Faith in God associated with improved survival after liver transplantation

Study reveals religiosity prolongs life span

01 oct 2010--Italian researchers report that liver transplant candidates who have a strong religious connection have better post-transplant survival. This study also finds that religiosity—regardless of cause of death—prolongs the life span of individuals who underwent liver transplantation. Full findings are now available online and in the October issue of Liver Transplantation. a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD).

Much of the medical profession today is focused on the delivery of services, rather than whole patient care which not only takes into account physical well-being, but psychological, social, and spiritual aspects as well. Although there is a lack of interest in religion by the medical community, the authors point out that 90% of the world's population today is involved in some form of religion or spiritual pursuit. Prior studies have demonstrated that religiosity allows individuals to better cope with illness, and may even influence disease progression. Furthermore, a report by McCullough et al. that included a meta-analysis of 42 studies (surveying roughly 126,000 people) found active religious involvement increased the odds of being alive at follow-up by 26%.

"Our study tested the hypothesis that religiosity—seeking God's help, having faith in God, trusting in God, trying to discern God's will even in the disease—improves survival of patients with end-stage liver disease who underwent liver transplantation," explains Franco Bonaguidi, D.Psych., and lead author of the study. The study team selected 179 patients who received a liver transplant between January 2004 and December 2007, and who also completed the religiosity questionnaire. Participants (129 males and 50 females) had a media age of 52 years and were followed for 4 years (median = 21 months) post-transplantation. Indications for liver transplant included: viral hepatitis (68%), alcoholic liver disease (17%), and autoimmune hepatitis (7%).

Results indicate that the Search for God factor (hazard ratio = 2.95) and length of stay in the intensive care unit (1.05) were independently associated with survival. Furthermore, it was the personal relationship between the patient and God, regardless of religious creed (Christian, Muslim, or other) rather than formal church attendance that positively affected survival. As one participant described, "I recovered my life by the will of Someone up there…I had great faith in Him. This closeness made me feel strong and calm."

Dr. Bonaguidi concluded, "We found that an active search for God—the patient's faith in a higher power rather than a generic destiny—had a positive impact on patient survival." The authors caution that this study focuses on a severely ill patient population, therefore the conclusions may not be applicable to individuals with different illnesses or degrees of disease severity.

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This study is published in the October issue of the Liver Transplantation. Media wishing to receive a PDF of this article may contact healthnews@wiley.com.

Full citation: "Religiosity Associated with Prolonged Survival in Liver Transplant Recipients." Franco Bonaguidi, Claudio Michelassi, Franco Filipponi, Daniele Rovai. Liver Transplantation; Published Online: June 18, 2010 (DOI: 10.1002/lt.22122); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/lt.22122/abstract

Physical Ability Measures Predict Death Risk in Elderly

Poor grip strength, walking speed, chair rising, and standing balance predict higher mortality

30 sept 2010 -- Community-dwelling elderly people with poor performance on objective measures of physical capability are at higher risk of death than those who perform better, according to a meta-analysis published online Sept. 9 in BMJ.

Rachel Cooper, Ph.D., of the University College London, and colleagues screened the medical literature and identified studies that examined the associations of four objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality. The researchers pooled the data and assessed mortality risks for each of the four measures.

Generally, the meta-analysis confirmed that mortality risk increased for those who performed less well on any or all of the four physical capability measures. Comparing the lowest performance quartile to the highest, mortality risks were as follows: for grip strength, hazard ratio (HR), 1.67 (P from Q statistic < p =" 0.25);">

"Objective measures of physical capability are predictors of all-cause mortality in older community-dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death," the authors write.

Two authors disclosed financial relationships with pharmaceutical companies.

Abstract
Full Text

Look AHEAD Results Favor Intensive Lifestyle Intervention

At four years, this diabetes intervention beats education for CVD risk factor reduction

29 sept 2010 -- Intensive lifestyle intervention (ILI) for patients with type 2 diabetes can result in sustained improvements in cardiovascular risk factors and in fitness, according to a report published in the Sept. 27 issue of Archives of Internal Medicine.

Rena R. Wing, Ph.D., of Brown Medical School in Providence, R.I., and other members of The Look AHEAD Research Group reported four-year results of the ongoing trial, which was designed to obtain long-term data on the effects of ILI compared to diabetes support and education (DSE; the control group) on changes in weight, fitness, and cardiovascular disease risk factors.

Averaged across the four years, the researchers found that ILI patients had significantly greater improvements in weight, treadmill fitness, hemoglobin A1c level, high-density lipoprotein cholesterol, triglycerides, and blood pressure. Low-density lipoprotein cholesterol was more improved in the DSE group, a finding related to greater use of lipid-lowering medications in the DSE group.

"ILI can produce sustained weight loss and improvements in fitness, glycemic control, and cardiovascular disease risk factors in individuals with type 2 diabetes. Whether these differences in risk factors translate to reduction in cardiovascular disease events will ultimately be addressed by the Look AHEAD trial," the authors write.

One author disclosed serving on a scientific advisory committee for Free & Clear and financial relationships with BodyMedia Inc., UPMCHealth Plan, and Proctor & Gamble.

Abstract

Friends, family detect early Alzheimer's signs better than traditional tests

Family members and close friends are more sensitive to early signs of Alzheimer's dementia than traditional screening tests, according to researchers at Washington University School of Medicine in St. Louis.

28 sept 2010--Doctors often evaluate a person who is having memory problems by testing them with a variety of cognitive tasks, such as recalling a list of words or comparing shapes of objects. Washington University researchers developed a different approach. The two-minute Ascertain Dementia 8 (AD8) questionnaire relies on a friend or family member who knows the person well, known as an informant, to evaluate whether cognitive changes have caused the individual to have difficulties in performing everyday activities.

In the new study, published online in the journal Brain, scientists validated the AD8 by checking to see if it could highlight individuals who had biological indicators, or biomarkers, for Alzheimer's disease, such as abnormal levels of certain factors in the spinal fluid or positive brain scans for Alzheimer's plaques. The AD8's results corresponded with biomarker results more consistently than traditional cognitive tests.

"It's not economically feasible to screen everyone for Alzheimer's disease biomarkers," says John C. Morris, MD, director of the Charles F. and Joanne Knight Alzheimer's Disease Research Center at Washington University School of Medicine. "The AD8 gives us a brief and very low-cost alternative that takes a few minutes of the informant's time to screen for dementia and thus identify those individuals who need follow-up evaluations to determine if there truly are signs of Alzheimer's."

According to Morris, the Harvey A. and Dorismae Hacker Friedman Distinguished Professor of Neurology, the difficulty with traditional early-stage dementia screening tools is that they only give a snapshot of a person's cognitive abilities at one point in time — when they're being tested. Asking the individual if his or her mental abilities have changed doesn't necessarily produce accurate results either, Morris says, because persons with early-stage dementia often lack insight into their problem.

Researchers at the Knight Alzheimer' s Disease Research Center, including first author James Galvin, MD, now at New York University, developed the AD8 from the Center's existing research tools. Informants are asked to rate whether there has been a change in the following areas:

• Problems with judgment, such as bad financial decisions;
• Reduced interest in hobbies and other activities;
• Repeating of questions, stories or statements;
• Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
• Forgetting the month or year;
• Difficulty handling complicated financial affairs, such as balancing a checkbook;
• Difficulty remembering appointments; and
• Consistent problems with thinking and memory.

Informants can respond yes or no to each item; each "yes" response is worth a point, and a score of two or more indicates a need for additional evaluation.

According to Morris, informants who have regular exposure to the individual provide the most accurate assessments.

"These informants can give us the retrospective perspective we need to know that a person's mental abilities have begun to meaningfully decline, indicating that additional testing is needed," Morris says.

For the new study, researchers gathered AD8 evaluations on 251 individuals and also tested them using the Mini Mental State exam, a traditional dementia screening test. They then evaluated biomarkers in the individuals, including spinal fluid assays and brain plaque scans.

"Based on our results, the AD8 appears to be superior to conventional testing in its ability to detect signs of early dementia," Morris says. "It can't tell us whether the dementia is caused by Alzheimer's or other disorders, but it lets us know when there's a need for more extensive evaluations to answer that question."

Since its development, the AD8 has been translated into several different languages and validated in those languages. It is currently in use in clinics around the world.

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Galvin JE, Fagan AM, Holtzman DM, Mintun MA, Morris JC. Relationship of dementia screening tests with biomarkers of Alzheimer's disease. Brain, online Sept. 10, 2010.

Funding from the National Institute on Ageing and the National Institutes of Health supported this research.

Baby boomers raise midlife suicide rate

Unmarried, non-college graduates at particular risk

Baby boomers appear to be driving a dramatic rise in suicide rates among middle-aged people, a new study finds.

