First blood test to determine cognitive impairment in Parkinson's disease developed

Researchers at the University of Pennsylvania School of Medicine’s Udall Center for Parkinson's Research have developed the first blood-based biomarker test to predict cognitive decline in Parkinson’s disease (PD). If results can be replicated and standardized in other Parkinson patients, by other investigators, the test could be a useful tool to use in selecting patients for the development of new drugs that can slow or prevent this complication of the disease.

30 nov 2010--After searching through a hundred different proteins found in blood plasma, researchers found that epidermal growth factor (EGF), a protein involved in regulating cell growth, proliferation, and differentiation, provided a strong biomarker signal for cognitive impairment in PD. The study determined that PD patients with low EGF levels and normal cognition were more likely to subsequently develop serious cognitive impairments during the 21-month median follow-up period. The study is published in the current issue of the Annals of Neurology.

“As a PD doctor, I hear all the time that my patients want to know whether their disease will progress rapidly, and if they’ll have the type of Parkinson’s where they get dementia,” said Alice Chen-Plotkin, MD, assistant professor of Neurology at the University of Pennsylvania and the study’s lead author. “If other studies verify these results, measuring EGF levels may be useful both as a clinical diagnostic tool and in the design of trials aimed at preserving cognition in Parkinson’s disease.”

As many as 83 percent of PD patients become demented over the long course of the illness. Although duration of the disease and advanced age have been identified as risk factors, some patients experience cognitive impairment relatively soon after the disease strikes, while others won’t experience dementia until the very end of their disease. And nearly 20 percent of patients never have dementia.

In the study, PD patients with EGF levels in the lowest range were eight times more likely to develop dementia, half of this group had dementia after 14 months. Cognitive follow-up data from the second set of patients, the replication group, will be available in 2012, to see if this pattern continues.

The most efficient and cost-effective way to test a drug that could preserve cognition in PD is to identify the most at-risk population for a clinical trial and evaluate the effect of the drug in a short timeframe. The EGF assay was designed to be broadly useful in clinical practice, and if validated, it could be used to select Parkinson patients for clinical trials.

“A test for cognitive impairment in PD could not only help patients in planning their futures, but by selecting patients at the greatest risk, we could significantly reduce the amount of time it would take to determine whether new drugs work,” said senior author John Q. Trojanowski, MD, PhD, director of the Penn Udall Center and co-director at Penn’s Center for Neurodegenerative Disease Research.

The EGF study was supported by the Penn-Pfizer Alliance – a peer-reviewed grant process sponsored by Pfizer and administered by Penn – and funding from the National Institutes of Health and the Marian S. Ware Alzheimer Program. Dr. Chen-Plotkin is also supported by a Burroughs Wellcome Fund Career Award for Medical Scientists and the Benaroya Fund.

More information: The EGF blood test is not currently available, except in select research studies aimed at replicating and potentially verifying these findings. For patients interested in participating in the Biofluid Collection Research Program at the Penn Udall Center – which involves cognitive, motor and biofluid (i.e. blood, spinal fluid, DNA) tests – please contact Jacqueline Rick at 215-829-7778 or Jacqui.Rick(at)uphs.upenn.edu.

Provided by University of Pennsylvania School of Medicine

Gene therapy prevents memory problems in mice with Alzheimer's disease

Scientists at the Gladstone Institute of Neurological Disease (GIND) in San Francisco have discovered a new strategy to prevent memory deficits in a mouse model of Alzheimer's disease (AD). Humans with AD and mice genetically engineered to simulate the disease have abnormally low levels of an enzyme called EphB2 in memory centers of the brain. Improving EphB2 levels in such mice by gene therapy completely fixed their memory problems. The findings will be published in the November 28 issue of the journal Nature.

29 nov 2010--In both humans and mice, learning and memory requires effective communication between brain cells called neurons. This communication involves the release of chemicals from neurons that stimulate cell surface receptors on other neurons. This important process, called neurotransmission, is impaired by amyloid proteins, which build up to abnormally high levels in brains of AD patients and are widely thought to cause the disease. But how exactly these poisonous proteins disrupt neurotransmission is unknown.

"EphB2 is a really cool molecule that acts as both a receptor and an enzyme," said Moustapha Cisse, PhD, lead author of the study. "We thought it might be involved in memory problems of AD because it is a master regulator of neurotransmission and its brain levels are decreased in the disease."

To determine if low EphB2 levels actually contribute to the development of memory problems, the investigators used gene therapy to experimentally alter EphB2 levels in memory centers of mice.
Reducing EphB2 levels in normal healthy mice disrupted neurotransmission and gave them memory problems similar to those seen in AD. This finding suggests that the reduced EphB2 levels in AD brains contribute to the memory problems that characterize this condition.

"What we were most curious about, of course, was whether normalizing EphB2 levels could fix memory problems caused by amyloid proteins," said Lennart Mucke, MD, director of the GIND and senior author of the study. "We were absolutely thrilled to discover that it did."

Increasing EphB2 levels in neurons of mice engineered to produce high levels of human amyloid proteins in the brain prevented their neurotransmission deficits, memory problems and behavioral abnormalities. The scientists also discovered that amyloid proteins directly bind to EphB2 and cause its degradation, which helps explain why EphB2 levels are reduced in AD and related mouse models.

"Based on our results, we think that blocking amyloid proteins from binding to EphB2 and enhancing EphB2 levels or functions with drugs might be of benefit in AD." said Mucke. "We are excited about these possibilities and look forward to pursuing them in future studies."

Provided by Gladstone Institutes

New device may reduce swallowing health risk in patients with Parkinson's disease

Speech pathologist Christine Sapienza (right) helps patient Lou DeLaney use an Expiratory Muscle Strength Training device at the UF Speech and Hearing Center on Sept. 29, 2010. New UF research shows that EMST therapy can improve swallowing function in patients with Parkinson’s disease.

28 nov 2010-- A hand-held device that strengthens the muscles involved in swallowing can address a serious symptom of Parkinson's disease, according to a new University of Florida study.

In what researchers believe is the largest randomized trial of a behavioral swallowing treatment in patients with Parkinson’s disease, scientists found that about one-third of the volunteers who used the device improved their ability to swallow. The findings appear in the Nov. 23 issue of the journal Neurology, the medical journal of the American Academy of Neurology.

Nearly 1 million Americans have Parkinson’s disease, according to the Parkinson’s Disease Foundation. Finding solutions to their swallowing problems is important because their most common cause of death is pneumonia caused by inhaling foreign material, such as food, during swallowing.

“The many muscles involved in swallowing progressively weaken in patients with Parkinson’s disease and become uncoordinated in the same way that patients lose coordination and strength in their arms and legs,” said Michelle Troche, the study’s lead investigator and a clinical lecturer and speech pathologist in the UF College of Public Health and Health Professions’ department of speech, language and hearing sciences.

It also becomes more difficult for patients to sense material in their airways and cough hard enough to expel it, she said.

For the study, researchers trained participants with Parkinson’s disease to exhale into an Expiratory Muscle Strength Training, or EMST, device. In previous studies, EMST has improved swallowing and cough function in patients with multiple sclerosis and in elderly, sedentary adults.

“EMST uses the basic exercise theory behind any strength training program,” said co-investigator Christine Sapienza, a professor and chairwoman of the department of speech, language and hearing sciences. “This small device capitalizes on that concept of overload with a calibrated pressure release valve that won’t open until you generate a great enough lung pressure. The patient or clinician can vary how much pressure is needed to open the valve on the device. The greater the pressure you need, the stronger the muscles have to be. It acts much like a pin on a weight machine and uses the same concept to strengthen the muscles involved in swallowing and breathing.”

Sapienza developed the device along with UF researchers Paul Davenport, a professor and interim chairman of the department of physiological sciences in the College of Veterinary Medicine, and A. Daniel Martin, a professor in the department of physical therapy.

“Their efforts are pioneering and it is likely that this study will stand the test of time as a landmark in Parkinson’s disease swallowing research,” said research collaborator Dr. Michael Okun, a co-director of UF’s Movement Disorders Center and an associate professor of neurology with the College of Medicine and UF’s McKnight Brain Institute.

Participants in the Parkinson’s disease study were divided into two groups of 30. In one group participants used the EMST device with proper calibration. The other participants used a device that looked exactly the same but did not work to strengthen the muscles. Neither the participants nor the study therapists knew who had the real device and who had the sham device. Participants used the devices in their homes for 20 minutes a day, five days a week for four weeks. Therapists visited once a week to make sure participants used the device correctly. Following the study period, participants in the sham group received the EMST treatment.

