'Biomarkers' Could Spot Alzheimer's Disease Early, Studies Suggest

11 aug 2010-- The presence of three proteins in cerebrospinal fluid may spot Alzheimer's disease long before symptoms start and might also signal how fast the disease is progressing.

The findings, appearing in the August issue of the Archives of Neurology, support recently released diagnostic criteria touting the use of such proteins, also known as biomarkers, in aiding diagnosis of this form of dementia.

"This just reinforces the recommendation by [Alzheimer's working groups] saying that biomarkers can actually be incorporated today into clinical practice in order to add a certain piece to the diagnosis if patients are already presenting with something that looks like Alzheimer's," said Maria C. Carrillo, senior director of medical and scientific relations at the Alzheimer's Association.

An accompanying editorial echoed that thought, by "strongly commend[ing] CSF [cerebrospinal fluid] analyses of A1-42, T-tau, and P-tau in circumstances where having a definitive diagnosis of AD is important for counseling patients about such concerns as work, driving, and making other lifestyle changes."

Scientists have been busily trying to find physiological indications that can indicate if a person has Alzheimer's disease or is going to develop it. Right now, effective medications against Alzheimer's do not exist. However, the disease likely begins a decade or so before symptoms appear, experts say, so spotting it early might someday mean earlier (and therefore more effective) prevention and treatment.

These researchers measured levels of three proteins - total tau protein, phosphorylated tau and amyloid protein - in the cerebrospinal (CSF) of 102 people with Alzheimer's, 200 people with mild cognitive impairment and 114 "normal" individuals.

An "Alzheimer's disease signature" was present in 90 percent of the Alzheimer's patients, 72 percent of those with mild cognitive impairment (MCI) and 36 percent of those who had no cognitive impairments.

A signature consisting of low amyloid levels and high phosphorylated tau levels identified patients with MCI who progressed to Alzheimer's with 100 percent accuracy, the team said.

The fact that the signature was also found in individuals with no sign of cognitive impairment underlines the likelihood that Alzheimer's disease has started long before it is symptomatic, stated the authors.

Another research group, this one set to report its finding in the December print issue of the Archives of Neurology verified that blood levels of the beta-amyloid protein predict progression toward Alzheimer's -- another step towards identifying valid biomarkers for the disease.

Patients who started out with high levels of the protein that later tapered off, saw their cognitive health decline more rapidly, even if they did not end up with full-blown Alzheimer's.

"High baseline levels of amyloid beta in combination with declining levels over time was sort of a high-risk profile for the development of Alzheimer's disease," explained study first author Stephanie Cosentino, an assistant professor of neuropsychology at Columbia University's Taub Institute in New York City.

The findings support the "amyloid cascade" theory of Alzheimer's, "which points to the accumulate of amyloid in brain as primary trigger for Alzheimer's disease," Cosentino said.

"This paper, which replicated an [earlier] study on these three risk genes indicates that ultimately, genetic biomarkers may play a very strong role in the whole spectrum of biomarkers [involved in Alzheimer's]," stated Carrillo, who was not involved with either study.

But, Cosentino cautioned, "amyloid beta is not ready to be used as a disease biomarker. Not everyone who has high levels of plasma amyloid beta will demonstrate Alzheimer's disease or cognitive decline. Other factors need to be taken into account."

This marker may have more immediately utility in clinical trials, as a way to determine if drugs-in-process are actually effective, she said.

More information

Visit the Alzheimer's Association for more on this disease.

Chronic Pain Gene Discovery May Spark Treatments

10 aug 2010- Nearly 20 percent of American adults suffer from persistent, chronic pain, but a new genetic clue may aid in the understanding and treatment of the debilitating condition.

Chronic pain can affect all aspects of life, from sleep, to work, to exercise. Some individuals are more susceptible to pain than others, but the reason for this has not been understood. For example, the amount of pain two patients experience after the same surgery can differ greatly.

An international team of researchers sought to find out if there is a genetic basis for susceptibility to pain. Using animal models, they were able to link mouse chromosome 15 with pain. Using two fine-mapping approaches, they narrowed it down to one gene: Cacgn2, which was previously know to be associated with cerebral function and epilepsy. Before now, no other gene has ever been associated with pain.

To further test the gene, scientists used a mouse strain harboring the mutant gene, previously used for epilepsy research, and the findings were consistent; the mice experienced different behavioral and electrophysiological characteristics linking the chronic pain to Cacgn2.

Researchers wanted to know if the Cacgn2 gene is responsible for chronic pain in humans as well. To find out, they studied a cohort of breast cancer patients that had all or partial removal of the breast, and found genetic polymorphisms in Cacgn2 were significantly associated with chronic pain experienced after surgery.

"The immediate significance is the mere awareness that differences in pain perception may have a genetic predisposition," Ariel Darvasi of the Hebrew University of Jerusalem in Israel, was quoted as saying. "Our discovery may provide insights for treating chronic pain through previously unthought-of mechanisms."

SOURCE: Genome Research, published online August 4, 2010

Tests Help Predict Falls in Parkinson's Disease

09 aug 2010— A group of tests may help predict which people with Parkinson's disease are more likely to fall, according to a study published in the June 23, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"Falls are a major problem for people with Parkinson's disease and can lead to injuries and reduced mobility, which can result in increasing weakness, loss of independence and increased use of nursing homes," said study author Graham K. Kerr, PhD, of Queensland University of Technology in Brisbane, Australia. "Despite these issues and their impact on the health care system and society, little research has been done to help predict which people with Parkinson's disease are more likely to fall so we can try to prevent these falls."

For the study, 101 people with Parkinson's disease who were able to walk without any aids took a variety of tests evaluating their Parkinson's symptoms, balance and mobility. The participants then reported any falls that occurred over a six-month period.

Most participants were in the early stage of the disease, with an average of six years since the disease was diagnosed. The majority of the participants (77 percent) had the type of Parkinson's that is mainly affected by difficulty with voluntary movements, while 20 percent had tremors as the central symptom of the disease.

A total of 48 percent of the participants had a fall during the study and 24 percent had more than one fall. A total of 42 percent reported that they had fallen in the year before the study started.

The tests that were the best predictors of whether a person was likely to fall included a test of overall Parkinson's symptoms, a questionnaire on how often people tended to "freeze" while walking, and a test of balance. When these tests were combined, the results produced a sensitivity of 78 percent and a specificity of 84 percent for predicting falls. Sensitivity is the percentage of actual positives that are correctly identified as positive, and specificity is the percentage of negatives that are correctly identified.

"These tests are easy to implement and take only a short time to complete," Kerr said. "Once we can identify those at risk of falling, we can take steps to try to prevent these falls." In the United States, it is estimated that about one million people have Parkinson's disease.

The study was supported by Parkinson's Queensland Inc., the Queensland University of Technology, and the Australian National Health and Medical Research Council.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.

Deep Brain Stimulation Shows Promise for Patients With Alzheimer's

08 aug 2010— In a world first, Dr. Andres M. Lozano and his team at Toronto Western Hospital has shown using Deep Brain Stimulation (DBS) on patients with early signs of Alzheimer's disease is safe and may help improve memory.

The phase one safety trial of six Ontario patients took place from 2005 to 2008. All patients left hospital within 2 to 3 days of surgery, and continue to participate in regular follow-up cognitive assessments.

Throughout these assessments, Dr. Lozano says half the patients continue to perform better than predicted -- that is -- their memory capacity has improved, or deteriorated less than expected.

"While the study was not looking for efficacy, the results suggest that of the six patients, three may have done better than if the Alzheimer's disease was allowed to run its course," commented Lozano. "We showed that not only is this a safe procedure, but that the evidence is there to warrant a bigger trial. Any amount of time that extends quality of life and quality years to someone with Alzheimer's may be a benefit."

Dr. Lozano first discovered the potential for DBS to treat Alzheimer's disease while treating a patient for obesity using DBS back in 2003. While signaling areas of the brain, Dr. Lozano and his team triggered memories in the patient. In follow-up testing the patient's memory improved and Dr. Lozano set in motion the first ever DBS trial of patients with early signs of Alzheimer's disease.

"We've demonstrated this is safe, and that the evidence warrants more study. We're now planning a phase two, multi-centred trial -- we're just waiting on the funding," says Dr. Lozano.

Results of Dr. Lozano's trial are published in the August 4 issue of Annals of Neurology.

Healing Prayer or Proximity?

07 aug 2010-- Many have prayed for a loved ones health to be restored, but researchers say for best results, get close.

A new study shows praying for another person's health can benefit that person, especially if the person praying is close to the ill. The Study of The Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique," measured how people in poorer areas who don't have glasses and hearing aids readily available reacted to prayer.