27 sept 2010--The suicide rate for middle-aged people – a group considered relatively protected from suicide and with historically stable suicide rates – took an upward jump between 1999 and 2005, according to research by sociologists Ellen Idler of Emory University and Julie Phillips of Rutgers University.

Their study has been published in the September/October issue of the journal Public Health Reports.

"The findings are disturbing, because they're a reversal of a long-standing trend," Idler says, noting that the suicide rate for the U.S. population overall has been declining for decades. And people aged 40-59, in particular, have long had a moderate suicide rate.

The baby boomers, people born between 1945 and 1964, have broken that pattern. "This is a striking new trend," says Phillips, a social demographer. "Since the 1930s and up to the 1990s, suicide rates among middle-aged people – people aged 40 to 59 – were declining or pretty stable. But after 2000, this picture changed dramatically."

By 2000, most people aged 40 to 59 were baby boomers and the suicide rate started climbing steadily for these middle-age ranges. Idler and Philips found significant increases of more than 2 percent per year for men, and more than 3 percent per year for women, from 1999 to 2005. (By 2005, all middle-aged people were baby boomers.)

The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree, the analysis showed. For example, from 2000 to 2005, the suicide rate jumped nearly 30 percent for men and women aged 50 to 59 with some college but no degree. Middle-aged people with a college degree appeared largely protected from the trend.

The baby boomers also experienced higher suicide rates during their adolescence and young adulthood, doubling the rate for those age groups at the time. Their suicide rate then declined slightly and stabilized, before beginning to increase again in midlife.

"You might think that the higher rates in adolescence would lead to lower rates later because the most suicide prone people would be gone but that doesn't appear to be the case," Idler says. "Clinical studies often show that knowing someone who committed suicide is considered a risk factor for later doing it yourself, and that may be one factor here. The high rates in adolescence could actually be contributing to the high rates in middle age."

Higher rates of substance abuse and the onset of chronic diseases are among other possible factors in the rising baby boomer suicide rate. "As children, the baby boomers were the healthiest cohort that had ever lived, due to the availability of antibiotics and vaccines," Idler says. "Chronic conditions could be more of a rude awakening for them in midlife than they were for earlier generations."

Traditionally, midlife has been considered a time when people are at their peak of social integration. "We need to pay attention to this new increase in suicides, during a period of life previously thought to be stable and relatively protected from suicide, and in an age group now occupied by extraordinarily large numbers of people," Idler says.

Data for the study were drawn from the National Center for Health Statistics and the U.S. Census Bureau. Preliminary data from 2006 and 2007, the latest time that statistics are available, indicate that the upward pattern in midlife suicide is continuing, Idler says.

Worldwide Dementia Price Tag $604 Billion: Report

26 sept 2010-- The global cost of Alzheimer's disease and related dementias in 2010 is an estimated $604 billion, according to a report released Tuesday by Alzheimer's Disease International.

The estimate includes direct costs of medical care in primary and secondary care settings, direct costs of social care provided in residential care settings and by community care professionals, and unpaid informal care offered by family caregivers and others.

The World Alzheimer Report 2010 found that the cost of Alzheimer's and related dementias is about 1 percent of the world's gross domestic product and that if dementia care were a country, it would be the world's 18th largest economy, ranking between Turkey and Indonesia.

Among the other findings:


If dementia care were a company, it would be the world's largest by annual revenue, ahead of such giants as Wal-Mart ($414 billion) and Exxon Mobil ($311 billion).
Worldwide costs of dementia will increase 85 percent by 2030. This is a conservative estimate that considers only increases in the number of people with dementia, said the report authors.
Costs in low- and middle-income countries are likely to rise much faster than in rich nations. This is because these countries will see a sharper rise in the numbers of people with dementia, and economic development will boost costs towards levels in rich countries.

Alzheimer's Disease International is a U.K.-based nonprofit federation of 73 national Alzheimer's organizations, including the Alzheimer's Association in the United States.

"This report clearly illustrates that dementia is already affecting health systems around the world, and for the families who are forced to face Alzheimer's the anguish is universal. The World Alzheimer Report 2010 urges all countries -- including the U.S. -- to develop national plans to deal with the disease," Harry Johns, president and CEO of the Alzheimer's Association, said in an association news release.

The group will present Congress with a 100,000-name petition Tuesday, urging lawmakers to make Alzheimer's disease a national priority.

"Given the magnitude and the impact of Alzheimer's, the U.S. federal government's response to this crisis has been stunningly neglectful," Johns said. "We know Alzheimer's will place a massive strain on an already overburdened health care system, especially Medicare and Medicaid. Substantial investment in Alzheimer research is required to avoid an even more painful future for American families and already overwhelmed state and federal budgets. Yet, the government has no national plan for how to deal with this crisis."

The rare aging disease, Progeria, linked to aging in the general population

Study results demonstrate progerin increases in blood vessels as we age

BOSTON, MA , 08 sept 2010– Progeria, also known as Hutchinson-Gilford Progeria Syndrome (HGPS), is a rare, fatal genetic disease characterized by an appearance of accelerated aging in children. All children with Progeria die of the same heart disease that affects millions of normal aging adults (atherosclerosis), but instead of occurring at 60 or 70 years of age, these children may suffer heart attacks and strokes even before age 10, and the average age of death is 13 years. Finding treatments and a cure for Progeria may provide clues to preventing or treating heart disease in the general population.

On August 26, 2010, Arteriosclerosis, Thrombosis, and Vascular Biology electronically published, ahead of print, the results of a study comparing Progeria, and typical cardiovascular aging, entitled "Cardiovascular Pathology in Hutchinson-Gilford Progeria: Correlation With the Vascular Pathology of Aging". The study found that progerin, the abnormal protein that causes Progeria, is also present in the vasculature of the general population and increases with age.

Researchers examined cardiovascular autopsies and progerin distribution in two patients with Progeria along with a group of 29 individuals without Progeria. Between the ages of one month and 97 years, researchers found that progerin in individuals without Progeria increased an average of 3.3 percent per year in the coronary arteries.

"We found similarities between many aspects of cardiovascular disease in both Progeria and the atherosclerosis that affects millions of people throughout the world" said Dr. Leslie Gordon, senior author of the study, and Medical Director of The Progeria Research Foundation. "We also found progerin in cardiac blood vessels of people without Progeria. The fact that progerin is present at all tells us that there may be a tie between the heart disease of Progeria and the heart disease that affects us all as we age. "

This study supports the possibility that progerin is a contributor to the risk of atherosclerosis in the general population, and merits examination as a potential new element influencing vascular health with aging.

"By examining one of the rarest diseases in the world, we are gaining crucial insight into a disease that affects millions of people worldwide. Ongoing research has the potential to have a significant impact on our understanding of heart disease and aging," said Dr. Gordon


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The Progeria Research Foundation (PRF) was established in 1999 to find the cause, treatment and cure for Progeria – a rapid aging disease that causes children to die from heart disease or stroke at an average age of 13. In the past 10 years, research conducted in partnership with PRF has identified the gene that causes Progeria and possible treatments. PRF is now funding first-ever Progeria clinical drug trials, currently underway at Children's Hospital Boston. To learn more about Progeria and what you can do to help, please visit progeriaresearch.org

Memory problems more common in men?

ST. PAUL, Minn.,07 sept 2010–A new study shows that mild cognitive impairment (MCI) may affect more men than women. The research is published in the September 7, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Mild cognitive impairment is a condition in which people have problems with memory or thinking beyond that explained by the normal rate of aging. The study found that MCI was 1.5 times higher in men compared to women. MCI often leads to Alzheimer's disease.

"This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men," said study author Ronald Petersen, MD, PhD, with the Mayo Clinic in Rochester, Minn. "If these results are confirmed in other studies, it may suggest that factors related to gender play a role in the disease. For example, men may experience cognitive decline earlier in life but more gradually, whereas women may transition from normal memory directly to dementia at a later age but more quickly."

For the study, 2,050 people between the ages of 70 to 89 in Olmstead County, Minn. were interviewed about their memory and their medical history and tested on their memory and thinking skills.

The study found that nearly 14 percent of participants had mild cognitive impairment, about 10 percent had dementia and 76 percent of those tested had normal memory and thinking skills. A total of 19 percent of men had mild cognitive impairment, compared to 14 percent of women.

"Our results, showing combined rates of MCI and dementia at 22 percent highlight the public health impact these conditions have and the importance of finding treatments for them," said Petersen. People in the study who had a low level of education or were never married also had a higher rate of MCI.

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The study was supported by the National Institute on Aging, as well as the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program of the Mayo Clinic.

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 epilepsy, dystonia, migraine, Huntington's disease, and dementia.

