Panel finds insufficient evidence for Alzheimer's disease preventive measures

Many preventive measures for cognitive decline and for preventing Alzheimer's disease—mental stimulation, exercise, and a variety of dietary supplements—have been studied over the years. However, an independent panel convened this week by the National Institutes of Health determined that the value of these strategies for delaying the onset and/or reducing the severity of decline or disease hasn't been demonstrated in rigorous studies.

29 april 2010--"Alzheimer's disease is a feared and heart-breaking disease," said Dr. Martha L. Daviglus, conference panel chair and professor of preventive medicine and medicine at Northwestern University, Chicago. "We wish we could tell people that taking a pill or doing a puzzle every day would prevent this terrible disease, but current evidence doesn't support this."

The panel's assessment of the available evidence revealed that progress to understand how the onset of these conditions might be delayed or prevented is limited by inconsistent definitions of what constitutes Alzheimer's disease and cognitive decline. Other factors include incomplete understanding of the natural history of the disease and limited understanding of the aging process in general. The panel recommended that the research community and clinicians collaborate to develop, test, and uniformly adopt objective measures of baseline cognitive function and changes over time.

Although many non-modifiable risk factors have been examined, age is the strongest known risk factor for Alzheimer's disease. Additionally, a genetic variant of a cholesterol-ferrying protein (apolipoprotein E), has strong evidence of association with the risk for developing Alzheimer's disease. Although it is hoped that improved understanding of genetic risk factors may ultimately lead to effective therapies, currently these associations are primarily useful in the clinical research setting.

The panel determined that there is currently no evidence of even moderate scientific quality supporting the association of any modifiable factor—dietary supplement intake, use of prescription or non-prescription drugs, diet, exercise, and social engagement—with reduced risk of Alzheimer's disease. The evidence surrounding risk reduction for cognitive decline is similarly limited. Low-grade evidence shows weak associations between many lifestyle choices and reduced risk of Alzheimer's disease and cognitive decline.

Although there is little evidence that these interventions lessen cognitive decline, some are not necessarily harmful and may confer other benefits. However, the panel also emphasized the need for enhanced public understanding that these proposed prevention strategies are currently, at best, only loosely associated with improved outcomes. This means that carefully-designed randomized studies may reveal that these modifiable factors enhance, detract, or have no effect on preventing Alzheimer's disease and cognitive decline.

"These associations are examples of the classic chicken or the egg quandary. Are people able to stay mentally sharp over time because they are physically active and socially engaged or are they simply more likely to stay physically active and socially engaged because they are mentally sharp?" added Dr. Daviglus. "An association only tells us that these things are related, not that one causes the other."

The panel found that certain chronic diseases, such as diabetes and depression, and risk factors such as smoking are associated with increased risk of both Alzheimer's disease and cognitive decline. However, studies have not yet demonstrated that these medical or lifestyle factors actually cause or prevent Alzheimer's disease or cognitive decline, only that they are related.

There is insufficient evidence to support the use of pharmaceuticals or dietary supplements to prevent Alzheimer's disease or cognitive decline. Ongoing studies exploring factors including but not limited to physical activity, omega-3 fatty acids (typically found in fish), antihypertensive medications, and cognitive engagement may provide new insight into Alzheimer's disease and cognitive decline prevention.

The panel made a variety of recommendations to shape the future research agenda and fill identified gaps, while acknowledging that advancing our understanding of these complex conditions in order to develop conclusive, evidence-based prevention recommendations will require considerable time and resources. For example, the panel advocated launching long-term, longitudinal studies to better characterize the natural history and progression of these diseases in the community. They also recommended the establishment of registries for Alzheimer's disease and cognitive decline, modeled on existing registries for cancer.

Extensive research over the past 20 years has provided important insights on the nature of Alzheimer's disease and cognitive decline and the magnitude of the problem. Nevertheless, there remain important and formidable challenges in conducting research on these diseases, particularly in the area of prevention. There are numerous ongoing or planned investigations which may offer promising new insights regarding the causes and prevention of these diseases.

###

An updated version of the panel's draft consensus statement, which incorporates comments received during this morning's public session, will be posted later today at http://consensus.nih.gov.

The panel will hold a press telebriefing to discuss their findings today at 2:00 p.m. EDT. To participate, call 1-888-428-7458 begin_of_the_skype_highlighting 1-888-428-7458 end_of_the_skype_highlighting (US) or 201-604-1577 begin_of_the_skype_highlighting 201-604-1577 end_of_the_skype_highlighting (International) and reference the NIH Alzheimer's conference. Audio playback will be available shortly after conclusion of the telebriefing, by calling 1-888-632-8973 begin_of_the_skype_highlighting 1-888-632-8973 end_of_the_skype_highlighting (U.S.) or 201-499-0429 begin_of_the_skype_highlighting 201-499-0429 end_of_the_skype_highlighting (International) and entering replay code 35986458.

The conference was sponsored by the NIH Office of Medical Applications of Research and the National Institute on Aging, along with other NIH and Department of Health and Human Services components. This conference was conducted under the NIH Consensus Development Program, which convenes conferences to assess the available scientific evidence and develop objective statements on controversial medical issues.

