WHO Launches Global Network Of Age-friendly Cities

30 june 2010--WHO launches the Global Network of Age-friendly Cities as part of a broader response to the rapid ageing of populations. Populations in almost every corner of the world are growing older. The greatest changes are occurring in less-developed countries. By 2050, it is estimated that 80% of the expected 2 billion people aged 60 years or over will live in low or middle income countries. The Network aims to help cities create urban environments that allow older people to remain active and healthy participants in society.

Positive contribution of older people

While the response to population ageing has often focussed on the implications for governments of increasing demand for pensions and health care, WHO tries to place more emphasis on the positive contributions older people make to society. "Older people are a vital, and often overlooked, resource for families and for society." said Dr John Beard. Director of the Department of Ageing and Life Course at WHO " Their contribution will only be fully realised if they maintain their health and if the barriers that prevent them engaging in family and community life are broken down".

Supporting active and healthy ageing

The WHO Age-friendly Cities initiative began in 2006 by identifying the key elements of the urban environment that support active and healthy ageing. Research from 33 cities, confirmed the importance for older people of access to public transport, outdoor spaces and buildings, as well as the need for appropriate housing, community support and health services. But it also highlighted the need to foster the connections that allow older people to be active participants in society, to overcome ageism and to provide greater opportunities for civic participation and employment.

Cities wishing to join the global network

The Global Network builds on these principles but takes them a significant step further by requiring participating cities to commence an ongoing process of assessment and implementation. Network members are committed to taking active steps to creating a better environment for their older residents.

Since invitations to join the Network were sent out last December, WHO has been swamped by responses. Many individual cities, both large and small have formally applied to join the Network. WHO has also established formal agreements with the French government, the Irish Ageing Well Network and the Slovenian Network of Age-friendly Cities to develop affiliated national programmes. The China National Committee on Ageing has also indicated interest in developing a national programme, and 5 Canadian Provinces are running complementary initiatives.

New York is the first city to join the network and today, New York Mayor Michael Bloomberg with be presented with the first certificate of membership.

Source:
WHO

Test Combination Predicts Fall Risk in Parkinson's Disease

Overall Parkinson's disease severity, balance, and tendency to 'freeze' indicate fall risk

29 june 2010-- A combination of tests on disease-specific and mobility- and balance-related measures can accurately predict which Parkinson's disease patients are more likely to fall, according to a study published online June 23 in Neurology.

Graham K. Kerr, Ph.D., of the Queensland University of Technology in Brisbane, Australia, and colleagues administered a battery of neurologic and functional tests to 101 medicated patients with early-stage Parkinson's disease who were able to walk without any aids. The tests included the Physiological Profile Assessment of Falls Risk, the Berg Balance Scale, the Timed Up and Go, the Tinetti, and the Functional Reach test. The cohort was then followed for six months for the incidence of falls.

The researchers found that 48 percent of participants had a fall and 24 percent had more than one fall. In multivariate analysis, the best sensitivity (78 percent) and specificity (84 percent) for predicting falls were achieved by combining the scores on a test of overall Parkinson's disease symptoms, a test indicating the patient's tendency to "freeze" when walking, and a balance test.

"Falls are a significant problem in optimally medicated early-stage Parkinson's disease. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with Parkinson's disease," the authors write.

One study author disclosed financial ties to several pharmaceutical companies.

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Caring For An Elderly, Sick Spouse Sometimes Has Positive Elements

27 june 2010--Although long-term care of sick or disabled loved ones is widely recognized as a threat to the caregiver's health and quality of life, a new study led by University at Buffalo psychologist Michael Poulin, PhD, finds that in some contexts, helping valued loved ones may promote the well being of helpers.

"Does a Helping Hand Mean a Heavy Heart?," published in the journal Psychology and Aging (2010, Vol. 25., No. 1), reports on a study by Poulin and five co-authors from the University of Michigan Department of Internal Medicine, which closely analyzed helping behavior and well-being among 73 spousal caregivers, many of them elderly.

Poulin, an assistant professor of psychology, says the study team wanted to learn if there were some positive aspects of caregiving, aspects that did not provoke the burnout, high stress and poor health associated with being a caregiver. If so, they wanted to know why these aspects had a positive effect.

They learned that despite the burdensome nature of their role, caregivers experience more positive emotions and fewer negative emotions when they engage in "active care" like feeding, bathing, toileting and otherwise physically caring for the spouse.

"Our data don't tell us exactly what psychological processes are responsible," he says, "but we hypothesize that people may be hardwired so that actively attending to the concrete needs and feelings of others reduces our personal anxiety."

The study found that passive care, on the other hand, which requires the spouse to simply be nearby in case anything should go wrong, provokes negative emotions in the caretaker, and leads to fewer positive emotions.

The study involved 73 subjects (mean age was 71.5 years, age range was 35-89 years) who were providing full-time home care to an ailing spouse. Participants carried Palm Pilots that beeped randomly to signal them to report how much time they had spent actively helping and/or being on call since the last beep, the activities they actually engaged in and their emotional state at that moment.

