Oleocanthal may help prevent, treat Alzheimer's

Natural compound in extra-virgin olive oil targets toxic beta-amyloid proteins

PHILADELPHIA, 30 sept 2009-- Oleocanthal, a naturally-occurring compound found in extra-virgin olive oil, alters the structure of neurotoxic proteins believed to contribute to the debilitating effects of Alzheimer's disease. This structural change impedes the proteins' ability to damage brain nerve cells.

"The findings may help identify effective preventative measures and lead to improved therapeutics in the fight against Alzheimer's disease," said study co-leader Paul A.S. Breslin, PhD, a sensory psychobiologist at the Monell Center.

Known as ADDLs, these highly toxic proteins bind within the neural synapses of the brains of Alzheimer's patients and are believed to directly disrupt nerve cell function, eventually leading to memory loss, cell death, and global disruption of brain function. Synapses are specialized junctions that allow one nerve cell to send information another.

"Binding of ADDLs to nerve cell synapses is thought to be a crucial first step in the initiation of Alzheimer's disease. Oleocanthal alters ADDL structure in a way that deters their binding to synapses," said William L. Klein, PhD, who co-led the research with Breslin. "Translational studies are needed to link these laboratory findings to clinical interventions." Klein is Professor of Neurobiology & Physiology, and a member of the Cognitive Neurology and Alzheimer's Disease Center, at Northwestern University.

Klein and his colleagues identified ADDLs in 1998, leading to a major shift in thinking about the causes, progression and treatment of Alzheimer's disease. Also known as beta-amyloid oligomers, ADDLs are structurally different from the amyloid plaques that accumulate in brains of Alzheimer's patients.

Reporting on a series of in vitro studies, the team of Monell and Northwestern researchers found that incubation with oleocanthal changed the structure of ADDLs by increasing the protein's size.

Knowing that oleocanthal changed ADDL size, the researchers next examined whether oleocanthal affected the ability of ADDLs to bind to synapses of cultured hippocampal neurons. The hippocampus, a part of the brain intimately involved in learning and memory, is one of the first areas affected by Alzheimer's disease.

Measuring ADDL binding with and without oleocanthal, they discovered that small amounts of oleocanthal effectively reduced binding of ADDLs to hippocampal synapses. Additional studies revealed that oleocanthal can protect synapses from structural damage caused by ADDLs.

An unexpected finding was that oleocanthal makes ADDLs into stronger targets for antibodies. This action establishes an opportunity for creating more effective immunotherapy treatments, which use antibodies to bind to and attack ADDLs.

Breslin commented on the implications of the findings. "If antibody treatment of Alzheimer's is enhanced by oleocanthal, the collective anti-toxic and immunological effects of this compound may lead to a successful treatment for an incurable disease. Only clinical trials will tell for sure."

In earlier work at Monell, Breslin and co-workers used the sensory properties of extra virgin olive oil to identify oleocanthal based on a similar oral irritation quality to ibuprofen. Oleocanthal and ibuprofen also have similar anti-inflammatory properties, and ibuprofen – like extra virgin olive oils presumably rich in oleocanthal – is associated with a decreased risk of Alzheimer's when used regularly.

Future studies to identify more precisely how oleocanthal changes ADDL structure may increase understanding of the pharmacological actions of oleocanthal, ibuprofen, and structurally related plant compounds. Such pharmacological insights could provide discovery pathways related to disease prevention and treatment.

The findings are reported in the October 15 issue of Toxicology and Applied Pharmacology.

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First author Jason Pitt, a graduate student in Klein's lab, conducted the studies. Also contributing to the work were chemist Amos B. Smith, III, of Monell and the University of Pennsylvania, who supplied the oleocanthal; William Roth, Pascale Lacor and Pauline Velasco from Northwestern; Matthew Blankenship from Western Illinois University; and Fernanda De Felice from the Universidade Federal do Rio de Janeiro. In addition to his faculty appointment at Monell, Breslin is Professor of Nutritional Sciences in the School of Environmental and Biological Sciences at Rutgers University.

The National Institute on Aging funded the research; Dr. Breslin is funded by the National Institute on Deafness and Other Communication Disorders.

Sexually satisfied women have better general well-being and more vitality

Older women have higher well-being scores than younger women

30 sept 2009--Pre- and post-menopausal women who self-rated themselves as being sexually satisfied had a higher overall psychological well-being score and scores for "positive well-being" and "vitality," compared with sexually dissatisfied women in a study of 295 women sexually active more than twice a month. The study, published today in The Journal of Sexual Medicine, also uncovered a positive association between age and well-being, but a negative association for general health.

The most commonly reported sexual problems in the area of consensual sexuality in women relate to sexual desire and interest, pleasure and satisfaction, and for most women these are part of the overall sexual experience, and are inextricably related. In contrast to studies of interventions for male erectile dysfunction, benefit of treatment in women with sexual dysfunction cannot be measured simply by the frequency of sexual events, as women frequently continue to be sexually active despite a high level of sexual dissatisfaction. Thus the frequency of self-reported satisfactory sexual events has been used as the primary outcome in recent studies.

To assess whether there was a correlation between sexual satisfaction and well-being, the team of Australian researchers recruited women from the community aged 20-65 who self-identified as being satisfied or dissatisfied with their sexual function. Participants were also asked questions which identified whether they were pre- or post menopausal, with recruitment closed when there was an equal number of women in each of the four subgroups.

"We wanted to explore the links between sexual satisfaction and wellbeing in women from the community, and to see if there was any difference between pre- and postmenopausal women," said lead author Dr Sonia Davison, of the Women's Health Program at Monash University, Australia. "We found that women who were sexually dissatisfied had lower well-being and lower vitality. This finding highlights the importance of addressing these areas as an essential part of women's healthcare, because women may be uncomfortable discussing these issues with their doctor."

"The problem with interpreting this finding is that it is impossible to determine if dissatisfied women had lower well-being because they were sexually dissatisfied, or if the reverse is true, such that women who started with lower well-being tended to secondarily have sexual dissatisfaction," added Davison. "As such, pharmacotherapies aimed to treat sexual dysfunction may have secondary effects on well-being, and the reverse may be true."

As over 90% of women in this study reported their sexual activity involved a partner, and was initiated by the partner at least 50% of the time, the sexual activity of the women may have been affected by partner presence (or absence), partner health, and sexual function, which were not addressed in this study. "The fact that women who self-identified as being dissatisfied maintained the level of sexual activity reported most likely represents established behaviour and partner expectation," said Professor Susan Davis, senior author of this study, also based at the Women's Health Program at Monash University, Australia. "It also reinforces the fact that frequency of sexual activity in women cannot be employed as a reliable indicator of sexual well-being."

"We are proud to publish this extremely important study in women's sexual health" said Dr. Irwin Goldstein, Editor-in-Chief of The Journal of Sexual Medicine. "This large study performed in the community emphasizes the role and importance of women's sexual health in women's overall health and well-being. Previous criticism equated physicians' efforts to improve a woman's satisfaction with her sexual life as medicalization. Dr. Davison's and co-workers' research will help health care professionals appreciate the need for overall women's healthcare to include women's sexual health care."

Uninterrupted chest-compressions key to survival in cardiac arrest outside hospital setting

DALLAS 29 sept 2009– Maximizing the proportion of time spent performing chest compressions during cardiopulmonary resuscitation (CPR) substantially improves survival in patients who suffer cardiac arrest outside a hospital setting, according to a multicenter clinical study that included UT Southwestern Medical Center.

