Acupuncture Plus Routine Care Relieves Osteoarthritis Pain - CME Teaching Brief� - MedPage Today
Acupuncture needles appear to help knit osteoarthritis pain in the bud, particularly when combined with routine care.

In a large randomized trial, patients with knee or hip joint pain who had acupuncture had significant improvement in severity and quality-of-life index scores, compared with those who had routine care alone, reported Claudia M. Witt, M.D., of the Charité University Medical Center here, and colleagues, in the November issue of Arthritis & Rheumatism.

"Given that the biologic mechanism of acupuncture is still unclear, the study by Witt et al furthers our understanding of acupuncture and adds to the accumulated evidence supporting its efficacy," wrote Tao Liu, M.D., and Chen Liu, M.D., of the 2nd Teaching Hospital of Jilin University in Changchun, Jilin, China, in an accompanying editorial. "Such evidence warrants extensive use of acupuncture in various chronic pain conditions."MORE

Flu shots: Important for people with heart disease - Mayo Clinic
Flu shots are recommended for anyone with heart disease.

Find out why from a Mayo Clinic specialist who helped develop the flu shot recommendations: Larry Baddour, M.D.

If you have heart disease, you should get an annual flu shot. That's the message put out by the American Heart Association and the American College of Cardiology. Studies have shown that death from the flu (influenza) is more common among people with cardiovascular disease than among people with any other chronic condition. Doctors have long recommended that older adults and other high-risk groups get flu shots, but are now placing more emphasis on the importance of flu shots for those with heart disease. The flu shot could prevent thousands of flu-related complications and deaths every year in people who have heart disease.

Larry Baddour, M.D., an infectious diseases specialist at Mayo Clinic and professor of medicine at Mayo Clinic College of Medicine, was on a joint American Heart Association and American College of Cardiology advisory panel that developed the recent recommendation. He shares his insight about the group's recommendation.

Why are flu shots important for those with heart disease?

According to the Centers for Disease Control and Prevention (CDC), the flu is estimated to cause more than 36,000 deaths annually in the United States. In addition, it sends 225,000 people to the hospital. The rate of flu-related complications is even higher for people with heart disease.

If you have heart disease, you are at increased risk of complications from the flu — including pneumonia, respiratory failure, heart attack and death. Having the flu can also cause dehydration and worsen heart failure, diabetes or asthma.

Most scientific evidence indicates that flu shots are associated with a reduced risk of cardiovascular events — such as heart attack — in people with known cardiovascular disease.

Is it safe to get a flu shot if I have heart disease?

Flu shots are safe for most people who have heart disease. Get your flu vaccine injected by needle, usually in the arm. Some people develop mild arm soreness at the injection site. The flu vaccine that is given by nasal spray isn't recommended for people with heart disease because it's made with live virus that can trigger flu symptoms in people with heart disease.
When should I get a flu shot?

If you have heart disease, get the flu shot each fall when it becomes available, usually late September through November. However, if flu shots are still available and you haven't yet received a vaccination, you'd still benefit from getting a flu shot in January or later. That's because the flu season doesn't typically peak until January, February or March.

Do I have to get a flu shot from my cardiologist?
MORE- Mayo Clinic

Eating fish can help fight Alzheimer's disease (click for more):
"Alzheimer's disease affects more than 4.5 million Americans. It is caused by brain degeneration and is marked by the death of cells, particularly the cells in the basal forebrain.

These cells are the primary source of the brain chemical messenger called acetylcholine. Alzheimer's disease impairs the production of acetylcholine, one of the main chemical messengers in the brain that is important for memory and cognitive function. The number of Americans with Alzheimer’s has more than doubled since 1980 and will continue to grow. By 2050, researchers say the number of people with the disease could range from 11.3 million to 16 million.

Currently, there are five FDA-approved medications that treat cognitive symptoms in patients with Alzheimer's disease. Four of these try to boost the brain levels of acetylcholine by blocking the enzyme that breaks down acetylcholine. The fifth drug acts on another brain chemical. However, none of the available drugs are known to change the underlying neurobiology of the disease.