Proximal prayer is often practiced by Pentacostal and Charismatic Christians. Pentacostals often pray for their own healing and ask others to do distant intercessory prayer, but they feel that proximal prayer is very important. They emphasize the importance of being close and physically touching the person for effective healing.

"When people feel that they have serious need for healing, they are willing to try almost anything," Candy Gunther Brown, an associate professor in the Department of Religious Studies at Indian University Bloomington, was quoted as saying. "If they feel that a particular religious or spiritual practice healed them, they are much more likely to become an adherent. This phenomenon, more than any other, accounts for the growth of these Christian subgroups globally."

The study was conducted in Mozambique and Brazil because of their reputation for being popular places for specialized prayer. Researvhers studied the effects of prayer on people with vision and hearing impairments. They decided on these to conditions because they are easily detectable with an audiometer and vision chart. The subjects were 14 Mozambican natives who were audibly impaired and 11 who were visually impaired. The subjects reported improvements in their vision and hearing. Two with hearing problems reported reducing the threshold at which they could hear by 50 decibels, and three visually impaired subjects went from 20/400 to 20/80 vision.

There is much controversy behind PIP because scientists and doctors argue that it is not clinically proven or scientific enough to be tested and used in clinical settings, but regardless, the medical community is committed to healing people any way necessary.

Source: Southern Medical Journal, September 2010

Eliminating diabetes and depression, and boosting education, most likely to ward off dementia

Research: Designing prevention programs to reduce incidence of dementia: Prospective cohort study of modifiable risk factors

06 aug 2010--Eliminating diabetes and depression, as well as increasing education and fruit and vegetable consumption, are likely to have the biggest impact on reducing levels of dementia in the coming years, should no effective treatment be found, concludes a study published on bmj.com today.

These findings suggest priorities for future public health interventions.

While the exact cause of dementia is still unknown, several modifiable risk factors have already been identified. These include vascular risk factors (heart disease, stroke, high blood pressure, obesity, diabetes, and high cholesterol), a history of depression, diet, alcohol consumption, and education level.

Based on this knowledge, a team of researchers based in France and the UK estimated which of these risk factors might be most effective in reducing the future burden of dementia, should no effective treatment be found.

Their analysis involved 1,433 healthy people aged over 65 years living in the south of France and recruited between 1999 and 2001. Participants underwent cognitive testing at the start of the study and again at two, four and seven years. A reading test (the Neale score) was also used as an indicator of lifetime intelligence.

Medical history and information on measures such as height, weight, education level, monthly income, mobility, dietary habits, alcohol consumption, and tobacco use was obtained. An individual's genetic risk of dementia was also measured: although it's not a factor that can be changed it served as a useful benchmark for dementia risk.

Results showed that eliminating depression and diabetes and increasing fruit and vegetable consumption were estimated to lead to an overall 21% reduction in new cases of dementia, with depression making the greatest contribution (just over 10%). However, the researchers point out that the direct (causal) relationship between depression and dementia remains unclear.

Increasing education would also lead to an estimated 18% reduction in new cases of dementia across the general population over the next seven years. By contrast, eliminating the principal known genetic risk factor from the general population would lead only to a 7% reduction in the number of new cases over the next seven years.

Given these findings, the authors suggest that public health initiatives should focus on encouraging literacy at all ages irrespective of ability, prompt treatment of depressive symptoms, and early screening for glucose intolerance and insulin resistance (early stages in the development of diabetes).

While these calculations can only provide a crude estimate of impact on incidence, they do make a significant statement about public health priorities in disease prevention in the face of current knowledge, conclude the authors. Further studies including younger adults are clearly needed to test the impact of intervention measures.

A second study, also published on bmj.com today, finds that death rates are more than three times higher in people with dementia than in those without dementia in the first year after diagnosis. The study also says that earlier and better detection of dementia in primary care is needed. An accompanying editorial suggests that key areas to focus on include better education and training in primary care, developing more integrated systems of care, and ensuring that policy makers and commissioners plan services that reflect the effects of dementia on primary care and other services.

Octogenarians have more heart surgery, live longer

NEW YORK , 05 aug 2010-- Heart surgery and the use of other invasive treatments have risen sharply in elderly people who've suffered a heart attack, Canadian researchers said Tuesday.

In addition, the number of deaths within one year of those heart attacks dropped by almost 10 percent between 1996 and 2006, data from Quebec hospital patients aged 80 and older show.

"Over the last decade we are doing procedures in patients once believed to be too old for these procedures," said chest surgeon Dr. Mark R. Katlic, of Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pennsylvania, who was not involved in the new study.

"It's my belief that this is a positive development," he said, cautioning that the study didn't prove the new treatment had reduced the number of deaths.

An earlier study found that U.S. heart patients of all ages are more likely to undergo procedures to clear blocked coronary arteries than are Canadians.

The current study, published in the Canadian Medical Association Journal, was carried out by Dr. Louise Pilote and colleagues of McGill University in Montreal.

Over a 10-year period, the researchers found that nearly 30,000 octogenarians in Quebec had suffered a heart attack.

In 1996, most of the patients received standard medications such as beta-blockers and cholesterol-lowering drugs, and only a few percent underwent invasive procedures.

Ten years later, however, that number had ballooned: A quarter of all patients were undergoing angioplasty, a procedure in which the doctor cleans out the blocked arteries that caused the heart attack.

Overall, almost half the patients died within a year of their heart attacks in 1996, while fewer than four in ten died in 2006.

The drop in mortality only occurred in patients who had undergone invasive procedures, suggesting those treatments might help patients survive longer. But it's possible that other changes in how doctors managed the patients could also have been involved.

Heart attacks kill more than 400,000 people in the U.S. every year according to the American Heart Association, and heart disease remains the leading cause of death.

Dr. Katlic, who wrote an editorial about the new study, said it was important to consider the cost of the procedures, which may amount to tens of thousands of dollars.

Medications are much less expensive, he told Reuters Health, but it's unclear if they are equally effective at preventing another heart attack.

"We should also study whether the quality of life is better after these procedures," he said.

SOURCE: link.reuters.com/ceh23n Canadian Medical Association Journal, online August 3, 2010.

Decreased Cardiac Function Linked to Faster Brain Aging

Bottom and middle cardiac index tertiles linked to significantly lower brain

04 aug 2010-- Reductions in cardiac function, as measured by cardiac index, may be associated with accelerated aging of the brain, according to a study published online Aug. 2 in Circulation.

Angela L. Jefferson, Ph.D., of the Boston University School of Medicine, and colleagues evaluated 1,504 individuals from the Framingham Heart Study Offspring Cohort who were free of clinical stroke, transient ischemic attack, or dementia (mean age, 61 years).

In multivariable-adjusted models, the researchers found that cardiac index was positively associated with total brain volume and information processing speed, as well as inversely associated with lateral ventricular volume. When excluding patients with clinically prevalent cardiovascular disease, the association between cardiac index and total brain volume remained. In post hoc analysis, the researchers found that participants in the bottom cardiac index tertile (values <2.54)>2.92).

"Whether lower cardiac index leads to reduced brain volumes and accelerates neurodegeneration on an eventual path to dementia is not yet clear," write the authors of an accompanying editorial. "What is known is that various vascular risk factors, including decrements in cardiac function, are determinants of dementia (both Alzheimer disease and variants of vascular cognitive disorders)."

Abstract
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Exercise and caloric restriction rejuvenate synapses in lab mice

03 aug 2010-- Harvard University researchers have uncovered a mechanism through which caloric restriction and exercise delay some of the debilitating effects of aging by rejuvenating connections between nerves and the muscles that they control.
The research, conducted in the labs of Joshua Sanes and Jeff Lichtman and described this week in the journal Proceedings of the National Academy of Sciences, begins to explain prior findings that exercise and restricted-calorie diets help to stave off the mental and physical degeneration of aging.
"Caloric restriction and exercise have numerous, dramatic effects on our mental acuity and motor ability," says Sanes, a professor of molecular and cellular biology and director of the Center for Brain Science at Harvard. "This research gives us a hint that the way these extremely powerful lifestyle factors act is by attenuating or reversing the decline in our synapses."
Sanes says their research, conducted with mice genetically engineered so their nerve cells glow in fluorescent colors, shows some of the debilitation of aging is caused by deterioration of connections that nerves make with the muscles they control, structures called neuromuscular junctions. These microscopic links are remarkably similar to the synapses that connect neurons to form information-processing circuits in the brain.
In a healthy neuromuscular synapse, nerve endings and their receptors on muscle fibers are almost a perfect match, like two hands placed together, finger to finger, palm to palm. This lineup ensures maximum efficiency in transmitting the nerve's signal from the brain to the muscle, which is what makes it contract during movement.
As people age, however, the neuromuscular synapses can deteriorate in several ways. Nerves can shrink, failing to cover the muscle's receptors completely. The resulting interference with transmission of nerve impulses to the muscles can result in wasting and eventually even death of muscle fibers. This muscle wasting, called sarcopenia, is a common and significant clinical problem in the elderly.
The new work showed that mice on a restricted-calorie diet largely avoid that age-related deterioration of their neuromuscular junctions, while those on a one-month exercise regimen when already elderly partially reverse the damage.
"With calorie restriction, we saw reversal of all aspects of the synapse disassembly. With exercise, we saw a reversal of most, but not all," Sanes says.
Because of the study's structure -- mice were on calorie-restricted diets for their whole lives, while those that exercised did so for just a month late in life -- Sanes cautions against drawing conclusions about the effectiveness of exercise versus calorie restriction. He notes that longer periods of exercise might have more profound effects, a possibility he and Lichtman are now testing.
Though much of Sanes and Lichtman's work focuses on brain synapses, both have investigated neuromuscular synapses for many years. Neuromuscular junctions are large enough to be viewed by light microscopy, and can be a jumping-off point for brain study, highlighting areas of inquiry and potential techniques.
"These findings in neuromuscular synapses make us curious to know whether similar effects might occur in brain synapses," Sanes says.
While the changes to the synapses through caloric restriction and exercise were clear in the images the researchers obtained, Sanes cautioned that their work was structural, not functional, and they have not yet tested how well the synapses worked.
Provided by Harvard University

