Report will aid in detecting, diagnosing cognitive impairment

A new report from The Gerontological Society of America's Workgroup on Cognitive Impairment Detection and Earlier Diagnosis outlines a course of action for increasing the use of evidence-based cognitive assessment tools as part of the Medicare Annual Wellness Visit (AWV).

07 fev 2015--The AWV was established by 2010's Affordable Care Act to allow Medicare beneficiaries to receive preventive and assessment services during visits with their primary care providers. And although detection of cognitive impairment is among the required AWV services, no specific tools are mandated and no data are available regarding tools used for this purpose.

The new report outlines a plan for addressing this shortcoming and shows how increased detection leads to earlier and optimal diagnostic evaluation, referral to post-diagnosis support and educational services in the community, and ultimately to improved health-related outcomes and well-being for Medicare beneficiaries with diagnosed dementia and their families.

"The Medicare AWV offers a universal opportunity for primary care providers to start a conversation with older adults and their families about cognitive changes that might be worthy of further investigation," said Richard Fortinsky, PhD, chair of the workgroup. "Our workgroup's report provides guidance for providers so they can start this conversation and, as appropriate, employ evidence-based assessment tools to detect cognitive impairment."

"Increased detection of cognitive impairment is essential for earlier diagnosis of Alzheimer's disease and related dementia—and also earlier diagnosis leads to more timely linkage of older adults and their families with community-based services and supports," said Katie Maslow, MSW, workgroup member.

In the report, the workgroup outlines a recommended for four-step process achieving its goals.

Step 1 is to kickstart the cognition conversation. To increase detection of cognitive impairment and promote earlier diagnosis of dementia in the Medicare population, the GSA workgroup endorses that primary care providers use the AWV as an annual opportunity to kickstart—that is, to initiate and continue—a conversation with beneficiaries and their families about memory-related signs and symptoms that might develop in older adulthood.

Step 2 is to assess the patient if he or she is symptomatic. The GSA workgroup endorses use of a cognitive impairment detection tool from a menu of tools having the following properties: it can be administered in five minutes or less; it is widely available free of charge; it is designed to assess age-related cognitive impairment; it assesses at least memory and one other cognitive domain; it is validated in primary care or community-based samples in the U.S.; it is easily administered by medical staff members who are not physicians; and it is relatively free from educational, language, and/or cultural bias. The report provides a list of tools that may be suitable for this purpose.

Step 3 is to evaluate with full diagnostic workup if cognitive impairment is detected. The GSA workgroup recommends that all Medicare beneficiaries who exceed threshold scores for cognitive impairment based on the cognitive assessment tools used in step 2 undergo a full diagnostic evaluation. Numerous published clinical practice guidelines are available to primary care providers and specialists to help them arrive at a differential diagnosis.

Step 4 involves referral to community resources and clinical trials, depending on the diagnosis. The GSA workgroup recommends that all Medicare beneficiaries who are determined to have a diagnosis of Alzheimer's disease or related dementia be referred to all appropriate and available community services to learn more about the disease process and how to prepare for the future with a dementia diagnosis.

"The GSA workgroup views this suggested four-step process as a framework for communicating with a wide variety of stakeholders about the critical importance of incorporating cognitive impairment detection into everyday clinical practice with older adults," Fortinsky said. "We look forward to building on this report by helping to plan additional activities intended to disseminate and implement the report's recommendations in communities throughout the country."

More information: The report is available at www.geron.org/ci

Provided by The Gerontological Society of America

Seniors need two pneumonia vaccines, CDC advisory panel says

05 fev 2015—Adults 65 and older need two vaccines to better protect them from bacterial infection in the blood (called sepsis), meningitis and pneumonia, according to a revised vaccination schedule from the 2015 Advisory Committee on Immunization Practices (ACIP).

The ACIP is the vaccine advisory panel for the U.S. Centers for Disease Control and Prevention.

Such infections are caused by pneumococcal bacteria, and older people have an increased risk of life-threatening infection from these bacteria.

"All adults aged 65 years or older should talk to their health care providers about getting pneumococcal vaccines for protection against pneumococcal diseases," said Dr. David Kim, the CDC's deputy associate director for adult immunizations.

The new recommendations were published in the Feb. 3 Annals of Internal Medicine.

The committee recommended that seniors get both the Prevnar 13 and the Pneumovax 23 vaccines. As their names imply, Prevnar 13 protects against 13 types of pneumococcal bacteria, and the Pneumovax 23 protects against 23 types of pneumococcal bacteria.

Why not just get the vaccine that covers more strains? Because the two vaccines work in different ways, which appears to offer broader protection, according to Dr. Sandra Fryhofer. She is an adjunct associate professor of medicine at Emory University School of Medicine in Atlanta and author of an accompanying editorial in the journal.

Additional protection is especially important for older adults because they're much more vulnerable to serious infections, she noted.

"The risk of invasive pneumococcal disease in older adults is nearly 10 times that of young adults," Fryhofer said.

According to the National Foundation of Infectious Diseases (NFID), about 1 million U.S. adults get pneumococcal pneumonia every year. As many as 7 percent die from these infections. Although fewer people get pneumococcal meningitis or sepsis, the death rate is higher—10 percent or more, according to the foundation.

Overall, pneumococcal pneumonia, meningitis and bloodstream infections kill tens of thousands annually in the United States. Of those deaths, 18,000 are adults ages 65 and older, the foundation said.

Pneumococcal disease is also responsible for serious illness and complications that may last a lifetime. These complications include heart problems, hearing loss, seizures, blindness and paralysis, the foundation said.

Fryhofer said that since these new recommendations come from the CDC's vaccination committee, both vaccines should be covered by health insurance companies. And, as of Feb. 2, Medicare should cover them as well.

However, both shots must be given at different times.

"These vaccinations cannot be given at the same time, because they induce an immune response in a different way," Fryhofer said.

For older adults, the Prevnar 13 vaccine is generally given first and then the Pneumovax 23 vaccine 12 months later, she said.