Investigators at Rush University Medical Center in Chicago successfully initiated a new technique that uses gene therapy to deliver nerve growth factor into regions of the brain where neurons are degenerating. Their hope is to prevent cell death and reverse cell atrophy, two hallmarks of Alzheimer's disease..."

Johns Hopkins University Bloomberg School of Public Health
PRESS RELEASE

DIABETES NOT THE SAME FOR ALL AGES

-Middle-Age and Elderly Onset Diabetes May Require Different Treatment Goals

Elderly persons who were diagnosed with diabetes during middle age (40-64 years) and those diagnosed later in life (over 65 years) comprise two distinct groups, according to new research from the Johns Hopkins Bloomberg School of Public Health.

The study, published in the November 2006 issue of Diabetes Care, found that these two age groups have different disease burdens and may require different treatment goals.

"The number of individuals aged 65 or older in the U.S. is increasing markedly and diabetes is a growing problem in this population. In addition, people are living to much older ages with high quality of life, which speaks to the need for more aggressive treatment among elderly persons with diabetes," said Elizabeth Selvin, PhD, MPH, lead author of the study and a postdoctoral fellow in the Bloomberg School of Public Health's Department of Epidemiology.

The study authors analyzed 1999-2002 data for 2,809 elderly persons in order to present a nationally representative estimate of the prevalence of diabetes among elderly persons in the general U.S. population. The data were taken from the National Health and Nutrition Examination Survey (NHANES), an on-going cross-sectional survey of the civilian, non-institutionalized U.S. population.

The authors report that 15 percent of the U.S. population aged 65 years or older, had been diagnosed with diabetes, a figure that represents approximately 5.4 million individuals. In addition, 6.9 percent of the U.S. population aged 65 years or older (2.4 million individuals) have undiagnosed diabetes and are unaware of their condition.

Elderly persons with middle-age-onset diabetes were more likely to have retinopathy, reflecting the cumulative damage of high glucose levels over the course of many years. They also had much worse glycemic control. In contrast, elderly persons with newly diagnosed diabetes had a comparable burden of cardiovascular disease but required less aggressive treatment to reach blood pressure and cholesterol treatment goals.

"The two types of elderly persons with diabetes have distinct characteristics, including different burdens of disease," said Selvin. "Elderly people with diabetes are a heterogeneous group and doctors may need to consider different treatment goals for these two groups in clinical practice."

"The Burden and Treatment of Diabetes in Elderly Individuals in the U.S." was co-authored by Elizabeth Selvin, Josef Coresh and Frederick L. Brancati.

Elisabeth Selvin was supported by a grant from the National Heart, Lung, and Blood Institute.

Harvard Medical School: 10 steps to lower your blood pressure


High blood pressure isn’t usually something that can be cured. Like an in-law who comes to stay for good, it’s something most people need to learn to live with. Drugs offer an easy fix, but most also cause unwanted side effects. Making healthful lifestyle changes is harder, but it yields benefits far beyond better blood pressure. That’s why it makes sense to start with these, and add medications only if needed. Here are 10 steps that can help you lower your blood pressure and keep it under control.

1. Check it. You can’t do much about your blood pressure unless you know what it is. Your doctor should check it at every visit. Measuring it at home is even better. Relatively inexpensive home monitors are available in most pharmacies.

2. Get moving. Regular exercise, even something as simple as brisk walking, improves blood vessel flexibility and heart function. It can lower blood pressure by 10 points, prevent the onset of high blood pressure, or let you reduce your dosage of blood pressure medications.

3. Eat right. A landmark study called Dietary Approaches to Stop Hypertension (DASH) showed that you can eat your way to better blood pressure. The DASH diet emphasizes fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, and nuts, and downplays red meat, sweets, sugar-containing beverages, and saturated fat and cholesterol.

4. Control your weight. If you are carrying too many pounds for your frame, losing weight can lower your blood pressure. You don’t need to become rail-thin — losing 10% of your current weight, or even 10 pounds, can make a big difference.