Social Relationships Linked to Improved Survival

Meta-analysis finds such relationships associated with 50 percent higher chance of survival

02 aug 2010-- Having stronger social relationships is associated with an increased likelihood of survival, with a magnitude of effect that's comparable to quitting smoking, according to research published online July 27 in PLoS Medicine.

Julianne Holt-Lunstad, Ph.D., of Brigham Young University in Provo, Utah, and colleagues performed a meta-analytic review of 148 studies with 308,849 participants that investigated the association between social relationships and mortality.

The researchers found a 50 percent increased likelihood of survival for participants who had stronger social relationships. The association was most prominent for complex measures of social integration (odds ratio, 1.91) and lowest for binary measures of residential status, such as living alone compared to living with others (odds ratio, 1.19). The authors write that the magnitude of the findings is comparable to quitting smoking and exceeds mortality risk factors such as obesity and physical inactivity.

"Physicians, health professionals, educators, and the public media take risk factors such as smoking, diet, and exercise seriously; the data presented here make a compelling case for social relationship factors to be added to that list. With such recognition, medical evaluations and screenings could routinely include variables of social well-being; medical care could recommend if not outright promote enhanced social connections; hospitals and clinics could involve patient support networks in implementing and monitoring treatment regimens and compliance, etc.," the authors conclude.

The study was partially funded by a grant from TP Industrial Inc.

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Calcium Supplements May Increase Heart Attack Risk

Meta-analysis reveals significant increase in risk in those taking calcium versus those on placebo

31 july 2010-- Calcium supplementation is associated with an increased risk of myocardial infarction, according to a meta-analysis published online July 29 in BMJ.

Mark J. Bolland, Ph.D., of the University of Auckland in New Zealand, and colleagues searched the medical literature for randomized, placebo-controlled studies of calcium supplementation (500 or more mg/day) involving more than 100 subjects (mean age, over 40). The reviewers analyzed 15 studies with an aggregate of more than 20,000 subjects.

In five studies with patient level data, the investigators found that 143 subjects taking calcium had myocardial infarctions compared to 111 on placebo (hazard ratio, 1.31). There were also increases in risk for stroke; the composite end point of myocardial infarction, stroke, or sudden death; and all-cause mortality; however, these were considered nonsignificant. In a meta-analysis of trial level data, 166 subjects taking calcium had myocardial infarctions compared to 130 on placebo (pooled relative risk, 1.27).

"Calcium supplements (without coadministered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used, these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population. A reassessment of the role of calcium supplements in the management of osteoporosis is warranted," the authors write.

One study author disclosed receiving research support from and acting as a consultant for the dairy company Fonterra, while four authors reported receiving study drugs for clinical trials of calcium supplementation from pharmaceutical companies.

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Editorial

Delirium in older patients associated with greater risk of death, dementia and institutionalization

30 JULY 2010--A review and analysis of previous research indicates that delirium in elderly patients is associated with an increased risk of death, dementia, and institutionalization, independent of age, co-existing illnesses or illness severity, according to a study in the July 28 issue of JAM
Delirium is a syndrome of acutely altered mental status characterized by inattention and a fluctuating course. With occurrence rates of up to half of older patients postoperatively, and even higher in very elderly admitted to intensive care units, delirium is the most common complication in hospitalized older people," the authors write. "Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease."
Joost Witlox, M.Sc., of the Medical Center Alkmaar, the Netherlands, and colleagues conducted an analysis of previous studies to assess the association between delirium and long-term poor outcomes in elderly patients while controlling for important confounders (other factors that can influence outcomes). The researchers identified 51 relevant articles. The primary analyses included only high-quality studies with statistical control for age, sex, comorbid (co-existing) illness or illness severity, and baseline dementia.
The primary analysis showed that delirium was associated with an increased risk of death compared with controls after an average follow-up of 22.7 months. "Moreover, patients who had experienced delirium were also at increased risk of institutionalization and dementia," the authors write. Further analysis confirmed the strength of the results.
"The results of this meta-analysis provide evidence that delirium in elderly patients is associated with an increased risk, of death, institutionalization, and dementia, independent of age, sex, comorbid illness or illness severity, and presence of dementia at baseline. Moreover, our stratified models confirm that this association persists when excluding studies that included in-hospital deaths and patients residing in an institution at baseline," the researchers write.
The authors add that the results of this meta-analysis can be instrumental in patient care. "The low rate of survival and the high rates of institutionalization and dementia indicate that older people who experience delirium should be considered an especially vulnerable population."
"Future studies will have to establish what exact mechanisms are responsible for the long-term poor outcomes after delirium and whether clinical characteristics of delirium itself (e.g., duration or subtype) differentially influence prognosis. Moreover, clinical trials are needed to investigate whether the long-term sequelae associated with delirium can be averted."
More information: JAMA. 2010;304[4]:443-451.

Obesity rise linked to disability increase among elderly in Latin America and the Caribbean


29 july 2010--Thanks to rising obesity rates in Latin America and the Caribbean, elderly people there are becoming more likely to suffer from disabilities, according to a paper recently published by University of Texas Medical Branch at Galveston researchers in the American Journal of Epidemiology.
The UTMB study drew on data from a Pan-American Health Organization and National Institute on Aging survey that covered more than 6,000 people over age 65 in six cities: Bridgetown, Barbados; São Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. Across the board, the investigators found that obese seniors were more likely to have significant trouble walking, bathing, dressing, eating, getting in and out of bed and using the toilet.
In this survey, a subject was defined as obese if he or she had body mass index (weight in kilograms divided by height in meters squared) equal or greater than 30.
"This greater prevalence obesity is a new thing in Latin America and the Caribbean, the result of people moving from rural to urban areas and shifting their nutritional habits and other aspects of their lives to a more Western pattern," said UTMB assistant professor Soham al Snih, lead author of "Obesity and Disability: Relation Among Older Adults Living in Latin America and the Caribbean," which appeared in the June 15 issue of the American journal of epidemiology "At the same time, we're seeing a substantial increase in life expectancy. The close relationship that we found between obesity and disability in older adults suggests that we really need to work to prevent these populations from becoming obese."
Without major efforts to promote healthy eating and exercise in Latin American and Caribbean populations, al Snih said, current trends will produce large numbers of people who are especially vulnerable to chronic medical conditions such as diabetes, cardiovascular disease and arthritis — conditions that could increase the degree of disability among the elderly, and which will severely strain the health care resources of poorer countries.
"We need to reorient people to better nutrition, we need to screen for these diseases and do as much as we can to prevent them, and we need to involve these populations in exercise and increase their activity level," al Snih said. "It's very important, because otherwise it will cost much more in the long run."
In addition to highlighting the connection between increasing obesity rates and increasing disability among elders, al Snih noted that the UTMB study provides a rare look at the prevalence of obesity in various populations of older adults in Latin America and the Caribbean, where much public health data focuses instead on childhood through middle age. Current rates of obesity among the elderly ranged from a low of 13.3 percent in Havana to a high of 37.6 percent in Montevideo. (According to the National Health and Nutrition Survey of 2007-2008, the U.S. obesity rate for men over 60 is 37.1 percent; for women over 60 it is 33.6 percent).
Provided by University of Texas Medical Branch at Galveston

Text And Email Alerts Welcomed By Older Patients - British Psychological Society


Text and email alerts could help older patients remember appointments and medication instructions, ultimately reducing NHS costs and potentially improving their own recovery.

