Opiate painkillers raise fracture risk

NEW YORK, 29 jan 2010– Older adults who take powerful prescription painkillers known as opioids face an increased risk of bone fractures, especially at moderately high medication doses, a new study finds.

Opioids are powerful narcotic pain medications that include morphine, oxycodone (Oxycontin and other brands) and hydrocodone (Vicodin and others).

The drugs work well against severe pain in the short term, but their longer-term effectiveness for chronic pain is less clear. Moreover, with longer use comes the risk of addiction, in addition to side effects such as nausea, constipation, dizziness and sedation.

That dizziness and sedation can also set opioid users up for falls, which, in older people especially, may result in serious fractures.

The new study, published in the Journal of General Internal Medicine, confirms the risk of fracture associated with opioids, and also shows that moderately higher drug doses further the hazard.

Researchers found that among more than 2,300 older adults with chronic pain, the risk of suffering a bone fracture was higher when patients were using an opioid for a prolonged period than when they were opioid- free.

The individuals in the study were 60 years of age or older. None of the patients was suffering from cancer-related pain. (Guidelines for treating severe cancer pain are often different than guidelines for non-cancer pain.)

The annual rate of fractures among study participants who were not currently using opioids was just under 4 percent, while current users showed a fracture rate of 6 percent. And among patients currently taking opioid doses of at least 50 milligrams per day, the annual fracture rate was 10 percent.

According to the researchers, 50 milligrams is considered to be in the moderate range for opioid doses.

"Some of these fractures were significant," said senior researcher Dr.

Michael Von Korff, of the Group Health Research Institute in Seattle.

In an interview, he noted that 37 percent of fracture victims ended up in the hospital and nearly one-quarter entered a nursing home within one month of the accident.

The findings come at a time when long-term opioid use for non-cancer- related pain is coming under increased scrutiny.

About 8 million Americans are using opioids to control chronic pain, Von Korff said, yet the long-term effectiveness of the drugs is uncertain, and may vary widely from person to person. Some people find relief, while others find their pain actually worsens, Von Korff noted.

A report published in October by the Cochrane Collaboration, an international medical research organization, concluded that for older adults with osteoarthritis, the risks of long-term opioids may outweigh the modest pain relief.

And in a separate study published this week in the Annals of Internal Medicine, Von Korff's team highlights the potential for overdose among people with legitimate prescriptions.

The researchers found that among 10,000 patients on opioids for at least three months, 51 suffered at least one overdose, with fatal results for six. As in this latest study, higher medication doses conferred a greater risk.

The bottom line, Von Korff said, is that "these drugs need to be taken cautiously and under close medical supervision."

The current study included 2,341 older adults who, at some point between 2000 and 2005, were prescribed opioids for at least 90 days -- most commonly for chronic back pain, osteoarthritis or pain in the extremities.

To limit the risks of falls and other side effects, Von Korff said that patients on opioids should work with a single physician who is aware of all the medications they are taking. That will help avoid any potentially hazardous drug interactions.

And given the importance of dosage, Von Korff said, "never use more medication than your doctor has prescribed."

He also advised opioid users who feel overly sedated or have had dizziness or falls to tell their doctors about it.

SOURCE: Journal of General Internal Medicine, online January 5, 2010.

Physical Activity Ups Women's Odds of Healthy Aging

Exercise reduces risk of falls, increases bone mineral density in elderly women

29 jan 2010---- Elderly women who follow a program of exercise are less likely to have falls and can improve bone mineral density compared to their non-exercising counterparts, according to a study in the Jan. 25 issue of the Archives of Internal Medicine, while another study found that higher levels of physical activity in middle age are associated with better health later in life.

Wolfgang Kemmler, Ph.D., of Friedrich-Alexander University of Erlangen-Nuremberg in Germany, and colleagues conducted a study of 246 women who were randomized to either an 18-month exercise program or a wellness program. They found that bone mineral density of the lumbar spine and femoral neck improved and the participants had fewer falls than those in the control group, and that the intervention incurred no extra direct costs.

Qi Sun, M.D., of the Harvard School of Public Health in Boston, and colleagues conducted a study of 13,535 nurses who were healthy in 1986 and who were aged 70 years or older between 1995 and 2001. They found that those in the top three quintiles for activity were more likely than those in the lowest quintiles to be free of 10 major chronic diseases, or physical or mental impairment.

"The notion that physical activity can promote successful survival rather than simply extend the lifespan may provide particularly strong motivation for initiating activity," the authors write.

Abstract - Kemmler
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Overweight septuagenarians live longer: study

WASHINGTON, 28 jan 2010-- – Overweight septuagenarians are less likely to die within 10 years than people of "normal" weight in the same age group, an Australian study said Thursday.

The study in the Journal of the American Geriatrics Society followed 4,677 men and 4,563 women aged 70 to 75 for a ten-year period from 1996.

In addition to their "body mass index," or BMI, which estimates a person's body fat, the researchers also took into account the state of their health and their lifestyle.

Participants whose body mass index was classified as overweight were 13 percent less likely to die than those classified as being of normal weight.

The benefits, however, were seen only in those who were overweight but not obese.

"These results add evidence to the claims that the WHO (World Health Organization) BMI thresholds for overweight and obese are overly restrictive for older people. It may be timely to review the BMI classification for older adults," said Leon Flicker, of the University of Western Australia and the lead researcher.

Although excess pounds reduced the risk of death among both men and women over 70, a sedentary lifestyle was found to double the risk among women, and to bump it up by 25 percent among men.

"Our study suggests that those people who survive to age 70 in reasonable health have a different set of risks and benefits associated with the amount of body fat to younger people, and these should be reflected in BMI guidelines," Flicker said.

The body mass index is calculated by dividing a person's weight in kilograms by the square of their height in meters.

A body mass index of between 18.5 and 24.9 is considered normal. A person with a BMI of 25 to 30 is classified as overweight, and as obese if their BMI is over 30.

Ginkgo herbal medicines may increase seizures in people with epilepsy

28 jan 2010--Restrictions should be placed on the use of Ginkgo biloba (G. biloba) — a top-selling herbal remedy — because of growing scientific evidence that Ginkgo may increase the risk of seizures in people with epilepsy and could reduce the effectiveness of anti-seizure drugs, a new report concludes. The article appears in ACS' monthly Journal of Natural Products. It also suggests that Ginkgo may have harmful effects in other people after eating raw or roasted Ginkgo seed or drinking tea prepared from Ginkgo leaves.

Eckhard Leistner and Christel Drewke note that consumers use pills, teas, and other products prepared from leaves of the Ginkgo tree to treat a wide array of health problems. Those include Alzheimer's disease and other memory loss, clinical depression, headache, irritable bladder, alcohol abuse, blockages in blood vessels, poor concentration, and dizziness. Scientific concern focuses mainly on one chemical compound in the herb. It is a potentially toxic material known as ginkgotoxin.

They reviewed scientific research on Ginkgo, and found 10 reports indicating that patients with epilepsy who take Ginkgo products face an increased risk of seizures. They note that laboratory studies explain how Ginkgo could have that unwanted effect. Ginkgotoxin seems to alter a chemical signaling pathway in ways that may trigger epileptic seizures. Further evidence showed that Ginkgo can interact with anti-seizure medications and reduce their effectiveness. "Contrary to our own previous assumption, we are now convinced, however, that G. biloba medications and other products can have a detrimental effect on a person's health condition," the report concludes. "It is therefore important that the large number of G. biloba product users and their health care providers be made aware of these risks, in order to enable them to make informed decisions about the use of these preparations."

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Physical Activity Ups Women's Odds of Healthy Aging

Exercise reduces risk of falls, increases bone mineral density in elderly women

27 jan 2010-- Elderly women who follow a program of exercise are less likely to have falls and can improve bone mineral density compared to their non-exercising counterparts, according to a study in the Jan. 25 issue of the Archives of Internal Medicine, while another study found that higher levels of physical activity in middle age are associated with better health later in life.

Wolfgang Kemmler, Ph.D., of Friedrich-Alexander University of Erlangen-Nuremberg in Germany, and colleagues conducted a study of 246 women who were randomized to either an 18-month exercise program or a wellness program. They found that bone mineral density of the lumbar spine and femoral neck improved and the participants had fewer falls than those in the control group, and that the intervention incurred no extra direct costs.

