No walk in the park: Factors that predict walking difficulty in elderly

Yale School of Medicine researchers have found that the likelihood of becoming disabled with age increases with the following factors: having a chronic condition or cognitive impairment; low physical activity; slower gross motor coordination; having poor lower-extremity function; and being hospitalized. Women are also more likely than men to become disabled in their later years.

17 jan 2012--Based on 12 years of data, the findings are published in the Jan.17 issue of Annals of Internal Medicine by a research team led by Thomas Gill, M.D., the Humana Foundation Professor of Geriatric Medicine and professor of medicine, epidemiology, and public health at Yale School of Medicine.

With age, many people can no longer walk short distances or drive a car, and those with long-term loss of mobility have difficulty regaining independence.

"Losing the ability to walk independently not only leads to a poorer overall quality of life, but prolonged disability leads to higher rates of illness, death, depression and social isolation," said Gill, who followed a group of 641 people aged 70 or older who could walk a quarter mile unassisted or who were active drivers at the start of the study. All participants could perform essential activities of daily living, such as bathing and dressing.

Gill and his team assessed the participants for changes in potential disability risk factors every 18 months between 1998 and 2008. They also assessed the participants' mobility each month. Those who said they needed help from another person to walk a quarter mile were considered to be walking disabled. Those who said that they had not driven a car during the past month were considered driving disabled.

On a monthly basis, the research team also assessed the participants' exposure to potential causes of disability, including illnesses or injuries leading to hospitalization and restricted activity, which increased the likelihood of long-term disability by 6-fold.

The team found that multiple risk factors, together with subsequent illness and injury leading to hospitalization and restricted activity, are associated with an increased likelihood of developing long-term walking and driving disability. The team considered a disability to be long term if it persisted for at least six months.

"We've learned that targeted strategies are needed to prevent disability among older people living independently in the community," said Gill.

More information: Annals of Internal Medicine, Vol. 156, No. 2: 131-140 (January 17, 2012)

Provided by Yale University

Active lifestyle associated with less Alzheimer disease-related brain change among persons with APOE epsilon4 genotype

A sedentary lifestyle is associated with greater cerebral amyloid deposition, which is characteristic of Alzheimer’s disease (AD), among cognitively normal individuals with the ε4 allele of the apolipoprotein E (APOE) gene, according to a report published Online First by Archives of Neurology, one of the JAMA/Archives journals.

16 jan 2012--“The presence of an APOE ε4 allele is the most established genetic risk factor for Alzheimer disease (AD), with a higher percentage of individuals with AD having an ε4 allele in comparison with the general population,” the authors write as background information in the article. “It has been suggested that APOE status may modify associations between lifestyle factors such as exercise engagement and risk of cognitive decline and dementia.”

More information: Exercise Engagement as a Moderator of the Effects of APOE Genotype on Amyloid Deposition, Arch Neurol. Published online January 9, 2012. doi:10.1001/archneurol.2011.845

ABSTRACT

Objective. APOE 4 status has been associated with greater cortical amyloid deposition, whereas exercise has been associated with less in cognitively normal adults. The primary objective here was to examine whether physical exercise moderates the association between APOE genotype and amyloid deposition in cognitively normal adults.
Design APOE genotyping data and answers to a questionnaire on physical exercise engagement over the last decade were obtained in conjunction with cerebrospinal fluid (CSF) samples and amyloid imaging with carbon 11–labeled Pittsburgh Compound B ([11C]PiB) positron emission tomography. Participants were classified as either low or high exercisers based on exercise guidelines of the American Heart Association.
Setting. Knight Alzheimer's Disease Research Center at Washington University, St Louis, Missouri.
Participants. A total of 201 cognitively normal adults (135 of whom were women) aged 45 to 88 years were recruited from the Knight Alzheimer’s Disease Research Center. Samples of CSF were collected from 165 participants. Amyloid imaging was performed for 163 participants.
Results. APOE 4 carriers evidenced higher [11C]PiB binding (P < .001) and lower CSF Aβ42 levels (P < .001) than did noncarriers. Our previous findings of higher [11C]PiB binding (P = .005) and lower CSF Aβ42 levels (P = .009) in more sedentary individuals were replicated. Most importantly, we observed a novel interaction between APOE status and exercise engagement for [11C]PiB binding (P = .008) such that a more sedentary lifestyle was significantly associated with higher [11C]PiB binding for 4 carriers (P = .013) but not for noncarriers (P = .20). All findings remained significant after controlling for age; sex; educational level; body mass index; the presence or history of hypertension, diabetes mellitus, heart problems, or depression; and the interval between assessments.
Conclusion. Collectively, these results suggest that cognitively normal sedentary APOE 4–positive individuals may be at augmented risk for cerebral amyloid deposition.

Provided by Washington University in St. Louis

Over-65s are frequent binge drinkers: US study

Binge drinking is more common in the United States than previously thought, particularly among young adults, though the most frequent offenders are over 65, said a US government study on Tuesday.

14 jan 2011--One in six Americans, or 17.1 percent of the population, binge drinks, defined as consuming five or more alcoholic beverages in a sitting for men and four or more among women, said the Centers for Disease Control and Prevention.

The latest data for 2010 is an increase over the CDC's report on the same topic for 2009, which said about 15 percent of US adults, or 33 million Americans, binge drink, a rate that had stayed the same for more than 15 years.

While the most common age group among the 38 million American who binge drink was 18-34, those who reported doing it most often were over 65, said the CDC's Vital Signs report, which also warned of the health and safety risks of high alcohol use.

Seniors who binge drink reported doing so 5.5 times per month, compared to an average of four times a month among the rest of the binge-drinking population.

The 18-24 age group had the highest amount of binge drinkers (28.2 percent) in their ranks and tended to drink the most -- 9.3 drinks -- in each setting. The age group 25-34 was a close second (27.9 percent).

"Binge drinking by adults has a huge public health impact, and influences the drinking behavior of underage youth by the example it sets," said CDC substance abuse and mental health services administrator Pamela Hyde.

"We need to reduce binge drinking by adults to prevent the immediate and long-term effects it has on the health of adults and youth."

The data was collected by a randomized phone survey in 48 states and the US capital region. This year, it also included cell phones, which likely resulted in a higher number of young people's participation.

The survey found that binge drinking was most common among people who earned $75,000 or more a year in household income, but those who earned less than $25,000 a year went on binges more frequently.

Low-income binge drinkers tended to consume excessive alcohol five times per month and 8.5 drinks each time.

Whites and Hispanics were more likely to binge drink than blacks. Also, men were more likely to binge drink than women.

"Binge drinking causes more than half of the 80,000 deaths and three quarters of the $223.5 billion in economic costs caused by excessive drinking," said the report.

"Drinking too much contributes to over 54 different injuries and diseases, including car crashes, violence, and sexually-transmitted diseases."