If someone has already had the Pneumovax 23, they can get the Prevnar 13 immunization 12 months later, according to the editorial.

When it comes to jogging, easy does it, study suggests

Just an hour or two a week confers life-extension benefits, researcher contends.

03 fev 2015—A little jogging is good for your health, researchers say, but too much might not be.

"In this study, the dose of running that was most favorable for reducing mortality was jogging 1 to 2.4 hours per week, with no more than three running days per week," said study researcher Jacob Marott of the Frederiksberg Hospital in Copenhagen, Denmark. The best pace was slow or average—about 5 miles per hour, he added.

Out of a pool of about 5,000 healthy Danish adults, Marott and his colleagues followed nearly 1,100 healthy joggers and 413 sedentary people for more than 12 years. The joggers noted their hours and frequency of jogging, and their perception of their pace.

The strenuous joggers, the investigators found, were as likely to die during that time period as the sedentary non-joggers. Light joggers and moderate joggers fared better, in that order, Marott's team found.

The findings were released online Feb. 2 in advance of publication in the Feb. 10 print edition of the Journal of the American College of Cardiology.

What is it about strenuous running that might be harmful? "We believe that long-term strenuous endurance exercise may induce pathological structural remodeling of the heart and large arteries," Marott said.

However, a U.S.-based researcher said the debate about the optimal dose of running for longevity is far from resolved.

The new study has limitations, said D.C. (Duck-chul) Lee, an assistant professor of kinesiology at Iowa State University, who co-authored an editorial accompanying the study.

In Lee's own study of 55,000 adults, including more than 13,000 runners, he found a lower risk of death over the follow-up period in joggers with the highest running time and frequency—nearly three hours a week and at least six times a week—compared with non-runners. It was published in 2014, also in the Journal of the American College of Cardiology.

In the Copenhagen study, joggers self-reported their pace. Even the slow joggers were getting vigorous exercise, the researchers said.

"The reported pace was not an absolute pace in miles per hours, but the subjects' own perception of pace as slow, average or fast," Marott said. He said that's more appropriate than an absolute scale when the age range is as wide as it was in their study (ages 20 to 95). In general, however, the slow or average pace was about 5 miles per hour or a 12-minute mile, and the fast pace was 7 miles per hour or about an 8-minute mile, he said.

In the United States, about 54 million people run regularly, according to background information with the study. In 2013, more than 540,000 people finished a marathon (26.2 miles), and nearly 2 million completed a half marathon.

One limitation of the current study, Lee said, is that a very small group logged the most jogging time. Just 47 joggers put in more than four hours a week, and only 80 ran more than three times a week. These small numbers could have affected the comparisons and results, Lee said.

Also, the researchers didn't look at more than 3,500 active non-joggers who exercised in other ways, Lee said. The researchers looked only at death from all causes, he said, instead of looking to see if high jogging miles and times affected certain causes of death, which could have given more specific information about potential harms.

"More [running] may be worse only in cardiovascular disease," he said. In another assessments on the effects of running and death rates, Lee's group found that death from all causes was lower in runners compared with non-runners, regardless of how much they ran, but there was a slight trend for less benefit from higher doses when compared with lower doses.

The study's good news, Lee said, is that the researchers found benefit even in jogging less than an hour a week, or even once a week, compared to not jogging at all. Perhaps this will motivate sedentary people to get moving, he said.

Although the study by Marott and colleagues found an association between light jogging and improved survival rates, it did not prove a cause-and-effect relationship.

"Basically, the study still shows it's a much better option to prescribe some form of running as a part of a healthy lifestyle and that sedentary behavior is not a prescription for long-term health and mortality," said Dave Watt, executive director of the American Running Association and the American Medical Athletic Association.

Five things you need to know about the Chikungunya virus

Aedes aegypti, a type of mosquito common in South Florida. can spread the Chikungunya virus.

02 fev 2015--It's no secret that mosquitos are a huge headache for residents in South Florida. But what appears to be a routine mosquito bite could wind up being something much worse.

Celebrity and party girl extraordinaire Lindsay Lohan found that out the hard way during her holiday vacation to Bora Bora, where she contracted a nasty virus called Chikungunya. She ended up in the hospital after returning to London with a fever and serious joint pains.

What is Chikungunya? How did she get it? Is there a treatment? A cure?

We asked Dr. Aileen Marty, professor of infectious diseases at the Herbert Wertheim College of Medicine, to help us answer five common questions about Chikungunya:

1. How to say it?

Think "chicken," even though it has nothing to do with chickens. More on that later. It's pronounced: "Chicken-Gun-Ye".

2. What causes it?

Mosquitos! Lohan, star of the film The Parent Trap, would have been better off with a mosquito trap. Chikungunya is a viral infection primarily spread by two types of mosquitos: Aedes aegypti (pictured above) and Aedes albopictus.

3. Where can you get it?

You don't have to go all the way to Bora Bora. We have it right here in our own backyard. Although still relatively rare in the U.S., in 2014 the nation's first locally acquired cases of Chikungunya were reported in South Florida last May. The two main mosquitos responsible for the virus are well-known Florida residents and the disease is rampant throughout the Caribbean, a popular vacation destination for many in the United States.

4. What are the symptoms?

Chikungunya is an African word that translates to "that which bends up" because people bend up with terrible joint pain, one of the most common symptoms. You can also get a high fever, back pain, headache, weariness and sometimes a rash.

"If you are very unlucky, you can get massive bruising and leaky blood vessels and—uncommonly—it can kill you," Marty says.

Fortunately, most people feel better in a week, but the joint pain can last for months, even years.

5. How do you treat it?

You can treat the different symptoms, but there's no specific treatment to get rid of the virus. And there is no vaccine.

Be thankful it's not mosquito season.

Provided by Florida International University

Eyes, ears and nose may aid Alzheimer's disease prevention and treatment

The researchers analysed blood vessel patterns in retinal photographs to identify individuals with AD.Image: Olivier Martins

01 fev 2015--Detecting a decline in certain sensory functions may become the future of preventing Alzheimer's disease (AD), with research showing smell testing and retinal imaging to be strong predictors of dementia risk.