Qi Sun, M.D., of the Harvard School of Public Health in Boston, and colleagues conducted a study of 13,535 nurses who were healthy in 1986 and who were aged 70 years or older between 1995 and 2001. They found that those in the top three quintiles for activity were more likely than those in the lowest quintiles to be free of 10 major chronic diseases, or physical or mental impairment.

"The notion that physical activity can promote successful survival rather than simply extend the lifespan may provide particularly strong motivation for initiating activity," the authors write.

Abstract - Kemmler
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Car Crash Trauma Often Under-Detected in Elderly


Study finds triage system less sensitive to elderly victims

27 jan 2010-- Elderly people involved in motor vehicle crashes (MVCs) are often under-triaged and inappropriately treated for injuries that go undetected, according to a study in the January issue of the Journal of Emergency Nursing.

Jenelle M. Weber, R.N., of the Johns Hopkins Hospital in Baltimore, and colleagues conducted a review of 17 articles on geriatric trauma published between 2003 and 2009 to identify trends in the reporting of MVC-related injuries.

The researchers found that geriatric trauma resulting from MVCs was under-detected, which resulted in patients being inappropriately assigned to non-trauma centers. The existence of comorbidities compromised the accuracy of trauma assessments. Also, prehospital triage guidelines were less sensitive to older people versus younger people. Shock and head injuries were the leading causes of trauma-related mortality in elders, and the incidence of potentially fatal injuries, such as intracranial hemorrhage and spinal cord and thorax injuries, was higher than among younger victims.

"Detection of injuries in older adults involved in MVCs is likely to continue to be a challenge for emergency nurses," the authors write. "By remaining cognizant of the interaction between comorbid conditions, physiologic changes associated with aging, medications, and the most common patterns of traumatic injuries, emergency nurses will be well prepared to anticipate and recognize trauma in elderly MVC victims."

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Omega-3 Fatty Acids Linked to Less Change in Telomeres

Telomere length regarded as marker of biological age; higher omega-3s linked to less shortening

26 jan 2010-- Higher blood levels of omega-3 fatty acids are associated with a slower rate of telomere shortening in individuals with coronary artery disease, according to research published in the Jan. 20 issue of the Journal of the American Medical Association.

Ramin Farzaneh-Far, M.D., of the University of California in San Francisco, and colleagues analyzed data from 608 subjects with a history of myocardial infarction or coronary revascularization, coronary stenosis, or exercise-induced ischemia. Subjects underwent blood testing of the omega-3 fatty acids DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). They also underwent testing for leukocyte telomere length at baseline and at five years. Short chromosomal telomeres have previously been linked to cardiovascular morbidity and mortality.

The researchers found that those in the lowest quartile of omega-3s had the fastest rate of telomere shortening, and those in the highest quartile had the slowest rate. Each increase in baseline levels by one standard deviation was associated with a 32-percent decrease in odds of telomere shortening.

"One possible explanation for the association of omega-3 fatty acids with decelerated telomere attrition may lie in the paradigm of oxidative stress, a powerful driver of telomere shortening and organismal aging," the authors write. "A second potential mechanism for the association of slowing of omega-3 fatty acid levels with decelerated telomere attrition is increased activity of the enzyme telomerase."

A co-author reported financial ties to companies with an interest in omega-3s, and founded a company offering omega-3 testing.

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Metformin May Worsen Peripheral Neuropathy

Study finds drug associated with vitamin B12 deficiency and elevated levels of other nutrients

26 jan 2010-- Metformin treatment of type 2 diabetes is associated with vitamin B12 deficiency and more severe peripheral neuropathy, according to a study in the January issue of Diabetes Care.

Daryl J. Wile, M.D., and Cory Toth, M.D., of the University of Calgary in Canada, examined the levels of vitamin B12 (cobalamin [Cbl]), homocysteine (Hcy), and methylmalonic acid (MMA) in 122 patients with type 2 diabetes and concurrent symptomatic peripheral neuropathy, where 59 had more than six months of metformin treatment and 63 had not been exposed to metformin. The researchers note that metformin is associated with Cbl deficiency and elevated levels of Hcy and MMA, which may damage peripheral nerves.

Long-term metformin treatment was associated with lower serum Cbl levels and elevated fasting Hcy and MMA levels, the investigators found. These patients had more severe peripheral neuropathy based on clinical and electrophysiological measures (two scoring systems and nerve conduction studies), which was strongly associated with cumulative metformin dose.

"Metformin exposure may be an iatrogenic cause for exacerbation of peripheral neuropathy in patients with type 2 diabetes," the authors conclude. "Interval screening for Cbl deficiency and systemic Cbl therapy should be considered upon initiation of, as well as during, metformin therapy to detect potential secondary causes of worsening peripheral neuropathy."

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Lighter Sedation For Elderly During Surgery May Reduce Risk Of Confusion, Disorientation After

25 jan 2010--A common complication following surgery in elderly patients is postoperative delirium, a state of confusion that can lead to long-term health problems and cause some elderly patients to complain that they "never felt the same" again after an operation. But a new study by Johns Hopkins researchers suggests that simply limiting the depth of sedation during procedures could safely cut the risk of postoperative delirium by 50 percent.

"Merely by adjusting how a person is sedated can have a profound effect on their postoperative cognitive state," says study leader Frederick E. Sieber, M.D., an associate professor of anesthesia at the Johns Hopkins University School of Medicine and director of anesthesiology at Johns Hopkins Bayview Medical Center.

Sieber says propofol, a short-acting anesthetic commonly used to induce anesthesia and keep patients asleep, and similar anesthetics may not behave as the clear "on/off phenomena" they were long thought to be, with effects disappearing as soon as the drugs are withdrawn. "What our study indicates," he says, "is that there may be lingering effects of anesthesia that heretofore may not have been appreciated, especially in the elderly."

In a double-blind randomized study of 114 patients undergoing hip fracture repair at Johns Hopkins Bayview Medical Center, patients first received spinal block anesthesia and were then either lightly sedated with propofol or more deeply sedated with the same medication. The prevalence of postoperative delirium was significantly lower in the group that was lightly sedated. The findings, which appear in the January issue of Mayo Clinic Proceedings, suggest that one incident of delirium could be prevented for every 4.7 patients treated with light sedation. The average age of the patients in the study was 81.

In addition to decreasing the prevalence of postoperative delirium in the study's patients, lighter sedation was associated with a one-day reduction in the duration of delirium in those patients who still emerged from surgery confused and disoriented.

Deeply sedated patients were unresponsive during surgery, while the lightly sedated patients were able to respond to questions. Researchers judged how deeply sedated the patient became by placing an EEG monitor on the patient's forehead.

The prevalence of delirium in elderly patients after hip fracture repair surgery has been estimated, in various studies, at between 16 percent and 62 percent. While it usually resolves after 48 hours, delirium can persist and is associated with poor functional recovery, increased length of hospital stay, higher costs and a greater likelihood of placement in an assisted living facility after surgery. It may even increase the risk of death in the first year after surgery, according to Sieber.

Surgeons and anesthesiologists for years have struggled with the question of whether the postoperative delirium they see in their elderly patients is caused by the anesthesia they are using during surgery. Sieber and his colleagues hypothesize that some drug-induced alteration of brain activity is increasing the cognitive dysfunction in those who are more deeply sedated, though the exact mechanism remains uncertain.

Sieber says it is unclear whether the results would be the same with different sedative drugs or with patients who have more serious cognitive impairment prior to surgery. The patients in this study were either cognitively intact or had mild to moderate cognitive problems before having hip surgery.

Sieber says reducing the depth of sedation is a simple and cost-effective way to attack this problem, which is seen more often as the population continues to age. He hopes this study will change the practices of fellow anesthesiologists and help reduce the number of patients who suffer from postoperative delirium.

"Elderly patients, when they come to surgery, often are not afraid of dying. They want to know if they'll return to the same functional level mental as well as physical as before surgery," Sieber says. "That's what their real worries are."

In addition to Sieber, other Johns Hopkins researchers on the study were Khwaja J. Zakriya, M.D.; Allan Gottschalk, M.D., Ph.D.; Mary-Rita Blute, R.N.; Hochang B. Lee, M.D.; Paul B. Rosenberg, M.D.; and Simon C. Mears, M.D., Ph.D.

