Why older people are less astute drivers and how the answer could help us understand depression

A test subject has the medial temporal visual area (MT) of her brain temporarily weakened so that researchers can study how it affects her ability to detect motion. University of Rochester Professor Duje Tadin has found that the MT area is responsible for allowing humans to ignore background motion in their environments and instead focus in on more important motion of smaller objects in the foreground. Credit: University of Rochester

26 jan 2011--When elderly drivers get behind the wheel, they often confront the harrowing reality that they cannot easily see other cars, pedestrians, or cyclists moving around them. This frightening effect of aging, it turns out, is not necessarily a result of a reduced ability to perceive moving objects, as one might suspect, but a heightened awareness of the backdrop against which these objects move.

A team of scientists led by University of Rochester Professor Duje Tadin has isolated the cause of this phenomenon, and the surprising results could not only help train elderly people to be better drivers, but they could also help psychiatrists better understand abnormal brain processes in psychological conditions like depression and schizophrenia. Their research, conducted at the Berenson-Allen Center for Noninvasive Brain Stimulation at the Harvard Medical School, will be published in the Journal of Neuroscience on January 25.

In a healthy, young person, a brain region called the middle temporal visual area, or MT, actively suppresses often irrelevant background motion so that he or she can concentrate on the more important motions of smaller objects in the foreground. Previous studies have found that elderly people, as well as those with psychological conditions such as schizophrenia and depression, are better at perceiving motion in the background. But this above average motion perception is not something to look forward to as we age. Because the brain is spending its limited resources constantly paying attention to the unimportant motions of background objects, it has a harder time noticing the motions of smaller objects.

“The amount of visual information around us is huge, and we don’t have the brain power to process it all,” Tadin said. “Evolutionarily speaking, moving objects are the most important visual features to detect quickly, because they could be your lunch or they could want to eat you for lunch. It just makes sense that our vision prioritizes processing them.”

Tadin and his colleagues discovered that the MT was responsible for this effect by using a technique called Transcranial Magnetic Stimulation (TMS). By precisely placing magnetic coils on the back of a subject’s head, the scientists stimulated the MT with electrical signals for 15 minutes to temporarily inhibit its functioning. Then, while the MT was less active, they tested how well subjects identified motions of smaller and larger objects. They found that when the MT was inhibited, subjects had an easier time identifying the motion of large, background-like objects. These results indicate that an improperly functioning MT may be the cause behind better than normal perception of background motion in older adults.

This knowledge could be useful to psychiatrists trying to better diagnose schizophrenia and depression, Tadin says. Current diagnostic techniques for these conditions can involve subjective and qualitative information like a history of hallucinations or feelings of apathy. But if a person also exhibits better than normal detection of background motion, it could be a quantitative confirmation that he or she has one of these afflictions.

Provided by University of Rochester

Weight loss plus walking essential for older, obese adults

Walking more and losing weight can improve mobility as much as 20 percent in older, obese adults with poor cardiovascular health, according to a new Wake Forest University study.

25 jan 2010--The results from the five-year study of 288 participants appear online Jan. 24 in the Archives of Internal Medicine.

The combination of weight loss and physical activity is what works best. These findings run counter to the commonly held belief that it is unhealthy for older adults to lose weight.

"To improve mobility, physical activity has to be coupled with weight loss," said Jack Rejeski, Thurman D. Kitchin Professor of Health and Exercise Science. "This is one of the first large studies to show that weight loss improves the functional health of older people with cardiovascular disease."

The study addresses what to do to help seniors with poor mobility, but it also proves existing community agencies can be used effectively to get seniors the help they need.

"With 60 percent of adults over age 65 walking less than one mile per week and a rapidly growing population of older adults, the need for cost-effective community-based intervention programs to improve the mobility of seniors is critical," said Rejeski, principal investigator for the Cooperative Lifestyle Intervention Program (CLIP). Key co-investigators included Dr. David C. Goff and Walter T. Ambrosius from Wake Forest University School of Medicine, Peter Brubaker, professor of health and exercise science at Wake Forest, Lucille Bearon and Jacquelyn McClelland from North Carolina State University, and Michael Perri from the University of Florida.

"Community-based preventative programs are extremely important," Rejeski said.

The researchers partnered with the North Carolina Cooperative Extension and trained health care professionals at centers in three counties (Davidson, Forsyth and Guilford) to lead the programs along with an intervention team from Wake Forest. The participants, ranging in age from 60 to 79, were tracked over an 18-month period. The study divided participants into three groups: a control group who received education on successful aging, a physical activity only group, and a physical activity and weight loss group.

The physical activity group did well, but the most dramatic effect was found in the participants who combined an increase in physical activity with weight loss.

On average, they improved their mobility by 5 percent as measured by the time it took them to walk 400 meters. Those with the most limited mobility improved by as much as 20 percent.

The 400-meter walk is a widely used measure of mobility disability in older adults because for those who cannot walk this distance the likelihood of losing their independence increases dramatically.

Rejeski uses this analogy for the loss of mobility in seniors who often don't realize its seriousness. "It is like being in a canoe paddling down a river and being completely unaware that a waterfall is only a short distance away. Once your canoe starts down the waterfall of disability, the consequences are severe."

The waterfall is the cascade of adverse outcomes including hospitalizations, worsening disability, institutionalization, and death that are more likely when seniors lose the basic ability to get around. Seniors with limited mobility require significantly more high-cost medical care.

"Clearly the ability to walk without assistance is a critical factor in an older person's capacity to function independently in the community," he said. "The next step is to develop a model that can be replicated at similar sites across the state and the country and we look forward to working with our colleagues from North Carolina to achieve this goal."

Provided by Wake Forest University

Youth adapt faster than seniors to unexpected events

Does experience give seniors an edge in reacting to sudden change or are younger people quicker to respond? A new study from Concordia University shows that when a routine task is interrupted by an unexpected event, younger adults are faster at responding. Published in the Journal of Gerontology, the findings have implications for educators and for older adults in situations where performance is crucial.

24 jan 2011--"When we frequently perform a task, our reactions become automatic," says Kevin Trewartha, first author and a PhD student in Concordia's Department of Psychology and a researcher at the Centre for Research in Human Development. "For example, experienced drivers are often 'on autopilot' when they're behind the wheel, but they do just fine, unless something unexpected happens. We're interested in reaction speeds in different age groups when something unexpected does occur while someone is performing a routine task."

Some 40 participants took part in the study: half were 19 to 36 years old, while the other half were 60 to 75 years old. Each participant was asked to follow visual cues on a computer screen and press corresponding keys on a piano keyboard. Some sequences were repeated frequently so that participants learned to expect them, while other sequences were randomly added at intervals to create unexpected sequences.

Reaction in older adults

"Older adults were less able to overcome their habitual responses when unexpected sequences arose," says Trewartha. "They were also slower in learning to adapt. They didn't improve as much as younger adults when they were asked to vary their learned routine on multiple occasions."

The study is one of the first to use 3D motion capture technology, the same tool used in film and animation, to link age-related cognitive changes to motor control. In short, the research sought to break down the reaction time of participants before they undertook a movement and the time they required to complete that movement. This breakdown produced unexpected results.

The research team found older adults tended to take less time to plan movements but more time to execute them – perhaps because they felt uncertain about their reactions. Trewartha and colleagues are already planning follow-up research to study the brain activity linked with the performance of learned and new movement patterns.

These results suggest that focus is even more important for older adults than for younger individuals. "When they really need to perform well at a given task, older adults should probably seek out an environment where they can focus on the task at hand without distractions," says senior author Karen Z.H. Li, a professor in Concordia's Department of Psychology and a researcher at the Centre for Research in Human Development.

More information: The study, "Movement Kinematics of Prepotent Response Suppression in Aging During Conflict Adaptation," published in the Journal of Gerontology, was authored by Kevin M. Trewartha, Virginia B. Penhune and Karen Z.H. Li from Concordia University. http://psychsocger … .gbq090.full

Provided by Concordia University

CT scanning aids rapid diagnosis, treatment planning for abdominal pain

The use of CT scanning to evaluate abdominal pain in emergency departments can help physicians arrive at a diagnosis quickly and decisively. A study conducted at Massachusetts General Hospital (MGH) and appearing in the February issue of the American Journal of Roentgenology also finds that information provided by CT scans changed treatment plans for almost half the patients studied and significantly reduced probable hospital admissions.