The findings, available in today's issue of Circulation, come from the largest clinical investigation to evaluate the association between chest compressions by emergency medical service (EMS) providers before the first attempted defibrillation and survival to hospital discharge. Out-of-hospital cardiac arrest is a leading cause of premature death worldwide, and survival is often less than 5 percent.

One of the most important aspects of quality CPR is the proportion of time spent performing chest compressions, but EMS providers typically perform chest compressions only 50 percent of the total time spent on resuscitative efforts.

"It's a common problem, because rescuers are involved in so many other tasks – checking for a pulse, starting intravenous therapy and giving ventilation, among other things," said Dr. Ahamed Idris, professor of emergency medicine at UT Southwestern and a pioneer in resuscitation research and CPR. Dr. Idris also is the principal investigator for the Dallas portion of the new study, conducted at seven clinical centers across North America.

"Compressions are being interrupted half of the time or more, and that has a detrimental effect on the survival of patients," Dr. Idris said. "This study reinforces that interrupting chest compressions has a bad effect on survival. It also provides a rationale for relatively simple changes to CPR training and practice, that if implemented are likely to improve survival."

Dallas-area paramedics and firefighters are being trained to begin CPR immediately and to administer uninterrupted chest compressions for two minutes before re-checking the heart rhythm or using a defibrillator to shock the heart. UT Southwestern's emergency medicine program provides medical oversight for EMS providers in more than a dozen Dallas-area cities.

In this study, researchers studied data from patients in the Resuscitation Outcomes Consortium (ROC) who had suffered from cardiac arrest with a heart rhythm indicating ventricular fibrillation or ventricular tachychardia. The researchers focused on the effect of the number of chest compressions paramedics administered per minute before they shocked the heart.

"People who received chest compressions 60 to 80 percent of the time during CPR did better than those who received fewer chest compressions," Dr. Idris said.

Previous animal studies have demonstrated that interruptions in chest compressions decrease coronary and cerebral blood flow. Based on further clinical and laboratory observations, the American Heart Association and the European Resuscitation Council Guidelines for Cardiopulmonary Resuscitation in 2005 recommended increasing the proportion of time spent delivering chest compressions.

In 2008 the American Heart Association updated its CPR guidelines and now advocates that bystanders only perform continuous chest compressions for cardiac arrest instead of combining chest compressions with mouth-to-mouth ventilation.

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The data for this study was collected from the ROC, which is comprised of 11 regional clinical centers funded by the National Institutes of Health and several U.S. and Canadian agencies to test lifesaving interventions for critical trauma and sudden cardiac arrest.

In addition to UT Southwestern in Dallas, the other U.S. resuscitation centers are in Birmingham, Ala.; Iowa City, Iowa; Milwaukee; Portland, Ore.; Seattle and King County, Wash.; Pittsburgh; and San Diego. Toronto and Ottawa also have resuscitation centers.

Impaired kidney function linked to cognitive decline in elderly

A new study published in the medical journal Neurology suggests that impaired kidney function is a risk factor for cognitive decline in old age.

29 sept 2009--The study, conducted by researchers at Rush University Medical Center, found that poor kidney function was linked specifically with cognition related to memory functions. Damage to one of these functions, episodic memory, which retrieves memories of time, place, associated emotions and other contextual knowledge, is often the earliest sign of Alzheimer's disease.

"Given the dearth of modifiable risk factors for age-related cognitive decline, these results have important public health implications," said Dr. Aron Buchman, a neuroscientist in the Rush Alzheimer's Disease Center. "Further work to understand the link between kidney function and the brain may provide new strategies for preventing memory loss in elders."

Buchman said the findings suggest that there are common disease processes that affect both the brain and the kidneys in the elderly, and hypothesized that underlying vascular problems, such as diabetes and hypertension, may account for the association between kidney problems and cognitive decline.

The study analyzed data for 886 older adults who participated in the Rush Memory and Aging Project, a group of community-dwelling seniors with a mean age of 81, all of them initially free of dementia. The participants were examined annually for up to six years to track changes in cognition over time. Cognitive assessments included multiple tests that were summarized as a composite measure of overall cognition and of five individual cognitive abilities.

The individual cognitive systems assessed were visuospatial ability; perceptual speed, or the ability to quickly and accurately compare letters, numbers, objects, pictures or patterns; semantic memory, related to meaning, understanding and other concept-based knowledge; working memory, which temporarily stores and manipulates information; and episodic memory.

Ruling out the influence of factors like aging and medications, which can affect cognition, the researchers found that poor kidney function, assessed at the beginning of the study, was linked with a more rapid rate of decline in cognition over the next several years – not in visuospatial ability or perceptual speed, but in three specific areas: episodic, semantic and working memory.

The rate of decline in cognition was equivalent to that of a person seven years older at baseline, Buchman said.

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The study was supported by funds from the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.

About Rush: Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Multiple Strokes Linked to Higher Risk for Post-Stroke Dementia

Characteristics of the stroke itself more important than underlying vascular risks

28 sept 2009-- The risk of developing dementia after stroke is higher in patients who have had multiple strokes, according to a study published online Sept. 24 in The Lancet Neurology.

Sarah T. Pendlebury and Peter M. Rothwell of John Radcliffe Hospital in Oxford, U.K., conducted a review and meta-analysis of studies published over a period of almost 60 years to May 2009, and analyzed 73 papers comprising 7,511 patients in eight population-based and 22 hospital-based cohorts.

Approximately 10 percent of patients had dementia before the occurrence of the first stroke, 10 percent were newly diagnosed with dementia after their first stroke, and over a third of cases with recurrent stroke had dementia, the investigators found. The most important predictors of post-stroke dementia were the characteristics of the stroke and multiple occurrence of stroke, not underlying vascular risk factors, the researchers note.

"Optimum acute stroke care and secondary prevention of stroke are likely to be effective for reducing the burden of post-stroke dementia," the authors write. "Further studies are needed to identify independent predictive factors, to develop a risk factor score for use in clinical practice and trials, and to ascertain the relative contributions of and interactions between degenerative and vascular processes in the causes of post-stroke dementia."

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AHA/HBP: Low Vitamin D Connected to Hypertension

Women with deficient levels have a tripled risk of systolic hypertension 14 years later

28 sept 2009-- Younger women with low vitamin D levels may have a tripled risk of subsequently developing systolic hypertension, according to research presented this week at the American Heart Association's 63rd High Blood Pressure Research Conference, held from Sept. 23 to 26 in Chicago.

Flojaune C. Griffin, of the University of Michigan in Ann Arbor, and colleagues studied 559 Caucasian women who were ages 24 to 44 years when first assessed in 1993, at which time the prevalence of 25-OH-D deficiency was 81 percent. When the subjects were assessed again in 2007, the prevalence of diagnosed hypertension (systolic and diastolic) was 19 percent.

After adjusting for age, fat mass, anti-hypertensive medication use, and smoking, the researchers found that women with a vitamin D deficiency in 1993 were significantly more likely to have systolic hypertension in 2007 (risk ratio, 3.0) but not diastolic hypertension.

"These results suggest that early vitamin D deficiency may increase the long-term risk of hypertension in women at mid-life," the authors conclude.

Rosuvastatin Merits Wider Use for Heart Disease Prevention

Good risk reduction profile in those with low cholesterol, high C-reactive protein levels

28 sept 2009-- Prescribing rosuvastatin for patients with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein levels has enough benefits in terms of number needed to treat values to merit wide use in primary prevention of cardiovascular events, according to a study published online Sept. 22 in Circulation: Cardiovascular Quality and Outcomes.

