Metabolic syndrome linked to memory loss in older people

Older people with larger waistlines, high blood pressure and other risk factors that make up metabolic syndrome may be at a higher risk for memory loss, according to a study published in the February 2, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

04 feb 2011--Metabolic syndrome was defined as having three or more of the following risk factors: high blood pressure, excess belly fat, higher than normal triglycerides (a type of fat found in the blood), high blood sugar and low high-density lipoprotein (HDL) cholesterol, or "good" cholesterol. Metabolic syndrome has also been tied to increased risk of heart attack.

For the study, 7,087 people age 65 and older from three French cities were tested for metabolic syndrome. A total of 16 percent of the participants had metabolic syndrome. Participants were given a series of memory and cognitive function tests two and four years later. The tests included a memory test, a test of visual working memory and a test of word fluency.

Researchers found that people who had metabolic syndrome were 20 percent more likely to have cognitive decline on the memory test than those who did not have metabolic syndrome. Those with metabolic syndrome also were 13 percent more likely to have cognitive decline on the visual working memory test compared to those who did not have the syndrome. Specifically, higher triglycerides and low HDL cholesterol were linked to poorer memory scores; diabetes, but not higher fasting blood sugar, was linked to poorer visual working memory and word fluency scores.

"Our study sheds new light on how metabolic syndrome and the individual factors of the disease may affect cognitive health," said study author Christelle Raffaitin, MD, of the French National Institute of Health Research in Bordeaux, France. "Our results suggest that management of metabolic syndrome may help slow down age-related memory loss, or delay the onset of dementia."

Provided by American Academy of Neurology

Scientists find 5 new Parkinson's genes

Scientists have identified five new genes linked to Parkinson's disease in a large genetic analysis of the illness, according to a new study. After reviewing nearly 8 million possible genetic mutations, researchers pinpointed five genes connected to Parkinson's disease. Previously, six other genes were identified, and experts say there is now increasing proof the degenerative disease is sparked by peoples' genes.

03 feb 2011--The discovery doesn't mean there are any new treatments just yet, but experts are optimistic they are getting closer.

"The major common genetic variants for Parkinson's have been found," said Nick Wood, a professor at the Institute of Neurology at University College London, one of the researchers who led the study. "We haven't put together all the pieces of the puzzle yet, but we're not that far off," he said. He predicted a diagnostic test might be ready within a few years.

Until recently, scientists hadn't been sure what caused Parkinson's disease, but assumed environmental factors such as exposure to chemicals or past head injuries were largely to blame.

Scientists analyzed genetic samples from more than 12,000 people with Parkinson's disease and more than 21,000 from the general population in Europe and the U.S. They found people with the highest number of mutations in the 11 genes linked to Parkinson's were two-and-a-half times more likely to develop the disease than people who had the least amount of mutations.

The average person has a 2.5 percent chance of developing Parkinson's disease in their lifetime, and the risk for people whose close relatives have the illness is about six percent.

The research was paid for by the Wellcome Trust, the National Institute of Aging and the U.S. Department of Defense. It was published online Wednesday in the medical journal Lancet.

Parkinson's is a degenerative brain disease that strikes when brain cells don't make enough of the chemical dopamine. That leads to symptoms including tremors, rigidity and slowness of movement. There are limited treatments and no cure for the disease. It mostly affects people over 50, though younger people, including actor Michael J. Fox, sometimes develop the disease.

Experts said Parkinson's disease was likely the result of a complex interaction between genetics and environmental risk factors.

In an accompanying commentary, scientists said identifying Parkinson's genes could help explain what triggers the disease and one day lead to new treatments.

"There is good reason for optimism that these advances will be translated into direct benefits for our patients," wrote Christine Klein and Andreas Ziegler of the University of Lubeck in Germany.

More information:
http://www.lancet.com

http://www.parkinsons.org.uk

Study predicts risk of memory loss in healthy, older adults

The combined results of a genetic blood test and a five-minute functional MRI successfully classified more than three-quarters of healthy older adults, many of whom were destined to develop cognitive decline within 18 months of testing.

02 feb 2011--John Woodard, Ph.D., associate professor of psychology in the College of Liberal Arts and Sciences and Institute of Gerontology at Wayne State University, is lead author of "Predicting Cognitive Decline in Healthy Older Adults Using fMRI" published in the Journal of Alzheimer's Disease (vol. 21, no. 3).