The CDC said that raising the price of alcohol, limiting the days and hours when it can be sold, and restricting the number of liquor licenses offered in a given geographic area could help cut down on binge drinking.

More information: CDC report: http://www.cdc.gov/vitalsigns

Hip fracture guidelines tackle 'considerable variations' in UK and Irish hospital care

All patients with hip fractures should be fast-tracked through hospital emergency departments and operated on within 48 hours of admission, according to new consensus guidelines developed by UK experts in anaesthesia, orthopaedics, geriatrics and emergency medicine and published in the January issue of Anaesthesia.

13 jan 2012--However, patients in one in five hospitals in England and Wales currently wait longer than two days, risking lengthier inpatient stays, increased health problems - such as pressure sores, pneumonia and blood clots - and even an increased chance of death if the delay is prolonged.

The Association of Anaesthetists of Great Britain and Ireland teamed up with a number of other organisations, including the Age Anaesthesia Association and British Orthopaedic Association, to develop the new ten-point plan for the Management of Proximal Femoral Fractures.

"Unlike existing guidelines, they review the current clinical evidence and also recommend best practice in numerous circumstances where evidence is controversial or incomplete, based on expert consensus" says consultant anaesthetist Dr Richard Griffiths, who chaired the working party.

"These are the first guidelines to cover some of the difficult clinical problems faced by anaesthetists on a daily basis.

"For example, we recommend that if any investigations need to be carried out on patients with systolic heart murmurs, this should be done as a matter of urgency to avoid delaying their operations.

"The management of patients on antiplatelet drugs to avoid blood clots forming is another controversial area. Evidence is incomplete, but the expert consensus is to proceed with surgery without stopping the drugs, as operating delays pose a greater risk to the patient."

Hip fractures present unique challenges for anaesthetists as they often occur in elderly patients with significant health problems, stresses Dr Griffiths.

"Despite the fact that guidance has been in place since the early 1990s concerning best practice management for these vulnerable patients, there remain considerable variations in models of post-operative care, rehabilitation and orthogeriatric input" he says.

"Bringing together experts in anaesthesia, orthopaedics, geriatrics and emergency medicine has enabled us to look at the journey of the hip fracture patients from admission to discharge and recommend how their care can be maximised by everyone involved."

Approximately 77,000 patients break their hips in the UK every year, spending an average of 16 days in hospital and costing the National Health Service £785 million. The majority (95 per cent) occur in people over 60 years of age and 75 per cent occur in females.

More than eight per cent of patients will die within 30 days of a hip fracture, especially if they are older, sicker or male, and this figure rises to up to 30 per cent within a year. It has been suggested that half of postoperative deaths are potentially preventable.

Only 44 per cent of UK patients admitted from home are discharged back to their home within 30 days of surgery. A further 22 per cent are discharged to a residential or nursing home and they can often spend a long time in hospital waiting for admission to these facilities, blocking much needed beds.

The ten-point action plan advises that:

1. There should be protocol-driven, fast-track admission of patients with hip fractures through the emergency department.
2. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians.
3. Surgery is the best analgesic for hip fractures.
4. Surgical repair of hip fractures should occur within 48 hours of hospital admission.
5. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists.
6. There must be high-quality communication between clinicians and allied health professionals.
7. Early mobilisation is a key part of the management of patients with hip fractures.
8. Pre-operative management should take into consideration plans for the patient's discharge from hospital.
9. Measures should be taken to prevent secondary falls.
10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip fracture.

"We hope that our guidelines will address current variations in clinical practice so that patients can all benefit from a more consistent approach" concludes Dr Griffiths, who is also lead clinician for the National Health Service Hip Fracture Perioperative Group, an initiative started by anaesthetists, but with increasing membership from orthogeriatricians.

More information: Management of proximal femoral fractures 2011. Griffiths et al. Anaesthesia. 67, pp85-98. (2012). doi:10.1111/j.1365-2044.2011.06957.x

Provided by Wiley

New study supports view that Lewy bodies are not the primary cause of cell death in Parkinson's Disease

The pathology of Parkinson's disease is characterized by a loss of dopamine-producing neurons in the pars compacta of the substantia nigra (SN), an area of the brain associated with motor control, along with the development of α-synuclein (αS) protein in the form of Lewy bodies (LB) in the neurons that survive. The spread of LB pathology is thought to progress along with the clinical course of Parkinson's disease, although recent studies suggest that they are not the toxic cause of cell death. A new study published in The Journal of Parkinson's Disease finds no support for a primary pathogenic role of LBs, as neither their distribution nor density was associated with the severity of nigral cell loss.

12 jan 2011--"We investigated the relationship between nigral dopaminergic cell loss, distribution and density of α-synuclein immunoreactive LBs, and the duration of motor symptoms in 97 patients with Parkinson's disease," explains lead investigator Andrew J. Lees, MD, of Queen Square Brain Bank for Neurological Disorders and the Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK. "Despite the reasonably close correlation between neuronal density in SN and severity of bradykinesia and rigidity in Parkinson's disease, our results suggest that nigral cell loss is gradual and there is considerable variability, which may explain the clinical heterogeneity."

Researchers confirmed that both neuronal number and density in SN in Parkinson's disease decrease over time. The density of nigral neurons was estimated to decrease by 2% each year after confirmation of the clinical diagnosis of Parkinson's disease, but showed marked heterogeneity across patients. Some patients with longer duration of illness still had a significant number of preserved nigral neurons at the time of death. An average of 15% of surviving nigral neurons contained LBs and the age-adjusted proportion of LB-bearing neurons appeared relatively stable through the disease duration. "This could be explained by a passive 'one-pass' phenomenon where the LBs appear at the beginning of the disease and then decrease at the same rate as nigral neurons are lost, or alternatively that a dynamic 'turnover' occurs with some LBs continuously produced and destroyed at the same rate," explains Dr. Lees.

Nigral neuron density was unrelated to the Braak PD stage of the disease (i.e. distribution of LBs in the brain) or to cortical LB densities. "In our view, the fact that neither the widespread regional distribution of LBs nor increased cortical LB densities were found directly linked with pars compacta nigral cell loss lends support to the view that they are not the primary cause of the pathological process leading to cell death in vulnerable regions in the brain in Parkinson's disease," concludes Dr. Lees.

More information: The article is "Disentangling the Relationship between Lewy Bodies and Nigral Neuronal Loss in Parkinson's Disease" by Laura Parkkinen, Sean S O'Sullivan, Catherine Collins, Aviva Petrie, Janice L. Holton, Tamas Revesz, and Andrew J. Lees. Journal of Parkinson's Disease. 1(2011) 277-286. DOI 10.3233/JPD-2011-11046

Provided by IOS Press

Study finds nicotine patches may help improve memory loss in older adults

Wearing a nicotine patch may help improve memory loss in older adults with mild cognitive impairment, according to a study published today in Neurology, the medical journal of the American Academy of Neurology.

