Should older men be screened for prostate cancer?

31 mar 2010-– Experts generally recommend against routinely using PSA blood tests to screen elderly men for prostate cancer, but using a strict age cutoff for when to stop screening may not be the best route either, a new study suggests.

Right now, there are conflicting opinions as to when men should stop being screened for prostate cancer using PSA, or prostate-specific antigen, tests.

Certain medical groups, like the American Urological Association and the American Cancer Society, say that PSA screening should be an option -- though not a routine procedure -- for any man whose health is good enough that he can expect to live at least 10 more years.

But 2008 guidelines from the U.S. Preventive Services Task Force (USPSTF) -- an independent panel of medical experts appointed by the federal government -- recommend against screening any man age 75 or older, regardless of his health.

The central problem with prostate cancer screening is that most prostate tumors are slow-growing and would not be deadly even without treatment. So screening can lead to unnecessary treatment of cancers that would never had been life-threatening, along with treatment's side effects.

According to the USPSTF's 2008 statement, there is "moderate certainty" that for men age 75 or older, the potential harms of prostate cancer screening outweigh the benefits.

For the new study, researchers looked at whether, before the 2008 guideline, U.S. doctors were appropriately using elderly men's health and life expectancy in recommending PSA testing.

Using data from 718 men age 75 and up who responded to a 2005 national health survey, the researchers found that 52 percent said they had had a PSA test in the past two years. Men who rated their own health as "fair" or "poor" were half as likely to have been tested as those who described their health as "very good" or "excellent."

Still, a substantial number of men who would not be expected to benefit from PSA screening were being tested nonetheless. Of the 182 men expected to live less than five years -- based on their age and reported health status -- 42 percent had had a recent PSA test.

That compared with 65 percent of the 214 men expected to live more than 10 years.

The findings, reported in the Journal of Urology, suggest that limiting PSA screening to men younger than 75 would prevent unnecessary testing of some men who would not benefit from treatment, according to lead researcher Dr. Karen E. Hoffman, of the University of Texas M.D. Anderson Cancer Center in Houston.

"However," she told Reuters Health by email, "the results also suggest a strict age cutoff may preclude the early detection of biologically aggressive prostate cancer in older men with a long life expectancy who may benefit from early detection and treatment of high-grade (aggressive) prostate cancer."

The study has its limits, Hoffman and her colleagues acknowledge -- including the fact that it relied on men's self-reported health and PSA screening history. Still, they say, the findings point to pros and cons of setting a strict age cutoff for PSA screening.

More research, the investigators write, is needed to understand the impact of using an age limit when it comes to screening healthy men.

The bottom line for older men, Hoffman said, is that they should talk with their doctors about the risks and benefits of PSA screening "in the context of their overall health status and their individual preferences."

But while doctors might recommend PSA screening to some men age 75 or older, there is no evidence yet that it lowers their risk of dying from the disease or extends their life expectancy overall.

Past clinical trials on prostate cancer screening have not included men in that age group, Hoffman said.

SOURCE: Journal of Urology, May 2010.

C-Reactive Protein Linked to Cognition in Older Adults

Higher levels of hs-CRP associated with poorer executive function performance, MRI findings

30 mar 2010-- Low-grade inflammation, as measured by high-sensitivity C-reactive protein (hs-CRP), is associated with cerebral microstructural disintegration and poorer performance in executive function in older adults, according to research published in the March 30 issue of Neurology.

Heike Wersching, M.D., of the University of Münster in Germany, and colleagues analyzed data from 447 individuals (mean age, 63 years) who provided a blood sample and underwent neuropsychological assessment. All were stroke-free. Of these, 321 also underwent high-field magnetic resonance imaging.

After adjustment for a variety of factors, including age and cardiovascular risk factors, the researchers found that higher levels of hs-CRP were associated with poorer performance in executive function. Higher levels of hs-CRP were also associated with lower global fractional anisotropy and regional fractional anisotropy scores of the corpus callosum, frontal lobes, and corona radiata. However, hs-CRP was not linked to white matter hyperintensity or brain atrophy.

"Recent interventional studies using anti-inflammatory drugs such as aspirin and statins to lower circulating CRP levels showed a significant reduction in the incidence of cardiovascular events. There is also evidence of a beneficial effect of lifestyle interventions on cognitive functions, such as physical activity and body weight control, which have been shown to decrease circulating CRP levels. Whether lowering of CRP can also prevent cognitive decline and/or microstructural white matter alterations needs to be addressed in upcoming clinical trials," the authors conclude.

Several co-authors reported financial relationships with pharmaceutical companies and publications.

Abstract

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Benefits of osteoporosis treatments outweigh possible risk of rare femoral fractures

The occurrence of an unusual type of fracture of the femur, or the thigh bone, is very low in patients with osteoporosis, including those treated with the drug family known as bisphosphonates, according to a new study led by a team of UCSF epidemiologists.

20 mar 2010--While these unusual femur fractures have been reported in case series studies in patients, particularly in those taking bisphosphonates, this UCSF study is the first to examine their occurrence systematically using data from randomized trials, the most rigorous type of study design. The study combined data from three bisphosphonate trials that involved more than 14,000 patients.

The new findings contextualize reports from the American Academy of Orthopaedic Surgeons and news stories on bisphosphonates and femur fractures that have appeared in recent weeks, according to study principal investigator Dennis Black, PhD, UCSF professor of epidemiology and biostatistics.

The study shows that these fractures remain rare even in a population of women who have been taking the drugs for as long as 10 years, said Black, who specializes in osteoporosis treatment and prevention in post menopausal women. While the risk was not significantly increased among the women taking bisphosphonates compared to placebo, the number of events was too low to definitely rule out a relationship, he said.

The study is scheduled to appear online on March 24, 2010 at NEJM.org and will be published in an upcoming print issue of the New England Journal of Medicine.

Bisphosphonates (marketed as Fosamax, Actonel, Boniva, and Reclast) are the most commonly used treatment for postmenopausal osteoporosis. They belong to the class of anti-restorative drugs that act by slowing bone degradation, or desorption, and thereby increase bone density and reduce the risk of fractures.

The UCSF researchers focused on fractures in the shaft of the femur. Breaks in this region are much less common than hip fractures that occur closer to the top of the bone and are most commonly associated with trauma.

Case reports in recent years have reported femur breaks in patients taking bisphosphonates, occurring with little trauma and having an atypical appearance on x-rays. However, there has been no rigorous large scale study to determine a relationship.

The UCSF study is now the first to do this, using data from the records of a total of 14,195 women who participated in three previous controlled, randomized bisphosphonate trials. The women ranged in age from 65 to 85, and the studies followed them for up to 10 years. There was a total of over 51,000 years of follow up in the three studies combined.

Black's team reevaluated the records for femur fractures in the three trials: two that studied use of oral alendronate (a placebo-controlled phase III trial and randomized extension to 10 years treatment) and one on the use of zoledronic acid (a placebo-controlled trial with the drug infused annually). The trials used similar protocols for original collection and classification of fractures.