The researchers measured participants’ swallowing function before and after treatment with a standardized swallow safety scale, the Penetration-Aspiration scale, developed in part by UF faculty member John Rosenbek, also with the department of speech, language and hearing sciences. Researchers used videofluoroscopy to obtain motion X-ray images of the participants’ swallowing muscles as they swallowed liquid.

One-third of participants who used the device with calibration had significantly improved swallow safety scores compared to 14 percent of the participants in the sham group. The researchers also found that for patients in the treatment group, there was greater movement in the muscles that lift the voice box out of the way during swallowing. Quality-of-life measures related to swallowing improved in both the treatment and sham groups.

“The fact that EMST is a home-based treatment is of particular importance as many individuals with Parkinson’s disease cannot travel the long distance to attend clinic or hospital therapy sessions,” said Stephanie Daniels, a visiting associate professor at the University of Houston and an assistant professor at Baylor College of Medicine, who was not involved in the study. “Very few swallowing treatment studies have incorporated the rigorous research design used in this study. We need more studies such as this to support the different treatment approaches used in swallowing rehabilitation.”

Sapienza has a potential financial interest in Aspire Products LLC, the manufacturer of EMST. Portions of the study were funded by the Veterans Affairs Rehabilitation Research and Development, the Michael J. Fox Foundation and the National Institutes of Health. The UF Movement Disorders Center receives support from the National Parkinson Foundation Center of Excellence.

Provided by University of Florida

Half of Americans will be diabetic or pre-diabetic by 2020

26 nov 2010-- A recent study by US health insurance giant UnitedHealth Group Inc. predicts that by 2020 over half of Americans will have either pre-diabetic conditions or type 2 diabetes if current trends continue, and the annual cost will be around $500 billion a year by the end of the decade, or one tenth of all health care spending. The estimate for 2010 is $194 billion.

The cost of healthcare in the US for non-diabetics was $4,400 per person in 2009, and $11,700 for diabetics. For those with complications arising from the disease the cost is around $20,700 per year. If the predicted rise in the incidence of diabetes eventuates, the total cumulative cost to the US health care system may be as high as $3.35 trillion, with over 60 percent paid for by the government. However, the report offers a number of suggestions, which if adopted could save as much as $250 billion over the next decade.

The United Health Group report said around 27 million Americans are estimated to have diabetes and as many as another 67 million may have undiagnosed pre-diabetic conditions. These figures differ from those issued in October by the US government’s Centers for Disease Control and Prevention, which estimated at least 32 million American adults have diabetes and the number of cases will more than double by 2050.

Complications of diabetes can include circulatory problems (sometimes leading to limb amputations), nerve damage, kidney disease, blindness, and it is a major contributor to heart disease and strokes. Pre-diabetes symptoms include high blood sugar levels, high blood pressure and high cholesterol levels, but the symptoms may not be obvious.

The report was titled: “The United States of Diabetes: Challenges and Opportunities in the Decade Ahead” and was produced for the National Diabetes Awareness month in November. It emphasizes the predicted rise in incidence of diabetes and related costs is not inevitable if measures are taken urgently to address the problem.

Diabetes is a progressive disease with people developing pre-diabetes many years before diabetes. This means there are many intervention possibilities that can prevent pre-diabetic people from developing the disease.

Type 2 diabetes is strongly associated with being seriously overweight or obese, and in the US the report estimates 68.3 percent of Americans were overweight or obese in 2008, with this figure rising each year. For people with pre-diabetes the odds of developing diabetes are considerably reduced if they reduce their weight by five percent or more and increase their levels of physical activity.

Simon Stevens, who is chairman of the UnitedHealth Center for Health Reform & Modernization and executive vice president of UnitedHealth Group, said what is needed now is “concerted, national, multi-stakeholder action.” He said some of the most promising preventive care models should be scaled up, and health plans should be developed to “engage customers in new ways.” The benefits to the US, both in economic and human terms, will be substantial if the steep rise can be averted.

More information: http://www.unitedh … 9dfdc97cedc5

Retirement reduces tiredness and depression

Retirement leads to a substantial reduction in mental and physical fatigue and depressive symptoms, finds a study published in the British Medical Journal today. However, the research also concludes that retirement does not change the risk of major chronic illnesses such as respiratory disease, diabetes and heart disease.

25 nov 2010--The authors, led by Dr Hugo Westerlund from Stockholm University, say their research findings have important implications given that people will be working for longer and retiring later in life.

Retirement is a major life transition, says the study. But the results of various studies investigating the health effects of retirement have been inconsistent with some suggesting a beneficial effect and others concluding the reverse.

This large scale population based study is ground-breaking as it observes participants for a long period of time (15 years) and for 7 years prior to retirement and 7 years post retirement. The research is based on almost 190,000 observation years.

The participants were drawn from a large French cohort study and included 11,246 men and 2,858 women who were surveyed annually from 1989 to 2007. The researchers argue that "a major strength of this study is that it is based on repeated yearly measurements over an extended time period."

Most participants were married (89%) and belonged to higher or middle employment grades. They all retired on a statutory basis - 72% between the ages of 53 and 57 inclusive - and all participants had retired by the age of 64. In the year before retirement, one in four (25%) participants had suffered from depressive symptoms and 728 (7%) were diagnosed with one or more of the following: respiratory disease, diabetes, heart disease or stroke.

Unmarried respondents and those in low employment grades had higher odds of physical (but not mental) fatigue.

The results show that retirement is linked with a substantial decrease in both mental and physical fatigue, with a smaller but significant decrease in depressive symptoms. However, the research also shows there is no association between retirement and chronic disease. As expected, say the authors, these diseases gradually increased with age.

The authors believe there are a number of explanations for the findings: "if work is tiring for many older workers, the decrease in fatigue could simply reflect removal of the source of the problem ... furthermore, retirement may allow people more time to engage in stimulating and restorative activities, such as physical exercise," they write.

They conclude that their research results "indicate that fatigue may be an underlying reason for early exit from the labour market and decreased productivity, and redesign of work, healthcare interventions or both may be necessary to enable a larger proportion of older people to work in full health."

In an accompanying editorial, Alex Burdorf, a professor in the determinants of public health in the Netherlands, says the study "is unique in that annual health measurements were carried out several years before and after retirement."

Burdorf believes further research is needed to corroborate the findings as they contradict other studies and says "it is too early to make definite claims about positive and negative benefits from retirement at a particular age." The author agrees, however, that efforts are needed to improve and adapt working conditions "to help elderly workers maintain good health."

Provided by British Medical Journal

3 big developments make AIDS outlook more hopeful

24 nov 2010-- In the nearly 30 years the AIDS epidemic has raged, there has never been a more hopeful day than this. Three striking developments took place Tuesday: U.N. officials said new HIV cases are dropping dramatically worldwide. A study showed that a daily pill already on pharmacy shelves could help prevent new infections in gay men. And the pope opened the way for the use of condoms to prevent AIDS.

"I don't know of a day where so many pieces are beginning to align for HIV prevention and treatment, and frankly with a view to ending the epidemic," said Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition, a nonprofit group that works on HIV prevention research. "This is an incredibly opportune moment and we have to be sure we seize it."

President Barack Obama said the groundbreaking research on the AIDS drug "could mark the beginning of a new era in HIV prevention."

The U.N. report said that new cases dropped nearly 20 percent over the last decade and that 33.3 million people are living with HIV now.

"We can say with confidence and conviction that we have broken the trajectory of the AIDS pandemic," said UNAIDS Executive Director Michel Sidibe in Geneva.

Health officials credit part of the decline to wider condom use, and on Tuesday, in a historic shift in church teachings, the Vatican said that using a condom is a lesser evil than infecting a sexual partner with HIV.

Condoms remain the best weapon against AIDS, and the new prevention pill is not the chemical equivalent. But scientists called it a true breakthrough. The pill, Gilead Science's Truvada, is already used to treat people with HIV. A three-year global study found that daily doses cut the risk of infection in healthy gay and bisexual men when given with condoms, counseling and other prevention services.

The drug lowered the chances of infection by 44 percent, and by 73 percent or more among men who took their pills most faithfully. Researchers had feared the pills might give a false sense of security and make men less likely to use condoms or to limit their partners, but the opposite happened - risky sex declined.

The results are "a major advance" that can help curb the epidemic in gay men, said Dr. Kevin Fenton, AIDS prevention chief at the U.S. Centers for Disease Control and Prevention. But he warned they may not apply to people exposed to HIV through male-female sex, drug use or other ways. Studies in those groups are under way.

