Vitamin D deficiency linked to higher mortality in female nursing home residents

The majority of institutionalized elderly female patients are vitamin D deficient and there is an inverse association of vitamin D deficiency and mortality, according to a recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology and Metabolism (JCEM).

7 march 2012--Recommendations for dietary vitamin D intake in the elderly are higher than any other age group because vitamin D deficiency is extraordinarily prevalent in this population and is considered a causal risk factor for skeletal diseases. Treatment involves the daily ingestion of up to 800 IU of vitamin D. The current study examined whether vitamin D deficiency is an independent risk factor for mortality in institutionalized elderly patients.

"Our findings show that the vast majority of nursing home residents are severely vitamin D deficient and those with the lowest vitamin D levels are at high risk of mortality," said Dr. Stefan Pilz, MD, of the Medical University of Graz, Austria, and lead author of the study. "This situation warrants immediate action to prevent and treat vitamin D deficiency."

In this study, researchers examined a sample of 961 nursing home residents in Austria, with an average age of 83.7 years. The researchers recorded 284 deaths—or 30 percent of the study cohort—after a mean follow-up time of 27 months. Their findings showed that vitamin D levels were below recommended levels in 92.8 percent of the study participants, suggesting that while vitamin D deficiency among frail and elderly populations has been acknowledged for several decades, no effective strategies to treat the deficiencies have been developed and implemented.

"Vitamin D supplementation in these patients can exert significant benefits on clinically relevant outcomes such as fractures," said Pilz. "In light of our findings, and the existing literature on adverse effects of vitamin D deficiency, there exists now an urgent need for effective strategies to improve vitamin D status in older institutionalized patients."

More information: The article, "Low 25-hydroxyvitamin D is associated with increased mortality in female nursing home residents," appears in the April 2012 issue of JCEM.

Provided by The Endocrine Society

New Alzheimer's marker strongly predicts mental decline

A new marker of Alzheimer's disease can predict how rapidly a patient's memory and other mental abilities will decline after the disorder is diagnosed, researchers at Washington University School of Medicine in St. Louis have found.

6 march 2012--In 60 patients with early Alzheimer's disease, higher levels of the marker, visinin-like protein 1 (VILIP-1), in the spinal fluid were linked to a more rapid mental decline in the years that followed.

Scientists need to confirm the results in larger studies, but the new data suggest that VILIP-1 potentially may be a better predictor of Alzheimer's progression than other markers.

"VILIP-1 appears to be a strong indicator of ongoing injury to brain cells as a result of Alzheimer's disease," says lead author Rawan Tarawneh, MD, now an assistant professor of neurology at the University of Jordan. "That could be very useful in predicting the course of the disease and in evaluating new treatments in clinical trials."

The study appears March 6 in Neurology.

VILIP-1 was originally identified as a potential indicator of brain cell damage in the laboratory of Jack Ladenson, PhD, the Oree M. Carroll and Lillian B. Ladenson Professor of Clinical Chemistry in Pathology and Immunology at Washington University. Scientists think VILIP-1 serves as a calcium sensor in brain cells. It is released into the cerebrospinal fluid when the cells are injured.

Tarawneh is a former postdoctoral research associate in the laboratory of David Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of Washington University's Department of Neurology. In an earlier study, she and her colleagues showed that healthy subjects with high levels of VILIP-1 were more likely to develop cognitive impairment and Alzheimer's disease over a two- to three-year follow-up period.

For the new study, scientists identified patients with very mild or mild Alzheimer's disease enrolled in studies at the Charles F. and Joanne Knight Alzheimer's Disease Research Center at Washington University School of Medicine. At the outset, researchers measured levels of VILIP-1 in patients' spinal fluid and assessed their mental abilities using an extensive battery of tests. The cognitive function testing was repeated annually.

"Memory and other mental abilities declined faster in patients with the highest levels of VILIP-1," Tarawneh says. "In patients with early symptoms of Alzheimer's disease, VILIP-1 seems to be at least as good as — and potentially even better than — the other prognostic indicators we used in the study."

The two additional indicators studied were the proteins amyloid beta and tau. Changes in the spinal fluid levels of those proteins mainly reflect the fact that amyloid beta and tau are starting to form abnormal deposits in the brain. In contrast, VILIP-1 appears to reveal how much damage to brain cells has occurred as a result of brain changes caused by Alzheimer's.

"These results are intriguing, but we need a larger study to fully understand how the insights provided by VILIP-1 compare to those we can gain from other markers," Tarawneh says.

She is working with Washington University scientists to standardize the tests that measure VILIP-1 for expanded use in research.

More information: Tarawneh R, Lee J-M, Ladenson JH, Morris JC, Holtzman DM. CSF VILIP-1 predicts rates of cognitive decline in early Alzheimer's disease. Neurology, March 6, 2012.

Provided by Washington University School of Medicine

Age affects risk of being diagnosed with cancer at advanced stage

Older women with breast cancer face a higher risk of being diagnosed with the disease at a late stage, while the risk of an advanced stage diagnosis of lung cancer decreases with age, a new study shows today.

5 march 2012--Researchers from the University of Cambridge and the Eastern Cancer Registration and Information Centre (ECRIC) said the study showed that efforts to diagnose cancer early need to be better tailored to different age groups.

The study, published in the British Journal of Cancer, used ECRIC data on stage – a measure of how advanced the cancer is when diagnosed.

The research aimed to find whether there was a link between age or socio-economic background and being diagnosed with advanced stage cancer.

Researchers looked at around 17,800 women with breast cancer and over 13,200 patients with lung cancer in the east of England who were diagnosed between 2006 and 2009.

They found that compared to women aged 65-69, women aged 70-74 had a 21 per cent increased chance of a late stage breast cancer diagnosis.

The chance of an advanced breast cancer diagnosis became higher as women got older – even accounting for the effect of screening. For example, it was 46 per cent higher in women aged 75-79.

In contrast, it was less likely that older patients would be diagnosed with advanced stage lung cancer than younger patients.

Compared with people aged 65-69, people aged 70-74 were 18 per cent less likely of be diagnosed with late stage lung cancer and this chance decreased further with age - for people aged 75-79 it was 26 per cent lower.

For breast cancer, the study also found that late stage diagnosis was more common in women from deprived backgrounds. For lung cancer, late stage diagnosis was more common in men.

Dr. Georgios Lyratzopoulos, study author based at the University of Cambridge, said: “Patient awareness of the signs of breast cancer is known to be lower among older women and this may explain why breast cancer is diagnosed later among this age group.

“But it is puzzling why older patients have a lower risk of advanced stage lung cancer. More research is needed to better understand this pattern.”

The researchers added that the strong likelihood of older women being diagnosed with late stage breast cancer was worrying given that the risk of the disease increases with age.

Dr. David Greenberg, study author based at ECRIC, said: “Collecting staging data has proved difficult in the past but this data is vital to understanding how to improve the diagnosis of cancer. ECRIC has the most complete information on stage. A modernisation programme for cancer registries aims to improve the collection of such information nationwide by end of 2012.”