In their analysis, the UCSF researchers considered the location of the fracture and compared occurrence in patients who received bisphosphonates versus those who received placeboes.

They reviewed records of 283 hip or femur fractures and found a total of 12 fractures in 10 women that were classified as subtrochanteric/diasphyseal femur fractures. They found no significant relationship between bisphosphonate use and increase in risk for these fractures, although the relatively small numbers preclude definitive conclusions, according to Black.

"We found that fractures are very rare, less then 3 per 10,000 years of treatment, even in populations treated for a very long time," Black said. "The trade-off between the risk of this type of fracture and the overall benefit of these medications to osteoporotic patients is striking. The public needs to understand the rare incidence of atypical femoral fractures and the high risk of debilitating fractures in patients with osteoporosis if left untreated. These are important risks and benefits for patients to weigh with their doctors."

He also recommends that patients taking bisphosphonates long term consult their doctors if they experience pain in their thighs, suggesting "It may be time to consider a drug holiday."

Black and his team recommend future studies to assess additional risk factors that could identify a subgroup of patients who might be more vulnerable to rare subtrochanteric/diasphyseal femur fractures.

The UCSF researchers say that an increase of risk might be focused on patients who take other medications such as corticosteroids or other medications that treat osteoporosis such as hormone replacement therapy. They suggest further research include observational studies from population-based registries or healthcare databases that retain radiographs as useful alternatives.

The three trials that provided data for the UCSF study are the Fracture Intervention Trial, known as FIT; the FIT Long-Term Extension Trial, known as FLEX; and the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly Pivotal Fracture Trial, known as HORIZON-PFT.

An estimated 10 million Americans have osteoporosis and 34 million more are prone because of low bone density. Patients with significant osteoporosis are at high risk of debilitating fractures: the disease is responsible for more than 1.5 million annually, according to the National Institutes of Health. Only half of people who have lived independently before a hip fracture are able to do so one year later, said Black.

4 preventable risk factors reduce US life expectancy and lead to health disparities

27 mar 2010--A study published this week in PLoS Medicine finds that four risk factors — smoking, high blood pressure, high blood sugar and obesity — explain a substantial amount of the disparity in life expectancy amongst the "Eight Americas", which are groups of the US population that can be defined by race, and location and socioeconomic features of counties they live in. Together, these four risk factors are estimated to reduce life expectancy in the United States by 4.9 years in men and 4.1 years in women. The researchers calculate that disparities in life expectancy in the "Eight Americas" would decline by 20% if the four risk factors were reduced to optimal levels.

Smoking, high blood pressure, high blood sugar and obesity are preventable risk factors responsible for hundreds of thousands of deaths in the United States each year through chronic diseases such as cardiovascular diseases, cancers and diabetes. Goodarz Danaei (of the Harvard School of Public Health) and collaborators used information from national surveys to estimate the number of deaths that would have been prevented in 2005 if exposure to these four risk factors had been reduced. They estimated the effect of the risk factors on life expectancy in the United States as a whole, and also on the disparities in life expectancy and deaths from specific diseases among the "Eight Americas" that were observed in a previous study (http://dx.doi.org/10.1371/journal.pmed.0030260)

The researchers found that a person's ethnicity and where they live is a predictor of life expectancy and health. The Asian American subgroup had the lowest body mass index, smoking rates and blood sugar, whilst the white subgroups had the lowest blood pressure. Blood pressure was highest in the US black population, especially in the rural south; body mass index was highest in western Native American men and southern low-income rural black women; and smoking highest in western Native Americans and low-income whites in Appalachia and the Mississippi Valley. The effect on life expectancy of these factors was smallest in the Asian group and largest in low-income southern rural blacks.

Whilst acknowledging that other factors such as alcohol use and dietary salt are also major contributors to disease, the researchers emphasize that public health interventions to reduce smoking, high blood pressure, blood sugar and obesity must be implemented and evaluated to improve the nation's health and reduce health disparities in the United States.


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Citation:Danaei G, Rimm EB, Oza S, Kulkarni SC, Murray CJL, et al. (2010) The Promise of Prevention: The Effects of Four Preventable Risk Factors on National Life Expectancy and Life Expectancy Disparities by Race and County in the United States. PLoS Med 7(3): e1000248. doi:10.1371/journal.pmed.1000248

Funding: This research was supported by a cooperative agreement from the US Centers for Disease Control and Prevention (CDC) through the Association of Schools of Public Health (ASPH) (grant no. U36/CCU300430-23). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC or ASPH. The funders had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript.

Competing Interests:The authors have declared that no competing interests exist.

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People Are Living Longer And Healthier -- Now What?

People in developed nations are living in good health as much as a decade longer than their parents did, not because aging has been slowed or reversed, but because they are staying healthy to a more advanced age.


26 mar 2010--"We're living longer because people are reaching old age in better health," said demographer James Vaupel, author of a review article appearing in the March 25 edition of Nature. But once it starts, the process of aging itself -- including dementia and heart disease -- is still happening at pretty much the same rate. "Deterioration, instead of being stretched out, is being postponed."

The better health in older age stems from public health efforts to improve living conditions and prevent disease, and from improved medical interventions, said Vaupel, who heads Duke University's Center on the Demography of Aging and holds academic appointments at the Max Planck Institute for Demographic Research in Rostock, Germany, and the institute of Public Health at the University of Southern Demark.

Over the past 170 years, in the countries with the highest life expectancies, the average life span has grown at a rate of 2.5 years per decade, or about 6 hours per day.

The chance of death goes up with age up until the most advanced ages. The good news is that after age 110, the chance of death does not increase any more. The bad news is that it holds steady at 50% per year at that point, Vaupel said.

"It is possible, if we continue to make progress in reducing mortality, that most children born since the year 2000 will live to see their 100th birthday -- in the 22nd century," Vaupel said. If gains in life expectancy continue to be made at the same pace as over the past two centuries, more than half of the children alive today in the developed world may see 100 candles on their birthday cake.

This leads to an interesting set of policy questions, said Vaupel. What will these dramatically longer lifespans mean for social services, health care and the economy? Can the aging process be slowed down or delayed still further? And why do women continue to outlive men - outnumbering them 6 to 1 at age 100?

It also may be time to rethink how we structure our lives, Vaupel said. "If young people realize they might live past 100 and be in good shape to 90 or 95, it might make more sense to mix education, work and child-rearing across more years of life instead of devoting the first two decades exclusively to education, the next three or four decades to career and parenting, and the last four solely to leisure."

One way to change life trajectories would be to allow younger people to work fewer hours, in exchange for staying in the workforce to a later age. "The 20th century was a century of the redistribution of wealth; the 21st century will probably be a century of the redistribution of work," Vaupel said.

Biodemography of human ageing," James W. Vaupel, Nature, Vol. 464, 25 March 2010 doi: 10.1038/nature08984

Source:
Karl Leif Bates
Duke University

Chest X-rays can help predict which H1N1 patients are at greatest risk

OAK BROOK, Ill., 23 mar 2010– A new study published in the April issue of Radiology suggests that chest x-rays may play an important role in the diagnosis and treatment of H1N1 influenza by predicting which patients are likely to become sicker.