11 jan 2012--The study looked at individuals with mild cognitive impairment (MCI), the stage between normal aging and dementia when others begin to notice that an individual is developing mild memory or thinking problems. Many older adults with MCI go on to develop Alzheimer's disease.

The study looked at 74 non-smokers with MCI and an average age of 76. Half of the patients were given a nicotine patch of 15 mg a day for six months and half received a placebo. The study was designed so neither the participants nor the investigators knew which group received the nicotine patch.

Paul Newhouse, M.D., professor of Psychiatry and director of the Center for Cognitive Medicine at Vanderbilt University Medical Center, who authored the study, said the results of the study should not be viewed as an endorsement of smoking or of nicotine for normal individuals. "What we and others have shown is that nicotine doesn't do much for memory and attention in the normal population, but it does do something for those whose cognitive function is already impaired."

"People with memory loss should not start smoking or using nicotine patches by themselves because there are harmful effects of smoking and a medication such as nicotine should only be used with a doctor's supervision," Newhouse said. "But this study provides strong justification for further research into the use of nicotine for people with early signs of memory loss which may help us determine whether benefits persist over long periods of time and provide meaningful improvement."

Newhouse said nicotine is a "fascinating drug with interesting properties." The effects of nicotine are dependent on the initial state of a person's cognitive functioning, he said. "If you're already functioning fine, but slip down the hill, nicotine will push you back up toward the top. A little bit of the drug makes poor performers better. Too much, and it makes them worse again, so there's a range. The key issue is to find the sweet spot where it helps."

The study showed evidence of improvement across multiple cognitive tests for attention memory, speed of processing and consistency of processing. For example, after 6 months of treatment, the nicotine-treated group regained 46 percent of normal performance for age on long-term memory, whereas the placebo group worsened by 26 percent over the same time period. One area that didn't show significant improvement was that of "global impression," which means a health care provider didn't observe the patient was any better or any worse.

Newhouse said that future study is needed. "We need to do a much longer and larger study, to see if we can make a significant impact on the process of change. "

Nicotine stimulates receptors in the brain that are important for thinking and memory and may have neuroprotective effects. People with Alzheimer's disease lose some of those receptors.

Newhouse said the future of nicotinic treatment is to try to identify earlier stages at which treatment can be applied, to see if it changes the trajectory of those who already have evidence of memory loss. "I don't think it's going to become a treatment for Alzheimer's disease by itself. That would be like trying to rebuild a house after a fire when the fire's still going. You need to prevent the fire. The holy grail would be changing the deterioration curve."

Those in the study group receiving the nicotine patch experienced only minor side effects like nausea and dizziness, similar to what a person would experience when smoking a cigarette for the first time, Newhouse said. Those on the nicotine patch also experienced mild weight loss, not surprising since nicotine is an appetite suppressant. There were also no withdrawal symptoms reported when the study participants stopped using the nicotine patch.

Provided by Vanderbilt University Medical Center

Mass prostate cancer screening doesn't reduce deaths: study

There's new evidence that annual prostate cancer screening does not reduce deaths from the disease, even among men in their 50s and 60s and those with underlying health conditions, according to new research led by Washington University School of Medicine in St. Louis.

10 jan 2012--A longer follow-up of more than 76,000 men in a major U.S. study shows that six years of aggressive, annual screening for prostate cancer led to more diagnoses of tumors but not to fewer deaths from the disease.

The updated results of the Prostate, Lung, Cancer, Colorectal and Ovarian (PLCO) Cancer Screening Trial will be published online Jan. 6 in the Journal of the National Cancer Institute.

"The data confirm that for most men, it is not necessary to be screened annually for prostate cancer," says the study's lead author and principal investigator Gerald Andriole, MD, chief urologic surgeon at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "A large majority of the cancers we found are slow-growing tumors that are unlikely to be deadly."

The PLCO study involved men ages 55 to 74, who were randomly assigned to receive either annual PSA tests for six years and digital rectal exams for four years or "routine care," meaning they had the screening tests only if their physicians recommended them.

The new research updates an earlier report of the data published in 2009 in the New England Journal of Medicine. At that time, when nearly all men had been followed for seven years, Andriole and his colleagues did not find a mortality benefit from prostate cancer screening.

But because so few men in the study had died from any causes, the researchers said then that it would be premature to make broad generalizations about whether men should continue to be screened. However, they did recommend against prostate cancer screening for men with a life expectancy of seven to 10 years or less.

"Now, based on our updated results with nearly all men followed for 10 years and more than half for 13 years, we are learning that only the youngest men — those with the longest life expectancy — are apt to benefit from screening. We need to modify our current practices and stop screening elderly men and those with a limited life expectancy," says Andriole, who also is the Robert K. Royce Distinguished Professor. "Instead, we need to take a more targeted approach and selectively screen men who are young and healthy and particularly those at high risk for prostate cancer, including African-Americans and those with a family history of the disease."

Andriole recommends that men get a baseline PSA test in their early 40s because recent studies have indicated that elevated levels at that age can predict the risk of prostate cancer in later years. Men in their 40s with low PSA levels are very unlikely to develop lethal prostate cancer and could potentially avoid additional testing.

The researchers detected 12 percent more prostate tumors among men screened annually compared to those who received routine care (4,250 tumors in the screening arm vs. 3,815 tumors in the control arm).

But deaths from prostate cancer did not differ significantly between the groups. There were 158 deaths from prostate cancer in the screening group and 145 deaths in the routine-care group.

Annual screening tests also did not reduce deaths from prostate cancer among men in their 50s and 60s, as the researchers had hoped.

In addition, men diagnosed with prostate cancer who also had a history of heart attacks, strokes, diabetes, cancer or lung and liver disease were far more likely to die from causes other than prostate cancer – a finding that suggests that screening often finds tumors that are not likely to cause harm.

"Mass screening of all men on the basis of age alone is not the way to go, but screening can still be useful in select men," says Andriole, who acknowledges that widespread testing has lead many men with slow-growing tumors to be over-diagnosed and over-treated with surgery or radiation therapy, the possible side effects of which include incontinence and impotence. "We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy."

The study comes just months after a draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older because of concerns that the test does not save lives and, when positive, often leads to invasive biopsies and aggressive treatments.

The researchers will continue to follow patients in the PLCO study for up to 15 years after they enrolled and evaluate the effects of prostate cancer screening on mortality.

More information: Andriole GL, Crawford ED, Grubb RL, Prorok PC et al. Prostate cancer screening in the randomized prostate, lung, colorectal and ovarian cancer screening trial: mortality results after 13 years of follow-up. Journal of the National Cancer Institute, published online Jan. 6, 2012.