Sara Hiom, director of information at Cancer Research UK, said: “If cancer is caught early, patients usually have a better chance of beating the disease as more effective treatment options are available.

“We have made great progress in improving cancer survival rates in the last 40 years, but there is still more work to be done to help more people survive cancer.

“Collecting information on stage at diagnosis is vital to do this and we must think how to target messages appropriately to the right audiences."

More information: Lyratzopoulos, G et al., Variation in advanced stage at diagnosis of lung and female breast cancer in an English region 2006-2009 British Journal of Cancer (2012) DOI: 10.1038/bjc.2012.30

Metacognition: I know (or don't know) that I know

An inflated cortical surface of the human brain reconstructed from MRI scans and viewed from the front. Areas of the prefrontal cortex where increased grey matter volume correlated with greater metacognitive ability are shown in hot colours. Credit: Dr Steve Fleming.

At New York University, Sir Henry Wellcome Postdoctoral Fellow Dr. Steve Fleming is exploring the neural basis of metacognition: how we think about thinking, and how we assess the accuracy of our decisions, judgements and other aspects of our mental performance.

04 march 2012--Metacognition is an important-sounding word for a very everyday process. We 'metacognize' whenever we reflect upon our thinking process and knowledge.

It's something we do on a moment-to-moment basis, according to Dr. Steve Fleming at New York University. "We reflect on our thoughts, feelings, judgements and decisions, assessing their accuracy and validity all day long," he says.

This kind of introspection is crucial for making good decisions. Do I really want that bar of chocolate? Do I want to go out tonight? Will I enjoy myself? Am I aiming at the right target? Is my aim accurate? Will I hit it? How sure am I that I'm right? Is that really the correct answer?

If we don't ask ourselves these questions as a kind of faint, ongoing, almost intuitive commentary in the back of our minds, we're not going to progress very smoothly through life.

As it turns out, although we all do it, we're not all equally good at it. An example Steve likes to use is the gameshow 'Who Wants to be a Millionaire?' When asked the killer question, 'Is that your final answer?', contestants with good metacognitive skills will assess how confident they are in their knowledge.

If sure (I know that I know), they'll answer 'yes'. If unsure (I don't know for sure that I know), they'll phone a friend or ask the audience. Contestants who are less metacognitively gifted may have too much confidence in their knowledge and give the wrong answer - or have too little confidence and waste their lifelines.

Metacognition is also fundamental to our sense of self: to knowing who we are. Perhaps we only really know anyone when we understand how, as well as what, they think - and the same applies to knowing ourselves. How reliable are our thought processes? Are they an accurate reflection of reality? How accurate is our knowledge of a particular subject?

Last year, Steve won a prestigious Sir Henry Wellcome Postdoctoral Fellowship to explore the neural basis of metacognitive behavior: what happens in the brain when we think about our thoughts and decisions or assess how well we know something?

Killer questions

One of the challenges for neuroscientists interested in metacognition has been the fact that - unlike in learning or decision making, where we can measure how much a person improves at a task or how accurate their decision is - there are no outward indicators of introspective thought, so it's hard to quantify.

As part of his PhD at University College London, Steve joined a research team led by Wellcome Trust Senior Fellow Professor Geraint Rees and helped devise an experiment that could provide an objective measure of both a person's performance on a task and how accurately they judged their own performance.

Thirty-two volunteers were asked to look at a series of two very similar black and grey pictures on a screen and say which one contained a brighter patch.

"We adjusted the brightness or contrast of the patches so that everyone was performing at a similar level," says Steve. "And we made it difficult to see which patch was brighter, so no one was entirely sure about whether their answer was correct; they were all in a similar zone of uncertainty."

They then asked the 'killer' metacognitive question: How sure are you of your answer, on a scale from one to six?

Comparing people's answers to their actual performance revealed that although all the volunteers performed equally well on the primary task of identifying the brighter patches, there was a lot of variation between individuals in terms of how accurately they assessed their own performance - or how well they knew their own minds.

Magnetic resonance imaging (MRI) scans of the volunteers' brains further revealed that those who most accurately assessed their own performance had more grey matter (the tissue containing the cell bodies of our neurons) in a part of the brain located at the very front, called the anterior prefrontal cortex. In addition, a white-matter tract (a pathway enabling brain regions to communicate) connected to the prefrontal cortex showed greater integrity in individuals with better metacognitive accuracy.

The findings, published in Science in September 2010, linked the complex high-level process of metacognition to a small part of the brain. The study was the first to show that physical brain differences between people are linked to their level of self-awareness or metacognition.

Intriguingly, the anterior prefrontal cortex is also one of the few parts of the brain with anatomical properties that are unique to humans and fundamentally different from our closest relatives, the great apes. It seems introspection might be unique to humans.

"At this stage, we don't know whether this area develops as we get better at reflecting on our thoughts, or whether people are better at introspection if their prefrontal cortex is more developed in the first place," says Steve.

I believe I do

Although this research and research from other labs points to candidate brain regions or networks for metacognition located in the prefrontal cortex, it doesn't explain why they are involved. Steve plans to use his fellowship to address that question by investigating the neural mechanisms that generate metacognitive reports.

He's approaching the question by attempting to separate out the different kinds of information (or variables) people use to monitor their mental and physical performance.

He cites playing a tennis shot as an example. "If I ask you whether you just played a good tennis shot, you can introspect both about whether you aimed correctly and about how well you carried out your shot. These two variables might go together to make up your overall confidence in the shot."

To evaluate how confident we are in each variable (aim and shot) we need to weigh up different sets of perceptual information. To assess our aim, we would consider the speed and direction of the ball and the position of our opponent across the net. To judge how well we carried out the actual shot, we would think about the position of our feet and hips, how we pivoted, and how we swung and followed through.

There may well have been some discrepancy between the shot we wanted to achieve and the shot we actually made. This is a crucial distinction for scientists exploring decision making. "Psychologists tend to think of beliefs, 'what I should do', as being separate from actions," explains Steve.

"When you're choosing between two chocolate bars, you might decide on a Mars bar - that's what you believe you should have, what you want and value. But when you actually carry out the action of reaching for a bar, you might end up reaching for a Twix instead. There's sometimes a difference there between what you should do and what you actually end up doing, and that's perhaps a crucial distinction for metacognition. My initial experiments are going to try to tease apart these variables."

Research into decision making has identified specific brain regions where beliefs about one choice option (one chocolate bar, or one tennis shot) being preferable to another are encoded. However, says Steve, "what we don't know is how this type of information [about values and beliefs] relates to metacognition about your decision making. How does the brain give humans the ability to reflect on its computations?"

He aims to connect the finely detailed picture of decision making given to us by neuroscience to the very vague picture we have of self-reflection or metacognition.

New York, New York

Steve is working with researchers at New York University who are leaders in the field of task design and building models of decision making, "trying to implement in a laboratory setting exactly the kind of question we might ask the tennis player."

They are designing a perceptual task, in which people will have to choose a target to hit based on whether a patch of dots is moving to the left or right. In other words, people need to decide which target they should hit (based on their belief about its direction of motion), and then they have to hit it accurately (action).