"No one had studied these combinations of tests in such a large sample," Woodard said. The results have strong implications for determining who is most likely to benefit from preventive Alzheimer's disease treatments.

Woodard and his colleagues performed five tests on 78 healthy elders: a structural MRI (sMRI) that measures the size of the hippocampal region of the brain; a functional MRI (fMRI) that shows how the brain is activated during mental tasks; a blood test that identifies the APOE ε4 allele (a known genetic marker for Alzheimer's disease); and two standard neuropsychological tests that measure mood and ability.

The most effective combination of tests to predict near-term cognitive decline was the fMRI and the APOE ε4 test. The APOE ε4 allele alone correctly classified 61.5 percent of participants, but the combination of the ε4 allele and low activity on the fMRI test correctly classified 78.9 percent of participants, including 35 percent who showed significant cognitive decline 18 months post-testing.

Age, years of education, gender and family history of dementia were not accurate predictors of future cognitive decline. Dr. Woodard and his colleagues also found that persons with larger hippocampal volume, greater functional brain activity and no APOE ε4 allele were less likely to demonstrate cognitive decline over the following 18 months.

The APOE and fMRI tests that combined as the best predictors are readily available, not time-consuming, and don't require special skills or effort on the part of the participant.

"Use of these tests could play a major role in development of medications for prevention of Alzheimer's and other dementias," Woodard said. "If we can intervene before people become symptomatic, we might be able to slow the progression of the disease or eliminate it altogether."

Alzheimer's is age-correlated; the older the person, the greater the likelihood the person will display symptoms.

"If we could delay the onset of Alzheimer's disease by five years, we could cut the number of new cases in half," Dr. Woodard said. "If we could delay the onset of Alzheimer's disease by 10 years, we could potentially eliminate the disease completely."

More information: The complete study is available at http://www.j-alz.c … vol21-3.html

Provided by Wayne State University

U.S. Dietary Guidelines Recommend Lower Salt Intake

New guidelines advise reducing salt and saturated fat intake, avoiding sugary beverages

01 feb 2011-- The seventh edition of the U.S. Department of Agriculture's Dietary Guidelines for Americans was released today, and it calls for Americans to limit their daily sodium intake to less than 2,300 mg, with individuals 51 years of age and older, all blacks, and those with high blood pressure, diabetes, or chronic kidney disease advised to limit their sodium intake to 1,500 mg or less.

The guidelines also recommend that no more than 10 percent of calories should come from saturated fat, which should be replaced with monounsaturated fats or polyunsaturated fatty acids. The guidelines also state that Americans should eat more lean meats and poultry, legumes, nuts, and seeds, as well as fat-free or 1 percent milk. In addition, Americans should avoid added sugars, refined grains, and solid fats as well as consume less than 300 mg per day of cholesterol, according to the guidelines.

Americans are advised to avoid trans fatty acids and consume alcohol in moderation, which means one alcoholic beverage or less for women per day and two drinks for men. Individuals should also drink water instead of sugary sodas or other sweetened beverages. Also, according to the guidelines, nutrients should come from eating nutritious food rather than taking nutritional supplements and Americans should consume more fruits, vegetables, and whole grains to get more needed nutrients.

"Helping Americans incorporate these guidelines into their everyday lives is important to improving the overall health of the American people," Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a statement. "The new Dietary Guidelines provide concrete action steps to help people live healthier, more physically active and longer lives."

More Information

Moderate aerobic exercise in older adults shown to modify brain hippocampus, improve memory

A new study shows that one year of moderate physical exercise can increase the size of the brain's hippocampus in older adults, leading to an improvement in spatial memory.

01 feb 2011--The project—conducted by researchers at the University of Pittsburgh, University of Illinois, Rice University, and Ohio State University—is considered the first study of its kind focusing on older adults who are already experiencing atrophy of the hippocampus, the brain structure involved in all forms of memory formation. The study, funded through the National Institute on Aging, appears in the Jan. 31 Proceedings of the National Academy of Sciences (PNAS).

The scientists recruited 120 sedentary older people without dementia and randomly placed them in one of two groups—those who began an exercise regimen of walking around a track for 40 minutes a day, three days a week, or those limited to stretching and toning exercises. Magnetic resonance images were collected before the intervention, after six months, and at the end of the one-year study.