Edith Cowan University Centre of Excellence for Alzheimer's Disease Research neuroscientist and clinical psychologist Dr Hamid Sohrabi says that easy and cost-effective tools for identification of subjects in the early stages of AD is critical to improve outcomes.

"We know that memory tests are very good at identifying people who already have dementia, but we need to recognise that they are at high risk well before memory decline commences because at the latter stage the brain would be irreversibly damaged," he says.

With clinical trials so far failing to effectively halt the progression of AD, Dr Sohrabi says scientists believe the main reason for failure is starting treatment too late when damage to the brain is too great to be reversible.

Along with work on blood biomarkers and neuropsychometric tests, Dr Sohrabi is developing a body of evidence supporting the use of smell and eye imaging assessment as predictors of future cognitive decline.

In a group of 308 46-86 year olds, the group demonstrated that poor ability to discriminate different smells significantly predicted cognitive decline at a three year follow-up.

Retinal photos identify AD sufferers

Similarly, analysis of blood vessel patterns in retinal photographs, taken as part of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing, allowed them to correctly identify individuals with AD from healthy subjects with very high accuracy.

"There's evidence of beta amyloid [a protein involved in the brain disease of AD] depositing in the eye—if we can detect it in the eye before it starts accumulating in the brain that may be one way of predicting who is at higher risk," he says.

In collaboration with Dr Brett Robertson and Dr Dona Jayakody from the Ear Science Institute Australia, Dr Sohrabi will now investigate the role of hearing loss in AD prediction with the hope of a combined sensory deficit score of hearing, eye and olfactory function with strong clinical effectiveness.

"Combining the three senses may put us in the best position to predict who is at a higher risk of developing dementia due to AD," Dr Sohrabi says.

"The best way to prevent neuropathology happening is to start finding those at higher risk, early."

A comprehensive review of innovations in AD diagnosis was published in Alzheimer's and Dementia.

More information: "Olfactory discrimination predicts cognitive decline among community-dwelling older adults": ro.ecu.edu.au/cgi/viewcontent.… context=ecuworks2012

Provided by Science Network WA

How negative stereotyping affects older people

The most comprehensive analysis to date of research on the effect of negative stereotypes on older people's abilities has concluded that these stereotypes create a significant problem for that demographic.

31 jan 2015--A research team at the University of Kent's School of Psychology carried out a review and meta-analysis of Aged-Based Stereotype Threat (ABST).

They statistically analysed international evidence from 37 research studies, both published and unpublished. They concluded that older adults' memory and cognitive performance is negatively affected in situations that signal or remind them of negative age stereotypes. These effects affect both men and women.

The research, funded by the Economic and Social Research council (ESRC), was carried out by Ruth Lamont, working with Dr Hannah Swift and Professor Dominic Abrams. It further found that older people's cognitive performance suffers more when the threat is induced by stereotypes rather than by facts.

The meta-analysis showed that even a hint that performance was being pre-judged because of age criteria was enough to affect older people's performance.

Ruth Lamont said that the study evidence highlighted that even 'subtle differences' in the way people behave toward older people - such as being patronising or speaking slowly - could be enough to make them underperform when others are testing their abilities, either formally or informally.

Researchers have previously concluded that stereotype threat affects the major social categories of gender and ethnicity, but this new meta-analysis, which looked at evidence from over a decade of research, highlights the need to be just as concerned about age stereotypes, Ruth Lamont suggested.

The research team further conclude that the vulnerability of some older adults to ABST when they perform memory, cognitive or physical tasks has important social, economic and clinical implications which will become more relevant given an increasingly aging population and workforce.

More information: The paper, titled A Review and Meta-Analysis of Age-Based Stereotype Threat: Negative Stereotypes, Not Facts, Do the Damage, is published in the American Psychological Association's journal Psychology and Ageing. See: psycnet.apa.org/?&fa=main.doiL… doi=10.1037/a0038586

Provided by University of Kent

New study reveals active sex lives of the over 70s

Older people are continuing to enjoy active sex lives well into their seventies and eighties, according to new research from The University of Manchester and NatCen Social Research.

28 jan 2015--More than half (54%) of men and almost a third (31%) of women over the age of 70 reported they were still sexually active, with a third of these men and women having frequent sex – meaning at least twice a month – according to data from the latest wave of the English Longitudinal Study of Ageing (ELSA).

The paper, lead authored by Dr. David Lee, an Age UK Research Fellow at The University of Manchester's School of Social Sciences and entitled "Sexual health and wellbeing among older men and women in England," is published in the American academic journal Archives of Sexual Behavior.

It is the first study on sexual health of its kind to include people over the age of 80 and uncovers a detailed picture of the sex lives of older men and women in England, finding that a sizeable minority remain sexually active in their old age.

Contrary to popular misconceptions, it finds that overall health and conflicting partnership factors were more closely linked to decreasing sexual activity and functioning, rather than simply increasing age.

Of the more than 7000 people who responded to the questionnaire, very few (less than 3%) declined to answer direct questions about their sexual activities and problems.

Dr Lee said: "This is the first nationally-representative study to include people over the age of 80 when asking older men and women in England about their sexual health.

"We hope our findings improve public health by countering stereotypes and misconceptions about late-life sexuality, and offer older people a reference against which they may relate their own experiences and expectations.

"Our ongoing research is also highlighting the diversity of late-life sexualities, and trying to impose youthful norms of sexual health on older people would be over-simplistic and even unhelpful.

"It is however important that health professionals act on this and are more open about discussing sexual health with older people – it can't simply be assumed to be an irrelevance."

Problems most frequently reported by sexually active women related to becoming sexually aroused (32%) and achieving orgasm (27%), while for men it was erectile difficulties (39%). Chronic health conditions and poor self-rated health seemed to have more obvious negative impacts on the sexual health of men compared to women.