"We can use a variety of techniques to manipulate the difficulty of the task. If we make the target very small, people are obviously going to be more uncertain about whether they're going to be able to hit it. So we can separately manipulate the difficulty of deciding what you should do, and the difficulty of actually doing it."

Once the task is up and running, they will then ask the volunteers to make confidence judgements - or even bets - about various aspects of their performance: how likely they thought it was that they chose the right target, or hit it correctly. Comparing their answers with their actual performance will give an objective measure of the accuracy of their beliefs (metacognition) about their performance.

Drilling down

Such a task will mean Steve and his colleagues can start to decouple the perceptual information that gives people information about what they should do (which target to hit) from the perceptual information that enables them to assess the difficulty of actually carrying out the action (hitting the target).

And that in turn will make it possible to start uncoupling various aspects of metacognition - about beliefs, and about actions or responses - from one another. "I want to drill down into the basics, the variables that come together to make up metacognition, and ask the question: how fine-grained is introspection?"

He'll then use a variety of neuroscience techniques, including brain scanning and intervention techniques such as transcranial magnetic stimulation (to briefly switch off metacognitive activity in the brain), to understand how different brain regions encode information relevant for metacognition. "Armed with our new task, we can ask questions such as: is belief- and action-related information encoded separately in the brain? Is the prefrontal cortex integrating metacognitive information? How does this integration occur? Answers to these questions will allow us to start understanding how the system works."

Since metacognition is so fundamental to making successful decisions - and to knowing ourselves - it's clearly important to understand more about it. Steve's research may also have practical uses in the clinic. Metacognition is linked to the concept of 'insight', which in psychiatry refers to whether someone is aware of having a particular disorder. As many as 50 per cent of patients with schizophrenia have profoundly impaired insight and, unsurprisingly, this is a good indicator of whether they will fail to take their medication.

"If we have a nice task to study metacognition in healthy individuals that can quantify the different components of awareness of beliefs, and awareness of responses and actions, we hope to translate that task into patient populations to understand the deficits of metacognition they might have." With that in mind, Steve plans to collaborate with researchers at the University of Oxford and the Institute of Psychiatry in London when he returns to finish his fellowship in the UK.

A science of metacognition also has implications for concepts of responsibility and self-control. Our society currently places great weight on self-awareness: think of a time when you excused your behaviour with 'I just wasn't thinking'. Understanding the boundaries of self-reflection, therefore, is central to how we ascribe blame and punishment, how we approach psychiatric disorders, and how we view human nature.

More information: Fleming S. Relating introspective accuracy to individual differences in brain structure. Science 2010;329(5998):1541-3.

American College of Rheumatology releases first classification criteria for polymyalgia rheumatica

The American College of Rheumatology has released the first classification criteria for polymyalgia rheumatica – aimed at helping physicians identify patients with this condition, which occurs in persons aged 50 years or older who have recent onset of pain in the shoulders, neck and hips along with other inflammatory symptoms not explained by an alternate diagnosis.

3 march 2012--Polymyalgia rheumatica is a relatively common cause of widespread aching and stiffness in older adults. It can be difficult to diagnose because it rarely causes swollen joints or other abnormalities on physical exam. In PMR, the aching is located primarily around the shoulders and hips, and the disease may occur with another rheumatic condition.

Until now, criteria to recognize polymyalgia rheumatica were not well established or tested. The pain and stiffness associated with PMR are common symptoms caused by other illnesses in older people. Additional factors that have contributed to low disease recognition include the lack of standardized tests to confirm the disease, minimal scientific research evaluating therapies, and the absence of genetic markers to identify disease risk.

The new criteria released by the ACR, in collaboration with The European League Against Rheumatism, will improve PMR recognition by defining the important disease features which are useful in classifying patient symptoms caused by this disease. The classification criteria will also provide a structure that will facilitate a better understanding of the disease and its course, and development of new therapies and clinical trials.

"The new criteria were developed by comparing patients with symptoms of PMR caused by a variety of conditions including rheumatoid arthritis and other conditions affecting shoulders and hips and patients with presumed PMR, and following them over a six month period. After six months, the investigators confirmed which patients had PMR, and what the characteristic disease features were, which separated the PMR patients from those with other conditions," says Eric Matteson, MD, MPH; ACR member and chief of rheumatology at the Mayo Clinic College of Medicine.

Dr. Matteson is one of the lead investigators who helped to develop the criteria and adds, "Fulfillment of these criteria will help to ensure that patients with the same disease are being evaluated, which will enhance our ability to study the disease, including performing outcomes studies and clinical trials. Still, there is much to be done to develop better tests for the diagnosis, assessment of disease activity and outcomes of PMR, including further assessment of the new criteria."

PMR is a common inflammatory rheumatic disease of the elderly affecting nearly 711,000 Americans. Under the new criteria, patients 50 years and older can be classified as having PMR if they meet all of the conditions below:

• Shoulder pain on both sides
• Morning stiffness that lasts at least 45 minutes
• High levels of inflammation measured by protein in blood and erythrocyte sedimentation
• Reported new hip pain
• Absence of swelling in the small joints of the hands and feet, and absence of positive blood tests for rheumatoid arthritis

The new classification criteria may also help to evaluate existing treatments for polymyalgia rheumatica. Currently, PMR is treated with low dose corticosteroid such as prednisone. The new criteria will help to assess the benefits of therapies in these patients by ensuring that the patients being evaluated actually all have the same condition. More information: "2012 Provisional Classification Criteria for Polymyalgia Rheumatica." Bhaskar Dasgupta, Marco A. Cimmino, Hilal Maradit Kremers, Wolfgang A. Schmidt, Michael Schirmer, Carlo Salvarani, Artur Bachta, Christian Dejaco, Christina Duftner, Hanne Slott Jensen, Pierre Dugaut, Gyula Poor, Novak Pal Kaposi, Peter Mandl, Peter V. Balint, Zsuzsa Schmidt, Annamaria Iagnocco, Carlotta Nannini, Fabrizio Cantini, Pierluigi Macchioni, Nicolo Pipitone, Montserrat Del Amo, Georgina Espigol-Frigole, Maria C. Cid, Victor M. Martinez-Taboada, Elisabeth Nordborg, Haner Direskeneli, Sibel Zehra Aydin, Khalid Ahmed, Brian Hazleman, Barbara Silverman, Colin Pease, Richard J. Wakefield, Raashid Luqmani, Andy Abril, Clement J. Michet, Ralph Marcus, Neil J. Gonter, Mehrdad Maz, Rickey E. Carter, Cynthia S. Crowson, and Eric L. Matteson. Arthritis & Rheumatism; Published Online: March 2, 2012 (DOI: 10.1002/art.34356).

Mortality of older people in Latin America, India and China: Causes and prevention

Stroke is the leading cause of death in people over 65 in low- and middle-income countries, according to new research published this week. Deaths of people over 65 represent more than a third of all deaths in developing countries yet, until now, little research has focused on this group. The study was led by researchers King's College London and is published in PLoS Medicine. The study also finds that education and social protection are as important in prolonging people's lives as economic development.