5. Don’t smoke. Nicotine constricts small blood vessels. Smoking a cigarette can cause a 20-point spike in systolic blood pressure. Quitting is tough, but there are now more aids to help.

6. Drink alcohol in moderation. A drink a day for women and one or two a day for men is good for the heart and blood vessels. Going beyond that can contribute to higher blood pressure.

7. Shake up your salts. Too much sodium and too little potassium boost blood pressure in people who are sensitive to salt. The imbalance is so great that the American Medical Association is calling for food makers and restaurants to cut the sodium content of food by 50% by 2016. Aim for less than 1.5 grams of sodium a day, and at least 4.7 grams of potassium.

8. Sleep is good. Burning the candle at both ends night after night can contribute to high blood pressure, not to mention increase the chances of developing heart disease or a sudden cardiac arrest. How much sleep is enough? At least six hours a night, though eight hours is probably more like it for most people.

9. Reduce stress. As surely as mental and emotional stress can raise blood pressure, meditation, deep breathing, and other stress-busting activities can lower it.

10. Stick with your medications. Taking pills to keep your blood pressure in check won’t make you feel any different. But it can keep you from having a stroke, heart attack, or other problem.

Dozens of drugs are available for lowering blood pressure. They come in a range of regimens (once a day to several times a day) and costs, and have a range of effects on other conditions, interactions with other drugs, and potential side effects.

Which drug is best for treating high blood pressure is one of the major controversies in medicine today. Current guidelines as of 2006 say that the first choice should be an inexpensive diuretic (water pill). Some experts argue that an ACE inhibitor or a calcium-channel blocker is a better place to start. In reality, what’s best for you isn’t necessarily right for someone else. Most people need more than one medication to get their blood pressure under control, and one of these should probably be a diuretic.

High blood pressure, like almost everything else in medicine, is a highly personal condition. Preventing it, and keeping it from doing you harm, requires careful, individualized evaluation from your doctor and focused commitment on your part.

A darker cloud over smokers: MORE BAD NEWSl
Lung cancer. Heart disease. Stroke. Premature infants. Just when you think the news about smoking and health can't get any worse, it gets a little worse.

Researchers in Denmark have found that the lifetime risk of developing a chronic obstructive pulmonary disease, such as bronchitis or emphysema, is significantly higher than was previously thought. ....MORE

Studies report deeper link between diet, Alzheimer's (click for more):
"A vegetable stir-fry and a glass of red wine might go a long way toward preventing the formation of the brain gunk that can lead to Alzheimer's disease, studies report Monday.

The findings involving experiments with mice add to an increasing body of evidence, including human studies, that suggest the high-fat Western-style diet might lead not just to heart attacks but also to Alzheimer's, a disease expected to afflict up to 16 million people in the United States by 2050.

But if new research by Narayan Bhat of the Medical University of South Carolina and others pans out, Americans might be able to change that future in part by steering clear of artery-clogging foods.

Bhat took healthy lab mice and fed them a diet with lots of saturated fat and cholesterol.

After two months, he gave the mice, which were middle-aged by then, a memory test and found that those fed the bad diet flunked: They made errors finding their way around a water maze.

Mice eating the bad diet also had an increase in a toxic brain protein called beta amyloid, Bhat says. Many scientists believe that beta amyloid deposits in the brain lead to the symptoms of Alzheimer's.

Bhat presented the results Sunday at the Society for Neuroscience annual meeting in Atlanta. The findings raise the hope that a diet low in saturated fat might prevent that build-up of beta amyloid — and Alzheimer's disease.

A study posted online this month suggests just that: The report in the Archives of Neurology found that people eating a Mediterranean-style diet had a lower risk of Alzheimer's than people eating standard American fare..."