Because Truvada is already on the market, the CDC is rushing to develop guidelines for doctors who want to use it to prevent HIV, and urged people to wait until those are ready.

As a practical matter, price could limit use. The pills cost $5,000 to $14,000 a year in the United States, but roughly $140 a year in some poor countries where they are sold in generic form.

Whether insurers or government health programs should pay for them is one of the tough issues to be sorted out, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"This is an exciting finding," but it "is only one study in one specific study population," so its impact on others is unknown, Fauci said.

His institute sponsored the study with the Bill & Melinda Gates Foundation. The findings were published online by the New England Journal of Medicine.

It is the third AIDS prevention victory in about a year. In September 2009, scientists announced that a vaccine they are now trying to improve protected 1 in 3 people from getting HIV in a study in Thailand. In July, research in South Africa showed that a vaginal gel spiked with an AIDS drug could cut nearly in half a woman's chances of getting HIV from an infected partner.

Gay and bisexual men account for nearly half of the more than 1 million Americans living with HIV. Worldwide, more than 7,000 new infections occur each day. Only 5 to 10 percent of global cases involve sex between men.

"The condom is still the first line of defense," because it also prevents other sexually spread diseases and unwanted pregnancies, said the study leader, Dr. Robert M. Grant of the Gladstone Institutes, a private foundation affiliated with the University of California, San Francisco. But many men don't or won't use condoms all the time, so researchers have been testing other prevention tools.

AIDS drugs already are used to prevent infection in health care workers accidentally exposed to HIV, and in babies born to infected mothers. Taking these drugs before exposure to the virus may keep it from taking hold, just as taking malaria pills in advance can prevent that disease when someone is bitten by an infected mosquito.

The strategy showed great promise in monkey studies using tenofovir (brand name Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by California-based Gilead Sciences Inc.

The company donated Truvada for the study, which involved about 2,500 men at high risk of HIV infection in Peru, Ecuador, Brazil, South Africa, Thailand and the United States (San Francisco and Boston). The foreign sites were chosen because of high rates of HIV infection and diverse populations.

More than 40 percent of participants had taken money for sex at least once. At the start of the study, they had 18 partners on average; that dropped to around six by the end.

The men were given either Truvada or dummy pills. All had monthly visits to get HIV testing, more pills and counseling. Every six months, they were tested for other sexually spread diseases and treated as needed.

After a median follow-up of just over a year, there were 64 HIV infections among the 1,248 men on dummy pills, and only 36 among the 1,251 on Truvada.

Among men who took their pills at least half the time, the risk of infection fell by 50 percent. For those who took pills on 90 percent or more days, risk fell 73 percent. Tests of drug levels in the blood confirmed that more consistent pill-taking gave better protection, and in one subgroup, the reduction in risk was 92 percent.

The treatment was safe. Side effects were similar in both groups except for nausea in the Truvada patients. Weight loss also was more common in the drug group, but it occurred in very few. Further study is needed on possible long-term risks.

All participants will get a chance to take Truvada in an 18-month extension of the study to see if men will take the pill more consistently if they know it helps, and whether that provides better protection. About 20,000 people are enrolled in other studies testing Truvada or its component drugs around the world.

The government will review all ongoing prevention studies, such as those of vaccines or anti-AIDS gels, and consider whether people getting dummy medicines should now get Truvada since it has been shown effective in gay men.

Gilead may seek approval to market Truvada for prevention, said Dr. Howard Jaffe, president of the company's philanthropic arm. Doctors can prescribe it for this purpose now if patients are willing to pay for it, and some already do.

Some people have speculated that could expose Gilead to new liability concerns, if someone took the pill and then sued if it did not prevent infection.

"The potential for having an intervention like this that has never been broadly available before raises new questions. It is something we would have to discuss internally and externally," Jaffe said.

Until the CDC's detailed advice on Truvada is available, the agency said gay and bisexual men should use condoms consistently and correctly, get tested and treated for HIV and other sexually transmitted diseases, get counseling and reduce their number of sexual partners.

More information:
CDC advice: http://www.cdc.gov … stp/newsroom

AIDS information: http://www.aidsinfo.nih.gov

and http://www3.niaid. … ics/HIVAIDS/

Pill study: http://www.iprexnews.com

Journal: http://www.nejm.org

UNAIDS: http://tinyurl.com/krq7kr

Prevention efforts: http://www.avac.org

The not-so-sweet truth about sugar : a risk choice?

More and more people have become aware of the dangers of excessive fructose in diet. A new review on fructose in an upcoming issue of the Journal of the American Society of Nephrology (JASN) indicates just how dangerous this simple sugar may be.

23 nov 2010--Richard J. Johnson, MD and Takahiko Nakagawa, MD (Division of Renal Diseases and Hypertension, University of Colorado) provide a concise overview of recent clinical and experimental studies to understand how excessive amounts of fructose, present in added sugars, may play a role in high blood pressure, diabetes, obesity, and chronic kidney disease (CKD).

Dietary fructose is present primarily in added dietary sugars, honey, and fruit. Americans most frequently ingest fructose from sucrose, a disaccharide containing 50% fructose and 50% glucose bonded together, and high fructose corn syrup (HFCS), a mixture of free fructose and free glucose, usually in a 55/45 proportion. With the introduction of HFCS in the 1970s, an increased intake of fructose has occurred and obesity rates have risen simultaneously.

The link between excessive intake of fructose and metabolic syndrome is becoming increasingly established. However, in this review of the literature, the authors conclude that there is also increasing evidence that fructose may play a role in hypertension and renal disease. "Science shows us there is a potentially negative impact of excessive amounts of sugar and high fructose corn syrup on cardiovascular and kidney health," explains Dr. Johnson. He continues that "excessive fructose intake could be viewed as an increasingly risky food and beverage additive."

Concerned that physicians may be overlooking this health problem when advising CKD patients to follow a low protein diet, Dr. Johnson and Dr. Nakagawa recommend that low protein diets include an attempt to restrict added sugars containing fructose.

More information: The article, entitled "The Effect of Fructose on Renal Biology and Disease," will appear online on November 29, 2010

Provided by American Society of Nephrology

Elderly can blame fractures and falls on low sodium

Older adults with even mildly decreased levels of sodium in the blood (hyponatremia) experience increased rates of fractures and falls, according to a study presented at the American Society of Nephrology's 43rd Annual Meeting and Scientific Exposition. Falls are a serious health problem for the elderly and account for about 50 percent of deaths due to injury in the elderly.

22 nov 2010--"Screening for a low sodium concentration in the blood, and treating it when present, may be a new strategy to prevent fractures," comments Ewout J. Hoorn, MD, PhD (Erasmus Medical Center, Rotterdam, the Netherlands). However, hyponatremia does not appear to affect the risk of osteoporosis, as defined by low bone mineral testing, so more research is needed to understand the link between sodium levels and fracture risk.

The study included more than 5,200 Dutch adults over age 55, all with initial information on sodium levels and six-year follow-up data on fractures and falls. "A number of recent studies suggested a relationship between hyponatremia, falls, osteoporosis, and fractures," Hoorn explains. The authors' goal was to confirm these possible associations using prospective, long-term follow-up data.

About eight percent of the study participants, all community dwelling adults, had hyponatremia. This group of older participants had a higher rate of diabetes and was more likely to use diuretics (water pills) than those with normal sodium levels. Subjects with hyponatremia had a higher rate of falls during follow-up: 24 versus 16 percent. However, there was no difference in bone mineral density between groups, so hyponatremia was not related to underlying osteoporosis.

Nevertheless, the group with low sodium levels had a higher rate of fractures. With adjustment for other risk factors, the risk of vertebral / vertebral compression fractures was 61 percent higher in the older adults with hyponatremia. The risk of non-spinal fractures, such as hip fractures, was also significantly increased: a 39 percent difference.

The relationship between hyponatremia and fracture risk was independent of the increased rate of falls in the low-sodium group. Subjects with hyponatremia also had a 21 percent increase in the risk of death during follow-up.

Hyponatremia is the most common electrolyte disorder, usually developing because the kidneys retain too much water. "Although the complications of hyponatremia are well-recognized in hospitalized patients, this is one of the first studies to show that mild hyponatremia also has important complications in the general population," says Hoorn.

Further study will be needed to clarify the mechanism by which low sodium levels increase fracture risk. In the meantime, "Screening older adults for and treatment of hyponatremia in older adults may be an important new strategy to prevent fractures," adds Hoorn.