23 jan 2011--"Our report addresses an important question with substantial policy relevance – what is the value of CT scanning in the emergency department setting?" says Scott Gazelle, MD, MPH, PhD, an MGH radiologist and director of the Institute for Technology Assessment, senior author of the study. "We specifically looked at how the use of CT for patients with abdominal pain affects physicians' thinking about their patients' diagnosis, their confidence in the diagnosis and the treatment plan; and we found that it significantly affected all three."

Gazelle explains that imaging has become a target for efforts to reduce health care costs. "We've strongly believed that the use of CT in the emergency department can improve efficiency in the workup for many conditions, but we haven't had the evidence we would like to back up that assertion. We chose abdominal pain for our study because it's a common presenting symptom that doesn't have the clearly defined diagnostic guidelines available for other common symptoms that can lead to CT, like headache."

Over a 15-month period from November 2006 through February 2008, physicians in the MGH Emergency Department (ED) who ordered CT scans for patients with abdominal pain not associated with a traumatic injury were asked to complete a questionnaire both before the scan was conducted and again after receiving the results. The questionnaire included the physicians' current diagnosis of the probable cause of symptoms, their level of confidence in the diagnosis and their expected treatment recommendations.

Complete sets of questionnaires on the care of 584 patients were available for analysis. The CT scan results changed the diagnosis for 49 percent of patients and the management plan for 42 percent. The number of patients who would have been held for observation – possibly including additional diagnostic procedures – decreased 44 percent, and the number of planned hospital admissions was reduced almost 20 percent. The use of CT scanning significantly increased physicians' confidence in their diagnosis – both when the scan changed and when it did not change the prescan diagnosis – and that improvement was more pronounced in resident physicians than in staff physicians.

"Poor diagnostic certainty can lead to poor decision making," explains lead author Hani Abujudeh, MD, MBA, of MGH Radiology. "Increased certainty improves treatment planning and can reduce inappropriate utilization of hospital resources. Overall, the CT scan is an important tool for providing our patients with appropriate and timely care."

Gazelle adds, "While we didn't include a cost analysis in our study, it is fair to say that our results suggest the CT scan might reduce the use of other tests and procedures and therefore lower overall costs. Another benefit is that CT provides rapid results, which makes the workup process more efficient and can reduce both monetary costs and the time required to move patients through the ED."

Provided by Massachusetts General Hospital

Study of nutrition, Alzheimer's links hampered by research approach

Research is trying to determine whether Alzheimer's disease might be slowed or prevented with nutritional approaches, but a new study suggests those efforts could be improved by use of nutrient "biomarkers" to objectively assess the nutrient status of elderly people at risk for dementia.

22 jan 2011--The traditional approach, which primarily relies on self-reported dietary surveys, asks people to remember what they have eaten. Such surveys don't consider two common problems in elderly populations – the effect that memory impairment has on recall of their diet, or digestive issues that could affect the absorption of nutrients.

This issue is of particular concern, experts say, because age is the primary risk factor for Alzheimer's disease, and the upcoming wave of baby boomers and people 85 years and older will soon place many more people at risk for dementia.

"Dietary and nutritional studies have yielded some intriguing results, but they are inconsistent," said Emily Ho, an associate professor of nutrition at Oregon State University, co-author of the study, and principal investigator with OSU's Linus Pauling Institute.

"If we are going to determine with scientific accuracy whether one or another nutritional approach to preventing dementia may have value, we must have methods that accurately reflect the nutritional status of patients," Ho said. "The gold standard to assess nutritional status should be biomarkers based on blood tests."

The research was just published in Alzheimer's Disease and Associated Disorders, in work supported by the National Institutes of Health. The study was led by Dr. Gene Bowman, a nutrition and aging researcher at Oregon Health and Science University, in collaboration with OSU researchers.

Prevention strategies for Alzehimer's disease are "becoming more feasible," researchers said, because scientists are beginning to understand what populations are at high risk for developing the disease.

"One of the issues in doing a good study is understanding the nutritional status of your participants when you start and how the nutrient treatment changes it," Ho said. "Giving supplements or foods to a person who already has a normal nutritional status of that nutrient may be very different than if the person is deficient."

Complicating the issue, she said, is that elderly people in general may not absorb or process many nutrients as well as younger adults, and because of genetic differences they many have different biological responses to the same level of a nutrient. Knowing what they ate gives, at best, only a partial picture of what their nutritional status actually is. And it also assumes that people, including those with beginning dementia, will always remember with accuracy what their diet actually has been when questioned about 124 food items in an interview that can last up to two hours.

In this study, the scientists recruited 38 elderly participants, half with documented memory deficit and the other half cognitively intact. They compared the reliability of the nutrient biomarkers to food questionnaires administered twice over one month.

The questionnaire was able to determine some nutrient levels, but only in the group with good memory. The reliability of the nutrient biomarkers depended on the nutrient of interest, but overall performed very well.

"Now that we have a reliable blood test for assessing nutritional status, we can begin to study nutrient biomarkers in combination, their interactive features, and how they collectively may influence chronic diseases, including risk for Alzheimer's disease and dementia," Bowman said.

Such approaches could lead to more effective nutritional therapies in the future to promote cognitive health, he said.

Are positive emotions good for your health in old age?

The notion that feeling good may be good for your health is not new, but is it really true? A new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science, reviews the existing research on how positive emotions can influence health outcomes in later adulthood.

21 jan 2011--"We all age. It is how we age, however, that determines the quality of our lives," said Anthony Ong of Cornell University, author of the review article. The data he reviews suggest that positive emotions may be a powerful antidote to stress, pain, and illness.

There are several pathways through which a positive attitude can protect against poor health later in life. For example, happier people might take a proactive approach to aging by regularly exercising and budgeting time for a good night's sleep. Alternately, these people may avoid unhealthy behaviors, such as smoking and risky sex. The benefits of these healthy lifestyle choices may become more important in older adults, as their bodies become more susceptible to disease.

An optimistic outlook has also been shown to combat stress—a known risk factor for a lot of disease. Studies have found that people with stronger positive emotions have lower levels of chemicals associated with inflammation related to stress. Also, by adopting a positive attitude people may even be able to undo some of the physical damage caused by stress.

Ong, a developmental psychologist, became interested in the study of positive emotion during graduate school when he learned about what researchers call the paradox of aging: Despite the notable loss of physical function throughout the body, a person's emotional capacity seemed to stay consistent with age. Ong speculates that if positive emotions are indeed good for our health then, "one direct, measureable consequence of this should be the extended years of quality living."

Provided by Association for Psychological Science

Evidence Limited on Statins for Primary Prevention

Statins found to reduce death, cardiac events, but selective and potentially biased reporting occurred

20 jan 2011-- There is not enough evidence to support the widespread use of statins in individuals with no history of cardiovascular disease (CVD), according to a review published in The Cochrane Library.

Fiona Taylor, of the London School of Hygiene and Tropical Medicine, and colleagues reviewed data from 14 trials involving 34,272 patients to assess the effects of statins among individuals with no history of CVD. Outcomes in patients prescribed statins were compared to outcomes in patients given placebos or usual care.

Using combined data from eight trials involving 28,161 patients that provided data on deaths from all causes, the investigators found that statins reduced the risk of dying from nine to eight deaths for every 1,000 people treated with statins each year. In addition, statins reduced fatal and non-fatal CVD events, stroke and revascularization surgery, and blood cholesterol levels. However, the researchers write that their conclusions are limited by unclear, selective, and possibly biased reporting and that patients' individual risk profiles should be carefully considered before statins are prescribed.

"Although reductions in all-cause mortality, composite end points, and revascularisations were found with no excess of adverse events, there was evidence of selective reporting of outcomes, failure to report adverse events, and inclusion of people with CVD. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk," the authors write.

Abstract

ASCO: Gene Test May Predict Colorectal Cancer Recurrence

ColoPrint predicts recurrence risk in patients with localized, stage II disease

20 jan 2011-- A novel microarray-based genetic test, ColoPrint, appears to effectively determine the risk of colorectal cancer recurrence among patients with localized, stage II disease, according to a study presented at the American Society of Clinical Oncology's annual Gastrointestinal Cancers Symposium, held from Jan. 20 to 22 in San Francisco.