Paul M. Ridker, M.D., of Harvard Medical School in Boston, and colleagues analyzed data from a trial evaluating rosuvastatin in 17,802 apparently healthy subjects with low-density lipoprotein cholesterol levels below 130 mg/dL and high-sensitivity C-reactive protein levels at or above 2 mg/L who were randomized to receive either 20 mg rosuvastatin or placebo.

The researchers looked at absolute risk reductions and the number needed to treat for a range of end points, time frames and sub-groups, and found that for myocardial infarction, stroke, revascularization or death, the five-year number needed to treat was 20, and that the number needed to treat was less than 50 for all sub-groups. The calculations compare favorably with those for other primary cardiovascular prevention therapies, the investigators note.

"The current analyses indicate that number needed to treat values associated with statin therapy among men and women with low levels of low-density lipoprotein cholesterol but elevated high-sensitivity C-reactive protein are at least comparable to number needed to treat values observed in prior primary prevention trials evaluating statin therapy for the treatment of hyperlipidemia," the authors write. "These data may be informative in policy discussions regarding new guidelines for the primary prevention of cardiovascular disease."

The JUPITER trial was funded by AstraZeneca; several authors reported financial relationships with the pharmaceutical industry.

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Study Casts Further Doubt on PSA for Cancer Screening


In terms of likelihood ratios, PSA didn't attain numbers needed for a screening test

27 sept 2009-- Based on likelihood ratios, prostate specific antigen (PSA) concentrations at any cutoff value didn't meet the criteria needed for a screening test, according to research published online Sept. 24 in BMJ.

Benny Holmstrom, M.D., of Umea University in Sweden, and colleagues analyzed data from 540 cases of prostate cancer and 1,034 matched controls drawn from a longitudinal cohort study. Blood samples were taken from cases an average of 7.1 years before diagnosis. The researchers assessed the likelihood ratios of PSA concentrations in predicting later cancer diagnosis. A positive likelihood ratio above 10 is considered strong evidence for ruling in disease, and a negative likelihood ratio below 0.1 is thought to be sufficient for ruling out disease.

The researchers found that, at PSA cutoff values of 3, 4 and 5 ng/mL, the positive likelihood ratios were 4.5, 5.5 and 6.4, respectively. Negative likelihood ratios were 0.47, 0.61 and 0.70, respectively. However, the authors note that concentrations below 1.0 almost completely ruled out a later diagnosis of cancer, suggesting that this cutoff might help identify men with very low risk.

"Converting sensitivity and specificity into likelihood ratios would help clinicians to evaluate how effective the test might be in ruling in or ruling out the disease. Clinicians should consider using likelihood ratios together with a patient's individual risk factors for the disease to explain the potential benefits and harms of the PSA test, allowing patients to contribute to decisions," write the authors of an accompanying editorial.

The editorial authors are members of the Cochrane Prostatic Diseases and Urologic Cancers Group.

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AHA/HBP: CRP Linked to BP, Metabolic Syndrome


Animal study suggests that CRP is associated with a wide range of adverse metabolic changes

27 sept 2009-- C-reactive protein (CRP) is not just a secondary marker of inflammatory disease but may be directly associated with hypertension and the metabolic syndrome, according to research presented this week at the American Heart Association's 63rd High Blood Pressure Research Conference, held from Sept. 23 to 26 in Chicago.

Michal Pravenec, M.D., of the Czech Academy of Sciences in Videnska, and colleagues studied spontaneously hypertensive rats with or without transgenically expressed human CRP in the liver under control of the apoE promoter.

Compared to control rats, the researchers found that treated rats showed hyperinsulinemia despite similar serum glucose levels, resistance to insulin stimulated non-oxidative glucose metabolism in skeletal muscle, elevated triglycerides, reduced serum adiponectin, and microalbuminuria. They also found evidence that treated rats had increased oxidative tissue damage.

"In addition, the results indicate that humanized CRP transgenic spontaneously hypertensive rats may provide a valuable model for 1) investigating mechanisms whereby human CRP enhances the risk for hypertension, diabetes, and target organ damage and 2) testing the therapeutic effects of new CRP inhibitors being developed for the prevention and treatment of common forms of cardiovascular and metabolic disease," the authors conclude.

Alcohol Found to Lessen Risk for Enlarged Prostate


Risk is 35 percent lower for men who drink 36 grams or more of alcohol per day

27 sept 2009-- A man's risk of developing benign prostatic hyperplasia (BHP) decreases as his consumption of alcohol increases, but not the risk of lower urinary tract symptoms (LUTS), according to a meta-analysis reported in the October issue of the Journal of Urology.

J. Kellogg Parsons, M.D., of the University of California San Diego, and colleagues screened 463 articles on alcohol intake, BHP and LUTS, and fully reviewed 33 articles before performing meta-analyses of 19 articles. The reviewers pooled data to assess the risk for BHP and LUTS for different levels of alcohol consumption.

The researchers calculated BHP risk in six strata defined by grams of alcohol per day: up to 5 gm/d, up to 12 gm/d, up to 15 gm/d, up to 24 gm/d, up to 36 gm/d, and more than 36 gm/d. Alcohol consumption was associated with a significant or marginally significant decrease in BHP risk for all six strata, with alcohol consumption of 36 gm or more daily associated with a 35 percent decrease in BHP risk compared to no alcohol consumption (odds ratio, 0.65). However, three of four studies that had a primary outcome of LUTS showed a non-significant trend toward increased likelihood of LUTS with increased alcohol consumption.

"Alcohol consumption is associated with a decreased likelihood of BPH but not of LUTS. Further studies are needed to determine the mechanisms by which alcohol modifies the risk of BPH," the authors write.

One study author reported financial relationships with two pharmaceutical companies.

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Lifestyle interventions in the prevention and treatment of cancer

Study in American Journal of Lifestyle Medicine

Los Angeles, 26 sept 2009--There is clear evidence that lifestyle choices affect the incidence and treatment of cancer, according to a study published in the current issue of American Journal of Lifestyle Medicine (AJLM).

The article "Lifestyle Interventions in the Prevention and Treatment of Cancer" looks at recent research on the five most common forms of cancer (lung, colorectal, breast, prostate and skin) and how some risk factors for these cancers can be lifestyle based and therefore controllable through alterations in human behavior. A Webinar based on the article will be moderated by James M. Rippe, MD, Editor-in-Chief of AJLM, and presented by lead author Clarence H. Brown III, MD, president and CEO of M.D. Anderson Cancer Center Orlando. Participants can earn 1 CME while learning about:

• lifestyle interventions that have been shown to be effective in preventing cancers
• recent evidence for specific lifestyle behaviors for specific cancers
• how to counsel patients for appropriate lifestyle behaviors to lower cancer risk

"While a universal cure for all types of cancer is still not in the foreseeable future," write the authors in the article, "changes in lifestyle – adhering to a healthy diet, regular exercise, and avoiding smoking and excessive exposure to ultraviolet radiation – can decrease the incidence of cancer."

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The Webinar: "Lifestyle Interventions in the Prevention and Treatment of Cancer," sponsored by Orlando Health, is being presented by Clarence H. Brown III, MD on Tuesday, October 6, 2009 from 2:00-3:00 P.M. EDT. This educational activity will be worth 1.0 AMA PRA Category 1 Credits™. For more information or to register, please visit http://ajl.sagepub.com.

The AJLM article, "Lifestyle Interventions in the Prevention and Treatment of Cancer," written by Clarence H. Brown III, MD, Said M. Baidas, MD, Julio J. Hajdenberg, MD, Omar R. Kayaleh, MD, Gregory K. Pennock, MD, Nikita C. Shah, MD, and Jennifer E. Tseng, MD, is being made available by SAGE for a limited time at http://ajl.sagepub.com/cgi/reprint/3/5/337.