Provided by American Society of Nephrology

Analysis: Pope's comments add to debate on condoms

21 nov 2010 -- With his striking comment on condoms and AIDS, Pope Benedict XVI has started a new chapter in the complex church debate about morality and preventing the spread of HIV.

The Roman Catholic prohibition against artificial contraception is not in question, but Benedict could be carving out a very rare exception for the use of condoms.

Benedict said that condoms are not a moral solution to stopping AIDS. But he said in some cases, such as for male prostitutes, their use could represent a first step in assuming moral responsibility "in the intention of reducing the risk of infection."

He made the remarks in an interview with a German journalist, Peter Seewald, and published as the book, "Light of the World: The Pope, the Church and the Signs of the Times." The Vatican newspaper L'Osservatore Romano ran excerpts on Saturday ahead of the book release Tuesday.

Benedict's comments put a spotlight on a nuanced discussion within the church about how best to address the scourge of AIDS.

The pope had previously said that condom use exacerbates the AIDS crisis. Some church officials echoed the sentiment, arguing that condoms are not foolproof and give people a false sense of protection. Abstinence and fidelity are the only way to stop HIV, they said.

Still, the Vatican never released an official, authoritative policy on condoms and AIDS, and cardinals from around the world often took positions on the issue that differed significantly.

William Portier, a Catholic theologian at the University of Dayton, a Marianist school in Ohio, has not yet read the book, but said it would be wrong to conclude that the comments mean the pope has made a fundamental change in church teaching.

"He's not going to do that in an offhand remark to a journalist in an interview," Portier said.

The pope's circumspect remarks should also not be viewed as encouraging condom use.

However, they could be read as making a distinction between greater and lesser evils, or what moral theologians call double effect, said Michael Baur, a philosopher at Fordham University. An evil may be tolerated for an intended good - in this case, disease prevention.

It is far from the first time such an argument has been made within the church.

The Rev. Martin Rhonheimer, an Opus Dei priest and ethics professor at the Pontifical University of the Holy Cross in Rome, argued in 2004 that an HIV-infected married man who uses a condom to protect his wife from the virus is not trying to block a pregnancy, but to prevent infection. His actions, therefore, could be seen as in accord with Catholic teaching.

"It's an interesting application of ancient moral principles," said Nicholas Cafardi, a canon lawyer and former dean of Dusquesne University School of Law. "Even if you are performing an otherwise evil act, you can mitigate the evil of the act."

Seewald's book is being released at a time when the pope and the Vatican have tried to overcome their widespread problems in communicating the church's message. Some analysts suggested that the pope's comment on condoms in the book could be just another in a series of public relations missteps.

The English publisher of the book, the Rev. Joseph Fessio of Ignatius Press, argued the pope was not justifying condom use, but was noting that protecting someone from the disease shows the signs of taking moral responsibility for another person.

In the book, the pope also reaffirms church teaching that sex should be between a married man and woman and that artificial contraception blocks God's plan for bringing life into the world.

Yet, even with just the narrow example he gave in the interview, Benedict has created an opening for Catholic bishops in Africa and elsewhere to renew their argument that condoms must be part of the fight against the spread of HIV.

Hormone therapy may prevent -- or contribute to -- dementia risk

Hormone therapy appears to affect the brain differently depending on the age of the woman when she receives it, researchers reported Thursday.

20 nov 2010--Hormone-replacement therapy for women has been the subject of considerable debate. Studies have shown both pros and cons. But hormone use has declined in the last decade because a major study on the issue, the Women's Health Initiative, found that the risks of taking hormones appeared to outweigh significantly the benefits in older postmenopausal women. Among the findings was that beginning hormone therapy in women ages 65 and older led to a twofold higher risk of dementia.

Questions remain about the effect of hormones if taken at a younger age - among perimenopausal (the phase before menopause when hormones decline and fluctuate) or menopausal women in their early 50s. The new study, published in the Annals of Neurology, supports the idea that hormones can affect dementia risk differently depending on the age of the woman when she takes them.

Kaiser Permanente researchers examined data from members in Northern California from 1964 to 1973, among women 40 to 55 years old. The study examined whether hormones were used at midlife - defined in this study by the average age of 48.7 - or in late life, defined as age 76. Compared with women who never used hormones, those taking hormones only at midlife had a 26 percent decreased risk of dementia. This link held true even when the researchers controlled for other factors that contribute to dementia, such as high cholesterol and stroke.

However, taking hormones in late life may counteract whatever benefits are seen by taking hormones at midlife, the authors said. Women taking hormone therapy only in late life had a 48 percent increase in dementia. Women using hormones at both midlife and late life did not differ in their dementia risk from women who didn't take hormones.

"The reduced risk of dementia associated with midlife hormone therapy use only lends support to the notion that it is not only early postmenopausal use of hormone therapy that is protective, but that use should also be limited to a few years," the authors wrote.

Animal studies suggest that estrogen benefits brain health, and observational studies have shown that women who take hormones are less likely to develop dementia later in life. But studies such as the Women's Health Initiative dashed hopes that hormones protected against cognitive impairment. Research now is focusing on whether there is a "critical window" for use - a specific time of life when hormones would do more good than harm.

Following 7 steps can cut a person's death risk by more than half, experts say

For those interested in reducing their risk of death from cardiovascular disease, heart experts have some good news: regular exercise, a healthy diet and five other simple measures can cut one's near-term risk of death by more than half.

19 nov 2010--And here's the bad news: In a nationwide study of more than 17,820 adults, only two people met all of the criteria for top-notch cardiovascular health.

The message of the study, presented Monday at the American Heart Association's Scientific Sessions conference in Chicago, is clear, said Dr. Mark Urman, medical director of Cedars-Sinai Heart Institute's Preventive and Consultative Heart Center.

"Boy, most Americans aren't very healthy," said Urman, who wasn't involved in the research. However, he added, "on a more positive note, the study confirms that individuals can take control of their health. Incremental changes can make a huge difference."

The changes, dubbed Life's Simple 7, were laid out in January as part of an AHA campaign to guide Americans toward "ideal cardiovascular health." They are:

-At least 150 minutes of moderate exercise, or 75 minutes of intense exercise, per week.

-Having a body mass index of less than 25.

-Being a non-smoker for at least one year.

-Meeting four out of five of the AHA's key components for a healthy diet.

-Keeping total cholesterol below 200 milligrams per deciliter of blood.

-Maintaining blood pressure below 120/80 millimeters of mercury.

-Having a fasting blood sugar level below 100 mg/dL of blood.

"These are the sorts of things your grandmother told you," said Dr. Mary Cushman, the cardiovascular disease researcher at the University of Vermont who conducted the study.

Cushman used a database of people between the ages of 45 and 84 who were already enrolled in a nationwide study on the prevalence of stroke. All of the participants had been evaluated for the factors that make up Life's Simple 7.

In addition to the two individuals who met all seven criteria, another 213 people were compliant with six.

Death rates for those who met at least five of the criteria were 55 percent lower over the five-year study period than for those who met none, Cushman reported.

The analysis showed how much each health factor mattered - for every additional one met, a person reduced his or her chance of dying in the next four years by 15 percent.

"That tells how powerful these things relate to heart-disease risk," Cushman said. "Being as good as you can be on all of these factors is what your goal should be."

On the whole, Americans are most compliant when it comes to maintaining a healthy blood pressure and abstaining from smoking. More than 80 percent of those in the survey were nonsmokers, and almost 67 percent were in the ideal range for blood pressure, Cushman said.

On the flip side, eating a healthy diet was the criterion with the fewest adherents - only 0.43 percent managed to do so, the study found.

The ideal diet requires meeting four of five of these key components based on a 2,000-calories-per-day meal plan: four-and-a-half cups of fruits and vegetables per day, two or more 3.5 ounce servings of fish (preferably oily fish) per day, fewer than 450 calories a week of sugar-sweetened beverages, three or more one-ounce servings per day of whole grains and less than 1,500 mg of sodium per day.

Cushman could not identify the two people who scored perfect on the assessment. "It would be interesting to go back and talk to them," to see just how they live so healthfully, she said.

But the large portion of Americans who are far from the ideal range suggests that societal, not just individual, changes are needed, she said. Public projects like more parks, sidewalks and farmers' markets; soda taxes; smoking restrictions and physical activity requirements in preschools and schools could move large numbers of people toward better health.

Biomarker may be able to help predict risk of heart failure, cardiovascular death

Certain measures of the blood biomarker cardiac troponin T (cTnT), a cardiac-specific protein, using a highly sensitive test, are associated with the development of heart failure or cardiovascular death in older adults, according to a study that will appear in the December 8 issue of JAMA. The study is being released early online because it will be presented at the American Heart Association's annual meeting.