2 march 2012--Professor Martin Prince, who led the study from the 10/66 Dementia Research Group at the Institute of Psychiatry at King's says: 'Chronic diseases are rapidly replacing communicable diseases as the leading cause of mortality and disability in developing countries. Since stroke is the leading cause of death in older people, and education is a strong protective factor, prevention may be possible, adding years to life and life to years.

Professor Prince, who is also co-director of London's Centre for Global Mental Health (CGMH), adds: 'The current global health chronic disease agenda is largely focused on reducing mortality among working age adults. The concept of 'premature mortality' applied in such cases, is essentially ageist. I hope our findings will help highlight the lack of information about end of life among older people in developing countries, both regarding potential for prevention, and support and care of the dying, who, in the poorest settings, may not receive timely or effective medical intervention.'

In 2005, deaths of people aged 60 and over accounted 61 percent of all deaths in middle-income countries, and 33 percent in low-income countries, compared to 84 percent in high-income countries, yet there has been little research into the causes and determinants of these deaths.

Researchers surveyed 12,373 people aged 65 and over between 2003 and 2005 in a total of 10 urban and rural sites in Cuba, the Dominican Republic, Venezuela, Peru, Mexico, China and India, documenting over 2,000 deaths over a three to five year follow-up period.

Chronic diseases – particularly stroke, heart disease and diabetes – were the leading causes of death in all sites other than rural Peru. Overall, stroke was the most common cause of death (21.4 percent), ranking first in all sites other than rural Peru and rural Mexico. The authors found that education, more than occupational status and wealth in late-life, had a strong effect in reducing mortality risk in later life.

Most deaths occurred at home, with a particularly high proportion in rural China (91 percent), India (86 percent), and rural Mexico (65 percent). Other than in India, most received medical care for their final illness, but this was usually at home rather than in the hospital or clinic.

More information: Ferri CP, Acosta D, Guerra M, Huang Y, Llibre-Rodriguez JJ, et al. (2012) Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study. PLoS Med 9(2): e1001179. doi:10.1371/journal.pmed.1001179

Study: Sleep gets better with age, not worse

Aging does not appear to be a factor in poor sleep, a new survey of more than 150,000 Americans shows. In fact, subjective sleep quality seems to improve over a lifetime, with the fewest complaints coming from people in their 80s.

01 mar 2012--"This flies in the face of popular belief," said Michael Grandner, PhD, lead author of the study. "These results force us to re-think what we know about sleep in older people – men and women."

The study, appearing in the March edition of the journal Sleep, examined rates of sleep disturbance and daytime fatigue reported by 155,877 adults participating in a randomized telephone survey. Respondents were asked about sleep disturbances and daytime tiredness. The survey also asked about race, income, education, depressed mood, general health and time of last medical checkup. All responses were weighted so that they matched U.S. Census data.

Health problems and depression were associated with poor sleep, and women reported more sleep disturbances and tiredness than men. But except for an uptick in sleep problems during middle age – more pronounced in women than men – sleep quality improved consistently over a lifetime. Or at least that's how people reported their sleep.

"Even if sleep among older Americans is actually worse than in younger adults, feelings about it still improve with age," said Grandner, Research Associate at the Center for Sleep and Circadian Neurobiology at the Perlman School of Medicine at the University of Pennsylvania. "Once you factor out things like illness and depression, older people should be reporting better sleep. If they're not, they need to talk to their doctor. They shouldn't just ignore it."

Grandner said the study's original intent was to confirm that increased sleep problems are associated with aging, using the largest and most representative sample ever to address this issue. Instead, the results challenge the conventional wisdom that difficulty sleeping is perceived more by older adults, and challenge the general clinical practice of ignoring sleep complaints from older adults as a normal part of aging.

More information: "Age and Sleep Disturbances Among American Men And Women: Data From the U.S. Behavioral Risk Factor Surveillance System," in journal Sleep.

Provided by American Academy of Sleep Medicine

Study finds higher death risk with sleeping pills

People are relying on sleeping pills more than ever to get a good night's rest, but a new study by Scripps Clinic researchers links the medications to a 4.6 times higher risk of death and a significant increase in cancer cases among regular pill users.

29 feb 2012--The results, published today by the open-access online journal BMJ Open, cast a shadow over a growing segment of the pharmaceutical industry that expanded by 23 percent in the United States from 2006 to 2010 and generated about $2 billion in annual sales.

"What our study shows is that sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease and other ail-ments," said author Daniel F. Kripke, M.D., of the Viterbi Family Sleep Center in San Diego.

The research is the first to show that eight of the most commonly used hypnotic drugs were associated with increased hazards of mortality and cancer, including the popularly prescribed medications zolpidem (known by the brand name Ambien) and temazepam (also known as Restoril), Dr. Kripke said. Those drugs had been thought to be safer than older hypnotics because of their shorter duration of action.

Study participants who took sleeping pills were matched with control patients of similar ages, gender and health who received no hypnotics in order to eliminate the possibility that other factors led to the results.

"We tried every practical strategy to make these associations go away, thinking that they could be due to use by people with more health problems, but no matter what we did the associations with higher mortality held," said co-author Robert D. Langer, M.D., M.P.H., of the Jackson Hole Center for Preventive Medicine in Jackson, Wyoming.

Even among patients who were prescribed 1 to 18 sleeping pills per year, the risk of death was 3.6 times higher than among similar participants who did not take the medications. The study looked at patients aged 18 years and older, and found the increased risk in all age groups.

Rates of new cancers were 35 percent higher among patients who were prescribed at least 132 hypnotic doses a year as compared with those who did not take the drugs.

Using data stored in an electronic medical record that has been in place for more than a decade, the researchers obtained information on almost 40,000 patients cared for by a large integrated health system in the northeastern United States.

The study included 10,531 sleeping pill users who were prescribed the medications for an average of 2.5 years and 23,674 control participants who were not prescribed the drugs. Information came from outpatient clinic visits conducted between Jan. 1, 2002, and Sept. 30, 2006.

"It is important to note that our results are based on observational data, so even though we did everything we could to ensure their validity, it's still possible that other factors ex-plain the associations," said co-author Lawrence E. Kline, D.O., who is medical director of the Viterbi Family Sleep Center. "We hope our work will spur additional research in this area using information from other populations."

Funding for the study came from the Scripps Health Foundation and other philanthropic sources.

The BMJ Open report should prompt physicians to consider alternatives to hypnotic medications, Dr. Kline said.

Clinicians at the Viterbi Family Sleep Center focus on cognitive therapy that teaches patients to better understand the nature of sleep. For example, some people suffering from insomnia might require less than the eight hours of sleep commonly recommended for each night.

Patients also can benefit from practicing good sleeping habits and relaxation, as well as taking advantage of the body's natural clock, which is driven by the rising and setting of the sun, Dr. Kline said. "Understanding how to use the circadian rhythm is a very powerful tool that doesn't require a prescription," he said.