27 july 2010--This is one of the findings from post-graduate researcher, Lyndsay Hughes, from the University of Hertfordshire, who presented her research on Wednesday 21st July at the British Psychological Society's Psychology Postgraduate Affairs Group conference at Sheffield Hallam University.

The study investigated ownership and use of email and mobile phone technologies in a sample of 112 patients with rheumatoid arthritis who were attending NHS clinics.

From this sample 73% of older patients had an email address and 93% owned a mobile phone. Those in the eldest category (over 65) also reported a high use of mobile phones with more than 63% stating they were "confident" at reading texts.

Almost half of those who had an email address or mobile phone said that they would like an email/text reminder for appointments. A quarter of patients who had access to these technologies said they would like an email/text medication reminder.

Lyndsay explained: "This shows that older patients with rheumatoid arthritis access emails and texts regularly and would like text or email reminders for appointments and medication use.

Even in the oldest age category of over 65's email and text reminders may be a useful means of increasing clinic attendance and medication adherence. As low attendance and adherence is associated with disease progression, these outcomes will not only improve patients health they could reduce NHS Costs."

For the full conference programme please visit the Psypag website.

Source:
British Psychological Society

Why more education lowers dementia risk

A team of researchers from the UK and Finland has discovered why people who stay in education longer have a lower risk of developing dementia – a question that has puzzled scientists for the past decade.

26 july 2010--Examining the brains of 872 people who had been part of three large ageing studies, and who before their deaths had completed questionnaires about their education, the researchers found that more education makes people better able to cope with changes in the brain associated with dementia.

Over the past decade, studies on dementia have consistently showed that the more time you spend in education, the lower your risk of dementia. For each additional year of education there is an 11% decrease in risk of developing dementia, this study reports.

However, these studies have been unable to determine whether or not education – which is linked to higher socioeconomic status and healthier lifestyles – protects the brain against dementia.

This is not the case, the new study lead by Professor Carol Brayne of the University of Cambridge has found. Instead, the study shows people with different levels of education have similar brain pathology but that those with more education are better able to compensate for the effects of dementia.

According to co-author Dr Hannah Keage of the University of Cambridge: "Previous research has shown that there is not a one-to-one relationship between being diagnosed with dementia during life and changes seen in the brain at death. One person may show lots of pathology in their brain while another shows very little, yet both may have had dementia. Our study shows education in early life appears to enable some people to cope with a lot of changes in their brain before showing dementia symptoms."

Compared with previous research, this study was able to answer the question because of its large size and statistical power.

The researchers used data from the EClipSE collaboration, which combines the three European population-based longitudinal studies of ageing (the Medical Research Council Cognitive Function and Ageing Study, the Cambridge City Over-75s Cohort Study and Vantaa 85+, a Finnish study).

The studies have assessed participants for up to 20 years and are three of only six such studies in the world.

The results have important implications for public health at a time when populations in many countries are ageing.

"Education is known to be good for population health and equity. This study provides strong support for investment in early life factors which should have an impact on society and the whole lifespan. This is hugely relevant to policy decisions about the importance of resource allocation between health and education," says Professor Brayne.

The results are published today in the journal Brain. The study was funded by the BUPA Foundation, the European Union and the Medical Research Council.

Gene linked to aging also linked to Alzheimer's

SIRT1 gene appears to control production of the devastating protein fragments

CAMBRIDGE, Mass, 25 july 2010 -- MIT biologists report that they have discovered the first link between the amyloid plaques that form in the brains of Alzheimer's patients and a gene previously implicated in the aging process, SIRT1.

The researchers found that SIRT1 appears to control production of the devastating protein fragments, termed A-beta peptides, that make up amyloid plaques. They also showed that in mice engineered to develop Alzheimer's plaques and symptoms, learning and memory deficits were improved when SIRT1 was overproduced in the brain, and exacerbated when SIRT1 was deleted.

The results, reported in the July 23 issue of the journal Cell, indicate that drugs that activate SIRT1 could be a promising strategy to combat Alzheimer's, says Leonard Guarente, the MIT biology professor who led the study.

Alzheimer's disease is a neurodegenerative disorder that affects up to one-third of people who reach the age of 80. Patients suffer from memory loss and other cognitive impairments believed to be the result of damage from amyloid plaques.

Amyloid plaques form when proteins called amyloid precursor proteins (APPs) are broken into smaller amyloid peptides. However, APPs can also be cleaved into harmless protein fragments.

In this study, the MIT researchers showed that SIRT1 activates the production of an enzyme that cleaves APPs into harmless fragments instead of the Alzheimer's-associated amyloid peptides. Mice engineered to produce excess SIRT1 had reduced peptide levels, while mice with SIRT1 knocked out showed increased peptide levels.

The SIRT1 gene, which produces proteins called sirtuins, has previously been shown to regulate many cell activities, especially those involved in stress response and calorie deprivation. Guarente first drew attention to sirtuins about 15 years ago when he discovered that the yeast version of the gene, SIR2, regulates longevity in yeast. Later work revealed similar effects in worms, mice and rats.

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Other authors of the Cell paper are MIT postdoctoral associates Gizem Donmez and Dena Cohen and junior Diana Wang. The research was funded by an American Parkinson Disease Association fellowship, a grant from the National Institutes of Health and a gift from the Paul F. Glenn Foundation.

Source: "SIRT1 Suppresses beta-Amyloid Production by Activating the alpha-Secretase Gene ADAM10," Gizem Donmez, Diana Wang, Dena E. Cohen, and Leonard Guarente. Cell, July 23, 2010.

Study links more time spent sitting to higher risk of death

Risk found to be independent of physical activity level

23 july 2010--A new study from American Cancer Society researchers finds it's not just how much physical activity you get, but how much time you spend sitting that can affect your risk of death. Researchers say time spent sitting was independently associated with total mortality, regardless of physical activity level. They conclude that public health messages should promote both being physically active and reducing time spent sitting. The study appears early online in the American Journal of Epidemiology.

Increasing obesity levels in the United States are widely predicted to have major public health consequences. A growing epidemic of overweight and obesity has been attributed in part to reduced overall physical activity. And while several studies support a link between sitting time and obesity, type 2 diabetes, cardiovascular disease risk factors (11, 16, 17), and unhealthy dietary patterns in children and adults (18-20), very few studies have examined time spent sitting in relation to total mortality (21-23). Thus, public health guidelines focus largely on increasing physical activity with little or no reference to reducing time spent sitting.

To explore the association between sitting time and mortality, researchers led by Alpa Patel, Ph.D. analyzed survey responses from 123,216 individuals (53,440 men and 69,776 women) who had no history of cancer, heart attack, stroke, or emphysema/other lung disease enrolled in the American Cancer Society's Cancer Prevention II study in 1992. They examined the amount of time spent sitting and physical activity in relation to mortality between 1993 and 2006. They found that more leisure time spent sitting was associated with higher risk of mortality, particularly in women. Women who reported more than six hours per day of sitting were 37 percent more likely to die during the time period studied than those who sat fewer than 3 hours a day. Men who sat more than 6 hours a day were 18 percent more likely to die than those who sat fewer than 3 hours per day. The association remained virtually unchanged after adjusting for physical activity level. Associations were stronger for cardiovascular disease mortality than for cancer mortality.

When combined with a lack of physical activity, the association was even stronger. Women and men who both sat more and were less physically were 94% and 48% more likely, respectively, to die compared with those who reported sitting the least and being most active.

"Several factors could explain the positive association between time spent sitting and higher all-cause death rates," said Dr. Patel. "Prolonged time spent sitting, independent of physical activity, has been shown to have important metabolic consequences, and may influence things like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure, and leptin, which are biomarkers of obesity and cardiovascular and other chronic diseases."

The authors conclude that "public health messages and guidelines should be refined to include reducing time spent sitting in addition to promoting physical activity. Because a sizeable fraction of the population spends much of their time sitting, it is beneficial to encourage sedentary individuals to stand up and walk around as well as to reach optimal levels of physical activity."

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Article: "Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults." Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, 5 Susan M. Gapstur, Graham A. Colditz, and Michael J. Thun. Am J Epid Published online July 22, 2010 (DOI: 10.1093/aje/kwq155).

Link to abstract: http://aje.oxfordjournals.org/cgi/content/abstract/kwq155

Depression May Increase Chances of Getting Alzheimer's

As if depression wasn't bad enough on its own, new research suggests older adults with depressive symptoms are at increased risk of developing Alzheimer's disease.

22 july 2010--Alzheimer's is a fatal brain disorder marked by memory loss and an inability to function in daily life. Researchers have long known that depression and Alzheimer's disease are linked, but it wasn't clear whether depression was a risk factor for Alzheimer's or a symptom of the disease. [Alzheimer's self-test works well]

Now, two studies published in the July 6 issue of the journal Neurology conclude that depression is indeed separate from Alzheimer's and that depressive symptoms can raise the risk of dementia by 50 percent.