The 15-member panel included experts in the fields of preventive medicine, geriatrics, internal medicine, neurology, neurological surgery, psychiatry, mental health, human nutrition, pharmacology, genetic medicine, nursing, health economics, health services research, and family caregiving. A complete listing of the panel members and their institutional affiliations is included in the draft conference statement. Additional materials, including panel bios, photos, and other related resources, are available at http://consensus.nih.gov/2010/alzmedia.htm. Interviews with panel members can be arranged by contacting Lisa Ahramjian at 301-496-4999 begin_of_the_skype_highlighting 301-496-4999 end_of_the_skype_highlighting or AhramjianL@od.nih.gov.

Investigational immune intervention slows brain shrinkage in Alzheimer's patients

18-month phase II study is first to show combined benefits of IGIV on clinical outcomes and brain-imaging measures

TORONTO, 26 april 2010-- An investigational intervention using naturally ocurring antibodies in human blood has preserved the thinking abilities of a group of mild- to moderate-stage Alzheimer's patients over 18 months and significantly reduced the rate of atrophy (shrinkage) of their brains, according to a study performed at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center. These and other findings from the Phase II clinical trial of GAMMAGARD LIQUID and GAMMAGARD S/D Immune Globulin Intravenous (Human) (IGIV) for Alzheimer's disease (AD) were presented today at the American Academy of Neurology (AAN) meeting in Toronto.

In a Late-Breaking News presentation at the AAN on Wednesday, April 14, at 7:30 am, Dr. Norman Relkin, director of the Memory Disorders Program at NewYork-Presbyterian/Weill Cornell, will report that patients receiving IGIV once or twice a month for 18 months had significantly lower rates of ventricular enlargement (6.7% vs 12.7% per year) and less whole-brain atrophy (1.6% vs 2.2% per year) than control subjects who initially received placebo. Dr. Relkin's findings were based on two independent analyses of brain-imaging data from 20 patients who underwent serial MRI scans during the Phase II study of IGIV for AD.

"Past AD studies that used MRI measures found no change or an accelerated rate of brain shrinkage after investigational treatments," Dr. Relkin notes. "To the best of my knowledge, this is the first trial in which long-term clinical benefits in Alzheimer's patients were accompanied by objective signs of reduced brain degeneration." Dr. Relkin is also an associate professor of clinical neurology and neuroscience at Weill Cornell Medical College in New York City. He was the principal investigator in the Phase II study and is currently leading a multicenter Phase III study of IGIV for Alzheimer's.

A typical AD patient's brain shrinks three to four times faster than a healthy older adult's as a consequence of accelerated brain cell death. This shrinkage of brain tissue causes the fluid-filled ventricles at the center of the brain to enlarge at a faster than normal rate. Changes in the size of the brain and ventricles can be measured accurately by analyzing results from two or more MRI scans obtained at an interval of at least several months apart.

The unprecedented reductions in these measures after IGIV reported by Dr. Relkin and his colleagues could indicate that IGIV exerts a disease-modifying effect that the current generation of approved AD treatments lack.

Dr. Relkin also found that rates of brain shrinkage after IGIV intervention were independent of the subject's age, gender and brain volume at the start of the study but strongly correlated with dose of IGIV and the clinical outcomes after 18 months of intervention.

The Weill Cornell research team also found that AD patients who responded best to IGIV did not measurably decline over 18 months, and had an average rate of brain shrinkage and average rate of ventricular enlargement comparable to the rate previously reported in normal elderly individuals. "A dose-related effect of an Alzheimer's intervention on brain ventricular enlargement has never been seen before, and it suggests that IGIV may, indeed, be sparing brain tissue," says Dr. James Brewer, a neurologist and assistant professor of neurology at the University of California at San Diego.

Dr. Brewer independently analyzed the MRIs from the Phase II IGIV study, and his findings closely matched those obtained by Dr. Dana Moore, a postdoctoral fellow working with Dr. Relkin at Weill Cornell. "I am particularly looking forward to examining the Phase III data when that study is completed," Dr. Brewer states. "Since it involves a considerably larger group of patients, it will permit us to obtain more detailed measures of atrophy in the brain regions specifically vulnerable to Alzheimer's disease."

More details about the study's cognitive testing results will be reported in a later presentation at the AAN meeting by Dr. Diamanto Tsakanikas, who performed cognitive and other testing of the study's participants. Dr. Tsakanikas is a clinical assistant attending neuropsychologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and an instructor of neuropsychology in the Department of Neurology and Neuroscience at Weill Cornell Medical College. While conducting the testing, Dr. Tsakanikas was blinded to whether patients were receiving IGIV or placebo and to the IGIV dose.

When the unblinded study results were later analyzed, her testing indicated that AD patients who received uninterrupted IGIV for 18 months showed significantly less decline in their overall function and thinking abilities than AD patients initially given an inactive placebo. In some cases, IGIV intervention resulted in improvements in certain areas of cognitive functioning. "Functions mediated by the frontal regions of the brain showed the most consistent benefits in IGIV responders," says Dr. Tsakanikas.