The researchers found no moderating effects of age on the association between helping and well-being. In other words, helping predicted positive and negative effects similarly for adults of all ages. One variable that did affect outcome was the level of perceived interdependence with the spouse experienced by the caregiver -- that is, the extent to which caregivers viewed themselves as sharing a mutually beneficial relationship with their spouse.

"For interdependent couples, the positive effects of active care were particularly strong," Poulin says, adding that this outcome supports the prediction that "individuals should derive the greatest satisfaction out of helping those with whom they perceive a shared physical or emotional fate."

Poulin says study findings have broad implications for research on caregiving and for research on helping behavior more generally, especially in the aging context.

"Overall," he says, "we wouldn't say that caring for an ailing loved one is going to be good for you or healthy for you, but certain activities may be beneficial, especially in high-quality relationships."

Researchers and social scientists want government or other agencies to provide respite for caregivers, which would be a good thing, Poulin says, "but as this study demonstrates, it is extremely important that caretakers receive the right kind of relief at the right time -- perhaps less time off from active care duties, and more time off from the onerous task of passively monitoring an ailing loved one."

Source:
Patricia Donovan
University at Buffalo

ADA: Diabetes Doubles Risk of Several Vascular Diseases

Meta-analysis suggests diabetes is responsible for 11 percent of cardiovascular deaths

26 june 2010-- Diabetes independently doubles the risk of a range of vascular diseases, and may now account for one in every 10 deaths from cardiovascular disease, according to research published in the June 26 special issue of The Lancet to coincide with a presentation at the American Diabetes Association's 70th Scientific Sessions, held from June 25 to 29 in Orlando, Fla.

Researchers from the Emerging Risk Factors Collaboration at the University of Cambridge in the United Kingdom conducted a meta-analysis of 102 prospective studies involving 698,782 people in 25 countries who initially had no vascular disease, of whom 52,765 eventually had nonfatal or fatal vascular outcomes.

The researchers found that diabetes was strongly associated with an increased risk for coronary heart disease, ischemic stroke, hemorrhagic stroke, unclassified stroke, and the aggregate for other vascular deaths (adjusted hazard ratios, 2.00, 2.27, 1.56, 1.84, and 1.73, respectively). At a 10 percent adult population-wide prevalence, they estimated that diabetes accounted for 11 percent of vascular deaths. In patients without diabetes, however, they found that fasting blood glucose concentration was only weakly associated with the risk of vascular disease.

"Our data suggest that in this decade about 10 percent of vascular deaths in populations in developed countries have been attributable to diabetes in adults, corresponding to an estimated 325,000 deaths per year in high-income countries alone (plus several-fold more people disabled by vascular disease)," the authors write. "This burden will increase if the incidence of diabetes continues to rise, even if rates of vascular disease continue to fall because of decreases in smoking, improvements in treatment, or other reasons."

This study was partly supported by Pfizer; one author disclosed financial ties to Pfizer and other pharmaceutical companies, and another author disclosed ties to GlaxoSmithKline.

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Brain Stimulation Seems to Boost Language Skills in Alzheimer's Patients

25 june 2010-- People with Alzheimer's who are losing their language skills may see some improvement by using a technique called repetitive transcranial magnetic stimulation (rTMS), early research by an Italian team suggests.

The noninvasive procedure delivers a series of rapid magnetic pulses at frequencies up to 100 Hz to the brain. Earlier studies have found that these pulses can change brain activity, depending on the frequency, the researchers explained.

Though "preliminary," the new findings "hold considerable promise, not only for advancing our understanding of brain plasticity mechanisms, but also for designing new rehabilitation strategies in patients with neurodegenerative disease," according to lead researcher Maria Cotelli, from IRCCS Centro San Giovanni di Dio Fatebenefratelli in Brescia.

The report is published in the June 24 online edition of the Journal of Neurology, Neurosurgery and Psychiatry.

For the study, Cotelli's team tried rTMS in 10 patients with moderate Alzheimer's disease. The researchers randomly assigned the patients to four weeks of rTMS at 20 Hz or two weeks of a dummy treatment followed by two weeks of rTMS. Pulses were delivered to the prefrontal lobes of the brain.

The people in the study had their memory, executive functions and language tested at the start of the study, after two and four weeks of treatment, and again after eight weeks.

After two weeks, the researchers found a significant difference between the two test groups in terms of their ability to understand spoken language.

Among people who underwent rTMS, the number of correct answers on a comprehension test went from 66 percent to more than 77 percent, while among those who did not receive the treatment the scores remained unchanged.

After the last two weeks of treatment, those who had not received rTMS initially showed improvement in language comprehension, the researchers noted.

Moreover, the improvement among those in both groups remained two months after the treatments.

rTMS did not change other language abilities or cognitive functions, including memory. This suggests that in this context rTMS is specifically related to language comprehension, Cotelli's group says.

How rTMS might work is not clear, the researchers noted. This stimulation may change activity in the brain and readjust unhealthy patterns caused by disease or damage, they speculated.

There is some evidence for this theory. Imaging studies of people with congenital or acquired brain damage show certain areas of the brain seem to be plastic and cortical activity can be "reorganized," Cotelli's group added.