The studies didn't address the question of why depression might contribute to later cognitive decline. One theory, said study author Robert Wilson, a neuropsychologist at Rush University Medical Center in Chicago, is that depression fundamentally alters the brain.

"There may be some actual structural changes associated with depression that render depressed individuals, by the time they reach old age, a little bit more vulnerable" to dementia, Wilson told LiveScience.

Risk factor or symptom?

Alzheimer's is caused by protein plaques and tangles that build up in and around nerve cells in the brain, causing cell death. Exactly why the plaques and tangles form is a mystery, but previous brain-anatomy studies suggested depression isn't to blame, Wilson said.

To Wilson, it seemed likely that depression was a risk factor for dementia, not a symptom of the disease. To test the theory, he and his colleagues analyzed data on older adults from Chicago's South Side who had undergone evaluation for depression and Alzheimer's every three years. About 350 of these individuals were diagnosed with dementia, which is most commonly caused by Alzheimer's.

By comparing the participants' self-reported depression ratings and dementia diagnoses, the researchers found "virtually no change" in depressive symptoms seven years prior to the dementia diagnosis and three years after it, Wilson said. Interviews with family members and caregivers confirmed that observable signs of depression also held steady.

The results suggest depression is not an inevitable symptom of Alzheimer's, Wilson said.

"It's not to say that people with Alzheimer's never have depression," he said. "We think they're as likely to have depression as they were before the disease."

Depression and dementia are linked, however. The second study, headed by epidemiologist Jane Saczynski of the University of Massachusetts Medical School, used data from the famous Framingham Heart Study to track depression and dementia in 949 people over 17 years.

At the beginning of the study, none of the participants had any dementia symptoms; by the end, 136 had developed Alzheimer's and 28 had other dementias. Of those who had depressive symptoms at the beginning of the study, 21.6 percent later developed dementia, compared with 16.6 percent of non-depressed individuals. After controlling for factors like smoking and genetics, the researchers found that depression raised the risk of later dementia by 50 percent.

The long time frame makes it less likely that the participants already had dementia-related damage at the beginning of the study, Saczynski said. And because the depression showed up so much earlier than the dementia, the study, like Wilson's, supports the notion of depression as a dementia risk factor, not a symptom.

Dementia by a thousand cuts

Exactly how a mood disorder like depression can contribute to Alzheimer's disease isn't known, but the effect is probably cumulative.

One theory, Saczynski said, is that depression weakens the body's defenses against dementia by affecting the brain's blood supply. Cardiovascular disease (another risk factor for Alzheimer's) and depression are often clinically linked, Saczynski said, perhaps because of reduced blood flow to the brain. These vascular changes might render the brain more vulnerable to Alzheimer's-related damage.

Another possibility is that the chronic stress of depression changes the brain's structure. Studies on animals find that the brains of mice and rats kept in stressful conditions show changes in areas associated with memory and learning.

Something similar seems to happen in humans. One study, published in May in the journal Archives of General Psychiatry and co-authored by Rush University's Wilson, revealed that Catholic nuns and priests who scored high on anxiety and depression measures had different brains than other clergy did. The nerve cells in the depressed group's hippocampi ¾ brain areas associated with memory and emotion ¾ were shorter and less branched-out than normal nerve cells.

The researchers didn't link these brain changes to Alzheimer's, but the findings suggest depression "takes a toll," Wilson said.

Blunting the vulnerability

If depression is a risk factor for Alzheimer's disease, it is just one of many. Family history is another, as is the presence of a gene called ApoE4. Lifestyle factors like diet, exercise and cognitive engagement may also contribute, although a National Institutes of Health panel determined in May that the evidence for these factors is not yet strong enough to warrant recommendations for Alzheimer's prevention.

In the case of depression, these lifestyle factors could make a difference. Exercise and diet might combat vascular disease linked to depression, Saczynski said. And, Wilson said, stressed mice and rats that exercise, take antidepressants and eat well show fewer brain changes than those that don't.

"Diet and exercise seem to lessen the impact," Wilson said. "So if we're on the right track here, there do seem to be tools that can blunt the vulnerability."


10 Ways to Keep Your Mind Sharp
Alzheimer's Disease: Bad News and Good News
7 Ways the Mind and Body Change With Age

Original Story: Depression May Increase Chances of Getting Alzheimer's

Dense Breasts + Hormones Up Cancer Risk After Menopause

Breast cancer risk particularly increased with estrogen plus progestin

21 july 2010-- Postmenopausal women with high breast density, especially those undergoing hormone therapy with estrogen plus progestin, are at higher risk for developing breast cancer, according to a study published online July 19 in the Journal of Clinical Oncology.

Karla Kerlikowske, M.D., of the California Pacific Medical Center Research Institute in San Francisco, and colleagues evaluated data on 587,369 women who underwent 1,349,027 screening mammography exams. Breast cancer was diagnosed among 14,090 women. The researchers used a survival model to determine five-year breast cancer risk for subgroups of women classified by their Breast Imaging Reporting and Data System (BIRADS) breast density, menopausal status, age, and current hormone therapy use, assuming a body mass index of 25 kg/m².

The researchers found that, among women aged 55 to 59 years with low breast density (BIRADS-1), the five-year breast cancer risk was 0.8 percent for those not using hormone therapy and 0.9 percent for those using estrogen and estrogen plus progestin. Among women aged 55 to 59 years with very high breast density (BIRADS-4), the five-year breast cancer risk was 2.4 percent for those not using hormone therapy, 3.0 percent for those using estrogen, and 4.2 percent for those using estrogen plus progestin. Compared to those with average breast density (BIRADS-2), risk of advanced-stage breast cancer was 1.7-fold higher for postmenopausal women using hormone therapy who had BIRADS-4.

"Approximately 50 percent of postmenopausal women have high or very high breast density, are at high breast cancer risk, and may be considering or using hormone therapy. Postmenopausal women with high breast density may want to consider the added risk of breast cancer when deciding on whether to start or stop hormone therapy, especially estrogen plus progestin," the authors conclude.

One author disclosed financial ties to Eli Lilly.

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Depression Linked to Erectile Dysfunction May Raise CV Risk

Severe depressive symptoms in ED associated with higher incidence of major cardiovascular events

20 july 2010-- Depressive symptoms in men with erectile dysfunction (ED) constitute an independent risk factor for the incidence of a major cardiovascular event (MACE), according to a study published online July 13 in the Journal of Sexual Medicine.

Elisa Bandini, M.D., of the University of Florence in Italy, and colleagues interviewed 2,303 male patients at a clinic for sexual dysfunction using a Structured Interview on Erectile Dysfunction with three scales to explore the organic, relational, and intra-psychic factors of the condition. The researchers assessed depression in the cohort using the Middlesex Hospital Questionnaire for depressive symptoms (MHQ-D) and correlated it to the incidence of MACE, as recorded by the City of Florence Registry Office, in a subset of 1,687 subjects followed for a mean 4.3 years in a longitudinal study.

The researchers identified a positive relationship between MHQ-D score in the ED patients and increasing difficulty achieving an erection sufficient for penetration. Among the subjects in the longitudinal study, there were 139 MACE incidents (15 fatal), with the unadjusted incidence of MACE significantly associated with baseline depressive symptoms. Also, having severe depressive symptoms was independently associated with a higher MACE incidence in a regression model that also included arteriogenic ED, the partner's reduced sexual desire, age, chronic diseases, and an index of psychopathology.

"In particular, our study demonstrates that depressive symptomatology constitutes an independent risk factor for cardiac morbidity and mortality in men with ED. The need for a regular screening for cardiac morbidity in men with ED is even greater in those patients showing depressive symptoms associated with ED," the authors write.

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Study shows that major Alzheimer's risk gene causes alterations in shapes of brain protein deposits

19 july 2010--Researchers at Mount Sinai School of Medicine have used a newly discovered class of biomarkers to investigate the possibility that the shape of brain protein deposits is different in people with Alzheimer's who have the highest-risk gene type than in those with the condition who have a neutral risk gene type. The study is being presented July 14 at the 2010 Alzheimer's Association International Conference on Alzheimer's Disease in Honolulu, Hawaii.

Sam Gandy, MD, PhD, the Mount Sinai Professor in Alzheimer's Disease Research, Professor of Neurology and Psychiatry, and Associate Director of the Alzheimer's Disease Research Center at Mount Sinai School of Medicine, led the study. Mount Sinai labs led by Patrick R. Hof, MD, Regenstreif Professor of Neuroscience and Vice-Chair for Translational Neuroscience of the Department of Neuroscience and Dara L. Dickstein, PhD, Assistant Professor, Neuroscience also collaborated on the study.