The Phase II study involved 24 patients with mild to moderate Alzheimer's disease who were randomly assigned to receive IGIV (16 patients) or saline placebo (eight patients) for six months. Over the following 12 months, the initially placebo-treated group were subsequently received various doses of IGIV while the other 16 patients had uninterrupted IGIV at the initially assigned dose. The study included a comparison of four dosing regimens of IGIV, with doses ranging from 0.2 g/kg every two weeks to 0.8 g/kg every four weeks. "The Phase II study was carried out with the explicit goal of determining whether further testing of IGIV for Alzheimer's was justified," Dr. Relkin points out. "It succeeded in achieving that goal with a relatively small number of subjects. However, we now have to await the results of the larger, pivotal Phase III study to establish the magnitude of its effects on rate of brain atrophy and to confirm whether IGIV is safe and effective for treating AD."

IGIV is being tested as a potential agent for AD immunotherapy because it contains antibodies against beta-amyloid (A?), which is the main constituent of amyloid plaques in the brains of AD patients. IGIV is not approved to treat Alzheimer's disease but it is approved in the United States and other countries for certain immune deficiency and autoimmune disorders. A critical Phase III study of IGIV for AD, supported jointly by the National Institutes of Health (NIH) and Baxter Healthcare, is currently enrolling patients at 35 sites in North America (see more below).

###

The Phase II study was supported by Baxter Healthcare, the Citigroup Foundation and The Clinical Translational Science Center (CTSC) of Weill Cornell Medical College.

Enrollment in Phase III Trial

The trial includes 35 actively enrolling sites at leading academic centers in the United States that are members of The Alzheimer's Disease Cooperative Study (ADCS), with an additional 12 sites pending in the U.S. and Canada. The involvement of the ADCS and NIH in the conduct of the Phase III trial will ensure the highest level of independent scientific evaluation of the potential role of IGIV in the treatment of Alzheimer's patients. For more information about enrolling in the ongoing Phase III trial, please visit www.GAPSTUDY.com or contact Jeffree Itrich at the Alzheimer's Disease Cooperative Study at (858) 622-5827 begin_of_the_skype_highlighting (858) 622-5827 end_of_the_skype_highlighting or jitrich@ucsd.edu.

95% Of People In Later Life Feel Ageing Should Be A Time Of Celebration - Despite 78% Feeling That Older People Are Ignored By Society, UK

New research by Age UK, the new force combining Age Concern and Help the Aged, has revealed that 95% of people over 60 think getting older should be a time of enjoyment and celebration.

20 april 2010--This is despite 78% of this age group feeling that older people are ignored by society. The polling for Age UK by YouGov also revealed that 82% of over-60s felt that older people's voices were not heard as much as younger people's. It also highlighted how work, not necessarily just age, may play a defining role in this, with 64% saying they felt working people had a greater voice than those who were retired.

The same poll also found that when asked about what could be done locally to improve their lives, being treated with dignity and respect came top for the over-60s (46%). This was closely followed by 34% saying opportunities to learn new hobbies, and 32% citing that more frequent and accessible public transport would improve their lives.

The research is released on the same day that Age UK launches a new Television advertising campaign. The advertisement - starring actor Brian Cox - will reach a wide audience and showcase the range of ways that Age UK can help, the products and services it offers, and how people can get in touch.

As part of its mission to improve later life for all, Age UK is calling for older people from across the country to come forward to tell their inspiring stories of achievements. Age UK will use these to highlight how later life can be a time of opportunity and to challenge some of the stereotypes about older age.

Diana Moran, aged 70, model and famously known as The Green Goddess, is fronting the campaign. She said:

'I am an extremely active 70-year-old and make a very valuable contribution to society. I am happy to help highlight the search to find stories of other people doing remarkable things and celebrating the joy of later life.'

Michelle Mitchell, Charity Director for Age UK said:

'As a group within society, people in later life often feel ignored, and this research clearly demonstrates how this is a reality experienced by the majority. Ageing can present many challenges, particularly for those experiencing disadvantage. Age UK campaigns and provides services and solutions to help improve later life.

'However, we believe an ageing society presents tremendous opportunities that should rightly be celebrated, and it is heartening to see that this is a belief held by such a high percentage of those polled. The search to find these inspirational stories is just one way to celebrate later life and is a first step in ensuring that the voices of people in later life are heard loud and clear.'

Older people who are interested in taking part in the campaign can send in their story, or the story of someone they know*, by emailing mystory@ageuk.org.uk.

Notes

All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 1076 adults 60+. Fieldwork was undertaken between 9th to 12th April 2010. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 60+).

Age UK is the new force combining Age Concern and Help the Aged. The Age UK family includes Age Scotland, Age Cymru and Age NI.

* If submitting a story about someone else, please ensure you get their permission before contacting us.

The new Age UK TV campaign launches on 19th April and aims to raise awareness of its work, the products and services it provides, the need to raise funds and how people can get involved. The ads feature actors Brian Cox, Sir Ian McKellen and Eleanor Bron, who are all over 60.