When insomnia results from emotional problems such as depression, doctors should treat the psychological disorder rather than prescribe sleeping pills that could prove to be harmful, Dr. Kripke said.

Provided by Scripps Health

Red Blood Cell Omega-3 Levels Linked to Brain Volume

Levels of DHA in the lowest quartile tied to smaller brain volume, cognitive impairment

28 feb 2012-- In adults without clinical dementia, low red blood cell (RBC) levels of omega-3 fatty acids are associated with smaller brain volumes and lower scores on tests of visual memory and executive function, according to a study published in the Feb. 28 issue of Neurology.

Zaldy S. Tan, M.D., M.P.H., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues investigated the association between RBC fatty acid levels in 1,575 dementia-free participants (aged 67 ± 9 years) and performance on cognitive tests and volumetric magnetic resonance imaging. In model A, adjustments were made for age, gender, and education; and in additional models, adjustments were also made for APOE ε4 and plasma homocysteine, for physical activity and body mass index, and for traditional vascular risk factors.

The researchers found that participants with RBC docosahexaenoic acid (DHA) in the lowest quartile had significantly lower total brain volume and greater white matter hyperintensity volumes, compared to those with RBC DHA levels in the second to fourth quartiles. The association with total brain volume persisted after multivariable adjustments. Participants with DHA and ω-3 index (RBC DHA + eicosapentaenoic acid [EPA]) levels in the lowest quartile had lower scores on tests of visual memory, executive function, and abstract thinking in all models, compared to those with levels in the second to fourth quartiles.

"Lower levels of RBC DHA and EPA in late middle-age were associated with markers of accelerated structural and cognitive aging," the authors write.

Several authors disclosed financial ties to the pharmaceutical and biotechnology industries.

Abstract

Variable Mortality Risk for Antipsychotic Use in Elderly

Effect strongest soon after start of treatment; dose-response relationship for most drugs

27 feb 2012-- The risk of mortality associated with antipsychotic drug use among elderly residents in nursing homes in the United States varies between drugs, according to a study published online Feb. 23 in BMJ.

To investigate the mortality risks associated with use of individual antipsychotic drugs, Krista F. Huybrechts, Ph.D., from the Brigham and Women's Hospital in Boston, and colleagues conducted a population-based cohort study of 75,445 new antipsychotic users (aged 65 or older) who lived in a nursing home in the United States from 2001 to 2005. The 180-day risks of all-cause and cause-specific mortality were compared for individual drugs.

The researchers found that users of haloperidol had an increased mortality risk, and users of quetiapine had a decreased risk, compared with users of risperidone (hazard ratios, 2.07 and 0.81, respectively), The effects remained after adjustment for dose, were strongest soon after the start of treatment, and were seen for all causes of mortality. There were no clinically meaningful differences seen for other drugs. For all drugs except quetiapine, there was a dose-response relationship.

"Though these findings cannot prove causality, and we cannot rule out the possibility of residual confounding, they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need," the authors write.

Full Text

US drafts plan to fight feared Alzheimer's disease

26 feb 2012-- The Obama administration declared Alzheimer's "one of the most feared health conditions" on Wednesday as it issued a draft of a new national strategy to fight the ominous rise in this mind-destroying disease.

More than 5 million Americans already have Alzheimer's or similar dementias, a toll expected to reach up to 16 million by 2050 - along with skyrocketing medical and nursing home bills - because the population is aging so rapidly.

The government's top goal: Find some effective ways to treat Alzheimer's by 2025. That's an ambitious quest. Today's treatments only temporarily ease symptoms. Scientists know that Alzheimer's brews for years before symptoms appear, but work to find better medications or at least stall the disease's emergence has been frustratingly slow.

Whether scientists can meet that deadline or not, the draft of the first National Alzheimer's Plan also makes clear that overwhelmed families need help right away to care for affected loved ones.

Moreover, as many as half of today's Alzheimer's sufferers haven't been formally diagnosed, and the draft in part blames stigma and misinformation.

Among the draft's planned steps:

-Conduct a major public awareness campaign to help people know the early warning signs of Alzheimer's and what to do.

-Educate doctors and other health workers about how to recognize Alzheimer's, what medications are available now that can help with the disease's symptoms, and what social services may help families to cope.

-Improve early detection, in part by determining the best cognitive screening to offer during Medicare's new annual wellness visit.

-Improve training of caregivers, so they know what resources are available and how to handle common behavior problems of dementia. Research shows that caregivers given such training are able to keep their loved ones at home for far longer.

-Study how to address the health needs of stressed and isolated caregivers.

Then there's the goal of better treatments. The National Institutes of Health spends about $450 million a year on dementia research. Earlier this month, the Obama administration announced it would add an extra $50 million to that tab this year, and seek $80 million more to spend on Alzheimer's research in 2013.

It plans to spend about $26 million on some of the plan's other provisions.

For comparison, the government spends nearly $3 billion on AIDS research; about 1.1 million Americans are living with the AIDS virus.

Wednesday's draft is open for public comment through March, and the government's Alzheimer's advisory council is sure to make changes before a final strategy is issued later this year. But some of the work isn't waiting: The NIH, for example, is bringing together top Alzheimer's scientists in May to discuss the most promising leads for better treatment.

Some members of that advisory council called the draft a good first step.

"They've covered the right topics. What is needed now is more detail," said Alzheimer's Association President Harry Johns. "There's real recognition at this point that Alzheimer's is devastating for not only the individual but for the families and caregivers."

"Today, with the strong commitment of federal leaders and louder outcry from the public, the urgency of the Alzheimer's disease crisis is being recognized and acted upon," said Eric J. Hall, president of the Alzheimer's Foundation of America.

More information: Alzheimer's plan: http://aspe.hhs.gov/daltcp/napa/(hash)DraftNatlPlan

International experts clarify hormonal changes of menopause

A panel of US and international experts met in September 2011, in Washington, DC, to review the latest scientific data on the hormonal changes that mark reproductive aging in women and to reach consensus on defining the reproductive stages in a woman's life from pre-menopause to the late postmenopausal period. STRAW+10 represents an update to the landmark STRAW (Stages of Reproductive Aging Workshop) system put into place ten years ago that paved the way for international studies that have led to a greater understanding of reproductive aging in women.

25 feb 2012--The new report includes the following revisions:

• Simplified bleeding criteria for the early and late menopausal transition
• Modified criteria for the late reproductive and early post-menopause stages
• Recommended application of this staging system to a wider range of women without limitation by age, ethnicity, body size or lifestyle characteristics

The STRAW+10 report is published in the Menopause, Journal of Clinical Endocrinology and Metabolism, Climacteric, and Fertility and Sterility.

The symposium was co-sponsored by The National Institute on Aging (NIA), The Office of Research on Women's Health (ORWH), as well as The North American Menopause Society (NAMS), The American Society for Reproductive Medicine (ASRM), The International Menopause Society (IMS), and The Endocrine Society.