Provided by Washington University School of Medicine

Low vitamin D levels linked to depression, psychiatrists report

Low levels of vitamin D have been linked to depression, according to UT Southwestern Medical Center psychiatrists working with the Cooper Center Longitudinal Study. It is believed to be the largest such investigation ever undertaken.

09 jan 2012--Low levels of vitamin D already are associated with a cavalcade of health woes from cardiovascular diseases to neurological ailments. This new study – published in Mayo Clinic Proceedings – helps clarify a debate that erupted after smaller studies produced conflicting results about the relationship between vitamin D and depression. Major depressive disorder affects nearly one in 10 adults in the U.S.

"Our findings suggest that screening for vitamin D levels in depressed patients – and perhaps screening for depression in people with low vitamin D levels – might be useful," said Dr. E. Sherwood Brown, professor of psychiatry and senior author of the study, done in conjunction with The Cooper Institute in Dallas. "But we don't have enough information yet to recommend going out and taking supplements."

UT Southwestern researchers examined the results of almost 12,600 participants from late 2006 to late 2010. Dr. Brown and colleagues from The Cooper Institute found that higher vitamin D levels were associated with a significantly decreased risk of current depression, particularly among people with a prior history of depression. Low vitamin D levels were associated with depressive symptoms, particularly those with a history of depression, so primary care patients with a history of depression may be an important target for assessing vitamin D levels. The study did not address whether increasing vitamin D levels reduced depressive symptoms.

The scientists have not determined the exact relationship – whether low vitamin D contributes to symptoms of depression, whether depression itself contributes to lower vitamin D levels, or chemically how that happens. But vitamin D may affect neurotransmitters, inflammatory markers and other factors, which could help explain the relationship with depression, said Dr. Brown, who leads the psychoneuroendocrine research program at UT Southwestern.

Vitamin D levels are now commonly tested during routine physical exams, and they already are accepted as risk factors for a number of other medical problems: autoimmune diseases; heart and vascular disease; infectious diseases; osteoporosis; obesity; diabetes; certain cancers; and neurological disorders such as Alzheimer's and Parkinson's diseases, multiple sclerosis, and general cognitive decline.

Investigators used information gathered by the institute, which has 40 years of data on runners and other fit volunteers. UT Southwestern has a partnership with the institute, a preventive medicine research and educational nonprofit located at the Cooper Aerobics Center, to develop a joint scientific medical research program aimed at improving health and preventing a wide range of chronic diseases. The institute maintains one of the world's most extensive databases – known as the Cooper Center Longitudinal Study – that includes detailed information from more than 250,000 clinic visits that has been collected since Dr. Kenneth Cooper founded the institute and clinic in 1970.

Provided by UT Southwestern Medical Center

Sexual satisfaction in women increases with age

A new study of sexually active older women has found that sexual satisfaction in women increases with age and those not engaging in sex are satisfied with their sex lives. A majority of study participants report frequent arousal and orgasm that continue into old age, despite low sexual desire. The study appears in the January issue of the American Journal of Medicine.

08 jan 2012--Researchers from the University of California, San Diego School of Medicine and the Veterans Affairs San Diego Healthcare System evaluated sexual activity and satisfaction as reported by 806 older women who are part of the Rancho Bernardo Study (RBS) cohort, a group of women who live in a planned community near San Diego and whose health has been tracked for medical research for 40 years. The study measured the prevalence of current sexual activity; the characteristics associated with sexual activity including demographics, health, and hormone use; frequency of arousal, lubrication, orgasm, and pain during sexual intercourse; and sexual desire and satisfaction in older women.

The median age in the study was 67 years and 63% were postmenopausal. Half the respondents who reported having a partner had been sexually active in the last 4 weeks. The likelihood of sexual activity declined with increasing age. The majority of the sexually active women, 67.1%, achieved orgasm most of the time or always. The youngest and oldest women in the study reported the highest frequency of orgasm satisfaction.

40% of all women stated that they never or almost never felt sexual desire, and one third of the sexually active women reported low sexual desire. Lead investigator Elizabeth Barrett-Connor, MD, Distinguished Professor and Chief, Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, comments, "Despite a correlation between sexual desire and other sexual function domains, only 1 in 5 sexually active women reported high sexual desire. Approximately half of the women aged 80 years or more reported arousal, lubrication, and orgasm most of the time, but rarely reported sexual desire. In contrast with traditional linear model in which desire precedes sex, these results suggest that women engage in sexual activity for multiple reasons, which may include affirmation or sustenance of a relationship."

Regardless of partner status or sexual activity, 61% of all women in this cohort were satisfied with their overall sex life. Although older age has been described as a significant predictor of low sexual satisfaction, the percentage of RBS sexually satisfied women actually increased with age, with approximately half of the women over 80 years old reporting sexual satisfaction almost always or always. Not only were the oldest women in this study the most satisfied overall, those who were recently sexually active experienced orgasm satisfaction rates similar to the youngest participants. "In this study, sexual activity was not always necessary for sexual satisfaction. Those who were not sexually active may have achieved sexual satisfaction through touching, caressing, or other intimacies developed over the course of a long relationship," says first author Susan Trompeter, MD, Associate Clinical Professor of Medicine. Division of General Internal Medicine, Department of Medicine at the University of California, San Diego School of Medicine and Staff Physician at the VA San Diego Healthcare System.

"Emotional and physical closeness to the partner may be more important than experiencing orgasm. A more positive approach to female sexual health focusing on sexual satisfaction may be more beneficial to women than a focus limited to female sexual activity or dysfunction," Trompeter concludes.

More information: The article is "Sexual Activity and Satisfaction in Healthy Community-Dwelling Older Women," by Susan E. Trompeter, MD, Ricki Bettencourt, MS, and Elizabeth Barrett-Connor, MD. It appears in the American Journal of Medicine, Volume 125, Issue 1 (January 2012)

Provided by Elsevier

A decade of research proves PET effectively detects dementia

In a new review of imaging studies spanning more than ten years, scientists find that a method of positron emission tomography (PET) safely and accurately detects dementia, including the most common and devastating form among the elderly, Alzheimer's disease. This research is featured in the January issue of the Journal of Nuclear Medicine.

07 jan 2012--Researchers reviewed numerous PET studies to evaluate a molecular imaging technique that combines PET, which provides functional images of biological processes, with an injected biomarker called 18F-FDG to pinpoint key areas of metabolic decline in the brain indicating dementia. Having physiological evidence of neurodegenerative disease by imaging patients with PET could give clinicians the information they need to make more accurate diagnoses earlier than ever before.