Healthy Lifestyle May Attenuate Short Telomere Associations

Appears to counterbalance link between shorter telomeres and coronary artery calcium

06 sept 2010-- Engaging in a healthy lifestyle might counterbalance the association between coronary artery calcium (CAC) and shorter telomeres in people who have the latter, according to research published in the Sept. 1 issue of the American Journal of Cardiology.

Vanessa A. Diaz, M.D., of the Medical University of South Carolina in Charleston, and colleagues studied the effect of healthy lifestyle behaviors (high fruit and vegetable consumption, low meat consumption, exercise, social support) on the association between telomere length and the presence of CAC in 318 subjects (aged 40 to 64) with no history of coronary heart disease, stroke, diabetes, or cancer.

After controlling for several factors, the researchers found that high social support, low meat consumption, and high fruit and vegetable consumption attenuated the relationship between shorter telomeres and the presence of CAC. Individuals with these healthy lifestyle characteristics and shorter telomeres did not differ significantly from those with longer telomeres. However, those with shorter telomeres and less healthy lifestyles were at a significantly higher risk for the presence of CAC (odds ratios, 3.30, 3.33, and 2.58 for low fruit and vegetable intake, high meat intake, and low social support, respectively). When individuals were stratified by gender, men had similar results, but only fruit and vegetable intake attenuated the shorter telomeres-CAC relationship in women.

"In conclusion, the results of the present study suggest that being involved in healthy lifestyle behaviors might attenuate the association between shorter telomere length and coronary atherosclerosis, as identified using CAC," the authors write.

Abstract

Over 50? You probably prefer negative stories about young people

COLUMBUS, Ohio, 05 sept 2010 – When given a choice, older people prefer to read negative news, rather than positive news, about young adults, a new study suggests.

In fact, older readers who chose to read negative stories about young individuals actually get a small boost in their self-esteem, according to the results.

And what about younger people? Well, they just prefer not to read about older people.

These results come from a study of 276 Germans who were asked to read what they thought was a test version of an online magazine featuring carefully selected stories about younger and older people.

"Our results bolster the argument that people use the media to enhance their social identity," said Silvia Knobloch-Westerwick, lead author of the study and associate professor of communication at Ohio State University.

"Older people and younger people have different goals when they use the media, and it shows in what they choose to read."

Younger people, who are less certain about their own identity, prefer to read about other younger people to see how they live their lives, Knobloch-Westerwick said.

Older people, on the other hand, have greater certainty regarding their identity. However, living in a youth-centered culture, they may appreciate a boost in self-esteem. That's why they prefer the negative stories about younger people, who are seen as having a higher status in our society.

Knobloch-Westerwick conducted the study with Matthias Hastall of Zeppelin University Friedrichshafen in Germany. Their results appear in the September 2010 issue of the Journal of Communication.

The study included 178 younger adults (18 to 30 years old) and 98 older adults (50 to 65 years old). All came to a computer laboratory, where they were told they were testing an online magazine that was not yet available to the public.

The experimental magazine was created specifically for the study and contained 10 carefully pre-tested stories. Each story focused on one individual, but there were two different versions: one that had a negative spin and one with a positive spin (each participant was offered just one of the two versions).

For example, one positive article was headlined (translated here from German) "Visitation rights gained after daring protest – Demonstration at 100 feet high a success." The negative version had the headline, "Visitation rights denied despite daring protest – Demonstration at 100 feet high in vain."

The stories included a photo of the person involved: half were clearly an older person and half were clearly a younger person.

Participants in the study were told they would not have time to read all the stories and were asked to click on the stories that they found interesting. Each was given a random mix of positive and negative stories about younger and older people.

The computer secretly logged which stories each participant clicked on and how long they spent reading each article.

All of the stories were extensively pretested by other participants to ensure that the stories were clearly positive or negative, and that the photos were clearly differentiated by age and that the people pictured were similar in how likeable they appeared, Knobloch-Westerwick said.

Results showed that the older participants were more likely to select negative articles about younger people, but they did not show a strong preference for either positive or negative stories about people in their own age group.

Younger people showed low interest in articles about older individuals – regardless of whether the stories were positive or negative. They did choose to read more positive stories about their own age group than they did negative stories, she said.

After participants finished browsing and evaluating the online magazine, they were given a short questionnaire aimed at measuring their self-esteem.

Results showed that younger people showed no differences in self-esteem based on what they had read. However, the more that older people read negative stories about younger individuals, the higher the older people's levels of self-esteem tended to be.

This study came about because a previous study by the same researchers, using this same data, had produced unexpected results, Knobloch-Westerwick said. The original study had hypothesized that people prefer media messages that portray people like themselves – people of the same age and the same gender, in this case.

Overall, the original study found that was indeed true. However, the researchers were puzzled by the fact that older people in that first study seemed as equally interested in stories about younger people as they were in stories about older people like themselves.

"Now we know why older people liked reading about the younger people – they were looking for negative stories about them," she said.

"Our new results go along with other research showing that people's social identity helps shape what media messages we choose. Age is just one type of social identity which may affect our media choices."

Active Lifestyle May Help Counter Obesity Genes

04 sept 2010-- Exercise can reduce a person's genetic predisposition to obesity by 40 percent, finds a new English study.

Researchers looked at 20,430 people in Norwich and focused on genetic variants known to increase the risk of obesity. Most people had inherited 10 to 13 of these variants from their parents, but some had more than 17 while others had fewer than six.

The participants also provided information about their levels of physical activity.

Overall, each additional obesity-related genetic variant was associated with an increase in body mass index (BMI) equivalent to 445 grams (0.98 pounds) for a person 1.70 meters (5 feet, 6 inches) tall. BMI is a measurement that takes into account a person's height and weight.

However, this effect was greater in sedentary people than in active people, the researchers found. For those with a physically active lifestyle the increase was 379 grams (0.84 pounds) per genetic variant. That's 36 percent less than the increase of 592 grams (1.3 pounds) per genetic variant for inactive people.

The researchers also found that each additional obesity susceptibility variant increased the odds of obesity by 1.1-fold. But this risk was 40 percent lower for active people compared to inactive people, the findings revealed.

The study shows that adopting a healthy lifestyle can benefit people at increased genetic risk of obesity, the authors explained.

"Our findings further emphasize the importance of physical activity in the prevention of obesity," Dr. Ruth Loos, of the Medical Research Council's epidemiology unit in Cambridge and colleagues wrote in the article published online this week in PLoS Medicine.

Older adults experience 'destination amnesia'
...and over-confidence with false beliefs


Older adults are more likely to have destination memory failures – forgetting who they've shared or not shared information with, according to a new study led by Baycrest's Rotman Research Institute.

03 sept 2010--It's the kind of memory faux pas that can lead to awkward or embarrassing social situations and even miscommunication in the doctor's office. Ironically, after making these memory errors older adults remain highly confident in their false beliefs.

The study appears online, ahead of print publication, in the Online First Section of Psychology and Aging.

"What we've found is that older adults tend to experience more destination amnesia than younger adults," said lead investigator and cognitive scientist Dr. Nigel Gopie, who led the study with internationally-renowned experts in memory and attention, Drs. Fergus Craik and Lynn Hasher.

"Destination amnesia is characterized by falsely believing you've told someone something, such as believing you've told your daughter about needing a ride to an appointment, when you actually had told a neighbour."

Why are older adults more prone to destination memory failures? The ability to focus and pay attention declines with age, so older adults use up most of their attentional resources on the telling of information and don't properly encode the context (ie. who they are speaking to) for later recall.

"Older adults are additionally highly confident, compared to younger adults, that they have never told people particular things when they actually had," added Dr. Gopie. "This over-confidence presumably causes older adults to repeat information to people."

A critical finding in the study is that destination memory is more vulnerable to age-related decline than source memory. Source memory is the ability to recall which person told you certain information.

In the research, 40 students from the University of Toronto (ages 18 - 30) and 40 healthy older adults from the community (ages 60 - 83) were divided into two experimental groups. The first experiment measured destination memory accuracy and confidence: requiring the individual to read out loud 50 interesting facts to 50 celebrities (whose faces appear on a computer screen), one at a time, and then remember which fact they told to which famous person. For example, "a dime has 118 ridges around it" and I told this fact to Oprah Winfrey.

The second experiment measured source memory accuracy and confidence: requiring the individual to remember which famous person told them a particular fact. For example, Tom Cruise told me that "the average person takes 12 minutes to fall asleep".

In the first experiment for destination memory accuracy, older adults' performance was 21% worse than their younger counterparts.

In the second experiment for source memory accuracy, older and younger adults performed about the same (60% for young, 50% for old) in recollecting which famous face told them a particular fact.


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The study was funded by the Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, U.S. National Institute on Aging, and a Baycrest Jack and Rita Catherall Award.