Source: Johns Hopkins Medicine

Common heart medications may also protect against Parkinson's disease, study finds

UCLA researchers have discovered that a specific type of medication used to treat cardiovascular conditions such as hypertension, angina and abnormal heart rhythms may also decrease the risk of developing Parkinson's disease.

25 jan 2010--In the first large-scale population-based study of its kind, Dr. Beate Ritz, professor of epidemiology at the UCLA School of Public Health, in collaboration with researchers from the Danish Cancer Society, found that a specific sub-class of dihydropyridine cardiovascular medications was associated with a 26 to 30 percent decrease in the risk of Parkinson's. The findings appear in an upcoming print edition of the journal Annals of Neurology and are currently available online.

Parkinson's disease, the second most common neurodegenerative disorder in the United States, is characterized by a loss of voluntary movement, the result of the death of neurons in an area of the brain known as the substantia nigra, which is involved in movement control.

Neurons of the substantia nigra that are important in Parkinson's are known to have calcium channels in their cell membranes. These calcium channels are structures that allow the cells to transmit electrical charges to each other. Muscles like the heart also contain calcium channels, and the opening of the calcium channel in the heart causes a muscle contraction.

Because cardiac and smooth muscles depend on calcium channels to function, substances that block or modify their action have been used for decades to treat hypertension, angina and arrhythmia in humans. In the heart, the dihydropyridine class of drugs acts on a specific type of channel known as the L-type. Within the dihydropyridine class is a sub-class of medications that can cross the blood-brain barrier, giving them the potential to act on neurons in the brain. It turns out that the neurons that degenerate in Parkinson's disease also contain a type of L-type calcium channel.

For their study, the researchers turned to Denmark, a country that provides its population with free and equal access to health care. Each health service–related event and prescription is recorded in a database using a unique personal identification number assigned to each Danish citizen at birth or the granting of citizenship.

Using this database, Ritz and her colleagues conducted a population-based, case-control study to evaluate medical histories and medication usage for 1,931 Parkinson's patients and 9,651 unaffected subjects for a period up to 12 years prior to the diagnosis of Parkinson's.

By separately evaluating different classes of a variety of drugs prescribed for hypertension, researchers found that only calcium channel blockers of the dihydropyridine sub-class that cross the blood-brain barrier were associated with a significant decrease in the risk of developing Parkinson's. Other classes of anti-hypertension medications, and dihydropyridines that were not able to cross the blood-brain barrier, were not associated with a lower risk.

"The key was to consider the mode of action of these drugs and whether or not they cross the blood-brain barrier," Ritz said. "Some do and some don't. We found that of all the hypertension medications taken by our study subjects, only the subset of dihydropyridine class drugs that cross into the brain, where they might be able to act on the calcium channels of neurons, provided a protective effect. This supports the idea that the mode of action of a given drug and whether it penetrates into the brain are important factors when studying drugs for neuroprotection."

Although the results are intriguing, Ritz cautions that more detailed studies and a more complete understanding of the biology underlying the action of these medications in the brain are warranted, particularly as some Parkinson's patients can suffer from low blood pressure, a condition which could be worsened by taking calcium channel blockers inappropriately.

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In addition to Ritz, study authors included Shannon L. Rhodes and Lei Qian of UCLA, Dr. Eva Schernhammer of Brigham and Women's Hospital and Harvard Medical School, and Dr. Jorgen Olsen and Dr. Soren Friis of the Danish Cancer Society. The authors declare no conflict of interest.

The study was supported by a grant from the U.S. National Institute of Environmental Health Sciences. Dr. Ritz also receives support from the U.S. National Institute of Neurological Disorders and Stroke, as part of the Center for the Study of Parkinson's Disease in the UCLA Department of Neurology.

Heart group lists 7 essentials for heart health

DALLAS, 22 jan 2010-- – Here are the seven secrets to a long life: Stay away from cigarettes. Keep a slender physique. Get some exercise. Eat a healthy diet and keep your cholesterol, blood pressure and blood sugar in check.

Research shows that most 50-year-olds who do that can live another 40 years free of stroke and heart disease, two of the most common killers, says Dr. Clyde Yancy, president of the American Heart Association. The heart association published the advice online Wednesday in the journal Circulation.

The group also is introducing an online quiz to help people gauge how close they are to the ideal. If you fall a bit short, it offers tips for improving.

"These seven factors — if you can keep them ideal or control them — end up being the fountain of youth for your heart," said Dr. Donald M. Lloyd-Jones, a cardiologist who was lead author of the statement. "You live longer, you live healthier longer, you have much better quality of life in older age, require less medication, less medical care."

Specifically, those with ideal cardiovascular health can answer yes to the following seven questions:

• Never smoked or quit more than one year ago.

• Body mass index less than 25.

• Get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.

• Meet at least four of these dietary recommendations: 4 1/2 cups of fruit and vegetables a day; two or more 3.5-ounce servings a week of fish; drink no more than 36 ounces of sugar-sweetened beverages a week; three or more 1-ounce servings of fiber-rich whole grains a day; less than 1,500 milligrams a day of salt.

• Total cholesterol of less than 200.

• Blood pressure below 120/80.

• Fasting blood glucose less than 100.

The online quiz calculates a score based on the answers, 10 being the ideal.

Doctors say the quiz is a good way for people to get a handle on how they're doing, especially since people often think they're doing better than they actually are.

The heart association found just that in a recent survey that showed 39 percent of Americans thought they had ideal heart health, yet 54 percent of those had been told they had either a heart disease risk factor or needed to make a lifestyle change to improve heart health, or both.

With America's obesity epidemic, weight especially is a pitfall for patients trying to meet these seven health factors, doctors say.

"Many people are surprised to find out how overweight they may be," said Dr. Randal Thomas, director of the cardiovascular health clinic at the Mayo Clinic.

Lloyd-Jones, also chair of the preventive medicine department at Northwestern University's Feinberg School of Medicine, said, "People I think are far too accepting of their waistlines."

Thomas praises the online tool for giving people a score so they'll have something to work toward. It offers advice for problem areas: for instance, advising someone who's over weight to set a goal of losing a pound a week by burning up to 3,500 more calories than are taken in.

Yancy, the heart association president and medical director of the Baylor Heart and Vascular Institute in Dallas, said the organization has a goal for 2020 of improving cardiovascular health of Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent.

He said that in the last decade, there's already been a nearly 40 percent reduction in death from heart disease and a nearly 35 percent reduction in death from stroke. He said those goals were achieved with improvements in treatments and prevention.

Linda Alvarado, 54, of Houston, said she knows how hard — and important — the changes can be. After having a quadruple bypass at the age of 47, she improved her diet and exercise, losing 40 pounds. Recently though, with a new 40-minute commute, some of those diet and exercise commitments have been put aside. While she's kept the lost pounds off, she would like to lose five more pounds.

"It's really up to you," Alvarado said.

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On the Net:

American Heart Association's My Life Check, http://www.heart.org/MyLifeCheck

How to live your life twice

Tel Aviv University psychologist busts a myth and offers tips to counter a mid-life crisis

22 jan 2010--Elliot Jacques coined the term "mid-life crisis" 40 years ago, when the average lifespan was 70 and "mid-life" came at age 35. Individuals could expect their quality of life to decline from that point forward, Jacques argued, so some extreme reactions to encroaching mortality were to be expected, such as having extra-marital affairs and buying a Corvette.

Not any more, says Prof. Carlo Strenger of Tel Aviv University's Department of Psychology. In an article co-authored with the Israeli researcher Arie Ruttenberg for the Harvard Business Review last year, and another in the journal Psychoanalytic Psychology, Prof. Strenger posits that the mid-life years are the best time of life to flourish and grow.

Citing research based on empirical evidence and studies from the field, Prof. Strenger says that adult lives really do have second acts.

"Somehow this line has been drawn around the mid and late 40s as the time for a mid-life crisis in our society," says Prof. Strenger. "But as people live longer and fuller lives, we have to cast aside that stereotype and start thinking in terms of 'mid-life transition' rather than 'mid-life crisis.'" He dismisses the prevailing myth that reaching the years between the 40s and the early 60s means adapting to diminished expectations, both internally and from society.

Thirty-five years of learning

"If you make fruitful use of what you've discovered about yourself in the first half of your life," Dr. Strenger argues, "the second half can be the most fulfilling."