Men were more concerned about their sexual activities and function than women and, with increasing age, these concerns tended to become more common. Sexually active women were less dissatisfied with their overall sex lives than men, and also reported decreasing levels of dissatisfaction with increasing age.

The study also found that many septuagenarians and octogenarians were still affectionate towards their partners, with 31% of men and 20% of women reporting frequent kissing or petting. Among those who reported any sexual activity in the past three months, 1% of men and 10% of women reported they felt obligated to have sex.

Caroline Abrahams, Charity Director at Age UK, said: "The fact this is the first time that people over 80 years old have been included in this kind of research highlights how often the public health needs of older people, including sexual health, are ignored or overlooked.

"With an ageing population it is important that providers of sexual health services understand the needs of older people in both clinical settings and when developing information and advice. These recent findings now need to be used to improve sexual health advice and information for older people."

Provided by University of Manchester

Higher dementia risk linked to more use of common drugs

Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.

27 jan 2015--A large study links a significantly increased risk for developing dementia, including Alzheimer's disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine (Benadryl). JAMA Internal Medicine published the report, called "Cumulative Use of Strong Anticholinergic Medications and Incident Dementia."

The study used more rigorous methods, longer follow-up (more than seven years), and better assessment of medication use via pharmacy records (including substantial nonprescription use) to confirm this previously reported link. It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist—and may not be reversible even years after people stop taking these drugs.

"Older adults should be aware that many medications—including some available without a prescription, such as over-the-counter sleep aids—have strong anticholinergic effects," said Shelly Gray, PharmD, MS, the first author of the report, which tracks nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought (ACT), a joint Group Health-University of Washington (UW) study funded by the National Institute on Aging. "And they should tell theirhealth care providers about all their over-the-counter use," she added.

"But of course, no one should stop taking any therapy without consulting their health care provider," said Dr. Gray, who is a professor, the vice chair of curriculum and instruction, and director of the geriatric pharmacy program at the UW School of Pharmacy. "Health care providers should regularly review their older patients' drug regimens—including over-the-counter medications—to look for chances to use fewer anticholinergic medications at lower doses."

For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg/day of doxepin, 4 mg/day of diphenhydramine, or 5 mg/day of oxybutynin for more than three years would be at greater risk for developing dementia. Dr. Gray said substitutes are available for the first two: a selective serotonin re-uptake inhibitor (SSRI) like citalopram (Celexa) or fluoxitene (Prozac) for depression and a second-generation antihistamine like loratadine (Claritin) for allergies. It's harder to find alternative medications for urinary incontinence, but some behavioral changes can reduce this problem.

"If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient," Dr. Gray said, "they should use the lowest effective dose, monitor the therapy regularly to ensure it's working, and stop the therapy if it's ineffective." Anticholinergic effects happen because some medications block the neurotransmitter called acetylcholine in the brain and body, she explained. That can cause many side effects, including drowsiness, sore throat, retaining urine, and dry mouth and eyes.

"With detailed information on thousands of patients for many years, the ACT study is a living laboratory for exploring risk factors for conditions like dementia," said Dr. Gray's coauthor Eric B. Larson, MD, MPH. "This latest study is a prime example of that work and has important implications for people taking medications—and for those prescribing medications for older patients." Dr. Larson is the ACT principal investigator, vice president for research at Group Health, and executive director of Group Health Research Institute (GHRI). He is also a clinical professor of medicine at the UW School of Medicine and of health services at the UW School of Public Health.

Some ACT participants agree to have their brains autopsied after they die. That will make it possible to follow up this research by examining whether participants who took anticholinergic medications have more Alzheimer's-related pathology in their brains compared to nonusers.

More information: Cumulative Use of Strong Anticholinergic Medications and Incident Dementia, JAMA Internal Medicine, 2015.

Provided by Group Health Research Institute

Four factors impact QoL from perspective of dementia sufferers

24 jan 2015—Four factors have been identified that affect quality of life from the perspective of people with dementia. The findings were published in the January issue of the Journal of the American Geriatrics Society.

Hannah M. O'Rourke, B.Sc.N., from the University of Alberta in Edmonton, Canada, and colleagues conducted a systematic review and meta-synthesis of primary qualitative studies to identify factors that influence quality of life from the perspective of individuals with dementia. Eleven qualitative studies were identified, which included a combined sample of 345 people with mild, moderate, and severe dementia. The techniques of taxonomic analysis, constant comparison, and importing concepts were used to synthesize findings from primary studies.

The researchers found that, according to people with dementia, four factors and the experience of connectedness versus disconnectedness within each factor influenced quality of life. These factors were relationships (together versus alone), agency in life today (purposeful versus aimless), wellness perspective (well versus ill), and sense of place (located versus unsettled). The key outcomes of good and poor quality of life were happiness and sadness, respectively.

"The four factors identified potentially modifiable areas to improve quality of life for people with dementia, even in the context of worsening cognitive function," the authors write.

More information: Abstract
Full Text

Hospitalized for pneumonia? Your risk of cardiovascular disease is higher

Your chance of having a heart attack or stroke increases significantly if you have been hospitalized for pneumonia, according to a paper published today in the influential JAMA (Journal of the American Medical Association).

21 jan 2015--"The main conclusion from our study is that someone hospitalized for pneumonia should be considered at greater risk of developing cardiovascular disease," said lead author Dr. Vicente Corrales-Medina, an infectious diseases physician and researcher at The Ottawa Hospital, and assistant professor with the University of Ottawa's Faculty of Medicine.

"This means two things. First, it provides yet another reason to do everything we can to prevent pneumonia from occurring in the community, through vaccination and basic hand hygiene, for example," he continued. "This is especially important for the elderly and those with other risk factors for cardiovascular disease, such as diabetes, smoking and high cholesterol."

"Second, once pneumonia has occurred, physicians should develop a care plan understanding that these patients are more likely to develop cardiovascular disease in the weeks, months and years following their recovery from this infection," added Dr. Corrales-Medina. "Such measures could include screening and primary prevention strategies for cardiovascular disease."