The study follows an earlier one published last year in Psychological Science by Dr. Gopie (Baycrest's Rotman Research Institute) and Dr. Colin M. MacLeod (University of Waterloo). That one looked at disrupted destination memory in a single age group – university-aged students.

Mental 'exercise' linked to faster dementia progression

NEW YORK 02 sept 2010– While staying mentally active in old age has been linked to a delayed onset of dementia, seniors who engage in such brain "exercise" may actually have a faster rate of decline once Alzheimer's is diagnosed, researchers reported Wednesday.

The findings, published online in the journal Neurology, do not mean that a mentally stimulating lifestyle is a bad thing.

Instead, the researchers suspect that their findings may point to the "cost" of delaying Alzheimer's onset by keeping the mind active with hobbies, reading, crossword puzzles and the like.

That is, once these mentally active older adults are showing the signs of dementia and are ultimately diagnosed, they may have a more advanced stage of brain damage compared with less mentally active seniors.

This idea fits in with the "cognitive reserve" hypothesis of dementia. That theory basically holds that people who are mentally active can better withstand the gradual brain-cell damage that marks Alzheimer's disease and other forms of dementia. But once that damage reaches a certain threshold, dementia symptoms will become apparent.

So mentally active older adults may develop dementia later than those who "exercise" their brains less often. But once they do develop it, they are in a more extensive state of brain damage.

That, at least, is "the working hypothesis," said Dr. Charles B. Hall, a researcher at Albert Einstein College of Medicine in New York. Hall was not involved in the current study, but is researching the connection between cognitive activities and dementia.

In an interview, he said these latest findings confirm work by his research group and others finding a link between a mentally active lifestyle and a delayed onset of dementia, but also a faster decline once dementia is diagnosed.

The current study, led by Dr. Robert S. Wilson of Rush University in Chicago, included 1,157 older adults who were dementia-free at the outset and were evaluated for cognitive decline over roughly six years.

At the study's start, participants reported on how often they engaged in a number of activities that were considered mentally stimulating -- including reading, doing crosswords or other puzzles, playing games like cards or checkers, watching TV, listening to the radio and going to museums.

During the study period, 614 participants remained cognitively healthy, while 395 developed mild impairment in their thinking abilities, and 148 were diagnosed with Alzheimer's disease.

Wilson's team found that among the group who remained healthy, those who reported a greater number of cognitive activities showed a slower rate of decline in cognitive tests over six years. Test scores remained essentially unchanged among those in the top 10 percent for cognitive activities, but showed a gradual dip among those in the bottom 10 percent.

In contrast, among study participants who were diagnosed with Alzheimer's, those who were the most mentally active at the study's outset showed a quicker rate of decline over time than those who had been the least mentally engaged.

According to Wilson's team, all of this suggests that mentally stimulating activities in older age might "compress" the amount of time a person ultimately spends with dementia symptoms.

However, Hall pointed out that the key limitation of this and past studies on the issue is that they are observational studies. That is, they can show an association between mental activities and dementia onset and progression, but cannot prove cause-and-effect.

"The evidence from observational studies suggests that cognitive activities might delay the onset of dementia," Hall said, "but that has to be confirmed in intervention studies."

In an intervention-type study, participants would, for example, be randomly assigned to regularly perform some sort of mentally stimulating activity and then have their cognitive health followed over time and compared with that of a similar group who did not perform the activity.

If staying mentally active does delay dementia onset, evidence so far suggests the benefit would be modest.

In a study Hall and his colleagues published last year, they found that of older adults who developed dementia during the study period, the most mentally active ones were typically diagnosed just over a year later than the least mentally active men and women.

People in the most active group typically reported 11 "activity days" per week -- meaning, for example, they performed one activity, such as reading, writing or playing games, on all days of the week, and a second activity on four days of the week. The least active group reported four activity days per week.

"This doesn't prevent dementia. This doesn't prevent the (brain) pathology," Hall said. However, he added, if mental activities were found to delay dementia symptoms, or the need for nursing home care, by even a year, that would have a "tremendous public health impact."

"I'm not ready to tell everyone to do crossword puzzles," Hall said. On the other hand, he added, there would be little chance of harm in doing so.

SOURCE: http://link.reuters.com/bar78n Neurology, online September 1, 2010.

Biobehavioral Approach Linked to Benefits in Dementia

Intervention aimed at patients, caregivers includes visits with therapists, advance practice nurses

01 sept 2010-- A biobehavioral environmental intervention -- Care of Persons with Dementia in their Environments (COPE) -- is associated with better functioning in patients with dementia after four months, as well as benefits for caregivers, according to research published in the Sept. 1 issue of the Journal of the American Medical Association.

Laura N. Gitlin, Ph.D., of Thomas Jefferson University in Philadelphia, and colleagues analyzed data from 209 pairs of patients and their family caregivers. Participants were randomized to receive up to 12 contacts in the home or over the phone with occupational therapists and an advanced practice nurse who provided training to caregivers on matters such as modifying the home environment and daily activities. Control caregivers received educational materials and up to three calls from research staff.

The researchers found that the COPE group had less functional dependence at four months and less dependence in instrumental activities of daily living compared with controls. COPE patients also had improved engagement, and their caregivers had improved well-being and improved confidence using activities. At nine months, changes in outcomes were similar for patients in the two groups, but COPE caregivers reported greater benefits.

"Because most patients live at home with functional decline, a non-pharmacologic, biopsychosocial-environmental intervention may positively contribute to disease management. Future research needs to examine effects of underlying medical conditions, ways to boost treatment effects, cost-effectiveness, COPE in combination with pharmacologic treatments, and translational potential," the authors conclude.

Research demonstrates benefits of medical cannabis as a treatment for chronic pain

31 aug 2010--The medicinal use of cannabis has been debated by clinicians, researchers, legislators and the public at large for many years as an alternative to standard pharmaceutical treatments for pain, which may not always be effective and may have unwanted side effects. A new study by McGill University Health Centre (MUHC) and McGill University researchers provides evidence that cannabis may offer relief to patients suffering from chronic neuropathic pain. The results of the groundbreaking study are published in the latest issue of the Canadian Medical Association Journal.

"This is the first trial to be conducted where patients have been allowed to smoke cannabis at home and to monitor their responses, daily," says Dr. Mark Ware, lead author of the study, who is also Director of Clinical Research at the Alan Edwards Pain Management Unit at the MUHC and an assistant professor of anesthesia in McGill University's Faculty of Medicine, and neuroscience researcher at the Research Institute of the MUHC.

In this study, low doses (25mg) of inhaled cannabis containing approximately 10% THC (the active ingredient in cannabis), smoked as a single inhalation using a pipe three times daily over a period of five days, offered modest pain reduction in patients suffering from chronic neuropathic pain (pain associated with nerve injury) within the first few days. The results also suggest that cannabis improved moods and helped patients sleep better. The effects were less pronounced in cannabis strains containing less than 10% THC.

"The patients we followed suffered from pain caused by injuries to the nervous system from post-traumatic (e.g. traffic accidents) or post-surgical (e.g. cut nerves) events, and which was not controlled using standard therapies" explains Dr. Ware. "This kind of pain occurs more frequently than many people recognize, and there are few effective treatments available. For these patients, medical cannabis is sometimes seen as their last hope."

"This study marks an important step forward because it demonstrates the analgesic effects of cannabis at a low dose over a shot period of time for patients suffering from chronic neuropathic pain," adds Dr. Ware. The study used herbal cannabis from Prairie Plant Systems (under contract to Health Canada to provide cannabis for research and medical purposes), and a 0% THC 'placebo' cannabis from the USA.

However, larger-scale studies with a longer time frame and higher doses of THC are needed to further evaluate the efficacy and long-term safety of medical cannabis. "Our challenge as researchers is to continue to conduct rigorous clinical studies on the medical use of cannabis with strict attention to details such as quality and dosage," says Dr. Ware. "This will allow us to move the debate forward by providing reliable scientific clinical data."

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About the Study

The article "Smoked cannabis for chronic neuropathic pain," is published in the Canadian Medical Association Journal (www.cmaj.ca) and was made possible by grants from the Canadian Institutes of Health Research (CIHR).

Click here for online access: http://www.cmaj.ca/embargo/cmaj091414.pdf

Click here for the related commentary: http://www.cmaj.ca/embargo/cmaj100799.pdf

Omega-3 margarines fail to help in heart study

STOCKHOLM, 30 aug 2010 - Giving patients with a history of heart attacks a margarine enriched with omega-3 oils in addition to standard drugs appears to make no difference to their chances of having a repeat attack.

A 40-month study of more than 4,800 patients showed taking low doses of omega-3 fatty acids in margarine did not significantly reduce rates of serious heart attacks and other cardiovascular events, Dutch researchers said on Sunday.