Most people make many of their most important life decisions before they really know who they are, he says. By age 30, most Americans have already married, decided where to live, bought their first home, and chosen their career. "But at 30, people still have the better part of their adult years ahead of them," Prof. Strenger says.

The good news is that extended life expectancy, better health practices, education, and a greater emphasis on emotional self-awareness and personal fulfilment have reversed the chances that one will have a mid-life crisis. Neurological research has also disproved the notion that the brain deteriorates after 40. "A rich and fruitful life after 50 is a much more realistic possibility," he says.

Four tips to avoid a mid-life crisis

How can you transition smoothly through the best years of your life?

"First, and most important," Prof. Strenger suggests, "invest some sincere thought in the fact that you have more high-quality adult years ahead of you than behind you. Realize what that means in planning for the future."

Second, he says, think about what you've learned about yourself so far. Consider what you've found to be your strongest abilities and about the things that most please you, not what your parents or society expected of you when you were young.

Third, don't be afraid of daunting obstacles in making new changes. "Once you realize how much time you have left in this world, you will find it is profoundly worth it to invest energy in changing in major ways. A new career choice is not an unreasonable move, for example," Dr. Strenger advises. And you may now have a better chance of succeeding, because your choices will be based on knowledge and experience, rather than youthful blind ambition.

Finally, Prof. Strenger says it is absolutely necessary to make use of a support network. Individuals should discuss major life changes with their colleagues, friends and families. The people who know you best will best be able to support you in the new directions you want to take, he advises, and a professional therapist or counsellor can also be helpful.

Prof. Stenger's 2004 book on the subject is The Designed Self, published by The Analytic Press. His latest book, Critique of Global Unreason: Individuality and Meaning in the Global Age, will be published by Palgrave this year.

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American Friends of Tel Aviv University (www.aftau.org) supports Israel's leading and most comprehensive center of higher learning. In independent rankings, TAU's innovations and discoveries are cited more often by the global scientific community than all but 20 other universities worldwide.

Internationally recognized for the scope and groundbreaking nature of its research programs, Tel Aviv University consistently produces work with profound implications for the future.

Drowsiness, staring and other mental lapses may signal Alzheimer's disease


ST. PAUL, Minn., 19 jan 2010–Older people who have "mental lapses," or times when their thinking seems disorganized or illogical or when they stare into space, may be more likely to have Alzheimer's disease than people who do not have these lapses, according to a study published in the January 19, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

These mental lapses, also called cognitive fluctuations, are common in a type of dementia called dementia with Lewy bodies, but researchers previously did not know how frequently they occurred in people with Alzheimer's disease and, equally important, what effect fluctuations might have on their thinking abilities or assessment scores.

The study involved 511 people with an average age of 78. Researchers interviewed the participant and a family member, evaluated the participants for dementia and tested their memory and thinking skills.

People with three or four of the following symptoms met the criteria for having mental lapses:

•Feeling drowsy or lethargic all the time or several times per day despite getting enough sleep the night before
•Sleeping two or more hours before 7 p.m.
•Having times when the person's flow of ideas seems disorganized, unclear, or not logical
•Staring into space for long periods

A total of 12 percent of the people with dementia in the study had mental lapses. Of 216 people with very mild or mild dementia, 25 had mental lapses. Of the 295 people with no dementia, only two had mental lapses.

Those with mental lapses were 4.6 times more likely to have dementia than those without mental lapses. People with mental lapses also tended to have more severe Alzheimer's symptoms and perform worse on tests of memory and thinking skills than people who did not have lapses.

"When older people are evaluated for problems with their thinking and memory, doctors should consider also assessing them for these mental lapses," said senior study author James E. Galvin, MD, MPH, of Washington University School of Medicine in St. Louis, who is a member of the American Academy of Neurology.


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The study was supported by the National Institute on Aging.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience

professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Parkinson's disease, ALS (Lou Gehrig's disease), dementia, West Nile virus, and ataxia.

For more information about the American Academy of Neurology, visit http://www.aan.com.

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Loss of Smell Could Be Early Sign of Alzheimer's


19 jan 2010 -- New research in mice suggests that loss of smell could serve as an early indicator of Alzheimer's disease.


People with Alzheimer's are already known to suffer from loss of smell. But the new research pinpoints a direct link between development of amyloid plaques -- the bits of gunk in the brain that cause Alzheimer's disease -- and a worsening sense of smell.


The findings are reported in the Jan. 13 issue of the Journal of Neuroscience.


Researchers found that the plaques first develop in the part of the mouse brain that's devoted to the sense of smell. When tested, the mice with the plaques had to spend more time sniffing odors to remember them, and they had a hard time telling the difference between odors.


"What was striking in our study was that performance of the mouse in the olfactory behavior test was sensitive to even the smallest amount of amyloid presence in the brain as early as 3 months of age (equivalent to a young adult)," study co-author Daniel W. Wesson, of New York University School of Medicine and the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, N.Y., said in a university news release.


"This is a revealing finding because, unlike a brain scan, a laboratory-designed olfactory test may be an inexpensive alternative to early diagnosis of Alzheimer's," Wesson said.


More information


The Alzheimer's Association has more on Alzheimer's disease.

Seeing a diagnosis: How an eye test could aid Alzheimer's detection

A simple and inexpensive eye test could aid detection and diagnosis of major neurological diseases such as Alzheimer's at an earlier stage than is currently possible, according to new research by UCL scientists.

15 jan 2010--The research, led by Professors Francesca Cordeiro & Stephen Moss and published today in Cell Death & Disease, demonstrates a new technique that enables retinal, and therefore brain cell death, to be directly measured in real time. The method, demonstrated in an animal model, could not only refine diagnosis of neurodegenerative disorders and help track disease progress; it could also aid the assessment and development of new treatments.

The technique uses fluorescent markers that attach themselves to the relevant cells and indicate the stage of cell death. The retina is then observed using a customised laser ophthalmoscope. Until now, this kind of technique has only been used in cells in the lab, rather than in live animals. This research is therefore the first ever in vivo demonstration of retinal nerve cell death in Alzheimer's Disease.

Professor Cordeiro, UCL Institute of Ophthalmology, said: "The death of nerve cells is the key event in all neurodegenerative disorders – but until now it has not been possible to study cell death in real time. This technique means we should be able to directly observe retinal nerve cell death in patients, which has a number of advantages in terms of effective diagnosis. This could be critically important since identification of the early stages could lead to successful reversal of the disease progression with treatment.

"Currently, the biggest obstacle to research into new treatments for neurodegenerative diseases is the lack of a technique where the brain's response to new treatments can be directly assessed – this technique could potentially help overcome that."

Although this paper outlines the technique in animal models (rats and mice), Professor Cordeiro's team are further along with work using the same technique to detect and assess glaucoma, and will be conducting their first patient trials later this year.

She added: "The equipment used for this research was customised to suit animal models but is essentially the same as is used in hospitals and clinics worldwide. It is also inexpensive and non-invasive, which makes us fairly confident that we can progress quickly to its use in patients.

"Few people realise that the retina is a direct, albeit thin, extension of the brain. It is entirely possible that in the future a visit to a high-street optician to check on your eyesight will also be a check on the state of your brain."

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The research was supported by funding from The Wellcome Trust and The Foundation Fighting Blindness. The project has also been supported by UCL Business proof of concept funds and two patents have been filed around this technology.

Notes to Editors

1.) For more information or to interview the researchers quoted, please contact Ruth Howells in the UCL Media Relations Office on tel: +44 (0)20 7679 9739, mobile: +07790 675 947, email: ruth.howells@ucl.ac.uk

2.) The paper, 'Imaging multiple phases of neurodegeneration: a novel approach to assessing cell death in vivo', is published today in Cell Death & Disease. For copies of the paper, please contact UCL Media Relations. This new journal is published by the Nature Publishing Group.

3.) Images are available from UCL Media Relations. Caption: Retinal cell death in the Alzheimer Triple Transgenic model. Retinal images of a living 14-month Alzheimer Triple Transgenic (3xTg-AD (a) compared to an aged control living mouse (b). Many more retinal nerve cells are in the early phase of apoptosis (green spots) in the Alzheimer mouse.

