this was more evident in women than men.

Fresh and dried chilli peppers were the most commonly used spices in those who reported eating spicy foods weekly, and further analysis showed those who consumed fresh chilli tended to have a lower risk of death from cancer, ischaemic heart disease, and diabetes.

Some of the bioactive ingredients are likely to drive this association, the authors explain, adding that fresh chilli is richer in capsaicin, vitamin C, and other nutrients. But they caution against linking any of these with lowering the risk of death.

Should people eat spicy food to improve health? In an accompanying editorial, Nita Forouhi from the University of Cambridge says it is too early to tell, and calls for more research to test whether these associations are the direct result of spicy food intake or whether this is a marker for other dietary or lifestyle factors.

More information: Consumption of spicy foods and total and cause specific mortality: population based cohort study, www.bmj.com/cgi/doi/10.1136/bmj.h3942

* A hazard ratio is a measure of how often a particular event happens in one group compared to how often it happens in another group, over time. 

Provided by British Medical Journal

Dementia patients, caregivers prefer better care, support over research for Alzheimer's cure

More than $100 million in federal funding was spent last year toward searching for a cure for Alzheimer's disease. However, if given the choice, most people with dementia and those caring for them would like to see the money go elsewhere, according to a recent study led by University at Buffalo researcher Davina Porock.

The study surveyed people with dementia and their care providers on how funding from the National Alzheimer's Project Act (NAPA), a federal plan to overcome the disease, should be spent.

05 aug 2015--It revealed that the majority of respondents ranked caregiving support and resources for long-term care ahead of research for a cure.

The findings are in contrast to current NAPA spending to support those with Alzheimer's disease, which dedicated only $10 million to care services and education, according to the Department of Health and Human Services.

With more than 5 million people in the U.S. living with dementia, each person receives less than $2 for care support, says Porock.

"Sure, most people in our surveys would love for there to be a cure, but in the meantime they all have this disease and they need help," says Porock, PhD, professor in the UB School of Nursing.

"We have 10 times more money going toward research instead of supporting the people who are living with dementia. Research is still high on the agenda, but they think that support is more important."

The study, "National Priorities for Dementia Care: Perspectives of Persons Living with Dementia and their Care Partners," was published in the Journal of Gerontological Nursing.

The nationwide survey recorded nearly 700 responses, drawing participants from more than 25 Alzheimer's disease advocacy and patient-support groups. Participants were asked to rank funding priorities based on 11 themes that included care setting, quality of life, and advocacy and awareness.

Of the responses, the top five priorities were: 

1. Financial resources for respite care and short-term caregiving support - care that typically lasts less than a week and is used to relieve family and daily care providers;
2. Financial resources for long-term care support and aging in place, which includes assistance with nursing home and assisted living expenses;
3. Research for a cure and medication;
4. Education and training for families, health professionals and volunteers;
5. Advocacy and awareness to reduce the stigma of dementia.

Respondents also preferred that not all research funding be allocated to finding a cure. Other areas of focus included workforce issues, education and training, impact on quality of life and the family, and alternative therapies and treatments.

Person-centered approaches to care were a clear theme in many of the responses. Most participants desired the person and family living with dementia, and not the disease, to be the center of care, policy and research.

Dementia is an irreversible condition that slowly impairs memory and cognitive skills, and eventually a person's ability to carry out daily activities. People with dementia often need assistance eating, bathing and dressing, and sometimes have difficulties communicating.

Alzheimer's disease makes up nearly half of all dementia cases, and symptoms typically first appear after age 65.

"It's a taxing job to take care of someone with dementia," says Porock. "Families, as much as they love each other, can find these tasks physically and emotionally difficult to do. And when the caregiver is a spouse who is close in age, it's not unheard of for them to die first."

Another common issue involves caregivers putting their careers on hold to support an ailing family member and having difficulty returning to the workforce, says Porock.

Increased funding for families living with dementia could improve their ability to afford nursing support in their home or at an assisted living home.

"Dementia is a major, and increasing, issue in the world because we have more and more people living longer. And one of the consequences of us not dying from heart disease, cancer or other organ failures is that we live long enough for our brains to wear out," says Porock.

Porock hopes the results lead policymakers and the NAPA advisory council to reconsider the priorities for funding to better address the needs of those living with dementia and those who care for them.

Provided by University at Buffalo

Eating away at cognitive decline: MIND diet may slow brain from aging by 7.5 years

While cognitive abilities naturally diminish as part of the normal aging process, it may be possible to take a bite out of this expected decline.

04 aug 2015--Eating a group of specific foods known as the MIND diet may slow cognitive decline among aging adults, even when the person is not at risk of developing Alzheimer's disease, according to researchers at Rush University Medical Center. This finding is in addition to a previous study by the research team that found that the MIND diet may reduce a person's risk in developing Alzheimer's disease.

The recent study shows that older adults who followed the MIND diet more rigorously showed an equivalent of being 7.5 years younger cognitively than those who followed the diet least.The results of the study recently were published online in the journal Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Mediterranean, with a DASH of other ingredients

The National Institute of Aging funded study evaluated cognitive change over a period of 4.7 years among 960 older adults who were free of dementia on enrollment. Averaging 81.4 years in age, the study participants also were part of the Rush Memory and Aging Project, a study of residents of more than 40 retirement communities and senior public housing units in the Chicago area.