"The new data support the role of 18F-FDG PET as an effective addition to other diagnostic methods used to assess patients with symptoms of dementia," says Nicolaas Bohnen, MD, PhD, lead author of the study and professor of radiology and neurology at the University of Michigan, Ann Arbor, Mich. "The review also identified new literature showing the benefit of this imaging technique for not only helping to diagnose dementia but also for improving physician confidence when diagnosing a patient with dementia. This process can be difficult for physicians, especially when evaluating younger patients or those who have subtle signs of disease."

Dementia is not a specific illness but a pattern of symptoms characterized by a loss of cognitive ability. These disorders can be caused by injury or progressive disease affecting areas of the brain that control attention, memory, language and mobility. While Alzheimer's is most commonly associated with progressive memory impairment, dementia with Lewy bodies, another form of the disease, can be associated with symptoms of Parkinson's and prominent hallucinations, while another disorder, called frontotemporal dementia, can be seen in patients showing uncharacteristic personality changes and difficulties in relating and communicating. Physicians can use FDG-PET with high accuracy to not only help diagnose dementia but also differentiate between the individual disorders. The role molecular imaging plays in the diagnosis of dementia has expanded enough that the official criteria physicians use to diagnose patients now includes evidence from molecular imaging studies.

"For the first time, imaging biomarkers of Alzheimer's disease are included in the newly revised clinical diagnostic criteria for the disease," says Bohnen. "This is a major shift in disease definition, as previously an Alzheimer's diagnosis was based mainly on a process of evaluating patients to exclude possible trauma, hemorrhage, tumor or metabolic disorder. Now it is becoming a process of inclusion based on biomarker evidence from molecular imaging."

The PET biomarker 18F-FDG comprises a radionuclide combined with fluorodeoxyglucose (FDG), which mimics glucose in the body. Cells metabolize FDG as fuel, and the variation in this uptake by cells throughout the body can then be imaged to detect a range of abnormalities. In the case of dementia, marked reductions in the metabolism of different lobes of the cerebral cortex can confirm a patient's disorder. Physicians can tell Alzheimer's disease apart from other dementias, depending on the specific cortices affected.

This review presents the most up-to-date and salient evidence of FDG-PET's usefulness for the evaluation of patients with suspected dementia. The objective of the study was to replace prior retrospective reviews that were performed as the technique was just emerging and that suggested methodological improvements. The new review includes studies with better methodology, including confirmation of diagnoses with autopsy, more expansive recruitment of subjects and use of multi-center studies. After reviewing 11 studies that occurred since the year 2000 and that met more stringent study review standards, researchers conclude that 18F-FDG is highly effective for detecting the presence and type of dementia.

"Using 18F-FDG PET in the evaluation of patients with dementia can improve diagnostic accuracy and lead to earlier treatment and better patient care," says Bohnen. "The earlier we make a diagnosis, the more we can alleviate uncertainty and suffering for patients and their families."

The biomarker 18F-FDG is among a variety of imaging agents being investigated for its efficacy in Alzheimer's imaging. As treatments for dementia become available for clinical use, PET will no doubt play an important role in not only the diagnosis of these diseases, but also the assessment and monitoring of future therapies.

According to the World Health Organization, an estimated 18 million people worldwide are currently living with Alzheimer disease. That number is projected to almost double by 2025.

More information: "Effectiveness and safety of FDG-PET in the evaluation of dementia: a review of the recent literature" Journal of Nuclear Medicine. http://jnm.snmjournals.org/

Provided by Society of Nuclear Medicine

Cognitive decline can begin as early as age 45: study

The brain's capacity for memory, reasoning and comprehension skills (cognitive function) can start to deteriorate from age 45, finds research published in the British Medical Journal today.

06 jan 2012--Previous research suggests that cognitive decline does not begin before the age of 60, but this view is not universally accepted.

Researchers, led by Archana Singh-Manoux from the Centre for Research in Epidemiology and Population Health in France and University College London in the UK, argue that "understanding cognitive ageing will be one of the challenges of this century," especially as life expectancy continues to rise.

They add that it is important to investigate the age at which cognitive decline begins because medical interventions are more likely to work when individuals first start to experience mental impairment.

Therefore the authors observed 5,198 men and 2,192 women over a 10-year period from 1997. They were all civil servants aged between 45 and 70 and were part of the Whitehall II cohort study established in 1985.

Participants' cognitive functions were assessed three times over the study period. Individuals were tested for memory, vocabulary and aural and visual comprehension skills. The latter include recalling in writing as many words beginning with "S" (phonemic fluency) and as many animal names (semantic fluency) as possible.

Differences in education level were taken into account.

The results show that cognitive scores declined in all categories (memory, reasoning, phonemic and semantic fluency) except vocabulary and there was faster decline in older people.

The findings also reveal that over the 10-year study period there was a 3.6% decline in mental reasoning in men aged 45-49 and a 9.6% decline in those aged 65-70. The corresponding figures for women were 3.6% and 7.4%.

The authors argue that robust evidence showing cognitive decline before the age of 60 has important ramifications because it demonstrates the importance of promoting healthy lifestyles, particularly cardiovascular health, as there is emerging evidence that "what is good for our hearts is also good for our heads."

They add that targeting patients who suffer from one or more risk factors for heart disease (obesity, high blood pressure and high cholesterol levels) could not only protect their hearts but also safeguard them from dementia in later life.

In an accompanying editorial, Francine Grodstein, Associate Professor of Medicine at Brigham and Women's Hospital in Boston, says the study "has profound implications for prevention of dementia and public health."

She adds that more creative research, perhaps using telephone and computer cognitive assessments, needs to be undertaken.

Provided by British Medical Journal

Another potential risk factor for developing dementia and Alzheimer's disease women

A hormone derived from visceral fat called adiponectin may play a role as a risk factor for development of all-cause dementia and Alzheimer disease (AD) in women, according to a study published Online First by the Archives of Neurology.

05 jan 2012--The number of people affected by dementia worldwide is estimated to double over the next 20 years from the current number of about 36 million people, the authors provide as background information in the article. AD is the most common form of dementia. The authors write that data suggest an association between insulin resistance and inflammation, hallmarks for type 2 diabetes, and development of dementia. "An additional potential factor that may contribute to the onset of AD and all-cause dementia is adiponectin. Adiponectin is a hormone derived from visceral fat, which sensitizes the body to insulin, has anti-inflammatory properties, and plays a role in the metabolism of glucose and lipids."

Thomas M. van Himbergen, Ph.D., from the Lipid Metabolism Laboratory, Human Nutrition Research Center on Aging, Tufts University, Boston, and colleagues measured levels of glucose, insulin, and glycated albumin, as well as C reactive protein, lipoprotein associated phospholipase A2, and adiponectin in the plasma of patients at the 19th biennial examination (1985 – 1988) of the Framingham Heart Study.