Age UK is inspired by the belief that it can improve the lives of people in later life. It celebrates ageing and believes it presents unprecedented opportunities and challenges at home and abroad. Age UK will challenge ageist prejudice in society, provide services that address market failures and support the public and private sectors to design age-friendly products and services. It will support people to remain in their own homes through campaigning and practical services, and its Information and Advice service will offer millions of people support on a range of issues, from claiming benefits to staying fit and healthy.

Age UK will fund biomedical research that helps tackle the ill health and poor quality of life that are too common as people age. Working with over 350 partners across the country, Age UK helps influence local decisions and deliver the most appropriate services. Its network of over 500 shops will act as a focal point for the local community, providing information and help with local services. Age UK works across the globe as well as in the UK, with its international partner, Help Age International, championing older people's rights and needs, and as an active member of the DEC.

Source
Help The Aged

It takes only 5 minutes to assess disability in patients with depression

19 april 2010--A research team has tested the utility of the short version of WHO-DAS II, a tool to assess within five minutes disability in patients with depression, "which in the case of primary care is even more practicable than the long version of the instrument." In Spain, more than 10% of the population suffer from severe depression.

The family doctor is usually the first to screen an individual who feels depressed. For this reason, training and tools that enable the diagnosis of this illness and the disability associated with it are essential. A new study now certifies the reliability and validity of the 12-item WHO-DAS II, the short version of the World Health Organization scale to assess disability in primary care patients.

Juan Vicente Luciano's research team, at Parque Sanitario Sant Joan de Déu, in Sant Boi de Llobregat (Barcelona), observed that the psychometric information available in Spain on WHO-DAS II in patients with depression was insufficient: "a significant limitation given the high prevalence of this pathology among patients who consult their family doctor", he explains to SINC.

The study, published in the Journal of Affective Disorders, has been based on 3,638 primary care patients from 17 Spanish provinces who have suffered "a major first depressive episode ", according to their family doctor.

"Luciano indicates that "the score obtained by patients on the new scale is more capable at predicting the severity of their depression symptoms than the scores obtained in a quality of life instrument used in the same study".

The authors conclude that the short version of this tool is "as reliable and valid as the full version" in assessing disability in patients with depression, and is even "more suitable" than the long version in the primary care field, given the short time (less than five minutes) it takes to use it.

WHO-DAS II is a tool that assesses functioning and disability in six areas (understanding and communication; ability to get by in their environment; self-care; relationships with others; daily life activities and participation in society). Its psychometric properties have been tested in more than 14 countries and in 16 different languages.

Spain: a depressed country?

Scientific literature shows a high prevalence of mental disorders in Spain. According to a study published in the journal Medicina Clínica in 2006, 19.5% of the population has had a mental disorder at some stage in their life. The most frequent mental disorder is a severe depressive episode, which affects 10.5% of the population.

In 2008, further research on the frequency of depression among primary care patients in six European countries, published in the British Journal of Psychiatry, revealed that Spain has the highest rate of depression in Europe, particularly among women.

The latest data from the World Health Organization (WHO) show that depression affects 121 million people around the world and is the main cause of work-related disability. Although this pathology can be diagnosed and treated effectively in primary care, less than 25% of people affected receive the appropriate treatment.

###

References: Juan V. Luciano, José L. Ayuso-Mateos, Ana Fernández, Antoni Serrano-Blanco, Miquel Roca, Josep M. Haro. "Psychometric properties of the twelve item World Health Organization Disability Assessment Schedule II (WHO-DAS II) in Spanish primary care patients with a first major depressive episode". Journal of Affective Disorders 121:52-58, febrero de 2010.

King et al.: "Prevalence of common mental disorders in general practice attendees across Europe". British Journal of Psychiatry (2008);192:362-367.

Josep M. Haro, Concepció Palacín, Gemma Vilagut, Montse Martínez, Mariola Bernal, Inma Luque, Miquel Codony, Montse Dolz, Jordi Alonso y el Grupo ESEMeD-España. "Prevalencia de los trastornos mentales y factores asociados: resultados del estudio ESEMeD-España". Medicina Clínica (2006);126(12):445-51.

Anti-aging hormones: Little or no benefit and the risks are high

17 april 2010--In the wake of the American Medical Association's (AMA) Council on Science and Public Health's recently released report "The use of hormones for "anti-aging": a review of efficacy and safety," a leading medical authority has criticized the use of anti-aging hormones. Dr. Thomas T. Perls, an associate professor of medicine at Boston University School of Medicine has long spoken out against the promotion and distribution of growth hormones for non-medical uses such as anti-aging and sports. In an editorial appearing in the Future Medicine journal Aging Health, Dr. Perls applauds the courage and example displayed by the AMA in its recently published assessment of the risks and benefits of growth hormone, testosterone, estrogen and DHEA for anti-aging. The editorial entitled "Anti-aging medicine: what should we tell our patients?" is freely available at http://www.futuremedicine.com/doi/full/10.2217/ahe.10.11

There have always been nostrums and potions peddled for eternal youth. Most recently these have been what some entrepreneurs call "bio-identical" or "all-natural" hormones. What they mean by these terms varies from substances made from vegetables – such as soy or yams, which some claim have estrogen-like effects to, more commonly, drugs that are exactly the same as hormones prescribed by endocrinologists for specific diseases. Dr. Perls remarked: "The terms bio-identical or all-natural, particularly in the case of the drugs prescribed by endocrinologists, misleadingly convey a sense of safety to the gullible customer. Arsenic is all-natural to, and it even has some medical uses, but it is anything but safe."

