Walking 6 to 9 Miles a Week May Help Save Memory

17 oct 2010-- Walking about six miles a week appears to protect against brain shrinkage in old age, which in turn helps stem the onset of memory problems and cognitive decline, new research reveals.

"We have always been in search of the drug or the magic pill to help treat brain disorders," noted Kirk I. Erickson, an assistant professor of psychology at the University of Pittsburgh and the study's lead author. "But really what we are after may be, at least partially, even simpler than that. Just by walking regularly, and so maintaining a little bit of moderate physical activity, you can reduce your likelihood of developing Alzheimer's disease and [can] spare brain tissue."

A report on the research, which was supported by the U.S. National Institute on Aging, is published online Oct. 13 in Neurology.

Erickson and his colleagues began tracking the physical activity and cognitive (or thinking) patterns of nearly 300 adults in 1989. At the start, all participants were in good cognitive health, they averaged 78 years old and about two-thirds were women. The researchers charted how many blocks each person walked in a week.

Nine years later, they were given a high-resolution MRI scan to measure brain size. All were deemed to be "cognitively normal."

But four years after that, testing showed that a little more than one-third of the participants had developed mild cognitive impairment or dementia.

By correlating cognitive health, brain scans and walking patterns, the research team found that being more physically active appeared to marginally lower the risk for developing cognitive impairment.

But more specifically, they concluded that the more someone walks, the more gray matter tissue the person will have a decade or more down the road in regions of the brain -- namely the hippocampus, the inferior frontal gyrus and the supplementary motor area -- that are central to cognition.

And among the more physically active participants who had retained more gray matter a decade out, the chances of developing cognitive impairment were cut in half, the study found.

However, the researchers stressed that the relationship between walking and gray matter volume appears to apply only to people who regularly walk relatively long distances that equal about six to nine miles a week.

Walking more than the six- to nine-mile range, however, did not have cognitive benefit, the study found.

"That's because the size of our brain regions can only be so large," Erickson said, adding that the opposite isn't true. "So with no exercise, there can be significant deterioration and decay with age."

However, he added, "what we often tend to think of as an inevitable component or characteristic of aging -- memory decline and brain decay -- is clearly not inevitable. There's plenty of evidence now, and this study is part of that, that shows that we can retain our brain tissue and retain our memories well into late adulthood by maintaining an active and engaged lifestyle."

Dr. Steven V. Pacia, chief of neurology at Lenox Hill Hospital in New York City, described the study's finding as both "intriguing" and an "undoubtedly positive message to send to the public."

"My first reaction to studies like this is that only in America do we have to prove to people that it's good to walk," he said with a chuckle.

"But it stands to reason that being active as we age is going to have a beneficial effect on the brain, just as being inactive is going to have a negative impact," Pacia noted. "Because the brain lives in the environment of the body."

But there may be a catch. "This is just an observational study," Pacia noted. "And while we may assume that the relationship between the brain and activity is a prevention-of-atrophy issue -- just like it is with muscle and bone -- this study doesn't actually prove that. We don't yet know enough about the use-it-or-lose-it notion with respect to brain and exercise. So we do need more research to look at that."

Chest-Compression-Only CPR Should Be Recommended

Emergency medical services shouldn't advise bystanders to perform CPR with mouth-to-mouth

16 oct 2010-- Chest-compression-only cardiopulmonary resuscitation (CPR) should be recommended by emergency medical services to bystanders caring for individuals experiencing out-of-hospital cardiac arrest rather than standard CPR with mouth-to-mouth, according to research published online Oct. 15 in The Lancet.

Michael Hupfl, M.D., of Medical University of Vienna in Austria, and colleagues systematically reviewed studies in which chest-compression-only bystander CPR was compared with standard bystander CPR for adult patients with out-of-hospital cardiac arrest. The investigators completed a primary meta-analysis in which patients were randomized to receive one of the two CPR techniques, as well as a secondary meta-analysis of observational cohort studies.

In the primary meta-analysis, using pooled data from three randomized trials, the investigators found that chest-compression-only CPR was associated with an improved chance of survival as compared with standard CPR (14 percent versus 12 percent). The data also revealed that the absolute increase in survival was 2.4 percent and the number needed to treat was 41. No difference was found between chest-compression-only CPR and standard CPR in the secondary meta-analysis of seven observational cohort studies.