The aerobic exercise group demonstrated an increase in volume of the left and right hippocampus of 2.12 percent and 1.97 percent, respectively. The same regions of the brain in those who did stretching exercises decreased in volume by 1.40 and 1.43 percent, respectively.

Spatial memory tests were conducted for all participants at the three intervals. Those in the aerobic exercise group showed improved memory function, when measured against their performance at the start of the study, an improvement associated with the increased size of the hippocampus. The authors also examined several biomarkers associated with brain health, including brain-derived neurotrophic factor (BDNF), a small molecule that is involved in learning and memory. They found that the increases in hippocampal size were associated with increased amounts of BDNF.

"We think of the atrophy of the hippocampus in later life as almost inevitable," said Kirk Erickson, professor of psychology at the University of Pittsburgh and the paper's lead author. "But we've shown that even moderate exercise for one year can increase the size of that structure. The brain at that stage remains modifiable."

"The results of our study are particularly interesting in that they suggest that even modest amounts of exercise by sedentary older adults can lead to substantial improvements in memory and brain health," said Art Kramer, director of the Beckman Institute at the University of Illinois and the senior author.

"Such improvements have important implications for the health of our citizens and the expanding population of older adults worldwide."

Provided by University of Illinois at Urbana-Champaign

Mindfulness meditation training changes brain structure in 8 weeks

31 jan 2011-- Participating in an 8-week mindfulness meditation program appears to make measurable changes in brain regions associated with memory, sense of self, empathy and stress. In a study that will appear in the January 30 issue of Psychiatry Research: Neuroimaging, a team led by Massachusetts General Hospital (MGH) researchers report the results of their study, the first to document meditation-produced changes over time in the brain's grey matter.

"Although the practice of meditation is associated with a sense of peacefulness and physical relaxation, practitioners have long claimed that meditation also provides cognitive and psychological benefits that persist throughout the day," says Sara Lazar, PhD, of the MGH Psychiatric Neuroimaging Research Program, the study's senior author. "This study demonstrates that changes in brain structure may underlie some of these reported improvements and that people are not just feeling better because they are spending time relaxing."

Previous studies from Lazar's group and others found structural differences between the brains of experienced mediation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

For the current study, MR images were take of the brain structure of 16 study participants two weeks before and after they took part in the 8-week Mindfulness-Based Stress Reduction (MBSR) Program at the University of Massachusetts Center for Mindfulness. In addition to weekly meetings that included practice of mindfulness meditation – which focuses on nonjudgmental awareness of sensations, feelings and state of mind – participants received audio recordings for guided meditation practice and were asked to keep track of how much time they practiced each day. A set of MR brain images were also taken of a control group of non-meditators over a similar time interval.

Meditation group participants reported spending an average of 27 minutes each day practicing mindfulness exercises, and their responses to a mindfulness questionnaire indicated significant improvements compared with pre-participation responses. The analysis of MR images, which focused on areas where meditation-associated differences were seen in earlier studies, found increased grey-matter density in the hippocampus, known to be important for learning and memory, and in structures associated with self-awareness, compassion and introspection. Participant-reported reductions in stress also were correlated with decreased grey-matter density in the amygdala, which is known to play an important role in anxiety and stress. Although no change was seen in a self-awareness-associated structure called the insula, which had been identified in earlier studies, the authors suggest that longer-term meditation practice might be needed to produce changes in that area. None of these changes were seen in the control group, indicating that they had not resulted merely from the passage of time.

"It is fascinating to see the brain's plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life." says Britta Hölzel, PhD, first author of the paper and a research fellow at MGH and Giessen University in Germany. "Other studies in different patient populations have shown that meditation can make significant improvements in a variety of symptoms, and we are now investigating the underlying mechanisms in the brain that facilitate this change."

Amishi Jha, PhD, a University of Miami neuroscientist who investigates mindfulness-training's effects on individuals in high-stress situations, says, "These results shed light on the mechanisms of action of mindfulness-based training. They demonstrate that the first-person experience of stress can not only be reduced with an 8-week mindfulness training program but that this experiential change corresponds with structural changes in the amydala, a finding that opens doors to many possibilities for further research on MBSR's potential to protect against stress-related disorders, such as post-traumatic stress disorder." Jha was not one of the study investigators.

