Is it Alzheimer's or another dementia form? Why doctors need to distinguish

Alzheimer's disease now affects an estimated 5.5 million Americans, and after decades of feverish work, researchers have so far failed to find a treatment that halts or reverses the inexorable loss of memory, function and thinking ability that characterize this feared illness.

31 july 2017--But researchers have been quite successful at devising ways to diagnose Alzheimer's earlier and earlier. And that capability has emerged alongside evidence of a tantalizing possibility: that if you can catch the disease early enough - ideally when symptoms of confusion or memory loss are just emerging, or before - some therapies already in hand might essentially halt its progress.
For anyone who detects some mental slippage and wonders, "Is it Alzheimer's?" the current state of dementia research raises a very real, and very wrenching, dilemma: If I can know, do I want to know?
That is, if it's Alzheimer's disease, would I do anything differently? Would there be some benefit in knowing for my loved ones, for myself?
Doctors and insurers, including the federal government, which administers Medicare, are asking some variants of the same questions: If an effective test, which costs between $3,000 and $5,000 a shot, can diagnose dementia early, and distinguish Alzheimer's from other forms of dementia, should it be recommended to patients with cognitive concerns and routinely covered by their insurance? Would it make patients' lives better, or lower the cost of their care?
Newly unveiled research results are bringing some clarity to such deliberations. And other new research, published Wednesday in the journal Neurology, proposes a new diagnostic tool that may be able to detect Alzheimer's, and distinguish it from another form of dementia, more simply and cheaply than does the best test now available.
At the Alzheimer's Association International Conference in London last week, researchers reported their preliminary findings from a trial that is testing the impact of diagnostic testing for Alzheimer's disease on nearly 19,000 Medicare beneficiaries.
All of these study participants - largely people in their 70s, all with a diagnosis of either "mild cognitive impairment" or atypical dementia - are living with the unconfirmed suspicion that they have Alzheimer's. The study is underwritten by the Centers for Medicare & Medicaid Services and the Alzheimer's Association. It set out to find out whether knowing - getting the costly test that would offer either confirmation or reprieve - would change the way that patients with cognitive troubles are treated, or the way that they plan their lives.
The preliminary results suggested it did. After getting the results of a PET brain scan to detect and measure amyloid deposits, which are the key hallmark of Alzheimer's disease, roughly two-thirds of the subjects saw their medication regimens changed or were counseled differently by their doctors about what to expect.
That new information may have guided family caregivers in planning their own futures, or prodded patients to make financial decisions and power-of-attorney assignments sooner. Some who learned that they did not have Alzheimer's discontinued medications that can have unpleasant side effects. Others learned they do have Alzheimer's and decided to enroll in clinical trials that will test new drugs.
A second study presented in London analyzed data from several studies, and found that in a large population of research participants with cognitive concerns, brain amyloid PET scans led to a change in diagnosis in approximately 20 percent of cases.
"People should know what's coming," said Dr. Maria Carrillo, chief science officer for the Alzheimer's Association. The Centers for Medicare & Medicaid Services has given amyloid scans a provisional approval, meaning they do not routinely pay for them. The results may guide the agency to rethink its position, she added.
The PET scan bore bad news for Ken Lehmann, who enrolled last year in the IDEAS trial, short for Imaging Dementia - Evidence for Amyloid Scanning. After his long, slow decline that has flummoxed doctors, Lehmann's brain scan clearly showed he has Alzheimer's disease.
The certainty that has brought has been a long time coming. When Lehmann began withdrawing from friends, forgetting to pay bills and having trouble following conversations, he was just 58. Now, he's 80.
Ken had always been considered a "Renaissance man" - a furniture company executive who rebuilt Porsches, played basketball and loved to entertain friends, said his wife, Mary Margaret Lehmann. But as years passed, his judgment seemed off. He would lose track of points he was making, and sometimes of where he was at.
It would take the loss of their home and a business bankruptcy for the Lehmanns to demand answers to what was going on. In 2009, they moved from Sacramento, Calif., to Edina, Minn., to live with a daughter. And there, at last, they found a neurologist who, despite initial skepticism ("but he presents so well!" the doctor proclaimed), diagnosed dementia.
For the Lehmanns and many patients and families like them - as well as for neurologists - that diagnosis is often just the beginning of a deeper mystery.
Alzheimer's disease is the most feared and most common form of dementia, accounting for between 60 percent and 80 percent of all dementia cases diagnosed. But at least seven other forms of dementia, and dementia linked to the movement disorder Parkinson's disease, can cause loss of memory, reasoning, judgment and the ability to speak, comprehend and care for oneself.
To the estimated 16 million Americans living with some form of cognitive impairment, telling the difference could make a significant difference. Dementia forms with different origins progress differently (or sometimes not at all). They respond best to different medications, and will come to require different levels of care and treatment. Some (though not Alzheimer's) can even be reversed with treatment.
Being able to distinguish which form of dementia a patient has should help doctors and caregivers to make better choices.
But it's a question that until recently could be answered only after death. At that point, a post-mortem examination of the brain could be done to look for the built-up clumps and tangles of beta-amyloid proteins, the overall shrinkage, and the loss of neurons in the brain's hippocampus that are, collectively, the hallmarks of Alzheimer's.
No more. Improved medical imaging technologies developed over the last decade have made it possible to peer inside the brain of a living patient, detect and measure the accumulation of beta-amyloid, and make a definitive diagnosis.
In 2012, the Food and Drug Administration took a first step in making such imaging possible, giving its blessing to the imaging agent florbetapir F18, which binds to amyloid aggregates in the brain and allows a PET scan to be used to make the diagnosis. In 2013, two new imaging agents won FDA approval, and new imaging agents and techniques promise ever more precise means to visualize and diagnose Alzheimer's in the brain.
On Wednesday, research published in the journal Neurology suggested that transcranial magnetic stimulation, a technique that can selectively turn up or down activity in different parts of the brain, could prove useful in distinguishing between Alzheimer's disease from frontotemporal dementia.
In many ways, Ken Lehmann's symptoms fit neatly into a diagnosis of frontotemporal dementia. A form of cognitive impairment that typically becomes evident earlier than most cases of Alzheimer's, FTD often affects judgment, personality and verbal communication. This form of dementia progresses as inexorably as does Alzheimer's. But its typical course differs slightly.
As an enrollee in the IDEAS trial, Lehmann was prepared to learn what it was he had.
"I had come to the conclusion they just don't know," said Lehmann, now 80, from his home in Minnesota. "In seven years, my journey of decline has been very miniscule, and they don't know why."
It turns out, he added, "I have all the biomarkers of Alzheimer's disease."
Once he and his wife learned that, they stepped up their preparations for further decline. And they redoubled their efforts to do things that bring joy, and that may slow Ken's decline as well.
They follow a diet rich in fatty fish, healthful fats and fruits and vegetables, and Ken does woodworking. He also sings in a Minneapolis chorus, Giving Voice, with other dementia patients. He has regained a long-lost ability to read music.
"Just not knowing is very disconcerting," says Mary Margaret, who is her husband's principal caregiver. "I don't know what the timeline is, but I now know what the needs are, in terms of financial and legal needs and end-of-life issues. Those all need to be planned for ahead of time, and now we have all of that in place. To me, that's a safety net."