"The AMA's review of the risks and benefits of these hormones in the setting of anti-aging and athletic enhancement is very important given its inclusion of the consensus and position statements of the key professional medical societies as well as the federal agencies that guard public health." states Dr. Perls in the editorial.

The editorial summarizes the AMA's assessment for each of the purported anti-aging hormones and essentially the bottom line of his argument is that in terms of anti-aging, the risks of these hormones out-weigh the little or no benefit. Dr. Perls denounces the marketing of these hormones, particularly growth hormone and anabolic steroids (anabolic steroids are variations of testosterone), for anti-aging. He also provides guidelines for spotting "red flags of quackery" and basic advice that physicians can lend to their patients in their pursuit of healthy aging.

AAN: New Gene Associated With Alzheimer's Disease

Study suggests that variation in MTHFD1L is linked to increased risk of late-onset disease

15 april 2010-- Variation in MTHFD1L -- a gene involved in mitochondrial tetrahydrofolate synthesis associated with risk of neural tube defects and mRNA splicing efficiency -- may be a novel risk factor for late-onset Alzheimer's disease, according to research presented at the annual meeting of the American Academy of Neurology, held from April 10 to 17 in Toronto.

Margaret Pericak-Vance, Ph.D., of the University of Miami Miller School of Medicine's John P. Hussman Institute for Human Genomics, and colleagues combined data on 483,399 single nucleotide polymorphisms from a previously reported genome-wide association study of 492 late-onset Alzheimer's disease cases and 496 controls, and from a novel set of 439 late-onset Alzheimer's disease cases and 608 cognitive controls. Associations exceeding the experiment-wide significance threshold were replicated in an additional 1,338 cases and 2,003 controls.

The researchers found that the single nucleotide polymorphism rs11754661 at 151.2Mb of chromosome 6q25.1 in the gene MTHFD1L was significantly associated with late-onset Alzheimer's disease. In addition, subsequent genotyping of single nucleotide polymorphisms in high linkage disequilibrium with rs11754661 identified statistically significant associations in multiple single nucleotide polymorphisms (rs803424, rs2073067, and rs2072064).

"This finding is noteworthy for late-onset Alzheimer's disease pathology specifically, as MTHFD1L may play a role in the generation of methionine from homocysteine and influence homocysteine-related pathways," the authors conclude. "Levels of homocysteine are a known risk factor for late-onset Alzheimer's disease development. Also, variation in MTHFD1L has been previously reported in a genome-wide association study to have a statistically significant association with coronary artery disease risk, which may suggest a role in vascular features of Alzheimer's disease."

One co-author disclosed financial ties to Athema Diagnostics; another co-author disclosed financial ties to Sabine Neurotechnology.

Abstract No. P03.296
More Information

Docs Issue Guidelines for Drivers With Dementia

13 april 2010-- Scores on a dementia test and input from family members are the most useful tools in determining who is no longer capable of driving when Alzheimer's or other dementia sets in, according to new guidelines from the American Academy of Neurology.

In fact, family members' assessments are usually more accurate than the patient's own opinion of his or her driving abilities in making these decisions, the research shows.

To develop the guidelines, researchers analyzed the results of 422 studies of Alzheimer's disease or other forms of dementia and driving, and rated each based on the quality of the study and the strength of the findings.

Among the strongest predictors of gauging who would fail a behind-the-wheel driving test: scoring a "1" or higher on the Clinical Dementia Rating, a test used by doctors to assess memory, judgment and the ability to function independently at work, home and in social life. A score of "0" is no impairment; 0.5 indicates very mild dementia; 1 is mild dementia, while scores of 2 and 3 are moderate to severe dementia.

The opinions of family members and caregivers are also helpful, said lead guideline author Dr. Donald Iverson, a neurologist with the Humboldt Neurological Medical Group in Eureka, Calif. In contrast, the patient's own assessment of his or her skills isn't really reliable.

One study found that caregivers who rated a patient's driving as "marginal" or "unsafe" were often right, while another found that 94 percent of people with Alzheimer's rated themselves as safe drivers, though only 41 percent passed a driving test.

Determining who is still safe to drive can be difficult, Iverson said. Recent research has found that as many as 76 percent of people with mild dementia can still pass behind-the-wheel driving tests, while other research shows drivers with dementia are at a much higher risk of accidents.

Taken together, the research suggests that some people with dementia can still drive reasonably safely, at least at the outset of the disease, Iverson said.

"Patients with mild dementia are at higher risk as a group for unsafe driving. But a lot of them, if not most of them, are safe drivers when put on the road," Iverson said. "The alarmist group would say that nobody with dementia should be driving. The apologist groups says, wait a minute, as many as 76 percent [of people] with dementia who take the test still pass. It's probably too categorical a statement to say nobody with dementia should be driving."

The guidelines were published in the April 12 online issue of Neurology and were to be presented Monday at the American Academy of Neurology's annual meeting, in Toronto.