"Our findings provide initial evidence for the persistent beneficial effects of rTMS on sentence comprehension in Alzheimer's disease patients," Cotelli said. "Rhythmic rTMS, in conjunction with other therapeutic interventions, may represent a novel approach to the treatment of language dysfunction in Alzheimer's disease patients."

One expert believes the findings are interesting, but they need to be replicated and extended before their value can truly be known.

Catherine M. Roe, a research instructor in neurology at the Washington University School of Medicine in St. Louis, called it "an intriguing study."

The results do seem to suggest that two to four weeks of rTMS treatment improved scores on a sentence-comprehension test among people with Alzheimer's disease, at least in the short term, she said.

However, "before concluding that the effects of the treatment are long-lasting, I think it would be important to also include in a study like this a group of participants who only received placebo treatment," Roe said.

As with all new research, it is also important to see whether the results can be shown in a larger, and different, group of people to see whether the effect is reliable, she added.

"We also need to keep in mind that we don't know whether improvement in scores on a sentence test will translate into improvement in day-to-day language comprehension," Roe said.

Test Combination Predicts Fall Risk in Parkinson's Disease

Overall Parkinson's disease severity, balance, and tendency to 'freeze' indicate fall risk


24 june 2010-- A combination of tests on disease-specific and mobility- and balance-related measures can accurately predict which Parkinson's disease patients are more likely to fall, according to a study published online June 23 in Neurology.

Graham K. Kerr, Ph.D., of the Queensland University of Technology in Brisbane, Australia, and colleagues administered a battery of neurologic and functional tests to 101 medicated patients with early-stage Parkinson's disease who were able to walk without any aids. The tests included the Physiological Profile Assessment of Falls Risk, the Berg Balance Scale, the Timed Up and Go, the Tinetti, and the Functional Reach test. The cohort was then followed for six months for the incidence of falls.

The researchers found that 48 percent of participants had a fall and 24 percent had more than one fall. In multivariate analysis, the best sensitivity (78 percent) and specificity (84 percent) for predicting falls were achieved by combining the scores on a test of overall Parkinson's disease symptoms, a test indicating the patient's tendency to "freeze" when walking, and a balance test.

"Falls are a significant problem in optimally medicated early-stage Parkinson's disease. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with Parkinson's disease," the authors write.

One study author disclosed financial ties to several pharmaceutical companies.

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Folic Acid, B12 Do Not Reduce Vascular Events

Supplements don't prevent major vascular events after MI, nor do they raise cancer risk

23 june 20010-- Supplementation with folic acid and vitamin B12 over an extended period does not have a beneficial effect on vascular outcomes in individuals who have had a myocardial infarction, but it also poses no excess cancer risk, according to a study in the June 23/30 issue of the Journal of the American Medical Association.

Jane M. Armitage, of the University of Oxford in the United Kingdom, and colleagues conducted a prospective study of 12,064 myocardial infarction survivors to assess the association of B-vitamin supplementation and major vascular events. Patients were randomly assigned to receive either folic acid 2 mg per day plus vitamin B12 1 mg per day, or placebo.

The researchers found that patients in the treatment group had homocysteine reductions averaging 28 percent; 25.5 percent of this group had a major vascular event over the 6.7-year study period, while patients in the placebo group had a 24.8 percent risk of having a major vascular event in the same period (P = .28). The researchers found that supplementation has no apparent effect on major coronary events, stroke, or non-coronary revascularizations. There was no significant difference in the incidence of vascular-related or nonvascular-related deaths between the two groups. There was also no significant difference in the risk of cancer between the two groups, which had been previously speculated.

"These results highlight the importance of focusing on drug treatments (e.g., aspirin, statins, and antihypertensive therapy) and lifestyle changes (in particular, stopping smoking and avoiding excessive weight gain) that are of proven benefit, rather than lowering homocysteine with folic acid-based vitamin supplements, for the prevention of cardiovascular disease," the authors write.

The study was funded by Merck (manufacturer of simvastatin and supplier of the vitamins). One author disclosed financial ties to several pharmaceutical companies.

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Vitamin D Deficiency Linked to Diabetes, Metabolic Syndrome in Studies

22 june 2010-- A pair of new studies has uncovered evidence that low levels of vitamin D could lead to poor blood sugar control among diabetics and increase the risk of developing metabolic syndrome among seniors.


Both findings are slated to be presented Saturday at the Endocrine Society's annual meeting in San Diego.


In one study, researchers at the Johns Hopkins University School of Medicine in Baltimore reviewed the medical charts of 124 type 2 diabetes patients who sought specialty care at an endocrine outpatient facility between 2003 and 2008.


More than 90 percent of the patients, who ranged in age from 36 to 89, had either vitamin D deficiency or insufficiency, the authors found, despite the fact that they all had had routine primary care visits before their specialty visit.


Just about 6 percent of the patients were taking a vitamin D supplement at the time of their visit, the research team noted, and those who had lower vitamin D levels were also more likely to have higher average blood sugar levels.


"This finding supports an active role of vitamin D in the development of type 2 diabetes," study co-author Dr. Esther Krug, an assistant professor of medicine, said in a news release from the Endocrine Society.