While other studies have made the connection between pneumonia hospitalization and cardiovascular disease, this is the first to only look at pneumonia patients with no previous history of cardiovascular disease while also taking into account the effect of other established cardiovascular risk factors. By doing so, their results strongly indicate that hospitalization for pneumonia should be considered its own risk factor for future cardiovascular disease.

The JAMA paper used records of 3,813 people from two community health studies, both based in the United States. One enrolled participants aged 65 and older and the other enrolled participants aged 45 to 64. The JAMA study analysed health data of 1,271 pneumonia patients against 2,542 control patients (matched by age) over a period of 10 years.

Results showed that these pneumonia patients had a raised level of risk for cardiovascular disease over the entire 10 years, with the highest risk experienced in the first year. For example, in the group aged 65 and older, a pneumonia patient was four times more likely to develop cardiovascular disease in the first 30 days following the infection. In the tenth year, they were a little less than twice as likely to develop cardiovascular disease.

Another way of looking at it: The 10-year risk of developing cardiovascular disease for a 72-year-old woman with two cardiovascular risk factors (hypertension and smoking) increases from 31% to 90% if she is hospitalized for pneumonia.

Results from the group aged 45 to 64 showed that the risk was higher in the first two years, but not significantly raised after that. In this younger group, a pneumonia patient was 2.4 times more likely to develop cardiovascular disease in the first 90 days after the infection.

Dr. Corrales-Medina's current research is focused on trying to determine what biological mechanisms are responsible for this raised risk of cardiovascular disease after pneumonia, in order to develop therapies to prevent the subsequent onset of cardiovascular disease.

More information: "Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease" JAMA, 2015. doi:10.1001/jama.2014.18229

Provided by Ottawa Hospital Research Institute

Drinking moderate amounts of alcohol is linked to reduced risk of heart failure

Evidence already exists for the beneficial effects of drinking moderate amounts of alcohol on the risk of developing a number of heart conditions; however, the role it plays in the risk of developing heart failure has been under-researched with conflicting results.

20 jan 2015--Now, a large study of nearly 15,000 men and women, published online today (Tuesday) in the European Heart Journal, shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.

Heart failure is a condition in which the heart can no longer pump blood around the body as well as it used to. The most common reason is that the heart muscle has been damaged, for instance by a heart attack. High blood pressure, heart muscle disease (cardiomyopathy), heart valve problems, an irregular heart beat (arrhythmia), viral infections, drinking excessive amounts of alcohol, consuming recreational drugs and the side-effects of radiotherapy treatment for cancer can all contribute to heart failure developing. Heart failure is a major public health problem with over 23 million people living with it worldwide.

Dr Scott Solomon, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women's Hospital, Boston, USA, Dr Alexandra Gonçalves, a research fellow at Brigham and Women's Hospital, and colleagues analysed data from 14,629 people aged between 45-64 years who had been recruited to the Atherosclerosis Risk in Communities Study between 1987 and 1989 in four communities in the USA. They followed the participants for 24-25 years to the end of 2011, and they questioned them about their alcohol consumption at the start and at each of the three subsequent visits made at three-yearly intervals.

They defined a drink as one that contains 14g of alcohol, equivalent to approximately one small (125ml) glass of wine, just over half a pint or a third of a litre of beer, and less than one shot of liquor such as whisky or vodka. The study participants were divided into six categories: abstainers (people who recorded having drunk no alcohol at every visit by the researchers), former drinkers, people who drank up to seven drinks a week, or between 7-14 drinks, 14-21 drinks, or 21 or more drinks a week.

During the follow-up period 1271 men and 1237 women developed heart failure. The lowest rate of heart failures occurred in those drinking up to 7 drinks per week and the highest rate was seen among former drinkers.

After taking account of various factors that could affect the results such as age, diabetes, high blood pressure, heart disease or heart attacks, body mass index, cholesterol levels, physical activity, education and smoking, men who consumed up to seven drinks a week had a 20% reduced risk of developing heart failure compared to abstainers, while the risk was reduced by 16% in women consuming the same amount. Former drinkers had the highest risk of developing heart failure - a 19% and 17% increased risk among men and women respectively compared to abstainers. Interestingly, among both men and women consuming the most amount of alcohol (14 or more drinks a week), the risk of heart failure was not significantly different compared to the risk for abstainers. Drinking excessive amounts of alcohol over a long period of time is known to increase the risk of cardiomyopathy. However, the number of very heavy drinkers in the study was small, which could have limited its power to detect such an association.

However, when the researchers looked at death from any cause, there was an increased risk of death of 47% for men and 89% of women who reported consuming 21 or more drinks a week at the start of the study.

Professor Solomon said: "These findings suggest that drinking alcohol in moderation does not contribute to an increased risk of heart failure and may even be protective. No level of alcohol intake was associated with a higher risk of heart failure. However, heavy alcohol use is certainly a risk factor for deaths from any cause.

"The people who were classified as former drinkers at the start of the study had a higher risk of developing heart failure and of death from any cause when compared with abstainers. This could be related to the reasons why they had stopped drinking in the first place, for instance because they had already developed health problems that might have made them more likely to go on to develop heart failure."

The protective effect of moderate drinking were more marginal in women than in men and the authors think this may be due to the fact that women metabolise alcohol in a different way to men and it can affect them differently.

Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to seven drinks a week, eight percent reporting seven to 14 drinks a week, and three percent reporting drinking 14-21 and 21 or more drinks a week respectively. Most drinkers also drank more than one type of drink. This meant that the researchers were unable to assess the role of binge drinking or any differences between types of drink.

"It is important to bear in mind that our study shows there is an association between drinking moderate amounts of alcohol and a lower risk of heart failure but this does not necessarily mean that moderate alcohol consumption causes the lowered risk, although we did adjust our results to take account, as far as possible, for a variety of other lifestyle factors that could affect a person's risk," concluded Professor Solomon.