Robert Rosenberg, M.D., of the University Hospital of the Technical University in Munich, Germany, and colleagues evaluated tumor tissue excised from 233 patients who underwent surgical resection for stage II or stage III colorectal cancer between 1987 and 2003. The investigators used ColoPrint to analyze tumors for the expression of 18 colon cancer recurrence-specific genes.

In 135 stage II patients, the investigators found that ColoPrint identified 73 percent of patients as being at low risk of recurrence, with just 5 percent of them experiencing recurrence within five or more years. ColoPrint identified 27 percent of stage II patients as high-risk, with 20 percent of these patients experiencing a recurrence over a median follow-up of 97 months. The five-year distant-metastasis-free survival was 95 percent for low-risk patients and 80 percent for high-risk patients. The genetic test is currently being prospectively compared to clinical risk factors in an international, multi-center, clinical study of stage II colon cancer patients (Prospective Analysis of Risk Stratification using ColoPrint). The genetic test is also being evaluated among stage III colorectal cancer patients.

"If the results from the ongoing studies validate our findings, we will be able to use ColoPrint in routine clinical practice as a commercially available assay," Rosenberg said in a statement. "Further goals are to combine results of the gene signature test with clinical parameters to further improve patient stratification and to offer individualized therapy options to our patients."

Two authors disclosed financial relationships with Agendia, maker of ColoPrint.

Abstract

Imaging procedure can identify biomarker associated with Alzheimer's disease

Preliminary research suggests that use of a type of molecular imaging procedure may have the ability to detect the presence of beta-amyloid in the brains of individuals during life, a biomarker that is identified during autopsy to confirm a diagnosis of Alzheimer disease, according to a study in the January 19 issue of JAMA.

20 jan 2011--"Both diagnosis and treatment of Alzheimer disease (AD) are hampered by the lack of noninvasive biomarkers of the underlying pathology. Between 10 percent and 20 percent of patients clinically diagnosed with AD lack AD pathology at autopsy, and community physicians may not diagnose AD in 33 percent of patients with mild signs and symptoms," according to background information in the article. "The ability to identify and quantify brain beta-amyloid could increase the accuracy of a clinical diagnosis of Alzheimer disease." Several types of positron emission tomographic (PET) imaging tests are under study, with florbetapir F 18 (a diagnostic chemical that binds with beta-amyloid) PET showing promise. "However, the definitive relationship between the florbetapir-PET image and beta-amyloid deposition has not been established."

Christopher M. Clark, M.D., of Avid Radiopharmaceuticals, Philadelphia, and colleagues conducted a study to determine if florbetapir F 18 PET imaging performed during life accurately predicts the presence of beta-amyloid in the brain at autopsy. Florbetapir-PET imaging was performed on 35 patients from hospice, long-term care, and community health care facilities near the end of their lives (6 patients to establish the protocol and 29 to validate), which was compared with measures of brain beta-amyloid that was determined by autopsy after their death. PET images were also obtained in 74 young individuals (18-50 years) presumed free of brain amyloid to better understand the frequency of a false-positive interpretation of a florbetapir-PET image.

Florbetapir-PET imaging was performed an average of 99 days before death for the 29 individuals in the primary analysis group. Fifteen of the 29 individuals (51.7 percent) met pathological criteria for AD. Analysis of images and other data indicated a correlation between florbetapir-PET images and presence and quantity of beta-amyloid pathology at autopsy. "Florbetapir-PET images and postmortem results rated as positive or negative for beta-amyloid agreed in 96 percent of the 29 individuals in the primary analysis cohort. The florbetapir-PET image was rated as amyloid negative in the 74 younger individuals in the nonautopsy cohort," the researchers write.

They add that while amyloid pathology is an essential element for an AD diagnosis, "clinically impaired function may depend, in part, on the ability of the individual's brain to tolerate aggregated amyloid. Genetic risk factors, lifestyle choices, environmental factors, and neuropathological comorbidities may alter the threshold for the onset of cognitive impairment associated with beta-amyloid aggregation."

"This prospective imaging to autopsy study provides evidence that a molecular imaging procedure can identify beta-amyloid pathology in the brains of individuals during life. Understanding the appropriate use of florbetapir-PET imaging in the clinical diagnosis of AD or in the prediction of progression to dementia will require additional studies," the authors conclude.

More information: JAMA. 2011;305[3]:275-283.

Provided by JAMA and Archives Journals

Use of antidepressant associated with reduction in menopausal hot flashes

Women who were either in the transition to menopause or postmenopausal experienced a reduction in the frequency and severity of menopausal hot flashes with the use of the antidepressant medication escitalopram, compared to women who received placebo, according to a study in the January 19 issue of JAMA.

19 jan 2011--"Hormonal agents have been the predominant therapy for menopausal hot flashes, but their use decreased substantially following the shifts in risk-benefit ratios that were identified in the Women's Health Initiative Estrogen plus Progestin randomized controlled trial. However, no other treatments have U.S. Food and Drug Administration approval for menopausal hot flashes, and the efficacy of alternative pharmacologic and nonpharmacologic agents is inconclusive," according to background information in the article. Selective serotonin and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs) have been investigated for hot flash treatment with mixed results. The SSRI escitalopram reduced hot flashes with minimal toxicities in 2 pilot investigations, but conclusions were limited by the small samples and unblinded treatment.

Ellen W. Freeman, Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues evaluated the efficacy of escitalopram vs. placebo to reduce the frequency and severity of hot flashes in healthy women, and examined whether race, menopausal status, depressed mood, and anxiety were important modifiers of any observed effect. The multicenter, 8-week, randomized trial enrolled 205 women (95 African American; 102 white; 8 other) between July 2009 and June 2010. Women received 10 to 20 mg/d of escitalopram or a matching placebo for 8 weeks. The primary outcomes measured included frequency and severity of hot flashes assessed by prospective daily diaries at weeks 4 and 8.

The average frequency of hot flashes at the beginning of the study was 9.8 per day. Escitalopram was associated with a significant reduction in the frequency of hot flashes relative to placebo, adjusted for race, site, and baseline hot flash frequency. In the escitalopram group, average hot flash frequency at week 8 decreased to 5.26 hot flashes per day (47 percent decrease or an average of 4.6 fewer hot flashes per day than at the beginning of the study). In the placebo group, hot flash frequency decreased to 6.43 hot flashes per day (33 percent decrease or an average of 3.2 fewer hot flashes per day).

Clinical improvement at week 8 (decrease of 50 percent or more from baseline in hot flash frequency) was significantly greater in the escitalopram group than in the placebo group (55 percent vs. 36 percent). Also, use of escitalopram significantly reduced hot flash severity compared with placebo, adjusted for race, site, and baseline severity.

Race did not significantly modify the treatment effect. Overall discontinuation due to adverse events was 4 percent (7 in the active group, 2 in the placebo group).

"The 3-week postintervention follow-up demonstrated that hot flashes increased after cessation of escitalopram but not after cessation of placebo, providing further evidence of escitalopram's effects," the authors write.

The researchers note that although the decreases in hot flash frequency and severity appear modest, the study participants perceived these improvements as meaningful, as indicated by their reported satisfaction with treatment and desire to continue the treatment.

"Our findings suggest that among healthy women, 10 to 20 mg/d of escitalopram provides a nonhormonal, off-label option that is effective and well-tolerated in the management of menopausal hot flashes. Further studies are needed to directly compare the relative efficacy of SSRIs and SNRIs with hormone therapy in the treatment of menopause-related hot flashes."

More information: JAMA. 2011;305[3]:267-274.

Provided by JAMA and Archives Journals

Lower biomarker levels, less education associated with greater cognitive decline

Older adults without dementia and with lower levels in plasma of the biomarkers beta-amyloid 42/40 (protein fragments) had an increased rate of cognitive decline over a period of 9 years, according to a study in the January 19 issue of JAMA. The researchers also found that this relationship was stronger among individuals with less education and lower levels of literacy.

19 jan 2011--An estimated 36 million people currently have dementia, with the prevalence expected to double every 20 years, according to background information in the article. "Thus, biomarkers to identify elderly persons at risk of developing dementia could be useful for early prevention, if and when such interventions are available, and treatment," the authors write. "Lower plasma beta-amyloid 42 and 42/40 levels have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among elders without dementia."

Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues conducted a study to investigate the association between plasma beta-amyloid 42 and 42/40 levels and cognitive decline in a large group of community-dwelling older adults without dementia, and also examined whether measures of cognitive reserve, as indicated by levels of education and literacy attained, modified the association of plasma beta-amyloid level with cognitive decline. The analysis included 997 black and white community-dwelling older adults who were enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998 with 10-year follow-up in 2006-2007. Participant average age was 74 years; 55.2 percent (n = 550) were female; and 54 percent (n = 538) were black. Measures of beta-amyloid 42 and 42/40 and cognitive function (via Modified Mini-Mental State Examination) were obtained.

The researchers found that low beta-amyloid 42/40 level was associated with greater cognitive decline over 9 years. After adjustment for several factors, the results remained statistically significant. There was also a significant association between plasma beta-amyloid 42 levels and cognitive decline. There was no association between plasma beta-amyloid 40 levels and baseline cognitive function or decline.

Also, cognitive reserve measures modified the association between beta-amyloid 42/40 level and cognitive decline. Older adults with low reserve (as measured by less than a high school diploma or sixth-grade or lower literacy) had an even greater association with beta-amyloid 42/40 level, whereas those with high reserve had less association.

"These results are important, as the prevalence of cognitive impairment is increasing exponentially and prevention will be crucial. To identify those at risk of dementia, biomarkers like plasma beta-amyloid level that are relatively easy to obtain and minimally invasive could be useful. In addition, our finding of an interaction of cognitive reserve with the association of plasma beta-amyloid level and cognitive decline could have public health importance because it may suggest pathways for modifying beta-amyloid effects on cognition," such as with cognitive activity or ongoing education, the authors write.

"Future studies should further explore the use of plasma beta-amyloid as a biomarker, assess the mechanisms by which cognitive reserve modifies this association, and determine whether increasing cognitive reserve through interventions can reduce the risk of Alzheimer disease."

More information: JAMA. 2011;305[3]:261-266.

Provided by JAMA and Archives Journals

Common antibiotics and blood pressure medication may result in hospitalization

Mixing commonly used antibiotics with common blood pressure medications may cause hypotension (abnormally low blood pressure) and induce shock in older patients, requiring hospitalization, according to a study published in CMAJ.

18 jan 2011--"Macrolide antibiotics (erythromycin, clarithromycin and azithromycin) are among the most widely prescribed antibiotics, with millions of prescriptions dispensed in Canada each year." writes Dr. David Juurlink, Scientist at the Sunnybrook Research Institute and the Institute for Clinical Evaluative Sciences with coauthors. "The drugs are generally well-tolerated, but they can cause several important drug interactions."

This study was conducted among Ontarians 66 years and older who were treated with a calcium-channel blocker (drugs often used to treat high blood pressure) between 1994 and 2009. The researchers then identified those who were hospitalized for low blood pressure and, in that group, whether or not a macrolide antibiotic had been prescribed shortly beforehand.

The researchers identified 7100 patients hospitalized for low blood pressure or shock while taking a calcium channel blocker. Treatment with erythromycin was found to increase the risk of low blood pressure almost 6-fold, while clarithromycin increased the risk almost 4-fold. In contrast, azithromycin did not increase the risk of hypotension.

"In older patients receiving calcium channel blockers, the two macrolide antibiotics erythromycin and clarithromycin are associated with a major increase in the risk of hospitalization for hypotension," conclude the authors. "However, the related drug azithromycin appears safe. When clinically appropriate, it should be used preferentially in patients receiving a calcium channel blocker."

Provided by Canadian Medical Association Journal

Popular sleep medicine puts older adults at risk for falls, cognitive impairment

A new study led by CU-Boulder Associate Professor Kenneth Wright, above, indicates a common sleep medication puts adults more at risk for nighttime falls and potential injuries. Credit: Photo by Patrick Campbell/University of Colorado

Adults who take one of the world's most commonly prescribed sleep medications are significantly more at risk for nighttime falls and potential injury, according to a new study by the University of Colorado at Boulder.

18 jan 2011--The study, which involved 25 healthy adults, showed 58 percent of the older adults and 27 percent of the young adults who took a hypnotic, sleep-inducing drug called zolpidem showed a significant loss of balance when awakened two hours after sleep. The findings are important because falls are the leading cause of injury in older adults, and 30 percent of adults 65 and older who fall require hospitalization each year, said CU-Boulder Associate Professor Kenneth Wright, lead study author.

To measure balance, the research team used a technique known as a "tandem walk" in which subjects place one foot in front of the other with a normal step length on a 16-foot-long, six-inch-wide beam on the floor. In 10 previous practice trials with no medication, none of the 25 participants stepped off the beam, indicating no loss of balance. All participants were provided with stabilizing assistance to prevent falls during the trials, he said.

"The balance impairments of older adults taking zolpidem were clinically significant and the cognitive impairments were more than twice as large compared to the same older adults taking placebos," said Wright, a faculty member in the integrative physiology department. "This suggests to us that sleep medication produces significant safety risks."

The new CU-Boulder study is the first to measure both the walking stability and cognition of subjects taking hypnotic sleep medicines or placebos. In addition to the balance problems caused by zolpidem, the study also showed that waking up after two hours of sleep after taking zolpidem enhances sleep inertia, or grogginess, a state that temporarily impairs working memory. The study participants were given computerized performance tests that involved adding randomly generated numbers.

A paper on the subject was published Jan. 13 in the Journal of the American Geriatric Society. Co-authors included CU-Boulder's Daniel Frey, Justus Ortega, Courtney Wiseman and Claire Farley. The study was funded primarily by the National Institutes of Health.

The effects of sleep inertia even without sleep medication has previously been shown to cause cognitive impairment, said Wright. But when the CU-Boulder study subjects took zolpidem rather than a placebo, the cognitive impairments essentially doubled.

One unexpected study finding was that young people taking placebos appear to be more cognitively impacted by sleep inertia than older adults taking placebos, he said.

A 2006 study led by Wright showed that study subjects who took no sleep medicine and were awakened after eight hours of sleep were more cognitively impaired, for a short period of time, than a totally sleep deprived person.

Several billion doses of zolpidem have been prescribed worldwide, said Wright, who also directs CU-Boulder's Sleep and Chronobiology Laboratory. Zolpidem is a generic drug that is marketed under a number of different brand names, including Ambien, Zolpimist, Edluar, Hypogen, Somidem and Ivedal.

The CU-Boulder team also measured balance and cognition in older adults who took no sleep medication and were kept awake for two hours past their normal bedtime. They found that 25 percent of these older adults failed the tandem walking balance test, which is consistent with what is seen in people who have insomnia. "Just having insomnia itself increases your risk of falls, even without sleep medication," he said.

The finding that zolpidem affected older adults more than younger adults in balance tests may be explained in part by the fact that both groups were given five milligram doses on study nights. While the normal dose for older adults is five milligrams, the standard dosage for younger adults being treated for insomnia is 10 milligrams. "This is an area that needs more study," he said.

The study results showing that both hypnotic sleep medications and sleep inertia cause significant impairment have important public health implications, said Wright. In older adults, falls have caused millions of nonfatal injuries annually and more than 300,000 fatalities worldwide. "Falls can be very debilitating, especially when older people break their hips and require hospitalization, causing their quality of life to go down," said Wright.

In addition, the cognitive impairments caused by both zolpidem and sleep inertia may impact decision-making, including responding to situations like fire alarms and medical emergencies as well as caring for sick children or driving to a clinic or hospital, said Wright.

"One of the goals of this study was to understand the risk of this sleep medication and of sleep inertia on human safety and cognition and to educate adults and health care workers about potential problems," said Wright. "We are not suggesting that sleep medications should not be used, because they have their place in terms of the treatment of insomnia."

One possible solution to reducing falls of older people due to zolpidem, other sleep medications or sleep inertia would be to install bedside commodes for those who frequently wake up in the night to void themselves, said Wright. Additional research is needed on this important public health and safety topic, he said.