The American Journal of Lifestyle Medicine (AJLM) is a bimonthly, peer-reviewed journal that focuses on recognizing and addressing the impact that lifestyle decisions have on health, emphasizing the interaction between traditional therapies and lifestyle modalities to achieve superior outcomes in disease treatment. The journal also provides information about therapies that minimize the extent to which illness impacts lifestyle. http://ajlm.sagepub.com

Prostate cancer patients on hormone therapy at increased risk for various heart diseases

Berlin, Germany, 26 sept 2009: New research has found that hormone therapy used to treat men with advanced prostate cancer is associated with an increased chance of developing various heart problems. Some choices of therapy appear, however, to be less risky than others.

Researchers told Europe's biggest cancer congress, ECCO 15 – ESMO 34 [1], in Berlin today (Tuesday 22 September) that the findings of their study, the largest and most comprehensive to date on the issue, indicate that doctors need to start considering heart-related side effects when they prescribe endocrine therapy for prostate cancer and might want to refer patients to a cardiologist before starting treatment.

A few smaller studies have indicated that some types of hormone therapy increase the risk of coronary heart disease and heart attacks in prostate cancer patients, but others have found no increased risk. This is the first large study to investigate how the broader range of hormone therapies affect a wider range of heart problems and provides for the first time a detailed picture of the impact of each sort of hormone therapy on individual types of heart trouble.

"If we have observed a causative effect, then for all hormone therapies put together, we estimate that compared with what's normal in the general population, about 10 extra ischaemic heart disease events a year will appear for every 1,000 prostate cancer patients treated with such drugs," said the study's leader, Ms Mieke Van Hemelrijck, a cancer epidemiologist at King's College in London. "However, not all types of therapy were associated with the risk of heart problems to the same degree. We found that drugs which block testosterone from binding to the prostate cells were associated with the least heart risk, while those that reduce the production of testosterone were associated with a higher risk. This may have implications for treatment choice."

Prostate cancer is diagnosed in more than 670,000 men each year worldwide, making it the second most common cancer among men worldwide, after lung cancer. Hormone therapy is a mainstay of treatment when the cancer is locally advanced and when it has spread to more distant parts of the body, but is increasingly being used in earlier stages of the disease. It involves either removing the testicles to eliminate the main source of testosterone production, injections of gonadotropin releasing hormone agonists to dramatically reduce the production of testosterone from the testicles or anti-androgen pills, which do not reduce the amount of testosterone produced but block it from attaching the prostate cells. Doctors sometimes use a combination of those approaches.

In the study, researchers analysed the link in 30,642 Swedish men with locally advanced or metastatic prostate cancer who had received hormone therapy as primary treatment for their disease between 1997 and 2006. The men were followed for an average of three years. The researchers calculated the risk of developing ischaemic heart disease, heart attacks, arrhythmia and heart failure requiring hospitalisation as well as the risk of dying from these heart diseases by comparing the rates among the cancer patients with what's normal in the general Swedish population. Most patients got one of the three hormone treatment choices, but 38% got a combination of the two types of drugs.

"We found that prostate cancer patients treated with hormone therapy had an elevated risk of developing all of the individual types of heart problems and that they were more likely than normal to die from those causes," Ms Van Hemelrijck said, adding that the problems started happening within a few months of initiating treatment.

Overall, prostate cancer patients treated with hormone therapy had a 24% increased risk of a non-fatal heart attack, a 19% increased risk of arrhythmia, a 31% increased risk of ischaemic heart disease and a 26% increased risk of heart failure. The risk of a fatal heart attack was increased by 28%, the risk of dying from heart disease by 21%, the risk of heart failure death was increased by 26% and the risk of fatal arrhythmia was increased by 5%.

"In a more detailed analysis by type of hormone therapy, the lowest increase in risk for ischaemic heart disease, heart attack and heart failure was seen in the group taking anti-androgen therapy, and we saw no increase in risk of death from heart disease in this group," Ms Van Hemelrijck said. "Patients on gonadotropin releasing hormone agonist therapy had the highest risk of these problems."

For instance, the increased heart failure risk for anti-androgens was 5%, compared with 34% for gonadotropin releasing hormone agonists and the increased ischaemic heart disease risk was 13% in the anti-androgen group, compared with 30% in the gonadotropin releasing hormone agonist therapy group.

"The finding that anti-androgens carry the least heart risk supports the view that circulating testosterone may protect the heart," she said.

The association with heart risk when the testicles were removed was close to that seen with the gonadotropin releasing hormone agonist therapy, Ms Van Hemelrijck added.

The increased risk of heart events requiring hospitalisation was less pronounced in patients who already had heart disease before hormone treatment, with a 17% risk increase for a new ischaemic heart disease event among those with a history of heart disease, compared with a 41% increase among men who didn't have any heart trouble before hormone treatment, for instance. Ms Van Hemelrijck said that could be because the men who already had heart disease were likely to be taking heart medications that protected them from further heart risk imposed by the endocrine treatment.

"We now need studies verifying the association and exploring plausible biological mechanisms. Then we would know how to best use these treatments according to a patient's history of various types of heart disease and whether it would be a good idea to give patients heart medicines to counteract these side effects," Ms Van Hemelrijck concluded.

Training By Experience For Medical Students Involved In Nursing Home Program

26 sept 2009--A geriatric training method pioneered by Marilyn R. Gugliucci, PhD, president of the Association for Gerontology in Higher Education (the educational branch of The Gerontological Society of America) has proved successful enough that she plans to implement it on a national level.

This project, called Learning by Living, involves students residing in a nursing home for two weeks to better understand the experience of aging in a long-term care setting. Gugliucci started this type of training four years ago with students at the University of New England College of Osteopathic Medicine, where she serves as director of geriatrics education and research.

"By living the life of an elder resident these students have learned to open their hearts to older adults and as a result have created meaningful friendships," Gugliucci said. "Prior to this experience they only considered the disease or frailty rather than seeing the person."

Last year, an Institute of Medicine report, "Retooling for an Aging America: Building the Health Care Workforce," indicated that America's aging citizens are facing a health care workforce too small and unprepared to meet their needs.

For example, when Gugliucci's program started in 2005, there was one geriatrician for every 5,000 people over 65; by 2030 that ratio is expected to increase to one for every 8,000 patients.

Several groups such as the Eldercare Workforce Alliance, a recently established coalition of over two dozen aging-focused organizations, are working to address this situation through legislative and regulatory actions.

Earlier this year, the Retooling the Healthcare Workforce for An Aging America Act was introduced in the U.S. Senate, co-sponsored by Senators Herb Kohl (D-WI), Blanche Lincoln (D-AR), Bob Casey (D-PA), Jeff Bingaman (D-NM) and Rep. Jan Schakowsky (D-IL).

Thanks to programs like Learning by Living, these issues are also gaining widespread media attention. The New York Times, the AOL Health website, SiriusXM satellite radio, and New Hampshire Public Radio all recently featured stories on Gugliucci's work.

"The longitudinal data from this project indicates that these students have changed how they care for all patients based on this experience and have maintained these skills over time," Gugliucci said. "They listen with their hearts, use touch as an added form of communication, and maintain eye contact at eye level with their patients."

Source:
Todd Kluss
The Gerontological Society of America

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Research shows safe dosages of common pain reliever may help prevent conditions related to aging

HUNTINGTON, W.Va., 24 sept 2009 – Recent studies conducted by Dr. Eric Blough and his colleagues at Marshall University have shown that use of the common pain reliever acetaminophen may help prevent age-associated muscle loss and other conditions.