About UCL

Founded in 1826, UCL was the first English university established after Oxford and Cambridge, the first to admit students regardless of race, class, religion or gender, and the first to provide systematic teaching of law, architecture and medicine. UCL is the fourth-ranked university in the 2009 THES-QS World University Rankings. UCL alumni include Marie Stopes, Jonathan Dimbleby, Lord Woolf, Alexander Graham Bell, and members of the band Coldplay. UCL currently has over 12,000 undergraduate and 8,000 postgraduate students. Its annual income is over £600 million.

UC Davis research confirms benefits of calcium and vitamin D in preventing fractures

Calif., 15 jan 2010— Taking both calcium and vitamin D supplements on a daily basis reduces the risk of bone fractures, regardless of whether a person is young or old, male or female, or has had fractures in the past, a large study of nearly 70,000 patients from throughout the United States and Europe has found.

The study included data published in 2006 from clinical trials conducted at UC Davis in Sacramento as part of the Women's Health Initiative (WHI). It appears online in this week's edition of the British Medical Journal.

"What is important about this very large study is that goes a long way toward resolving conflicting evidence about the role of vitamin D, either alone or in combination with calcium, in reducing fractures," said John Robbins, professor of internal medicine at UC Davis and a co-author of the journal article. "Our WHI research in Sacramento included more than 1,000 healthy, postmenopausal women and concluded that taking calcium and vitamin D together helped them preserve bone health and prevent fractures. This latest analysis, because it incorporates so many more people, really confirms our earlier conclusions."

Led by researchers at Copenhagen University in Denmark, Robbins and an international team of colleagues analyzed the results of seven large clinical trials from around the world to assess the effectiveness of vitamin D alone or with calcium in reducing fractures among people averaging 70 years or older. The researchers could not identify any significant effects for people who only take vitamin D supplements.

Among the clinical trial results analyzed was Robbins' WHI research, which was part of a 15-year, national program to address the most common causes of death, disability and poor quality of life in postmenopausal women such as cardiovascular disease, cancer and osteoporosis. Those trials were primarily designed to study the effect of calcium and vitamin D supplementation in preventing hip fractures, with a secondary objective of testing the supplements on spine and other types of fractures, as well as on colorectal cancer. The results were published in the Feb. 16, 2006 edition of the New England Journal of Medicine.

Fractures are a major cause of disability, loss of independence and death for older people. The injuries are often the result of osteoporosis, or porous bone, a disease characterized by low bone mass and bone fragility. The National Osteoporosis Foundation estimates that about 10 million Americans have osteoporosis; 80 percent of them are women. Four of 10 women over age 50 will experience a fracture of the hip, spine or wrist in their lifetime, and osteoporosis-related fractures were responsible for an estimated $19 billion in health-related costs in 2005.

"This study supports a growing consensus that combined calcium and vitamin D is more effective than vitamin D alone in reducing a variety of fractures," said Robbins. "Interestingly, this combination of supplements benefits both women and men of all ages, which is not something we fully expected to find. We now need to investigate the best dosage, duration and optimal way for people to take it."

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UC Davis Health System is an academic health center that includes a top-ranked school of medicine, a 613-bed acute care hospital, the Betty Irene Moore School of Nursing, a National Cancer Institute-designated cancer center, the unique MIND Institute for the study of neurodevelopmental disorders, a comprehensive children's hospital, a level 1 trauma center and outpatient clinics in communities throughout the Sacramento region. Consistently ranked among the nation's top medical schools and best hospitals, UC Davis has established itself as a national leader in telehealth, rural medicine, cancer, neurodevelopmental disorders, vascular medicine, and trauma and emergency medicine. Other areas of research strength include clinical and translational science, regenerative medicine, infectious disease, neuroscience, functional genomics and mouse biology, comparative medicine and nutrition, among many others.

'Longevity Gene' Helps Prevent Memory Decline And Dementia

14 jan 2010--Scientists at Albert Einstein College of Medicine of Yeshiva University have found that a "longevity gene" helps to slow age-related decline in brain function in older adults. Drugs that mimic the gene's effect are now under development, the researchers note, and could help protect against Alzheimer's disease.

The paper describing the Einstein study is published in the January 13 edition of the Journal of the American Medical Association.

"Most work on the genetics of Alzheimer's disease has focused on factors that increase the danger," said Richard B. Lipton, M.D., the Lotti and Bernard Benson Faculty Scholar in Alzheimer's Disease and professor and vice chair in the Saul R. Korey Department of Neurology at Einstein and senior author of the paper. As an example, he cites APOE ε4, a gene variant involved in cholesterol metabolism that is known to increase the risk of Alzheimer's among those who carry it.

"We reversed this approach," says Dr. Lipton, "and instead focused on a genetic factor that protects against age-related illnesses, including both memory decline and Alzheimer's disease."

In a 2003 study, Dr. Lipton and his colleagues identified the cholesteryl ester transfer protein (CETP) gene variant as a "longevity gene" in a population of Ashkenazi Jews. The favorable CETP gene variant increases blood levels of high-density lipoprotein (HDL) - the so-called good cholesterol - and also results in larger-than-average HDL and low-density lipoprotein (LDL) particles.

The researchers of the current study hypothesized that the CETP longevity gene might also be associated with less cognitive decline as people grow older. To find out, they examined data from 523 participants from the Einstein Aging Study, an ongoing federally funded project that has followed a racially and ethnically diverse population of elderly Bronx residents for 25 years.

At the beginning of the study, the 523 participants - all of them 70 or over - were cognitively healthy, and their blood samples were analyzed to determine which CETP gene variant they carried. They were then followed for an average of four years and tested annually to assess their rates of cognitive decline, the incidence of Alzheimer's disease and other changes.

"We found that people with two copies of the longevity variant of CETP had slower memory decline and a lower risk for developing dementia and Alzheimer's disease," says Amy E. Sanders, M.D., assistant professor in the Saul R. Korey Department of Neurology at Einstein and lead author of the paper. "More specifically, those participants who carried two copies of the favorable CETP variant had a 70 percent reduction in their risk for developing Alzheimer's disease compared with participants who carried no copies of this gene variant."

The favorable gene variant alters CETP so that the protein functions less well than usual. Dr. Lipton notes that drugs are now being developed that duplicate this effect on the CETP protein. "These agents should be tested for their ability to promote successful aging and prevent Alzheimer's disease," he recommends.

Other co-authors of the paper, "Association of a Functional Polymorphism in the Cholesteryl Ester Transfer Protein (CETP) Gene with Memory Decline and Incidence of Dementia," are Cuiling Wang, Ph.D., Mindy Katz, M.P.H., Carol A. Derby, Ph.D., and Nir Barzilai, M.D., from Einstein, and Laurie Ozelius, Ph.D., from Mt. Sinai School of Medicine.

The research was funded by the National Institute on Aging, one of the 27 institutes and centers of the National Institutes of Health.

Source: Deirdre Branley
Albert Einstein College of Medicine

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Vitamin D Levels Linked to Cardiovascular Mortality

Lower levels among African-Americans may explain racial disparities observed in CV mortality

14 jan 2010-- Low vitamin D levels are associated with increased cardiovascular mortality, and may explain why African-Americans have higher rates of cardiovascular mortality than Caucasians, according to a study in the January/February issue of the Annals of Family Medicine.

Kevin Fiscella, M.D., of the University of Rochester School of Medicine and Dentistry in New York, and colleagues analyzed data from the third National Health and Nutrition Examination Survey 1988 to 1994 and cause-specific mortality through 2001 from the National Death Index.

Compared to subjects with the three highest quartiles of vitamin D levels, the researchers found that those in the lowest quartile had a higher adjusted risk of cardiovascular death (incident rate ratio, 1.40). They also found that the higher age- and sex-adjusted cardiovascular mortality among African-Americans (incident rate ratio, 1.38) was reduced after adjustment for vitamin D levels (incident rate ratio, 1.14) and eliminated after additional adjustment for income (incident rate ratio, 1.01).

"Randomized controlled trials of vitamin D supplementation in those with low 25(OH)D levels are needed to determine whether optimization of these levels improves outcomes from cardiovascular mortality, particularly among blacks, who bear a disproportionate burden of cardiovascular disease," the authors conclude.

Abstract
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Hypertension linked to dementia in older women

Study adds to evidence that high blood pressure causes brain lesions

BRONX, 13 jan 2010— Older women with hypertension are at increased risk for developing brain lesions that cause dementia later in life, according to data from the Women's Health Initiative Memory Study (WHIMS). The findings were published in the December 2009 online issue of the Journal of Clinical Hypertension.