"Our findings support the idea that emergency medical services dispatch should instruct bystanders to focus on chest-compression-only CPR in adults with out-of-hospital cardiac arrest," the authors write. "However, whether chest-compression-only CPR should be recommended for unassisted lay bystander CPR is unclear."

One author disclosed financial ties to Roche Diagnostics and Gerson Lehrman Group, and another disclosed financial ties to St John's Ambulance Service in Vienna and Novo Nordisk.

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The Hispanic Mortality Paradox: Why Do Latinos Outlive Other Americans?

For the first time, the U.S. Department of Health and Human Services has collected national life expectancy data for the Hispanic population, and backed up the surprising findings of past studies: the average life expectancy of a Hispanic baby born in 2006 was 80.6 years. That's 2.5 years longer than the life expectancy for whites, 7.7 years longer than for blacks and nearly three years higher than the national average.

15 oct 2010--The results are interesting because the Hispanic population, which makes up 15% of the American public, has several characteristics that are traditionally associated with shorter life: more obesity, less education and more poverty; 18.9% of Latinos are poor, compared with 6.1% of whites. (One exception to the paradox: Hispanics' median income is higher than blacks', and fewer Hispanics than blacks are poor, making it unsurprising that average Hispanic life expectancy is higher.)

Trying to understand why Hispanics live longer is difficult because the Hispanic community as a whole is so diverse. But their diversity may well explain the mortality data. One statistical advantage may be the large number of Hispanic immigrants: 69% of the non-Mexican Latino population is foreign-born (49% of Mexican-Americans are foreign-born); it may be that healthier and longer-lived people tend to emigrate to other countries. Cubans immigrants, for example - who had their major migration to the U.S. in the 1950s - have a larger percentage of elderly individuals than American-born white or black communities.

Also, while the Hispanic population on average is poorer and less educated, income and education vary greatly between specific Hispanic communities. For instance, 25% of Dominicans fall below the poverty line and 15% have a college degree; by comparison, 25% of Cubans have graduated from college, while TK% of those of Spanish descent are poor.

Statisticians are scrambling to explain the Hispanic paradox, and as USA Today reports, the research is just beginning:

"I don't think anyone has a great idea," says Carl Haub, a demographer at the Population Reference Bureau. "We might want to see what Hispanics are doing and try to emulate them."

Solving the puzzle may help the nation deal with health care issues because Hispanics use health services less - they make fewer doctors visits and spend less time in hospitals, [David] Hayes-Baustista, [director of the Center for the Study of Latino Health and Culture at UCLA's David Geffen School of Medicine] says.

"It's clearly something in the Latino culture," he says. "If this was the 'healthy migrant effect,' we would see it in all immigrant groups. It seems to be something in what Latinos do."

The report acknowledged that misidentification of age and ethnicity on death certificates may have contributed some error to the data.

View this article on Time.com

Consensus reached on use of Parkinson's treatment

Since the late 1990s, deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, a cruel neurological disorder that can cause lack of control over movement, poor balance and coordination, and rigidity, among other symptoms.

14 oct 2010--The procedure is used only for patients whose symptoms cannot be adequately controlled with medications. A neurosurgeon uses magnetic resonance imaging or computed tomography to identify the exact target within the brain where abnormal electrical nerve signals generate the disease's tremors and other symptoms, and a neurostimulator is then surgically implanted to deliver electrical stimulation to that area to block the signals.

The goal, ultimately, is to improve the patient's quality of life.

Yet despite its effectiveness, there has been no consensus on several aspects of the use DBS, including which patients make the best candidates, where the optimal location for the placement of electrodes is, and the role that still exists for surgical removal of the damaged areas of the brain.

To address these concerns, a more than 50 DBS experts — including world-renowned neurologists, clinicians and surgeons — pooled their experience with the procedure and reached a consensus. The goal of this "meeting of the minds" was to better inform Parkinson's patients and their families about the potential of DBS treatment and to better inform the medical community in suggesting the procedure.

The results of their April 2009 meeting are presented in the current online edition of the journal Archives of Neurology.

"We know that very little accessible information is out there to help a Parkinson's patient make an informed decision as to whether he or she would be a good candidate for deep brain stimulation," said Jeff Bronstein, a UCLA professor of neurology and lead author of the report.