Dog walking could be key to ensuring activity in later life

A new study has shown that regularly walking a dog boosts levels of physical activity in older people, especially during the winter.
Published in the Journal of Epidemiology and Community Health, the study used data from the EPIC Norfolk cohort study, which is tracking the health and wellbeing of thousands of residents of the English county of Norfolk.

30 july 2017--The researchers from the University of East Anglia (UEA) and Centre for Diet and Activity Research (CEDAR) at the University of Cambridge found that owning or walking a dog was one of the most effective ways to beat the usual decline in later-life activity, even combatting the effects of bad weather.
Dog owners were sedentary for 30 minutes less per day, on average.
More than 3000 older-adults participating in the study were asked if they owned a dog and if they walked one. They also wore an accelerometer, a small electronic device that constantly measured their physical activity level over a seven-day period.
As bad weather and short days are known to be one of the biggest barriers to staying active outdoors, the researchers linked this data to the weather conditions experienced and sunrise and sunset times on each day of the study.
Lead author of the paper, Dr Yu-Tzu Wu, said "We know that physical activity levels decline as we age, but we're less sure about the most effective things we can do to help people maintain their activity as they get older.
"We found that dog walkers were much more physically active and spent less time sitting overall. We expected this, but when we looked at how the amount of physical activity participants undertook each day varied by weather conditions, we were really surprised at the size of the differences between those who walked dogs and the rest of the study participants."
The team found that on shorter days and those that were colder and wetter, all participants tended to be less physically active and spent more time sitting. Yet dog walkers were much less impacted by these poor conditions.
Project lead Prof Andy Jones said: "We were amazed to find that dog walkers were on average more physically active and spent less time sitting on the coldest, wettest, and darkest days than non-dog owners were on long, sunny, and warm summer days. The size of the difference we observed between these groups was much larger than we typically find for interventions such as group physical activity sessions that are often used to help people remain active."
The researchers caution against recommending everyone owns a dog, as not everyone is able to look after a pet, but they suggest these findings point to new directions for programmes to support activity.
Prof Jones said: "Physical activity interventions typically try and support people to be active by focussing on the benefits to themselves, but dog walking is also driven by the needs of the animal. Being driven by something other than our own needs might be a really potent motivator and we need to find ways of tapping into it when designing exercise interventions in the future."
'Dog ownership supports the maintenance of physical activity during poor weather in older English adults: cross-sectional results from the EPIC Norfolk cohort' is published in the Journal of Epidemiology and Community Health.

More information: Dog ownership supports the maintenance of physical activity during poor weather in older English adults: cross-sectional results from the EPIC Norfolk cohort, Journal of Epidemiology & Community Health, jech.bmj.com/lookup/doi/10.1136/jech-2017-208987


Provided by University of East Anglia

Ketamine for depression encouraging, but questions remain around long-term use

3-D model of Ketamine. 

A world-first systematic review into the safety of ketamine as a treatment for depression, published in the prestigious Lancet Psychiatry, shows the risks of long-term ketamine treatment remain unclear.
Led by researchers from UNSW Sydney and Black Dog Institute, the review examined all prior published studies of ketamine treatment for depression, and finds few existing studies effectively report the safety of repeated doses or sustained use.


29 july 2017--Ketamine research leader UNSW Professor Colleen Loo, who is based at the Black Dog Institute, said these major gaps in the literature must be addressed before ketamine is widely adopted as a clinical treatment for depression.
"Despite growing interest in ketamine as an antidepressant, and some preliminary findings suggesting its rapid-acting efficacy, to date this has not been effectively explored over the long term and after repeated dosing," said Professor Loo, a co-author of the study.
"As ketamine treatment will likely involve multiple and repeated doses over an extended time period, it is crucial to determine whether the potential side effects outweigh the benefits to ensure it is safe for this purpose."
The review follows research revealed earlier this week, which provided preliminary evidence of promising results for ketamine delivered to elderly patients in repeated intravenous doses.
Globally, ketamine is increasingly being used off-label to treat severe and treatment-resistant depression. Also known by its party drug name 'Special K', ketamine is not approved for use in Australia, but has Therapeutic Goods Administration (TGA) approval as an anaesthetic.
Researchers in the current study trawled the literature on ketamine for depression to identify its main side effects and whether these differed between single or repeated dosing. They analysed 288 articles, of which 60 studies met the inclusion criteria, which encompassed a total of 899 patients who had received at least one dose of ketamine.
The results show that despite acute side effects commonly occurring after a single treatment of ketamine, not all studies actively monitored for or reported on them. Side effects were more likely to occur when ketamine was given intravenously, and were usually reported on immediately following a single dose.
The most common side effects reported in the literature were headache, dizziness, dissociation, elevated blood pressure and blurred vision. This is consistent with side effects reported in existing user groups - recreational drug users or those prescribed ketamine for chronic pain. However, most studies only reported on side effects in an ad-hoc way, with a lack of conclusive data available into ketamine's longer-term or cumulative effects.
"Despite low ketamine doses currently being used in depression studies, urological toxicity, liver function abnormalities, negative cognitive affects and risk of dependency may limit the safe use of ketamine as a long-term antidepressant treatment," the authors state.
Previous studies have linked longer-term ketamine use to bladder inflammation, liver damage, cognitive changes like memory loss, and craving or addiction. Very few studies have examined human ketamine dependence, with less than 15 cases described in the scientific literature over the past 20 years.
"Our study also raises questions over the risk of administering ketamine in patients with pre-existing or co-morbid medical conditions, such as those with a history of high blood pressure or heart disease," said Professor Loo.
"For instance, we know that when used to treat chronic pain, ketamine is associated with acute blood pressure changes, and experts recommend lower doses administered through slower-acting, non-intravenous means accordingly."
Future ketamine-related depression studies should focus on assessing the safety of repeated dosing regimes, consider co-morbid physical health factors, and actively assess and report on potential side effects in a systematic way, the authors recommend.
The research team are now developing a new tool to standardise future reporting on these side effects, called the Ketamine Side Effect Tool (K-SET) and Ketamine Safety Screening Tool (KSST), to address inconsistencies in the literature.
Professor Colleen Loo is also currently leading the world's largest independent trial of ketamine to treat depression, testing its effects after twice-weekly treatments over a period of four weeks amongst 200 participants.