"Working in the emergency room is very stressful and physicians need information fast," said lead author Galit Aviram, M.D., head of cardiothoracic imaging in the Department of Radiology at Tel Aviv Sourasky Medical Center in Tel Aviv, Israel. "Our study provides significant findings that will help clinicians triage patients presenting with clinically suspected H1N1 influenza."

According to the Centers for Disease Control and Prevention (CDC), the H1N1 virus is the predominant influenza virus in circulation during the 2009-2010 flu season. The CDC estimates that between April 2009 and January 2010 there have been approximately 57 million cases of H1N1 in the U.S., resulting in 257,300 hospitalizations and 11,686 deaths.

As in past pandemics, the virus can occur in waves. It is possible that the U.S. could experience additional waves of the virus throughout 2010.

In the study, Dr. Aviram's research team analyzed the chest x-rays of 97 consecutive patients with flu-like symptoms and laboratory-confirmed diagnosis of H1N1, admitted to the emergency department of Tel Aviv Sourasky Medical Center between May and September 2009. The researchers then correlated the x-ray findings with adverse patient outcomes.

"To our knowledge, this is the largest series describing the presentation of chest x-ray findings in patients diagnosed with H1N1 influenza," Dr. Aviram said.

The chest x-rays revealed abnormal findings for 39 of the patients, five (12.8 percent) of whom experienced adverse outcomes, including death or the need for mechanical ventilation. For the other 58 patients, chest x-ray findings were normal, although two (3.4 percent) of the patients experienced adverse outcomes. The mean age of patients in the study, which included 53 men and 44 women, was 40.4 years.

"Abnormal findings in the periphery of both lungs and in multiple zones of the lungs were associated with poor clinical outcomes," Dr. Aviram said.

Although a normal chest x-ray did not exclude the possibility of an adverse outcome, Dr. Aviram said the study's findings can help physicians better identify high-risk H1N1 patients who require close monitoring.

"In H1N1, as in various types of community-acquired pneumonia, initial chest x-rays may not show abnormalities that develop later in the course of the disease," Dr. Aviram explained. "Further x-rays should be performed according to the patient's clinical course."

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"H1N1 Influenza: Initial Chest Radiographic Findings in Helping Predict Patient Outcome." Collaborating with Dr. Aviram were Amir Bar-Shai, M.D., Jacob Sosna, M.D., Ori Rogowski, M.D., Galia Rosen, M.D., Iuliana Weinstein, M.D., Arie Steinvil, M.D., and Ofer Zimmerman, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsnajnls.org/)

RSNA is an association of more than 44,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. (RSNA.org)

For patient-friendly information on chest x-rays, visit RadiologyInfo.org.

Article Evaluates Options for Non-Motor Parkinson's Issues

AAN practice parameter touches on treatments for erectile dysfunction, constipation, sleep problems

22 mar 2010-- Several medications may be helpful in treating such non-motor symptoms of Parkinson's disease as erectile dysfunction and constipation, but there is insufficient evidence for certain treatments for other issues such as anxiety and urinary incontinence, according to an American Academy of Neurology (AAN) practice parameter published in the March 16 issue of Neurology.

Theresa A. Zesiewicz, M.D., of the University of South Florida in Tampa, and colleagues performed a literature search from 1966 to mid-2008 for clinical trials involving patients with Parkinson's. They found that sildenafil citrate has level C evidence supporting its potential benefit in treating erectile dysfunction and that polyethylene glycol also has level C evidence for treating constipation.

In addition, they found that level B evidence suggests levodopa/carbidopa may be useful in treating periodic limb movements of sleep, and level A evidence supports considering modafinil for improving the subjective perception of excessive daytime somnolence. An earlier AAN practice parameter found that botulinum toxin should be considered for drooling. However, the authors could not find enough evidence to support or refute particular treatments for urinary incontinence, anxiety, or orthostatic hypotension.

"Although common, non-motor symptoms of Parkinson's disease are underdiagnosed. There is a paucity of research concerning treatment of non-motor symptoms in Parkinson's disease. A concerted and multidisciplinary effort needs to be made toward finding treatments for non-motor symptoms in Parkinson's disease," the authors conclude.

A number of co-authors reported financial relationships with various of pharmaceutical companies, publications, and associations.

Abstract
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Multiple Generations Under One Roof, Again

Adult children are moving back in with parents, and grandparents are taking up residence with their kids' families. Sound like old times? In fact, multi-generational households are making a comeback, according to a report released today.

20 mar 2010--Some 49 million Americans now live in such an arrangement, up from 28 million in 1980.

The tight-knit families could be the result of both social and economic factors, including the recession but more broadly reflecting a years-long trend, according to study researchers from the Pew Research Center's Social and Demographic Trends project.

The finding extends previous research. Pew research out last year suggested 13 percent of parents with grown children had an adult son or daughter who had moved back home over the past year to take refuge from the dim economy, among other reasons.

The new study involved telephone surveys conducted in February and March 2009 with a nationally representative sample of 2,969 adults living in the continental United States.

Multi-generational family households were defined as: two generations (parents or in-laws and adult children ages 25 and older); three generations (parents or in-laws, adult children and grandchildren); skipped generation (grandparents and grandchildren, without parents); and more than three generations.

Flip-flop

Between 1980 and 2009, there was a 33 percent increase in the share of Americans living in multi-generation households. Just the opposite was found in the decades' prior. For instance, from 1940 to 1980, that share had declined by more than half, from 25 percent in 1940 to 12 percent in 1980.

Demographic factors, such as growth of the nuclear family-centered suburbs, contributed to the falling out of grace of extended family households, Pew reports suggest.

As for the recent growth in such households, Pew researchers say it's partly the result of demographic and cultural shifts, including the increasing proportion of immigrants (who are more inclined than native-born Americans to live with multiple generations), and the rising median age of first marriage of all adults.

On average a guy marries for the first time at age 28, while a typical women ties her first knot at 26. The ages are about five years older than in 1970, Pew researchers say. The result: More unmarried 20-somethings in the population who might be drawn to their childhood home as an attractive living situation.

That's especially true in the weak economy, as high unemployment and rising foreclosures are driving individuals from different generations to double up under the same roof, the researchers say. In fact, from 2007 to 2008, the number of Americans living in a multi-generational family household grew by 2.6 million. No age group is immune. For instance, about one-in-five adults ages 25 to 34 now live in multi-generational households. (The recession began in December 2007.)

Who is affected
This trend has affected adults of all ages, especially the elderly and the young. For example, about one-in-five adults ages 25 to 34, and the same proportion of the 65 and older group, now live in a multi-generational household.

The shift has impacted adults of ages - the elderly, the young, and those "sandwiched" in middle age.
Among the elderly, there has been also been a different, but complementary trend change. After rising steeply for nearly a century, the share of adults ages 65 and older who live alone flattened out around 1990 and has since declined a bit. The report explores the reasons for this trend reversal. Using our own survey data, it also examines the differences in overall happiness, health, well-being and various life experiences between older adults who live alone and those who live with others.