Among the other warning signs: a history of crashes; traffic citations; reductions in miles driven; avoiding driving at night, in the rain or other situations; showing aggressive or impulsive personality traits; and scoring low on the Mini-Mental State Examination, another test of thinking skills used to detect impairment.

With driving so important for independence and quality of life, the decision to stop driving is never easy, said Dr. David Knopman, a professor of neurology at the Mayo Clinic in Rochester, Minn.

In addition to memory loss, Alzheimer's causes problems with geographic orientation, slowed reaction times and slowed mental processing, all of which are necessary for safe driving.

"People with dementia are more likely to be uncertain where they are going and more likely to hesitate in intersections or abruptly change directions -- behaviors that would put them at greater risk of having accidents," Knopman said.

Because of changes in the brain caused by Alzheimer's, the patient may be unaware there's a problem, Knopman said. Lapses in judgment are a common symptom of the disease.

"As a doctor, I absolutely have to rely on the family's observations," he said. "The brain supports the capacity for insight into your own actions or capabilities. That is critically eroded in patients with Alzheimer's."

Some states require doctors to report medical conditions that may impair driving ability.

"All of us who have treated patients with Alzheimer's have had the experience of discussing cessation of driving and having the patient become very upset. They think their driving skills are excellent," Knopman said.

Diffuse Idiopathic Skeletal Hyperostosis Causes Dysphagia In Older Patients

12 april 2010--Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in elderly people. All papers related to DISH demonstrate a consistent and marked increase of the disease with advancing age. Various local structural lesions such as oropharyngeal tumors, vascular pathologies, retropharyngeal abscesses, and anterior cervical osteophytes may lead to mechanical esophageal dysphagia.

A research article published in the World Journal of Gastroenterology addresses this issue. A research team led by Dr. Berrin Karadag reported a case of a geriatric patient with diffuse idiopathic skeletal hyperostosis.

This study concluded that DISH should be considered an important, although rare, cause of dysphagia among older adults. However, it should not be accepted as the cause of dysphagia until all other causes have been ruled out.

Reference: Karadag B, Cat H, Aksoy S, Ozulu B, Ozturk AO, Oguz S, Altuntas Y. A geriatric patient with diffuse idiopathic skeletal hyperostosis. World J Gastroenterol 2010; 16(13): 1673-1675.

Source:
Ye-Ru Wang
World Journal of Gastroenterology

Belief That Intentional Weight Loss Is Harmful To Seniors Is Unfounded

A new study by researchers at Wake Forest University Baptist Medical Center is the first to refute the widely held belief that intentional weight loss in older adults leads to increased risk of death.

11 april 2010--In fact, the research shows that seniors who intentionally exercised and/or modified their diets to lose weight were half as likely to die within eight years of follow-up as their peers who did not work toward weight loss, said M. Kyla Shea, Ph.D., first author on the study and a research associate in the Department of Internal Medicine, Section on Gerontology and Geriatric Medicine.

"It was an unusually strong and surprising finding," Shea said. "Our data suggest that people should not be concerned about trying or recommending weight loss to address obesity-related health problems in older adults."

The study, funded by the National Institute on Aging, is currently available online and is schedule to appear in a future print issue of the Journal of Gerontology: Medical Sciences.

Prior to this study, research that has looked at the association between mortality and weight loss has not factored in the many different potential causes of the weight loss. So, using a more rigorous randomized trial approach, Shea and colleagues sought to prove or disprove the idea that older individuals who actively tried to lose weight increased their risk of death.

The research team re-analyzed data from a study of 318 community-dwelling, older adults over age 60, all with knee arthritis, who were enrolled in a trial assessing the effects of weight loss and/or exercise on physical function in the late 1990s. The initial weight-loss intervention took place over a period of 18 months from 1996 through 1998, during which time the 159 individuals in the intervention groups actively lost an average of 10.5 pounds. The non-intervention group lost an average of 3.1 pounds naturally.

The researchers then checked to see if the study participants were still living eight years later.

"Overall, we found that there were far fewer deaths - half the number - in the group of participants that lost weight compared to the group that did not," Shea said.

The finding was unexpected to seasoned gerontologists.

"For years, the medical community has relied on multiple epidemiological studies that suggested that older people who lost weight were more likely to die," said Stephen B. Kritchevsky, Ph.D., director of the J. Paul Sticht Center on Aging at the Medical Center. "Weight loss in old folks is just understood to be a bad prognostic sign. The data that people have been using has been unable to separate the cause and effect of the weight loss, however, and our study suggests that the weight loss they've been studying may be the result of other health problems and not of intentional weight loss."

The participants in this study had a constellation of common health problems occurring in aging adults, Kritchevsky added.

"These were the seniors living out in the community, getting around and doing their daily tasks just like your neighbor," he said. "All were overweight and dealing with the signs of aging when the study started."

When the researchers evaluated the effect of weight loss in the oldest of the participants - 75 and older - they found the same reduction in mortality as they saw in the younger group - those 60 and older - who lost weight.

Weight loss in older adults has been shown to help several medical problems, Kritchevsky said, such as high blood pressure, high cholesterol and high fasting glucose levels. However, physicians have been hesitant to recommend weight loss in older adults because of a concern for mortality based on previous research.