The finding raised questions about the benefits of omega-3, which has been shown in previous studies to make for healthier hearts. The margarines used in the study were developed for the researchers by food and consumer goods giant Unilever.

Doctors, however, are unlikely to rush to change clinical practice. Many already prescribe omega-3 fish oil capsules, including GlaxoSmithKline's Lovaza, to reduce triglycerides, a type of blood fat linked to clogged arteries.

"It will be viewed as a largely negative study and people who are enthusiasts for omega fatty acids will continue to be enthusiasts and people who are skeptics will continue to be skeptics," said Scott Wright of the Mayo Clinic in the United States, who was not involved in the research.

Daan Kromhout of Wageningen University, who led the study, told the European Society of Cardiology the lack of efficacy might reflect the good background drug treatment patients were receiving, with 85 percent on cholesterol-lowering statins, as well as blood pressure and blood-thinning tablets.

"We found the cardiovascular mortality rate in the study population was only half that expected, probably because of their excellent treatment," he said.

"This may also be why the rate of major cardiovascular events during follow-up was no lower in the fatty acid groups than in the placebo group."

All the men and women in the Dutch study were aged between 60 and 80 and had suffered a heart attack roughly four years previously.

They were randomly assigned use of one of four margarines on bread instead of their regular spread -- one containing no extra omega-3 fatty acids; one with 400 milligrams a day of extra eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA); one with 2 grams of alpha-linolenic acid (ALA); and one with a combination of EPA-DHA and ALA.

Fish like salmon, herring and sardine are a common source of EPA-DHA, while ALA is found in vegetables including soybeans, flax seeds and walnuts.

Despite the overall negative results, researchers did find there was a reduction in repeat heart attacks and other cardiovascular events in women who took ALA margarine, although this was not statistically significant. Diabetes patients also showed a possible benefit.

Unilever, whose margarine brands that contain omega-3 include Flora and I Can't Believe It's Not Butter, said the lack of benefit seen with EPA and DHA was surprising, considering the weight of evidence published to date.

"The results indicate that more investigation is required into the efficacy of vegetable omega 3, but do not question the current authoritative dietary recommendations and advices for omega 3 intakes on which our products are based," the company said in a statement.

The results of the study, which was supported by the Netherlands Heart Foundation, the National Institutes of Health, and Unilever, were also published in the New England Journal of Medicine.

Doctors' Religious Beliefs Strongly Influence End-of-Life Decisions, Study Finds

28 aug 2010— Atheist or agnostic doctors are almost twice as willing to take decisions that they think will hasten the end of a very sick patient's life as doctors who are deeply religious, suggests research published online in the Journal of Medical Ethics.

And doctors with a strong faith are less likely to discuss this type of treatment with the patient concerned, the research shows.

The findings are based on a postal survey of more than 8500 UK doctors, spanning a wide range of specialties, which was designed to see what influence religious belief -- or lack of it -- had on end of life care.

The specialties included those in which end of life decisions would be particularly likely to arise, such as neurology, elderly care, palliative care, intensive care and hospital specialties, and general practice.

The doctors were asked about the care of their last patient who died, if relevant -- including whether they had provided continuous deep sedation until death and whether they had discussed decisions judged likely to shorten life with the patient -- their own religious beliefs, ethnicity, and their views on assisted dying/euthanasia.

Nearly 4000 doctors responded (42% of the total surveyed), and almost 3000 reported on the care of a patient who had died.

Specialists in the care of the elderly were somewhat more likely to be Hindu or Muslim, while palliative care doctors were somewhat more likely than other doctors to be Christian, white, and agree that they were "religious."

But, overall, white doctors, who comprised the largest ethnic group among the respondents, were the least likely to report strong religious beliefs.

Ethnicity was largely unrelated to rates of reporting ethically controversial decisions, although it was related to support for assisted dying/euthanasia legislation.

Specialty was strongly related to whether a doctor reported having taken decisions, expected or partly intended to, end life. Doctors in hospital specialties were almost 10 times as likely to report this as palliative care specialists.

But irrespective of specialty, doctors who described themselves as "extremely" or "very non-religious" were almost twice as likely to report having taken these kinds of decisions as those with a religious belief.

The most religious doctors were significantly less likely to have discussed end of life care decisions with their patients than other doctors.

These attitudes were reflected in support for assisted dying/euthanasia legislation, with palliative care specialists and those with a strong faith more strongly opposed to it. Asian and white doctors were less opposed to such legislation than doctors from other ethnic groups.

The author concludes that the relationship between doctors' values and their clinical decision making needs to be acknowledged much more than it is at present.

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List Of Medications That Put Elderly Patients At Risk: The PRISCUS List

In the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2010; 107[31-32]: 543-51), Stephanie Holt, a clinical pharmacologist, and coauthors present the PRISCUS List: a list of medications that carry an increased risk of side effects when given to elderly patients.

27 aug 2010--The authors present the new list, which was developed specifically for Germany in the setting of a joint project entitled PRISCUS (Latin for "old and venerable"), and discuss its potential applications. Most patients take more medications as they grow older and thus run a greater risk of drug interactions and side effects. Medications that might cause side effects more frequently in elderly patients than they do in the overall population are called potentially inappropriate medications (PIM). A number of PIM lists already exist for countries other than Germany; these cannot be applied directly to the German situation because of differences between countries with respect to drug approval, prescribing practices, and treatment guidelines. The experts who created the PRISCUS list for Germany, proceeding on the basis of a literature search and a qualitative analysis of existing PIM lists from other countries, judged 83 medications to be potentially inappropriate for elderly patients. The authors of the article call the PRISCUS list an important aid in medical decision-making.

Source:
Prof. Petra A. Thuermann
Deutsches Aerzteblatt International

Vit D linked to cancer, autoimmune disease genes

LONDON,25 aug 2010- Scientists have found that vitamin D influences more than 200 genes, including ones related to cancer and autoimmune diseases like multiple sclerosis -- a discovery that shows how serious vitamin D deficiency can be.

Worldwide, an estimated one billion people are deficient in vitamin D, and a team of scientists from Britain and Canada said health authorities should consider recommending supplements for those at most risk.

"Our study shows quite dramatically the wide-ranging influence that vitamin D exerts over our health," said Andreas Heger of the Functional Genomics Unit at Britain's Oxford University, who led the study.

Vitamin D effects our DNA through something called the vitamin D receptor (VDR), which binds to specific locations of the human genome. Heger's team mapped out these points and identified more than 200 genes that it directly influences.

Vitamin D deficiency is a well-known risk factor for rickets, and some evidence suggests it may increase susceptibility to autoimmune diseases such as multiple sclerosis (MS), rheumatoid arthritis and type 1 diabetes, as well as certain cancers and even dementia.

With this is mind, the group looked at disease-associated regions of the gene map to see if they had higher levels of VDR binding. They found VDR binding was "significantly enriched" in regions linked to several common autoimmune diseases, such as MS, type 1 diabetes and Crohn's disease, as well as in regions associated with cancers such as leukemia and colorectal cancer.

"SUNSHINE VITAMIN"

Sreeram Ramagopalan, of the Wellcome Trust Center for Human Genetics at Oxford University, said the results, published on Monday in the journal Genome Research, showed "just how important vitamin D is to humans, and the wide variety of biological pathways that vitamin D plays a role in."

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 fish liver oil, eggs and fatty fish such as salmon, herring and mackerel, or taken as a supplement.

Some experts say that up to half the world's population has lower than optimal levels of vitamin D, and that about one billion people are actually vitamin D deficient. The problem is getting worse as people spend more time indoors.

A study published in March found that vitamin D is vital for activating the immune system's killer cells, known as T cells, which remain dormant and unaware of threats from infections if vitamin D is lacking in the blood.

Ramagopalan said the latest study suggested vitamin D played a role "in susceptibility to a host of diseases" and that health authorities should consider giving supplements to pregnant women and young children as a preventative measure.

"Vitamin D supplements during pregnancy and the early years could have a beneficial effect on a child's health in later life," he wrote. "Some countries such as France have instituted this as a routine public health measure."

There are no definitive studies on the optimal daily dose of vitamin D but some experts recommend 25 to 50 micrograms.

Urinary incontinence common in older men too

NEW YORK 24 aug 2010– It's not just women who suffer from urinary incontinence: Nearly one in twenty U.S. men have moderate to severe forms of the condition, which is as common as one in six among elderly men, a new study finds.

Research suggests that urinary incontinence affects women about twice as often as it does men. But the new findings, researchers say, underscore the fact that despite their relatively lower risk, men commonly deal with the condition as well.