"Since primary care providers diagnose and treat most patients with type 2 diabetes, screening and vitamin D supplementation as part of routine primary care may improve health outcomes of this highly prevalent condition," Krug added.


A second study involving nearly 1,300 white Dutch men and women over the age of 65 found almost half were vitamin D-deficient, while 37 percent had metabolic syndrome.


Metabolic syndrome is a grouping of health risk factors, including high blood pressure, abdominal obesity, abnormal cholesterol levels and high blood sugar.


"Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases," study co-author Dr. Marelise Eekhoff, of VU University Medical Center in Amsterdam, said in the same news release.


Regardless of gender, those with insufficient amounts of vitamin D in their blood were more likely to have the syndrome than those with sufficient amounts of vitamin D, Eekhoff and her colleagues found.


"It is important," added Eekhoff, "to investigate the exact role of vitamin D in diabetes to find new and maybe easy ways to prevent it and cardiovascular disease."

'Watchful Waiting' Often Best Strategy for Slow-Moving Prostate Cancer

21 june 2010-- For patients with prostate cancer that has a low risk of progression, active surveillance, also known as "watchful waiting," may be a suitable treatment option, according to a large-scale study from Sweden.

The issue of how (or whether) to treat localized prostate cancer is controversial because, especially for older men, the tumor may not progress far enough to cause real trouble during their remaining expected lifespan. In those cases, deferring treatment until there are signs of disease progression may be the better option.

The researchers looked at almost 6,900 patients from the National Prostate Cancer Registry Sweden, age 70 or younger, who had localized prostate cancer and a low or intermediate risk that the cancer would progress. From 1997 through December 2002, over 2,000 patients were assigned to active surveillance, close to 3,400 underwent radical prostatectomy (removal of the prostate and some surrounding tissue), and more than 1,400 received radiation therapy.

After a median follow-up of just over 8 years, the surveillance group had a much higher death rate from causes other than prostate cancer -- 19.2 percent, compared with 6.8 percent in the prostatectomy group and 10.9 percent in the radiation therapy group.

This suggests that patients with a shorter life expectancy were more often selected for active surveillance rather than surgery or radiation therapy, the researchers said.

The patients who underwent surgery for prostate cancer had a lower risk of dying from prostate cancer than those in the active surveillance group. However, the difference in absolute risk of patients dying from prostate cancer was very small -- only 1.2 percent after 10 years of follow-up.

The researchers concluded that, based on these findings, active surveillance is the best strategy for many patients with low-risk prostate cancer.

"With a 10-year prostate cancer-specific mortality of less than three percent for patients with low-risk prostate cancer on surveillance, this strategy appears to be suitable for many of these men," wrote Dr. Par Stattin, of Umea University, and colleagues.

The study was published online June 18 in the Journal of the National Cancer Institute.

Researchers Identify Symptoms Of Male Menopause

European researchers have for the first time identified the symptoms of late-onset hypogonadism, also termed "male menopause", a condition that follows reductions in the male hormone testosterone in older men, and suggest that unlike the female menopause it is quite rare.

20 june 2010--You can read about these findings in the 16 June online issue of the New England Journal of Medicine, NEJM. The authors were from The University of Manchester, Imperial College London, UCL (University College London), both in the UK, and other European research establishments.

The link between aging-related drops in testosterone and late-onset hypogonadism in men is a controversial topic in medicine, and the researchers hope their findings will help guide doctors prescribing male testosterone therapy, the practice of which has gone up by 400 per cent in the US in the last decade.

Lead author Dr Fred Wu, a professor at The University of Manchester's School of Biomedicine, and colleagues suggest that unlike the female menopause which generally affects all women, the male menopause only affects about 2 per cent of elderly men and is often associated with obesity and poor general health.

Because of the controversy over the link between symptoms and low levels of the male hormone, the researchers decided to look for hard evidence in the general population to help produce a list of criteria for late-onset hypogonadism.

For the study, which is part of the European Union-funded European Male Ageing Study, they surveyed a random population sample of 3,369 men aged from 40 to 79 at eight European centres.

The men completed questionnaires about their general, sexual, physical and psychological health and also gave blood samples from which the researchers were able to assess levels of testosterone (they actually measured total and free testosterone).

From a potential list of 32 candidate symptoms, the researchers found that only nine (three sexual, three physical and three psychological) were actually linked in any significant way with low testosterone.

But the strongest links were with the three sexual symptoms: decreased frequency of morning erection, erectile dysfunction, and decreased frequency of sexual thoughts ("sex drive"). The researchers wrote:

"Only the three sexual symptoms had a syndromic association with decreased testosterone levels."

They also observed that the lower the testosterone levels, the more sexual symptoms there were.

Wu and colleagues concluded that:

"Late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter)."

The other six symptoms, three physical and three psychological symptoms, that were only weakly related to low testosterone, were: an inability to walk more than 1 km; an inability to engage in vigorous activity (eg lifting heavy objects, running); an inability to bend, kneel or stoop; loss of energy; sadness; and fatigue.

Wu and colleagues also ruled out some symptoms that are often linked with male menopause: changes in sleeping pattern, feelings of worthlessness, poor concentration, anxiety, nervousness, and difficulty getting out of a chair. These were in the candidate symptom list but they did not show any significant links with low testosterone.