18 nov 2010--"Older adults comprise the majority of new-onset heart failure (HF) diagnoses, but traditional risk-factor prediction models have limited accuracy in this population to identify those at highest risk for hospitalization or death," according to background information in the article. Blood-based biomarkers, including troponins, have been advocated for use as supplemental to clinical risk factors to identify older adults at high risk for adverse cardiovascular outcomes, but studies examining the prognostic value of these markers have reported inconsistent results.

Prior studies have used standard troponin assays that are only able to detect circulating troponin levels in a small proportion of individuals. Recently, a highly sensitive cardiac troponin T assay has been developed, designed to improve accuracy. "This assay has detected circulating cTnT in almost all patients with chronic HF or ischemic heart disease and provides independent prognostic information with respect to HF admission and cardiovascular death in these patients," the authors write.

Christopher R. deFilippi, M.D., of the University of Maryland School of Medicine, Baltimore, and colleagues examined the ability to detect a measurable cTnT concentration in older adults using the highly sensitive cTnT assay and whether higher concentrations would be associated with a greater risk of new-onset HF and cardiovascular death. The researchers analyzed data from the Cardiovascular Health study and included 4,221 community-dwelling adults ages 65 years or older without prior HF who had cTnT measured using the highly sensitive assay at the beginning of the study (1989-1990) and repeated after 2 to 3 years (n = 2,918). Concentrations of cTnT were equal to or more than the limit of detection in 2,794 participants (66.2 percent).

During a median (midpoint) follow-up of 11.8 years from the initial cTnT measurement, 1,279 participants experienced new-onset HF and 1,103 cardiovascular deaths occurred, with a greater risk of both end points associated with higher cTnT concentrations. Also, the risks of HF and cardiovascular death were higher among those participants with detectable compared with undetectable levels at follow-up, irrespective of the baseline level.

Analysis indicated that for participants with measurable cTnT levels at the beginning of the study, an increase of more than 50 percent was associated with an increased risk of HF and a greater risk of cardiovascular death, adjusting for baseline cTnT and risk factors. In contrast, a decrease of more than 50 percent was associated with a risk-factor adjusted lower risk of HF and lower risk of cardiovascular death compared with those participants with 50 percent or less change.

For the prediction of both outcomes, the addition of baseline cTnT measurements to clinical risk factor models only modestly but statistically significantly improved classification.

"Detectable cTnT levels as measured by a highly sensitive assay were present in the majority of community-dwelling older adults in this cohort, and higher concentrations—within a normal range established for a younger general population—reflect a greater burden of cardiovascular risk factors and imaging evidence of cardiac disease. Independent of these comorbidities, cTnT concentrations were associated with risk of new-onset HF and cardiovascular death. Furthermore, longitudinal changes in cTnT concentrations were common in this cohort and correspond with a dynamic change in risk levels over time," the authors conclude.

More information: JAMA. 2010;304[22]:doi:10.1001/jama.2010.1708

Provided by JAMA and Archives Journals

Prostate cancer treatment linked to higher rate of colon cancer, study finds

Men treated with hormone-based therapy for prostate cancer faced a 30 percent to 40 percent higher risk of colorectal cancer, compared to patients who did not receive this treatment, according to a new study.

17 nov 2010--The study looked at use of androgen deprivation therapy, a common type of treatment for prostate cancer that involves blocking the male hormone testosterone through either surgical removal of the testicles or a series of injections. It's been shown to benefit men with advanced cancers, but its benefit for less-advanced disease is unclear. Still, more than half a million men in the United States currently receive this therapy.

Researchers looked at data from 107,859 men aged 67 and older with prostate cancer, identified through the Surveillance, Epidemiology and End Results and Medicare linked database, which provides information about older adults with newly diagnosed cancer. Results of the study were published online in the Journal of the National Cancer Institute.

The study is the first to link androgen deprivation therapy for prostate cancer to an increased risk of colorectal cancer. The researchers found that the risk increased the longer a man received androgen deprivation therapy. Patients who had their testicles removed, a procedure called orchiectomy, had the highest rates of colorectal cancer.

Overall, the risk of colorectal cancer was still low – less than 1 percent per year even among orchiectomy patients. But any increased risk should be carefully considered when using androgen deprivation therapy in cases when its benefit is not clear, the researchers say.

"Androgen deprivation therapy still continues to be used in situations where there are not evidence-based studies showing its benefit. When androgen deprivation therapy is clearly known to be beneficial, people should not shy away from using it. But where there's not solid evidence, this is potentially another harm," says lead study author Vahakn B. Shahinian, M.D., M.S., assistant professor of internal medicine at the University of Michigan Medical School and a member of the U-M Comprehensive Cancer Center.

Shahinian stresses that androgen deprivation therapy can be lifesaving for certain men with prostate cancer, and those patients should not hesitate to use it. The study authors suggest that continued routine preventive care, including colorectal cancer screening, is important during prostate cancer treatment.

More information: Journal of the National Cancer Institute , doi:10.1093/jnci/djq419, published online Nov. 10, 2010

Provided by University of Michigan Health System

Palliative care for patients with dementia more available but still not adequate

A new national survey conducted by researchers from Indiana University and the Regenstrief Institute has found that while palliative care may be available for those with dementia, there are significant barriers to providing or receiving services to relieve the pain, eating difficulties and other symptoms associated with dementia.

The survey findings are reported in the Nov. 2010 issue of the Journal of the American Geriatrics Society.

16 nov 2010--"Although the general public and many physicians do not associate palliative or hospice care with dementia, dementia is a terminal disease and should be respected as such. Palliative care is needed throughout the illness and can provide those who are unable to communicate their needs with a better quality of life as well as lowering the stress the illness places on caregivers and the entire family," said study first author Alexia M. Torke, M.D., M.S., who is an IU School of Medicine assistant professor of medicine and geriatrics and a Regenstrief Institute investigator. She is also on the faculty of the IU Center for Aging Research and the Fairbanks Center for Clinical Medical Ethics.

Palliative care for those with dementia focuses on relieving symptoms such as pain, shortness of breath, fatigue, nausea, loss of appetite and difficulty sleeping. Hospice care provides palliative care at the final stage of life. Palliative care, which is often provided in the patient's home, can be administered through the course of the disease along with medical treatment and does not hasten death.

Hospices provide palliative care to individuals in the final weeks or months of life. According to National Hospice and Palliative Care Organization data, only 11 percent of hospice patients in the facilities had a primary diagnosis of dementia. That may be because it is often difficult to determine how close to the end of life dementia patients may be and they therefore are not provided with hospice care.

In the new study the researchers conducted telephone interviews about the provision of palliative care to patients with dementia with directors of 426 hospice and palliative care programs. A detailed online survey was completed by 80 program directors.

The study found that 94 percent of hospice and 72 percent of palliative care program directors reported that their programs have recently cared for patients with dementia. This is a substantial increase from a 1995 study that found only 21 percent of hospice programs had provided this care.

Non-hospice palliative care programs are relatively new and typically care for patients earlier in the disease before the patient is hospice eligible. To learn more about these programs, the authors asked in-depth questions of palliative care program directors. The directors indicated the existence of significant barriers to providing non-hospice palliative care. These obstacles included inadequate insurance coverage for home services by Medicare and other insurers, home health benefits that expired before the individual was eligible for hospice care as well as insufficient family and healthcare provider knowledge of palliative care for dementia.

Strategies highlighted as critical for successful palliative care for dementia and reduction of caregiver burden were an interdisciplinary team usually composed of a nurse, social worker, physician and chaplain, collaboration with community organizations and campaigns to provide information to families and physicians.

"While it is heartening to see that most of these programs provide care for patients with dementia, there are many, many more who need this care than are receiving it. Education and policy efforts should focus on communicating with families and providers about palliative care, supporting caregivers who often are frustrated in their efforts to improve quality of life for a loved one with dementia, and reforming reimbursement structures to provide coverage earlier in the disease when patients have high needs but are not hospice eligible," said Dr. Torke.

Provided by Indiana University School of Medicine

Synchronizing a failing heart

November 14, 2010 – One of the largest, most extensive worldwide investigations into heart failure, led by the University of Ottawa Heart Institute (UOHI), conclusively proves that a new therapeutic implant synchronizes and strengthens a fading heart beat while reducing risk of death by 24% compared to the current treatment.

15 nov 2010--The research, co-led by Dr. Anthony Tang and Dr. George Wells at the Heart Institute, brings the promise of life-saving treatment for patients with symptoms of mild to moderate heart failure – an increasingly common condition among an aging population that can lead to sudden cardiac death. Each year, more than 500,000 Canadians and five million Americans suffer heart failure.