More information: Psychiatry Research: Neuroimaging

Provided by Massachusetts General Hospital

Hormone therapy begun at menopause may pose risk for breast cancer

Starting hormone therapy at around the time of menopause is associated with a greater risk of breast cancer compared to starting after a longer gap, according to a study published online Jan. 28 in The Journal of the National Cancer Institute.

In this large, prospectively followed cohort of women, those who started hormone therapy five years or more after menopause had little or no increased risk, regardless of the type of hormone therapy used, how long they used it, and whether they were overweight or obese.

30 jan 2011--Many studies have established that breast cancer incidence increases in users of hormonal therapy, in particular among women who use an estrogen-progestin combination as opposed to estrogen-alone. Few studies have looked at the timing of hormone therapy as a risk factor, although two previous studies suggested the interval between menopause and initiating hormone therapy may influence breast cancer risk.

To investigate this question, Valerie Beral, FRS, of Oxford University and colleagues, used data from the Million Women Study (MWS) in the UK. The researchers estimated the adjusted relative risks of breast cancer in hormone therapy users and past users compared to non-users in 1.13 million women in the study. They also compared women on different types of hormone therapy.

They found that women starting hormone therapy at the time of menopause were at greater risk of breast cancer than those starting it later. They write, "A new finding of this study, which has been little investigated previously, is that the interval between menopause and starting hormonal therapy has a substantial effect on breast cancer risk."

Two previous studies have suggested this association but only in certain subgroups. "In this large study, we found greater risks of breast cancer if hormonal therapy use began either before or soon after menopause than after a longer gap; and this pattern of risk was seen across different types of hormonal therapy, among women who used hormonal therapy for either short of long durations, and also in lean and in overweight and obese women."

In an accompanying editorial, Rowan T. Chlebowski, M.D., Ph.D., of Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and Garnet Anderson from the Fred Hutchinson Cancer Research Center note the study provides substantial support for similar findings from the Women's Health Initiative (WHI) in the U.S. They add that the similarities between the patterns of breast cancer risk in these two large studies increase the likely validity of the results, especially since the methodologies of the two studies were quite different.

The editorialists also discuss discrepancies in the two studies' findings regarding the risk of estrogen-only hormone therapy; the WHI found little risk associated with estrogen alone while the MWS found a statistically significant increased risk, except in overweight and obese women. They conclude that "the question of the effect of estrogen-only formulation use on breast cancer risk in postmenopausal women, even with longer-term hormone use, still stands unanswered."

Provided by Journal of the National Cancer Institute

Adult ADHD Linked to Lewy Body Dementia

Patients with Lewy body dementia more likely to have history of attention deficit in adulthood

29 jan 2011-- Adults with symptoms of attention-deficit and hyperactivity disorder (ADHD) may be at increased risk of developing dementia with Lewy bodies (DLB), according to a study published in the January issue of the European Journal of Neurology.

Angel Golimstok, M.D., of the Hospital Italiano Buenos Aires in Argentina, and colleagues investigated the link between ADHD symptoms in adults and the subsequent development of DLB. The frequency of ADHD symptoms during adult life was evaluated in 109 patients with DLB, 251 patients with Alzheimer's disease, and 149 controls, between 2000 and 2005.

The researchers found the prevalence of ADHD symptoms to be significantly higher in DLB cases compared to either the control group or the Alzheimer's disease group. The frequency of preceding ADHD symptoms in DLB cases was 47.8 percent, compared with 15.2 percent in those with Alzheimer's disease and 15.1 percent in the control group.

"The association between ADHD symptoms and DLB that we observed may be explained by a common neurotransmitter pathway dysfunction in both entities. We hypothesized that a common process is involved in both illnesses: ADHD in the initial state of that dysfunction that progresses to DLB in senescence," the authors write.

Abstract

Yearly mammograms from age 40 save 71 percent more lives, study shows

A new study questions the controversial U.S. Preventative Service Task Force recommendations for breast cancer screening, with data that shows starting at a younger age and screening more frequently will result in more lives saved.

29 jan 2011--The study analyzed the same data looked at by the task force, which issued its guidelines on mammography screening in November 2009. The study authors compared the task force's recommendations for screening every other year in women 50-74 to American Cancer Society guidelines of screening every year in women 40-84.

The study was conducted by R. Edward Hendrick, Ph.D., clinical professor of radiology at the University of Colorado School of Medicine, and Mark Helvie, M.D., director of breast imaging at the University of Michigan Comprehensive Cancer Center. It appears in the February issue of the American Journal of Roentgenology.