Wu said in a statement that:

"The diagnosis of classical hypogonadism is corroborated by underlying diseases affecting the testes or pituitary gland, which controls testicular function, but this well-practiced diagnostic approach is frequently found wanting when dealing with the age- related decline of testosterone in elderly men who are prone to have a significant background of non-hormone-related complaints."

He said their findings have for the first time identified the key symptoms of late-onset hypogonadism and suggest that:

"Testosterone treatment may only be useful in a relatively small number of cases where androgen deficiency is suspected, since many candidate symptoms of classic hypogonadism were not associated with decreased testosterone levels in older men."

However, he added a cautionary note, emphasizing the difficulty of diagnosing this condition:

"The long list of nonspecific symptoms that have a potential association with testosterone deficiency makes it difficult to establish a clear diagnosis of late-onset hypogonadism."

"This situation is further complicated when you consider that even the most specific sexual symptoms of androgen deficiency was relatively common among men with normal testosterone levels," he added.

He stressed the importance of establishing the presence of all three of the sexual symptoms from the nine that they found to be linked to low testosterone, plus the presence of low testosterone, to increase the likelihood of correctly diagnosing late-onset hypogonadism.

"The application of these new criteria should guard against the excessive diagnosis of hypogonadism and curb the unwise use of testosterone therapy in older men," said Wu.

"Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men."
Wu, Frederick C.W., Tajar, Abdelouahid, Beynon, Jennifer M., Pye, Stephen R., Silman, Alan J., Finn, Joseph D., O'Neill, Terence W., Bartfai, Gyorgy, Casanueva, Felipe F., Forti, Gianni, Giwercman, Aleksander, Han, Thang S., Kula, Krzysztof, Lean, Michael E.J., Pendleton, Neil, Punab, Margus, Boonen, Steven, Vanderschueren, Dirk, Labrie, Fernand, Huhtaniemi, Ilpo T., the EMAS Group.
N Engl J Med, Published online 16 June 2010.
DOI: 10.1056/NEJMoa0911101

Source: University of Manchester.

10 Top Tips For Aging Well With The AGS Foundation For Health In Aging New Health Guide

19 june 2010--Aging well doesn't mean simply living longer-it means staying healthy and active so that you can continue doing what you love for as long as possible. Now, a growing body of research suggests that the key to healthy aging is in our hands, and tells us that it's never too late to make the vital lifestyle changes that will help ensure a longer, more vibrant life.

To help older adults and their loved ones discover what they need to do to live well for as long as possible, the American Geriatrics Society's (AGS') Foundation for Health in Aging (FHA) has published an easy to understand health "tip sheet"-- "Ten Top Tips for Aging Well."

"Adopting healthy lifestyle practices, even when you're older, can have an enormous impact on how well you'll age," says Cheryl Phillips, MD, AGSF. "Maintaining these practices is essential for living a higher quality, more independent life."

The FHA tip sheet for healthy aging includes these three key strategies: Eat a colorful, nutrient rich diet; exercise safely to stay physically strong and mentally alert; and keep your mind sharp with games and activities. The tip sheet also offers advice on how to get the most from your visits to healthcare professionals, including must-have vaccines, reviewing all medications and supplements with your doctor to guard against complications, and discussing any feelings of sadness, loss of appetite, or anxiety. Knowing how to enjoy safe sex, how much alcohol is safe to drink, and how much shut eye you need every night, is also addressed in the tip sheet.

This information is the latest in the Foundation's ongoing series simple, up-to-date and authoritative health tip sheets for older adults and their caregivers.

Source
American Geriatrics Society

Mediterranean Diet Linked to Better Cardiac Function

Greater conformity to the diet associated with higher heart rate variability

17 june 2010-- The closer a person conforms to a Mediterranean diet, the greater the likelihood of higher heart rate variability (HRV), indicating better cardiac autonomic function and lower risk for coronary artery disease, according to a study published online June 15 in Circulation: Cardiovascular Quality and Outcomes.

Jun Dai, M.D., of Indiana University in Bloomington, and colleagues administered the Willett Food Frequency Questionnaire to 276 middle-aged male twins. With the dietary data, the researchers used an established algorithm to derive a score to reflect each subject's conformance to a Mediterranean diet. All twins also had an ambulatory 24-hour electrocardiogram to record five time domain and six frequency domain HRV parameters. Regression analysis was used to associate diet and HRV differences between- and within-twin pairs.

The researchers found that a one-unit higher score on the Mediterranean diet scale had a significant association with higher time domain and frequency domain HRV parameters (ranging from 3.9 to 13 percent). These estimates stayed the same after the researchers controlled for known cardiovascular risk factors and use of medications and fish oil supplements.

"In conclusion, our study demonstrates for the first time a positive association between the Mediterranean dietary pattern and HRV. Our findings suggest that autonomic tone may be one of mechanisms linking the Mediterranean diet to a lower rate of cardiovascular events," the authors write.

Abstract
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Can Alzheimer's disease be prevented?