Provided by University of Colorado at Boulder

'Thirdhand smoke' may be bigger health hazard than previously believed

Scientists are reporting that so-called "thirdhand smoke" — the invisible remains of cigarette smoke that deposits on carpeting, clothing, furniture and other surfaces — may be even more of a health hazard than previously believed. The study, published in ACS' journal, Environmental Science & Technology, extends the known health risks of tobacco among people who do not smoke but encounter the smoke exhaled by smokers or released by smoldering cigarette butts.

17 jan 2011--Yael Dubowski and colleagues note that thirdhand smoke is a newly recognized contributor to the health risks of tobacco and indoor air pollution. Studies show that that nicotine in thirdhand smoke can react with the ozone in indoor air and surfaces like clothing and furniture, to form other pollutants. Exposure to them can occur to babies crawling on the carpet, people napping on the sofa, or people eating food tainted by thirdhand smoke.

In an effort to learn more about thirdhand smoke, the scientists studied interactions between nicotine and indoor air on a variety of different materials, including cellulose (a component of wood furniture), cotton, and paper to simulate typical indoor surfaces. They found that nicotine interacts with ozone, in indoor air, to form potentially toxic pollutants on these surfaces. "Given the toxicity of some of the identified products and that small particles may contribute to adverse health effects, the present study indicates that exposure to [thirdhand smoke] may pose additional health risks," the article notes.

More information: "Thirdhand Smoke: Heterogeneous Oxidation of Nicotine and Secondary Aerosol Formation in the Indoor Environment", Environmental Science & Technology.

Provided by American Chemical Society

'A stark warning:' Smoking causes genetic damage within minutes after inhaling

In research described as "a stark warning" to those tempted to start smoking, scientists are reporting that cigarette smoke begins to cause genetic damage within minutes -- not years -- after inhalation into the lungs.

17 jan 2011--Their report, the first human study to detail the way certain substances in tobacco cause DNA damage linked to cancer, appears in Chemical Research in Toxicology, one of 38 peer-reviewed scientific journals published by the American Chemical Society.

Stephen S. Hecht, Ph.D., and colleagues point out in the report that lung cancer claims a global toll of 3,000 lives each day, largely as a result of cigarette smoking. Smoking also is linked to at least 18 other types of cancer. Evidence indicates that harmful substances in tobacco smoke termed polycyclic aromatic hydrocarbons, or PAHs, are one of the culprits in causing lung cancer. Until now, however, scientists had not detailed the specific way in which the PAHs in cigarette smoke cause DNA damage in humans.

The scientists added a labeled PAH, phenanthrene, to cigarettes and tracked its fate in 12 volunteers who smoked the cigarettes. They found that phenanthrene quickly forms a toxic substance in the blood known to trash DNA, causing mutations that can cause cancer. The smokers developed maximum levels of the substance in a time frame that surprised even the researchers: Just 15-30 minutes after the volunteers finished smoking. Researchers said the effect is so fast that it's equivalent to injecting the substance directly into the bloodstream.

"This study is unique," writes Hecht, an internationally recognized expert on cancer-causing substances found in cigarette smoke and smokeless tobacco. "It is the first to investigate human metabolism of a PAH specifically delivered by inhalation in cigarette smoke, without interference by other sources of exposure such as air pollution or the diet. The results reported here should serve as a stark warning to those who are considering starting to smoke cigarettes," the article notes.

Provided by American Chemical Society

New guidelines for preventing falls in the elderly include: Start tai chi, cut-back on meds

In the first update of the American Geriatrics Society and the British Geriatric Society's guidelines on preventing falls in older persons since 2001, they now recommend that all interventions for preventing falls should include an exercise component and that a number of new assessments should be used, including; feet and footwear, fear of falling, and ability to carry out daily living activities. The guidelines, a summary of which are published today in the Journal of the American Geriatrics Society, also state that fall screening and prevention should be a part of all healthcare practices for older adults.

16 jan 2011--The guidelines were compiled by a panel comprising members from the previous panels and new members with substantial knowledge, experience, and publications in fall prevention and care of older patients, and are based on a systematic review of the randomized controlled trials of fall prevention interventions. The literature search included meta-analyses, systematic literature reviews, randomized controlled trials, controlled before-and-after studies, and cohort studies published between May 2001 and April 2008. The panel also reviewed the RCTs published between April 2008 and July 2009 and concluded that the additional evidence did not change the ranking of the evidence or the guideline recommendations.

"Falls are one of the most common health problems experienced by older adults and are a common cause of losing functional independence," said Dr. Mary Tinetti of Yale University School of Medicine, USA, and one of the panel chairs. "Given their frequency and consequences, falls are as serious a health problem for older persons as heart attacks and strokes."

The guidelines now state that doctors and other health professionals should determine whether their older patients are at risk of falling by asking if they have fallen recently or if they are unsteady walking. If so, health providers should look for the presence of known problems such as muscle weakness, poor balance or blood pressure that drops too much on standing. If they have these problems, then older adults should receive the interventions described in the guidelines, but if there is no evidence of gait problems or recurrent falls, they do not require a risk assessment.

The new recommendations for interventions focus on:

• Multifactorial interventions which include exercise for balance, gait and strength training, such as Tai Chi or physical therapy
  
• Environmental adaptation to reduce fall risk factors in the home and in daily activities
  
• Cataract surgery where needed, but they recommend against vision intervention as an individual approach
  
• Medication reduction, regardless of the number of medications prescribed (in 2001 this was only recommended for those on at least four) with particular attention to medications that affect the brain such as sleeping medications and antidepressants
  
• Focus on raising low blood pressure and managing heart rate and rhythm abnormalities

"We found that the most effective trials for preventing falls in older people looked at multiple interventions rather than just one; previous studies have indicated that it is more effective to focus on one intervention, but because we looked at not only what recommendations were given, but also which carried out, we're confident that multifactorial interventions is the best course of action," said Tinetti.

"There is emerging evidence that the rate of serious fall injuries, such as hip fractures, is decreasing modestly in areas in which fall prevention is integrated into clinical practice. By making fall prevention part of the clinical care of older adults this trend can continue."

FDA Limits Acetaminophen in Combo Prescription Products

Sets 325 mg maximum in order to lower risk of liver toxicity; also requesting boxed warning

15 jan 2011-- The U.S. Food and Drug Administration is requesting that manufacturers of prescription combination products containing acetaminophen limit the amount of acetaminophen to a maximum of 325 mg in each tablet or capsule to reduce the risk of liver toxicity. In addition, the agency is directing manufacturers to update labels of all prescription combination products to warn consumers of the possible risk for severe liver injury.

Combination prescription products that contain acetaminophen may also contain codeine (Tylenol with Codeine), oxycodone (Percocet), and hydrocodone (Vicodin). According to the FDA, the risk of severe liver injury appears to be highest among those who take more than the prescribed dose of an acetaminophen-containing product in a 24-hour period, take more than one acetaminophen-containing product at the same time, or consume alcohol while taking acetaminophen products. The current maximum dose is 4,000 mg within 24 hours.

Over the next three years, higher dose prescription products containing acetaminophen will be phased out, but this poses no threat of a shortage of pain medication, according to the FDA. The FDA is also proposing a boxed warning to be added to the label of acetaminophen prescription products. Acetaminophen is also available over-the-counter (OTC) alone or in combination with other OTC ingredients, such as cough and cold ingredients. The FDA action regarding prescription acetaminophen products is not intended to impact the use of OTC acetaminophen products.

"There is no immediate danger to patients who take these combination pain medications and they should continue to take them as directed by their health care provider," Sandra Kweder, M.D., deputy director of the Office of New Drugs in FDA's Center for Drug Evaluation and Research, said in a statement.

Online tool can help seniors quickly determine risk for dementia

15 jan 2011 -- A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate herself about a disease that doctors now believe is best managed if caught early.

“As the population ages and dementia becomes more prevalent, it’s important to get people diagnosed early,” says Jason Brandt, Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer’s & Dementia. “Alzheimer’s disease and other types of dementia don’t just creep up on you. They’re incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

Among the questions asked on the Dementia Risk Assessment are about whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment at alzcast.org. Those who scored lowest on the memory test were significantly older, and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss — a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

Brandt says the assessment may be helpful in weeding out those who have signs of dementia from those who are simply experiencing the memory loss that comes with aging or a busy lifestyle. Not being able to find your keys or remembering where you parked is rarely a failsafe sign that a person is suffering from dementia.