More information: Lancet Psychiatry (2017). www.thelancet.com/journals/lan … ulltext?elsca1=tlxpr


Provided by University of New South Wale

World-first ketamine trial shows promise for geriatric depression

Australian researchers have completed the world's first randomised control trial (RCT) assessing the efficacy and safety of ketamine as a treatment for depression in elderly patients.
The results, published in the latest American Journal of Geriatric Psychiatry, provide preliminary evidence suggesting ketamine's effectiveness as an antidepressant when delivered in repeated intravenous doses.

28 july 2017--Led by a team of researchers from UNSW Sydney and Black Dog Institute, the trial tested different doses of ketamine among 16 older age participants (aged over 60 years) who had treatment-resistant depression, administered at Wesley Hospital.
"These findings take us a big step forward as we begin to fully understand the potential and limitations of ketamine's antidepressant qualities," said lead author UNSW Professor Colleen Loo, who is based at Black Dog Institute.
"Not only was ketamine well-tolerated by participants, with none experiencing severe or problematic side effects, but giving the treatment by a simple subcutaneous injection (a small injection under the skin) was also shown to be an acceptable method for administering the drug in a safe and effective way."
Participants received increasing doses of ketamine over a period of five weeks, with doses optimised for each individual participant using a new dose-titration approach developed by Professor Loo's Sydney research team and collaborators.
As part of the double-blind, placebo-controlled trial, an active control treatment which causes sedation similar to ketamine, was used to substitute for one of the treatment sessions. Researchers monitored for mood and other side-effects after each treatment session.
Following the RCT, participants also received 12 ketamine treatments in an open-label phase to investigate the effectiveness of multiple doses of ketamine.
By the six-month follow-up, 43% of participants (7 of 14) who completed the RCT had entered remission, with five remitting at amounts below the commonly-used dose of 0.5 mg/kg. Repeated treatments also resulted in a higher likelihood of remission or a longer time to relapse, with an overall response and remission rate of 68.8% for the patients receiving ketamine treatment.
"Elderly patients with severe depression face additional barriers when seeking treatment for the condition. Many medications may cause more side effects or have lower efficacy as the brain ages," said co-author Dr Duncan George from UNSW.
"Older people are also more likely to have co-morbidities like neurodegenerative disorders and chronic pain, which can cause further complications due to ketamine's reported side effects.
"Our results indicate a dose-titration method may be particularly useful for older patients, as the best dose was selected for each individual person to maximise ketamine's benefits while minimising its adverse side effects."
Previous studies into ketamine treatments for older people with depression – which are limited to just five case reports – show mixed success, with findings limited by small sample sizes.
More broadly, little is known about ketamine's potential side effects at different doses, which include cognitive and dissociative effects, elevated blood pressure and heart rate, liver inflammation and urinary problems.
"These results are a promising early piece of the puzzle, but the risks of ketamine use are still not wholly understood. Future studies with greater sample sizes are needed to formally assess ketamine's side effects, such as its impact on liver function," Professor Loo added.

More information: Duncan George et al. Pilot Randomized Controlled Trial of Titrated Subcutaneous Ketamine in Older Patients with Treatment-Resistant Depression, The American Journal of Geriatric Psychiatry (2017). DOI: 10.1016/j.jagp.2017.06.007


Provided by University of New South Wales

New global aging index gauges health and wellbeing of aging populations

The five countries in the index coping best with their aging populations are: Norway, Sweden, the United States, the Netherlands and Japan. Credit: John A. Hartford Foundation Index of Societal Aging

27 july 2017--Researchers from Columbia University's Mailman School of Public Health and University of Southern California Schaeffer Center for Health Policy & Economics, with the support of The John A. Hartford Foundation, have developed a new barometer that estimates how countries are adapting to the dramatic increases in the number and proportion of older persons. The Index is composed of specific measures across five social and economic Indicators that reflect the status and wellbeing of older persons in a country and which can be followed over time and used to compare across nations.
"Now that previously unimagined numbers of older persons are living longer it is critical that we shift from our prior sole focus on the characteristics of individuals and their immediate environments to one that includes a strategy for the entire society to successfully adapt to an aging population" said John Rowe, MD, Julius B. Richmond Professor of Health Policy and Aging, Health Policy and Management at the Mailman School of Public Health, who led the interdisciplinary team of researchers.
Developed for 30 countries at the outset, the Index can track national sources of data for countries with aged populations including the United States and Western Europe. A sample analysis of the data shows that the five countries in the index coping best with their aging populations are: Norway, Sweden, the United States, the Netherlands and Japan. (See chart)
"Interestingly, the Index demonstrates that the United States - despite general problems with inequity and social cohesion - has done well in keeping older Americans financially secure, productive, and engaged," noted Dana Goldman, PhD, Distinguished Professor and Leonard D. Schaeffer Director's Chair at the USC Schaeffer Center for Health Policy & Economics.
The John A. Hartford Index of Societal Aging's five indicators provide new context for measuring the health of aging populations including an evidence-based metric to assess effectiveness over time and across many countries. Earlier indexes either made comparisons for a select group of industrialized nations only, sometimes excluding the U.S., were heavily weighted on economic metrics, such as late life labor force participation, did not fully capture inequalities within the advanced developed aging societies or did not measure many other characteristics of an aging society.
"The Index provides an accurate look at how well societies are adapting to this aging challenge," said Goldman. "Utilizing reliable and sensitive economic and social indicators that are widely available, the tool allows countries to take a broader view of both current conditions and likely future demographic realities."

Elements of the index. Credit: John A. Hartford Index of Societal Aging

Elements of The Hartford Index

• Productivity and Engagement - Measures connectedness within and outside the workforce.
• Well-being - Measures the state of being healthy.
• Equity—Measures gaps in well-being and economic security between the haves and have-nots.
• Cohesion - Measures across generations and social connectedness
• Security—Measures support for retirement and physical safety.

"Failure to adapt to aging is a risky strategy for a country," noted Rowe. "If we neglect to develop and implement effective policies we will be left with a society rife with intergenerational tensions, characterized by enormous gaps between the haves and the have-nots, and unable to provide needed goods and services for any of its members—especially a progressively older and more dependent population. The good news is this gloomy scenario is avoidable."
In addition to Drs. Rowe and Goldman, the Index was presented at the conference by Cynthia Chen, a postdoctoral fellow at the USC Schaeffer Center who worked on the project. Other members of the MacArthur Research Network on an Aging Society served as advisors to the project.*


Provided by Columbia University's Mailman School of Public Health

Using money to buy time linked to increased happiness

New research is challenging the age-old adage that money can't buy happiness.
The study, led by researchers at the University of British Columbia and Harvard Business School, suggests that using money to buy free time— such as paying to delegate household chores like cleaning and cooking— is linked to greater life satisfaction.