At the other end of the living-arrangement spectrum, single-person households have also increased over the past century. In 1900, just about 1 percent of Americans lived in such a household, compared with 10 percent by 2008.

Among those ages 18 to 24, just 4.6 percent live by themselves, down from 5.7 percent in 1980; for adults ages 65 and older nearly 6 percent lived alone in 1900 compared with 28.8 percent in 1990 and 27.4 percent in 2008.

The bump might not be a good sign for the well-being of those flying solo. According to a Pew Research Center survey conducted last year, adults ages 65 and older who live alone say their health is worse and they are more like to feel sad, depressed or lonely than their counterparts living with a spouse or other family member.

But that's open for debate, as a recent study using data from the General Social Survey found Americans grow happier with age.

• Original Story: Multiple Generations Under One Roof, Again

Alzheimer's Disease-Like Changes Discovered In Elderly People Without The Disease

19 mar 2010--The emergence of multiple new brain imaging technologies and the combined application of these new approaches is helping to create new insights into aging and Alzheimer's disease. One of the hallmarks of Alzheimer's disease is the deposition of amyloid beta protein in clumps or "plaques" within the brain. These plaques can be measured in humans with PET scans that use a chemical marker or radiotracer called 11C-PIB.

It was long thought that the formation of plaques injured and perhaps even caused the death of nerve cells in the brain. Recent studies, however, suggest that a form of the amyloid beta protein that is soluble rather than the form that is deposited in plaques mediates most of the destructive impact of this protein.

In a new study published in Biological Psychiatry, by Elsevier, researchers have related the findings that are emerging from PET-PIB imaging to changes in the function of brain circuits. Sheline and colleagues examined Alzheimer's disease patients and cognitively normal, healthy individuals who were then divided into those with or without brain amyloid plaques.

Using functional connectivity brain mapping, they found that amyloid plaques are present in the brains of people with Alzheimer's disease as well as some healthy elderly people who do not show behavioral evidence of Alzheimer's disease. However, they found that the healthy participants with brain amyloid deposits were associated with compromise of the connections between important brain regions involved in learning and memory even though their memory functions were not markedly impaired. Similar disruptions in brain connections were found in individuals with Alzheimer's disease.

"This elegant study illustrates that amyloid plaques are only a component of the disease process in Alzheimer's disease, in that that there are many people who have the plaques but not the disease. These data raise a number of important questions," comments Dr. John Krystal, Editor of Biological Psychiatry. "What is missing from the disease process or what protective factors are present among people who have amyloid deposition in plaques but who appear to be without Alzheimer's disease? If the amyloid plaques were eliminated in the healthy elderly, would their brain circuitry function normalize?"

These questions are important and timely as a number of approaches for reducing brain amyloid beta protein levels are currently being tested, including antibodies that might bind to and promote the clearance of amyloid beta protein as well as drugs that inhibit amyloid beta protein synthesis. If amyloid beta protein is only part of the biology of Alzheimer's disease, it may be difficult to predict the extent to which these novel treatments might work.

According to Dr. Yvette Sheline, Professor of Psychiatry and Radiology at Washington University and lead author on the study, "the important thing about this study is that none of the participants had cognitive or behavioral abnormalities. This indicates that Alzheimer's disease likely begins quietly, clinically undetected, but still slowly eroding brain networks." Thus, these findings further underscore the importance of being able to identify individuals at risk for developing Alzheimer's disease, and will aid researchers as they continue to work to understand the disruption in brain functioning associated with Alzheimer's disease.

Notes:
The article is "Amyloid Plaques Disrupt Resting State Default Mode Network Connectivity in Cognitively Normal Elderly" by Yvette I. Sheline, Marcus E. Raichle, Abraham Z. Snyder, John C. Morris, Denise Head, Suzhi Wang, and Mark A. Mintun. The authors are affiliated with the Washington University School of Medicine, St. Louis, Missouri. The article appears in Biological Psychiatry, Volume 67, Issue 6 (March 15, 2010), published by Elsevier.

The authors' disclosures of financial and conflicts of interests are available in the article.

Source:
Maureen Hunter
Elsevier

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Plaque on CT scan is strong predictor of heart disease, worse long-term outcomes

The presence of plaque on an abdominal CT scan is a strong predictor of coronary artery disease and mortality, according to a Henry Ford Hospital study.

18 mar 2010--Researchers found that patients are nearly 60 percent at risk of having coronary artery disease when the CT scan showed very high levels of abdominal aortic calcium, commonly known as plaque. High levels of the abdominal aortic calcium also increased their risk of dying, researchers say.

Conversely, researchers found that the lack of abdominal aortic calcium, or AAC, was associated with a low risk of coronary artery disease, a chronic, progressive form of heart disease that results from a buildup of plaque in the arteries found on the surface of the heart,.

The study is being presented Sunday, March 14 at the 59th annual American College of Cardiology Scientific Sessions in Atlanta.

"If you get a CT scan on your abdomen, there's probably a good chance that image can provide us with more information about the health of your heart arteries," says Mouaz Al-Mallah, M.D., director of Cardiac Imaging Research at Henry Ford and lead author of the study.

"This study clearly demonstrates that higher scores of abdominal aortic calcium are associated with higher rates of coronary artery disease and mortality."

Prior research has shown that coronary artery calcium found by computed tomography or CT is strongly associated with coronary artery disease and mortality. However, little is known about the risk associated between AAC and coronary artery disease.

Henry Ford researchers studied 367 patients who underwent an abdominal CT and cardiac catheterization within one year between January 2004 and May 2009. Patients had a 58 percent risk of having coronary artery disease with an AAC score over 1,000 compared to patients who had an 11 percent risk with an AAC score of zero. A high ACC score also was linked to a higher risk of mortality.

"If you have heart disease and abdominal aortic calcifications, your chance of dying is higher than just having heart disease alone," Dr. Al-Mallah says.

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The study was funded by Henry Ford Hospital.

Technology And Positive Attitudes Improving Older People's Lives

17 mar 2010--The population of the UK is ageing. Sixteen per cent of the UK population is 65 or older, and for the first time, there are more people over the age of 65 than there are under the age of 18. This raises a lot of questions on issues such as pension provision, health care and wellbeing. Ensuring that elderly people have access to medical and social support; the use of new technologies to make it easier for them to live independent lives; and helping the elderly to stay active within society. These are issues discussed during the Economic and Social Research Council's (ESRC) Festival of Social Science (12-21 March).

Loneliness and the lack of independence are major issues for many old people. New technologies have enormous potential to help elderly people live independently. However, many are not aware of the benefits, do not know how to use and engage with digital technologies or simply don't feel confident enough to use it. As one person put it, "My computer is in cobwebs." At 'Improving everyday life: getting connected to public services' older people will talk about their personal experiences with digital technologies and their applications, and how these helped them be less isolated and more independent. IT taster sessions will be offered to the elderly to encourage them to explore new technologies, and local service providers will demonstrate how their services can be accessed and requested online.