Memory Screening Survey Shows Americans Are Concerned About Memory Loss, Though Few Share Concerns With Others, Even Their Doctors (click for more):
"With The Alzheimer's Foundation of America and The Center for Productive Aging at Towson University Business Editors/Health/Medical Writers WESTPORT, Conn.--(BUSINESS WIRE)--Oct. 18, 2006--A MetLife Mature Market Institute study of people who attended voluntary memory screening during National Memory Screening Day sponsored by the Alzheimer's Foundation of America (AFA) shows 73% have memory concerns, though many may be reluctant to discuss them with others, even their physician.

Among those who were concerned about their memory, 30% had not discussed their concerns with anyone. Of those who did share their concerns, most confided in their spouse.

While 84% of those who completed a survey while attending a voluntary screening said they had visited their doctor within the previous six months, only 24% of those concerned about their memory shared their unease with their physician.

A large discrepancy existed between the genders, as more women (74%) than men (29%) said they had concerns about their memory.

Better than 36% of respondents said the memory screening was their first health screening of any type, with the top motivating factors being forgetfulness (50%), a desire to obtain a baseline score (56%) and having a relative with Alzheimer's disease (21%).

An estimated 4.5 million Americans now have Alzheimer's disease with that number predicted to grow to between 11.3 and 16 million by the year 2050. A MetLife Foundation Alzheimer's survey conducted in early 2006 showed that outside of cancer, Americans fear Alzheimer's more than heart disease, stroke and diabetes.

'With the high incidence of Alzheimer's disease and the aging of the population, individuals are more much aware that certain changes in memory are not part of normal aging. While memory screening is relatively new, it will likely grow in usage as one way for individuals to begin to assess concerns about such memory changes,' said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute..."

Stress significantly hastens progression of Alzheimer's disease (click for more):
"Stress hormones appear to rapidly exacerbate the formation of brain lesions that are the hallmarks of Alzheimer's disease, according to researchers at UC Irvine. The findings suggest that managing stress and reducing certain medications prescribed for the elderly could slow down the progression of this devastating disease.

In a study with genetically modified mice, Frank LaFerla, professor of neurobiology and behavior, and a team of UCI researchers found that when young animals were injected for just seven days with dexamethasone, a glucocorticoid similar to the body's stress hormones, the levels of the protein beta-amyloid in the brain increased by 60 percent. When beta-amyloid production increases and these protein fragments aggregate, they form plaques, one of the two hallmark brain lesions of Alzheimer's disease. The scientists also found that the levels of another protein, tau, also increased. Tau accumulation eventually leads to the formation of tangles, the other signature lesion of Alzheimer's. The findings appear in this week's issue of the Journal of Neuroscience.

'It is remarkable that these stress hormones can have such a significant effect in such a short period of time,' LaFerla said. 'Although we have known for some time that higher levels of stress hormones are seen in individuals in the early stages of Alzheimer's, this is the first time we have seen how these hormones play such a direct role in exacerbating the underlying pathology of the disease.'

The researchers injected four-month-old transgenic mice with levels of dexamethasone similar to the level of hormones that would be seen in humans under stress. At this young age, there would be little formation of plaques and tangles in the brains of the mice. After one week, the scientists found that the level of beta-amyloid in the brains of the animals compared to what is seen in the brains of untreated eight- to nine-month-old mice, demonstrating the profound consequence of glucocorticoid exposure. When dexamethasone was given to 13-month-old mice that already had some plaque and tangle pathology, the hormone again significantly worsened the plaque lesions in the brain and led to increased accumulation of the tau protein..."

Exercise helps keep your brain in shape (click for more):
"A fast spin on the dance floor or taking daily walks might help keep the brain in top shape as people age -- and might reduce the risk of developing age-related diseases such as Alzheimer's or Parkinson's, experts now say.

Both Alzheimer's and Parkinson's are degenerative, incurable diseases of the brain. Both are more common in older people; together they afflict more than 5 million people in the United States. Alzheimer's causes memory problems, and Parkinson's leads to tremors and shakiness, but the diseases often overlap: Some people with Parkinson's also have memory loss.

Growing evidence now suggests that lifestyle factors such as diet, exercise and challenging activities, might help ward off or delay the onset of neurodegenerative diseases, possibly by building connections between brain cells or even spurring the production of new brain cells. People who power up the brain in this way may have a better shot at reaching old age with a brain that still performs at top speed, says Elizabeth Edgerly, a brain expert at the Alzheimer's Association.