Apolipoprotein E (APOE) is a gene containing instructions needed to make a protein that helps carry cholesterol in the bloodstream. The APOE gene, which comes in several different forms, is related to increased risk of developing Alzheimer's disease. People with APOE ε4/ε4 gene type have the highest risk of developing the disease and people with APOE ε3/ε3 have a neutral risk. Discovering the important mechanisms underlying how APOE ε4/ε4 increases Alzheimer's risk has been one of the most vexing mysteries facing Alzheimer's researchers for over a decade.

Luminescent conjugated oligothiophenes (LCOs) or luminescent conjugated polymers (LCPs), the newly discovered class of biomarkers, can stick to protein structures in the body and emit colors reflecting the different shapes or forms of the proteins. Among other uses, LCPs/LCOs are currently being employed in test tubes, animal models, and autopsied Alzheimer's brains to study the structure of proteins deposits caused by the disease. The new markers bind to the two well-established hallmarks of Alzheimer's – beta amyloid plaques and tau tangles – and glow different colors depending on which forms of the deposits they "stick" to (e.g., plaques often "glow" orange, while tangles "glow" yellowish green).

In the study, frozen brain sections from people who died with Alzheimer's were stained using two LCPs/LCOs: pentamer formyl thiophene acetic acid (pFTAA) and polythiophene acetic acid (PTAA). Using PTAA, the researchers observed that Alzheimer patients with APOE ε4/ε4 gene type had core and cerebrovascular amyloid of different shapes, while in people with APOE ε3/ε3, the two amyloid structures had the same shape. Using pFTAA revealed that tau tangle densities in ε4/ε4 Alzheimer patients that were apparently greater than those with ε3/ε3.

"The findings support our hypothesis that APOE genotype changes amyloid structure," Dr. Gandy said. "This is important because the different shapes might respond differently to treatments that attempt to clear amyloid deposits from the brain. We already know, for example, that APOE ε4/ε4 patients respond less well to anti-amyloid antibody with bapineuzumab."


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LCOs/LCPs were pioneered by Peter Nilsson, PhD, Assistant Professor of the Department of Chemistry, Linköping University, Sweden. The study also involved collaborating teams from Charité – Universitätsmedizin Berlin, Germany, led by Frank Heppner MD, Director of the Department of Neuropathology and Washington University, St Louis, led by David Holtzman MD, Professor and Chair of Neurology.

About The Mount Sinai Medical Center

The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of few medical schools embedded in a hospital in the United States. It has more than 3,400 faculty in 32 departments and 15 institutes, and ranks among the top 20 medical schools both in National Institute of Health funding and by U.S. News & World Report. The school received the 2009 Spencer Foreman Award for Outstanding Community Service from the Association of American Medical Colleges.

Sniffing insulin may help memory lost to Alzheimer's

HONOLULU, 17 july 2010-- Squirting insulin up the noses of patients with early forms of Alzheimer's disease showed signs of improving their memory, U.S. researchers said on Wednesday.

Patients who got the treatment for four months showed improvements in tests of memory recall that lasted for two months.

"We believe our results are very promising and they warrant future trials," said Dr. Suzanne Craft of the VA Puget Sound Health Care System and the University of Washington in Seattle, who presented her findings at a meeting of the Alzheimer's Association in Honolulu.

Alzheimer's disease is a fatal and incurable deterioration of the brain that affects 26 million people globally. It is the most common form of dementia.

Several studies have suggested that people with Alzheimer's have reduced levels of insulin in the brain, even in the earliest stages. Insulin is important for communication between brain cells and is needed for brain function.

Craft's team wanted to see what would happen if they delivered insulin directly to the brain.

They studied 109 non-diabetic patients with Alzheimer's disease or a precursor condition called mild cognitive impairment.

A third of the patients got a placebo and the other two-thirds received different doses of insulin that had been loaded into a nebulizer and squirted up their nose twice daily for four months.

Patients who got the lower dose of insulin showed significant improvements on all primary measures of thinking and memory and in a test of their ability to do daily activities.

In 15 insulin-treated patients who agreed to a spinal tap, the team found a link between improved memory and improvements in measurements of key proteins linked with Alzheimer's disease.

Craft said the treatment is a long way from being useful to patients, but the findings are strong enough to be studied in a large clinical trial.

Current Alzheimer's drugs only treat symptoms, but so far no drugs have been shown to improve memory in patients with Alzheimer's.

Early diagnosis can cut Alzheimer's costs: study

HONOLULU, 16 july 2010-- Identifying dementia early can cut the cost of care by nearly 30 percent, U.S. researchers said on Wednesday, a finding that may reduce the heavy financial burden of the disease on the health care system.

They said routine screening that identified patients with early signs of dementia helped cut average healthcare costs by nearly $2,000 per patient in the first year, often by eliminating money spent on unnecessary tests and treatments.

"That runs into billions of dollars we could potentially save," Dr. Riley McCarten of the Minneapolis Veterans Medical Center told reporters at the Alzheimer's Association meeting in Honolulu.

On Tuesday experts at the National Institute on Aging and the Alzheimer's Association proposed new guidelines for diagnosing the fatal and incurable brain disease even before patients have symptoms.

The U.S. government, private insurance and individuals spend $172 billion a year to treat people with Alzheimer's disease, a fatal and incurable deterioration of the brain that affects more than 26 million people globally. It is the most common form of dementia.

By 2050, the cost of Alzheimer's care will reach $1.08 trillion a year in the United States, according to the Alzheimer's Association.

McCarten said most people in the United States with dementia are never diagnosed, and they often turn up in the emergency room with an acute problem when what they really have is a fatal brain disease.

"People lurch from one crisis to another," he said. "There is a tremendous amount of healthcare resources dedicated to acutely managing a chronic disease."

HAVING A SAY

McCarten and colleagues at seven Veterans Administration medical centers looked to see how much they could save by routinely screening patients with a two-minute memory test.

More than 8,000 people over age 70 took the test and 26 percent failed. Those who failed were offered a 90-minute work-up to diagnose dementia, and about a third of those who failed the initial screening were tested. Of these, 97 percent had some form of cognitive impairment and 76 percent had dementia.

People who got a diagnosis and their families met with case managers to devise a care plan, and the team tracked their health costs for a year.

After subtracting the cost of the evaluation, patients saved an average of $1,700 annually, McCarten said.

"We found cost savings in the short run -- within one year," he said. McCarten said early diagnosis gives patients the chance to have a say in their own care, and it gives families time to come to grips with the disease.

A separate study by researchers at Johnson & Johnson and Pfizer found that a large portion of the financial burden of caring for Alzheimer's patients falls on families and caregivers.

Their Internet survey of nearly 1,000 families of Alzheimer's patients found they spend an average of $1,000 per month out of pocket to care for a family member in a nursing home, and $375 a month to care for them at home.

The team also found that families spend nearly 70 hours a week caring for an Alzheimer's patient at home, and close to 30 hours a week when their family member is in a nursing home.

Palliative care lacking in much of the world

HONG KONG, 15 july 2010-- Most people who are dying around the world have inadequate or no access to painkillers, hospice and palliative care, according to a report by the Economist Intelligence Unit on Wednesday.

The report blamed the cultural taboos surrounding death, government avoidance of the issue, poor public awareness and untrained healthcare workers for the problem, which affects even advanced countries like the United States and Japan.

While more than 100 million people worldwide would benefit from hospice and palliative care each year, less than 8 percent access it, according to the Worldwide Palliative Care Alliance.

"The focus is on curative care, where doctors focus on curing patients at all costs; the U.S. is an extreme example of that," said Tony Nash, EIU global director and key author of the report, which gave a "Quality of Death Index" covering 40 countries.

"There really isn't an acceptance of hospice and palliative care as a viable option, they are seen almost as surrendering once you enter those environments," Nash said in a telephone interview from Singapore.

Britain topped the index with the best quality-of-death care, followed by Australia, New Zealand, Ireland and Belgium. Near the bottom were China, Brazil and Uganda, with India ranked 40th.

The United States was ranked 9th, dragged down by the financial burden of healthcare near death, which reflects the high overall cost of healthcare, according to the report.

Singapore was ranked 18th, Hong Kong 20th and Japan 23rd.

The rankings took into account factors like availability of painkillers, hospices and public funding, transparency between doctor and patient, training of healthcare workers and whether palliative care is incorporated into national health policies.

The report cited India as having least access to painkillers because of strict laws against illicit drug use. Even doctors and nurses in some large cancer hospitals in India were not trained to administer morphine, the report said.

Five billion people live in countries with insufficient or no drugs controlling severe or moderate pain, according to the World Health Organization. The world's population is 6.8 billion.