Surgical trials take a long time, he said, and what information is available on DBS appears in academic journals, is focused and limited, and is usually written by one group reflecting their biases.

Bronstein, who directs the UCLA Movement Disorder Program and is a member of the UCLA Brain Research Institute, said the results of the group's meeting will help clarify some of the issues about DBS treatment. Among their findings:

• The best candidates for DBS are those who can't tolerate the side effects of medications, who don't suffer from significant active cognitive or psychiatric problems, and who do suffer from tremors and/or motor fluctuations.


• DBS surgery is best performed by an experienced team and neurosurgeon with expertise in stereotactic neurosurgery — microsurgery deep within the brain that is based on a three-dimensional coordinate system using advanced neuroimaging.


• DBS, when used in the two most commonly treated areas of the brain — the subthalamic nuclei and the globus pallidus pars interna — is effective in addressing the motor symptoms of Parkinson's, but treatment in the subthalamic nuclei may cause increased depression and other symptoms in some patients.


• Surgical removal of the area of the brain causing Parkinson's disease is still an effective alternative and should be considered in patients.


• Surgical complication rates vary widely, with infection being the most commonly reported complication of DBS.

Multiple authors were involved in the report; Bronstein, the lead author, reports no conflict of interest.

Experts Propose New Lexicon for Alzheimer's Disease

AD redefined as a clinical-biological syndrome, allowing earlier diagnosis and targeted treatment

13 oct 2010-- The International Working Group for New Research Criteria for the Diagnosis of AD (Alzheimer's disease) has proposed a new lexicon as a point of reference for earlier diagnosis of AD patients in a position paper published online Oct. 11 in The Lancet Neurology.

Bruno Dubois, M.D., of the Institute for Memory and Alzheimer's Disease in Paris, and colleagues provide a broader diagnostic definition of AD as a clinical-biological syndrome. The definition aims to enable earlier diagnosis of AD by using biomarkers to diagnose patients with the condition instead of requiring a post-mortem examination.

According to the proposed lexicon, patients must present with episodic memory impairment and at least one positive biomarker shown on magnetic resonance imaging, neuroimaging with positron emission tomography, or cerebrospinal fluid analysis to meet the criteria for the diagnosis of AD. The authors write that the new definition could aid in selecting patients for trials of disease-modifying drugs and help in diagnosing patients at an earlier stage of disease to target treatment more effectively.

"The value of these definitions is their potential application in clinical trials of disease-modifying drugs," the authors write. "Individuals identified as 'asymptomatic at risk for AD' or 'presymptomatic AD' might be enrolled in trials aimed at delaying the onset of clinical signs. Patients with prodromal AD could be included in trials of drugs targeting progression to more severe stages of AD (AD dementia)."

Multiple authors disclosed financial relationships with medical device and pharmaceutical companies, including companies developing drugs for Alzheimer's disease.

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Physical symptoms prevalent no matter what stage of cancer including remission

INDIANAPOLIS,12 oct 2010 – Twenty-two physical symptoms associated with cancer – symptoms often unrecognized and undertreated – are prevalent in all types of cancers regardless of whether the patient is newly diagnosed, undergoing treatment or is a cancer survivor, according to researchers from the Regenstrief Institute and the Indiana University schools of medicine and nursing.

Common symptoms include fatigue, pain, weakness, appetite loss, dry mouth, constipation, insomnia and nausea. These physical symptoms are associated with substantial functional impairment, disability and diminished quality of life.

The study of 405 patients was reported in the Oct. 11, 2010, issue of the Archives of Internal Medicine. Numerous physical symptoms, rather than just a few, were prevalent in patients with cancer and this prevalence did not diminish after completion of therapy.

"We found that regardless of where they are in the course of their diseases, many individuals with cancer have a high symptom burden," said Kurt Kroenke, M.D., the study's principal investigator and first author. Dr. Kroenke is a Regenstrief Institute investigator and a Chancellor's Professor of Medicine in the IU School of Medicine.

"These symptoms impact them at home and at work throughout their lives," he said.

Study participants, all of whom had pain, depression or both, experienced substantial disability, reporting on average 17 of the past 28 days as either bed days or days in which they had to cut down on activities by at least 50%. Almost all patients reported feeling tired (97.5%) and most (78.8%) were bothered "a lot" by this symptom. Of the 22 symptoms studied, 15 were reported by more than half of the study participants.