Their study examined how acetaminophen may affect the regulation of protein kinase B (Akt), an enzyme known to play an important role in regulation of cellular survival, proliferation and metabolism.

The researchers' data indicates that aging skeletal muscles experience a decrease in the proper functioning of the enzyme and that acetaminophen intervention in aged animals could be used to restore Akt activity to a level comparable to that seen in young animals. In turn, this improvement in Akt activity was associated with improvements in muscle cell size and decreased muscle cell death.

"Using a model that closely mimics many of the age-associated physiological changes observed in humans, we were able to demonstrate that chronic acetaminophen treatment in a recommended dosage is not only safe but might be beneficial for the treatment of the muscle dysfunction many people experience as they get older," said Blough, an associate professor in the university's Department of Biological Sciences.

The lab's work, which was published in the July 29 issue of the international research journal PLoS One, is the first study to show that acetaminophen ingestion, at least in animals, can be safely used for the treatment of age-related muscle loss. This finding could have far-reaching implications, given the fact that people age 65 and older make up the fastest-growing segment of the U.S. population.

Additional research in their laboratory, which was published in the March issue of the journal Diabetes/Metabolism Research and Reviews, demonstrates the medication may also be useful in diminishing the severity of age-associated hyperglycemia, commonly referred to as high blood sugar.

"It is thought that acetaminophen may exert its action by decreasing the amount of reactive oxygen species," explained Dr. Miaozong Wu, the lead author and a postdoctoral fellow in Blough's lab. "Given the finding that increases in reactive oxygen species may play a role in the development of several age-associated disorders, it is possible that acetaminophen could be used to treat many different types of conditions."

Dr. John Maher, vice president for research and executive director of the Marshall University Research Corporation, said, "These findings are yet another indication that Marshall's researchers are conducting vital research in areas of great importance to human health and safety. I could not be more pleased and wish Dr. Blough and his team continued success."

According to Blough, scientists in his lab will now turn their attention to examining other physiological systems, such as the heart and blood vessels, to see if acetaminophen therapy might have similar benefits for people with cardiovascular disease.

People with type 2 diabetes improved muscular strength

Exercise counseling and fitness center training effective

Alexandria, VA, 24 sept 2009 – Physical therapist-directed exercise counseling combined with fitness center-based exercise training can improve muscular strength and exercise capacity in people with type 2 diabetes, with outcomes similar to those of supervised exercise, according to a randomized clinical trial published in the September issue of Physical Therapy, the scientific journal of the American Physical Therapy Association (APTA).

Type 2 diabetes is associated with numerous health complications, including a decline in muscular strength and exercise capacity. Studies show that a decline in muscular strength increases the risk of loss of physical function and that a decline in exercise capacity increases the risk of cardiovascular and all-cause mortality. "Improving muscular strength and exercise capacity in people with type 2 diabetes is crucial to preventing loss of physical function and decreasing comorbidity and mortality in these patients," said lead researcher J. David Taylor, PT, PhD, CSCS, assistant professor in the Department of Physical Therapy at the University of Central Arkansas.

Supervised exercise programs improve both muscular strength and exercise capacity in people with type 2 diabetes; however, Medicare and other health insurance programs do not currently reimburse physical therapists and other clinicians for these exercise programs.

In this study, 24 people with type 2 diabetes were randomly allocated to either an experimental group that received two months of physical therapist-directed exercise counseling and fitness center-based exercise training or a comparison group that received two months of laboratory-based, supervised exercise. Exercise training for all participants consisted of resistance training (chest press, row, and leg press exercises) and aerobic training (walking or jogging on a treadmill) as recommended for people with type 2 diabetes by the American Diabetes Association and the American College of Sports Medicine. Participants in the experimental group received a face-to-face counseling session at baseline and one month after baseline, weekly 10-minute telephone calls, and seven-day-per-week access to a local fitness center. Each participant in the comparison group received the same prescribed exercise program as the experimental group, but in a supervised environment.

Although both groups had significant improvements in muscular strength and exercise capacity following exercise training, the results showed no significant differences in improvements between these two groups. "The fact that there were no significant differences in improvements between patients who received exercise counseling and those in a supervised program suggests that physical therapists may make an evidence-based choice of prescribing either exercise counseling combined with fitness center-based training or supervised exercise training for patients with type 2 diabetes," said Taylor.

New Parkinson's Drug Draws Mixed Reviews

24 sept 2009-- A study to see whether a new drug can stop the progression of Parkinson's disease has produced results that have drawn sharply differing reactions from neurologists.

The drug, rasagiline (Azilect), was approved in 2006 by the U.S. Food and Drug Administration on the basis of studies showing that it reduced Parkinson's symptoms such as trembling and slowed motion. The new study, reported in the Sept. 24 issue of the New England Journal of Medicine, was designed to determine whether the drug also acts on the underlying nerve deterioration that causes the disease.

"In our heart, what we are hoping for is neuroprotection," said study author Dr. C. Warren Olanow, a professor of neurology and neuroscience at Mount Sinai School of Medicine, in New York City.

To distinguish the effect on symptoms from the hoped-for effect on the underlying disease, "we used a totally new study design, to see if it is disease-modifying," Olanow explained.

The study enlisted 1,176 people with previously untreated Parkinson's disease who were seen at medical centers around the world. At the start, half took daily doses of either 1 milligram or 2 milligrams of rasagiline for 36 weeks, while the other half took a placebo. After that, all the participants took either 1 milligram or 2 milligrams of rasagiline for another 36 weeks.

A complex system to measure the treatment effects showed an apparent improvement in the participants who took the 1-milligram doses but not in those taking the 2-milligram doses.

"It did something to affect the course of the disease," Olanow said. "We don't know why, but we are entitled to speculate."

His speculation is based on a detailed study of the 25 percent of participants who showed the greatest benefit. "What I think is right is that the higher dose had a greater effect on symptoms than the lower dose, so that masked our ability to detect its effect on disease progression," Olanow said. "We thought that this floor effect was why we couldn't see a difference."

Olanow was enthusiastic about the results. "This doesn't prove unequivocally that it [rasagiline] is neuroprotective, but there is no other rational explanation for the results," he said. "This is good news for Parkinson's patients."

Asked if he would prescribe the drug for that reason, Olanow said, "Yes, I would personally prescribe it."

A much more skeptical response came from Dr. William J. Weiner, chair of neurology at the University of Maryland, who took part in the study.

"The authors were very careful in the paper not to indicate that they had shown neuroprotection," Weiner said. "The tone of the article itself is moderate."

The methods used to determine trial results need scrutiny, he said. "They used a lot of very fancy mathematical models, some of which had not been used before," Weiner said. "Most neurologists wouldn't understand the mathematical models they used. Research neurologists don't deal with equations about the slope of curves."

And the end results were not impressive, he maintained. "The difference reported in the study is less than two points on a scale that has 150 points," Weiner said.

The reason why the lower dose worked, and the higher one didn't? "It simply could be luck," he said.

While rasagiline can provide benefits in reducing symptoms of early Parkinson's disease, Weiner said he was worried that "patients will be given what I believe to be false hopes" by the new study.

"It has mild symptomatic effects, but I do not prescribe this drug for neuroprotection and this study doesn't convince me to do that," Weiner said.

Several of the study authors have received consulting or lecturing fees from pharmaceutical companies, including Teva, the maker of Azilect.

More information

Learn about Parkinson's disease from the U.S. National Institute of Neurological Disorders and Stroke.