More information: "Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study", by Alexandra Gonçalves et al. European Heart Journal. DOI: 10.1093/eurheartj/ehu514

Provided by European Society of Cardiology

100 million Americans live with chronic pain, but treatment research is insufficient

An estimated 100 million Americans live with chronic pain. A new report by an independent panel convened by the National Institutes of Health has found a need for evidence-based, multidisciplinary approaches to pain treatment that incorporate patients' perspectives and desired outcomes while also avoiding potential harms.

19 jan 2015--"We learned that sufficient clinical research doesn't exist to show physicians how best to treat chronic pain in adults, many of whom suffer from multiple health problems," said the founding director of the Indiana University Center for Aging Research and Regenstrief Institute investigator Christopher Callahan, M.D., who served on the seven-member panel.

While opioids are frequently prescribed for chronic pain, the panel noted the absence of pain assessment and treatment guidelines. The panel also reviewed reports that suggest insufficient data exists on drug characteristics, dosing strategies and tapering options.

"Are opioids the appropriate treatment? And, if so, at what dose and for how long? Could other, less dangerous treatments work for some people? The panel found that, in spite of what many clinicians believe, there is no evidence that pain narcotics—with their risks of dependency, addiction and death—are an effective long-term pain treatment. More research is needed to guide effective care for chronic, often debilitating, pain," Dr. Callahan said.

The panel identified barriers to implementing evidence-based, patient-centered care, including what Dr. Callahan described as the important emotional aspects of pain, including the perceptions of suffering endured by people with chronic pain.

"Ten years ago, the medical community spoke of pain as the fifth vital sign," Dr. Callahan said. "Even though we know that treatment should be tailored to individual patients, there is no existing algorithm that helps researchers or clinicians determine which patients with which type of pain should be treated with which available approach.

"We heard information presented that there has been a dramatic increase in opioid overdoses by individuals who illegally obtain and abuse these prescription drugs—often family members or family friends who take the medications from the patient," Dr. Callahan said.

"The panel did hear suggestions of what providers might do in the face of the limited available evidence. For example, physicians might prescribe smaller quantities of opioids. This could potentially require individuals in pain to travel more frequently for prescription refills, but it would also decrease the amount of drugs potentially available to abusers.

"In educating their patients, providers might also tip the balance of their cautions about these drugs to highlight that they are important drugs with important dangers to both the patient and those who might obtain them accidentally or illegally. At the same time, the panel heard testimony that patients who responsibly use these medications should not be treated like criminals."

Dr. Callahan, who is the Cornelius and Yvonne Pettinga Professor of Medicine at the IU School of Medicine, calls for funding for clinical trials designed with input from both patients and those who treat pain. An internist and geriatrician who is an expert in health services research, health care systems and policy, Dr. Callahan has conducted several studies that have found the multidisciplinary team approach recommended by the panel has been effective in the care of older adults, who, like many chronic pain patients, often have multiple health problems and needs.

More information: The panel's report, "National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain," published online first at www.annals.org by the Annals of Internal Medicine,

Provided by Indiana University

Scientists look to heart disease and strokes for clues to treating Alzheimer's

A growing body of research suggests that the most common cause of dementia in older people is a mix of vascular and Alzheimer's-related brain abnormalities, and that approximately half of people who die with Alzheimer's also have evidence of strokes in their brains. Furthermore, when strokes and hallmark Alzheimer's plaques and tangles are combined, it increases a person's likelihood of experiencing dementia. Stroke, or as it is known more generally as cerebrovascular disease, occurs with aging and is made worse by conditions like smoking, hypertension or diabetes.

16 jan 2015--Recommendations by a group of scientists to bolster research on how Alzheimer's and vascular conditions progress together and influence each other are available online today, in advance of publication, by Alzheimer's & Dementia: The Journal of the Alzheimer's Association. The authors hope this research agenda, if executed, will uncover new clues for effectively treating or preventing dementia.

"We are encouraged by the potential for new treatment strategies for dementia to arise from studying the crossover of vascular factors with the progression of Alzheimer's," says Heather M. Snyder, Ph.D., director of medical and scientific operations for the Alzheimer's Association, and first author of the new article. "In terms of next steps, we need to develop the research tools and collaborations necessary to further scientific investigation in this promising area of study."

Cerebrovascular disease can be prevented with a variety of drug and lifestyle interventions; however, this has not yet been established for dementia. Snyder says, "Whether improved control of vascular risk factors can be translated to decreased dementia risk is not known, but results from a number of studies suggest that it is possible, and this untapped potential definitely deserves greater research attention."

In December 2013, the Alzheimer's Association, with scientific input from the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS) and National Heart, Lung and Blood Institute (NHLBI), convened a group of scientific experts to discuss the scientific findings to date and gaps in research on vascular contributions in Alzheimer's and related forms of dementia. The newly-published article summarizes the meeting and discussions, including an outline of next steps.

"Blood vessels that deliver nutrients to the brain and carry away waste are vital for normal cognitive function," says co-author Roderick Corriveau, Ph.D., the NINDS program director who oversees dementia research. "Understanding vascular contributions to cognitive impairment and dementia, including changes due to stroke, heart disease and diabetes, are critically important to guide the development of preventions and treatments for dementia."

"Inadequate blood flow can damage and eventually kill cells anywhere in the body," says Donna M. Wilcock, Ph.D., a neurovascular researcher who is an assistant professor in the Department of Physiology at the University of Kentucky College of Medicine in Lexington and a co-author of the paper. "Since the brain has one of the body's richest networks of blood vessels, it is especially vulnerable. Considering this and demonstrated success in reducing risk for heart disease, stroke and other vascular-related diseases through healthy lifestyle modifications and use of medications, it only makes sense to increase our understanding of the role vascular factors play in Alzheimer's and dementia."

The authors of the article recommend filling gaps in several key areas of research, including:

• The relationship between diabetes and insulin resistance and risk of vascular disease, Alzheimer's and related dementia.
• Genetic factors that may influence vascular processes and other changes in the brain.
• Impact of immune system response on blood flow in the brain in the progression of Alzheimer's disease.
• The role of fat breakdown in the brain in the removal of amyloid build-up that leads to the hallmark brain plaques in Alzheimer's disease.
• Controlling the impact of vascular risk factors on memory and thinking abilities.