For many old people, their quality of life is also affected by poor health. Currently there are 800,000 people with dementia in the UK: the most common being Alzheimer's disease. Behind these facts and figures are individuals and families learning to live with the condition and get on with their lives. Stereotypes about people are however often negative and disabling. In the spirit of one person with dementia who says "Positivity is my greatest weapon", the event promotes a more balanced and positive perspective on dementia. At 'Dementia: don't fear it' two people with dementia who are active campaigners will speak about their experiences and views. Images and interviews from an ongoing research project on how and why some people with dementia become campaigners or change agents will stimulate a debate with a Q & A session.

The media play a major role in shaping people's attitudes. The way old people are portrayed in the media influence the way we think about them. But what do we actually think about ageism? The European Social Survey (ESS) database collects and stores information on the social attitudes of thousands of residents across Europe. The 'What do the British think about… Ageism, Welfare and Political Institutions' is an event aimed at journalists. The event will demonstrate the range of data freely accessible through the ESS database and explain how to access and use it. Data on individual states as well as comparative data can be quickly and easily gathered. By better understanding social science data, it is hoped that stereotypes will be challenged.

Events on ageing include:

What do the British think about…Ageism, Welfare and Political Institutions?
Organiser: European Social Survey, Centre for Comparative Social Surveys and ESS UK National Coordinator, NatCen
Monday 15 March 9:00am - 11.00am
Venue: Social Science Building, St John Street, Centre for Comparative Social Surveys, School of Science Sciences, Northampton Square, London. EC1V 0BH
Audience: For professionals as part of their work

Improving everyday life: getting connected to public services
Organiser: Graduate School, BLSS, Nottingham Trent University
Friday 19 March 2pm-5.00pm
Venue: Cotmanhay Enterprise Centre, Cotmanhay, Ilkeston. DE7 8PF
Audience: Suitable for all

Dementia: Don't fear it
Organiser: Bradford Dementia Group, University of Bradford
Friday 19 March 6.00pm - 8.30pm
Venue: Otley Courthouse, Courthouse Street, Otley, West Yorkshire. LS21 3AN
Audience: Suitable for all

Source:
Danielle Moore Economic & Social Research Council

New guidelines aim to prevent unnecessary death from thoracic aortic disease

Multidisciplinary team of experts weighs in on diagnosis and management

16 mar 2010--When actor John Ritter died suddenly in 2003 from a tear in his thoracic aorta—the large artery that carries blood from the heart to the rest of the body—that tragedy brought attention to a rare but deadly condition that takes the lives of an estimated 10,000 Americans each year. Now, new clinical guidelines spearheaded by the American College of Cardiology (ACC) and the American Heart Association (AHA) not only offer new recommendations for the diagnosis and management of thoracic aortic disease (TAD), they deliver a powerful message to physicians and patients: Early diagnosis and treatment can save lives.

"If thoracic aortic disease can be detected early and managed, it gives us the opportunity to select patients for surgical or endovascular repair when the patient is stable," said Loren F. Hiratzka, M.D., who chaired the guidelines writing committee and is the medical director of cardiac surgery for TriHealth, Inc. (Bethesda North and Good Samaritan Hospitals) in Cincinnati, OH. "The results of treatment for stable disease are far better than for acute—and often catastrophic—aortic rupture or dissection."

The new guidelines appear in the April 6, 2010, issues of the Journal of American College of Cardiology (JACC) and Circulation: Journal of the American Heart Association, as well as on web sites of the ACC (www.acc.org) and the AHA (www.americanheart.org). They were developed in collaboration with the American Association for Thoracic Surgery (AATS), American College of Radiology (ACR), American Stroke Association (ASA), Society of Cardiovascular Anesthesiologists (SCA), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of Thoracic Surgeons (STS), and Society for Vascular Medicine (SVM). The American College of Emergency Physicians (ACEP) and the American College of Physicians (ACP) were also represented on the writing committee.

Recent scientific and clinical advances drove the development of guidelines to aid physicians in the diagnosis and management of aortic dissection, aortic aneurysm and other forms of TAD, said Kim A. Eagle, M.D., director of the University of Michigan Cardiovascular Center in Ann Arbor and co-author of the guidelines.

"We now have a deeper understanding of the genetic underpinnings of TAD, and we continue to expand our knowledge in this area," he said. "There have been rapid advances in noninvasive imaging. Medical therapy is much better. Open surgical techniques with anesthesia have improved dramatically. We can even use endovascular (minimally invasive, catheter-based) approaches in some patients."

An aortic aneurysm occurs when a portion of the aorta balloons out, increasing the diameter of the blood vessel by at least 50 percent at that spot. Although the wall of the aorta can become dangerously thin, patients with an aortic aneurysm often have no symptoms unless the aneurysm ruptures.

In the case of aortic dissection, a tear in the inner lining of the aorta (the intima) allows blood to invade the middle layer (the media), creating a false passageway through which blood can flow. This false passageway steals a portion of the blood supply from the rest of the body. Classical symptoms include the sudden onset of intense pain in the chest, back, shoulder or abdomen. However, patients often experience less definite symptoms, which makes diagnosis difficult.

In aortic rupture, all three layers of the aortic wall burst, resulting in massive bleeding inside the body.

Risk factors for TAD include poorly controlled high blood pressure, advancing age, male gender, atherosclerosis, inflammatory diseases that damage the blood vessels, and certain genetic conditions that weaken connective tissue, such as Marfan syndrome. In addition, people whose aortic valve has only two leaflets (bicuspid valve) instead of the normal three leaflets may be at increased risk for an aortic aneurysm. Pregnancy, intense weight lifting and cocaine use increase the risk of aortic dissection.

One of the most important messages in the guidelines is that TAD often runs in families. As a result, family history is a critical tool for uncovering undiagnosed cases of TAD. Patients should tell their physicians not only about close relatives with aortic aneurysm, dissection, or rupture, but also about any family history of unexplained sudden death. "Family history is very important," Dr. Eagle said. "Sudden cardiovascular collapse could have been a heart attack, but it could also have been sudden catastrophic aortic dissection."

Additional highlights from the TAD guidelines include:

• Imaging of the thoracic aorta by computed tomography (CT), magnetic resonance imaging (MRI) or, in some cases, echocardiography is the best way to detect TAD and determine future risk. A chest x-ray alone is not sufficient.
• Patients with genetic conditions that increase the risk of TAD should have aortic imaging at the time of diagnosis to establish the size of the aorta, with periodic follow-up imaging thereafter.
• All patients with a bicuspid aortic valve should be evaluated to determine whether the aorta is dilating, or widening.
• The symptoms of acute aortic dissection, which can mimic those of a heart attack or another cause of chest pain, often make it difficult to arrive at a prompt diagnosis and may delay life-saving treatment. Physicians should keep aortic dissection in mind when asking questions about medical history, family history, and the type and pattern of pain, and when examining the patient.
• Aortic dissection involving the ascending aorta (the portion nearest the heart) is a life-threatening emergency that should be treated surgically.
• Aortic dissection involving the descending thoracic aorta may often be managed with medications that control the blood pressure and heart rate, unless life-threatening complications develop. Additional medical therapy may include statins to lower elevated blood cholesterol levels.
• Minimally invasive endovascular techniques are an option in some patients with aneurysm or dissection of the descending thoracic aorta.
• All immediate relatives of a patient with thoracic aortic aneurysm or dissection, or a bicuspid aortic valve, should be evaluated by a cardiovascular physician and undergo aortic imaging to measure the size of the aorta and identify asymptomatic disease.