The study found that among 5,300 U.S. men age 20 or older who participated in a government health survey, 4.5 percent reported symptoms of moderate to severe urinary incontinence -- defined as having leakage at least once a week, or once a month at volumes "more than drops."

Among men age 75 and older, 16 percent met that definition.

In all, that translates to an estimated 8.2 million U.S. men with moderate to severe urinary incontinence, the researchers report in the Journal of Urology.

"It's a common problem," said lead researcher Dr. Alayne D. Markland, of the Birmingham VA Medical Center and the University of Alabama at Birmingham.

Yet, she told Reuters Health, doctors and patients alike may not think to bring up urinary incontinence symptoms. "Older patients often think that it is just part of aging," Markland noted.

But she advised men to discuss any incontinence problems with their doctors, as there are a number of effective treatments.

The options include Kegel exercises -- a set of exercises that help strengthen the muscles of the pelvic floor -- as well as behavioral changes, such as scheduled bathroom trips and limiting fluids at certain times of the day. There are also a number of medications that help treat incontinence, and two of Markland's co-authors had relationships with companies that sell or research such drugs. In more severe cases, surgery may be an option.

Men with urinary incontinence will have the added step of needing a prostate check, because prostate-gland enlargement is a common cause of urinary symptoms.

Markland and her colleagues also found that several factors were linked to an increased risk of moderate to severe urinary incontinence.

One, not surprisingly, was older age. Another was major depression.

Among men who screened positive for major depression, about 11 percent had moderate to severe urinary incontinence, versus 4 percent of men who did not screen positive.

When the researchers accounted for other factors -- including age and the presence of chronic physical diseases -- depressed men had between two and three times the risk of moderate to severe urinary incontinence that non-depressed men had.

Other studies have seen a similar link between depression and urinary incontinence in both men and women, according to Markland. "But we don't know if that's a cause-and-effect relationship," she said.

On one hand, it's possible that serious problems with incontinence contribute to social isolation and depression in some people. Alternatively, there could be physiological effects connected to depression -- such as alterations in the brain chemical dopamine -- that impair bladder function.

Another possibility is that some of the medications used to treat depression cause incontinence as a side effect. Markland noted, however, that there is no evidence that the widely used SSRI antidepressants cause urinary incontinence.

In what Markland said was a rather surprising finding, the researchers also found that men with high blood pressure had an increased risk of incontinence. Roughly 9 percent had moderate to severe symptoms, versus 3 percent of men without high blood pressure. With other factors taken into account, high blood pressure was linked to a 30 percent increase in the risk of urinary incontinence.

As with depression, Markland said, the reasons for the connection between high blood pressure and incontinence are not yet clear. Again, she said it's possible that medications used to treat high blood pressure cause bladder control problems in some men, but that has yet to be shown.

Fear of falling linked to future falls in older people

Research: Determinants of disparities between perceived and actual fall risk in community living older people

23 aug 2010--Fear of falling is likely to lead to future falls among older people, irrespective of their actual fall risk, finds a study published on bmj.com today.

This indicates that measures of both actual and perceived fall risk should be included in fall risk assessments to help tailor interventions for preventing falls in older people, say the authors.

Fear of falling is common in older people and is associated with poor balance, anxiety, depression and falls. But the problem of irrational fear has been neglected in the scientific literature.

So a team of researchers from Australia and Belgium set out to improve their understanding of fear of falling and its impact on the risk of falls.

Five hundred people, aged 70 to 90 years, living in Sydney took part in the study and underwent an extensive medical and neuropsychological assessment. Actual and perceived fall risks were then estimated using recognised scoring scales and participants were followed up monthly over a one-year period.

The researchers found that both actual fall risk and perceived fall risk independently contribute to a person's future fall risk.

Further analysis was then used to split the sample into four groups based on the disparity between actual and perceived risk.

Most people had an accurate perception of their fall risk. Those in the "vigorous" group (low actual and low perceived fall risk) were considered at low risk of future significant falls, while those in the "aware" group (high actual and high perceived fall risk) were considered at high risk of future significant falls.

However, about one third of elderly people either underestimated or overestimated their risk of falls.

For example, the "anxious" group had a low actual but high perceived fall risk, which was related to depressive symptoms, neurotic personality traits and poor physical functioning. In contrast, the "stoic" group had a high actual but low perceived fall risk, which was protective for falling, and related to a positive outlook on life, physical activity, and community participation.

Overall, it seems that high levels of perceived fall risk are likely to result in future falls, irrespective of the actual risk, and the disparity between actual and perceived fall risk contributes to risk mainly through psychological pathways, say the authors.

The findings also suggest that reducing fear of falling is not likely to increase the risk of falls by making older people overly confident, they add.

And they conclude that measures of both actual and perceived fall risk should be included in fall risk assessments so as to tailor interventions for preventing falls in older people.

Moderate Chocolate Intake Tied to Lower Heart Failure Risk

However, protective association not observed with intake of one or more servings daily

22 aug 2010-- Regular, moderate chocolate consumption is linked to a lower rate of heart failure hospitalization or death, but no protective association is seen in individuals consuming one or more servings of chocolate daily, according to a study published online Aug. 16 in Circulation: Heart Failure.

In a prospective cohort study, Elizabeth Mostofsky, of Harvard Medical School in Boston, and colleagues followed 31,823 women, aged 48 to 83 years, without baseline diabetes or a history of heart failure or myocardial infarction from Jan. 1, 1998, through Dec. 31, 2006.

During nine years of follow-up, the investigators found that 419 women were hospitalized for incident heart failure (379) or died of heart failure (40). The multivariate adjusted rate ratio of heart failure was 0.74 for those consuming one to three servings of chocolate per month, 0.68 for those consuming one to two servings per week, 1.09 for those consuming three to six servings per week, and 1.23 for those consuming one or more servings per day, compared to those not regularly consuming chocolate.

"Further studies are needed to confirm or refute these findings and to determine the optimal dose and type of chocolate and to clarify the mechanisms involved," the authors write.

Abstract
Full Text

Moderate drinking, especially wine, associated with better cognitive function

21 aug 2010--A large prospective study of 5033 men and women in the Tromsø Study in northern Norway has reported that moderate wine consumption is independently associated with better performance on cognitive tests. The subjects (average age 58 and free of stroke) were followed over 7 years during which they were tested with a range of cognitive function tests. Among women, there was a lower risk of a poor testing score for those who consumed wine at least 4 or more times over two weeks in comparison with those who drink <>

It has long been known that "moderate people do moderate things." The authors state the same thing: "A positive effect of wine . . . could also be due to confounders such as socio-economic status and more favourable dietary and other lifestyle habits.

The authors also reported that not drinking was associated with significantly lower cognitive performance in women. As noted by the authors, in any observational study there is the possibility of other lifestyle habits affecting cognitive function, and the present study was not able to adjust for certain ones (such as diet, income, or profession) but did adjust for age, education, weight, depression, and cardiovascular disease as its major risk factors.

The results of this study support findings from previous research on the topic: In the last three decades, the association between moderate alcohol intake and cognitive function has been investigated in 68 studies comprising 145,308 men and women from various populations with various drinking patterns. Most studies show an association between light to moderate alcohol consumption and better cognitive function and reduced risk of dementia, including both vascular dementia and Alzheimer's Disease.

Such effects could relate to the presence in wine of a number of polyphenols (antioxidants) and other micro elements that may help reduce the risk of cognitive decline with ageing. Mechanisms that have been suggested for alcohol itself being protective against cognitive decline include effects on atherosclerosis ( hardening of the arteries), coagulation ( thickening of the blood and clotting), and reducing inflammation ( of artery walls, improving blood flow).

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Study source: Arntzen KA, Schirmer H, Wilsgaard T, Mathiesen EB. Moderate wine consumption is associated with better cognitive test results: a 7 year follow up of 5033 subjects in the Tromsø Study. Acta Neurol Scand 2010; Suppl 190:23-29.

Lung Cancer Patients Receiving Palliative Care Have Improved Quality of Life, Extended Survival, Study Finds

Aug. 20, 2010— Integrating palliative care early in the treatment of patients with advanced lung cancer not only improved their mood and quality of life, it also extended their lives. In the August 19 New England Journal of Medicine, Massachusetts General Hospital (MGH) investigators report that patients with metastatic non-small-cell lung cancer (NSCLC) who received early palliative care along with standard treatment lived more than two months longer than patients receiving standard care only. Metastatic NSCLC is difficult to treat, and patients typically are expected to survive less than one year.

"For me as an oncologist, results like this are incredibly exciting," says Jennifer Temel, MD, of the MGH Cancer Center, the paper's lead author. "We showed that adding the services of a care team focused on quality of life and not altering patients' cancer treatments could both enhance and extend life in patients with an incurable cancer diagnosis. These findings are very promising, and we are already taking steps to examine the impact of early palliative care in other situations."