The research was conducted as part of the Women's Health Initiative (WHI), the largest multi-site longitudinal study looking at health risks among postmenopausal women. WHIMS, which involves a subgroup of the women enrolled in WHI, looks at the influence of hormone therapy on thinking and memory. All the women in WHIMS were 65 or older.

Upon enrolling in the trial and annually during their participation in it, the women had their blood pressure measured and underwent tests to measure their cognitive ability. Some of the WHIMS participants – 1,403 of them – also underwent magnetic resonance imaging (MRI) at 14 U.S. academic centers in 2005 and 2006. All of these women were free of dementia when they enrolled. Examination of the data on these 1,403 women was led by Lewis H. Kuller, M.D., Dr.P.H., of the University of Pittsburgh, in conjunction with researchers at other WHI centers, including Dr. Sylvia Wassertheil-Smoller, Ph.D., professor of epidemiology and population health and the Dorothy and William Manealoff Foundation & Molly Rosen Chair in Social Medicine at Albert Einstein College of Medicine. Dr. Wassertheil-Smoller is also the principal investigator of Einstein's WHI and WHIMS studies.

The MRI studies revealed that women who, on entry to the WHIMS trial, had elevated blood pressure (defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥ 90 mmHg, or being on antihypertensive drug therapy), had significantly higher amounts of white matter lesions (WMLs) when they underwent MRIs eight years later. Normal blood pressure is defined as a systolic blood pressure of 120 or less and a diastolic pressure of 80 or less.

"Based on our findings, we would encourage women to maintain their blood pressure at normal levels, which may reduce their risk of dementia," says study co-author Dr. Wassertheil-Smoller.

The small blood vessels in the brain are especially susceptible to damage from even moderately elevated blood pressure – resulting in damage to the white matter served by those vessels. The brain's white matter is composed of whitish myelin-coated axons (nerve cell appendages) that allow nerve cells to communicate with each other and help the regions of the brain work together. Several studies have found that damage to white matter, as indicated by the presence of WMLs, seems to be an independent risk factor for dementia.

The current study reinforces earlier research showing that hypertension plays a role in causing dementia, suggesting that preventing hypertension from developing – through weight loss, exercise or other lifestyle changes – would be beneficial.

"However, we don't know whether hypertension treatment will prevent WMLs from developing, or how much blood pressure should be lowered so that these brain lesions won't occur," says Dr. Wassertheil-Smoller. "We do have suggestive evidence that the progression of WMLs can be slowed by anti-hypertensive therapy."

"Nonetheless," she adds, "it would be prudent for women to keep their blood pressure low, and the earlier in life they start doing so, the better. At present, keeping blood pressure at normal levels is probably the most effective way we know of to prevent dementia from occurring." According to baseline data on more than 98,705 women ages 50-79 who enrolled in the WHI study, 37.8% had hypertension, which is defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg or being on medication for high blood pressure; 64.3% of the hypertensive women were treated with drugs, and blood pressure was controlled in only 36.1% of the hypertensive women, with lower rates of control in the oldest group.

Dr. Wassertheil-Smoller notes that high blood pressure is also a major risk factor for stroke, "so it is certainly not good for the brain." She says that further clinical trials are needed to better establish whether anti-hypertensive therapy can prevent or slow WMLs, and, if so, to find the specific drug therapies that work best.

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The study, "Relationship of Hypertension, Blood Pressure (BP) and BP Control with White Matter Abnormalities in the Women's Health Initiative Memory Study (WHIMS) MRI Study," was published in the December 16 online edition of the Journal of Clinical Hypertension. Other contributors include: Karen L. Margolis, M.D., Health Partners Research Foundation, Minneapolis, Minn.; Sarah A. Jaramillo, M.S. and Jeff Williamson, M.D., Wake Forest University School of Medicine, Winston-Salem, N.C.; Nick R. Bryan, M.D., University of Pennsylvania, Philadelphia, Penn.; Diana Kerwin, M.D., Froedtert & Medical College of Wisconsin, Milwaukee, Wis.; Marian Limacher, M.D., University of Florida, Gainesville, Fla.; and Jennifer G. Robinson, M.D., M.P.H., University of Iowa, Iowa City, Iowa.

Web-based curriculum in rational prescribing wins geriatrics Educational Product of the Year Award

WINSTON-SALEM, 13 jan 2010 – "Principles of Rational Prescribing," a web-based lesson developed by faculty at Wake Forest University School of Medicine, was voted "Educational Product of the Year" recently among products developed by 40 academic geriatrics programs in the United States.

The designation was made at the national meeting of grantees of the Donald W. Reynolds Foundation, which funds comprehensive programs to strengthen physicians' training in geriatrics.

"Principles of Rational Prescribing" is part of the SmartPrescribe curriculum, developed at the School of Medicine to combat the influence that increasing drug company marketing can have on physician prescribing. The 30-minute interactive "Principles of Rational Prescribing" lesson is now also featured as the Editor's Choice on the curricular clearinghouse, Portal of Geriatrics Online Education (www.POGOe.org).

"There is a big concern now about drugs being over marketed, and with consumer marketing being so prevalent, sometimes brand-name drugs are being prescribed too often for conditions where there is not sufficient research to support that use," said Janice S. Lawlor, M.P.H., SmartPrescribe program coordinator at the School of Medicine.

"Older adults are particularly vulnerable to the effects of less than optimal prescribing, such as potentially inappropriate medications, avoidable interactions, and off-label prescribing of drugs," added Hal H. Atkinson, M.D., M.S. Atkinson co-developed the rational prescribing lesson with colleague Kaycee M. Sink, M.D., M.A.S. "Our interactive module provides case-based discussions, mini-lectures, and a drug interaction game that physicians, including those in practice for many years, have found effective."

In addition to the rational prescribing lesson, the SmartPrescribe curriculum includes lessons aimed at teaching clinicians about critically assessing clinical trial reports, the U.S. Food and Drug Administration's approval process for new drugs, marketing techniques used by drug companies, and avoiding and managing marketing influence in physician practice. Using videos, surveys, quizzes and slides, the overall SmartPrescribe program also breaks down the research on drug company marketing to educate users that:

• Drug companies spend more than $27 billion each year on marketing – and about $8,200 per physician each year on sales representative visits to practices.
• Many marketing efforts have been shown to directly influence how often some drugs are prescribed.
• The majority of off-label prescribing is for uses with little or no supporting scientific evidence.

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In addition to Lawlor, Atkinson and Sink, the Wake Forest team that developed SmartPrescribe includes principal investigator Curt D. Furberg, M.D., Ph.D., David L. Bowton, M.D., David P. Miller, M.D., and Roger T. Anderson, Ph.D., now a faculty member of Penn State College of Medicine.

The SmartPrescribe team received a grant to develop the lessons from the Attorney General Consumer and Prescriber Education Grant Program, funded by a multi-state settlement of consumer fraud claims involving Neurontin®. That drug received Food and Drug Administration approval for treating epilepsy but was marketed by the manufacturer for conditions including migraines and psychiatric disorders. It is illegal to market drugs for off-label uses.

The National Public Health Association also recently endorsed SmartPrescribe for use by its members.

What Connects The Elderly And Sports People? Smart Sensor Technology

Innovative smart sensing devices promise to boost mobility and quality of life for the elderly, reduce healthcare costs and even give sports people an edge through more effective training.

11 jan 2010--The wireless devices are currently being sold by McRoberts, a Netherlands-based company that developed them as part of the SensAction-AAL project, an EU-funded initiative to create remote mobility monitoring solutions coordinated by the University of Bologna.

Unlike many health monitoring systems that require multiple sensors as well as separate components for data storage and transmission, the DynaPort Hybrid device and MoveMonitor application developed by the SensAction-AAL researchers carry out movement sensing, data collection and data transmission in a single compact package. Worn on the user's waist in a special elastic belt, the devices monitor and record a person's physical movement and body posture, assist them in performing rehabilitation exercises, and can be configured to automatically alert emergency services in the event of a fall.

More data, better treatment

"These devices respond to a growing demand from the medical community for the long-term collection of data from people with mobility problems and motor disorders. The information they gather allows doctors to better understand a patient's symptoms and in turn treat them more effectively," explains Rob van Lummel, the founder and president of McRoberts, whose devices are now sold in more than 20 countries.