During the course of the study, they received annual, standardized testing for cognitive ability in five areas - episodic memory, working memory, semantic memory, visuospatial ability, and perceptual speed. The study group also completed annual food frequency questionnaires, allowing the researchers to compare participants' reported adherence to the MIND diet with changes in their cognitive abilities as measured by the tests.

Martha Clare Morris, ScD, a nutritional epidemiologist, and colleagues developed the diet, whose full name is the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. As the name suggests, the MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both diets have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke.

"Everyone experiences decline with aging; and Alzheimer's disease is now the sixth leading cause of death in the U.S., which accounts for 60 to 80 percent of dementia cases. Therefore, prevention of cognitive decline, the defining feature of dementia, is now more important than ever," Morris says. "Delaying dementia's onset by just five years can reduce the cost and prevalence by nearly half."

A wine and no cheese party

The MIND diet has 15 dietary components, including 10 "brain-healthy food groups" and five unhealthy groups - red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

To adhere to and benefit from the MIND diet, a person would need to eat at least three servings of whole grains, a green leafy vegetable and one other vegetable every day—along with a glass of wine—snack most days on nuts, have beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week. In addition, the study found that to have a real shot at avoiding the devastating effects of cognitive decline, he or she must limit intake of the designated unhealthy foods, especially butter (less than 1 tablespoon a day), sweets and pastries, whole fat cheese, and fried or fast food (less than a serving a week for any of the three).

Berries are the only fruit specifically to be included in the MIND diet. "Blueberries are one of the more potent foods in terms of protecting the brain," Morris says, and strawberries also have performed well in past studies of the effect of food on cognitive function.

"The MIND diet modifies the Mediterranean and DASH diets to highlight the foods and nutrients shown through the scientific literature to be associated with dementia prevention." Morris explains. "There is still a great deal of study we need to do in this area, and I expect that we'll make further modifications as the science on diet and the brain advances."

Provided by Rush University Medical Center

Seniors get mental health drugs at twice the rate of other adults, see psychiatrists less

Seniors (white bars) had a much higher rate of doctor's visits where mental health drugs were prescribed, and a lower rate of visits with psychiatrists, according to a new analysis of outpatient data from 2007-2010. Rates are visits per 100 people per year. Credit: University of Michigan

01 aug 2015--Older Americans receive prescriptions for mental health medications at more than twice the rate that younger adults do, a new study finds.

But they're much less likely to be getting their mental health care from a psychiatrist, the results also show.

That raises questions about whether they could be at risk of problems caused by a collision of multiple medications - and about whether primary care doctors may need more support to care for older people with depression, anxiety and other conditions.

The new findings, published in the Journal of the American Geriatrics Society by a team from the University of Michigan Medical School and VA Ann Arbor Healthcare System, come from the first study to compare overall outpatient mental health treatment in adults over age 65 with that of patients between ages of 18 and 64.

The authors probed nationally representative outpatient visit data, combined with U.S. Census data, to come up with rates of different types of care.

The worry of previous decades - that America's seniors weren't receiving attention for mental health issues - may now need to shift, says Donovan Maust, M.D., M.S., the geriatric psychiatrist who led the analysis.

A photo illustration of the key findings from a nationally representative study of mental health-related care for adults over 65 and younger adults. Credit: University of Michigan

"Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients," he says. "In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care."

The issue of medication use is particularly concerning for older adults, because the risk/benefit balance can shift as they become more likely to experience side effects or other adverse events.

For instance, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin and Ativan (and their generic counterparts) may be relatively safe for younger adults, but carry a higher risk of car accidents, falls, fractures and worsening of thinking ability or memory for older patients.

Antidepressants can interact with blood thinners and painkillers and can raise blood pressure, all of which are more likely to be problems for older adults, who are generally on more medications than their younger counterparts.

"We need to pay special attention to polypharmacy, or multiple drugs taken at once, when prescribing psychotropic drugs in this population, because so many older adults are already on multiple medications," says Maust, an assistant professor in the U-M Department of Psychiatry.

He and his colleagues started with information from over 100,000 outpatient visits to outpatient physicians between 2007 and 2010 collected by the National Ambulatory Medical Care Survey, a national survey administered by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

They examined four types of visits: ones where patients received a mental health diagnosis; saw a psychiatrist; received psychotherapy; and/or received a prescription or renewal of a psychotropic medication (including antidepressants, anxiety-calming drugs called anxiolytics, mood stabilizers, antipsychotics, or stimulant drugs).

They converted their results to a population-based visit rate, which helps consider the number of visits out of the eligible pool of potential outpatients in the community.

In this light, for example, visits related to antidepressant and anti-anxiety drug use among older adults (63 and 62 visits per 100 people per year, respectively) occurred at nearly double the rates of such visits by younger adults (36 and 29 visits per year per 100 people, respectively). In contrast, older adults see psychiatrists at about half the rate of younger adults (6.3 versus 12 visits per year per 100 people).

"While it's still true that we have patients who are not getting treated for mental health concerns, these data suggest that we also need to be mindful of the possibility of overtreatment, especially given the changing balance of risk and benefit as patients age," says Maust. "Collaborative care efforts in primary care that seek to create structure and support for these patients, along with appropriate reimbursement for this type of service, could be key."

More information: Journal of the American Geriatrics Society, Vol. 63, Issue 7, pp. 1364-1372, July 2015 

Provided by University of Michigan Health System