To keep the brain healthy:

• Stay fit. Physical activity boosts the blood supply to the brain, and that keeps brain cells well nourished.

Edgerly recommends taking a walk, swimming, yoga or anything that's physically active three to five days a week. Spend about 30 minutes a day on such activities if you can, but a study suggested that even a 15-minute daily walk could reduce the risk of Alzheimer's..."

A New Alzheimer's Vaccine (click for more):
"Vaccination against Alzheimer's disease is one of the most promising treatment strategies. But safety concerns arising after initial human trials have slowed clinical development of such vaccines. Now new research that aims to bring the benefits of vaccines without the harmful side effects are raising hopes once again for this largely untreatable disease.
'There is tremendous interest in this approach,' says Neil Buckholtz, chief of the dementias of aging branch at the National Institute on Aging (NIA), in Bethesda, MD. 'People believe this could be a promising therapeutic, but they are proceeding slowly because of safety concerns.'

Alzheimer's vaccines work by preventing or clearing the buildup of a protein, known as beta-amyloid, which clogs the brains of Alzheimer's patients. A patient can be injected with either an active or passive vaccine. Active vaccines contain the protein itself, triggering the body's immune response to produce protein-specific antibodies that tag the protein for clearance. Passive vaccines, on the other hand, contain antibodies to the protein and therefore may not require an active immune response.

Animal tests of both approaches have been promising: animals given the vaccines showed less buildup of the toxic protein and better performance on cognitive tests. But an early clinical trial of an active vaccine, sponsored by the Ireland-based Elan Corporation, was stopped in 2002 after four patients developed encephalitis, an inflammation of the brain. Later, autopsies of these patients' brains showed that despite the inflammation, the vaccine did clear the toxic protein from the brain.

'The challenge now is, are there other ways to use the immunotherapy approach to get the benefits without the adverse effects?' says Richard J. Hodes, director of the NIA..."

Juices may reduce Alzheimer's disease risk (click for more):
"In a large epidemiological study, researchers found that people who drank three or more servings of fruit and vegetable juices per week had a 76 percent lower risk of developing Alzheimer’s disease than those who drank juice less than once per week.

The study by Qi Dai, M.D., Ph.D., assistant professor of Medicine, and colleagues appears in the September issue of The American Journal of Medicine.

The researchers followed a subset of subjects from a large cross-cultural study of dementia, called the Ni-Hon-Sea Project, which investigated Alzheimer’s disease and vascular dementia in older Japanese populations living in Japan, Hawaii and Seattle, Wash.

For the current study, called the Kame Project, the researchers identified 1,836 dementia-free subjects in the Seattle population and collected information on their dietary consumption of fruit and vegetable juices. They then assessed cognitive function every two years for up to 10 years.

After controlling for possible confounding factors like smoking, education, physical activity and fat intake, the researchers found that those who reported drinking juices three or more times per week were 76 percent less likely to develop signs of Alzheimer’s disease than those who drank less than one serving per week.

The benefit appeared particularly enhanced in subjects who carry the apolipoprotein E �-4 allele, a genetic marker linked to late-onset Alzheimer’s disease – the most common form of the disease, which typically occurs after the age of 65.

The researchers chose to study this group because of the low incidence rate of Alzheimer’s disease in the Japanese population. However, the incidence of Alzheimer’s in Japanese people living in the United States is higher, approaching the incidence rates in Americans. This pointed to environmental factors like diet and lifestyle as important contributors to disease risk.

Originally, researchers suspected that high intakes of antioxidant vitamins (vitamins C, E and -carotene) might provide some protection against Alzheimer's disease, but recent clinical studies have not supported this hypothesis..."

Antipsychotics No Better Than Placebo for Alzheimer's Patients (click for more):
"Antipsychotic drugs, which are commonly prescribed to treat psychosis, agitation and aggression in Alzheimer's patients, are essentially no more effective than a sugar pill, new research suggests.