In spite of high symptom prevalence, the researchers did not uncover greater use of the health care system. There may be several explanations for this including patients' inclinations to focus on cancer treatment while with their physicians or to accept the symptoms as an inevitable result of the disease or its treatment. Alternatively, the explanation may lie with the fact that those in the study, as cancer patients or former patients, were already frequently interacting with many parts of the health care system.

"Patients and their families should be encouraged to bring up symptoms like pain or insomnia with physicians. But because oncologists are necessarily focused on treatment of the cancer itself, they often have insufficient time to optimally evaluate and manage symptoms and other factors impacting quality of life. We have shown in an earlier study that one effective solution might be a partnership between a telephone-based symptom management team and community-based oncology practices,," said Dr. Kroenke, who is a research scientist with the Center for Implementing Evidence-Based Practice at the Richard Roudebush VA Medical Center and an Indiana University Melvin and Bren Simon Cancer Center member.

The previous study, published earlier in 2010 in the Journal of the American Medical Association, reported that an economical, centralized approach is feasible to conduct and significantly improved symptoms of pain and depression in patients in any phase of cancer. That approach gave patients, many of whom lived in underserved rural areas, one-stop assistance they probably wouldn't have had access to unless they went to a major cancer center, Kroenke said.

Recognizing and managing physical symptoms such as fatigue, pain, nausea, and insomnia may make a significant difference regardless of type or phase of cancer. The researchers plan to investigate medical and behavioral strategies and combinations of both approaches to control these symptoms.

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In addition to Dr. Kroenke, co-authors of "Somatic Symptoms in Patients with Cancer Experiencing Pain or Depression" are "Xin Zhong, R.N. and Janet Carpenter, Ph.D., R.N., of the IU School of Nursing; Dale Theobald, M.D., Ph.D. of Community Home Health Hospice and Symptom Management Group; Jingwei Wu, M.S., of the IU School of Medicine; and Wanzhu Tu, Ph.D., of the Regenstrief Institute and the IU School of Medicine.

The study was supported by a grant from the National Cancer Institute.

MRI may predict continued decline in patients with mild cognitive impairment

OAK BROOK, Ill.,11 oct 2010 – Using advanced MRI and an artificial intelligence technique, researchers in Geneva, Switzerland, have identified a method that may help identify which individuals with mild cognitive impairment (MCI) will continue to decline, according to a study published online and in the December issue of Radiology.

"We know that about half of all individuals with early-stage mild cognitive impairment will progress to Alzheimer's disease," said lead researcher Sven Haller, M.D, M.Sc., a radiologist at University Hospitals of Geneva. "But not knowing which patients will continue to decline makes it difficult to treat Alzheimer's early in the disease process."

Haller and a team of researchers used two novel techniques to image the brains of 35 control participants (mean age 63.7) and 69 patients with MCI (mean age 65 years), including 38 women and 31 men. Patients were diagnosed with MCI based on a battery of neuropsychological tests, which were repeated on 67 of the patients one year later to determine whether their disease was stable (40 patients) or progressive (27 patients).

Using an advanced technique called susceptibility-weighted MRI, the researchers were able to generate scans with greater detail of the many blood vessels in the brain, including the presence of tiny leaks called microhemorrhages or microbleeds.

"The number of cerebral microbleeds was significantly higher in the individuals with mild cognitive impairment than those in the control group," Dr. Haller said.

The MRI scans revealed microbleeds in 33 percent of individuals with stable MCI and 54 percent of those with progressive MCI. Only 14 percent of the control participants had microbleeds.

The susceptibility-weighted MRI also revealed that compared to the control participants, individuals with MCI had significantly increased iron concentration in certain areas deep within the structure of the brain and reduced levels of iron in others.

"Altered iron distribution in the subcortical nuclei was another distinguishing feature between the healthy control individuals and patients with mild cognitive impairment," Dr. Haller said.

Haller's team also analyzed the MRI data with support vector machines (SVM), an artificial intelligence technique that uses algorithms to identify patterns within a group and create classifications. SVM analysis of baseline MRI data acquired at the initial exam distinguished patients with progressive MCI from those with stable MCI with 85 percent accuracy.

"The goal of my work is to identify biomarkers of mild cognitive impairment that will help us diagnose individual patients at risk for further decline," Dr. Haller said. "Using SVM to analyze iron deposits in the brain may be such a biomarker."