Rethinking Alzheimer's disease and its treatment targets

23 sept 2009--The standard explanation for what causes Alzheimer's is known as the amyloid hypothesis, which posits that the disease results from of an accumulation of the peptide amyloid beta, the toxic protein fragments that deposit in the brain and become the sticky plaques that have defined Alzheimer's for more than 100 years.

Billions of dollars are spent yearly targeting this toxic peptide — but what if this is the wrong target? What if the disease begins much earlier, fueled by a natural process? Reporting in the current edition of the journal Neurobiology of Aging, UCLA professor of psychiatry George Bartzokis argues just that and says that a better working hypothesis is the "myelin model."

"The greatest promise of the myelin model of the human brain is its application to the development of new therapeutic approaches," Bartzokis said.

Like insulation around wires, myelin is a fatty sheath that coats our nerve axons, allowing for efficient conduction of nerve impulses. It is key to the fast processing speeds that underlie our higher cognitive functions and encoding of memories.

But the lifelong, extensive myelination of the human brain also makes it uniquely vulnerable to damage. The myelin model's central premise is that it is the normal, routine maintenance and repair of myelin throughout life that ultimately initiates the mechanisms that produce degenerative diseases like Alzheimer's. That is, the amyloid-beta peptide and the tau peptide, which is also implicated in Alzheimer's, as well as the signature clinical signs of the disease, such as memory loss and, ultimately, dementia, are all byproducts of the myelin breakdown and repair processes.

"The pervasive myelination of our brain is the single most unique aspect in which the human brain differs from other species," said Bartzokis, who is a member of the Laboratory of Neuro Imaging in the UCLA Department of Neurology and a member of UCLA's Brain Research Institute. Myelin is produced by oligodendrocytes, specialized glial cells that themselves become more vulnerable with age.

Bartzokis notes that myelination of the brain follows an inverted U-shaped trajectory, growing strongly until our 50s, when it very slowly begins to unravel as we age. The myelin that is deposited in adulthood ensheaths increasing numbers of axons with smaller axon diameters and so spreads itself thinner and thinner, Bartzokis said. As a result, it becomes more susceptible to the ravages of age in the form of environmental and genetic insults and slowly begins to break down faster than it can be repaired.

The exclusive targeting of the amyloid-beta peptide for many years is understandable because the same genes and enzymes involved in controlling myelination and myelin repair are, ironically, also involved in the production of amyloid-beta proteins. Bartzokis' point is that the amyloid beta may actually develop as a result of the natural process of the repair and maintenance of myelin.

"So the breakdown that leads to Alzheimer's and other age-related brain diseases, such as Parkinson's, may begin much earlier, before the formation of the protein deposits that are used to define these diseases," Bartzokis said.

Most drugs being developed for Alzheimer's are targeting amyloid beta, but little if any clinical improvement is being seen. This is, according to Bartzokis, "similar to cleaning up a house that's been flooded by water but never repairing the actual pipe that created the flood.

"For drug development then, the targets should be much further upstream, earlier in the process before the AB plaques even develop," he said.

Instead of focusing on reducing amyloid beta, Bartzokis argues, the myelin model suggests entirely different approaches to treatment and prevention of Alzheimer's disease that precede plaque formation. With modern brain imaging technology, clinicians could track the dynamic changes taking place in the brain and intercede well before any signs of Alzheimer's are seen.

"With earlier intervention," Bartzokis said, "we could reduce and potentially eliminate the increasingly catastrophic burden of dementia on the individual and their family, the health care system, and our society."

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The research was supported by the National Institutes of Health, the RCS Alzheimer's Foundation and the U.S. Department of Veterans Affairs. The author reports no conflicts of interest.

Inflammation Linked to Peripheral Atherosclerosis


Genetics likely also important, but no genetic marker has been identified

23 sept 2009-- Inflammatory markers are consistently associated with lower extremity peripheral arterial disease (PAD) and particular outcomes, but are not necessarily causally associated; and, although genetics may play an important role, no genetic marker has been associated with the disease, according to a review in the Sept. 29 issue of the Journal of the American College of Cardiology.

Mary M. McDermott, M.D., and Donald M. Lloyd-Jones, M.D., from Northwestern University in Chicago note that patients with lower extremity PAD have higher levels of inflammatory biomarkers, including C-reactive protein, interleukin-6, tumor necrosis factor-alpha and soluble adhesion molecules, and that the biomarkers are associated with adverse outcomes such as adverse calf skeletal muscle characteristics and cardiovascular mortality.

The reviewers observed that statin treatment is beneficial in PAD patients, possibly due to statins' ability to reduce inflammation, although clinical trials examining whether treatments that affect inflammatory biomarkers improve outcomes have not been done. An estimated 20 to 45 percent of PAD risk is attributed to genetics, but the authors note that a consistent genetic marker has not yet been identified.

"Despite the consistent associations of elevated inflammatory biomarkers with adverse outcomes in PAD, there are insufficient data to conclude that inflammatory biomarkers are causally related to adverse outcomes in PAD," the authors conclude. "Similarly, insufficient data exist to support targeting PAD patients who have higher levels of inflammation with more intensive secondary prevention therapies, such as antiplatelet therapies or statins."

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Breast Cancer Prevention Drugs and Cognition Studied


Researchers say neither tamoxifen not raloxifene shows clear advantage in preserving cognition

23 sept 2009-- The selective estrogen receptor modulators tamoxifen and raloxifene, used for breast cancer prevention in postmenopausal women, have similar effects on cognition, according to a study published online Sept. 21 in the Journal of Clinical Oncology.

Claudine Legault, Ph.D., of the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues studied a subgroup of women 65 years and older who had participated in the Study of Tamoxifen and Raloxifene. The subgroup in the present study consisted of 1,498 women, including 1,225 who took baseline cognitive tests when already on treatment and 273 who were tested pretreatment. Cognitive tests were repeated at follow-up visits over two years.

The researchers found no significant differences in mean cognitive scores between the medication groups. However, there were significant time effects for the California Verbal Learning Test that were higher with raloxifene than with tamoxifen. Mean cognitive scores were similar for the women tested on treatment and those tested pretreatment. Because there was no placebo arm, only comparative cognition changes were evaluated.

"In summary, the present findings indicate that tamoxifen and raloxifene are associated with similar patterns of cognitive function in healthy postmenopausal women at increased risk of breast cancer. These findings will help women and their health care providers make more informed decisions regarding the use of tamoxifen or raloxifene for the prevention of breast cancer, because the data do not support one selective estrogen receptor modulator conferring a cognitive advantage over the other," the authors write.

Several of the study authors reported receiving honoraria or research funding from pharmaceutical companies.

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Impaired Financial Skills Could Help Predict Alzheimer's

Study finds link with progression to Alzheimer's in patients with mild cognitive impairment

22 sept 2009-- Patients with mild cognitive impairment (MCI) may have faltering financial reasoning in the year before converting to Alzheimer's disease, which could have implications for their families, according to research published in the Sept. 22 issue of Neurology.

Kristen L. Triebel, of the University of Alabama in Birmingham, and colleagues analyzed data from 87 patients with MCI and memory loss and 76 healthy older controls. Between baseline and one-year follow-up, 25 patients with MCI developed Alzheimer's-type dementia, and comprised the "MCI converter" group. All took the Financial Capacity Instrument at both points.

At baseline, the researchers found that controls performed better on most parts of the financial instrument than MCI converters and non-converters. However, non-converters performed better than converters on several domains and total scores at this time. At follow-up, converters showed greater decline than the other groups on checkbook management and total scores.