"This study puts to rest a lot of unfounded concerns about how to address the epidemic of obesity among our older adults," Kritchevsky said.

He cautioned that the study was relatively small and the results should be confirmed in other trials, but that the data gathered from this analysis are sufficient enough to rule out any significant excess risk due to intentional weight loss and to suggest that there may be a mortality benefit to losing the weight, as well.

In addition to Shea and Kritchevsky, Wake Forest Baptist co-authors included Denise K. Houston, Ph.D., Barbara J. Nicklas, Ph.D., Dalane W. Kitzman, M.D., and Kimberly Kennedy, B.A., all of the J. Paul Sticht Center on Aging; Cralen C. Davis, M.S. and Michael E. Miller, Ph.D., both of the Department of Public Health Sciences; Stephen P. Messier, Ph.D., of Wake Forest University; and Tamara B. Harris, M.D., of the National Institute on Aging.

Source
Wake Forest University Baptist Medical Center

'Five-a-day' has limited impact on cancer risk

PARIS, 07 april 2010– Eating lots of fruit and vegetables has only a small effect on warding off cancer, a study published on Wednesday says, although its authors insist that tucking into the recommended "five-a-day" is still good for general health.

Doctors led by Paolo Boffetta at the Mount Sinai Medical Center, New York, pored over eight years of data from a major European investigation into the relationship between cancer risk and food.

The investigation, which is continuing, covers nearly 470,000 volunteers recruited in 10 Western European countries.

Between 1992 and 2000, more than 30,000 of the participants were diagnosed with cancer.

Boffetta's team found that high consumption of fruit and vegetables gave only modest protection against cancer.

An increase of 200 grammes (about seven ounces) a day resulted in a three-percent reduction of cancer risk.

Vegetable consumption by itself also gave a small benefit, although this was restricted to women, while heavy drinkers who ate a lot of fruit and veggies had a somewhat reduced risk, but only for cancers linked to alcohol and smoking.

"The bottom line here is that, yes, we did find a protective effect of fruit and vegetable intake against cancer, but it is a smaller connection than previously thought," Boffetta said in a press release issued by Mount Sinai.

"Any cancer protective effect of these foods is likely to be modest, at best. However, eating fruits and vegetables is beneficial for health in general and the results of this study do not justify changing current recommendations aiming at increasing intake of these foods."

The UN's World Health Organisation (WHO) issued a recommendation in 1990 suggesting that five servings of fruit and vegetables per day helped prevent cancer and other diseases.

"Worldwide, low intake of fruits and vegetables is estimated to cause about 19 percent of gastrointestinal cancer, about 31 percent of ischaemic heart disease and 11 percent stroke," the WHO says on its website.

Ischaemic heart disease is caused by lack of blood supply to the cardiac muscles, typically as a result of artery disease, hypertension, smoking or high cholesterol levels.

The new study appears online in the Journal of the National Cancer Institute, published by Britain's Oxford University Press.

1. WHO
2. Journal of the National Cancer Institute

Scientists find new, inexpensive way to predict Alzheimer's disease

Your brain's capacity for information is a reliable predictor of Alzheimer's disease and can be cheaply and easily tested, according to scientists.

05 april 2010--"We have developed a low-cost behavioral assessment that can clue someone in to Alzheimer's disease at its earliest stage," said Michael Wenger, associate professor of psychology, Penn State. "By examining (information) processing capacity, we can detect changes in the progression of mild cognitive impairment (MCI)."

MCI is a condition that affects language, memory, and related mental functions. It is distinct from the ordinary mental degradation associated with aging and is a likely precursor to the more serious Alzheimer's disease. Both MCI and Alzheimer's are linked to a steady decline in the volume of the hippocampus, the area of the brain responsible for long term memory and spatial reasoning.

MRIs -- magnetic resonance imaging -- are the most reliable and direct way to detect hippocampal atrophy and diagnose MCI. But for many, the procedure is unavailable or too expensive.

"MRIs can cost hundreds of dollars an hour," Wenger said. "We created a much cheaper alternative, based on a memory test, that correlates with hippocampal degradation." Wenger and his collaborators at the Mayo Clinic College of Medicine, Rochester, Minn., detail their findings in a recent issue of the Journal of Mathematical Psychology.

From a computer model of an atrophying hippocampus, the researchers determined how to estimate capacity with a statistical measure of how quickly tasks are completed. Applying this analysis to a memory test for people with MCI, the researchers were able to gauge their hippocampal capacity and compare it to the progression of their ailment.

"My collaborators at the Mayo Clinic backed up this study with MRIs for the MCI group," Wenger said. "These capacity measures we developed showed a reliable relationship to the hippocampal volume measurements, so we know we are on the right track."

The scientists began by modeling the hippocampus as a complex electrical circuit. Equations governing electric current and voltage mimicked the electrical firing of neurons within the circuit. The researchers switched off neurons in the simulation to model atrophy of the hippocampus.

With fewer cells available to process electrical signals, the model hippocampus slowed down, but its capacity for processing information decreased at an even faster rate. Capacity was the most sensitive measure of how the hippocampus was deteriorating, more than the average processing speed.