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"Cerebral Microhemorrhage and Iron Deposition in Mild Cognitive Impairment: Susceptibility-weighted MR Imaging Assessment." Collaborating with Dr. Haller were Andreas Bartsch, M.D., Duy Nguyen, M.D., Cristelle Rodriguez, M.R.Psychol., Joan Emch, M.R.Psychol., Gabriel Gold, M.D., Karl O. Lovblad, M.D., and Panteleimon Giannakopoulos, M.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (http://radiology.rsna.org/)

Americans' life expectancy continues to fall behind other countries'

Obesity, smoking, traffic fatalities and homicide ruled out as causes of failure of US to keep up with gains in life expectancy in other countries

10 oct 2010—The United States continues to lag behind other nations when it comes to gains in life expectancy, and commonly cited causes for our poor performance—obesity, smoking, traffic fatalities, and homicide—are not to blame, according to a Commonwealth Fund-supported study published today as a Health Affairs Web First. The study, by Peter Muennig and Sherry Glied at Columbia University, looked at health spending; behavioral risk factors like obesity and smoking; and 15-year survival rates for men and women ages 45 and 65 in the U.S. and 12 other nations (Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, and the United Kingdom).

While the U.S. has achieved gains in 15-year survival rates decade by decade between 1975 and 2005, the researchers discovered that other countries have experienced even greater gains, leading the U.S. to slip in country ranking, even as per capita health care spending in the U.S. increased at more than twice the rate of the comparison countries. Fifteen-year survival rates for men and women ages 45 and 65 in the US have fallen relative to the other 12 countries over the past 30 years. Forty-five year old U.S. white women fared the worst—by 2005 their 15-year survival rates were lower than that of all the other countries. Moreover, the survival rates of this group in 2005 had not even surpassed the 1975 15-year survival rates for Swiss, Swedish, Dutch or Japanese women. The U.S. ranking for 15-year life expectancy for 45-year-old men also declined, falling from 3rd in 1975 to 12th in 2005, according to the study, "What Changes in Survival Rates Tell Us About U.S. Health Care."

When the researchers compared risk factors among the 13 countries, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, the U.S. had faster declines in smoking between 1975 and 2005 than almost all of the other countries. In terms of obesity, the researchers found that, while people in the U.S. are more likely to be obese, this was also the case in 1975, when the U.S. was not so far behind in life expectancy. In fact, even as the comparison countries pulled ahead of the US in terms of survival, the percentage of obese men and women actually grew faster in most of those countries between 1975 and 2005. Finally, examining homicide and traffic fatalities, the researchers found that they have accounted for a stable share of U.S. deaths over time, and would not account for the significant change in 15-year life expectancy the study identified.

The researchers say that the failure of the U.S. to make greater gains in survival rates with its greater spending on health care may be attributable to flaws in the overall health care system. They point to the role of unregulated fee-for-service payments and our reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.

"It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them," said lead author Peter Muennig, assistant professor at Columbia University's Mailman School of Public Health. "But what really surprised us was that all of the usual suspects—smoking, obesity, traffic accidents, and homicides—are not the culprits. The U.S. doesn't stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy."

"This study provides stark evidence that the U.S. health care system has been failing Americans for years," said Commonwealth Fund President Karen Davis. "It is unacceptable that the U.S. obtains so much less than should be expected from its unusually high spending on health care relative to other countries." The good news is that the Affordable Care Act will take significant steps to improve our health care system and the health of Americans by expanding health insurance, improving primary care, and holding health care organizations accountable for their patients' overall health and ensuring the coordination of primary care and specialty care to eliminate errors, waste of patients' time, and wasteful duplication of tests and services."

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The article is available on the Health Affairs Web site at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0073.

Informant-Based Tool Is Good Screen for Alzheimer's

AD8 screen correlates strongly with Alzheimer's disease biomarkers

09 oct 2010 -- A brief informant-based dementia assessment can identify Alzheimer's disease better than more traditional methods and may be a lower-cost alternative for Alzheimer's screening, according to a report published online Sept. 7 in Brain.

James E. Galvin, M.D., of Washington University in St. Louis, and colleagues developed and tested a new, brief dementia screening test -- the Ascertain Dementia 8 (AD8) questionnaire, which is administered to friends or family members who know the patient very well -- to ascertain observed changes in memory and behavior in 257 patients. The purpose of the study was to validate the AD8 against traditional biomarkers, such as those found in spinal fluid assays and brain plaque scans, as well as cognitive testing methods for Alzheimer's disease screening.