Two of the drugs studied in this multi-center trial did seem to ease some symptoms, but the advantages were offset by the severity of the side effects.

'It doesn't leave us in a great position,' conceded Dr. Thomas Insel, director of the National Institute of Mental Health, which sponsored the study. 'To me, it's a call to arms to push the research forward much more quickly.'

There might be some patients who benefit from certain drugs, even though the overall picture was bleak, Insel noted. And some non-drug therapies might help.

'I hope this will highlight behavioral interventions which are effective though not perfect,' said Dr. Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City and chairman of the Geriatric Mental Health Foundation, in Bethesda, Md..

Newer antipsychotic medications are used widely for Alzheimer's patients, despite an absence of solid evidence of their efficacy.

More than half of Alzheimer's patients experience delusions, hallucinations, aggression and agitation at some point in the progression of their disease. Traditional antipsychotics such as haloperidol have a lower risk of side effects than the newer agents, although both are thought to be equally effective.

Recently, however, new concerns about safety have emerged with the second-generation drugs. Namely, some studies have found an increased risk of cerebrovascular problems and even death.

This study involved 421 participants, all of whom had
Alzheimer's disease along with psychosis, aggression or agitation. All participants also lived with a family member or caregiver or in an assisted-living facility, not a nursing home, to give the study more relevance to a real-world setting..."

Elan and Transition Therapeutics collaborate to develop and commercialize Alzheimer drug:
"AZD-103 is a small molecule compound in Phase I clinical development that acts by breaking down and preventing the assembly of beta amlyoid fibrils, a hallmark pathology of Alzheimer disease.

Under the terms of the agreement, Transition will receive upfront payments of US$15 million: US$7.5 million in 2006 and the remaining US$7.5 million in 2007. In addition, dependant upon the successful development, regulatory approval and commercialization of AZD-103, Transition will be eligible to receive milestone payments of up to US$185 million. Elan and Transition will share the costs and operating profits of AZD-103 if successfully developed and commercialized. Each party's cost share and ownership interest may vary throughout the term of the agreement dependent on certain elections that may be made during the development of AZD-103.

'We are delighted to have this opportunity to work closely with Dr. Cruz and his team at Transition. The opportunity to advance this program to provide much needed therapeutic choice in the treatment of Alzheimer's will be a strategic priority and focus for all of us here at Elan. By joining forces, we increase our probability of success. The AZD-103 program represents a significant addition to our scientific portfolio and continues to reinforce our commitment and leadership in bringing more therapeutic choice to patients and their caregivers suffering from Alzheimer's around the world,' said Kelly Martin, chief executive officer and president of Elan.

'We are extremely pleased to have Elan as our collaborator in developing AZD-103. Elan shares our vision and commitment to develop an effective Alzheimer's disease therapy. We are confident this collaboration will allow us to fully achieve the potential of the disease-modifying compound AZD-103 and help make a difference in the lives of millions of Alzheimer's disease patients and their loved ones,' said Dr. Tony Cruz, chairman and chief executive officer of Transition."

Pot-Like Compound May Slow Alzheimer's, Tests On Rats Show Less Brain Inflammation, Better Memory With Synthetic Cannabinoid - CBS News (click for more):
"A marijuana-like compound may cut brain inflammation and slow the progression of Alzheimer's disease, scientists report. The compound is a synthetic cannabinoid, made in a lab to resemble marijuana.

Old rats given the compound performed better in a maze, according to research by Gary Wenk, Ph.D., professor of psychology and neuroscience at Ohio State University, and others.

What about people? 'Now, I don't know, because I'm just a rat guy, whether this is going to work that well in humans,' Wenk tells WebMD. 'But it looks like it will, because of what we've seen with other drugs in other diseases.'

The marijuana-like drug 'won't cure the disease, but what it might do is stop the processes that are involved in making the disease worsen,' Wenk says.