"This kind of device brings the potential to save thousands of lives in Canada alone and offers new hope to so many heart patients and their families. Helping the lower chambers of the heart beat strongly and in unison can improve a person's quality of life, keep them out of hospital longer and reduce their risk of sudden death," said Dr. Tang.

Results of the clinical trial, which got under way in 2003, were published online today in the prestigious New England Journal of Medicine and coincided with the release of the Heart Institute analysis at the Scientific Sessions of the American Heart Association in Chicago. The research represents one of the largest international medical device trials undertaken in 2003, comprising 1,798 patients in 24 centres in Canada, Australia, Europe and Turkey.

The Ottawa team consisted largely of top electrophysiologists – cardiologists specializing in surgical procedures to regulate a faulty heart rhythm. Heart failure patients were implanted with either a basic miniature defibrillator (ICD) or with a new device carrying insulated wires called leads to transmit signals and electrical impulses to the heart in an effort to stimulate and coordinate the heart to be beating in-sync. This therapy is called cardiac resynchronization therapy (CRT).

The study, which followed patients for an average of 40 months, showed that patients with CRT live longer with a reduction of the rate of death. In addition, patients with CRT were less likely to be admitted to hospital for worsening of heart failure.

Until now, no research had been undertaken to examine the specific benefits and survival rates in heart failure patients who have been implanted with a CRT along with an ICD.

"This trial represents a tremendous research success for cardiovascular scientists and demonstrates the importance of clinical evaluative research," said Dr. Alain Beaudet, President of the Canadian Institutes of Health Research, which co-funded the research. "We congratulate the Heart Institute for its efforts, which will lead to better health outcomes and longer lives for heart patients."

"Medtronic recognizes the expertise of Canadian electrophysiologists and congratulates them for their leadership in participating and leading this key clinical trial to investigate the benefits of cardiac device therapy in heart failure patients," said Neil Fraser, President of Medtronic of Canada Ltd., which also co-funded the research. "This trial demonstrates that a broader population of heart failure patients could benefit from our therapies, including those with mild symptoms, and they should receive them."

Provided by University of Ottawa Heart Institute

Timely depression diagnosis critical to maintain health of elderly

Depression affects approximately 30 to 40 percent of nursing home residents, but it often goes unrecognized, according to American Geriatrics Society, which can lead to lower quality of life or even suicide. Now, researchers at the University of Missouri have found a series of indicators, other than changes in mood that are associated with the development of depression in nursing home residents.

14 nov 2010--"Prompt diagnosis and treatment of depression is essential to improve the quality of life for nursing home residents," said Lorraine Phillips, assistant professor in the Sinclair School of Nursing. "Many elderly people develop certain clinical characteristics at the same time they develop depression. Understanding these changes is essential to quickly and accurately diagnosing depression in nursing home residents."

Changes in characteristics that Phillips found to be associated with the development of depression include increased verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability and decline in performance of daily living activities.

"Depression is currently diagnosed using several methods that emphasize mood symptoms including interviewing and self-reporting of depression symptoms," Phillips said. "However, since elderly depression may appear with non-mood symptoms, these characteristics identified in this study can help diagnose depression that may be overlooked by traditional screening methods."

Phillips found that residents with increased verbal aggression were 69 percent more likely to be diagnosed with depression than those who had not shown these changes. Decreases in activities of daily living, such as feeding or dressing one's self, also were associated with increased depression diagnosis. The research indicates that men and women in nursing homes are equally likely to develop depression. This contrasts with the overall population, where women are more likely than men to experience depression.

To study these changes, MU researchers analyzed data on more than 14,000 nursing home residents aged 65 and older who were not diagnosed with depression at the beginning of the study. Researchers analyzed changes in various clinical factors, other than mood changes, to discover which changes were associated with the development of depression during a three-month interval of time. The data was collected from the Missouri Minimum Data Set, a federally mandated process for clinical assessment of all residents in Medicare- or Medicaid-certified nursing homes.

More information: The study was published in the Journal of Gerontological Nursing.

Provided by University of Missouri-Columbia

Fructose-rich beverages associated with increased risk of gout in women

Consumption of fructose-rich beverages, such as sugar-sweetened sodas and orange juice is associated with an increased risk of gout among women, although their contribution to the risk of gout in the population is likely modest because of the low incidence rate among women, according to a study that will appear in the November 24 print edition of JAMA. The study is being released early online to coincide with its presentation at the American College of Rheumatology annual scientific meeting.

13 nov 2010--Gout is a common and very painful inflammatory arthritis. "The increasing disease burden of gout in the United States over the last few decades (e.g., an annual incidence of 16/100,000 in 1977 vs. 42/100,000 in 1996) coincided with a substantial increase in soft drink and fructose consumption," the authors write. "Fructose-rich beverages such as sugar-sweetened soda and orange juice can increase serum uric acid levels and, thus, the risk of gout, but prospective data on the relationship are limited."

Hyon K. Choi, M.D., Dr.P.H., of the Boston University School of Medicine, and colleagues examined the relationship between intake of fructose-rich beverages and fructose and incidence of gout in a large group of women. The study consisted of data from the Nurses' Health Study, a U.S. prospective cohort study spanning 22 years (1984-2006). The researchers analyzed data from 78,906 women with no history of gout at the beginning of the study and who provided information on intake of beverages and fructose through validated food frequency questionnaires.

During 22 years of follow-up, the researchers documented 778 newly diagnosed cases meeting American College of Rheumatology survey criteria for gout. They found that increasing intake of sugar-sweetened soda was associated with increasing risk of gout. Compared with consumption of less than 1 serving per month, women who consumed one serving per day had a 74 percent increased risk of gout; and those with 2 or more servings per day had a 2.4 times higher risk. Diet soft drinks were not associated with the risk of gout.

Orange juice intake was also associated with risk of gout. Compared with women who consumed less than a glass (6 oz.) of orange juice per month, women who consumed 1 serving per day had a 41 percent higher risk of gout, and there was a 2.4 times higher risk with 2 or more servings per day. Also, compared with women in the lowest quintile (fifth) of free fructose intake, women in the highest quintile had a 62 percent higher risk of gout.

The authors note that although the relative risks of gout associated with fructose-rich beverages among women were substantial, the corresponding absolute risk differences were modest given the low incidence rate of gout among women.

The researchers add that their findings have practical implications for the prevention of gout in women, and that physicians should be aware of the potential effect of these beverages on the risk of gout. "Our data provide prospective evidence that fructose poses an increased risk of gout among women, thus supporting the importance of reducing fructose intake."

More information: JAMA. 2010;304[20]:doi:10.1001/jama.2010.1638

Silent vascular disease accompanies cognitive decline in healthy aging

Older people who are leading active, healthy lifestyles often have silent vascular disease that can be seen on brain scans that affect their ability to think, according to a new study led by UC Davis researchers and published online today in the Archives of Neurology

12 nov 2010--"This study shows that silent vascular disease is really common as we get older and it influences our thinking abilities," said Charles DeCarli, professor of neurology in the School of Medicine at UC Davis and director of the UC Davis Alzheimer's Disease Center. "We're beginning to realize that vascular disease plays a major role in Alzheimer's disease — they go together."

The study findings are based on data from participants in the Alzheimer's Disease Neuroimaging Initiative. The initiative tracks individuals who are normal, those who have mild cognitive impairment (MCI) and people with Alzheimer's disease using magnetic resonance imaging (MRI), positron emission tomography (PET) imaging and laboratory and cognitive testing to track changes in their cognitive status.

Over 5 million elderly people in the United States have Alzheimer's disease, a progressive, incurable and terminal disease and the most common form of age-related dementia. In its 2009 World Alzheimer Report, Alzheimer's Disease International found that there are more than 35 million people worldwide with Alzheimer's disease or other types of dementia. It also projected that the number should nearly double in the next 20 years.

Cardiovascular disease, including hypertension, high cholesterol and atherosclerosis, is also common in the elderly, and causes "white matter hyperintensities," regions of damaged brain tissue that look like white-hot areas on MRI scans. The purpose of the study was to better understand the relationship between white matter hyperintensities and the extent to which they precede, coincide with or follow short-term changes in cognitive functioning.

For the study, more than 800 participants ages 55 to 90 were recruited from more than 50 research sites throughout the United States and Canada. Some 200 participants were cognitively normal individuals who were followed for three years. Approximately 400 people with mild cognitive impairment also were followed for three years. Two hundred people with Alzheimer's disease were followed for two years. Potential participants with serious brain anomalies, such as brain tumors or prior surgery, were excluded from the study.