“Our goal is really to educate people about what some of the risk factors are and, often, to put people’s minds at ease,” he says. “We somehow expect our memories to be as good at 50 as they were at 30. We can’t run as fast as we could 20 years ago. Why should our memory be as good?”

Alzheimer’s disease still has no cure, but early interventions are being used to slow cognitive decline, Brandt says. Brandt says he hopes this assessment will get patients with several risk factors or symptoms to consult a physician.

Some forms of dementia, he says, may not be permanent, and getting to a doctor could help to restore brain function.

Sometimes, Brandt says, seniors are afraid to mention they are having memory or other cognitive issues. The new tool, he says, lets them learn more about themselves and their individualized risk factors in the privacy of their homes.

The aging population means that many more people will be diagnosed with dementia in the coming decades.

“Screening procedures that have demonstrated validity and predictive value and are noninvasive, brief and do not require any special expertise to administer may have the greatest potential to be accepted and actually used by the greatest number of people,” Brandt says. “This tool, which this study preliminarily validates, is the first step toward developing such a procedure.”

Brandt and colleagues are currently conducting research that compares a patient’s results from the online Dementia Risk Assessment with an in-person, comprehensive evaluation by a physician at one of two Johns Hopkins clinics.

More information: http://www.alzcast.org/

Population-wide reduction in salt consumption recommended

The American Heart Association today issued a call to action for the public, health professionals, the food industry and the government to intensify efforts to reduce the amount of sodium (salt) Americans consume daily.

14 jan 2011--In an advisory, published in Circulation: Journal of the American Heart Association, the association sets out the science behind the American Heart Association's recommendation for the general population, which is to consume no more than 1500 milligrams (mg) of sodium a day because of the harmful effects of sodium – elevated blood pressure and increased risk of stroke, heart attacks and kidney disease. Elevated blood pressure (hypertension) is a major public health problem – approximately 90 percent of all Americans will develop hypertension over their lifetime.

Sodium consumption is currently more than two times higher than the recommended upper limit of 1,500 mg daily, with 77 percent of that consumption coming from packaged, processed and restaurant foods. "Even a modest decline in intake – say 400 mg per day –would produce benefits that are substantial and warrant implementation," say the advisory authors. The 2005 United States Dietary Guidelines for Americans recommended a sodium intake limit of 2,300 mg per day, which many health experts say is too much for most Americans. Earlier this year, the Dietary Guidelines Advisory Committee recommended to the secretaries of the United States Departments of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) that the goal should be modified to 1,500 mg per day for the general population. The advisory committee consists of leading scientists who reviewed the most recent scientific studies and created a set of recommendations that are being reviewed by the secretaries.

Recently, the American Heart Association lowered their recommendation to no more than 1500 mg of sodium daily for the general public, after a report from the Centers for Disease Control found that a majority of the American population either have high blood pressure or are at high risk for developing it.

According to the advisory:

• As sodium intake rises, so does blood pressure and the risk of negative health outcomes.
  
• Independent of its effects on blood pressure, excess sodium intake adversely affects the heart, kidneys, and blood vessels.
  
• The potential public health benefits of sodium reduction are enormous and extend to all Americans.
  
• Scientific evidence on the adverse effects of excess sodium is strong and compelling
  
• The American Heart Association's 2020 impact goals – to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent – include a population-wide reduction of sodium consumption to less than 1,500 mg daily as one of the ways the association will measure the nation's cardiovascular health. Furthermore, a normal range blood pressure is another key factor the association will use to measure the nation's cardiovascular health status.
  
• The American Heart Association is part of the National Salt Reduction Initiative, which is working with the food industry to reduce sodium content in packaged and restaurant food.

Inherent to the negative health effects are rising healthcare costs, the authors add. They point to one recent study that suggests a national effort that reduces sodium intake by 1,200 mg per day should reduce the health burdens related to heart disease in addition to reducing costs by up to $24 billion per year.

"Americans deserve the opportunity to choose how much sodium is in the food they eat. By supporting measures that will reduce sodium in the overall food supply, we are giving consumers freedom to select foods that could allow them to meet sodium recommendations and improve their ideal cardiovascular health," said Ralph Sacco, M.D., president of the American Heart Association.

The American Heart Association advocates for more robust sodium criteria within school nutrition standards, foods advertised and marketed to children and foods purchased by employers or government feeding programs, and for the Secretaries of HHS and USDA to adopt the Dietary Guidelines Advisory Committee recommendations.

The association also supports improved food labeling that helps consumers understand how much sodium is in their diet and consumer education in restaurants to help consumers choose lower-sodium options.

Provided by American Heart Association

Cancer costs projected to reach at least $158 billion in 2020

Medical expenditures for cancer in the year 2020 are expected to reach at least $158 billion (in 2010 dollars), based on the growth and aging of the US population. If medical advances continue to become more expensive, cancer spending could reach as high as $207 billion. Credit: National Cancer Institute/National Institutes of Health

13 jan 2011--Based on growth and aging of the U.S. population, medical expenditures for cancer in the year 2020 are projected to reach at least $158 billion (in 2010 dollars) – an increase of 27 percent over 2010, according to a National Institutes of Health analysis. If newly developed tools for cancer diagnosis, treatment, and follow-up continue to be more expensive, medical expenditures for cancer could reach as high as $207 billion, said the researchers from the National Cancer Institute (NCI), part of the NIH. The analysis appears online, Jan. 12, 2011, in the Journal of the National Cancer Institute.

The projections were based on the most recent data available on cancer incidence, survival, and costs of care. In 2010, medical costs associated with cancer were projected to reach $127.6 billion, with the highest costs associated with breast cancer ($16.5 billion), followed by colorectal cancer ($14 billion), lymphoma ($12 billion), lung cancer ($12 billion) and prostate cancer ($12 billion).

If cancer incidence and survival rates and costs remain stable and the U.S. population ages at the rate predicted by the U.S. Census Bureau, direct cancer care expenditures would reach $158 billion in 2020, the report said.

However, the researchers also did additional analyses to account for changes in cancer incidence and survival rates and for the likelihood that cancer care costs will increase as new technologies and treatments are developed. Assuming a 2 percent annual increase in medical costs in the initial and final phases of care – which would mirror recent trends – the projected 2020 costs increased to $173 billion. Estimating a 5 percent annual increase in these costs raised the projection to $207 billion. These figures do not include other types of costs, such as lost productivity, which add to the overall financial burden of cancer.

"Rising health care costs pose a challenge for policy makers charged with allocating future resources on cancer research, treatment, and prevention," said study author Angela Mariotto, Ph.D., from NCI's Surveillance Research Program. "Because it is difficult to anticipate future developments of cancer control technologies and their impact on the burden of cancer, we evaluated a variety of possible scenarios."

To project national cancer expenditures, the researchers combined cancer prevalence, which is the current number of people living with cancer, with average annual costs of care by age (less than 65 or 65 and older). According to their prevalence estimates, there were 13.8 million cancer survivors alive in 2010, 58 percent of whom were age 65 or older. If cancer incidence and survival rates remain stable, the number of cancer survivors in 2020 will increase by 31 percent, to about 18.1 million. Because of the aging of the U.S. population, the researchers expect the largest increase in cancer survivors over the next 10 years to be among Americans age 65 and older.

"The rising costs of cancer care illustrate how important it is for us to advance the science of cancer prevention and treatment to ensure that we're using the most effective approaches," said Robert Croyle, Ph.D., director, Division of Cancer Control and Population Sciences, NCI. "This is especially important for elderly cancer patients with other complex health problems."

To develop their cost projections, the authors used average medical costs for the different phases of cancer care: the first year after diagnosis, the last year of life, and the time in between. For all types of cancer, per-person costs of care were highest in the final year of life. Per-person costs associated with the first year after a cancer diagnosis were more varied, with cancers of the brain, pancreas, ovaries, esophagus and stomach having the highest initial costs and melanoma, prostate and breast cancers having the lowest initial-year costs.

These new projections are higher than previously published estimates of direct cancer expenditures, largely because the researchers used the most recent data available – including Medicare claims data through 2006, which include payments for newer, more expensive, targeted therapies which attack specific cancer cells and often have fewer side effects than other types of cancer treatments. In addition, by analyzing costs according to phase of care, which revealed the higher costs of care associated with the first year of treatment and last year of life (for those who die from their disease), the researchers were able to generate more precise estimates of the cost of care.