The 840 patients (541 women, median age of 76 years) were followed-up for an average of 13 years and evaluated for signs of the development of AD and all-cause dementia. During that time, 159 patients developed dementia, including 125 cases of AD. After adjustment for other dementia risk factors (age, apoE genotype, low plasma docosahexaenoic acid, weight change) only adiponectin in women was associated with an increased risk of all-cause dementia and AD.

"It is well established that insulin signaling is dysfunctional in the brains of patients with AD, and since adiponectin enhances insulin sensitivity, one would also expect beneficial actions protecting against cognitive decline," the authors write. "Our data, however, indicate that elevated adiponectin level was associated with an increased risk of dementia and AD in women."

"One of the main features of adiponectin is that it has been shown to play a role in the sensitization of insulin and therefore may become a therapeutic target for the treatment of T2D (type 2 diabetes). Surprisingly, a higher adiponectin level was found to be a predictor of all-cause and vascular mortality. In concurrence with the mortality findings, the current investigation shows that an elevated adiponectin level is also an independent predictor for all-cause dementia and AD in women," the authors conclude.

More information: Arch Neurol. Published online January 2, 2012. doi:10.1001/archneurol.2011.670

Provided by JAMA and Archives Journals

Genetic predisposition to disease common in two supercentenarians: study

The first-ever published whole-genome sequences of not just one, but two supercentenarians, aged more than 114 years, reveal that both unusual and common genetic phenomena contribute to the genetic background of extreme human longevity.

04 jan 2012--Data from the study led by researchers from the Boston University Schools of Public Health and Medicine and Boston Medical Center -- will be available to researchers around the world at the NIH data repository.

In the study, published Jan. 3 in the open-access journal Frontiers in Genetics, researchers at BU, the University of Florida, Gainesville, and The Scripps Research Institute report a comprehensive analysis of the whole genome sequences of a man and a woman, both of whom lived past the age of 114. Supercentenarians (age 110+ years) are very rare, occurring at a rate of one person per five million in developed countries, and there is growing evidence supporting a strong genetic influence in survival to such ages.

The study, led by Paola Sebastiani, professor of biostatistics at the BU School of Public Health, shows that the overall genomic architecture of these two subjects is comparable to that of other published full genomes, in terms of rates of novel variants, functional variants, and variants that predispose to common age-related diseases and common cancers. But while the two carried as many disease-associated genes as the general population, their longevity suggests other protective mechanisms at work.

For example, the male subject had 37 genetic mutations associated with increased risk for colon cancer -- indicating that he was in no way immune to that age-related disease. "In fact, he had presented with an obstructing colon cancer earlier in his life that had not metastasized and was cured with surgery. He was in phenomenal cognitive and physical shape near the time of his death," said Dr. Thomas Perls, director of the New England Centenarian Study and senior author of the article.

The female supercentenarian also had numerous genetic variations associated with age-related diseases, including those related to increased risks for Alzheimer's, cancer and heart disease. She did have congestive heart failure and mild cognitive impairment, but these diseases did not become evident until after the age of 108 years.

"The presence of these disease-associated variants is consistent with our and other researchers' findings that centenarians carry as many disease-associated genes as the general population," Perls said. "The difference may be that the centenarians likely have longevity-associated variants that cancel out the disease genes. That effect may extend to the point that the diseases don't occur -- or, if they do, are much less pathogenic or markedly delayed towards the end of life, in these individuals who are practically living to the limit of the human lifespan."

In support of this conjecture, Sebastiani and colleagues identified more than 50 putative longevity-associated variants in genes that determine two forms of progeria (an accelerated aging disease), and genes linked to cardiovascular disease and Alzheimer's disease. The authors highlighted the importance of performing follow-up studies to determine the impact and function of these genetic variants and their role in regulating health span, as well as life span.

The findings of the study suggest that unusual genetic phenomena and a combination of rare and common genetic variants contribute to the genetic background of extreme human longevity, the authors said.

"The study of these two supercentenarians is just the beginning, and genetic study of many more such subjects needs to be performed," said Perls. A number of such endeavors are underway, on a larger scale, including the Archon Genomics X Prize and a collaboration between Complete Genomics, Inc., The Scripps Translational Science Institute, and other institutions.

More information: http://www.frontie … 090/abstract

Provided by Boston University Medical Center

Changes seen in cerebrospinal fluid levels before onset of Alzheimer dementia

Cerebrospinal fluid levels of Aβ42 appear to be decreased at least five to 10 years before some patients with mild cognitive impairment develop Alzheimer disease (AD) dementia whereas other spinal fluid levels seem to be later markers of disease, according to a report in the January issue of Archives of General Psychiatry.

03 jan 2012--Hopefully, new therapies that can retard or even halt progression of the disease will soon be available. Together with an early and accurate diagnosis, such therapies could be initiated before neuronal degeneration is too widespread and patients are already demented," the authors conclude.

The researchers note as background in the study that disease-modifying therapies, such as immunotherapy, are more likely to be successful if started in the early stages of the disease so there is a need to identify patients with Alzheimer disease before neurodegeneration is not too severe.

Peder Buchhave, M.D., Ph.D, who is affiliated with Lund University and Skane University, Sweden, and colleagues conducted an extended follow-up of the cohort from a previous study of 137 patients with mild cognitive impairment (MCI) at baseline. The median follow-up was 9.2 years.

During the follow-up, 72 patients (53.7 percent) developed AD and 21 (15.7 percent) progressed to other forms of dementia. At the baseline, cerebrospinal fluid Aβ42 levels were reduced and other biomarkers T-tau and P-tau levels were elevated in patients who converted to AD during follow-up compared with levels in patients who did not develop AD.

The study indicates baseline CSF Aβ42 levels were equally reduced in patients with MCI who converted to AD within five years (the early converters) compared to those who converted later between five and 10 years. However, T-tau and P-tau levels were significantly higher in early converters compared to later ones.

Researchers suggest that "approximately 90 percent of patients with MCI and pathologic CSF biomarkers at baseline will develop AD within 9.2 years."

"Therefore, these markers can identify individuals at high risk for future AD least five to 10 years before conversion to dement

Provided by JAMA and Archives Journals

How to prevent, treat a New Year's hangover

01 jan 2012-- New Year’s Eve is fast approaching and many plan on ringing in the new year with a few drinks.

Dr. Aaron Michelfelder, a Loyola University Health System family physician, offers these tips on how to avoid the misery of a New Year's hangover:

Before the party:

• Plan to drink moderately -- a maximum of five drinks for men and three drinks for women during a minimum three-hour periode.

During the party:

• Eat first, and then drink, not the other way around. Food slows the absorption of alcohol.

• Drink slowly.

• To prevent dehydration, drink a glass of water after each alcoholic drink.

• Take a B vitamin supplement.

After the party:

• Do not drink and drive.

• Get as much sleep as possible.

• The morning after:

• Take another B vitamin.

• Drink lots of water.