All of the participants' baseline cognitive functioning was established using clinical diagnostic evaluation, including the Mini Mental State Exam and the Alzheimer's Disease Assessment Scale-Cognitive Subscale. Criteria for the normal group included no evidence of depression, mild cognitive impairment or dementia. Individuals were included in the MCI category if they had a subjective memory complaint or objective memory loss, among other measures. Participants with Alzheimer's disease met nationally accepted criteria for probable Alzheimer's disease.

Participants whose white matter hyperintensities were significantly above average at the beginning of the study lost more points each year in cognitive testing than those whose white matter hyperintensities were average at baseline. Those with mild cognitive impairment or Alzheimer's disease at baseline had additional declines on their cognitive testing each year, meaning that the presence of white matter hyperintensities and MCI or Alzheimer's disease together added up to even faster and steeper cognitive decline. In addition, participants who were older at baseline saw faster declines over time in their Mini Mental State Exam scores.

The researchers found that, at the outset of the study, the extent of white matter hyperintensities was associated with greater subsequent declines in global cognition over a one-year period.

"In a sample … with frequent evaluations, short-term follow-up and a relatively mild profile of cardiovascular risk, white matter disease may be an important predictor of subsequent short-term global cognitive change," the study found.

"There's a big group of people who have not had major cardiovascular events such as heart attacks. But we see signs that even milder vascular-related insults can contribute to loss of cognitive functioning," said Owen Carmichael, the study's lead author and an assistant professor in the Department of Neurology in the School of Medicine at UC Davis.

Carmichael said that the study suggests that reducing your cardiovascular risk factors to a moderate level may not be enough to avert all forms of brain disease that can lead to cognitive decline in aging.

"Every little bit counts — you have got to squeeze every little bit of healthy lifestyle out of your day" to avoid brain aging, he said.

Provided by University of California - Davis

Bilingualism delays onset of Alzheimer's symptoms

A Canadian science team has found more dramatic evidence that speaking two languages can help delay the onset of Alzheimer's symptoms by as much as five years.

11 nov 2010--The latest study, led by Baycrest's Rotman Research Institute, examined the clinical records of more than 200 patients diagnosed with probable Alzheimer's disease and found that those who have spoken two or more languages consistently over many years experienced a delay in the onset of their symptoms by as much as five years. The study is published in the Nov. 9th issue of Neurology.

The science team includes internationally-renowned cognitive researcher Dr. Fergus Craik of the Rotman Research Institute; Dr. Ellen Bialystok of York University, a leading expert in bilingualism research; and Dr. Morris Freedman, one of Canada's leading clinicians in the diagnosis and treatment of Alzheimer's and other dementias.

"We are not claiming that bilingualism in any way prevents Alzheimer's or other dementias, but it may contribute to cognitive reserve in the brain which appears to delay the onset of Alzheimer's symptoms for quite some time," said Dr. Craik, lead investigator and co-editor of The Oxford Handbook of Memory.

The brains of people who speak two languages still show deterioration from Alzheimer's pathology; however, their special ability with two languages seems to equip them with compensatory skills to hold back the tell-tale symptoms of Alzheimer's, such as memory loss, confusion, and difficulties with problem-solving and planning.

"These results are especially important for multicultural societies like ours in Canada where bilingualism is common," said Dr. Bialystok, professor of Psychology at York University and associate scientist at the Rotman Research Institute. "We need to understand how bilingualism changes cognitive ability, especially when there are clinical implications as in this case."

Observations were made on 211 patients diagnosed with probable Alzheimer's from the Sam and Ida Ross Memory Clinic at Baycrest, from 2007 to 2009. The patients' date of diagnosis and age of onset of cognitive impairment were recorded along with information on occupational history, education and language history (i.e. fluency in English and any other languages). Following this procedure, 102 patients were classified as bilingual and 109 as monolingual.

The researchers found that bilingual patients had been diagnosed with Alzheimer's 4.3 years later and had reported the onset of symptoms five years later than the monolingual patients. The groups were equivalent on measures of cognitive and occupational level, there was no apparent effect of immigration status, and there were no gender differences.

The Neurology paper replicates findings from the team's widely-reported 2007 study led by Dr. Bialystok and published in Neuropsychologia. That study examined the clinical records of 184 patients diagnosed with probable Alzheimer's and other forms of dementia – and found that bilingual patients delayed the onset of their symptoms by four years compared to monolingual patients.

The current study adds to mounting scientific evidence that lifestyle factors – such as regular cardiovascular exercise, a healthy diet, and speaking more than one language – can play a central role in how the brain copes with age-related cognitive decline and diseases such as Alzheimer's.

"Although a great deal of research is being focused on the development of new and more effective medications for Alzheimer's disease, there are currently no drug treatments that show any effects on delaying Alzheimer's symptoms, let alone delaying the onset of these symptoms by up to five years," said Dr. Freedman, head of Neurology and director of the Sam and Ida Ross Memory Clinic at Baycrest.

Provided by Baycrest Centre for Geriatric Care

High cholesterol in middle age women not a risk factor for Alzheimer's and other dementias

High cholesterol levels in middle age do not appear to increase women's risk of developing Alzheimer's disease and other forms of dementia later in life, new Johns Hopkins-led research finds, despite a body of scientific evidence long suggesting a link between the two.

11 nov 2010--What the study, published online in the journal Neurology, does find is that women whose cholesterol levels decline from middle age to old age are at 2.5 times greater risk of developing the memory-wasting diseases than those whose cholesterol stayed the same or increased over the years.

"Our research refutes the notion that high cholesterol in midlife is a risk factor for Alzheimer's disease, at least among women," says Michelle M. Mielke, Ph.D., an assistant professor of psychiatry at the Johns Hopkins University School of Medicine and the study's lead author.

Even though Mielke and her colleagues found no link between high middle-age cholesterol levels and dementia risk, Mielke cautions that people still need to watch their cholesterol. High cholesterol levels are linked to cardiovascular and other diseases. Cholesterol levels can be kept in check through diet, exercise and medication.

Mielke and her colleagues examined data from the Prospective Population Study of Women, which began in 1968 and consisted of 1,462 Swedish women ages 38 to 60. Follow-ups were conducted at four intervals across the intervening decades, with the most recent examinations concluding in 2001. As part of the study, the women were given physical exams, heart tests, chest x-rays and blood tests. The group was also surveyed for smoking habits, alcohol and medication use, education and medical history. Throughout the study, body mass index (BMI), a measurement of weight-per-height, and blood pressure were taken. Women were assessed for dementia throughout the 32 years of follow-up between 1968 and 2001. In 2001, 161 of the original group had been diagnosed with Alzheimer's or other forms of dementia, but the youngest group was just reaching age 70.

Despite the advances being made in biomarker and other dementia research, the biggest known risk factor for these neurodegenerative diseases is old age.

Mielke says that later in life, women with slightly higher body mass index, higher levels of cholesterol and higher blood pressure tend to be healthier overall than those whose weight, cholesterol and blood pressure are too low. But it is unclear whether "too low" cholesterol, BMI and blood pressure are risk factors for dementia or if they could be signs that dementia is developing, she says. For example, an inadvertent loss of weight often precedes the development of dementia, she says, but the exact cause is unclear.

Provided by Johns Hopkins Medical Institutions

'Sweet 16' tool may be useful for detecting cognitive impairment

A new cognitive assessment tool with 16 items appears potentially useful for identifying problems in thinking, learning and memory among older adults, according to a report posted online today that will be published in the March 14 print issue of Archives of Internal Medicine.

10 nov 2010--An estimated 3.4 million older adults in the United States have dementia, and an additional 5.4 million have milder forms of cognitive impairment, according to background information in the article. "For many older adults, cognitive impairment contributes to loss of independence, decreased quality of life and increased health care costs," the authors write. "While the public health impact of cognitive impairment is clear, this condition is often under-recognized. A simple, rapid cognitive assessment instrument is therefore a valuable tool for use in both clinical and research settings."

The most widely known and used measure of cognitive impairment is the Mini-Mental State Examination (MMSE); however, scores on this assessment may be influenced by education level, and the copyright limits its widespread availability. Tamara G. Fong, M.D., Ph.D., of Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, and colleagues developed a new instrument called the Sweet 16 to rapidly assess cognitive status in older adults. To develop the questions, the researchers used information from a group of 774 patients who completed the MMSE as part of a screening process for a large randomized trial of a method to decrease delirium. They then validated their results among 709 participants in another study that also used two different dementia and cognitive decline rating scales.