The report said strong taboos surrounded death in Japan, China and India, adding that in some cases, relatives forbade healthcare workers from informing patients of their conditions.

It called for more discussion and public debate on providing end-of-life care, saying that would raise public awareness, encourage governments to incorporate palliative care into national health policies and open the way for healthcare workers to be trained in this area.

Only seven countries in the index -- Australia, Mexico, New Zealand, Poland, Switzerland, Turkey and Britain -- have national health policies that include palliative care. (

Updated Alzheimer's guidelines add very early stage

HONOLULU, 14 july 2010-- Proposed new guidelines for diagnosing Alzheimer's released on Tuesday would look at the disease at its earliest stages, when clumps of a protein called amyloid are just beginning to form in the brains of people who are otherwise healthy.

This pre-clinical stage about 10 years before dementia sets in is seen as the best place to intervene in the disease, and it is why new imaging agents for PET scans, spinal fluid tests and other so-called biomarkers that predict Alzheimer's are becoming so important to researchers and drug companies.

The changes, presented at the Alzheimer's Association meeting in Honolulu, are the first update of the criteria used to diagnose Alzheimer's disease in more than 25 years. They are the work of three expert panels put together by the National Institute on Aging and the Alzheimer's Association.

They suggest Alzheimer's should be diagnosed in three stages -- advanced disease, mild disease and the new category called pre-clinical disease.

"I think we're realizing that the process of Alzheimer's disease begins many years before dementia," Dr. Reisa Sperling of Brigham and Women's Hospital in Boston, who led the group on pre-clinical Alzheimer's disease, said in an interview.

Many researchers believe most Alzheimer's drugs have failed because they were tried in people whose disease was too advanced to do any good.

Currently, only an autopsy can confirm that a person has Alzheimer's disease, a fatal and incurable deterioration of the brain that affects more than 26 million people globally.

Doctors diagnose Alzheimer's by excluding other potential causes of memory loss, such as stroke, tumors and heavy drinking. They can also administer simple paper-and-pencil tests.

Bill Thies, chief medical officer of the Alzheimer's Association, said the changes reflect an increased scientific understanding of Alzheimer's, including the use of biomarkers tracked by brain scans, blood and spinal fluid tests.

Many of these new tests will still need to be validated before the recommendations are fully adopted, Thies said.

"I do think it is useful to stage Alzheimer's disease," said Sperling, who runs clinical trials on Alzheimer's drugs.

She said many diseases, including cancer, heart disease and kidney disease, are diagnosed on the basis of tests, even before symptoms appear.

"We shouldn't put Alzheimer's disease to a higher standard than we do every other disease," she said.

The guidelines are just the first step. The NIA, a part of the National Institutes of Health, and the Alzheimer's Association are seeking comment on the new guidelines from other Alzheimer's experts, and they plan to include those comments and publish them in a medical journal.

Current Alzheimer's drugs only treat symptoms, but so far no drugs can change the course of the disease.

Larger Head Size Tied to Less Decline in Alzheimer's Patients

Greater head circumference may protect against cognitive impairment with atrophy

14 july 2010 -- Greater head circumference appears to be protective against cognitive decline in patients with Alzheimer's disease, according to research published in the July 13 issue of Neurology.

Robert Perneczky, M.D., of the Technische Universität München in Germany, and colleagues analyzed the results of cognitive testing, APOE genotyping, and brain magnetic resonance imaging on 270 patients with Alzheimer's disease to determine whether there is a correlation between head circumference and cognitive performance in people with the same level of brain pathology.

The researchers found a significant decrease in cognitive function with brain atrophy, and also a significant interaction between head circumference and atrophy. In patients with higher levels of atrophy, those with a greater head circumference had higher levels of cognition.

"This study suggests that larger head circumference is associated with less cognitive impairment in the face of cerebral atrophy. This finding supports the notion that head circumference (and presumably brain size) offers protection against Alzheimer's disease symptoms through enhanced brain reserve," the authors conclude.

Four authors disclosed financial ties to the pharmaceutical industry.

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Low vitamin D increases risk of dementia in elderly

LONDON , 13 july 2010– Older people with low levels of vitamin D appear more likely to have problems with memory, learning and thinking, suggesting low vitamin D could give an early warning for dementia risk, scientists said on Monday.

Researchers from Britain, Italy and the United States studied 850 Italians aged 65 or older and found that those who were severely vitamin D deficient were 60 percent more likely to experience substantial general cognitive decline, and 31 percent more likely to experience problems with mental flexibility.

"This is the first study to identify a clear link between low vitamin D levels and cognitive decline," said David Llewellyn of the Peninsula Medical School at Britain's Exeter University, who led the study.

"We have now been able to demonstrate a connection between having low levels of vitamin D and going on to develop cognitive problems."

Since an estimated that one billion people worldwide have insufficient levels of vitamin D, Llewellyn said the findings were "a cause for real concern."

Giving vitamin D supplements to older people to boost their levels could be "a highly promising therapeutic target for the prevention of dementia," he said, particularly since supplements are cheap, safe and have already been shown to help prevent to reduce the risk of falls and fractures.

Most vitamin D is made by the body as a natural by-product of the skin's exposure to sunlight. It can also be found in a few foods such as oily fish and is vital for health, as it helps cells absorb calcium and is key for bone strength.

Some recent studies have also suggested vitamin D may protect against cancer, artery disease and tuberculosis.

In this study, Llewellyn's team found that older people who were severely deficient in vitamin D -- defined as having blood levels of 25-hydroxyvitamin D of less than 25 nanomoles per liter -- were 60 percent more likely to have substantial cognitive decline over a 6-year period studied.

They were also 31 percent more likely to show decline in a test measuring executive function than those with good vitamin D levels. The findings were published in the Archives of Internal Medicine journal.

Dementia is a brain-wasting condition that affects around 35 million people worldwide.

Its most common form is Alzheimer's disease, in which patients gradually to lose their memory, their ability to navigate and understand the world around them and to look after themselves. Despite decades of research, doctors still have few effective weapons against it.

Llewellyn's team said they thought Vitamin D may help prevent the degeneration of brain tissue by having a role in formation of nervous tissue, maintaining levels of calcium in the body, or clearing of beta-amyloid, the substance that forms the brain plaques that are associated with Alzheimer's disease.

Experts estimated that in the United States and Europe, between 40 percent to 100 percent of older adults are deficient in vitamin D and the problem is aggravated in the elderly as they spend more time indoors and their skin becomes less efficient at producing vitamin D with age.

Exercise, Vitamin D Seem to Cut Alzheimer's Risk: Researchers

12 july 2010-- Physical activity and adequate levels of vitamin D appear to reduce the risk of cognitive decline and dementia, according to two large, long-term studies scheduled to be presented Sunday at the International Conference on Alzheimer's Disease in Hawaii.

In one study, researchers analyzed data from more than 1,200 people in their 70s enrolled in the Framingham Study. The study, which has followed people in the town of Framingham, Mass., since 1948, tracked the participants for cardiovascular health and is now also tracking their cognitive health.

The physical activity levels of the 1,200 participants were assessed in 1986-1987. Over two decades of follow-up, 242 of the participants developed dementia, including 193 cases of Alzheimer's.

Those who did moderate to heavy amounts of exercise had about a 40 percent reduced risk of developing any type of dementia. People with the lowest levels of physical activity were 45 percent more likely to develop any type of dementia than those who did the most exercise. These trends were strongest in men.

"This is the first study to follow a large group of individuals for this long a period of time. It suggests that lowering the risk for dementia may be one additional benefit of maintaining at least moderate physical activity, even into the eighth decade of life," study author Dr. Zaldy Tan, of Brigham and Women's Hospital, VA Boston and Harvard Medical School, said in an Alzheimer's Association news release.

The second study found a link between vitamin D deficiency and increased risk of cognitive impairment and dementia later in life.

Researchers in the United Kingdom analyzed data from 3,325 people aged 65 and older who took part in the third U.S. National Health and Nutrition Examination Survey. The participants' vitamin D levels were measured from blood samples and compared with their performance on a measure of cognitive function that included tests of memory, orientation in time and space, and ability to maintain attention. Those who scored in the lowest 10 percent were classified as being cognitively impaired.

The study found that the risk of cognitive impairment was 42 percent higher in people who were deficient in vitamin D, and 394 percent higher in those with severe vitamin D deficiency.

"It appears that the odds of cognitive impairment increase as vitamin D levels go down, which is consistent with the findings of previous European studies. Given that both vitamin D deficiency and dementia are common throughout the world, this a major public health concern," study author David Llewellyn, of the University of Exeter Peninsula Medical School, said in the news release.

Skin naturally produces vitamin D when exposed to sunlight. However, most older adults in the United States have insufficient vitamin D levels because skin becomes less efficient at producing vitamin D as people age and there's limited sunlight for much of the year.