The researchers found that patients who had positive AD8 scores had abnormal Pittsburgh compound B binding and cerebrospinal fluid biomarkers compared with individuals who had negative AD8 scores. The AD8 was also better at detecting early stages of dementia than the Mini Mental State Examination.

"We found a strong relationship between the AD8, a brief, informant-based dementia screening tool, and biomarkers of Alzheimer's disease. Individuals with AD8 scores of greater than or equal to two had a biomarker phenotype (positive PiB binding, low CSF Aβ42, high tau, high tau phosphorylated at threonine 181) consistent with Alzheimer's disease," the authors write. "A positive AD8 screening test corresponded to lower performance on tests of episodic memory, supporting a clinical phenotype of Alzheimer's disease."

Two of the authors hold the copyright for the AD8; another author is a consultant for Avid Radiopharmaceuticals.

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Tinnitus in the elderly is prevalent and impacts quality of life

Alexandria, VA, 08 oct 2010 — Tinnitus is common among elderly Nigerians and associated with treatable health conditions like otitis media, rhinosinusitis, head injury and hypertension, according to new research published in the October 2010 issue of Otolaryngology – Head and Neck Surgery.

Nearly 36 million Americans, however, suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. In Nigeria, tinnitus affects between 10.1% and 33% of the population, with about 3 to 4% consulting a doctor on at least one occasion in their lifetime. Its effect makes it a significant contributor to morbidity in the elderly.

The study included face-to-face interviews of 1,302 elderly people aged 65 years and over; age, sex, economic status or residence were not associated with the occurrence of tinnitus. The researchers found a significant difference between the prevalence of tinnitus among "young elderly" subjects aged 65-69 (6.5%), and the older (80+ years) group (41.9 %). Also in this study, a non-significant trend was observed for the prevalence of tinnitus to increase with decreasing socioeconomic and educational level.

"Our results are of potential value in the overall consideration of the health consequence of aging in this setting, especially given the projections of a rapid increase in the proportion of the elderly in developing countries," said study author Akeem Olawale Lasisi, MBChB, FWACS, FMCORL.

In spite of its public health significance, tinnitus among the elderly has received poor research attention in Sub-Saharan Africa where, with relatively poor access to health service, etiologically important medical conditions that would otherwise be readily treated could become chronic and increase vulnerability to tinnitus. In this study, the authors focused on subjective tinnitus; in selecting risk factors to study, they speculated that the presence of chronic recurrent rhinosinusitis may lead to eustachian tube dysfunction, hence middle ear pressure dysregulation and tinnitus. In addition, chronic medical conditions predisposing to arteriosclerosis have been considered as correlates because when untreated or complicated (as often found in this area), they might lead to hypoperfusion of the cochlear and dysregulation of inner ear fluid dynamics, which could then cause tinnitus. Furthermore, control of these risk factors may help in ameliorating tinnitus and improving quality of life, which would be a significant benefit to the majority of the elderly.

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Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF). The study's authors are Akeem Olawale Lasisi, MBChB, FWACS, FMCORL; Taiwo Abiona, MSc; Oye Gureje, MBBS, PhD,

AACR: Memory Problems May Plague Cancer Survivors

40 percent more likely to report memory problems severe enough to affect daily functioning

07 oct 2010-- Cancer survivors are more likely than those with no cancer history to experience memory problems that thwart daily activities, according to research presented at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities, held from Sept. 30 to Oct. 3 in Miami.

Michael Antoni, Ph.D., of the University of Miami Miller School of Medicine, and colleagues analyzed data from a sample of 9,819 respondents to the National Health and Nutrition Examination Survey to determine the prevalence of memory impairment in cancer and non-cancer populations.

The researchers found that memory problems were reported more often by the 1,305 respondents who had cancer or a history of cancer than by those who did not, at 14 and 8 percent, respectively. Cancer history was also independently associated with memory impairment (odds ratio, 1.5). Those with cancer were 40 percent more likely to have memory problems severe enough to interfere with daily functioning.

"These memory issues can be related to treatment, such as chemotherapy, radiation, and hormone therapies, or to the tumor biology itself, which could change brain chemistry and neurobehavioral function," a co-author of the research said in a statement.