'I think that's the most exciting aspect. What may matter is that we can tell people that we might be able to step in, stop the inflammation, and they might die of old age before the inflammation has a chance to rebuild itself, which we believe takes many decades,' Wenk says. 'That's the main hope, I think.'

Wenk's team tested the synthetic cannabinoid to curb brain inflammation in rats. 'We know that brain inflammation at a low level plays a role in lots of diseases' including Alzheimer's, Wenk explains. 'Now inflammation in all these conditions doesn't cause the disorder,' he says..."

Two scientific reviews of the health effects of dietary fish
Two scientific reviews of the health effects of dietary fish intake probably made bigger splashes than expected by being released on the same day.

Earlier this week, the Institute of Medicine (IOM) released Seafood Choices: Balancing Benefits and Risks, its summary of current knowledge on the health benefits of eating fish and the potential risks from contaminants such as methylmercury, dioxins, and polychlorinated biphenyls (PCBs) [1]. The same day, a literature review on much the same topic was published by the Journal of the American Medical Association [2].

Both documents offer positive messages about the health effects of the n-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) abundant in fish and other seafood. The IOM report arrives at no firm conclusions about whether the regular consumption of fish will prevent disease. The JAMA report's authors, however, appear certain that its health benefits outweigh any risks.

As covered by heartwire earlier this week, Dr Dariush Mozaffarian (Harvard School of Public Health, Boston, MA) and Dr Eric B Rimm (Brigham and Women's Hospital, Boston, MA) found that intake of EPA and DHA equivalent to one or two servings of fish per week was associated with a 36% decrease in the risk of death from coronary heart disease (p<0.001) and a 17% drop in total mortality (p=0.046). They also concluded that the n-3 PUFAs are likely important to early brain development. Those benefits far outweigh any risks from contaminants, they write.

"Avoidance of modest fish consumption due to confusion regarding risks and benefits could result in thousands of excess CHD deaths annually and suboptimal neurodevelopment in children," they write.

The IOM report's dietary recommendations are more circumspect and less concrete. The document "confirms that eating fish and shellfish may reduce people's overall risk for developing heart disease," according to a press release from the organization [3]. "It is not certain whether this is because substituting the lean protein of seafood for fatty cuts of meat reduces consumers' intake of saturated fat and cholesterol or because of the protective effects of omega-3 fatty acids. . . . The report also found evidence that maternal consumption of omega-3 fatty acids through seafood can contribute to vision and cognitive development in infants and lengthen the duration of gestation."

The report acknowledges potential risks from methylmercury, dioxins, and PCBs but notes, according to the IOM statement, that "reliable data on the distribution of some contaminants is lacking, and there is little evidence on how beneficial effects of seafood might counteract some of the risks from contaminants."

Both reports include caveats about contaminant exposure and fish intake for special populations, particularly women of childbearing age or who are nursing, and cautions for people who fish and eat their own catch from potentially polluted inland waters.

More than 400 pages long and designed to help the US government communicate these issues to the public, the IOM report is noteworthy for observing how little is actually known about either the benefits or the risks of consuming fish and for identifying knowledge gaps that can help guide future research. The IOM, an arm of the National Academy of Sciences (NAS), a nonprofit corporation, describes itself as "an adviser to the federal government on issues of medical care, research, and education."

The differences and similarities of the IOM and JAMA....

Marijuana - Like Compound May Fight Alzheimer's - New York Times
(Reuters Health) - In rats with brain inflammation due to natural aging or in response to an artificial inflammatory stimulus, treatment with a synthetic compound akin to marijuana markedly reduced brain inflammation and slowed memory loss.

``It will be important to find a drug that reduces brain inflammation, but that does not produce the classic 'high''' that marijuana does, Dr. Gary L. Wenk from Ohio State University in Columbus told Reuters Health.

Wenk said his research is motivated by evidence that brain inflammation contributes to many age-related degenerative brain disorders, including Alzheimer's disease. ``This inflammation appears to be present many, many years prior to the onset of the symptoms,'' he said.