The authors also conclude that biological markers, which are used to detect and measure disease progression, of key vascular processes related to impairment of brain function, memory and thinking abilities are needed to move this research further and faster.

"Having the methods to detect early signs of vascular-related brain injury or disease with the greatest impact on Alzheimer's and dementia would greatly enhance our efforts to develop effective therapies," says David Knopman, M.D., professor of neurology at the Mayo Clinic College of Medicine in Rochester, MN, and a co-author of the paper. "Especially needed are tools that are highly accurate and do not require invasive procedures to collect and measure." Dr. Knopman is vice chair of the Alzheimer's Association Medical and Scientific Advisory Council.

Among the biological markers the authors say are necessary are:

• Ability to detect amyloid in blood vessels in the brain.
• Imaging technology that can detect changes from dying brain tissue.
• Indicators of risk for Alzheimer's in pre-diabetic individuals.
• Improved methods for measuring the impact of blood flow in the brain on memory and thinking abilities.

"Future investment for these areas of scientific discovery will be essential to galvanize the scientific community and provide forums of communication between the dementia and vascular fields," the authors state in the paper.

As a further next step, research sessions and scientific presentations focusing on the relationship between vascular factors, Alzheimer's disease and related dementias are being planned for upcoming major scientific and medical conferences—including meetings hosted or sponsored by the Alzheimer's Association, the American Heart Association, and the National Institutes of Health.

Provided by Alzheimer's Association

Experts recommend weight loss drugs, surgery as supplement to lifestyle interventions

The Endocrine Society today issued a Clinical Practice Guideline (CPG) on strategies for prescribing drugs to manage obesity and promote weight loss.

15 jan 2015--The CPG, entitled "Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the February 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.

Obesity is a worsening public health problem. According to the 2012 National Health and Nutrition Examination Survey, about 33.9 percent of adults ages 19-79 were overweight, 13.4 percent were obese and 6.4 were extremely obese.

The Food and Drug Administration has approved four new anti-obesity drugs - lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide - in the past two years. Medications like these can be used in combination with diet and exercise to help people lose weight.

"Lifestyle changes should always be a central part of any weight loss strategy," said Caroline M. Apovian, MD, of Boston University School of Medicine and Boston Medical Center, and chair of the task force that authored the guideline. "Medications do not work by themselves, but they can help people maintain a healthy diet by reducing the appetite. Adding a medication to a lifestyle modification program is likely to result in greater weight loss."

In the CPG, the Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug's label.

Other recommendations from the CPG include:

• If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication should be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
• Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications' potential effects on weight with patients.
• Certain types of medication - angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers - should be used as a first-line treatment for high blood pressure in obese people with Type 2 diabetes. These are effective blood pressure treatments that are less likely to contribute to weight gain than the alternative medication, beta-adrenergic blockers.
• When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option's anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
• In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.

More information: The Hormone Health Network offers resources on weight and health at www.hormone.org/diseases-and-c… ns/weight-and-health

Provided by The Endocrine Society

MRI could predict Alzheimer's disease, improving treatment

UQ scientists have found MRI’s could be used to predict Alzheimer’s disease. Credit: Tane Sinclair-Taylor

14 jan2015--Scientists at the University of Queensland have discovered that magnetic resonance imaging (MRI) could be used to predict the risk of Alzheimer's disease.

The discovery could greatly improve outcomes for Alzheimer's patients, as early diagnosis could increase the effectiveness of drug treatments.

The study, led by Associate Professor Elizabeth Coulson of UQ's Queensland Brain Institute, found that people with a shrinking basal forebrain were seven-times more likely to have worsened cognitive function within 18 months.

"Existing Alzheimer's disease drugs try to enhance the function of the degenerating basal forebrain, but often too much damage is already done by the time drugs are administered," Associate Professor Coulson said.

"Early diagnosis is important for being able to treat people with Alzheimer's disease earlier, and work out a personal treatment course for them.

"If we can give the existing drugs to people earlier, when they first display evidence of a decline in their basal forebrain, even perhaps before they are diagnosed with Alzheimer's disease, then hopefully those drugs will be more effective."

More than 330,000 Australians suffer from Alzheimer's disease and are primarily treated with cholinergic drugs that target the basal forebrain, which degenerates with the condition.

Lead author and QBI PhD student Georg Kerbler said the study used data from the CSIRO's Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing.

They analysed data involving more than 220 elderly people, including 145 healthy people, 40 showing mild cognitive impairment, and 38 with Alzheimer's disease.

"We're now working on validating these findings so a method to assess basal forebrain dysfunction can be rolled out into hospitals in the future," Mr Kerbler said.

"Our MRI method is currently a specialised research tool, and routine diagnosis needs to be performed in hospital MRI departments."

Large clinical trials have found that the effects of cholinergic drugs used to treat Alzheimer's disease are often transient and mild; but some patients appear to benefit from them for many years.

Geriatrician and Prince Charles Hospital Internal Medicine Services Head of Research Dr Eamonn Eeles, said the outcomes of using such drugs could be improved if they were given to patients earlier.

More information: Georg M Kerbler, Jürgen Fripp, Christopher C Rowe, Victor L Villemagne, Olivier Salvado, Stephen Rose, Elizabeth J Coulson, Alzheimer's Disease Neuroimaging Initiative, "Basal forebrain atrophy correlates with amyloid β burden in Alzheimer's disease," NeuroImage: Clinical, Volume 7, 2015, Pages 105-113, ISSN 2213-1582, dx.doi.org/10.1016/j.nicl.2014.11.015.