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Mortality Predictors for Parkinson's Disease Identified

Dementia, psychosis, motor severity, and age at onset among independent predictors

06 oct 2010-- Age at onset (AAO), chronological age, presence of dementia, motor severity, and psychosis are among the independent factors predictive of mortality in Parkinson's disease (PD) patients, according to research published in the Oct. 5 issue of Neurology.

Elin Bjelland Forsaa, M.D., of the Stavanger University Hospital in Norway, and colleagues analyzed assessments of motor and non-motor symptoms from 1993 to 2005 in 230 patients with PD to identify risk factors for mortality during a long-term follow-up.

The researchers found AAO, chronological age, male sex, Unified Parkinson's Disease Rating Scale motor score, psychotic symptoms, and dementia to be independent predictors of mortality; 211 patients (92 percent) died during the study period, and the median survival time from onset of motor symptoms was 15.8 years, ranging from 2.2 to 36.6 years.

"This population-based long-term study demonstrates that in addition to AAO, chronological age, motor severity, and dementia, psychotic symptoms independently predict increased mortality in PD. In contrast, no significant impact of antipsychotic or antiparkinsonian drugs on survival was observed in our PD cohort. Early prevention of motor progression and development of psychosis and dementia may be the most promising strategies to increase life expectancy in PD," the authors write.

Two authors disclosed financial relationships with pharmaceutical companies.

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Informatics = essential M.D. competency

JAMA article recommends biomedical informatics in education of physicians

		IMAGE: Dr. Edward H. Shortliffe is the president and CEO of AMIA, a professional association for informatics professionals; an emerging field in health care that supports clinical decision-making and...

05 oct 2010--In an article published in the Sept. 15 edition of the Journal of the American Medical Association, (JAMA), author Edward H. Shortliffe, MD, PhD, points out that although information underlies all clinical work, and despite the growing role that information management and access play in healthcare delivery and clinical support, there is a dearth of informatics competency being developed in America's future corps of physicians. Formalized education in the application of informatics and the use and methodologies of health information technology and exchange, Dr. Shortliffe observes, is not typically a specific part of medical education.

In his article, "Biomedical Informatics in the Education of Physicians," Dr. Shortliffe writes that knowledge management is key to clinical decision-making and yet "a coherent approach to information and knowledge management and their application has generally not been part of medical education." He identifies and defines the formal discipline missing from medical school curricula: biomedical and health informatics, defined as "the interdisciplinary, scientific field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem-solving and decision-making, motivated by efforts to improve human health."

Biomedical informatics has four major areas of applications, Dr. Shortliffe writes: bioinformatics, encompassing molecular and cellular processes; imaging informatics (of tissues and organ systems); clinical informatics, which relates to individuals and patients; and public health informatics, which focuses on populations and society (e.g., disease control, epidemic surveillance, vaccine development). More specific subareas also contribute to the major applications: nursing informatics, pharmacogenomics, and consumer health informatics, to name a few.

Dr. Shortliffe observes that medical students need to learn both the practical applied side of informatics and the core concepts that will remain valuable throughout careers practicing medicine or conducting research in the computer age. To function successfully as physicians, medical students also need to learn about the value and role of online bibliographic databases, the role of order-entry systems, electronic health records, regional data exchanges, telemedicine and other current informatics applications in health and medicine, says Shortliffe.

"Biomedical informatics is not a topic that is optimally taught in a single course during the preclinical years," says Dr. Shortliffe, "but rather should be blended into the four-year curriculum. . ..with the use of clinical examples and challenges to motivate and direct the grasp of informatics concepts."

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Dr. Shortliffe is a professor in the School of Biomedical Informatics at UTHealth, Houston, and editor-in-chief of the Journal of Biomedical Informatics. He is also President and CEO of the American Medical Informatics Association (AMIA), the leading professional association of informatics professionals and an important player in medicine, health care, and science, that serves as the voice of the nation's top biomedical and health informatics professionals.

Women's study finds longevity means getting just enough sleep

A new study, derived from novel sleep research conducted by University of California, San Diego researchers 14 years earlier, suggests that the secret to a long life may come with just enough sleep. Less than five hours a night is probably not enough; eight hours is probably too much.