The researchers used 2005 incidence and mortality data from NCI's Surveillance, Epidemiology and End Results (SEER) program to estimate cancer prevalence for 2010 and 2020. Population estimates for the United States was obtained from the U.S. Census Bureau's National Interim Projections for 2006 to 2020. Medical cost estimates were obtained using the SEER-Medicare database which links SEER data to Medicare claims data from the Center for Medicare and Medicaid Services.

More information: More information about these cost projections is available at: http://costproject … s.cancer.gov

Provided by National Institutes of Health

Zoster vaccine associated with lower risk of shingles in older adults

Vaccination for herpes zoster, a painful rash commonly known as shingles, among a large group of older adults was associated with a reduced risk of this condition, regardless of age, race or the presence of chronic diseases, according to a study in the January 12 issue of JAMA.

12 jan 2011--"The pain of herpes zoster is often disabling and can last for months or even years, a complication termed postherpetic neuralgia. Approximately 1 million episodes of herpes zoster occur in the United States annually, but aside from age and immunosuppression, risk factors for this condition are not known," the authors write. Although prelicensure data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions to show whether benefits of the vaccine can be generalized to conditions of clinical practice, according to background information in the article. The researchers note that this is particularly important for the herpes zoster vaccine, given the medical and physiological diversity in the elderly population for whom the vaccine is indicated.

Hung Fu Tseng, Ph.D., M.P.H., of Southern California Kaiser Permanente, Pasadena, Calif., and colleagues evaluated the risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings. The study included community-dwelling adults, age 60 years or older, who were members of a managed care organization. There were 75,761 members in the vaccinated cohort, who were age matched (1:3) to 227,283 unvaccinated members.

Compared with the unvaccinated cohort, individuals in the vaccinated cohort were more likely to be white, women, and to have had more outpatient visits, and a lower prevalence of chronic diseases. There were 5,434 herpes zoster cases identified in the study (6.4 cases per 1,000 persons per year among vaccinated individuals and 13.0 cases per 1,000 persons per year among unvaccinated individuals). In the fully adjusted analysis, vaccination was associated with reduced risk of herpes zoster. The reduction in risk did not vary by age at vaccination, sex, race, or with presence of chronic diseases. Herpes zoster vaccine recipients had reduced risks of ophthalmic herpes zoster and hospitalizations coded as herpes zoster. Overall, the vaccine was associated with a 55 percent reduction in incidence of herpes zoster.

"Herpes zoster vaccine was licensed recently, which means the durability of its protection needs to be assessed in future studies. Meanwhile, however, this vaccine has the potential to annually prevent tens of thousands of cases of herpes zoster and postherpetic neuralgia nationally. To date, herpes zoster vaccine uptake has been poor due to weaknesses in the adult vaccine infrastructure and also due to serious barriers to the vaccine among clinicians and patients. Solutions to these challenges need to be found so that individuals seeking to receive herpes zoster vaccine will be able to reduce their risk of experiencing this serious condition," the authors conclude.

More information: JAMA. 2011;305[2]:160-166.

Provided by JAMA and Archives Journals

Protective properties of green tea uncovered

Regularly drinking green tea could protect the brain against developing Alzheimer's and other forms of dementia, according to latest research by scientists at Newcastle University.

11 jan 2011--The study, published in the academic journal Phytomedicine, also suggests this ancient Chinese remedy could play a vital role in protecting the body against cancer.

Led by Dr Ed Okello, the Newcastle team wanted to know if the protective properties of green tea – which have previously been shown to be present in the undigested, freshly brewed form of the drink – were still active once the tea had been digested.

Digestion is a vital process which provides our bodies with the nutrients we need to survive. But, says Dr Okello, it also means that just because the food we put into our mouths is generally accepted to contain health-boosting properties, we can't assume these compounds will ever be absorbed by the body.

"What was really exciting about this study was that we found when green tea is digested by enzymes in the gut, the resulting chemicals are actually more effective against key triggers of Alzheimer's development than the undigested form of the tea," explains Dr Okello, based in the School of Agriculture, Food and Rural Development at Newcastle University.

"In addition to this, we also found the digested compounds had anti-cancer properties, significantly slowing down the growth of the tumour cells which we were using in our experiments."

As part of the research, the Newcastle team worked in collaboration with Dr Gordon McDougall of the Plant Products and Food Quality Group at the Scottish Crop Research Institute in Dundee, who developed technology which simulates the human digestive system.

It is this which made it possible for the team to analyse the protective properties of the products of digestion.

Two compounds are known to play a significant role in the development of Alzheimer's disease – hydrogen peroxide and a protein known as beta-amyloid.

Previous studies have shown that compounds known as polyphenols, present in black and green tea, possess neuroprotective properties, binding with the toxic compounds and protecting the brain cells.

When ingested, the polyphenols are broken down to produce a mix of compounds and it was these the Newcastle team tested in their latest research.

"It's one of the reasons why we have to be so careful when we make claims about the health benefits of various foods and supplements," explains Dr Okello.

"There are certain chemicals we know to be beneficial and we can identify foods which are rich in them but what happens during the digestion process is crucial to whether these foods are actually doing us any good."

Carrying out the experiments in the lab using a tumour cell model, they exposed the cells to varying concentrations of the different toxins and the digested green tea compounds.

Dr Okello explained: "The digested chemicals protected the cells, preventing the toxins from destroying the cells.

"We also saw them affecting the cancer cells, significantly slowing down their growth.

"Green tea has been used in Traditional Chinese medicine for centuries and what we have here provides the scientific evidence why it may be effective against some of the key diseases we face today."

The next step is to discover whether the beneficial compounds are produced during digestion after healthy human volunteers consume tea polyphenols. The team has already received funding from the Biotechnology and Biological Sciences Research Council (BBSRC) to take this forward.

Dr Okello adds: "There are obviously many factors which together have an influence on diseases such as cancer and dementia - a good diet, plenty of exercise and a healthy lifestyle are all important."

Provided by Newcastle University

Women with both diabetes and depression at higher risk of dying from heart disease, other causes

Depression and diabetes appear to be associated with a significantly increased risk of death from heart disease and risk of death from all causes over a six-year period for women, according to a report in the January issue of Archives of General Psychiatry.

10 jan 2011--Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.

An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of type 2 diabetes were confirmed using a supplementary questionnaire.

During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.

When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.

"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.

"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.

More information: Arch Gen Psychiatry. 2011;68[1]:42-50.

Provided by JAMA and Archives Journals

Communication study reveals complexities of family decision-making

While a much hailed communication intervention works for families making decisions for chronically-ill loved ones in medical intensive care units, Case Western Reserve University researchers found the intervention was less effective for surgical and neurological ICU patients.

09 jan 2011--Barbara Daly and Sara Douglas, the study's lead researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve, attribute the varied results to different types of patients served by the three types of ICUs and differences among ICU cultures.

"We found the same approach is not going to have the same results for everyone," Daly said.

With the number of ICU patients predicted at more than 600,000 patients annually by 2020, researchers search for ways to help families make critical decisions for their loved ones. This study contributes to those ICU practices involving complex communication issues.

The researchers repeated a study from a Boston hospital that resulted in shorter stays and less unneeded tests and treatments when families were routinely informed through a systemized communications intervention about their family member's progress in a medical ICU. They compared the effect of the new communication system in 346 patients to usual practice in 135 patients.

The intervention involved a 30-minute communication meeting between the clinical staff and family, beginning five days after a patient requiring a ventilator was admitted to the ICU. The staff and family covered five components: medical update, preferences and goals for the patient, treatment plans, prognosis, and milestones (the markers that can tell whether a person is improving).

The meetings continued weekly until the patient was transferred to a regular hospital ward, to a long-term facility, went home or died.

According to Daly, the discussions are important because up to 40% of these ICU patients do not survive beyond two months if they have spent more than five days on a mechanical ventilator.

For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.

Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.

"The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. "We took the study into real-life situations."

Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.

In the medical units, the patients generally are older and chronically ill—many suffering several chronic illnesses. The other ICUs generally serve younger patients who are more likely to have suffered a sudden acute health crisis, such as an emergency surgery or trauma from a motor vehicle accident.