Dr. Margery Gass, Executive Director of The North American Menopause Society comments: "The North American Menopause Society convened a group of experts from key medical societies around the world to update our understanding of the stages women go through from adolescence to menopause and beyond. This new update has broader application to more women and provides additional details for determining where a woman is in these reproductive stages".

Provided by The North American Menopause Society (NAMS)

Study: Virtual colonoscopy effective screening tool for adults over 65

Computed tomography (CT) colonography can be used as a primary screening tool for colorectal cancer in adults over the age of 65, according to a new study published online in the journal Radiology.

24 feb 2012--Some previous medical studies have found no significant difference in the diagnostic accuracy of CT colonography, also known as "virtual colonoscopy," and traditional optical colonoscopy. This study looks at whether both exams are as effective for adults over 65 as they are for adults between 50 and 65 years of age.

In the study, C. Daniel Johnson, M.D., professor and chair of radiology at Mayo Clinic in Scottsdale, Ariz., and a team of researchers conducted a follow-up analysis of data from the National CT Colonography Trial, in which 2,600 patients over the age of 50 underwent both virtual and optical colonoscopies at 15 centers around the country.

Dr. Johnson's team analyzed trial data from 477 patients over the age of 65 and 2,054 patients between the ages of 50 and 65 who were screened with the two procedures for clinically significant pre-cancerous growths called polyps. Patients in the study were comprised of both men and women at predominantly an average risk for colorectal cancer.

Cancerous lesions 1 centimeter or larger were found in 6.9 percent of patients in the 65 and older group and in 3.7 percent of the younger patients.

There was no significant difference in the accuracy of CT colonography for the detection of large and intermediate-sized cancers in the older participants compared to the younger participants. Sensitivity and specificity among the older and younger groups were 0.82 and 0.83 and 0.92 and 0.86, respectively.

"We found no statistical difference in the diagnostic performance between the two patient groups," Dr. Johnson said. "This is good information for patients of any age, as they can consider CT colonography as a valid option for colorectal cancer screening."

Colorectal cancer is the third most commonly diagnosed cancer in both men and women and the third leading cause of cancer deaths in the U.S. According to the American Cancer Society (ACS), a decline in colorectal cancer incidence rates over the last two decades is largely attributable to screening tests that allow polyps to be removed before they progress to cancer.

"I don't believe there is any screening test that can intervene as early in the biology of the tumor as colorectal cancer screening," Dr. Johnson said. "We have the opportunity to detect pre-malignant polyps, remove them and prevent an entire class of cancers."

Despite the effectiveness of colorectal cancer screening, the ACS estimates that only half of the U.S. population over the age 50 is being screened as recommended for the disease. Experts point to cost and a lack of access to health care as contributing factors.

Although both optical and virtual colonoscopy procedures typically require the use of laxatives to empty the colon prior to the test, there are major differences between the two exams.

In the traditional colonoscopy, an optical instrument called a colonoscope allows a physician to visually examine the colon and to remove polyps by passing a wire loop through the scope. In this procedure, the risk of perforating the bowel is higher and sedation is required.

"For the older patient, the risks of and recovery from sedation are issues," Dr. Johnson said.

Introduced in the 1990s, CT colonography produces cross-sectional, three-dimensional images of the entire colon and rectum. While the CTC exam itself is quicker to perform and about half the cost of the optical colonoscopy, it involves exposure to low doses of radiation and it must be repeated more often. When polyps 6 millimeters or larger are detected by CT colonography, the patient must undergo an optical colonoscopy to have them removed. In addition, incidental CT findings outside the colon might require additional follow-up.

"There isn't a fight between CT colonography and colonoscopy, but there is a fight in medicine against colon cancer," Dr. Johnson said. "We want patients to be screened. CT colonography is a preferred test for some patients and should be an option. Patients should talk to their doctor and choose the best option for them."

More information: "The National CT Colonography Trial: Assessment of Accuracy in Participants Aged 65 and Older." http://radiology.rsna.org/

Provided by Radiological Society of North America

Many women having a heart attack don't have chest pain

23 feb 2012--Two out of five women having a heart attack do not experience chest pain, according to a new study.

Instead, they may have harder-to-recognize symptoms, such as pain in the jaw, neck, shoulders or back; stomach discomfort; or sudden trouble breathing, researchers said.

That may be one reason why women also have a higher risk of dying from a heart attack when they're in the hospital compared to men, the study found.

"The hallmark symptoms of a heart attack are chest pain and discomfort. But, women are more likely to have a different attack presentation," said study lead author Dr. John Canto, director of cardiovascular prevention, research and education at the Watson Clinic and director of the Chest Pain Center at Lakeland Regional Medical Center in Fla.

Men and women who have risk factors for heart disease, such as obesity, diabetes, high blood pressure, high cholesterol or a family history of heart disease, should be particularly concerned if they experience these symptoms.

"The reality is that most people who have chest pain and discomfort aren't having a heart attack. But, you can't wait to find out. Time is heart muscle. If you delay seeking treatment, you may be outside the window where you can get the most effective treatment," he said.

The study is in the Feb. 22/29 issue of the Journal of the American Medical Association.

Researchers analyzed data on more than 1.1 million patients seen at U.S. hospitals for heart attacks from 1994 to 2006. About 42 percent were women, who were also on average older than men when they had their heart attack.

Among both men and women, just over 35 percent -- or about one in three -- did not have chest pain.

However, women were more likely to experience an attack without chest pain compared to men, at 42 percent and 31 percent, respectively.

In-hospital deaths from heart attack were also more common among women: 14.6 percent of women died while still in the hospital, compared to just over 10 percent of men.

Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association, said other heart attack symptoms women may experience include sweating, nausea and flu-like symptoms.

Though it can be hard to connect those symptoms to a heart attack, if "all of a sudden your daily activities become daunting, and you feel like you just can't function, you have to get checked out. If it's not your heart, so what? It's better to be safe than sorry," she said.

She also advised women to be assertive about their worries with doctors. Say, "I think I'm having a heart attack," she recommended.

Men may need to heed this advice as well, because they too may not have classic chest pain symptoms, she added.

The study found that for men and women -- but particularly for young women -- heart attacks without chest pain were associated with a greater risk of death. One of the main reasons, said Canto, is that people may delay going to the ER, and once they do call for help or go to the hospital, they may downplay their symptoms, leading to less urgent action from health care providers.

In the case of women, said Canto, the higher mortality rates may also be linked to biological differences in heart disease between men and women. When the researchers compared women without chest pain and men without chest pain, they still found a higher risk of death for women.

Cognitive stimulation beneficial in dementia

Cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, according to a systematic review by Cochrane researchers. Despite concerns that cognitive improvements may not be matched by improvements in quality of life, the review also found positive effects for well-being.

22 feb 2012--There is a general belief that activities that stimulate the mind help to slow its decline in people with dementia. Cognitive stimulation provides people with dementia with activities intended to stimulate thinking, memory and social interaction, in order to delay the worsening of dementia symptoms. In 2011, the World Alzheimer's Report recommended that cognitive stimulation should be routinely offered to people with early stage dementia. However, increased interest in its use in dementia in recent years has provoked concern about its effectiveness and potential negative effects on well-being.