"One of the most common misconceptions about palliative care is that it indicates treatment has failed -- that it means giving up," says Vicki Jackson, MD, MPH, acting chief of the MGH Palliative Care Service and a co-author of the NEJM study. "In this study the addition of palliative care early in the course of illness extended the survival of patients with incurable lung cancer. These patients not only lived longer, they also experienced improved quality of life and were better able to enjoy the time they had remaining."

Palliative care teams consist of physicians, nurses, social workers and chaplains specially trained to help patients facing serious illness cope with the psychological and spiritual aspects of their disease, as well as managing symptoms such as pain, nausea and shortness of breath. Cancer patients traditionally have been enrolled in palliative care late in the course of their illness, often when they are hospitalized and symptoms have become debilitating. A 2007 study by members of the MGH team found it feasible to integrate palliative care into the treatment of patients newly diagnosed with metastatic NSCLC, the leading cause of cancer death in the U.S. The current study was designed to evaluate the impact of early, continuing palliative care on patients' lives.

Study participants -- all of whom had recently been diagnosed with metastatic NSCLC -- were randomly assigned to receive either standard oncology care or early palliative care integrated with standard care. Those in the latter group met with members of the palliative care team within three weeks of study enrollment and then at least monthly throughout the course of their illness. Additional sessions could be scheduled as needed. The visits included assessing and treating symptoms, establishing goals of care, providing psychosocial support and coordinating care with other services. Participants receiving standard care who wished to access palliative services were free to do so at any point during the study.

Members of both groups completed standard questionnaires assessing mood and quality of life when they enrolled in the study and 12 weeks later. The research team collected data on the services and treatments participants received -- including hospital admission, hospice services, chemotherapy and other medications -- as well as whether patients' resuscitation preferences were documented in the medical record. A total of 151 patients enrolled -- 77 assigned to the palliative care group, and 74 to standard care -- during the three-year study period.

Responses to the quality-of-life questionnaire showed significant improvement from enrollment to 12-week assessment in the palliative care group but worsening quality of life in the standard care group. Depression symptoms in the palliative care group were about half those reported in the standard care group at 12 weeks, although the rates of new antidepressant prescriptions among both groups was similar. While more than half the palliative care participants had documented resuscitation preferences, essential to ensuring that patients' goals and end-of-life wishes are respected, fewer than 30 percent of standard care participants had documented preferences.

More than half the standard care participants received what the study protocol defined as aggressive end-of-life care -- chemotherapy within 14 days of death, a time when it is usually considered futile, and either no or late referral to hospice care -- compared with only a third of the palliative care group. Despite the lack of such aggressive end-of-life care, patients in the palliative care group lived an average of 11.6 months, while survival for standard care patients was less than 9 months.

Temel says, "Traditionally, cancer care has focused on treating the disease itself, but now we realize we must also focus on managing patient's symptoms and distress related to their diagnosis. We hypothesize that the increased survival was due to improved mood and quality of life, to early and more comprehensive management of symptoms and complications, and possibly to more appropriate end-of-life care. Similar studies in patients with other types of cancers and in other care settings will help us better understand the impact palliative care can have on the well-being and health of all patients with cancer." Temel is an assistant professor of Medicine, and Jackson an instructor in Medicine at Harvard Medical School.

The study was supported by grants from the American Society of Clinical Oncology, the Joanne Hill Monahan Cancer Fund and Golf Fights Cancer.

Discovery May Aid Search for Anti-Aging Drugs: Gene's Action May Help Explain Why Restricting Diet Lengthens Life in Animals

Ao-Lin Hsu. (Credit: Image courtesy of University of Michigan Health System)

Aug. 18, 2010 — A team of University of Michigan scientists has found that suppressing a newly discovered gene lengthens the lifespan of roundworms. Scientists who study aging have long known that significantly restricting food intake makes animals live longer. But the goal is to find less drastic ways to achieve the same effect in humans someday.

The U-M results offer promising early evidence that scientists may succeed at finding targets for drugs that someday could allow people to live longer, healthier lives.

In a study in the August issue of Aging Cell, U-M scientists found that a gene, drr-2, is an important component in a key cellular pathway, the TOR nutrient-sensing pathway, where many scientists are looking for potential drug targets. The U-M scientists then found that when they caused the drr-2 gene to be under- or over-expressed, they could lengthen or shorten lifespan in C. elegans, a worm widely used in research. Manipulating the drr-2 gene's action produced the same effects as reducing or increasing caloric intake.

"We showed that in C. elegans, drr-2 is one of the essential genes for the TOR pathway to modulate lifespan," says Ao-Lin Allen Hsu, Ph.D., the study's senior author and a scientist at the U-M Geriatrics Center. He also is an assistant professor in internal medicine and molecular and integrative physiology at U-M. The study also found that drr-2 appears analogous to a human gene, eIF4H, that controls similar cell functions.

Context

To find possible avenues for future anti-aging drugs, many scientists around the world are focusing on signaling pathways in cells that sense nutrients. The one Hsu examined, the target of rapamycin pathway or TOR pathway, is so named because its activity can be influenced by the drug rapamycin. Recent results from a large federal study being conducted at U-M and elsewhere have shown that in mice, rapamycin is effective at mimicking the anti-aging effects of dietary restriction.

Research in the last 25 years has shown that animals, including mammals, live longer and have lower levels of certain measures of age-related decline when scientists have restricted their food intake. No one has been able to show yet that the same effect happens in humans, though some studies are under way.

When calories or certain nutrients are restricted, scientists detect less oxidative damage in animal cells and a slower decline in DNA repair, a decline that normally occurs with age. It's thought that limiting oxidative damage and slowing the decline in DNA repair could help postpone or avoid many age-related diseases.

But scientists know relatively little about why reducing food intake causes these effects. In the last 10 years, they have made progress in identifying genes and associated proteins that are suppressed when diet is restricted. By learning more about the cell processes involved, they may be able to discover targets for future drugs that could delay aging without the need to restrict food intake.

Drugs tailored to block specific genes or proteins involved in nutrient-sensing pathways would have much more appeal than reducing what one eats. To achieve anti-aging benefits, it's thought that people would have to restrict food intake by 30 to 40 percent, a grim prospect. In addition, drugs might be designed to avoid other disadvantages of this level of dietary restriction, which include reduced fertility.

C. elegans is a tiny roundworm, a nematode whose two-week lifespan is a great advantage for scientists studying aging. The 1-millimeter-long transparent worms have other advantages, too. C. elegans exhibits many age-associated changes observed in higher organisms.

"Many genes identified in C. elegans to control the speed of aging turned out to be evolutionarily conserved, meaning that you can find them in other animals, too. And many are very similar to those found in humans," Hsu says.

Research details

Hsu and his team created different mutant strains of roundworms, some with drr-2 genes silenced and others in which the gene was over-expressed. They wanted to learn whether inactivating drr-2 is essential for TOR to influence longevity, and found that it was. Other newly discovered genes may affect TOR signaling as well. But Hsu's team has found a promising lead for anti-aging drugs of the future: They were able to show that silencing drr-2's action alone was sufficient to make worms live longer than wild-type C. elegans used as controls.

"It is known that reduction of TOR signaling in response to a change in the environment or genetic manipulation triggers a cascade of cellular signals that alter cell growth, metabolism, and protein synthesis, and decrease the pace of aging," says Hsu. "Our recent studies have shown that drr-2 might play a pivotal role in the TOR signaling network to control protein synthesis as well as longevity."

Additional U-M authors: Tsui-Ting Ching, Alisha B. Paal, Avni Mehta, and Linda Zhong, all of the Division of Geriatric Medicine, U-M Department of Internal Medicine Funding: Ellison Medical Foundation and the National Institutes of Health

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Journal Reference:

1. # Tsui-Ting Ching, Alisha B. Paal, Avni Mehta, Linda Zhong and Ao-Lin Hsu. drr-2 encodes an eIF4H that acts downstream of TOR in diet-restriction-induced longevity of C. elegans. Aging Cell, 2010;
   

Dysphagia found to increase length of hospital stay and mortality risk

Underdiagnosed swallowing condition causes complications in hospitalized patients

18 aug 2010--Researchers from Mount Sinai School of Medicine have found that hospitalized patients with dysphagia, or difficulty swallowing, averaged a 40 percent longer hospital stay than patients without the condition. They also had a generally poorer prognosis. The research is published in the August issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.

The researchers evaluated more than 77 million hospital admissions during 2005-2006, 271,983 of which were associated with dysphagia, as indicated by the National Hospital Discharge Survey (NHDS). The median number of days in the hospital for patients with dysphagia was 4.04, compared to 2.40 days for patients without dysphagia. Mortality increased significantly in patients with dysphagia and disk disorders or heart disease, and those undergoing rehabilitation had a greater than 13-fold increased risk of mortality. Patients ages 75 and older were twice as likely to have dysphagia.