The Sweet 16 scale is scored from zero to 16 (with 16 representing the best score) and includes questions that address orientation (identification of person, place, time and situation), registration, digit spans (tests of verbal memory) and recall. "The Sweet 16 required no pencil, paper or other props and was easy to administer with a minimum of training," the authors write. "In the pilot group, completion time for the instrument ranged from 1.4 to 2.9 minutes, with a mean [average] of 2.0 minutes and a median [midpoint] of 1.9 minutes."

When administered to participants in the validation group, a Sweet 16 score of 14 or less correctly identified 80 percent of the individuals with cognitive impairment (as identified by another questionnaire) and correctly identified 70 percent of those who did not have cognitive impairment. In the same group, the MMSE correctly identified 64 percent of those with cognitive impairment and correctly identified 86 percent of those who were cognitively normal.

The researchers also compared the Sweet 16 to clinicians' diagnoses of cognitive impairment. Sweet 16 scores of 14 or less occurred in 99 percent of patients diagnosed with cognitive impairment and 28 percent of those without such a diagnosis.

"The Sweet 16 could be used in place of other screening measures, such as the MMSE, to rapidly identify cognitive impairments in general clinical practice as well as in research settings," the authors write. "Further studies, including prospective studies to establish the predictive validity of the Sweet 16, to assess test-retest reliability and to compare performance with other brief cognitive measures, are greatly needed. Ultimately, it is hoped that this test will help improve assessment of cognitive function across many settings."

More information: Arch Intern Med. Published online November 8, 2010.

Study: Tai Chi relieves arthritis pain, improves reach, balance, well-being

In the largest study to date of the Arthritis Foundation's Tai Chi program, participants showed improvement in pain, fatigue, stiffness and sense of well-being.

09 nov 2010--Their ability to reach while maintaining balance also improved, said Leigh Callahan, PhD, the study's lead author, associate professor in the University of North Carolina at Chapel Hill School of Medicine and a member of UNC's Thurston Arthritis Research Center.

"Our study shows that there are significant benefits of the Tai Chi course for individuals with all types of arthritis, including fibromyalgia, rheumatoid arthritis and osteoarthritis," Callahan said. "We found this in both rural and urban settings across a southeastern state and a northeastern state."

Callahan will present these results on Monday, Nov. 8, at the annual scientific meeting of the American College of Rheumatology in Atlanta.

In the study, 354 participants were recruited from 20 sites in North Carolina and New Jersey. They were randomly assigned to two groups. The intervention group received the 8-week, twice-weekly Tai Chi course immediately while the other group was a delayed control group. All participants received baseline and 8-week follow-up evaluations, after which the control group also received the Tai Chi course.

To be eligible for study, participants had to have any type of self-reported, doctor-diagnosed arthritis, be 18 years old or older and able to move independently without assistance. However, they did not have to be able to perform Tai Chi standing. They were eligible for the study if they could perform Tai Chi seated, Callahan said.

Self-reports of pain, fatigue and stiffness and physical function performance measures were collected at baseline and at the eight-week evaluation. Participants were asked questions about their ability to perform activities of daily living, their overall general health and psychosocial measures such as their perceived helplessness and self-efficacy. The physical performance measures recorded were timed chair stands (which are a measure of lower extremity strength), gait speed (both normal and fast) and two measures of balance: a single leg stance and a reach test.

At the end of eight weeks the individuals who had received the intervention showed moderate improvements in pain, fatigue and stiffness. They also had an increased sense of well being, as measured by the psychosocial variables, and they had improved reach or balance, Callahan said.

Provided by University of North Carolina School of Medicine

Beneficial effects of testosterone for frailty in older men are short-lived

The beneficial effects of six months of testosterone treatment on muscle mass, strength and quality of life in frail elderly men are not maintained at six months post-treatment, according to a study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).

08 nov 2010--Frailty is an age-related state of physical limitation caused by the loss of muscle mass and function and can lead to adverse clinical outcomes such as dependency, institutionalization and death. Testosterone levels naturally decline with aging and testosterone replacement is a common therapy. Short-term testosterone treatment in frail elderly men has been shown to improve muscle mass and strength, but until now it has been unclear whether these effects could be maintained post-treatment.

"Since the use of testosterone in elderly men raises concerns regarding adverse effects on the prostate and cardiovascular system, it's important to determine if short-term treatment can lead to prolonged benefits beyond the duration of testosterone exposure," said Frederick Wu, MD, of the University of Manchester in the United Kingdom and lead author of the study. "Our findings suggest it may not be possible to break or interrupt the cycle of decline in physical function in frailty by short-term anabolic pharmacological intervention using testosterone supplementation for six months."

In this study, researchers evaluated 274 intermediate-frail and frail elderly men aged 65-90 years with low testosterone levels. Study participants received either a testosterone gel or placebo for six months. Assessments were carried out at baseline, the end of treatment and six months after treatment cessation. Researchers found that the increased lean body mass, muscle strength and quality of life after six months of testosterone treatment were not maintained six months after treatment.

"At present, the optimal duration of anabolic hormonal intervention to produce sustained benefits in treating frailty in older men is unknown," said Wu. "To best interrupt the downward spiral into frailty a greater emphasis should be placed on a multi-disciplinary interventional approach including resistance exercise, diet and other lifestyle options, in conjunction with pharmacological agents."

More information: The article, "Do the Effects of Testosterone on Muscle Strength, Physical Function, Body Composition and Quality of Life Persist Six Months Post-treatment in Intermediate-Frail and Frail Elderly Men," will appear in the February 2011 issue of JCEM.

Provided by The Endocrine Society

Sodas, other sugary beverages linked to increased risk of type 2 diabetes, metabolic syndrome

A new study has found that regular consumption of soda and other sugar-sweetened beverages is associated with a clear and consistently greater risk of metabolic syndrome and type 2 diabetes. According to the Harvard School of Public Health (HSPH) researchers, the study provides empirical evidence that intake of sugary beverages should be limited to reduce risk of these conditions.

The study appears online October 27, 2010, in the journal Diabetes Care and will appear in the November print edition.

07 nov 2010--"Many previous studies have examined the relationship between sugar-sweetened beverages and risk of diabetes, and most have found positive associations but our study, which is a pooled analysis of the available studies, provides an overall picture of the magnitude of risk and the consistency of the evidence," said lead author Vasanti Malik, a research fellow in the HSPH Department of Nutrition.

Consumption of sugary drinks, the majority of which are sodas, has increased substantially in the U.S. and across the globe and previous scientific studies have shown consistent associations with weight gain and risk of obesity. However, this study is the first meta-analysis to quantitatively review the evidence linking sugar-sweetened beverages with type 2 diabetes and metabolic syndrome. (Metabolic syndrome is a group of risk factors, such as high blood pressure and excess body fat around the waist, that increase the risk of coronary artery disease, stroke and diabetes.)

The researchers, led by Malik and senior author Frank Hu, professor of nutrition and epidemiology at HSPH, did a meta-analysis that pooled 11 studies that examined the association between sugar-sweetened beverages and those conditions. The studies included more than 300,000 participants and 15,043 cases of type 2 diabetes and 19,431 participants and 5,803 cases of metabolic syndrome.

The findings showed that drinking one to two sugary drinks per day increased the risk of type 2 diabetes by 26% and the risk of metabolic syndrome by 20% compared with those who consumed less than one sugary drink per month. Drinking one 12-ounce serving per day increased the risk of type 2 diabetes by about 15%.

"The association that we observed between soda consumption and risk of diabetes is likely a cause-and-effect relationship because other studies have documented that sugary beverages cause weight gain, and weight gain is closely linked to the development of type 2 diabetes," said Hu.

While a number of factors are at work in the development of type 2 diabetes and metabolic syndrome, sugar-sweetened beverages represent one easily modifiable risk factor that if reduced will likely make an important impact, say the researchers. "People should limit how much sugar-sweetened beverages they drink and replace them with healthy alternatives, such as water, to reduce risk of diabetes as well as obesity, gout, tooth decay, and cardiovascular disease," said Malik.

Other HSPH authors include Walter Willett, chair of the Department of Nutrition and Frederick John Stare professor of nutrition and epidemiology.

More information: "Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes," Vasanti S. Malik, Barry M. Popkin, George A. Bray, Jean-Pierre Despres, Walter C. Willett, Frank B. Hu, Diabetes Care, vol. 33, no. 11, online Oct. 27, 2010.

Provided by Harvard School of Public Health