26 july 2017--"People who hire a housecleaner or pay the kid next door to mow the lawn might feel like they're being lazy," said study lead author Ashley Whillans, assistant professor at Harvard Business School who carried out the research as a PhD candidate in the UBC department of psychology. "But our results suggest that buying time has similar benefits for happiness as having more money."
The researchers surveyed more than 6,000 adults in the United States, Denmark, Canada and the Netherlands. Respondents were asked if and how much they spent each month to buy themselves free time. They also rated their life satisfaction, and answered questions about feelings of time stress.
Respondents who spent money on time saving purchases reported greater life satisfaction. The effect held up even after controlling for income.
"The benefits of buying time aren't just for wealthy people," said UBC psychology professor and the study's senior author Elizabeth Dunn. "We thought the effects might only hold up for people with quite a bit of disposable income, but to our surprise, we found the same effects across the income spectrum."
To test whether buying time actually causes greater happiness, the researchers also conducted a field experiment. Sixty adults were randomly assigned to spend $40 on a time saving purchase on one weekend, and $40 on a material purchase on another weekend. The results revealed that people felt happier when they spent money on a time saving purchase than on a material purchase.
Despite the benefits, the researchers were surprised to discover how few people choose to spend their money on time saving purchases in daily life. Even in a sample of 850 millionaires who were surveyed, almost half reported spending no money outsourcing disliked tasks. A survey of 98 working adults asking how they would spend a windfall of $40 also revealed that only two per cent would use it in a way that saved them time.
"Although buying time can serve as a buffer against the time pressures of daily life, few people are doing it even when they can afford it," said Dunn. "Lots of research has shown that people benefit from buying their way into pleasant experiences, but our research suggests people should also consider buying their way out of unpleasant experiences."
The study was published today in Proceedings of the National Academy of Sciences.

More information: Ashley V. Whillans el al., "Buying time promotes happiness," PNAS (2017). www.pnas.org/cgi/doi/10.1073/pnas.1706541114


Provided by University of British Columbia

Study finds day-to-day experiences affect awareness of aging, mood

A study of older adults finds an individual's awareness of aging is not as static as previously thought, and that day-to-day experiences and one's attitude toward aging can affect an individual's awareness of age-related change (AARC) - and how that awareness affects one's mood.

25 july 2017--"People tend to have an overall attitude toward aging, good or bad, but we wanted to know whether their awareness of their own aging - or AARC - fluctuated over time in response to their everyday experiences," says Shevaun Neupert, an associate professor of psychology at North Carolina State University and lead author of a paper on the study.
For the study, researchers enrolled 116 participants between the ages of 60 and 90. Each participant took a survey to establish baseline attitudes toward aging. For the following eight days, participants kept a log of daily stressors (such as having an argument), completed a daily evaluation of age-related experiences (such as "I am becoming wiser" or "I am more slow in my thinking"), and reported on their affect, or mood.
"We found that people's AARC, as reflected in their daily evaluations, varied significantly from day to day," says Jennifer Bellingtier, a recent Ph.D. graduate from NC State and co-author of the paper. "We also found that people whose baseline attitudes toward aging were positive also tended to report more positive affect, or better moods."
"People with positive attitudes toward aging were also less likely to report 'losses,' or negative experiences, in their daily aging evaluations," Neupert says.
"However, when people with positive attitudes did report losses, it had a much more significant impact on their affect that day," Neupert says. "In other words, negative aging experiences had a bigger adverse impact on mood for people who normally had a positive attitude about aging."
The study expands on previous work that found having a positive attitude about aging makes older adults more resilient when faced with stressful situations.
The paper, "Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect," is published in the journal The Gerontologist.

More information: Shevaun D. Neupert et al, Aging Attitudes and Daily Awareness of Age-Related Change Interact to Predict Negative Affect, The Gerontologist (2017). DOI: 10.1093/geront/gnx055


Provided by North Carolina State University

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

24 july 2017--Now, research from the University of Michigan School of Public Health shows that people of fairly normal weight who never smoked and drank only in moderation have a life expectancy at age 50 that is seven years longer than the average American. They also are able to delay disability up to six years.

Current life expectancy in the United States is about 78 years for men and 82 years for women but for the low-risk group the ages are 85 and 89, respectively.
"It's important to convince people to improve these behaviors in order, not only to live a longer life, but live a long life free of disability," said Neil Mehta, assistant professor of health management and policy at the U-M School of Public Health. "However, from a societal perspective, caring for individuals with disability is very costly and our study shows that risky behaviors are significantly increasing the burden of early disability."
While previous research has focused on life expectancy impacts from the individual behaviors, the study, released today by Health Affairs, is believed to be the first to show the effect of all three factors combined.
Of course, Mehta said, people who have avoided these unhealthy behaviors are not the norm.
"Eighty percent of Americans in their 50s either have smoked or been obese. That's huge," he said. "Our study speaks to the importance of prevention at whatever level that can occur in community health or in public policy."
The study used data from U-M's Health and Retirement Study of Americans age 50 and older that began in 1992. The research sample in 1998 included nearly 15,000 respondents ages 50–74.
The researchers defined the low-risk category as those who never smoked, drank moderately (at the top end, fewer than 14 drinks per week for men and fewer than 7 drinks per week for women) and had a body mass index that was less than the classification for obese (30+)—in other words, those who would be considered normal and overweight (18.5-29.9 BMI).
Although the study did not set out to look at what happens when people change one or more of the behaviors, the team found that non-obese people who had quit smoking for 10 years prior to the study and who drank moderately had overall and disability-free life expectancies that were only one year shorter than non-obese people who had never smoked and were moderate drinkers.
"There is some evidence that you can still do a lot to improve your health, even if you have these risk factors at some point. We've done a great job with smoking cessation but it's not clear where we're going with obesity," Mehta said, adding that current budget proposals in Washington put federal funds targeted at reducing obesity and other prevention measures in jeopardy.

More information: Neil Mehta et al. The Population Health Benefits Of A Healthy Lifestyle: Life Expectancy Increased And Onset Of Disability Delayed, Health Affairs (2017). DOI: 10.1377/hlthaff.2016.1569


Provided by University of Michigan

Self-perceptions of aging

In the 1960s, the Beatles sang about wondering whether their true love would still love them as they grew older—after they've lost their hair and are no more adventurous than wanting to knit a sweater.
A group of four studies led by University of Michigan researchers has found that however the hero of the Beatles song turns out, his health—and his wife's health—may be dictated by their perceptions of their own aging.