• Exercise (if you can stand it). During vigorous exercise, blood circulates three times as fast as it does when you are sitting on the couch. And the faster you circulate blood through your liver and kidneys, the faster your body will remove the toxins.

What doesn't work:

• Coffee will make you more alert, but it won't prevent or help a hangover.

• Forget "hair of the dog" -- the notion that having a drink can relieve a hangover. It will only make you feel worse.

Provided by Loyola University Health System

How to make New Year's resolutions that you'll actually follow

Drop 10 pounds. Quit smoking. Stop cursing.

31 dec 2011--New Year's resolutions come around every 365 days or so, about the time the tree is tossed, the menorah is stored and one year elbows aside the other. Even though it seems people break them before they have finished making them, those resolutions can be good things.

"Resolutions are important because they promote goal-setting, which is critical to getting things done," said Michael Pantalon, assistant clinical professor of psychiatry at the Yale University School of Medicine in New Haven, Conn. via email.

But the reason behind the resolution can be as important as setting goals.

"If [a resolution] is merely an exercise designed to satisfy an external pressure, the importance diminishes and the issue can become moot," wrote Jacqueline Keller, founding director of NutriFit LLC, Los Angeles, and a licensed professional wellness coach, in an email.

Even with the best of intentions, people often break their resolutions.

Pantalon said people fail due to three main reasons: They promote goals that are too big. They proclaim their goal to the wrong people, those who will pressure them too much or chastise them instead of those who will actually help them realize their goal. They often focus on how to accomplish goals versus why they want to accomplish them, ignoring the "reason behind the reason," which could provide "more powerful and lasting motivation," he said.

"Be very, very clear not only on how you will accomplish your resolution but also on why you want to accomplish it," Pantalon said. "If you can't come up with good and meaningful reasons that resonate with you, then it's probably not a good resolution."

Resolutions should be more than mere "wishes."

According to Srinivasan Pillay, assistant clinical professor of psychiatry at Harvard Medical School in Boston, Mass., biology plays a role in resolutions, and the brain is the director. Pillay noted that for resolutions to work, they have to take root in the brain, which requires more than simply saying or writing them.

Pillay suggested several tips to make solid resolutions with high probability of accomplishment. Getting excited about your resolutions makes the brain more likely to cement the goal. Forming resolutions in a quiet place will allow the brain to focus on them. It is also important to think them through and phrase them carefully and specifically. Broad goals such as "I want to lose weight" may be more difficult to implement than statements of action such as "I will change my diet tomorrow in the following ways." Framing the goal as a positive statement and picturing yourself undertaking the actions of the resolution will activate centers in your brain and make you more likely to fulfill it.

"Resolutions are like goals, and we know that the setting of goals helps us to get things done," said Simon A. Rego, assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and director of psychology training at the Montefiore Medical Center in Bronx, N.Y., in an email.

Rego stressed that goals are more likely to be reached if they are "smart," meaning specific, measurable, attainable, rewarding, and time-limited. He cautioned against, for example, simply making losing weight a goal, but instead suggested being more specific, such as "I'd like to lose five pounds over the first two months of the year and then set a new goal from there," he said.

Even the best of intentions don't always play out well.

Psychotherapist Karen R. Koenig, a Sarasota, Fla.-based author and expert on the psychology of eating, noted some individuals can sabotage themselves by reacting against their resolutions and do not succeed. Those who do succeed exhibit an internal desire and high motivation to "simply keep doing what's good for them every day without even thinking about commitments or resolutions,” she said.

Breaking an initial resolution doesn't mean a person cannot succeed. And, there's no shame in falling short.

"You are definitely allowed to revise your resolution at any point," said Pantalon.

Provided by Inside Science News Service

New clues as to why some older people may be losing their memory

New research links 'silent strokes,' or small spots of dead brain cells, found in about one out of four older adults to memory loss in the elderly. The study is published in the January 3, 2012, print issue of Neurology, the medical journal of the American Academy of Neurology.

30 dec 2011--"The new aspect of this study of memory loss in the elderly is that it examines silent strokes and hippocampal shrinkage simultaneously," said study author Adam M. Brickman, PhD, of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at Columbia University Medical Center in New York.

For the study, a group of 658 people ages 65 and older and free of dementia were given MRI brain scans. Participants also underwent tests that measured their memory, language, speed at processing information and visual perception. A total of 174 of the participants had silent strokes.

The study found people with silent strokes scored somewhat worse on memory tests than those without silent strokes. This was true whether or not people had a small hippocampus, which is the memory center of the brain.

"Given that conditions like Alzheimer's disease are defined mainly by memory problems, our results may lead to further insight into what causes symptoms and the development of new interventions for prevention. Since silent strokes and the volume of the hippocampus appeared to be associated with memory loss separately in our study, our results also support stroke prevention as a means for staving off memory problems," said Brickman.

Provided by American Academy of Neurology

Diet, nutrient levels linked to cognitive ability, brain shrinkage

New research has found that elderly people with higher levels of several vitamins and omega 3 fatty acids in their blood had better performance on mental acuity tests and less of the brain shrinkage typical of Alzheimer's disease – while "junk food" diets produced just the opposite result.

29 dec 2011--The study was among the first of its type to specifically measure a wide range of blood nutrient levels instead of basing findings on less precise data such as food questionnaires, and found positive effects of high levels of vitamins B, C, D, E and the healthy oils most commonly found in fish.

The research was done by scientists from the Oregon Health and Science University in Portland, Ore., and the Linus Pauling Institute at Oregon State University. It was published today in Neurology, the medical journal of the American Academy of Neurology.

"This approach clearly shows the biological and neurological activity that's associated with actual nutrient levels, both good and bad," said Maret Traber, a principal investigator with the Linus Pauling Institute and co-author on the study.

"The vitamins and nutrients you get from eating a wide range of fruits, vegetables and fish can be measured in blood biomarkers," Traber said. "I'm a firm believer these nutrients have strong potential to protect your brain and make it work better."

The study was done with 104 people, at an average age of 87, with no special risk factors for memory or mental acuity. It tested 30 different nutrient biomarkers in their blood, and 42 participants also had MRI scans to measure their brain volume.

"These findings are based on average people eating average American diets," Traber said. "If anyone right now is considering a New Year's resolution to improve their diet, this would certainly give them another reason to eat more fruits and vegetables."

Among the findings and observations:

• The most favorable cognitive outcomes and brain size measurements were associated with two dietary patterns – high levels of marine fatty acids, and high levels of vitamins B, C, D and E.
• Consistently worse cognitive performance was associated with a higher intake of the type of trans-fats found in baked and fried foods, margarine, fast food and other less-healthy dietary choices.
• The range of demographic and lifestyle habits examined included age, gender, education, smoking, drinking, blood pressure, body mass index and many others.
• The use of blood analysis helped to eliminate issues such as people's flawed recollection of what they ate, and personal variability in nutrients absorbed.
• Much of the variation in mental performance depended on factors such as age or education, but nutrient status accounted for 17 percent of thinking and memory scores and 37 percent of the variation in brain size.
• Cognitive changes related to different diets may be due both to impacts on brain size and cardiovascular function.