Not all health insurers pay for aortic imaging in high-risk asymptomatic patients, particularly based on family history, Dr. Hiratzka said.

"I hope the new guidelines will change that," he said. "It could be lifesaving."

"People with aortic disease do not have to die prematurely; they can live a long lifespan if they are diagnosed and receive treatment," said Carolyn Levering, president and chief executive officer of the National Marfan Foundation, which convened the TAD (Thoracic Aortic Disease) Coalition of nonprofit, patient and professional groups. "That's why the TAD Coalition has come together to launch a comprehensive public and medical awareness campaign to help maximize the impact of the new guidelines. Our first initiative is the dissemination of Ritter Rules, named to honor John Ritter. The purpose of Ritter Rules is to help people remember the important facts about aortic dissection so they can avoid the same kind of tragedy that took the life of the beloved actor."

Prostate test 'public health disaster': discoverer

WASHINGTON,14 mar 2010– The most commonly used tool for detecting prostate cancer, routine PSA screening, has become "a hugely expensive public health disaster," its discoverer said on Wednesday.

Dr. Richard Ablin of the University of Arizona joined the ongoing debate over the blood test, saying the screening procedure is too costly and ineffective.

"I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster," Ablin wrote in a commentary for The New York Times.

Ablin said that as Congress searches for ways to cut costs in the U.S. health care system, a significant savings could come from changing the way PSA is used.

"The test's popularity has led to a hugely expensive public health disaster," he wrote.

He said the annual bill for PSA screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

"As I've been trying to make clear for many years now, PSA testing can't detect prostate cancer and, more important, it can't distinguish between the two types of prostate cancer -- the one that will kill you and the one that won't," he wrote.

"Instead, the test simply reveals how much of the prostate antigen a man has in his blood."

Prostate cancer is the second most common cancer in men worldwide after lung cancer, killing 254,000 men a year.

PSA is a protein made only by prostate cells, and levels can shoot up as a prostate tumor proliferates. But levels can also rise as the prostate naturally enlarges with age.

A high PSA reading is usually followed by a biopsy, which is a sample of the prostate tissue taken and examined for signs of a tumor.

SLOWLY TURNING AGAINST

Doctors have routinely recommended PSA tests to men over 50 in the belief that early diagnosis and aggressive treatment for any cancer is better than standing by and doing nothing.

But prostate cancer can often be a slow-growing tumor and men will often die of something else before the cancer becomes dangerous.

Prostate cancer treatments, including surgery or radiation, can cause incontinence and erectile dysfunction in about a third of patients. Many men also experience bowel problems.

Citing recent studies and reversals of some early screening proponents, Ablin said the medical community is slowly turning against PSA screening.

"So why is it still used? Because drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened," Ablin wrote.

Ablin said PSA testing does have a place, after treatment for prostate cancer and for men with a family history of prostate cancer.

"Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit," Ablin wrote.

He urged the medical community to "confront reality and stop the inappropriate use of PSA screening."

Technique Shows Potential of Bapineuzumab in Alzheimer's


11C-PiB PET shows the drug reduces amyloid-β deposits in the brain more than placebo

12 mar 2010-- A neuroimaging technique known as carbon-11-labelled Pittsburgh compound B (11C-PiB) positron emission tomography (PET) shows that treating patients with mild to moderate Alzheimer's disease with an antibody that targets amyloid-β is associated with a 25 percent reduction in amyloid-β deposits compared with placebo, according to a study published online March 1 in The Lancet Neurology.

Juha O. Rinne, M.D., from the University of Turku in Finland, and colleagues randomly assigned 28 patients with mild to moderate Alzheimer's disease to placebo or intravenous infusions of one of three doses of bapineuzumab, a humanized anti-amyloid-β monoclonal antibody, every 13 weeks.

Using 11C-PiB PET as a marker of cortical fibrillar amyloid-β load, the researchers found that, at 78 weeks, patients taking bapineuzumab had a significant decrease in the mean 11C-PiB retention ratio, while patients on placebo had a significant increase in the mean retention ratio. The effect was similar for all three bapineuzumab doses. They estimated that bapineuzumab treatment was associated with a 25 percent reduction in cortical fibrillar amyloid-β compared with placebo. Adverse events were observed in both groups and were typically transient and mild to moderate in severity.

"Treatment with bapineuzumab for 78 weeks reduced cortical 11C-PiB retention compared with both baseline and placebo," Rinne and colleagues conclude. "11C-PiB PET seems to be useful in assessing the effects of potential Alzheimer's disease treatments on cortical fibrillar amyloid-β load in vivo."

The study was funded by Elan Pharmaceuticals and Wyeth Research. Several authors reported financial, advisory or consulting relationships with Elan and Wyeth, as well as with other pharmaceutical and biotechnology companies.

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Men likelier than women to enjoy sex in old age

PARIS , 10 mar 2010– Men are more than twice as likely as women to be sexually active in old age but good health is the key for both to feeling naughty, says a study published Wednesday by the British Medical Journal.

Doctors looked over two big probes into the health of the American population.

One survey covered 3,000 people aged 25-74 who filled in questionnaires in the mid-1990s as part of an investigation into midlife.

The other survey, focussing on old age, was carried out a decade later among a similar number of volunteers aged 57-85.

At the age of 55, men have on average almost 15 years of sexually active life ahead of them, and women 10-and-a-half years, the researchers found.

They also discovered a major gap between the genders on sex lives.

"Overall, men were more likely than women to be sexually active, report a good-quality sex life and be interested in sex. These gender differences increased with age," according to the paper online.

The biggest gap was among 75- to 85-year-olds, where 38.9 percent of men said they were sexually active, compared with 16.8 percent of women.

Another 41.2 per cent of the men were interested in sex, compared with 11.4 percent of the women.

Within the "sexually active" group of the 75- to 85-year-olds, 70.8 percent of men rated their sex life as of good quality, compared with 50.9 percent among women.

Why such a difference?

It could be partly explained by opportunity, say the investigators.

Around three-quarters of men across all age groups said they had a partner.

Among women, though, only two-thirds of respondents between 25 and 54 had a partner. For women aged 75 and beyond, fewer than four in 10 had a partner -- a figure reflecting women's longer lifespan and the tendency of men to marry younger women.

Good health, too, was vital for sexual wellbeing, said the study.

An individual in sound health is almost twice as likely to be interested in sex and can expect to enjoy around six more years of sexual activity compared to a peer in poor health.

Authors Stacy Tessler Lindau and Natalia Gavrilova, from the University of Chicago hope the findings will help end a taboo.

"Doctors rarely address sexual concerns in older adults, particularly in women," they say.