23 july 2017--"Beliefs about one's own aging are shared within couples, and these beliefs are predictive of future health above and beyond individual beliefs," said Shannon Mejia, a postdoctoral fellow at U-M's Institute for Social Research. "Husbands' and wives' individual experiences of physical activity and disease burden are important for their current shared beliefs and future functional health."
That is, couples who tend to view their aging negatively tend to become less healthy and less mobile than couples who view their aging positively. In addition, husbands' disease burden shape their attitudes toward both their own aging and their wives' aging. Mejia and colleagues surmise that the husbands' limitations stemming from disease negatively affect the wives' health because of the increased burden of caregiving.
Jennifer Sun, an M.D./Ph.D. candidate at the U-M Medical School who conducted the research as a psychology doctoral candidate, found that a person's self-perception of aging affects whether he or she accesses health care in a timely fashion. She found that the more negatively a person viewed his or her aging, the more likely he or she was to delay seeking health care and the more barriers he or she saw for seeking care.
This association between negative self-perceptions of aging and health care delay persisted even after Sun controlled for problems that can delay health care, such as low socioeconomic status, lack of health insurance and multiple chronic health conditions.
"While many studies have focused on financial and structural barriers to care, it is also important to consider how psychosocial, emotional and cognitive factors are affecting the decisions of older adults to delay medical care," Sun said.
A third study authored by U-M doctoral candidate Hannah Giasson found that people who experience age discrimination feel less positive about their own aging.
A fourth study found that as people aged, their explicit bias toward older people—or how they would talk out loud about how they felt toward fellow older adults—improved as they aged. But their implicit bias—how they felt internally about fellow older adults—became more negative as they aged. Giasson and William Chopik, a Michigan State University researcher, led this study.
The papers are published today in a special supplement to the August issue of The Gerontologist.
"We're interested in the way people interpret their own lives," said Jacqui Smith, the principal investigator of a project on well-being in midlife and old age and second author on some of the published papers.
"We know that the images in the world and age stereotypes play a role in how people perceive their own aging. But subtle experiences of discrimination in interactions with strangers and sometimes with your own kids or partner—that is feedback that people take to heart and either rebel against it or begin to believe it."
The AARP supported the publishing of the supplement ahead of the annual meeting of the International Association of Gerontology and Geriatrics.
"Wherever these negative perceptions come from, the damage can be profound—for individuals, communities and larger populations," said AARP CEO Jo Ann Jenkins. "We need to change the conversation about age and aging in this country. It's not about being 'polite.' It's a necessity."


Provided by University of Michigan

AARP, GSA focus on effects of negative attitudes on aging

The ways in which negative attitudes about aging can affect people's health and quality of life are the focus of 12 peer-reviewed research papers in a new AARP-sponsored supplement issue of The Gerontologist—the respected research and analysis journal published by The Gerontological Society of America (GSA) since 1961.

20 july 2017--"Attitudes and stereotypes about aging haven't changed or have gotten worse. And many ideas about aging and solutions available to us as we age, as portrayed in the media or even in conversations among families and friends, are negative and out of date," said AARP Director of Thought Leadership-Health Erwin Tan, MD.
While the papers examine a diverse range of aging-related subjects and research considerations, a common theme is the prevalence of negative associations about aging and their impact, ranging from memory performance to use of health care. The research explores cultural, geographic, community, and family influences that may play a role in shaping an individual's attitude on aging.
"Wherever these negative perceptions come from, the damage can be profound—for individuals, communities, and larger populations," said AARP CEO Jo Ann Jenkins, whose book "Disrupt Aging" examines how aging is represented in society. "We need to change the conversation about age and aging in this country. This is not about being 'polite,' it's a necessity. "
In addition to elevating a collection of timely and insightful research, the August supplement to the The Gerontologist has a broader goal, according to Jenkins.
"We seek to enlist the aid of gerontologists in helping to change the conversation about what it means to grow older," Jenkins said. "Additionally, we want to remind gerontologists of the critical role they play, not just in academia, but in people's real lives. We are all aging, every day so there is no more mainstream topic than aging."


Provided by The Gerontological Society of America

Elderly yoginis have greater cortical thickness

Yoga practitioners showed greater cortical thickness in a cluster in the left prefrontal cortex.

17 july 2017--Scientists in Brazil have imaged elderly female yoga practitioners' brains and found they have greater cortical thickness in the left prefrontal cortex, in brain areas associated with cognitive functions like attention and memory. The results suggest that yoga could be a way to protect against cognitive decline in old age.

As we age, the structure and functionality of our brains change and this often leads to cognitive decline, including impaired attention or memory. One such change in the brain involves the cerebral cortex becoming thinner, which scientists have shown is correlated with cognitive decline. So, how can we slow or reverse these changes?
You might think medication would be required, but surprisingly, the answer could lie in contemplative practices like yoga. Yoga practitioners consciously maintain postures, and perform breathing exercises and meditation.
"In the same way as muscles, the brain develops through training," explains Elisa Kozasa of Hospital Israelita Albert Einstein in São Paulo, Brazil, a researcher involved in the study, which was recently published in Frontiers in Aging Neuroscience. "Like any contemplative practice, yoga has a cognitive component in which attention and concentration are important."
Previous studies have suggested that yoga can have greater health benefits than similar aerobic exercises, and yoga practitioners have shown improved awareness, attention and memory. Older adults with mild cognitive impairment have also shown improvements after a short yoga training program.

Credit: CC0 Public Domain

But can practicing yoga over several years significantly shape your brain and if so, could it offset some of the changes that happen in the aging brain? The research team wanted to see if elderly long-term yoga practitioners had any differences in terms of brain structure compared with healthy elderly people who had never practiced yoga.
They recruited 21 female yoga practitioners (also known as yoginis) who had practiced yoga at least twice a week for a minimum of 8 years, although the group had an average of nearly 15 years of yoga practice. The researchers compared the yoginis with another group of 21 healthy women, who had never practiced yoga, meditation or any other contemplative practices, but who were well-matched to the yoginis in terms of their age (all the participants were 60 or over) and levels of physical activity. For more consistent results, the researchers only recruited women, and the participants completed surveys to see if there were any other factors at work that could affect brain structure, such as depression or level of formal education.
The researchers scanned the participants' brains using magnetic resonance imaging to see if there were any differences in brain structure. "We found greater thickness in the left prefrontal cortex in the yoginis, in brain regions associated with cognitive functions such as attention and memory," says Rui Afonso, another researcher involved in the study. As the groups were well-matched in terms of other factors that can change brain structure, such as education and levels of depression, yoga practice appears to underlie the yoginis' different brain structure.
The results suggest that practicing yoga in the long-term can change the structure of your brain and could protect against cognitive decline in old age. However, the team plan to carry out more studies to see if these brain changes result in enhanced cognitive performance in elderly yoginis.
Another possibility is that people with these brain features are more likely to be attracted to yoga. "We have compared experienced yoginis with non-practitioners, so we do not know if the yoginis already had these differences before they started yoga," explains Afonso. "This can only be confirmed by studying people for a few years from the time they start yoga."