Researchers explore potential interventions in a special issue of the Journal of Alzheimer's Disease

Amsterdam, The Netherlands, 16 june 2010 – Although effective treatment for Alzheimer's disease (AD) has been slow to emerge, there has been substantial progress in identifying AD risk factors and developing treatments that might delay or prevent onset of the disease. In a Special Issue of the Journal of Alzheimer's Disease, "Basics of Alzheimer's Disease Prevention," researchers report on key findings that point towards possible significant interventions.

The significance of "Basics of Alzheimer's Disease Prevention" is that it provides for the first time, a strategic blueprint using the 4 pillars of preventive medicine. These pillars are:

1. Identification of disease-related and lifestyle risk factors;
2. Pathologic consequences and impact of AD risk; factors
3. Detection of AD risk factors;
4. Treatment of AD risk factors.

Guest editor Jack C. de la Torre, MD, PhD, from the Center for Alzheimer's Research, Banner Sun Health Research Institute, Sun City, Arizona, USA, has assembled a collection of 24 articles that address these four pillars of AD prevention.

According to Dr. de la Torre, "Just as the harmful consequences of cervical cancer, pancreatitis, severe anemia, and acute renal failure can be generally improved through routine lab test detection and administration of appropriate therapy, so too can preclinical AD become responsive to early detection of risk factors and targeted treatments aimed at reducing the severity and progress of the discovered pathology. Unlike the potentially lethal disorders stated above, people with AD have no effective treatment options—prevention thus becomes the alternate and essential primary weapon to combat this disease."

The strategies proposed offer a realistic hope to the millions of people who face a range of maladies associated with aging and cognitive decline—including multiple risk factors that can culminate in dementia. This approach of knowledge-to-action using evidence-based medical decisions to opt for the most judicious treatments or management of patients when risk factors to AD are discovered, as reviewed in this issue, should become a gold standard of clinical practice.

Collectively, the contributing authors advocate an AD preventive plan that would incorporate:

1. Early identification/detection of AD risk factors;
2. Early intervention based on evidence-based medical decisions;
3. Patient follow-up to assess and modify when necessary, strategic intervention.

The information contained in this Special Issue will be fundamental to recognizing, managing and reducing the major risk factors for AD, a process which should take the sting out of the growing prevalence of this dementia in years to come. The articles will be of interest to anyone involved in the care, management or treatment of AD and to those who wish to learn more about this form of dementia.

"Moving AD from inevitable to avoidable is what we are all hoping for as we understand the disease," commented George Perry, PhD and and Mark A. Smith, PhD, Editors-in-Chief of the Journal of Alzheimer's Disease.

Depression Can Make Pain Worse

15 jun 2010-- Being depressed can make real physical pain feel worse, British researchers have found.

Noting that pain and depression often occur at the same time, the current observation blends two competing schools of thought, in which some believe that pain is "all in the head" while others contend that pain is "all in the body."

To see how pain and depression might intersect, the research team -- led by the University of Oxford's Dr. Chantal Berna -- used brain imaging to conduct pain tests on healthy participants who were induced to feel sad.

A depressed mood appeared to affect brain nerve circuitry responsible for emotion, resulting in a stronger perception of pain, according to the report published in the June 1 issue of Biological Psychiatry.

"When the healthy people were made sad by negative thoughts and depressing music, we found that their brains processed pain more emotionally, which lead to them finding the pain more unpleasant," Berna said in a news release from the journal's publisher.

Berna's team theorized that one's ability to control the negative emotions linked to pain are short-circuited by depression, leading to a bigger punch when pain hits. In other words, depression may not only be a consequence of being in pain. It might actually exacerbate pain, making it worse than it would be for those in a positive frame of mind.

"Our research suggests depressed mood leads to maladaptive changes in brain function associated with pain, and that depressed mood itself could be a target for treatment by medicines or psychotherapy in this context," Berna explained in the news release.

Following this line of research, the next step would be to study patients with chronic pain, because they often also suffer from depression, the researchers noted. The goal would be to find ways to more effectively treat the millions of people worldwide who experience chronic pain and depression, the authors explained.

More information

For more on pain and depression, visit National Pain Foundation.

Family Caregivers Share Experiences of Dying Patients

14 jun 2010-- People who are taking care of a family member with lung cancer need support for the entire time that their loved one is terminally ill because they encounter tremendous stress during the dying process, a new study has found.

In many cases, the caregivers suffered from fatigue and felt as if they were also sick. The caregivers, "like patients, often felt they were on an emotional rollercoaster, experiencing peaks and troughs at key times of stress and uncertainty in the cancer trajectory," according to the report published online June 10 in BMJ.

In the study, Scott A. Murray, of the University of Edinburgh, and colleagues interviewed 19 patients with lung cancer and 19 family caregivers every three months for a one-year period, or until the patient died. While the caregivers were generally in better health than the patients, their ability to provide care was diminished when they encountered their own health problems, the investigators noted in a BMJ news release about the study.

Caregivers need support just like the people they're assisting at the four stages considered most stressful for terminally ill cancer patients: when they're diagnosed, when they're at home recovering from their initial treatment, when the cancer recurs, and when death is near, "not just in the terminal phase and during bereavement, as currently tends to be the case," the study authors concluded.