Van Lummel points to the case of neurologists attempting to treat sufferers of Parkinson's disease. Until now they have had to mostly base their assessment of the severity of the patient's mobility problems on the patient's own descriptions. However, such accounts often provide an incomplete picture as people vary in how they interpret events affecting their mobility, from falls to difficulty standing, and may not remember all of them. Objective information, gathered by sensors, fills the gaps, providing a more detailed picture and ultimately leading to more accurate diagnosis and more effective treatment.

"A key feature of our devices is that they allow data to be gathered over a longer period of time, from three to seven days. This is important because doctors need to see how mobility problems affect people during their daily lives and while performing different activities," Van Lummel says.

McRoberts' DynaPort Hybrid device runs for 75 hours on a single battery charge and, at just 14mm thick and weighing just 74 grams, it is light and comfortable to wear. Movement and posture data, gathered from internal gyroscopes and accelerometers, is stored on flash memory and can be transmitted to a doctors or user's PC via the Bluetooth wireless protocol.

Besides improving the diagnosis of mobility problems, the devices can also greatly assist patient rehabilitation by translating movement data into audio and/or tactile signals that let a patient know if they are performing exercises correctly, thereby improving their motion and posture awareness. Used as part of a comprehensive rehabilitation programme, the application allows patients to carry out exercises at home with remote supervision rather than having to visit hospitals and rehabilitation centres.

Cost savings for healthcare providers

"We are certain that, in the future, more and more healthcare services will be provided remotely in the home rather than in hospitals," Van Lummel says.

Such a shift seems inevitable in light of demographic changes. Today, nearly 14 percent of Europe's population is older than 65, but by 2050 that proportion is expected to double, necessitating dramatic changes in the way healthcare is provided if spiralling costs are to be avoided. And because mobility problems are more likely to occur in old age, whether as a result of deteriorating eyesight and balance or due to age-related diseases, such as Alzheimer's and Parkinson's, it is a field of research that is drawing increased interest from both public healthcare systems and private healthcare providers.

"We are seeing a lot of interest in remote monitoring solutions," notes Lorenzo Chiari, the coordinator of the SensAction-AAL project at the University of Bologna in Italy. "Patients like the sense of safety and reassurance they provide, while healthcare providers see the potential to provide better treatment at lower cost.

Van Lummel notes that the price of remote monitoring using McRoberts' products averages out to about 25 euros per patient per week if they are used just 30 weeks a year, a relatively small sum compared to the time and financial cost of gathering mobility data in a hospital or having patients visit a clinic for rehabilitation sessions.

McRoberts is focusing on selling its products in the "huge" healthcare market, although Van Lummel and Chiari note that they could equally be put to use in the sports world, in ergonomics or to monitor workers in hazardous environments.

"A similar application to that used for rehabilitation could be used for training athletes, or a gymnast or dancer could use it to improve balance," Chiari says.

One of the project partners, STMicroelectronics, is even incorporating research from the SensAction-AAL project into its MotionBee range of wireless sensors for remote motion recognition and tracking in many different application areas, including healthcare, security, industrial control and environmental monitoring.

SensAction-AAL was funded under the ICT strand of the EU's Sixth Framework Programme for research.

This is the second of a two-part special feature on SensAction-AAL appearing on ICT Results.

Source: ICT Results

Technological Safety Net For Fall Prone Elderly

11 jan 2010--Falls are the main cause of injuries among elderly people, but until now doctors have had few ways of effectively monitoring and counteracting mobility problems among patients. Work by European researchers is set to change that.

Mobility problems, ranging from frequent accidental falls to difficulty standing up or walking, affect millions of Europeans both young and old. Elderly people in particular become more liable to trip due to poor eyesight or poor balance, while health complications, such as strokes and circulatory problems, or debilitating diseases like Parkinson's and Alzheimer's can make performing everyday tasks even reaching into a cupboard difficult or even dangerous.

Injuries caused by falls among the elderly range from mild scrapes and bruises to serious complications requiring long-term treatment. Nine out of ten hip fractures, for example, occur in people over 50 and 80 percent of them women.

"Falls and other mobility problems have a major societal and economic impact," says Lorenzo Chiari, a researcher at the University of Bologna, Italy. "For the elderly, there is not only the risk of physical injury but also the psychological trauma falling causes and the long-term effects mobility problems have on quality of life. For healthcare systems, the costs of treating injuries caused by falls are only going to escalate as Europe's population ages."

In Chiari's view, new technology offers a solution. Just as advances in sensing devices and wireless communications are allowing doctors to monitor their patients' vital signs remotely through so-called telecare and telemedicine systems, similar technology can be used to monitor, prevent and detect mobility problems.

Monitoring mobility remotely

The approach, developed by a team of researchers led by Chiari as part of the EU-funded SensAction-AAL project, involves using a wearable, wireless-enabled device equipped with motion sensors to monitor people susceptible to falls. The information can then be used to help patients perform rehabilitation exercises to improve their balance and mobility, evaluate the progression of a disorder or, crucially, alert emergency services, doctors or relatives in the event of a fall.

"Falls in which a person does not get up, so-called unrecovered falls, are usually a sign that they need immediate assistance. But detecting them remotely is not easy. The main challenge is developing a software algorithm that can differentiate between an unrecovered fall and something less serious," Chiari explains.

The SensAction-AAL team's software is able to detect unrecovered falls with a high degree of accuracy and send an SMS or e-mail alert immediately. That makes it a potentially life-saving technology in the event that a user has suffered a heart attack, stroke or other serious health incident.

The software is embedded in the same compact device, designed to be worn around the waist, which also contains the gyroscopes and accelerometers used to carry out the motion and position sensing. Bluetooth or Zigbee wireless communications technology connect it to the user or doctor's computer and, via an internet connection, to a secure database and server.

"We wanted to ensure that the device was comfortable, compact and simple to use. We didn't want to have sensors and wires connected to people's arms, legs and chests as it is not very comfortable or practical for the patient," Chiari says. "Combined with the sense of safety and reassurance that remote monitoring gives patients, I think the design helped us overcome the obstacles that often occur when introducing new technology to older people."

Besides alerting caregivers in the event of an emergency, the SensAction-AAL system also provides doctors with long-term information about patients' mobility, including objectively reporting falls that may otherwise go unreported, masking potentially serious health problems.

"Such information, taken from many patients will help the medical community gain a better understanding of what causes falls and what happens before, during and after a fall, ultimately leading to better preventive care," Chiari says.

In addition, the SensAction-AAL system can assist people undergoing rehabilitation programmes by encouraging them to perform prescribed exercises. Patients' movements, picked up by the accelerometers and gyroscopes, can be translated into feedback signals, such as sounds and vibrations emitted via an audio headset or small vibrating actuators on different parts of the user's body. The patients can learn to improve their balance and posture by responding to changes in pitch, tone and intensity.

"One application involves using the device as an MP3 player so the user can listen to their favourite music while exercising. If they move incorrectly the music will become distorted or change volume or tempo," Chiari says.

Improving quality of life

In trials conducted with sufferers of Parkinson's disease at three different sites in the Netherlands, Germany and Israel, test users were overwhelmingly positive in their evaluation of the system, underscoring particularly how increased monitoring can help their self-confidence and, in turn, improve their quality of life.

The wearable monitoring device developed by the project is currently being commercialised by project partner McRoberts, while other components and software have fed into products being developed or sold by other partners.

Chiari says that the consortium is interested in finding investment partners to help conduct more extensive clinical trials and develop a commercial version of the full system.

SensAction-AAL was funded under the ICT strand of the EU's Sixth Framework Programme for research.

This is the first of a two-part special feature on SensAction-AAL appearing on ICT Results.

Source: ICT Results

Could Your Cell Phone Help Shield You From Alzheimer's?

10 jan 2010---- Cell phone addicts of the world, listen up: Electromagnetic waves emanating from these ubiquitous gadgets may prevent or even reverse Alzheimer's disease, researchers say.

Normal mice who had long-term exposure to such electromagnetic waves avoided developing Alzheimer's, while mice who were already sick started getting better, scientists report in the Jan. 6 issue of the Journal of Alzheimer's Disease.

The findings were actually the opposite of what the researchers were expecting.

"You can imagine our surprise when we did our first memory assessment and they were actually better," said study author Gary Arendash, a research professor with the Florida Alzheimer's Disease Research Center, part of the University of South Florida in Tampa. "[And] we continued to see the beneficial effects in test after test, in group after group."