More information: Rui F. Afonso et al, Greater Cortical Thickness in Elderly Female Yoga Practitioners—A Cross-Sectional Study, Frontiers in Aging Neuroscience (2017). DOI: 10.3389/fnagi.2017.00201


Provided by Frontiers

Surgery for early prostate cancer may not save lives

Gerald L. Andriole, M.D., (right) director of Washington University's Division of Urologic Surgery, performs surgery on a patient with prostate cancer. New research provides further evidence that surgery is unnecessary for early-stage prostate cancer, although some men whose disease is further along may benefit.

15 july 2017--A major 20-year study provides further evidence that prostate cancer surgery offers negligible benefits to many men with early-stage disease. In such men, who account for most cases of newly diagnosed prostate cancer, surgery did not prolong life and often caused serious complications such as infection, urinary incontinence and erectile dysfunction.
The study, by a national research team including Washington University School of Medicine in St. Louis, was led by the Minneapolis Veterans Administration Health Care System. It is published July 13 in The New England Journal of Medicine.
In men with early prostate cancer, the study compared surgery with observation. With the latter, men only were treated if they developed bothersome symptoms, such as urinary difficulty or bone pain. Such symptoms may indicate progression of the cancer. Many men in the observation group received no treatment at all because early-stage prostate cancer often grows slowly and rarely causes symptoms.
"The findings will go a long way in helping to improve prostate cancer care," said co-author Gerald L. Andriole, MD, director of Washington University's Division of Urologic Surgery. "About 70 percent of patients newly diagnosed with prostate cancer cases are in the early stages, meaning the cancer is confined to the prostate gland, and they have nonaggressive tumors. As such, these patients have an excellent prognosis without surgery. This study confirms that aggressive treatment usually is not necessary. We hope the findings will steer doctors away from recommending surgery or radiation to their patients with nonaggressive early-stage prostate cancer and patients away from thinking it's necessary."
The American Cancer Society ranks prostate cancer as the second most common cancer in men and the third-leading cause of cancer deaths among men, after lung and colorectal cancer. In 2017, about 161,360 men will be diagnosed with prostate cancer, and 26,730 will die from it.
The study, known as the Prostate Cancer Intervention Versus Observation Trial, or PIVOT, is one of the largest and longest involving cancer patients. It got underway in 1994 just as the prostate-specific antigen blood test for prostate cancer became routine. With many more men diagnosed with prostate cancer, the standard treatment for all prostate cancers became surgery or radiation, with the thinking that removing or irradiating the tumor would increase survival. But over the next decade, reports of treatment-related complications raised concerns, as did data indicating that most early-stage cancers grew so slowly they were unlikely to cause health problems.
To evaluate any potential benefits of surgery, the researchers randomly assigned 731 men in the U.S. with localized prostate cancer to receive either surgery or observation at one of 44 Department of Veteran Affairs Health Care Centers or eight academic medical centers, including Washington University. The average age of men in the study was 67 at the time of enrollment.
Of the men who had prostate cancer surgery, 223 (61 percent) died of other causes after up to 20 years of follow-up, compared with 245 men (66 percent) in the observation group - a difference that is not statistically different. Further, 27 (7 percent) men in the surgery group died of prostate cancer, compared with 42 men (11 percent) in the observation group, but that difference also is not statistically significant.
However, the data show that surgery may have a mortality benefit in some men, particularly those with a long life expectancy and intermediate-risk prostate cancer. (Such men generally have PSA scores of 10-20 ng/ml and a Gleason score of seven. The latter score signifies tumor aggressiveness.)
"It would be a disservice to dismiss surgery as a viable option for patients with intermediate-risk prostate cancer," said Andriole, the School of Medicine's Robert K. Royce Distinguished Professor of Urologic Surgery. He treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. "For these patients, and for some men with high-risk prostate cancer, surgery is often beneficial, as are other other treatments such as radiation."
Technology has advanced since the study began, allowing physicians to more accurately classify tumors and avoid overtreating patients who have prostate cancer.
Of the 364 men treated with surgery, 53 (15 percent) suffered from erectile dysfunction, and 63 (17 percent) reported having incontinence. Another 45 developed other complications.
"The benefits of surgery also need to be balanced against the negative long-term consequences of surgery that occur early and often," said senior author Timothy Wilt, MD, a physician-researcher with the Center for Chronic Disease Outcomes Research at the Minneapolis VA Health Care System and a professor of medicine at the University of Minnesota. "Our results demonstrate that for the majority of men with localized prostate cancer, selecting observation for their treatment choice can help them live a similar length of life, avoid death from prostate cancer and prevent harms from surgical treatment. Physicians can use information from our study to confidently recommend observation as the preferred treatment option for men with early prostate cancer."

More information: New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1615869


Provided by Washington University in St. Louis

Cognitive function up with adherence to mediterranean diet

12 july 2017--For older adults, greater adherence to the Mediterranean diet (MedDiet) and the Mediterranean-DASH diet Intervention for Neurodegeneration Delay (MIND) is associated with improved cognitive function, according to a study published online recently in the Journal of the American Geriatrics Society.
Claire T. McEvoy, Ph.D., from the University of California in San Francisco, and colleagues conducted a cross-sectional study involving 5,907 community-dwelling older adults to examine adherence to dietary patterns. Diet scores were generated for the MedDiet and the MIND diet using food frequency questionnaires. A composite test score of global cognitive function was used to measure cognitive performance.
The researchers found that in fully adjusted models, participants with mid and high MedDiet scores were less likely to have poor cognitive performance than those with low scores (odds ratios, 0.85 [95 percent confidence interval, 0.71 to 1.02; P = 0.08] and 0.65 [95 percent confidence interval, 0.52 to 0.81; P < 0.001]). Similar results were seen for the MIND diet. In each dietary pattern, higher scores were independently correlated with significantly better cognitive function (P < 0.001) in a dose-response pattern (P_trend < 0.001).
"Clinical trials are required to elucidate the role of dietary patterns in cognitive aging," the authors write.
One author disclosed financial ties to Takeda Pharmaceuticals.

More information: Abstract
Full Text

Shingles increases risk of heart attack, stroke

Contracting shingles, a reactivation of the chickenpox virus, increases a person's risk of stroke and heart attack, according to a research letter published today in the Journal of the American College of Cardiology.