The review, published in The Cochrane Library, included 15 randomised controlled trials involving 718 people with mild to moderate dementia, mainly in the form of Alzheimer's disease or vascular dementia. Participants were treated in small groups and involved in different activities, from discussions and word games to music and baking. All activities were designed to stimulate thinking and memory. Improvements were weighed against those seen without treatment, with "standard treatments", which could include medicine, day care or visits from community mental health workers, or in some cases alternative activities such as watching TV and physical therapy.

"The most striking findings in this review are those related to the positive effects of cognitive stimulation on performance in cognitive tests," said lead author, Bob Woods, of the Dementia Services Development Centre Wales, at Bangor University in Bangor, UK. "These findings are perhaps the most consistent yet for psychological interventions in people with dementia."

Those who received cognitive stimulation interventions scored significantly higher in cognitive function tests, which measure improvements in memory and thinking. These benefits were still being seen one to three months after treatment. In addition, positive effects on social interaction, communication and quality of life or well-being were observed in a smaller number of the trials, based on self-reported or carer-reported measures.

In one trial, family members were trained to deliver cognitive stimulation on a one-to-one basis, with no additional strain on burden on caregivers reported. "Involving family caregivers in the delivery of cognitive stimulation is an interesting development and deserving of further attention," said Woods.

Provided by Wiley

Cellular aging increases risk of heart attack and early death

This is Clinical Professor of Genetic Epidemiology Borge Nordestgaard from the University of Copenhagen. Professor Nordestgaard is also a chief physician at Copenhagen University Hospital, where he and colleagues conduct large scale studies of groups of tens of thousands of Danes over several decades. Credit: University of Copenhagen

Every cell in the body has chromosomes with so-called telomeres, which are shortened over time and also through lifestyle choices such as smoking and obesity. Researchers have long speculated that the shortening of telomeres increases the risk of heart attack and early death. Now a large-scale population study in Denmark involving nearly 20,000 people shows that there is in fact a direct link, and has also given physicians a future way to test the actual cellular health of a person.

20 feb 2012--In an ongoing study of almost 20,000 Danes, a team of researchers from the University of Copenhagen have isolated each individual's DNA to analyse their specific telomere length – a measurement of cellular aging.

"The risk of heart attack or early death is present whether your telomeres are shortened due to lifestyle or due to high age," says Clinical Professor of Genetic Epidemiology Borge Nordestgaard from the Faculty of Health and Medical Sciences at the University of Copenhagen. Professor Nordestgaard is also a chief physician at Copenhagen University Hospital, where he and colleagues conduct large scale studies of groups of tens of thousands of Danes over several decades.

In an ongoing study of almost 20,000 Danes, a team of researchers from the University of Copenhagen have isolated each individual’s DNA to analyze their specific telomere length - a measurement of cellular aging. The conclusion was clear: If the telomere length was short, the risk of heart attack and early death was increased by 50 and 25 percent, respectively. Professor Borge Nordestgaard explains the study and the breakthrough results. Read the full University of Copenhagen press release: http://news.ku.dk/all_news/2012/2012.2/cellular-aging-increases-risk-of-heart-attack/ Credit: Credits: Speak: Henrietta von Schilling. Camera: Carl Hagman and Tue Nielsen. Production: Tue Nielsen and Lasse Foghsgaard, Experimentarium.

Lifestyle can affect cellular aging

The recent "Copenhagen General Population Study" involved almost 20,000 people, some of which were followed during almost 19 years, and the conclusion was clear: If the telomere length was short, the risk of heart attack and early death was increased by 50 and 25 per cent, respectively.

"That smoking and obesity increases the risk of heart disease has been known for a while. We have now shown, as has been speculated, that the increased risk is directly related to the shortening of the protective telomeres - so you can say that smoking and obesity ages the body on a cellular level, just as surely as the passing of time," says Borge Nordestgaard.

One in four Danes has short telomeres

The study also revealed that one in four Danes has telomeres with such short length that not only will they statistically die before their time, but their risk of heart attack is also increased by almost 50 per cent.

"Future studies will have to reveal the actual molecular mechanism by which the short telomere length causes heart attacks," says Borge Nordestgaard, and asks, "Does one cause the other or is the telomere length and the coronary event both indicative of a third - yet unknown - mechanism?"

Another possible prospect of the study is that general practitioners could conduct simple blood tests to reveal a person's telomere length and thereby the cellular wear and age.

More information: The study "Short Telomere Length, Myocardial Infarction, Ischemic Heart Disease, and Early Death" is scheduled for the March issue of the journal Arteriosclerosis, Thrombosis and Vascular Biology published by the American Heart Association.

Provided by University of Copenhagen

Aging studies suggest older people are happier

Lab manager Julia Harris (right) places glasses with a mobile tracking device on Derek Isaacowitz, associate professor of psychology, in the Lifespan Emotional Development Lab (LEDlab). Credit: Mary Knox Merrill.

19 feb 2011-- We get wrinkles. Our hair turns gray, or we lose it altogether. Our job prospects diminish and our chances of incurring disease increase. Researchers across the globe focus their efforts on increasing our life span because so many of us believe getting old stinks.

But that may not be so, according to Derek Isaacowitz a newly appointed associate professor of psychology in the College of Science. Contrary to popular opinion, he says, older people are happier than their younger counterparts.

“Self-report studies of happiness typically find that older people are happier,” Isaacowitz explains. But for the psychologist, who joined the Northeastern faculty after spending a decade at Brandeis, self-reporting is not enough. He wants to know why older people are happier.

To tackle this question, he employs a state-of-the-art testing method not typically used in aging research: eye tracking.

Eye tracking, he says, follows a participant’s eye movements by taking 60 snapshots of his or her pupils each second. Isaacowitz couples self-reports of mood with eye tracking data to pinpoint exactly what a person is looking at while rating his or her mood.

“We can analyze data in a moment to say, ‘how does what you’re looking at relate to what you feel?’” Isaacowitz says.

Results revealed that older and younger participants might regulate their emotions in vastly different ways. As Isaacowitz puts it, “One way of regulating emotion is to change your thinking about something, to see something upsetting and say ‘no’.” This seems to be the strategy of most younger test subjects.

On the other hand, older people tend to look at negative images less often, possibly indicating that they regulate emotion by distracting themselves from negative stimuli.

Isaacowitz says this makes sense, since the elderly tend to have fewer resources than the young: “If I made you really tired or gave you something else to do, it would be easier to distract instead of reappraise.”

While Isaacowitz’ research has already confirmed a cognitive difference between older and younger people, many questions remain about how this difference may relate to the role of age in regulating day-to-day emotion.

Isaacowitz was eager to join the Affective Science Institute at Northeastern and help advance the university’s strength in aging research. He says his lab on campus will conduct a number of new studies, including an analysis of subjects in a more natural environment. “We’ll be nicely set up to do that in the lab here,” he says.

Provided by Northeastern University

Psychiatry debates whether the pain of loss is really depression

The pain of losing a loved one can be a searing, gut-wrenching hurt and a long-lasting blow to a person's mood, concentration and ability to function. But is grief the same as depression?