04 oct 2010--A team of scientists, headed by Daniel F. Kripke, MD, professor emeritus of psychiatry at UC San Diego School of Medicine, revisited original research conducted between 1995 and 1999. In that earlier study, part of the Women's Health Initiative, Kripke and colleagues had monitored 459 women living in San Diego (ranging in age from 50 to 81) to determine if sleep duration could be associated with mortality.

Fourteen years later, they returned to see who was still alive and well.

Of the original participants, 444 were located and evaluated. Eighty-six women had died. Previous studies, based upon questionnaires of people's sleep habits, had posited that sleeping 6.5 to 7.5 hours per night was associated with best survival. Kripke and colleagues, whose 1990s research had used wrist activity monitors to record sleep durations, essentially confirmed those findings, but with a twist.

"The surprise was that when sleep was measured objectively, the best survival was observed among women who slept 5 to 6.5 hours," Kripke said. "Women who slept less than five hours a night or more than 6.5 hours were less likely to be alive at the 14-year follow-up."

The findings are published online in the journal Sleep Medicine.

Kripke said the study should allay some people's fears that they're not getting enough sleep. "This means that women who sleep as little as five to six-and-a-half hours have nothing to worry about since that amount of sleep is evidently consistent with excellent survival. That is actually about the average measured sleep duration for San Diego women."

Researchers uncovered other interesting findings as well. For example, among older women, obstructive sleep apnea (pauses in breathing during sleep) did not predict increased mortality risk. "Although apneas may be associated with increased mortality risk among those under 60, it does not seem to carry a risk in the older age group, particularly for women," Kripke said.

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Co-authors of the study include Robert D. Langer of the Jackson Hole Center for Preventive Medicine; Jeffrey A. Elliot and Katharine M. Rex of the UCSD Department of Psychiatry; and Melville R. Klauber of the UCSD Department of Family and Preventive Medicine.

New depression guidelines favor tailored treatment

CHICAGO, 03 oct 2010 - New depression treatments favor a tailored approach and include recommendations for the use of shock therapy and other alternatives, including exercise when people fail to get relief from drugs.

The guidelines, issued on Friday by the American Psychiatric Association, are the first update on depression treatment in more than a decade.

"The five-year process of intense review, discussion and thoughtful revision-making has led us to today's release of new guidelines that we believe will improve patient care," Dr. Alan Gelenberg, an Arizona-based psychiatrist who led the group that drafted the guidelines, said in a statement.

"We are hopeful these guidelines will lead to improved lives for many patients."

The panel searched more than 13,000 scientific articles published between 1999 and 2006 to craft the new guidelines.

Among the changes, the researchers recommend:

* Doctors should use rating scales to assess their patients' conditions and tailor treatment according to the severity of symptoms. They can adjust various strategies such as medication, healthy behaviors, exercise and therapy.

* For people who repeatedly fail to benefit from drugs, the guidelines recommend use of electro-convulsive or so-called shock therapy, which has the most scientific data supporting its use.

* The recommendations also added newer treatments, including transcranial magnetic stimulation, which uses highly focused, pulsed magnetic fields to restore function to stimulate brain regions linked with depression.

Privately held Neurotonics Inc's NeuroStar device was approved for this use by the U.S. Food and Drug Administration in 2008.

* Researchers also recommend use of vagus nerve stimulation, such as a device made by Cyberonics Inc, which delivers electrical stimulation to the vagus nerve, a major nerve linking the brain to internal organs.

* The guidelines also recommend regular exercise, which studies have shown can reduce depressive symptoms, especially in older adults or those with chronic medical problems.

* They recommend more frequent use of maintenance drug treatment, especially for people whose depression is likely to recur. This is especially important for people who have had three prior episodes of depression or chronic illness.

In a separate report, the U.S. Centers for Disease Control and Prevention said on Thursday that about 9 percent of U.S. adults surveyed in 2006 and 2008 had current symptoms of depression, including 3.4 percent who had symptoms of major depression, in which a person reports having five or more depressive symptoms for at least two weeks.

The survey included more than 235,000 people in 45 states, the District of Columbia and two U.S. territories.

Of these, only 4.8 percent of North Dakota residents were depressed, compared with 14.8 percent of those in Mississippi.

Overall, depression affects more than 13 million U.S. adults each year and costs billions of dollars to treat in costs for treatment, loss of productivity, workers compensation and death.

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.