09 july 2017--According to the Centers for Disease Control and Prevention, almost 1 out of every 3 people in the United States will develop shingles in their lifetime. Anyone who has suffered from chickenpox may develop shingles; however, the risk of shingles increases as a person gets older.
Researchers in South Korea used the National Health Insurance Service's "medical check-up" database to identify patients with newly diagnosed herpes zoster—or shingles, stroke and heart attack using the relevant International Classification of Disease-10 diagnostics codes.
A total of 519,880 patients were followed from 2003-2013, during this period there were 23,233 cases of shingles. The final cohort of 23,213 was matched with the same number of shingles-free patients to serve as control subjects.
Patients with shingles were more likely to be female and common risk factors for stroke and heart attack, such as old age, high blood pressure, diabetes and high cholesterol, were also more commonly seen in these patients. However, this group was also less likely to smoke, have a lower alcohol intake, more exercise and be part of a higher socioeconomic class.
Shingles was found to raise the risk of a composite of cardiovascular events including heart attack and stroke by 41 percent, the risk of stroke by 35 percent and the risk of heart attack by 59 percent. The risk for stroke was highest in those under 40 years old, a relatively younger population with fewer risks for atherosclerosis. The risks of both stroke and heart attack were highest the first year after the onset of shingles and decreased with time. However, these risks were evenly distributed in the shingles-free group.
"While these findings require further study into the mechanism that causes shingles patients to have an increased risk of heart attack and stroke, it is important that physicians treating these patients make them aware of their increased risk," said Sung-Han Kim, MD, PhD, a physician in the department of infectious diseases at Asan Medical Center in Seoul and one of the study authors.


Provided by American College of Cardiology

Healthy lifestyle may help older adults preserve their independence

In a study of men with an average age of 71 years, lifestyle factors such as never smoking, maintaining a healthy diet, and not being obese were associated with survival and high functionality over the next 16 years.

07 july 2017--The study included 1104 men who completed a questionnaire. High functionality was defined as preserved ability in personal activities of daily living and cognitive function.
Additional studies are needed to investigate whether lifestyle changes after the age of 70 years may also lead to preserved independence.
The findings are published in the Journal of the American Geriatrics Society.

More information: Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14971


Provided by Wiley

Popular heartburn drugs linked to higher death risk

Millions of US residents take proton pump inhibitors which are widely prescribed to treat heartburn, ulcers and other gastrointestinal problems. The drugs also are available over the counter under brand names that include Prevacid, Prilosec and Nexium. Now, a new study from Washington University School of Medicine in St. Louis shows that long-term use of the popular drugs carries an increased risk of death.

06 july 2017--Popular heartburn drugs called proton pump inhibitors (PPIs) have been linked to a variety of health problems, including serious kidney damage, bone fractures and dementia. Now, a new study from Washington University School of Medicine in St. Louis shows that longtime use of the drugs also is associated with an increased risk of death.
Millions of U.S. residents take proton pump inhibitors which are widely prescribed to treat heartburn, ulcers and other gastrointestinal problems. The drugs also are available over the counter under brand names that include Prevacid, Prilosec and Nexium.
For the study, the researchers examined medical records of some 275,000 users of PPIs and nearly 75,000 people who took another class of drugs - known as H2 blockers - to reduce stomach acid. The research is published online July 3 in the journal BMJ Open.
"No matter how we sliced and diced the data from this large data set, we saw the same thing: There's an increased risk of death among PPI users," said senior author Ziyad Al-Aly, MD, an assistant professor of medicine. "For example, when we compared patients taking H2 blockers with those taking PPIs for one to two years, we found those on PPIs had a 50 percent increased risk of dying over the next five years. People have the idea that PPIs are very safe because they are readily available, but there are real risks to taking these drugs, particularly for long periods of time."
Both PPIs and H2 blockers are prescribed for serious medical conditions such as upper gastrointestinal tract bleeding, gastroesophageal reflux disease and esophageal cancer. Over-the-counter PPIs are most often used for heartburn and indigestion.
PPIs have become one of the most commonly used classes of drugs in the United States with 15 million monthly prescriptions in 2015 for Nexium alone, according to WebMD.
A kidney doctor by profession, Al-Aly has previously published studies linking PPIs to kidney disease, and other researchers have shown an association with other health problems. Al-Aly, first author Yan Xie, PhD, a data scientist, and colleagues reasoned that since each of these side effects carries a small risk of death, together they may affect the mortality rate of PPI users.
To find out, the researchers sifted through millions of de-identified veterans' medical records in a database maintained by the U.S. Department of Veterans Affairs. They identified 275,933 people who had been prescribed a PPI and 73,355 people prescribed an H2 blocker between October 2006 and September 2008, and noted how many died and when over the following five years. The database did not include information on cause of death.
Al-Aly and colleagues found a 25 percent increased risk of death in the PPI group compared with the H2 blocker group. The researchers calculate that, for every 500 people taking PPIs for a year, there is one extra death that would not have otherwise occurred. Given the millions of people who take PPIs regularly, this could translate into thousands of excess deaths every year, Al-Aly said.
The researchers also calculated the risk of death in people who were prescribed PPIs or H2 blockers despite not having the gastrointestinal conditions for which the drugs are recommended. Here, the researchers found that people who took PPIs had a 24 percent increased risk of death compared with people taking H2 blockers.
Further, the risk rose steadily the longer people used the drugs. After 30 days, the risk of death in the PPI and H2 blocker groups was not significantly different, but among people taking the drugs for one to two years, the risk to PPI users was nearly 50 percent higher than that of H2 blocker users.
Although the recommended treatment regimen for most PPIs is short - two to eight weeks for ulcers, for example - many people end up taking the drugs for months or years.
"A lot of times people get prescribed PPIs for a good medical reason, but then doctors don't stop it and patients just keep getting refill after refill after refill," Al-Aly said. "There needs to be periodic re-assessments as to whether people need to be on these. Most of the time, people aren't going to need to be on PPIs for a year or two or three."
As compared with the H2 blocker group, people in the PPI group were older (64 years old, on average, versus 61) and also somewhat sicker, with higher rates of diabetes, hypertension and cardiovascular disease. But these differences cannot fully account for the increased risk of death since the risk remained even when the researchers statistically controlled for age and illness.
Over-the-counter PPIs contain the same chemical compounds as in prescription PPIs, just at lower doses, and there is no way to know how long people stay on them. The Food and Drug Administration recommends taking PPIs no longer than four weeks before consulting a doctor.
Al-Aly emphasizes that deciding whether to take a PPI requires a risk-benefit calculation.
"PPIs save lives," Al-Aly said. "If I needed a PPI, I absolutely would take it. But I wouldn't take it willy-nilly if I didn't need it. And I would want my doctor to be monitoring me carefully and take me off it the moment it was no longer needed."


Provided by Washington University School of Medicine

Endocrine Society issues Scientific Statement on obesity's causes

A new Scientific Statement issued by the Endocrine Society calls for more research aimed specifically at understanding the underlying mechanisms that make it difficult to maintain long-term weight loss.