In a commentary, Patricia Goodson, a professor at Texas A&M University, said the news that US adults can enjoy "many years of sexual activity beyond age 55" was good news.

But there were also intriguing questions, she said.

If the study's measure of "sexually active life expectancy" ia credible, American men generally stop having sex around the age of 70, about eight or nine years before their death, according to demographic life expectancy.

For women, "sexually active life expectancy" would ended around 65, yet their demographic life expectancy was around 82 or 83.

"The measure sheds no light on the intriguing -- and still poorly understood -- question of why, even though they enjoy fewer years of a sexually active life, many women do not perceive this as a 'problem'," said Goodson.

"Neither does the measure provide details on how women and men manage, attempt to enhance, or deal meaningfully (and uniquely) with their ageing sexuality."

The survey carried out in 1995-6 defined sexual activity as having had sex with at least one partner in previous six months, whereas the survey from 2005-6 defined it as having sex with at least one partner in the previous 12 months.

Respondents who had sex two or three times a month or more were defined in both surveys as having sex regularly. Between 95.0 and 97.8 of respondents described themselves as heterosexual.

The most frequent error in medicine

INDIANAPOLIS, 09 mar 2010 – The most frequent error in medicine seems to occur nearly one out of three times a patient is referred to a specialist. A new study found that nearly a third of patients age 65 and older referred to a specialist are not scheduled for appointments and therefore do not receive the treatment their primary care doctor intended.

According to a new study appearing in the February 2010 issue of the Journal of Evaluation in Clinical Practice, only 71 percent of patients age 65 or older who are referred to a specialist are actually scheduled to be seen by that physician. Furthermore, only 70 percent of those with an appointment actually went to the specialist's office. Thus, only 50 percent (70 percent of 71 percent) of those referred to a specialist had the opportunity to receive the treatment their primary care doctor intended them to have, according to the findings by researchers from the Regenstrief Institute and the Indiana University School of Medicine.

The Institute of Medicine, in its seminal report "To Err is Human," defines a medical error as a "wrong plan" or a failure of a planned action to be completed.

"Patients fail to complete referrals with specialists for a variety of reasons, including those that the health care system can correct, such as failure of the primary care doctor's office to make the appointment; failure of the specialist's office to receive the request for a consultation—which can be caused by something as simple as a fax machine without paper – or a failure to confirm availability with the patient," said Michael Weiner M.D., M.P.H., first author of the study.

"There will always be reasons – health issues or lack of transportation, for example – why a referred patient cannot make it to the specialist he or she needs, but there are many problems we found to be correctable using health information technology to provide more coordinated and patient-focused care. Using electronic medical records and other health IT to address the malfunction of the referral process, we were able to reduce the 50 percent lack of completion of referrals rate to less than 20 percent, a significant decrease in the medical error rate," said Dr. Weiner.

The JECP study followed 6,785 primary care patients seen at an urban medical institution, all over age 65, with a mean age of 72. Nearly all (91 percent) of the patients were covered by Medicare.

"This is not necessarily the fault of patients or doctors alone, but it may take both working together – along with their health system – to correct this problem. Our study highlights how enormous a problem this is for patients who were not getting the specialized care they needed. Although our findings would likely differ among institutions, unfortunately overall trends are similar in other parts of the country" said Dr. Weiner.

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Dr. Weiner is director of the Regenstrief Institute's Health Services Research Program, director of the Indiana University Center for Health Services and Outcomes Research, and director of the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice at the Roudebush VA Medical Center.

Co-authors of the study are Anthony J. Perkins, M.S., of the Regenstrief Institute and the IU Center for Aging Research, and Christopher M. Callahan, M.D., a Regenstrief Institute investigator and Cornelius and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. Dr. Callahan is founding director of the IU Center for Aging Research.

This study was supported by the National Institute on Aging.

ASA: Carotid Stenting May Be Effective in Preventing Stroke

But two other studies say it has worse outcomes than endarterectomy in carotid stenosis patients

08 mar 2010-- Carotid stenting and carotid endarterectomy have similar long-term outcomes for preventing stroke in patients with carotid stenosis, according to a study presented at the American Stroke Association's 2010 International Stroke Conference, held from Feb. 23 to 26 in San Antonio. However, two studies published online Feb. 26 in The Lancet and The Lancet Neurology found that carotid stenting is associated with worse outcomes than carotid endarterectomy in patients with carotid artery stenosis in the months after the procedure and is associated with ischemic brain lesions shortly after treatment.

In the study presented at the International Stroke Conference, Thomas G. Brott, M.D., from the Mayo Clinic in Jacksonville, Fla., and colleagues randomly assigned symptomatic patients and symptomatic patients with carotid stenosis to carotid stenting or carotid endarterectomy. After a mean follow-up of 2.5 years, the researchers found that outcomes were similar in both groups in terms of stroke, heart attack, and death. However, in the weeks after the procedure, the risk of stroke was higher in the stenting group, while the risk of myocardial infarction was lower.

In The Lancet study, Martin M. Brown, M.D., of University College London, and colleagues randomly assigned patients with carotid artery stenosis to carotid artery stenting or carotid endarterectomy. After 120 days, the stenting group had a higher risk of disabling stroke or death; stroke, death, or procedural myocardial infarction; any stroke; and death from any cause. In The Lancet Neurology study, Leo H. Bonati, M.D., from University Hospital Basel in Switzerland, and colleagues performed magnetic resonance imaging on a subset of patients who participated in the trial from The Lancet. Using diffusion-weighted imaging, the researchers found that patients in the stenting group were more likely to have at least one new ischemic brain lesion after treatment.

"The widespread use of carotid stenting, especially its routine use as first-choice treatment for symptomatic carotid stenosis, does not seem to be justified for the time being," writes the author of an accompanying editorial in The Lancet Neurology, adding that "an objective outcome surrogate parameter, such as the occurrence of ischemic lesions in serial diffusion-weighted imaging, seems a promising research tool."

Both Lancet studies were partially funded by Sanofi-Synthélabo, and two authors reported financial or consulting relationships with medical device companies. The conference study was partially funded by Abbott Laboratories.

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International Stroke Conference 2010

ACS Updates Prostate Cancer Screening Guidelines

American Cancer Society's updated guidelines reaffirm that shared decision making is key

07 mar 2010-- Men should participate in shared decision-making over whether or not they undergo screening for prostate cancer, according to updated guidelines for prostate cancer screening from the American Cancer Society, published online March 3 in CA: A Cancer Journal for Clinicians. These guideline updates are the first since 2001.

Andrew M.D. Wolf, M.D., of the University of Virginia School of Medicine in Charlottesville, and colleagues write that a series of systemic reviews of evidence were undertaken by the American Cancer Society Prostate Cancer Advisory Committee in 2009 to facilitate the updating process.

The evidence showed that men without symptoms of prostate cancer and at least 10 years' life expectancy can and should make an informed decision about the pros and cons of prostate cancer screening. Men at average risk should be given the information they need to fully participate in the decision-making process at the age of 50, while men at higher risk should be educated about prostate cancer screening earlier. Annual screening is recommended for men who choose to be tested and who have a prostate-specific antigen (PSA) level of 2.5 ng/mL or higher. Men with a PSA under that threshold can be safely screened every two years, per the new recommendations, while men with a PSA level of 4.0 ng/mL or higher should consider getting further evaluation.