Hendrick and Helvie used six model scenarios of screening mammography created by the Cancer Intervention and Surveillance Modeling Network. This is the same modeling data the task force considered. The authors compared task force guidelines to American Cancer Society guidelines.

They found that if women begin yearly mammograms at age 40, it reduces breast cancer deaths by 40 percent. When screening begins at 50 and occurs every other year, it reduces breast cancer deaths 23 percent.

The difference between these two screening strategies comes down to 71 percent more lives saved with yearly screening beginning at 40.

"Task force guidelines have created confusion among women, leading some to forego mammography altogether. Mammography is one of the few screening tools that has been proven to save lives and our analysis shows that for maximum survival, annual screening beginning at 40 is best. This data gives women more information to make an informed choice about the screening schedule that's best for them," says Helvie, professor of radiology at the U-M Medical School.

As part of their recommendation, the task force emphasized the potential harms mammography can cause – including pain during the screening exam and anxiety from false-positives, which can lead to additional imaging or biopsy.

The study authors found that on average women ages 40-49 who are screened annually will have a false-positive mammogram once every 10 years. They will get asked back for more tests once every 12 years and will undergo a false-positive biopsy once every 149 years.

"The task force overemphasized potential harms of screening mammography, while ignoring the proven statistically significant benefit of annual screening mammography starting at age 40," Hendrick says. "In addition, the panel ignored more recent data from screening programs in Sweden and Canada showing that 40 percent of breast cancer deaths are averted in women who get regular screening mammography. Our modeling results agree completely with these screening program results in terms of the large number of women lives saved by regular screening mammography."

More information: American Journal of Roentgenology, Vol. 196, W112-W116, February 2011

Provided by University of Michigan Health System

Diabetes Prevalence Reaches 26 Million in United States

8.3 percent of U.S. population now affected, and 35 percent of adults have prediabetes

28 jan 2011 -- Nearly 26 million people in the United States have diabetes, and 79 million U.S. adults are estimated to have prediabetes, according to new estimates released by the U.S. Centers for Disease Control and Prevention.

Members of the CDC collected data from their own surveys, the Indian Health Service's National Patient Information Reporting System, the U.S. Renal Data System of the National Institutes of Health, the U.S. Census Bureau, and published studies to compile a fact sheet representing the current status of diabetes in the United States.

The researchers note that, in 2011, diabetes affects 8.3 percent of all Americans, or almost 26 million people, and that prediabetes affects 35 percent (79 million) of adults aged 20 and older. The CDC estimates that 27 percent of individuals with diabetes, or 7 million people, do not know they have it. In 2008, the agency estimated that 23.6 million Americans -- 7.8 percent of the population -- had diabetes and that 57 million adults had prediabetes. The CDC notes that the 2011 estimates have increased because more people are developing diabetes, more people are living longer with the disease, and hemoglobin A1c is now used as a diagnostic test and was incorporated into national prevalence calculations for the first time.

"These distressing numbers show how important it is to prevent type 2 diabetes and to help those who have diabetes manage the disease to prevent serious complications such as kidney failure and blindness," Ann Albright, Ph.D., R.D., director of CDC's Division of Diabetes Translation, said in a statement. "We know that a structured lifestyle program that includes losing weight and increasing physical activity can prevent or delay type 2 diabetes."

Little-known growth factor enhances memory, prevents forgetting in rats

A naturally occurring growth factor significantly boosted retention and prevented forgetting of a fear memory when injected into rats' memory circuitry during time-limited windows when memories become fragile and changeable. In the study funded by the National Institutes of Health, animals treated with insulin-like growth factor (IGF-II) excelled at remembering to avoid a location where they had previously experienced a mild shock.

28 jan 2011--"To our knowledge, this is the first demonstration of potent memory enhancement via a naturally occurring factor that readily passes through the blood-brain barrier – and thus may hold promise for treatment development," explained Cristina Alberini, Ph.D., of Mount Sinai School of Medicine, New York, a grantee of the NIH's National Institute of Mental Health (NIMH).

Alberini and colleagues say IGF-II could become a potential drug target for boosting memory. They report on their discovery in the Jan. 27, 2011 issue of Nature.

"As we learn more about such mechanisms of fear memory formation and extinction, we hope to apply this knowledge to address clinical problems, including post-traumatic stress disorder," said NIMH Director Thomas R. Insel, M.D.