Provided by University of Queensland

A virtual reality brain training game can detect mild cognitive impairment

A virtual reality brain training game can detect mild cognitive impairment (MCI). Credit: Journal of Alzheimer's Disease

13 jan 2015--Greek researchers demonstrated the potential of a virtual supermarket cognitive training game as a screening tool for patients with mild cognitive impairment (MCI) among a sample of older adults. MCI is a condition that often predates Alzheimer's disease (AD) and is characterized by memory loss and inability to execute complex activities such as financial planning.

So far virtual reality game-based applications and especially virtual supermarkets have been used as cognitive training applications and as measures of cognitive functions, although it has been shown that they can detect MCI only when used in combination with standardized neuropsychological tests. However scientists from the Aristotle University of Thessaloniki (AUTH), the Greek Association of Alzheimer's Disease and Related Disorders (GAADRD) and the Centre for Research and Technology Hellas/Information Technologies Institute (CERTH/ITI) have succeeded in making the shift to MCI screening via robust virtual reality game applications that can be used on their own for accurate MCI detection.

In an article published in the Journal of Alzheimer's Disease, the researchers have indicated that the virtual supermarket (VSM) application displayed a correct classification rate (CCR) of 87.30%, achieving a level of diagnostic accuracy similar to standardized neuropsychological tests, which are the gold standard for MCI screening. Patients with MCI can live independently and not all such patients progress to AD. Therefore the global effort against cognitive disorders is focused on early detection at the MCI stage.

A large number of older adults use computerized cognitive training exercises/games as an easy and enjoyable means of exercising their brain. If these games and exercises can also detect cognitive disorders, the whole cognitive screening process could become more pleasurable, thus motivating more people to be evaluated. With the majority of older adults examining their cognitive health regularly through such games, possible cognitive impairment will be detected at the MCI stage thus allowing patients to enjoy a better quality of life and remain independent for a longer time.

Enlarge

A virtual reality brain training game can detect mild cognitive impairment (MCI). This is a VSM payment screen. Credit: Journal of Alzheimer's Disease

The use of the VSM as a robust screening test could have profound implications for the diagnosis and treatment of MCI, the most important of which is the possibility for automated remote MCI screening. The performance of older adults playing such a game at home could be monitored and an algorithm embedded in the game could inform them when their performance suggests possible cognitive impairment due to MCI, prompting them to visit an appropriate health service. Such a system would have the ability to screen the majority of older adults effectively, while at the same time minimizing examination costs. As computer applications increasingly become embedded in our work and social life, they could also become part of our preventive healthcare. Research on the use of the VSM for remote assessment is already underway and the results of that study will be published soon.

The VSM has been developed as part of the "Εν-ΝΟΗΣΗΣ" project for the use of new technologies in the screening, diagnosis, treatment and support of patients with MCI. Its development, testing and research application have been undertaken by research organizations that have been heavily involved in the transfer and dissemination of high-quality research knowledge, advanced solution development and leading-edge technologies. The same organizations are currently involved in the development and trialing of other novel technological instruments that respond to a number of clinical and organizational needs in the effort against cognitive disorders.

More information: "Can a Virtual Reality Cognitive Training Application Fulfill a Dual Role? Using the Virtual Supermarket Cognitive Training Application as a Screening Tool for Mild Cognitive Impairment," by Stelios Zygouris, Dimitrios Giakoumis, Konstantinos Votis, Stefanos Doumpoulakis, Konstantinos Ntovas, Sofia Segkouli, Charalampos Karagiannidis, Dimitrios Tzovaras, and Magda Tsolaki,, DOI: 10.3233/JAD-141260, Journal of Alzheimer's Disease, published online in advance of Volume 44, Issue 4.

Provided by IOS Press

Physical activity intervention for the elderly

Aerobic, strength, balance, and flexibility training can improve overall physical function—even among people who already have lost muscle mass due simply to aging—a condition called “sarcopenia.” Credit: Stephen Ausmus

12 jan 2015--Bone loss is not the only nemesis of the elderly. As the percentage of people aged 85 and older grows, the stakes are high for healthy individuals living independently who do not maintain their muscle mass and strength. Age-related muscle loss—which excludes disease-related muscle loss—is called "sarcopenia." This condition can lead to costly surgeries and hospital stays due to fractures after falls that occurred from weak muscles, says physiologist Roger Fielding.

In 2012 alone, 2.4 million nonfatal falls among older adults were treated in emergency departments, according to the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control. In addition, death rates from falls among older people have risen sharply during the past decade, CDC reports.

Fielding is with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Massachusetts. He is director of the center's Nutrition, Exercise, Physiology, and Sarcopenia Laboratory. The HNRCA is funded in part by the USDA Agricultural Research Service.

HNRCA and international scientists have now arrived at a consensus on sarcopenia's clinical definition. The team developed simple tests to help local healthcare practitioners make diagnoses and treatment plans. The tests include assessing whether a person can walk 13 feet in 4 seconds or less.

"The gait speed cut point we found is 1 meter—or 3.25 feet—per second," says Fielding. "Below that, the risk of mortality and institutionalization increases dramatically." Fielding wants clinicians to think of these tests as an important vital sign for elders, similar in importance to blood pressure readings.

By age 80, an estimated 40 percent of the muscle mass that was present at age 20 is lost, HNRCA researchers say. But a subpopulation of older adults has muscle loss that is even greater than that of others in their age group. This extrememuscle loss has been associated with physical performance limitations and disability.

A study headed by HNRCA's geriatrician Christine Liu and coauthored by Fielding and others looked at data collected on a group of 177 elders aged 70 to 89 years who were functionally limited and at risk of becoming disabled due to lack of mobility. The data was collected during the "Lifestyle Interventions and Independence for Elders" study. The volunteers' body composition, including lean muscle and body fat, was measured both before and after the intervention.

One group of volunteers participated in a physical activity intervention that included aerobic, strength, balance, and flexibility training. The results demonstrated that elders with sarcopenia are capable of improving their overall physical function, including balance, walking, and strength, in response to physical activity.

"Sarcopenia should not deter clinicians from encouraging physical activity in older clients," says Liu. "Even with relatively little muscle mass, these individuals benefited from preventive exercise."

Provided by Agricultural Research Service