"Clinicians should proactively monitor patients with MCI for declining financial skills and advise patients and families about appropriate interventions. Family members can oversee a patient's checking transactions, contact the patient's bank to detect irregularities such as bills being paid twice, or become cosignatory on a checking account so that joint signature is required for checks above a certain amount," the authors write.

Several co-authors reported disclosures related to journals, invention royalties, financial relationships with companies, and consulting on legal cases.

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Pain Linked to Functional Decline in Middle-Aged Adults

Mobility limitations are similar to those seen in people without pain who are decades older

22 sept 2009-- In middle-aged adults, pain is associated with an accelerated decline in physical function, with mobility limitations similar to those decades older without pain, according to a study in the September issue of the Journal of the American Geriatrics Society.

Kenneth E. Covinsky, M.D., of the University of California in San Francisco, and colleagues studied 18,531 adults ages 50 years and older who were enrolled in the 2004 Health and Retirement Study, 24 percent of whom had significant pain.

Among subjects ages 50 to 59 years, the researchers found that those with significant pain were significantly less able than those without pain to jog one mile (9 versus 37 percent), walk several blocks (50 versus 91 percent), and walk one block without difficulty (69 versus 96 percent). The authors further note that the subjects aged 50 to 59 years with pain had similar mobility limitations as subjects aged 80 to 89 years without pain.

"In summary, this population-based study of the epidemiology of pain and functional limitations across middle and late life found strong associations between pain and functional limitations across many decades of life," the authors conclude. "In terms of their degree of limitation, subjects with pain are similar to subjects without pain who are two to three decades older. Evaluation and management strategies for pain and functional limitation should consider the strong co-occurrence of these conditions."

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Insufficient levels of vitamin D puts elderly at increased risk of dying from heart disease

22 sept 2009--A new study by researchers at the University of Colorado Denver and Massachusetts General Hospital (MGH) shows vitamin D plays a vital role in reducing the risk of death associated with older age. The research, just published in the Journal of the American Geriatrics Society, evaluated the association between vitamin D levels in the blood and the death rates of those 65 and older. The study found that older adults with insufficient levels of vitamin D die from heart disease at greater rates that those with adequate levels of the vitamin.

"It's likely that more than one-third of older adults now have vitamin D levels associated with higher risks of death and few have levels associated with optimum survival," said Adit Ginde, MD, MPH, an assistant professor at the University of Colorado Denver School of Medicine's Division of Emergency Medicine and lead author on the study. "Given the aging population and the simplicity of increasing a person's level of vitamin D, a small improvement in death rates could have a substantial impact on public health."

Older adults are at high risk for vitamin D deficiency because their skin has less exposure to the sun due to more limited outdoor activities as well as reduced ability to make vitamin D.

The study analyzed data from the Third National Health and Nutrition Examination Survey conducted by the National Center for Health Statistics. The research team analyzed vitamin D in blood samples of more than 3,400 participants that were selected to be representative of the 24 million older adults in the United States. Compared to those with optimal vitamin D status, those with low vitamin D levels were 3 times more likely to die from heart disease and 2.5 times more likely to die from any cause.

Dr. Ginde says the findings suggest that current daily recommendations of vitamin D may not be enough for older adults to maintain optimal health. The research team has applied for research funding from the National Institutes of Health to perform a large, population-based clinical trial of vitamin D supplementation in older adults to see if it can improve survival and reduce the incidence of heart disease.

"Confirmation of these results in large randomized trials is critically important for advancing public health," says Carlos Camargo, MD, DrPH, of the MGH Department of Emergency Medicine, the senior author of the study and an associate professor of medicine at Harvard Medical School.

The study looking at elderly death rates is the second of two studies by the same team of researchers on vitamin D and general health. The first study, published in Archives of Internal Medicine earlier this year, identified vitamin D as playing a significant role in boosting the immune system and warding off colds and flu.

"Vitamin D has health effects that go beyond strong bones," says Ginde. "It's likely that it makes a vital contribution to good health."

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Faculty at the University of Colorado Denver's School of Medicine work to advance science and improve care. These faculty members include physicians, educators and scientists at University of Colorado Hospital, The Children's Hospital, Denver Health, National Jewish Health, and the Denver Veterans Affairs Medical Center. Degrees offered by the UC Denver School of Medicine include doctor of medicine, doctor of physical therapy, and masters of physician assistant studies. The School is located on the University of Colorado's Anschutz Medical Campus, one of four campuses in the University of Colorado system. For additional news and information, please visit the UC Denver newsroom online (http://ucdenver.edu/about/newsroom/Pages/Newsroom.aspx).

Report: 35 million-plus worldwide have dementia

WASHINGTON, 21 sept 2009– More than 35 million people around the world are living with Alzheimer's disease or other types of dementia, says the most in-depth attempt yet to assess the brain-destroying illness — and it's an ominous forecast as the population grays.

The new count is about 10 percent higher than what scientists had predicted just a few years ago, because earlier research underestimated Alzheimer's growing impact in developing countries.

Barring a medical breakthrough, the World Alzheimer Report projects dementia will nearly double every 20 years. By 2050, it will affect a staggering 115.4 million people, the report concludes.

"We are facing an emergency," said Dr. Daisy Acosta, who heads Alzheimer's Disease International, which released the report Monday.

The U.S. and other developed countries long have been bracing for Alzheimer's to skyrocket. But the report aims to raise awareness of the threat in poorer countries, where finally people are living long enough to face what is mostly a disease of the 65-and-older population.

While age is the biggest driver of Alzheimer's, some of the same factors that trigger heart disease — obesity, high cholesterol, diabetes — seem to increase the risk of dementia, too. Those are problems also on the rise in many developing countries.

In poorer countries, "dementia is a hidden issue," Acosta said, and that's complicating efforts to improve earlier diagnosis. "You're not supposed to talk about it."

For example, the report notes that in India, such terms such as "tired brain" or "weak brain" are used for Alzheimer's symptoms amid widespread belief that dementia is a normal part of aging — when it's not.

That mistake isn't confined to the developing world. Even in Britain, the report found, just over half of the families caring for someone with dementia believed the same thing.

The new study updates global figures last reported in 2005, when British researchers estimated that more than 24 million people were living with dementia. Using that forecast, scientists had expected about 31 million people would be struggling with dementia by 2010.

But since 2005, a flurry of research on Alzheimer's in developing countries has been published, leading Alzheimer's Disease International — a nonprofit federation of more than 70 national groups — to ask those scientists to re-evaluate. After analyzing dozens of studies, the scientists projected 35.6 million cases of dementia worldwide by 2010.

That includes nearly 7 million people in Western Europe, nearly 7 million in South and Southeast Asia, about 5.5 million in China and East Asia and about 3 million in Latin America.

The report puts North America's total at 4.4 million, although the Alzheimer's Association of the U.S. uses a less conservative count to say more than 5 million people in this country alone are affected. The disease afflicts one in eight people 65 and older, and nearly one in two people over 85.

The report forecasts a more than doubling of dementia cases in parts of Asia and Latin America over the next 20 years, compared with a 40 percent to 60 percent jump in Europe and North America.

The report urges the World Health Organization to declare dementia a health priority and for national governments to follow suit. It recommends major new investments in research to uncover what causes dementia and how to slow, if not stop, the creeping brain disease that gradually robs sufferers of their memories and ability to care for themselves, eventually killing them.

There is no known cure; today's drugs only temporarily alleviate symptoms. Scientists aren't even sure what causes Alzheimer's.

But major studies under way now should show within a few years if it's possible to at least slow the progression of Alzheimer's by targeting a gunky substance called beta-amyloid that builds up in patients' brains, noted Dr. William Thies of the U.S. Alzheimer's Association. His group is pushing for an increase in U.S. research spending, from just over $400 million to about $1 billion.