"Our study shows that dysphagia has a significant impact on length of stay and prognostic indicators," said Kenneth W. Altman, MD, PhD, Associate Professor of Otolaryngology, lead author on the study. "Early identification of dysphagia and therapeutic intervention are critical to preventing further complications in these patients and reducing length of stay. These data indicate the necessity for health care providers to prevent or diagnose this condition early to reduce complications."

The impact of dysphagia on hospital resources was also substantial. Patients with dysphagia are often at risk of aspirating, which often requires antibiotic use and intubation. The increased mortality risk associated with the condition also increases end-of-life costs. Using a measurement tool previously developed for community-acquired pneumonia, the researchers estimated the cost of dysphagia at nearly $550 million over the two year period.

"With our country moving into a value-based health care system, we will truly feel the impact of the costs associated with dysphagia," said Dr. Altman. "As such, it's important to develop strategies to prevent and treat this debilitating condition to reduce those costs."

Dysphagia is present with a number of serious conditions, which may contribute to mortality risk. The most common conditions associated with dysphagia were stroke, aspiration pneumonia, urinary tract infection, esophageal disease, fluid or electrolyte disorder, and congestive heart failure. Patients with these conditions are especially susceptible to aspiration. The authors emphasize that dysphagia is severely underreported, due to minor cases not being documented, or clinicians seeing it as a side effect of another condition rather than a condition itself.

"Hospitals should implement assessment tools to identify dysphagia in high risk patients, including the elderly, stroke and rehabilitation patients, and patients with malnutrition, neurodegenerative disease, pneumonia, or heart disease," said Dr. Altman. "At Mount Sinai, we are making every effort to identify these patients early to prevent further complications."

Immune system gene linked with Parkinson's: study

CHICAGO, 17 aug 2010– A gene linked with the immune system may play a role in developing Parkinson's disease, researchers said on Sunday, marking a possible advance in the search for effective treatments.

They said a gene in the human leukocyte antigen region or HLA -- which contains a large number of genes related to immune system function -- was strongly linked with Parkinson's disease.

"That means the immune system probably plays a role in your body developing Parkinson's disease," said Dr. Cyrus Zabetian of the University of Washington and Veteran's Administration Puget Sound Health Care System, whose study appears in the journal Nature Genetics.

Zabetian said there had been hints that the immune system may be linked to Parkinson's disease, a neurodegenerative disease that affects 1 to 2 percent of people over age 65.

"This is the best evidence we've seen so far," Zabetian said in a telephone interview.

The finding came from a large, long-term study of more than 2,000 Parkinson's disease patients and 2,000 healthy volunteers from clinics in Oregon, Washington, New York and Georgia.

Parkinson's sufferers have tremors, sluggish movement, muscle stiffness and difficulty with balance.

Researchers looked at clinical, genetic and environmental factors that might contribute to the development and progression of Parkinson's disease and its complications.

"We found strong evidence that a gene within the HLA region is associated with Parkinson's disease," Zabetian said.

HLA genes play an important role in helping the body discern between foreign invaders and the body's own tissues.

"We don't know specifically which gene because there is a cluster of genes in that region, but it is the first really strong link that the immune system plays a role," he said.

That may mean infections, inflammation or an auto-immune response play some role in the development of Parkinson's disease, Zabetian said.

"What this allows us to do is to hone in on the immune system," he said.

Although current medical treatments may improve symptoms, none can slow or halt the progression of the disease.

The study was funded in part by the National Institute of Neurological Disorders and Stroke, one of the National Institutes of Health.

CHC/IHF: Two Newer BP Drugs Not Better Than Diuretic

Extended ALLHAT study shows lisinopril, amlodipine not superior to chlorthalidone

16 aug 2010-- The ACE inhibitor lisinopril and the calcium channel blocker amlodipine are no better than the older, cheaper diuretic chlorthalidone for lowering blood pressure and preventing cardiovascular disease, according to research presented at the China Heart Congress and International Heart Forum, held from Aug. 12 to 15 in Beijing.

Paul Whelton, M.D., of the Loyola University Health System in Maywood, Ill., and chairman of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), reported the findings from the trial, which used data from participants (initial results published in 2002) who were followed for an additional four to five years. The original ALLHAT data showed that chlorthalidone, which costs only $25 to $40 per year, was superior to the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure, and overall cardiovascular disease.

In the new study, the differences in treatment effect between the chlorthalidone group and the other two groups were smaller than they were previously, but there was no evidence of any superiority of the ACE inhibitor or the calcium channel blocker in terms of prevention of major cardiovascular disease events.

The researchers "are continuing to mine data that we collected during the trial," Whelton said in a statement.

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Brain fitness programs may help frail elderly walk faster

13 aug 2010– Computerized brain fitness programs are known to help seniors improve their memory and focus. Now, a study led by researchers at Albert Einstein College of Medicine of Yeshiva University has found preliminary evidence that such programs may help frail seniors walk faster, potentially preventing disability and improving quality of life. Results appear in the July 19 online edition of the Journal of Gerontology.

The researchers recruited 20 frail seniors (aged 70 or older) who were sedentary (exercised once a week or less) and walked slowly (a speed of one meter per second or less). Ten of the seniors (the intervention group) participated in the Mindfit brain fitness program three times weekly for eight weeks, with each training session lasting from 45 to 60 minutes. During the sessions, they carried out tasks aimed at sharpening cognitive abilities such as focusing, planning, organizing and problem solving. The other 10 seniors constituted the control group.

Compared with their speeds at the start of the study, the 10 seniors in the intervention group improved their normal-walking velocity, although the gain was not statistically significant. For walking while talking – which requires considerably more concentration than normal walking – the seniors who took computer training notably improved compared with their initial speeds. By contrast, no improvement in walking speed was observed for the control group.

"This was a small study – we're now preparing to do a larger clinical trial – but the results suggest that brain fitness programs show promise for helping the frail elderly walk better," says lead author Joe Verghese, M.D., professor in the Saul R. Korey Department of Neurology and the Murray D. Gross Memorial Faculty Scholar in Gerontology at Einstein.

The findings, if duplicated in a larger study, could have important implications since the frail elderly are often in poor health and unable to participate in exercises that build strength and improve balance. Intervening through brain fitness programs could provide a useful alternative.

Three Genotypes Confirmed as Alzheimer's Disease Risk Loci

CR1, CLU, and PICALM confer risk for AD; plasma β-amyloid associated with faster cognitive decline

12 aug 2010-- Three specific genotypes at CLU, PICALM, and CR1 confer risk for Alzheimer's disease (AD), and an apolipoprotein E genotype, APOE ε4, interacts synergistically in those who also have the PICALM variant, according to a study published online Aug. 9 in the Archives of Neurology. A related study in the same issue clarifies the association between plasma β-amyloid (Aβ) and various aspects of cognition.

Gyungah Jun, Ph.D., of Boston University, and colleagues conducted a meta-analysis of studies on AD and the CLU, PICALM, CR1, and APOE genotypes. They included studies with 8,169 elderly cognitively normal controls and 7,070 cases with AD from four ethnic groups (whites, African-Americans, Israeli-Arabs, and Caribbean Hispanics). CLU, PICALM, and CR1 were associated with AD in whites, but not in other ethnicities. The Arab cohort and all except one small white cohort had significant associations between AD and APOE ε4. After adjustments for the presence of APOE ε4, age, and sex, there was reduced evidence for association of AD with PICALM but not CR1 or CLU.

In another study, Stephanie A. Cosentino, Ph.D., of the Columbia University Medical Center in New York City, and colleagues studied 888 ethnically diverse individuals who had two Aβ samples and were free of dementia at the first sample. The study subjects had three visits over about four and a half years; 481 stayed cognitively healthy, 329 were cognitively or functionally impaired but never demented, and 70 developed AD. The researchers found that high baseline plasma Aβ42 and Aβ40 were related to faster cognitive decline in several domains, as was decreasing or relatively stable Aβ42. In cognitively healthy subjects, high baseline plasma Aβ42 and relatively stable or decreasing Aβ42 were also related to faster decline, especially in memory.

"The association between plasma Aβ and multiple aspects of cognition more clearly specifies the previously documented downward trajectory of plasma Aβ with AD onset. The predominant association with memory seen only in healthy elderly individuals also suggests that plasma Aβ is linked with even earlier neurologic changes that may or may not culminate in dementia," Cosentino and colleagues write.

Authors of the first study disclosed financial ties to pharmaceutical and medical device companies.

Abstract - Jun
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Abstract - Cosentino
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