Daly said many treatments in the medical ICU will not sustain life, and families face complicated end-of-life decisions to stop or continue ineffective treatments.

The research group also tracked conversational interchanges between family members and doctors.

All families received medical updates. About 86% of the meetings covered treatment plans; 94%, prognosis; 78 percent, preferences and goals; and only 68%, milestones.

Daly said analyses of the types of conversations found that 98% of the time was spent relaying facts about the patient, and only 2% was spent on personal, emotional, or relationship conversation.

The researchers also found that on average, doctors asked families one question, which was: "Do you have any questions?"

The families asked an average of six.

"Better communications is needed. Overall the process is not working as well as we would like and there are missed opportunities to better support families in their decisions," Daly concluded.

More information: "Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients," in the journal Chest.

Provided by Case Western Reserve University

On the road: Bike riding helps Parkinson's diagnosis

Neurologists examining a patient with early symptoms of Parkinson's disease should ask that individual to ride a bike, according to unusual research by Dutch doctors.

08 jan 2011--Distinguishing between patients with Parkinson's and those with a disorder known as atypical parkinsonism is important as the two conditions have different causes and treatments.

They share a set of shared symptoms, including limb tremor, slowed movement, muscle rigidity and unsteadiness -- and sometimes even advanced medical technology is unable to make an early distinction.

But, say researchers at the Parkinson Centre in Nijmegen, an effective, non-disruptive, low-cost diagnostic tool is this: can the patient ride a bike?

It may seem counter-intuitive, but people with "regular" Parkinson's often have a remarkable ability to ride a bike, as they have few problems with sideways balance and with the short, rhythmic movements needed to pedal, the doctors said in a letter published on Friday by The Lancet.

This task, though, is often too demanding for people with atypical parkinsonism, the umbrella term for half a dozen syndromes such as progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration.

Parkinson's disease comes from the death of cells in a key part of the brain called the substantia nigra that produce a neurotransmitter chemical called dopamine.

The standard treatment is a drug called levodopa, which the brain converts into dopamine. But the treatment does not work effectively, or may not even work at all, in atypical parkinsonism.

The Nijmegen doctors tested their theory on 111 patients with Parkinson-like symptoms and who were able to ride a bike at the start of the study.

Afterwards, 45 of the patients went on to be confirmed as having Parkinson's and 64 as having atypical parkinsonism.

During the 30 months that they were under study, two of the 45 later found to have Parkinson's stopped riding a bike, but the tally was 34 out of the 64 who were eventually diagnosed with the "atypical" disease.

"We suggest that the loss of the ability to cycle after disease onset might serve as a new red flag, signalling the presence of atypical parkinsonism," said the letter.

A blood test for Alzheimer's disease?

Scientists from the Florida campus of The Scripps Research Institute, have developed a novel technology that is able to detect the presence of immune molecules specific to Alzheimer's disease in patients' blood samples. While still preliminary, the findings offer clear proof that this breakthrough technology could be used in the development of biomarkers for a range of human diseases.

07 jan 2011--The study, led by Scripps Research Professor Thomas Kodadek, Ph.D., was published in the January 7, 2011 edition of the journal Cell.

Traditionally, antigens—a substance such as a protein from a virus or bacteria that stimulates an immune response—have been necessary for the discovery of antibody biomarkers. There has previously been no way to identify an antibody (a type of targeted immune molecule) without first knowing the antigen that triggers its production. The new study, however, challenges conventional wisdom and uses synthetic molecules rather than antigens to successfully detect signs of disease in patients' blood samples.

These synthetic compounds have many advantages – they can be modified easily and can be produced quickly in relatively large amounts at lower cost.

"Dr. Kodadek has conceived of a new approach for identifying antibody biomarkers of human disease that bypasses the conventional, but difficult, step of identifying the natural antigens or antigen mimics," said James M. Anderson, M.D., Ph.D., director of the National Institutes of Health (NIH) Division of Program Coordination, Planning, and Strategic Initiatives, who helps oversee the NIH Common Fund's Pioneer Award Program. "The results in the paper suggest great potential for using this approach to rapidly develop diagnostic biomarkers for a variety of significant human diseases. Such boldness to challenge conventional paradigms to achieve important scientific advances is a hallmark of the NIH Director's Pioneer Award Program, which supported much of this research."

"This study essentially puts an end to the notion that the only way to pull a potentially useful antibody from blood samples is with a specific antigen," said Kodadek. "Because the antigen identification problem has proven to be so difficult, we decided to take it out of the equation."

A Focus on the Immune System

To test the concept, Kodadek and his colleagues used comparative screening of combinatorial libraries of synthetic molecules – peptoids – against serum samples obtained from mice with a multiple-sclerosis-like condition or healthy controls. Those synthetic molecules that retained more immunoglobulin (IgG), a major type of antibody, from the blood samples of the diseased animals were identified as potential agents for capturing diagnostically useful molecules. This worked well.

The team next turned to serum samples from six Alzheimer's patients, six healthy individuals, and six Parkinson's disease patients. Three peptoids were identified that captured at least three-fold higher levels of IgG antibodies from all six of the Alzheimer's patients than any of the control or Parkinson's patients. The results showed that two of the peptoids bind the same IgG antibodies; a third binds different antibodies, resulting in at least two candidate biomarkers for the disease.

"We use these peptoids as a lure to capture the IgG antibodies," Kodadek said. "Some of these synthetic molecules recognize the antigen-binding sites of disease-specific antibodies well enough to pull them from blood samples, although they almost certainly don't bind as well as the native antigens. This ability should make it possible to short circuit the discovery of the natural antigens."

More information: "Identification of Candidate IgG Antibody Biomarkers for Alzheimer's Disease through Screening of Synthetic Combinatorial Libraries," by M. Muralidhar Reddy et al.

Provided by The Scripps Research Institute

Too many cancer screening options confuse patients, lead them to avoid screenings altogether

06 jan 2011-- Adhering to cancer screening recommendations is one of the best things people can do to reduce their risk of dying from cancer. But research at Virginia Commonwealth University Massey Cancer Center suggests that when patients are presented more than one colorectal cancer screening option, there is a greater chance of confusion and, therefore, a greater chance of neglecting screening recommendations.

The study, published in the journal Cancer Epidemiology, Biomarkers & Prevention, included data from more than 3,350 patients and provides the first empirical evidence linking multiple screening options with patient confusion, and patient confusion with screening adherence. Of the patients surveyed, the researchers found that 56 percent had discussed two or more colorectal cancer screening options with their physicians. Those patients presented with multiple options were 1.6 times more likely to be confused than those presented with one screening method. They also were 1.8 times less likely to follow screening recommendations.

The research was led by Resa M. Jones, M.P.H., Ph.D., assistant professor of epidemiology and community health at VCU Massey Cancer Center, whose recent research has been focused on evaluating barriers to colorectal cancer screenings.

“We found that confusion about multiple colorectal cancer screening options may act as a barrier to screening. Recognizing and minimizing confusion about the various options through public health messages, patient-physician communication and interventions could lead to increased screening adherence,” says Jones. “These results also have potential implications for other health-related topics where multiple options or choices are given.”

Currently, there are several different ways to screen for colorectal cancer: fecal occult blood testing, flexible sigmoidoscopy, colonoscopy and barium enema. These methods vary by frequency, accuracy, preparations, discomfort and cost. Additionally, the American Cancer Society and the U.S. Multi-Society Task Force on Colorectal Cancer now recommend more screening options than the U.S. Preventive Services Task Force suggests. All of these factors could add to patient confusion.

The data for this study were obtained using a questionnaire mailed to patients 50 to 75 years old who visited their doctor at least once in the past two years. Most of the patients earned more than $20,000 per year and were insured. Jones plans to further explore socioeconomic factors contributing to patient confusion about colorectal cancer screening and hopes to conduct a randomized trial to increase screening adherence in underserved populations by addressing barriers.

“Colorectal cancer is the second leading cause of cancer death. Patients whose cancers are detected early face much better outcomes than those diagnosed in later stages,” says Jones. “It’s important that patients have choices, but we have to be sure those choices are understood so that they don’t overwhelm the patient and become barriers to proper screening and care.”

Provided by Virginia Commonwealth University