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On the Net:

Alzheimer's Disease International: http://www.alz.co.uk/

Alzheimer's Association: http://www.alz.org

Study finds aspirin protects against colon cancer

BERLIN, 21 sept 2009– A daily dose of aspirin can prevent cancer in people with a genetic disorder

that increases their risk of developing the disease, scientists said on Monday.

The finding could also have important implications for the wider population, although more research is needed and unraveling the connection will take some time since the benefits of aspirin were only seen after several years.

John Burn of the Institute of Human Genetics at Newcastle University in Britain said his study might also have uncovered a simple way of controlling stems cells that make tumors grow.

"We believe that aspirin may have an effect on the survival of aberrant (faulty) stem cells in the colon," Burn said, presenting his findings at the ECCO-ESMO European cancer congress in Berlin.

Burn and colleagues tested 1,071 people with Lynch syndrome -- an inherited condition that predisposes a person to a range of cancers, particularly of the colon -- by giving some of them aspirin and some a placebo.

Follow-up tests after 10 years showed that although there was no difference in cancer rates after 29 months, a significant difference was detected after four years, with fewer people in the aspirin group developing colon cancer, Burn said.

"To date, there have been only six colon cancers in the aspirin group as opposed to 16 who took placebo," he added. "There is also a reduction in endometrial cancer."

People with Lynch syndrome have an increased risk of many cancers including stomach, colon, brain, skin, and prostate. Women carriers also have a high risk of developing endometrial and ovarian cancers.

Burn said that although people in the trial stopped taking aspirin, its effect clearly continued.

Colorectal is the second biggest cause of cancer death in the United States and Europe, where a total of 560,000 people develop the disease each year, and 250,000 die from it.

Aspirin, originally developed by Bayer, is a cheap over-the-counter drug which in low daily doses has been found to stave off the risk of heart attacks and strokes, as well as chase away occasional aches and pains.

Other scientists have previously found it can reduce the risk of developing colon cancer and suggested it does so by blocking the enzyme cyclooxygenase2, or COX-2, which promotes inflammation and cell division and is found in high levels in tumors.

But Burn said he thought this explanation was unlikely, and thinks that aspirin hits faulty stem cells before they mutate into pre-cancerous cells.

"If aspirin reduced the chances of such cells surviving, this would explain our results," he said.

Despite its benefits, aspirin is also well known for causing stomach upsets. In the study, 11 patients on aspirin had stomach bleeds or ulcers compared with nine on placebo.

The team plans a further study using a larger group of patients taking differing aspirin doses.

Depression hard on the bones: study

NEW YORK, 21 sept 2009– People who suffer from major depression are at risk for low bone mineral density (BMD), research hints.

In the last 14 years, "ample research" has implicated major depression in bone loss and the bone-thinning disease osteoporosis, Dr. Raz Yirmiya and Dr. Itai Bab from The Hebrew University of Jerusalem in Israel note in the journal Biological Psychiatry.

To investigate further, the investigators pooled data from 23 studies involving 2327 depressed and 21,141 non-depressed adults.

Overall, depressed individuals had less dense bones than non-depressed individuals, they found. Depressed individuals also had increased levels of bone resorption markers.

Based on these findings and prior studies, "We propose that all individuals psychiatrically diagnosed with major depression are at risk for developing osteoporosis, with depressed women -- particularly those who are premenopausal -- showing a higher risk than men," Yirmiya and Bab conclude.

People with major depression should have their BMD checked periodically, they conclude.

SOURCE: Biological Psychiatry, September 1, 2009.

Earlier Parkinson's Treatment Based on Disability, Education

Greater impairment, disability, and education associated with the need for earlier treatment

20 sept 2009-- Patients with early Parkinson's disease are more likely to need treatment earlier with greater impairment, disability, and education level, according to a study in the September issue of Archives of Neurology.

Sotirios A. Parashos, M.D., from Struthers Parkinson's Center in Golden Valley, Minn., and colleagues analyzed data from 413 patients with untreated Parkinson's disease who had participated in two clinical trials of experimental drugs for the disease.

The researchers found that 48.5 percent of patients started symptomatic treatment within 12 months of baseline. Based on the Unified Parkinson Disease Rating Scale, Modified Rankin Scale scores, and education, greater impairment and disability at baseline and a higher level of education were independently associated with the need for earlier treatment.

"In early Parkinson disease, greater impairment and disability and higher level of education are independently associated with an earlier need for symptomatic treatment," Parashos and colleagues conclude.

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Study Explores Framingham Score, CAD Relationship

Multislice computed tomography, stress testing may refine CAD risk assessment

20 sept 2009-- There is a strong correlation between Framingham Risk Score (FRS) and the development of functionally relevant obstructive coronary artery disease (CAD), according to research published in the Sept. 15 issue of the American Journal of Cardiology.

Gaetano Nucifora, M.D., of the Leiden University Medical Center in the Netherlands, and colleagues analyzed data from 255 subjects without known CAD who underwent multislice computed tomographic (MSCT) coronary angiography and stress testing with electrocardiographic exercise test or myocardial perfusion imaging, and calculated FRS from baseline characteristics.

The researchers found that coronary calcifications, based on calcium scoring, were more often found in subjects with a high FRS than a low score (74 versus 29 percent). Normal coronary arteries, based on MSCT coronary angiogram, were more often found in patients with a low FRS than a high score (62 versus 10 percent). Positive stress test results were also less likely in patients with a low FRS than a high FRS (4 versus 50 percent). And the prevalence of functionally relevant obstructive CAD increased along with increasing FRS.

"The present study describes the prevalence of positive stress testing compared to evidence of coronary atherosclerosis (by coronary artery calcium score and MSCT coronary angiography) across FRS categories. A significant increase in the prevalence of functionally relevant coronary lesions was observed in line with an increasing FRS," the authors write. "Selective use of MSCT coronary angiography and stress testing may refine the traditional risk assessment of CAD events, especially in patients deemed at intermediate and high risk."

Several co-authors reported financial relationships with medical equipment makers.

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Conservative Management in Prostate Cancer Feasible

Older men with localized disease have favorable 10-year prostate cancer-specific outcomes

20 sept 2009-- In older men with localized prostate cancer, conservative management is associated with significantly improved 10-year outcomes compared to earlier eras, according to a study published in the Sept. 16 issue of the Journal of the American Medical Association.

Grace L. Lu-Yao, Ph.D., of the Cancer Institute of New Jersey in New Brunswick, and colleagues studied outcomes in 14,516 men ages 65 years or older who were diagnosed with stage T1 or T2 prostate cancer between 1992 and 2002 and managed without surgery or radiation for six months after diagnosis.

In men who were diagnosed at a median age of 78 years, the researchers found that 10-year prostate cancer-specific mortality rates associated with well, moderate, and poorly differentiated tumors were 8.3, 9.1, and 25.6 percent, respectively, and that the corresponding 10-year risks of dying from competing causes were nearly 60 percent. In men who were diagnosed between ages 66 and 74 years with moderately differentiated tumors, they found that the 10-year prostate cancer-specific mortality rate was 60 to 74 percent lower than the 6 percent rate observed in earlier 1992 to 2002 studies compared to the 15 to 23-percent rates observed in the pre-PSA era (1949 to 1992).

"Considering favorable 10-year outcomes following conservative management, men with a life expectancy of less than 10 years may wish to consider an active surveillance or watchful waiting protocol as an alternative to immediate attempted curative therapy," the authors conclude.

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