18 feb 2012--That's a lively debate right now, as the psychiatric profession considers a key change in the forthcoming rewrite of its diagnostic "Bible." That proposed modification - one of many - would allow mental health providers to label the psychic pain of bereavement a mood disorder and act quickly to treat it, in some cases, with medication. With the Diagnostic and Statistical Manual's fifth edition set for completion by the end of this year, the editors of the British journal The Lancet have come out in strong opposition to the new language, calling grief a natural and healthy response to loss, not a pathological state.

"Grief is not an illness. It is more usefully thought of as part of being human, and a normal response to the death of a loved one," writes the editor of The Lancet. "Most people who experience the death of someone they love do not need treatment by a psychiatrist or indeed by any doctor. For those who are grieving, doctors would do better to offer time, compassion, remembrance, and empathy, than pills."

The change under consideration would expunge any reference to the passage of time since a loved one's death before a diagnosis of depression could be considered. The current edition of the diagnostic manual states that if a patient's low mood and energy, sleep difficulties and appetite changes persist for more than two months following bereavement, a diagnosis of depression might be considered. An earlier edition of the manual had established a year as the period during which mourning should not be confused with depression.

"Putting a time frame on grief is inappropriate," The Lancet's lead editorial states simply. And in a "Perspectives" essay also published Thursday in Lancet, Harvard University medical anthropologist Dr. Arthur Kleinman agrees, eloquently exploring what's at stake.

"Is grief something we can or should no longer tolerate?" asks Kleinman, who describes his own grief after his wife of 46 years died last March from Alzheimer's Disease. "Is this existential source of suffering like any dental or back pain unwanted and unneeded?"

Kleinman calls the current two-month time period allowed for grief a "shockingly short expectation" that no religion or society would support. To allow grief to be redefined as depression with no allowance at all for the passage of time not only spells "the loss of grief": it risks redefining vast numbers of Americans who are taking their time to adjust to the loss of a loved one as sick, he writes. And it powerfully rewrites cultural values about how we understand and mark the loss of a fellow human being.

Proponents of the change have argued that it would allow the bereaved to seek help for their suffering. And they add that it would not define all who grieve as depressed. They argue there is often no difference, but for the recent death of a loved one, between the behaviors that define depression and those that define grief.

The Lancet's editors note there is no evidence that antidepressant medications improve the moods of people who are healthy to begin with. Citing fellow critics of the proposed move, Kleinman suggests that it might have been inevitable once the financial interests of pharmaceutical manufacturers collided with psychiatry's loose definitions of mental illness and the profession's tendency to expand its patient base.

"Its ubiquity makes grief a potential profit centre for the business of psychiatry," writes Kleinman.

Study: Weight training improves Parkinson's symptoms

New research suggests weight training for two years significantly improves the motor symptoms of Parkinson's disease compared to other forms of exercise such as stretching and balance exercises. The clinical trial, which compared two forms of exercise for Parkinson's disease, was released today and will be presented at the American Academy of Neurology's 64th Annual Meeting in New Orleans April 21 to April 28, 2012.

17 feb 2012--"While we have known that many different types of exercise can benefit Parkinson's patients over short time periods, we did not know whether exercise improves the motor symptoms of Parkinson's over the long term," said study author Daniel Corcos, PhD, with the University of Illinois at Chicago.

For the study, 48 people with Parkinson's disease were randomized to progressive resistance exercise, known as weight training, or they were assigned to the exercise known as fitness counts, which includes flexibility, balance and strengthening exercises. The groups exercised for one hour, twice a week for two years.

The severity of motor symptoms, including tremors, was measured using the Unified Parkinson's Disease Rating Scale (UPDRS) after six, 12, 18 and 24 months of exercise. Scores were taken when the participants were not taking their medication.

While both forms of exercise reduced motor symptoms at six months of exercise, participants who did weight training saw a 7.3 point improvement in their UPRDS score after two years while the fitness counts group returned to the same scores they had at the start of the study.

"Our results suggest that long-term weight training could be considered by patients and doctors as an important component in managing Parkinson's disease," said Corcos.

Provided by American Academy of Neurology

Stem cell treatments improve heart function after heart attack

Stem cell therapy moderately improves heart function after a heart attack, according to a systematic review published in The Cochrane Library. But the researchers behind the review say larger clinical trials are needed to establish whether this benefit translates to a longer life.

16 feb 2012--In a heart attack, the blood supply to parts of the heart is cut off by a blocked artery, causing damage to the heart tissue. The cells in the affected area start to die. This is called necrosis and in the days and weeks that follow, the necrotic area may grow, eventually leaving a large part of the heart unable to contract and increasing the risk of further heart problems. Stem cell therapy uses cells from the patient's own bone marrow to try to repair and reduce this damage. Currently, the treatment is only available in facilities with links to scientific research.

The authors of the review drew together all the available evidence to ask whether adult bone marrow stem cells can effectively prevent and repair the damage caused by a heart attack. In 2008, a Cochrane review of 13 stem cell therapy clinical trials addressed the same question, but the new review adds 20 more recent trials, drawing its conclusions from all 33. By incorporating longer follow up, the later trials provide a better indication of the effects of the therapy several years after treatment.

The total number of patients involved in trials was 1,765. All had already undergone angioplasty, a conventional treatment that uses a balloon to open the blocked artery and reintroduce the blood supply. The review's findings suggest that stem cell therapy using bone marrow-derived stem cells (BMSCs) can produce a moderate long-term improvement in heart function, which is sustained for up to five years. However, there was not enough data to reach firm conclusions about improvements in survival rates.

"This new treatment may lead to moderate improvement in heart function over standard treatments," said lead author of the study, Enca Martin-Rendon, of the Stem Cell Research laboratory, NHS Blood and Transplant at the John Radcliffe Hospital in Oxford, UK. "Stem cell therapy may also reduce the number of patients who later die or suffer from heart failure, but currently there is a lack of statistically significant evidence based on the small number of patients treated so far."

It is still too early to formulate guidelines for standard practice, according to the review. The authors say further work is required to establish standard methods, including cell dosage, timing of cell transplantation and methods to measure heart function. "The studies were hard to compare because they used so many different methods," said Martin-Rendon. "Larger trials with standardised treatment procedures would help us to know whether this treatment is really effective.

Recently, the task force of the European Society of Cardiology for Stem Cells and Cardiac Repair received funding from the European Union Seventh Framework Programme for Research and Innovation (EU FP7-BAMI) to start such a trial. Principal Investigator for the BAMI trial, and co-author of this Cochrane review, Anthony Mathur, said, ''The BAMI trial will be the largest stem cell therapy trial in patients who have suffered heart attacks and will test whether this treatment prolongs the life of these patients."

More information: Clifford DM, Fisher SA, Brunskill SJ, Doree C, Mathur A, Watt S, Martin-Rendon E. Stem cell treatment for acute myocardial infarction. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD006536. DOI: 10.1002/14651858.CD006536.pub3