"Vitamin D supplements have proven to be a safe, inexpensive and effective way to treat deficiency," Llewellyn said. "However, few foods contain vitamin D and levels of supplementation in the U.S. are currently inadequate. More research is urgently needed to establish whether vitamin D supplementation has therapeutic potential for dementia."

Previous research has pointed to a number of factors that may be associated with cognitive decline and Alzheimer's, especially cardiovascular risk factors, said William Thies, chief medical and scientific officer at the Alzheimer's Association.

He added that "the Alzheimer's Association and others have repeatedly called for longer-term, larger-scale research studies to clarify the roles that these factors play in the health of the aging brain."

These new studies "are some of the first reports of this type in Alzheimer's, and that is encouraging, but it is not yet definitive evidence," Thies said in the news release.

More information

The U.S. National Institute on Aging has more about Alzheimer's disease.

Blood Protein Reflects Severity and Progression in Alzheimer's

Clusterin identified as a 'peripheral signature' of Alzheimer's but not a stand-alone biomarker

09 july 2010-- Elevated plasma concentration of clusterin is associated with Alzheimer's disease pathology, severity, and rate of clinical progression, according to research published in the July issue of the Archives of General Psychiatry.

Madhav Thambisetty, M.D., of King's College London, and colleagues, using data on subjects from two studies of Alzheimer's disease, compared blood samples from subjects with the disease, subjects with mild cognitive impairment, and healthy subjects to identify associations of blood proteins with brain atrophy, disease severity, and clinical progression rate. In an extension study in six-month-old transgenic mice modeling Alzheimer's disease, the researchers also looked for associations between candidate proteins and brain amyloid.

The researchers found that clusterin/apolipoprotein J was associated with disease severity at baseline, entorhinal cortex atrophy, and rapid disease progression. Among subjects with Alzheimer's disease, increased clusterin messenger RNA in the blood also was observed. A greater concentration of clusterin in blood was associated with a greater burden of amyloid-β in the medial temporal lobe. In the mouse model, the researchers found increased blood clusterin, age-related increased brain clusterin, and amyloid and clusterin together in brain plaques.

"We identified clusterin as a plasma protein associated with disease pathology, severity, and progression in Alzheimer's disease. Although these findings do not support the clinical utility of plasma clusterin concentration as a stand-alone biomarker for Alzheimer's disease, they reveal a robust peripheral signature of this amyloid chaperone protein that is responsive to key features of disease pathology," the authors write.

Kings College London has registered as intellectual property a process for the use of plasma proteins, including clusterin, as Alzheimer's disease biomarkers, with two of the study authors named as inventors. Another study author disclosed receiving research support from pharmaceutical and medical device companies.

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Doctor-Patient E-Mails Are a Healthy Addition, Research Shows

08 july 2010-- Patients with diabetes or hypertension or both who communicated with their doctors via e-mail got better care and better health outcomes, new California research contends.

The improvements as a result of the e-mail exchanges included such measures as blood sugar and blood pressure control, according to a report appearing in Health Affairs.

The American Recovery and Reinvestment Act of 2009 has called for implementing "secure patient-physician messaging" as part of electronic health records by 2013.

Kaiser Permanente health system started phasing in secure e-mail communication nationwide in 2004. In southern California, some three million patients as well as all primary and specialty care Kaiser doctors signed up for it and, by the end of 2008, 35,423 adult patients (7.8 percent of members in that geographical area) and 3,092 primary care physicians had actually used it.

The study authors, from Kaiser Permanente, analyzed 630,807 e-mail messages between patients and doctors from March 2006 to December 2008, then compared them to baseline data from the previous year. The vast majority of the e-mails (85 percent) were initiated by the patients.

Those who emailed their doctors saw improvements of 2.4 percent to 6.5 percent in blood sugar control and screening, cholesterol screening and control as well as screening for retinopathy and nephropathy (kidney disease).

Also, more patients with diabetes or hypertension alone achieved blood pressure levels under 140/90.

And the more frequently emails were exchanged, the greater the improvements.

According to prior studies, patients most often emailed to report some kind of change in their condition, to talk about lab results and to discuss medication issues.

Patients also tended to respect the doctor's time, with three-quarters sending messages on actual medical issues as opposed to "their mother's favorite meatloaf recipe," said Terhilda Garrido, vice president for health information technology transformation and analytics at Kaiser Permanente and senior author of the study.

"It sounds a little cliche . . . but the hypothesis [about why this works] is that putting the information in the patient's hands makes them feel empowered and, therefore, in control of their condition," Garrido added.

"A lot of our patients say this actually makes them closer or more connected to their physician, and there's information in the health literature that that kind of bonding and improved relationship is very supportive of improved health outcomes," she said.

The appeal of electronic communication is not catching on quite as quickly in the wider world, however. A recent Harris Interactive/HealthDay poll found that fewer than 1 in 10 American adults utilizes electronic medical records or turns to e-mail to contact his or her physician.

Dr. Noelle LoConte, an assistant professor of medicine at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center in Madison, who uses e-mail in her practice, said she gets "surprisingly few" e-mails each day, only five or six.

Still, for her, the system is working.

"For me, it's easier to do e-mail than to constantly be on the phone because I can decide when I'm going to open the e-mail account," LoConte said. Often, that means after the kids go to sleep and before they wake up.

As for the patients, she's heard no complaints and "they still have the phone," she said.

More information

The National Institutes of Health has more on electronic health records.

USPSTF To Update Osteoporosis Guidelines With Recos For Screening Men And Women At Low Risk For Fracture

In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended bone density screening for women 65 years or older and women aged 60 to 64 at increased risk for osteoporotic fractures. At the time, the Task Force made no recommendations for or against screening men or women in other patient populations.

07 july 2010--Researchers reviewed research published between 2001 and 2009 to determine the effectiveness and harms of osteoporosis screening in reducing fractures for men and postmenopausal women without known previous fractures; the performance of risk-assessment instruments and bone measurement tests in identifying persons with osteoporosis; optimal screening intervals; and efficacy and harms of medications to reduce primary fractures.

The researchers found that although methods to identify risk for osteoporotic fractures are available and medications to reduce fractures are effective, no trials directly evaluate screening effectiveness, harms, and intervals for this patient population.

A draft recommendation statement will be posted for public comment on the USPSTF Web page for a period of four weeks. The USPSTF will consider posted comments when finalizing the recommendations.

News from the Annals of Internal Medicine: July 6, 2010

Source:
Angela Collom
American College of Physicians

Alzheimer's imaging study identifies changes in brain's white matter

MRI reveals that changes occur in high-risk seniors before symptoms appear

LEXINGTON, Ky. 05 july 2010 − Scientists at the University of Kentucky's College of Medicine have identified changes in the brains of normal individuals at high risk for Alzheimer's disease that could prove important for early detection of the disease.

The research, led by Brian Gold, associate professor of anatomy and neurobiology, focused on the brain's white matter, which forms the majority of deep parts of the brain and consists primarily of myelinated nerve cell processes, or axons. These myelinated axons serve to connect the brain's gray matter regions, which contain nerve cell bodies.

"The brain's white matter can be thought of as a set of telephone wires which enable communication between gray matter 'thinking regions'," Gold said.

Previous studies have demonstrated decline in both gray and white matter tissue types in individuals with Alzheimer's. In the present study, the authors sought to determine which of these changes are present in normal seniors at high risk for Alzheimer's disease, a likely target group for emerging interventions.

The high-risk group consisted of individuals whom have both genetic and family risk factors for Alzheimer's disease but do not yet show cognitive changes. The low-risk control group consisted of individuals who had neither risk factor but were similar to the high-risk group in terms of age, education level and cognitive functioning.

The study used several magnetic resonance imaging (MRI) techniques to assess the integrity of gray matter and white matter brain tissue in the high and low risk groups. In particular, a recently developed form of MRI called diffusion tensor imaging (DTI) was used to assess the integrity of the brain's white matter. This technique allows for assessment of the microstructural integrity of axons and their surrounding myelin.

Results indicated that the two groups did not differ in the tissue volumes of several gray matter regions know to contribute to memory function. However, the high-risk group showed decreased integrity in white matter tracts that inter-connect gray matter regions involved in memory function. Both the axonal and myelin integrity of these white matter tracts were reduced.

These data suggest that changes in white matter connections may be among the earliest brain changes in Alzheimer's disease, which may prove important for early detection by non-invasive imaging. In addition, the findings may have implications for the development of new preventative treatment interventions in Alzheimer's disease, which could attempt to protect axon and myelin integrity in seniors at risk for this neurological disorder.

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The findings were published in an article in the journal Neuroimage. This research was supported by grants from the National Institutes of Health and the National Science Foundation.