Caregivers may be empowered by knowing that "it is common to feel stressed and in need of support at certain times," Murray's team wrote.

More information

The U.S. National Cancer Institute has tips for caregiver

Mental decline from diabetes can start in middle age

NEW YORK , 13 jun 2010– Diabetes can lead to a decline in memory, thinking speed, and mental flexibility in middle age, but controlling the blood sugar disorder might prevent some of these effects, new research from the Netherlands suggests.

While the mental decline may be invisible to the individual, the fact that the drop-off starts accumulating in middle age puts diabetics at greater risk later on because of reduced "brain reserves," Dr. David Knopman, of the Mayo Clinic in Rochester, Minnesota, told Reuters Health.

"Like a bicycle tire that's been partially deflated -- you'll be OK riding around but if you develop another little leak you'll be much closer to a flat tire much faster," said Knopman, who was not involved in the Dutch study.

Astrid Nooyens and colleagues at the National Institute for Public Health and the Environment in the Netherlands examined the health records and mental acuity scores of more than 2,600 men and women between the ages of 45 and 70 who enrolled in a large ongoing study into lifestyle effects on health.

At the five-year mark, of the 139 participants with type 2 diabetes, 61 were diabetics at the beginning of the study and 78 developed the chronic disease within the next five years.

The study confirmed the findings of earlier research, by Knopman and others, of an association between diabetes and declines in such mental functions as the ability to think quickly and recall words, but this is the first project to test memory and demonstrate how quickly the drop-off can occur.

Over a five-year period, decline in overall mental functioning in people with type 2 diabetes, while small, was nearly 3 times more pronounced than in non-diabetics.

But it didn't take many years for the impact to be felt. Even those who developed diabetes after beginning the study saw twice as much of a decline as their non-diabetic counterparts.

Compared to the "healthy" participants, participants who had long-term diabetes registered the largest declines in mental function. Those who developed diabetes during the trial saw less pronounced declines than their long-term counterparts in most areas except information processing, where they appeared to do a little better than the "healthy" people.

Type 2 diabetes is characterized by high blood sugar levels caused by the body's inability to process sugar properly. The illness can usually be controlled through diet and exercise but may also require drugs.

The Nooyens group found that while memory continues to decline for those with diabetes, the drop-off in thinking speed appears to occur in the first five years and then level off. That led the authors to suggest that early treatment and control of blood sugar levels could help thinking speed, but probably not memory, they note in the journal Diabetes Care.

The researchers found that for a small group of people who had lived with diabetes for nearly seven year, blood sugar levels did not explain the entire decline in mental function. In those people, they suspect other conditions related to diabetes such as high blood pressure and obesity.

The study did not look at whether patients with well-controlled diabetes experienced less mental decline compared to their poorly controlled counterparts, although the authors point out that there are other reasons, such as heart disease, to control sugar levels as well.

They also note that the random blood tests of both the long- and short-term diabetics suggested what treatment they were getting was "insufficient."

SOURCE: http://link.reuters.com/xyd69k Diabetes Care, online June 2, 2010

Cognitive ability, not age, predicts risky decisions

DURHAM, N.C., 12 jun 2010 – Just because your mother has turned 85, you shouldn't assume you'll have to take over her financial matters. She may be just as good or better than you at making quick, sound, money-making decisions, according to researchers at Duke University.

"It's not age, it's cognition that makes the difference in decision-making," said Scott Huettel, Ph.D., Associate Professor of psychology and neuroscience and director of the Duke Center for Neuroeconomic Studies. He recently led a laboratory study in which participants could gain or lose money based on their decisions.

"Once we accounted for cognitive abilities like memory and processing speed, age had nothing to do with predicting whether an individual would make the best economic decisions on the tasks we assigned," Huettel said.

The study was published in the Psychology and Aging journal, published by the American Psychological Association.

Duke researchers assigned a variety of economic tasks that required different types of risky decisions, so that participants could gain or lose real money. They also tested subjects' cognitive abilities – including both how fast they could process new information and how well they could remember that information. They worked with 54 older adults between 66 and 76 years of age and 58 younger adults between 18 and 35 years of age. .

The researchers used path analysis, a statistical method of finding cause-and-effect relationships, to determine whether age affected the economic decisions directly or whether it had indirect effects, such as age influencing memory, which in turn influenced decisions.

"The standard perspective is that age itself causes people to make more risky, lower-quality decisions – independent of the cognitive changes associated with age," said Huettel, who is also with the Duke-UNC Brain Imaging and Analysis Center. "But that isn't what we found."

The path analyses showed that age-related effects were apparently linked to individual differences in processing speed and memory. When those variables were included in the analysis, age was no longer a significant predictor of decision quality, Huettel said.

On a bell curve of performance, there was overlap between the younger and older groups. Many of the older subjects, aged 66 to 76, made similar decisions to many of the younger subjects (aged 18 to 35). "The stereotype of all older adults becoming more risk-averse is simply wrong," Huettel said.