04 july 2017--Despite decades of research and billions of dollars spent each year on treatment, understanding of the underlying causes of obesity remains limited. One in three American adults is affected by obesity, and it costs an estimated $147 billion a year to treat obesity and its consequences in the United States, according to the Centers for Disease Control and Prevention.
Growing evidence suggests obesity is a disorder of the body's intricate energy balance systems. Once an individual loses weight, the body typically reduces the amount of energy expended at rest, during exercise and daily activities while increasing hunger. This combination of lower energy expenditure and hunger creates a "perfect metabolic storm" of conditions for weight gain.
"Because of the body's energy balance adjustments, most individuals who successfully lose weight struggle to maintain weight loss over time," said Michael W. Schwartz, M.D., of the University of Washington in Seattle, Wash., and the chair of the task force that authored the Society's Scientific Statement. "To effectively treat obesity, we need to better understand the mechanisms that cause this phenomenon, and to devise interventions that specifically address them. Our therapeutic focus has traditionally been on achieving weight reduction. Most patients can do this; what they have the most trouble with is keeping the weight off."
"Healthcare providers and patients need to view this tendency as the body's expected response to weight loss, rather than as a sign of a failed treatment regimen or noncompliance with treatment," Schwartz said.
The Society's statement also calls for additional research into factors influencing obesity;

• Interactions between genetics, developmental influences and the environment. Though a substantial portion of obesity risk is conveyed by genes, researchers have not yet been able to identify all of the relevant genes and to understand the nature of their interactions with developmental processes and the environment.
• The effect of endocrine-disrupting chemicals such as bisphenol A on obesity.
• The microbiome, or bacteria in the gut, and its interactions with the endocrine and digestive systems as well as the brain.
• The reasons behind the therapeutic success of bariatric surgery.
• The role that diet composition plays in the development of obesity.
• Biological markers and predictors for diabetes, heart disease and other conditions that often develop in conjunction with obesity.
• The effects of socioeconomic status on obesity risk.
• Brain imaging to better understand appetite and feeding behavior.

More information: Michael W. Schwartz et al, Obesity Pathogenesis: An Endocrine Society Scientific Statement, Endocrine Reviews (2017). DOI: 10.1210/er.2017-00111


Provided by The Endocrine Society

Alzheimer's disease patients with psychosis more likely to be misdiagnosed, study suggests

Dr. Corinne Fischer, director of the Memory Disorders Clinic at St. Michael's Hospital in Toronto and lead author of the study.

People with Alzheimer's disease who experience psychosis—including delusions and hallucinations—are five times more likely to be misdiagnosed with dementia with Lewy bodies compared to patients who do not, new research suggests.

03 july 2017--Alzheimer's disease is a type of dementia characterized by protein deposits in the brain including twisted fibers found inside brain cells. Dementia with Lewy bodies is believed to be caused by the buildup of a different abnormal protein aggregate found in nerve cells in the brain. Effective treatments for these conditions are still under development, but will almost certainly be different, according to the authors.
Researchers also found that Alzheimer's disease was misdiagnosed in 24 per cent of all cases, with false positive and false negative rates both being 12 per cent. Previous research suggested that the rate of misdiagnosis in Alzheimer's disease ranged from 12-23 per cent.
The findings, published online today in Alzheimer's & Dementia: Translational Research & Clinical Interventions, raise concern that there may be an under appreciation of how common psychotic symptoms are in Alzheimer's disease, said Dr. Corinne Fischer, director of the Memory Disorders Clinic at St. Michael's Hospital in Toronto and lead author of the study.
"Psychosis can be a symptom of Alzheimer's disease, but it is a defining clinical feature in other types of dementia, including Parkinson's disease related dementia and dementia with Lewy bodies," she said. "Consequently, clinicians are more reluctant to diagnose a patient with Alzheimer's disease when they present with delusions or hallucinations."
About 36 per cent of people with Alzheimer's are thought to have delusions and 18 per cent have hallucinations. Psychotic symptoms are significant in Alzheimer's patients because they have been shown to be associated with increased burden on caregivers, increased functional decline and more rapid progression of the disease.
Researchers examined 961 people using data from the National Alzheimer's Coordinating Centre database, collected from 29 Alzheimer's disease centres in the United States between 2005 and 2012. They included participants who had been clinically diagnosed with Alzheimer's while they were alive, as well as those whose autopsies showed they the signature physical signs of Alzheimer's in their brains.
Patients who experienced psychosis had a higher rate of false negative diagnosis and a lower rate of false positive diagnosis of Alzheimer's disease compared to those who did not. Whether patients experienced delusions, hallucinations, or a combination of both did not affect the rate of misdiagnosis, according to the authors.
The Alzheimer's Society of Canada estimates there are 564,000 people living with dementia in Canada, and that number is expected to almost double over the next 15 years, thus reinforcing the relevance of the study's findings according to Winnie Qian, a Master's student in the Neuroscience Research Program at St. Michael's and an author on the study.
"An advantage of our study is that we used the final clinical diagnosis after years of follow-up, so the rate of misdiagnosis we described is the rate under ideal conditions," she said.
"This means that it should be considered a minimum. If you extrapolate that and apply it to the general population, the magnitude of the problem could be much greater."
Dr. Fischer said when patients do not present with psychosis, clinicians should be more careful when considering alternative diagnoses to Alzheimer's disease.
"Many dementia patients never receive a definitive clinical diagnosis while they're alive, so the hope is that by understanding what factors can lead to a misdiagnosis, we can be more accurate and provide patients with the best possible care," she said.


Provided by St. Michael's Hospital

Brain stimulation no better than escitalopram for depression

Escitalopram may outperform transcranial direct-current stimulation (tDCS) in the treatment of depression, according to a study published in the June 29 issue of the New England Journal of Medicine.

01 july 2017--Andre Brunoni, M.D., Ph.D., director of the Service of Interdisciplinary Neuromodulation at the University of Sao Paulo in Brazil, and colleagues randomly assigned 245 patients with depression to one of four groups. One group had tDCS plus a placebo pill, another had sham tDCS plus escitalopram. The third group had tDCS plus escitalopram, and the final group had sham tDCS plus a placebo. The treatment was given for 15 consecutive days at 30 minutes each, then once a week for seven weeks. Escitalopram was taken daily for three weeks, after which the daily dose was increased from 10 to 20 mg for the next seven weeks.
After 10 weeks, patients receiving tDCS fared no better than those taking escitalopram. Patients receiving tDCS, however, experienced more side effects, the researchers found. Specifically, patients receiving tDCS had higher rates of skin redness, ringing in the ears, and nervousness than those receiving sham brain stimulation. In addition, two patients receiving tDCS developed new cases of mania. Patients taking escitalopram reported more frequent sleepiness and constipation.
"tDCS has been increasingly used as an off-label treatment by physicians," Brunoni told HealthDay. "Our study revealed that it cannot be recommended as a first-line therapy yet and should be investigated further."

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