The epidemiology of Alzheimer's disease has suggested a role for nutrition, the researchers said in their study, but previous research using conventional analysis, and looking in isolation at single nutrients or small groups, have been disappointing. The study of 30 different blood nutrient levels done in this research reflects a wider range of nutrients and adds specificity to the findings.

The study needs to be confirmed with further research and other variables tested, the scientists said.

Provided by Oregon State University

Scientists identify an innate function of vitamin E

Dr. Paul McNeil, cell biologist at Georgia Health Sciences University, has discovered one of the innate functions of vitamin E. Credit: Phil Jones/GHSU photographer

It's rubbed on the skin to reduce signs of aging and consumed by athletes to improve endurance but scientists now have the first evidence of one of vitamin E's normal body functions.

28 dec 2011--The powerful antioxidant found in most foods helps repair tears in the plasma membranes that protect cells from outside forces and screen what enters and exits, Georgia Health Sciences University researchers report in the journal Nature Communications.

Everyday activities such as eating and exercise can tear the plasma membrane and the new research shows that vitamin E is essential to repair. Without repair of muscle cells, for example, muscles eventually waste away and die in a process similar to what occurs in muscular dystrophy. Muscle weakness also is a common complaint in diabetes, another condition associated with inadequate plasma membrane repair.

"Without any special effort we consume vitamin E every day and we don't even know what it does in our bodies," said Dr. Paul McNeil, GHSU cell biologist and the study's corresponding author. He now feels confident about at least one of its jobs.

Century-old animal studies linked vitamin E deficiency to muscle problems but how that happens remained a mystery until now, McNeil said. His understanding that a lack of membrane repair caused muscle wasting and death prompted McNeil to look at vitamin E.

Vitamin E appears to aid repair in several ways. As an antioxidant, it helps eliminate destructive byproducts from the body's use of oxygen that impede repair. Because it's lipid-soluble, vitamin E can actually insert itself into the membrane to prevent free radicals from attacking. It also can help keep phospholipids, a major membrane component, compliant so they can better repair after a tear.

For example, exercise causes the cell powerhouse, the mitochondria, to burn a lot more oxygen than normal. "As an unavoidable consequence you produce reactive oxygen species," McNeil said. The physical force of exercise tears the membrane. Vitamin E enables adequate plasma membrane repair despite the oxidant challenge and keeps the situation in check.

When he mimicked what happens with exercise by using hydrogen peroxide to produce free radicals, he found that tears in skeletal muscle cells would not heal unless pretreated with vitamin E.

Next steps, which will be aided by two recent National Institutes of Health grants, include examining membrane repair in vitamin E-deficient animals.

McNeil also wants to further examine membrane repair failure in diabetes. Former GHSU graduate student Dr. Amber C. Howard showed in a recent paper in the journal Diabetes that cells taken from animal models of types 1 and 2 diabetes have faulty repair mechanisms. Howard found high glucose was a culprit by soaking cells in a high-glucose solution for eight to 12 weeks, during which time they developed a repair defect. It's also well documented that reactive oxygen species levels are elevated in diabetes.

The Nature Communications paper showed that vitamin E treatment in an animal model of diabetes restored some membrane repair ability. Also, an analogue of the most biologically active form of vitamin E significantly reversed membrane repair deficits caused by high glucose and increased cell survival after tearing cells in culture.

Now McNeil wants to know if he can prevent the development of advanced glycation end products – a sugar that high glucose adds to proteins that his lab has shown can also impede membrane repair – in the animal models of diabetes. The researchers have a drug that at least in cultured animal cells, prevents repair defects from advanced glycation end products.

Provided by Georgia Health Sciences University

99-year-old woman regains mobility following spinal procedures

Scans of Elizabeth DiGennaro's spine show the compression fracture, above, and the results, below, after doctors at University of Rochester Medical Center performed kyphoplasty to repair the bone.

27 dec 2011-- A 99-year-old woman has returned to her daily routine after doctors repaired three separate compression fractures in her spine three times in a month. Specialists at the University of Rochester Medical Center repaired the brittle vertebra using bone glue while the patient was under sedation, which is easier for elderly patients.

Elizabeth DiGennaro of Scottsville is the oldest person to undergo the procedure at URMC exemplifying doctors’ commitment to providing comprehensive care for the fast-growing elderly population. She believes the injury occurred during routine chores that may have been too much for her aging, osteoporotic bones.

She will celebrate her 100th birthday Jan. 3.

“Looking at the scans, you can see that bone had crumbled into pieces,” said Per-Lennart Westesson, M.D., D.D.S., Ph.D., a neuroradiologist who collaborated with Orthopedic surgeon Susan V. Bukata, M.D., and Freda B. Hannafon, FNP-C,MSN, of The Center for Bone Health, to care for DiGennaro.

After several weeks of being bedridden with back pain, DiGennaro’s family worried that she would never recover. They sought help from Bukata, who suggested balloon kyphoplasty. The procedure involves injecting bone cement directly into the compression fracture and using balloons to shift the vertebrae back into place to relieve pain and hasten healing.

This procedure has been used for decades by doctors in Orthopedics, Neurosurgery and Interventional Radiology. Bukata recognized that traditional surgery under general anesthesia may not be best for DiGennaro, because it can elevate a risk of stroke in elderly patients. Bukata suggested Westesson perform kyphoplasty using sedation in an interventional radiology suite, rather than an operating room.

“This was a better option for Mrs. DiGennaro and other elderly patients who suffer these types of injuries,” said Westesson, professor of Imaging Sciences.

The near-centenarian has always been an active, strong-willed woman, according to her daughter, Barbara Galbraith. And the spinal fracture was very painful and the medications to control the pain made her confused and exhausted, and as a result, she was bedridden

“We were really worried that she’d never be able to enjoy her life again,” Galbraith said. “That was no way for her to live.”

“The pain went away immediately and she was back to her normal self again. Two days later she was in pain again, and it was a break, but not the same place. And then there was a third one. Each time we went back and had the second and third procedures she did really well.”

DiGennaro had the first surgery on Sept. 30, followed by a second on Oct. 12, and the third on Nov. 23. Each procedure was a success; the pain was gone and she was able to resume her normal life.

URMC doctors perform more than 100 kyphoplasty procedures each year, providing much needed relief for aging adults with compression fractures.

“This is something we’ll do more and more often with sedation as we see the baby boomer generation age further,” Westesson said.

Provided by University of Rochester Medical Center