"Two decades into the PSA era of prostate cancer screening, the overall value of early detection in reducing the morbidity and mortality from prostate cancer remains unclear," Wolf, chair of the advisory committee, said in a statement. "While early detection may reduce the likelihood of dying from prostate cancer, that benefit must be weighed against the serious risks associated with subsequent treatment, particularly the risk of treating men for cancers that would not have caused ill effects had they been left undetected."

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Research: How you think about your age may affect how you age

05 mar 2010-- The saying "You're only as old as you feel" really seems to resonate with older adults, according to research from Purdue University.

"How old you are matters, but beyond that it's your interpretation that has far-reaching implications for the process of aging," said Markus H. Schafer, a doctoral student in sociology and gerontology who led the study. "So, if you feel old beyond your own chronological years you are probably going to experience a lot of the downsides that we associate with aging.

"But if you are older and maintain a sense of being younger, then that gives you an edge in maintaining a lot of the abilities you prize."

Schafer and co-author Tetyana P. Shippee, a Purdue graduate who is a research associate at Purdue's Center on Aging and the Life Course, compared people's chronological age and their subjective age to determine which one has a greater influence on cognitive abilities during older adulthood. Nearly 500 people ages 55-74 were surveyed about aging in 1995 and 2005 as part of the National Survey of Midlife Development in the United States.

In 1995, when people were asked what age do you feel most of the time, the majority identified with being 12 years younger than they actually were.

"We found that these people who felt young for their age were more likely to have greater confidence about their cognitive abilities a decade later," Schafer said. "Yes, chronological age was important, but the subjective age had a stronger effect.

"What we are not sure about is what comes first. Does a person's wellness and happiness affect their cognitive abilities or does a person's cognitive ability contribute to their sense of wellness. We are planning to address this in a future study."

Schafer also said that the current study's findings have both positive and negative implications.

"There is a tremendous emphasis on being youthful in our society and that can have a negative effect for people," Schafer said. "People want to feel younger, and so when they do inevitably age they can lose a lot of confidence in their cognitive abilities.

"But on the other hand, because there is such a desire in America to stay young, there may be benefits of trying to maintain a sense of youthfulness by keeping up with new trends and activities that feel invigorating. Learning new technologies is one way people can continue to improve their cognitive abilities. It will be interesting to see how, or if, these cultural norms shift as the Baby Boomer generation ages."

Other studies have shown that women are prone to aging stereotypes, so Schafer expected to see that women who felt older about themselves would have less confidence in their cognitive abilities.

"There is a slight difference between men and women, but it's not as pronounced as we expected," Schafer said. "This was surprising because of the emphasis on physical attractiveness and youth that is often disproportionately placed on women."

Schafer also is studying how stressful events, such as family members' health issues, affect aging, as well as how happiness and aging relate.

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These finding were published in January's Journal of Gerontology: Social Sciences, and the study was funded by the National Institutes of Health.

Writer: Amy Patterson Neubert, 765-494-9723 begin_of_the_skype_highlighting 765-494-9723 end_of_the_skype_highlighting, apatterson@purdue.edu

Source: Markus Schafer, 765 49-41631, mhschafe@purdue.edu

Related Web site: Center on Aging and the Life Course: http://www.purdue.edu/aging/

Hormone thought to slow aging associated with increased risk of cancer death

According to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), older men with high levels of the hormone IGF-I (insulin-like growth factor 1) are at increased risk of cancer death, independent of age, lifestyle and cancer history.

03 mar 2010--IGF-I is a protein hormone similar in structure to insulin and is regulated in the body by growth hormone (GH). Levels of GH and IGF-I decline progressively with age in both men and women and this drop is thought to be related to deteriorating health conditions found with advanced age. In an attempt to combat aging some people use GH as its actions elevate IGF-1.This study however showed that older men who had higher levels of IGF-I were more likely to die from a cancer-related cause in the following 18 years than men with lower levels.

"This is the first population-based study to show an association of higher IGF-I levels with increased risk of a cancer-related death in older men," said Gail Laughlin, PhD, of the University of California San Diego, and corresponding author of the study. "Although the design of this study does not explicitly show that the higher IGF-I levels caused the cancer death, it does encourage more study as well as a reexamination of the use of IGF-I enhancing therapies as an anti-aging strategy."

In this study researchers used data on 633 men aged 50 and older from the Rancho Bernardo Study, a population-based study of healthy aging. Study participants took part in a research clinic examination between the years of 1988 and 1991 where their blood was obtained and IGF-1 was measured. All participants had their vital status followed through July 2006. Researchers found that men in this study who had IGF-I levels above 100 ng/ml had almost twice the risk of cancer death in the following 18 years than men with lower levels.

"In this study, the increased risk of cancer death for older men with high levels of IGF-I was not explained by differences in age, body size, lifestyle or cancer history," said Jacqueline Major, PhD, lead author on the study, now at the National Cancer Institute. "If these results are confirmed in other populations, these findings suggest that serum IGF-I may have potential importance as a biomarker for prognostic testing."

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Other researchers working on the study include: the Principal Investigator and founder of the Rancho Bernardo Study, Elizabeth Barrett-Connor; and Donna Kritz-Silverstein and Deborah Wingard of the University of California, San Diego.

The article, "Insulin-like Growth Factor-I (IGF-I) and Cancer Mortality in Older Men," will appear in the March 2010 issue of JCEM.

Greater Purpose in Life Linked to Lower Risk of Alzheimer's

Rate of cognitive decline is also slower in seniors with a greater purpose in life

03 mar 2010-- Seniors with a greater purpose in life have a slower rate of cognitive decline and are less likely to develop Alzheimer's disease, according to a study in the March Archives of General Psychiatry.

Patricia A. Boyle, Ph.D., and colleagues from Rush University Medical Center in Chicago, assessed purpose of life, defined as the tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness that guides behavior, among 951 community-dwelling elderly individuals without dementia using the 10-item scale derived from Ryff's Scales of Psychological Well-Being.

During a mean follow up of four years, the researchers found that 16.3 percent of individuals developed Alzheimer's disease. After adjusting for age, sex, and education, having a greater purpose in life was associated with a significantly lower risk of developing Alzheimer's disease (hazard ratio, 0.48). The association remained after further adjusting for depressive symptoms, neuroticism, social network size, and chronic medical conditions (hazard ratio, 0.60). A greater purpose in life was also associated with a significantly lower risk of developing mild cognitive impairment (hazard ratio, 0.71) and a slower rate of cognitive decline.

"During up to seven years of follow-up, greater purpose in life was associated with a substantially reduced risk of Alzheimer's disease such that a person with a high score (90th percentile) on the purpose in life measure was approximately 2.4 times more likely to remain free of Alzheimer's disease than was a person with a low score (10th percentile)," Boyle and colleagues conclude.

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