"Some of the older subjects we studied were able to make better decisions than younger subjects who scored lower on tests of their cognitive abilities," Huettel said. "If I took 20 younger adults and 20 older adults, all of whom were above average on these measures, then on average, you could not tell them apart based on decisions. On the whole, it is true, more older people process slowly and has poorer memory. But there are also older people who do as well as younger people."

Huettel said that the findings suggest strategies to assist people, such as allowing more time for decisions, or presenting data in certain ways to assist people in making decisions.

"Decision scaffolding is the concept that you can give people structure for decision-making that helps them," Huettel said. "We should try to identify ways in which to present information to older adults that gives them scaffolding to make the best choices. If we can reduce the demand on memory or the need to process information very quickly that would be a great benefit to older adults and may push them toward making the same economically beneficial decisions as younger adults."

In reality, younger adults more often work to obtain credit cards with lower interest rates and lower interest rates on mortgages, for example. Huettel said that using surveys that track real-world behavior might help to identify who would benefit from getting information in one manner versus another.

"Some younger adults, too, may benefit from getting their information in a slow, methodical way, while others may not," Huettel said. "We may be able to predict that based on cognition." Self-recognition is important, too, so that if someone knows they process things well over time, they might ask for more time to make a decision rather than making an impulsive decision on the spot, he added.

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Other authors included lead author Debra Henninger, who was with Duke but is now at CIGNA in the department of valuation & evaluation informatics, and David J. Madden, Ph.D., from the Duke Center for the Study of Aging and Human Development and the Duke department of psychiatry. The work was supported by NIH grants.

Two New Studies Reveal Well-Being Over A Lifetime And The Well-Being Challenges Faced By Caregivers

11 jun 2010-Studies published by Healthways Center for Health Research (CHR) in its May 2010 publication of Outcomes & Insights provide new knowledge of the impact of age on well-being, and the effect of caregiving on the well-being of the 52 million Americans providing care for an adult who is ill or disabled. The studies, based on more than 355,000 individual responses collected through 2008, leverage data from the Gallup-Healthways Well-Being Index™ (WBI), the largest survey of its kind, and the pulse of well-being in America.

The Impact of Caregiving and Employment on Well-Being

The first study, "Estimating the Impact of Caregiving and Employment on Well-Being," demonstrates those who provide care for other adults are in need of well-being support themselves. Employed non-caregivers experience significantly higher well-being than their employed caregiver counterparts.

"One in five American households is already providing support for a loved one (who is not a child) 18 hours or more each week," said Joseph Coughlin, an author of both CHR papers and Director of the Massachusetts Institute of Technology AgeLab. "The need for caregivers is not going away. We need to look now at how we can help these people who will be over worked and over stressed."

The ongoing call for caregivers will demand innovations in the workplace, Coughlin said. Jobs that provide flexible hours, unpaid family leave and paid sick or vacation days are more likely to retain caregivers as employees. Additionally, workplace wellness programs can provide a valuable resource to help employees maintain their own well-being while caring for someone else.

The study also shows caregivers worry more than non-caregivers and also experience less happiness. Employed non-caregivers reported feeling happiest (47.1 percent), with employed caregivers falling significantly behind (39.9 percent). The higher stress and lower happiness scores is even more apparent in non-employed caregivers, of which fewer than a third reported happiness the day before.

Overall, these results demonstrate caregivers are more in need of support systems to maintain their well-being. Although the financial and social support offered through employment appear to diminish some of the stress stemming from the caregiving role, employees who act as a caregiver are worse off than their counterparts who do not have to juggle both responsibilities.

The Impact of Age on Well-Being

The second study, "Facets of Well-Being Across the Age Spectrum in the American Population," shows well-being follows a U-shaped curve over the course of adulthood. While young, buoyed by physical health and optimism for the future, people generally have an intermediate (65.9) well-being score. Seniors, age 65 and up, have a significantly higher well-being score (68.8) than any other age group, despite reduced physical health. Those considered middle aged, ages 44 through 64, have the lowest well-being (64.8).

"These data are a wake up call to boomers, business leaders and policymakers," Coughlin said. "While it is great news that today's older adults 'feel better,' we also know that how we manage our well-being in mid life predicts personal health and public costs in late life. All middle-aged Americans should see these findings as a call to engage with their friends, employers, insurers and communities to invest in their well-being now to ensure quality living across the lifespan."

"Both the caregiver and age spectrum well-being studies underscore the importance of addressing the social and emotional factors that influence well-being," said Ben R. Leedle, Jr., CEO of Healthways. "The good news is that programs exist that effectively allow employers to enhance the well-being of their constituents and engage those in the greatest need of assistance."

Complementary research on well-being over a lifetime, also based on WBI data, was published in the May 2010 edition of Proceedings of the National Academy of Sciences. That study, "A Snapshot of the Age Distribution of Psychological Well-Being in the United States," supports the CHR conclusion that well-being follows a U-shaped curve over a lifetime, with highest well-being attained post age 50.

Complete content of "Estimating the Impact of Caregiving and Employment on Well-Being" and "Facets of Well-Being Across the Age Spectrum in the American Population" are available at http://www.healthways.com. Additional information about the Gallup-Healthways Well-Being Index is available at http://www.well-beingindex.com.

Source
Healthways