The staying power of a memory depends on the synthesis of new proteins and structural changes in the connections between brain cells. These memory-strengthening changes occur within time-limited windows right after learning, when memories undergo consolidation, and also right after a memory is retrieved, a process called reconsolidation.

Hints from other studies led the researchers to suspect that IGF-II plays a role in these processes within the brain's memory center, the hippocampus, where it is relatively highly concentrated. The little-known growth factor is part of the brain's machinery for tissue repair and regeneration; it is important during development and declines with age.

To find out how it might work in memory, Alberini's team employed a standard test of fear memory called inhibitory avoidance training. They tracked the movement of rats in an environment where the animals learned to associate a dark area with mild foot shocks. The more an animal avoided the dark area, the better its fear memory.

This kind of learning boosted the expression of naturally occurring IGF-II in the hippocampus. So the researchers injected synthetic IGF-II directly into the hippocampus during windows of consolidation or reconsolidation, when memories are malleable. Remarkably, the rats' memory markedly improved – with the effects lasting at least a few weeks. An examination of the animals' brains revealed that IGF-II had strengthened the cellular connections and mechanisms underlying long-term memory – a process called long-term potentiation.

So IGF-II both strengthened a memory and delayed its normal decay – forgetting, noted Alberini.

The researchers had previously discovered that the fragility induced by memory retrieval requires new protein synthesis in the brain's fear area, the amygdala – but only if the memory is less than two weeks old. In the new study, they found that memory enhancement triggered by IGF-II during this reconsolidation window depended on new protein synthesis in the hippocampus during the same time period. They suggest that these time-limited effects might be explained by a gradual shift in the site where a memory is stored as it grows older, from the hippocampus to the brain's outer mantle, or cortex.

The study showed that the growth factor works through its own – also little known – IGF-II receptor and depends on activation of an enzyme (GSK3 beta), and AMPA receptors for the chemical messenger glutamate, both of which are implicated in memory. Evidence suggests that rather than activating new neurons, it appears to work through already activated connections between cells – or synapses – that are regulated by the enzyme and receptor.

Among future directions, researchers could explore whether IGF-II might enhance other types of memory, such as extinction learning, in which a fear memory is replaced by a memory of safety, said Alberini. If so, it might provide clues to new treatments for anxiety disorders like PTSD.

Provided by National Institutes of Health

Cost to treat heart disease in United States will triple by 2030

The cost to treat heart disease in the United States will triple by 2030, according to a policy statement published in Circulation: Journal of the American Heart Association.

27 jan 2011--"Despite the successes in reducing and treating heart disease over the last half century, even if we just maintain our current rates, we will have an enormous financial burden on top of the disease itself," said Paul Heidenreich, M.D., chair of the American Heart Association expert panel issuing the statement.

The panel estimated future medical costs based on the current rates of disease and used Census data to adjust for anticipated population shifts in age and race. The rigorous methods they devised didn't double count costs for patients with multiple heart conditions.

"These estimates don't assume that we will continue to make new discoveries to reduce heart disease," Heidenreich said. "If our ability to prevent and treat heart disease stays where we are right now, costs will triple in 20 years just through demographic changes in the population."

The panel said effective prevention strategies are needed to limit the growing burden of cardiovascular disease — the leading cause of death in the United States that accounts for 17 percent of overall national health expenditures.

"Unhealthy behaviors and unhealthy environments have contributed to a tidal wave of risk factors among many Americans," said Nancy Brown, American Heart Association CEO. "Early intervention and evidence-based public policies are absolute musts to significantly reduce alarming rates of obesity, hypertension, tobacco use and cholesterol levels."

Currently, 1 in 3 Americans (36.9 percent) have some form of heart disease, including high blood pressure, coronary heart disease, heart failure, stroke and other conditions. By 2030, approximately 116 million people in the United States (40.5 percent) will have some form of cardiovascular disease, the panel said. The largest increases are anticipated in stroke (up 24.9 percent) and heart failure (up 25 percent).

Between 2010-30, the cost of medical care for heart disease (in 2008 dollar values) will rise from $273 billion to $818 billion, the authors predicted. "We were all surprised at the remarkable increase in costs that are expected in the next two decades," Heidenreich said. "We need to continue to invest resources in the prevention of disease, the treatment of risk factors and early treatment of existing disease to reduce that burden."

Provided by American Heart Association

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