"We then applied this to the gold standard of the field -- the Free and Cued Selective Reminding Test (FCSRT)," Wenger said. "This is a test that can discriminate between normal age-related memory changes and changes caused by impairment."

The researchers gave this test to five groups of participants: college students, healthy middle-aged adults, healthy elderly individuals, people with diagnosed cases of MCI, and a control group of age-matched individuals without MCI. The first three groups each had 100 members and the last two each had 50.

During the FCSRT, the researchers showed the participants descriptive words, such as "part of the body" and "artery" and asked the participants to choose the picture that fit these cues from a set of 24 images, in this case, a picture of a heart. The psychologists then asked the subjects to recall as many items as they could. For objects they failed to remember, the psychologists provided the category cues, providing more information and testing the limits of the subjects' capacity.

The researchers analyzed the response times for the tasks and the number of items that were recalled, with and without additional cues. The MCI group showed the greatest sensitivity to added cues – the additional input either substantially helped or inhibited their performance. But like the computer model, estimates of capacity highlighted the greatest cognitive difference between the MCI group and the others.

This study's approach to defining processing capacity is unusual. The scientists combined disparate principles of engineering and statistics, mathematically translating processing capacity into what is called the "hazard function."

The hazard function is well known in engineering, but relatively new for fields like psychology. It gives the probability that a task that is not yet completed will be completed in the next interval of time.

By measuring how long it takes a participant to recall the objects during the FCSRT, the psychologists fit a model based on the hazard function to each participant and obtain a measure of his or her capacity for the memorization task.

The difference in hazard function measures between the MCI group and all other groups was statistically much more pronounced than the differences between all groups in the number of items they recalled. These hazard function differences also outweighed the contrasts between all groups in their response times. The hazard function model proved to be the most sensitive diagnostic for cognitive distinctions in the groups, making it a reliable indicator of capacity and a better signal of the underlying hippocampal atrophy than processing speed alone.

The researchers' results are valid for every person, not just for the whole group. Since the modified FCSRT relies on personal reaction times, hazard analysis and performance, it can track the progression of MCI for anyone, anywhere there is access to a computer.

"These results are still preliminary, but very encouraging," Wenger said. "We plan to study what this approach can tell us about mental impairments related to other conditions, like iron deficiencies, in the future."

###

Wenger worked with Selamawit Negash, neurology research fellow, Ronald C. Peterson, professor of neurology, and Lyndsay Peterson, research associate, all at the Mayo Clinic College of Medicine.

The National Institute on Aging provided funding for this project.

Cognition declines 4 times faster in people with Alzheimer's disease than those with no dementia

No differences in decline among African American and white patients

03 april 2010--People with Alzheimer's disease experience a rate of cognitive decline four times greater than those with no cognitive impairment according to a new study by researchers at Rush University Medical Center in Chicago. The results of the study, which is only the second population-based study to quantify the rate of cognitive decline in Alzheimer's disease, are published in the March 23, 2010 issue of the journal Neurology, the medical journal of the American Academy of Neurology.

"Knowledge about the progressive cognitive decline in Alzheimer's disease is mainly based on studies of persons evaluated in clinical settings. In such studies, the full spectrum of the disease is unlikely to be represented," said study author Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer's Disease Center. "As a result, it has been difficult to securely determine the cognitive consequences of the disease and to test whether they vary in racial or ethnic subgroups of the population."

Researchers at the Rush Alzheimer's Disease Center and the Rush Institute for Healthy Aging set out to quantify the rates of cognitive decline in people who developed Alzheimer's disease and its precursor, mild cognitive impairment.

The study followed 1,168 older adults. All were participants in the Chicago Health and Aging Project, a longitudinal cohort study of older white and black persons residing on the south side of Chicago. At the beginning of the study, participants did not have dementia. After a mean of five to six years, they had a detailed clinical evaluation and 614 persons were found to have no cognitive impairment, 395 had mild cognitive impairment, and 149 had Alzheimer's disease. They then completed brief cognitive testing at 3-year intervals for a mean of five and half years.

In comparison to the no cognitive impairment group, the annual rate of cognitive decline was increased more than twofold in those with mild cognitive impairment and more than fourfold in those with Alzheimer's disease. The results did not vary by race, sex, or age.

"This study is especially significant because half of the participants are African Americans. Most of what we know about Alzheimer's disease is based on studies of Caucasians," said Wilson. "Our study found no difference in how the disease played out in the two races."

Study authors note that this is one of the few studies to look at a large population without the disease and track the disease progression as it is newly diagnosed. The results were similar to the only other study of its kind, which was completed over a decade ago.

"Part of understanding this disease is carefully quantifying what the consequences are in a defined population," said Wilson. "Such knowledge is especially important now with the prevalence of Alzheimer's disease expected to sharply increase by the middle of the 21st century."

###

Other researchers involved with the study include Dr. Neelum Aggarwal, Dr. Lisa Barnes, Carlos Mendes de Leon, PhD; Liesi E. Hebert, ScD; and Dr. Denis Evans. The study was funded by the National Institute on Aging.