Although preliminary, the findings also raise the tantalizing possibility that exposing people to electromagnetic waves could stave off or treat the debilitating disorder, which currently affects 5.3 million people in the United States alone.

"This needs further study to figure out how well this carries over to other animals, but it does start making you think that maybe there's something to it," said Dr. Michael Palm, an assistant professor of neuroscience and experimental therapeutics and internal medicine at Texas A&M Health Science Center College of Medicine in College Station. "But I don't think we can quite jump to having people strap cell phones to their heads."

William Thies, chief medical and scientific officer at the Alzheimer's Association, agreed.

"This article is certainly no call to self-medicate by spending more time on your cell phone, especially in risky environments such as while driving," Thies said in a statement. "No one should feel they are being protected from Alzheimer's/dementia/cognitive decline by using their cell phones based on this study."

Thies believes the finding "needs to be replicated in animals before we begin to even consider trying it in people, as animal models of Alzheimer's and people with the disease are very different. Potential therapies that have been successful in mouse models of Alzheimer's have not worked in people."

Although various international health organizations have decided there are no health problems associated with cell phone-generated electromagnetic fields (EMFs), there's a paucity of data on the long-range effects of EMFs on the brain, the study authors noted.

And researchers are still trying to tease out any risks associated with regular cell phone use. For instance, one recent study found an association -- albeit a weak one -- between talking on the cell phone and brain tumors.

In the new study, the USF team exposed mice that were genetically engineered to have Alzheimer's disease to two one-hour sessions of high-frequency electromagnetic waves per day, for seven to nine months.

Healthy, younger mice exposed to the waves avoided developing Alzheimer's altogether, while older mice with Alzheimer's saw memory and other cognitive deficits improve, the researchers found.

Normal mice also developed better memory capacity after EMF exposure, the team noted.

Autopsies revealed that the waves had diminished the beta-amyloid protein plaques in the mouse brain -- plaques that are believed by many to cause Alzheimer's disease. The researchers hypothesized that an increase in brain temperature while being exposed to magnetic waves might be responsible for the change.

"In the Alzheimer's mice, the cell phone exposure seems to have two effects that directly affect the disease process," Arendash explained. "One is that electromagnetic fields suppress the aggregation of the bad protein. If the newly formed bad protein, beta amyloid, can't form plaques, it's more likely to be removed from the brain into the blood."

The second possible method of action is that exposure increases brain cell activity which, again, could help flush bad proteins out of the brain, Arendash said.

While raising hopes, the small animal study does leave a slew of other questions unanswered, Palm said.

"The mouse model for Alzheimer's doesn't correlate exactly with what people have," he noted.

And scientists don't know how well cell phone-generated electromagnetic waves might penetrate the much thicker human skull, he added.

The researchers also didn't look at neurofibrillary tangles, another hallmark of the disease typically found in the brain tissue of Alzheimer's patients.

"Is this the whole picture or not?" Palm asked.

According to Arendash, the researchers next want to see if they can speed up any beneficial effects on the brain by changing the frequency or strength of the electromagnetic waves. Safety is also a big concern. And, of course, the findings need to be replicated in humans, he said.

More information

There's more on this condition at the Alzheimer's Association.

Older Unsupported Women More Likely To Have Heart Failure With Preserved Systolic Function

10 jan 2010--Older women who have less social support and live in nursing homes are more likely to have heart failure with preserved systolic function than those who are married or living in their own home, according to the results of research published in the Medical Journal of Australia.

Dr Sepehr Shakib, from the Royal Adelaide Hospital, and his co-authors, including cardiologists Dr Dennis Wong and Dr Ben Dundon with social epidemiologist Dr Robyn Clark from the Samson Institute, University of South Australia, undertook a retrospective analysis of clinical data for 2961 patients admitted with chronic heart failure over a period of 10 years.

The authors found patients who had heart failure with preserved systolic function (HFPSF) were predominantly older women with less social support and a greater burden of comorbid conditions such as renal impairment, anaemia and atrial fibrillation compared with those with left ventricular systolic dysfunction.

There was also an increase in the risk of re-hospitalisation among patients with HFPSF. Dr Shakib said lack of social and carer support and a greater burden of comorbid conditions in patients with HFPSF may have played a significant predisposing role in hospitalisation and readmissions. "Our study is the first to identify significant differences in the social environment of these patients," Dr Shakib said.

"We propose that the burden of reduced survival in HFPSF may relate more to comorbid conditions than suboptimal cardiac management."

In an accompanying editorial in the MJA, Prof Peter MacDonald, Conjoint Professor of Medicine at the University of New South Wales, writes that there is an urgent need to gain a better understanding of the pathogenesis of HFPSF in order to identify additional preventive and treatment approaches. Prof MacDonald said this would be particularly challenging in a population exposed to multiple comorbid conditions, increasing physical frailty and social isolation.

"Optimal management of these patients will require a multidisciplinary approach with the general practitioner taking the central role," he said.

Source
Medical Journal of Australia

Healthy older adults with subjective memory loss may be at increased risk for MCI and dementia

09 jan 2009--Forgot where you put your car keys? Having trouble recalling your colleague's name? If so, this may be a symptom of subjective cognitive impairment (SCI), the earliest sign of cognitive decline marked by situations such as when a person recognizes they can't remember a name like they used to or where they recently placed important objects the way they used to. Studies have shown that SCI is experienced by between one-quarter and one-half of the population over the age of 65. A new study, published in the January 11, 2010, issue of the journal Alzheimer's & Dementia, finds that healthy older adults reporting SCI are 4.5 times more likely to progress to the more advanced memory-loss stages of mild cognitive impairment (MCI) or dementia than those free of SCI.

The long-term study completed by researchers at NYU Langone Medical Center tracked 213 adults with and without SCI over an average of seven years, with data collection taking nearly two decades. Further cognitive decline to MCI or dementia was observed in 54 percent of SCI persons, while only in 15 percent of persons free of SCI.

"This is the first study to use mild cognitive impairment as well as dementia as an outcome criterion to demonstrate the outcome of SCI as a possible forerunner of eventual Alzheimer's disease," said Barry Reisberg, MD, professor of psychiatry, director of the Fisher Alzheimer's Disease Program and director, Clinical Core, NYU Alzheimer's Disease Center at NYU Langone Medical Center. "The findings indicate that a significant percentage of people with early subjective symptoms may experience further cognitive decline, whereas few persons without these symptoms decline. If decline does occur in those without SCI symptoms, it takes considerably longer than for those with subjective cognitive symptoms."

According to the authors, scientists and physicians can now target the prevention of eventual Alzheimer's disease in the SCI stage, beginning more than 20 years before dementia becomes evident

"These intriguing results more fully describe the possible relationship between early signs of memory loss and development of more serious impairment. This is critical to know, as we look for ways to define who is at risk and for whom the earliest interventions might be successful," said Neil Buckholtz, PhD, National Institute on Aging (NIA) which supported the research. "These findings also underscore the importance of clinicians' asking about, and listening to, concerns regarding changes in cognition and memory among their aging patients."

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Co-authors of Dr. Reisberg at the NYU Alzheimer's Disease Center include Melanie B. Shulman, MD, Carol Torossian, PsyD, and Wei Zhu, PhD.

Primary funding for this study was provided by the NIA, which is part of the National Institutes of Health. Additional funding was provided by Mr. Leonard Litwin and the Fisher Center for Alzheimer's Research Foundation.

About NYU Langone Medical Center

NYU Langone Medical Center is one of the nation's premier centers of excellence in healthcare, biomedical research, and medical education. For over 168 years, NYU physicians and researchers have made countless contributions to the practice and science of health care. Today the Medical Center consists of NYU School of Medicine, including the Smilow Research Center, the Skirball Institute of Biomolecular Medicine, and the Sackler Institute of Graduate Biomedical Sciences; the three hospitals of NYU Hospitals Center, Tisch Hospital, a 705-bed acute-care general hospital, Rusk Institute of Rehabilitation Medicine, the first and largest facility of its kind, and NYU Hospital for Joint Diseases, a leader in musculoskeletal care; and such major programs as the NYU Cancer Institute, the NYU Child Study Center, and the Hassenfeld Children's Center for Cancer and Blood Disorders.