In rats with brain inflammation that mimics that seen in patients with Alzheimer's disease, Wenk and his associates discovered that daily treatment with a synthetic marijuana-like drug called WIN reduced inflammation in the brain and improved memory.

On tests of memory performed during the third week of treatment, WIN-treated older rats were able to hold on to key details of a specific water maze task that they'd been taught, whereas the untreated older rats were not.

Younger WIN-treated rats also navigated the water maze faster than non-treated younger rats, but the difference wasn't as remarkable as that of the older group, perhaps because of the lack of age-related changes in the brains of the younger rats.

Wenk presented his group's research today at the Society for Neuroscience annual meeting in Atlanta.

Studies have shown that people who routinely use anti-inflammatory drugs, particularly the ones that cross the blood brain barrier, have a significantly reduced incidence of Alzheimer's disease.

Marijuana has strong anti-inflammatory effects. ``This is why I believe that people who used marijuana a few decades ago are much less likely to develop any disease, such as Alzheimer's, that relies upon the slow development of brain inflammation,'' Wenk told Reuters Health.

``What we need now is to better understand the mechanisms underlying this effect,'' Wenk said. Increased efforts to find or create a drug with the anti-inflammatory but not the psychoactive properties of marijuana are also in order.

Old but Not Frail: A Matter of Heart and Head - New York Times: "scientists are surprised to find that, in many cases, a single factor %u2014 undetected cardiovascular disease %u2014 is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace. Investigators say that there is a ray of hope in the finding %u2014 if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded clich� %u2014 you%u2019re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence. %u201CI am changing my initially skeptical view,%u201D says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. %u201CThere is growing evidence that these subjective experiences might be more important than we thought.%u201D"

Old but Not Frail: A Matter of Heart and Head - New York Times: free registration
...scientists are surprised to find that, in many cases, a single factor — undetected cardiovascular disease — is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace.

Investigators say that there is a ray of hope in the finding — if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.

A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded cliché — you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.

Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence.

“I am changing my initially skeptical view,” says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. “There is growing evidence that these subjective experiences might be more important than we thought.”

It turned out that people who had more positive views about aging were healthier over time. They lived an average of 7.6 years longer than those of a similar age who did not hold such views, and even had less hearing loss when their hearing was tested three years after the study began.....

Popular Anti-Aging Supplement Found Useless - CME Teaching Brief:
"The widely used anti-aging supplement DHEA (dehydroepiandrosterone) has no beneficial effect on body composition, physical performance, insulin sensitivity, or quality of life, according to Mayo Clinic researchers.

A two-year placebo-controlled, randomized, double-blind trial revealed no effect on aging markers, such as muscle strength, peak endurance, muscle and fat mass, glucose tolerance, or quality of life, reported K. Sreekumaran Nair, M.D., Ph.D., and colleagues, in the Oct. 19 issue of the New England Journal of Medicine.


In a separate analysis, low-dose testosterone given to older men also fell short, they found.


The DHEA findings flatly contradicted the persistent belief that the popular supplement, an adrenal sex steroid, sold in health food-stores and other shopping venues, has anti-aging properties."....

HOW A LITTLE RED WINE PROTECTS AGAINST STROKE DAMAGE

Johns Hopkins Medicine PRESS RELEASE:

Researchers at Johns Hopkins say they've discovered how red wine protects the brain from damage following a stroke.

Feeding normal mice a single modest dose of a chemical found in red grape skins and seeds two hours before inducing stroke-like damage, the scientists found that the animals suffered less brain damage than similarly damaged mice without benefit of the chemical.

Called resveratrol, the protective compound apparently increases a specific enzyme in the brain -- dubbed HO for heme oxygenase -- that was already known to shield nerve cells from deadly assaults.

In a separate study, the Johns Hopkins scientists treated mouse nerve cells with resveratrol and then bathed the cells in either a known cellular toxin or the toxin plus a drug that blocks HO. Blocking HO eliminated most of resveratrol's protective effects on nerve cells, causing cells to die. Cells treated with resveratrol but not blocked for HO survived 60 percent longer than those not treated.

Although it's hard to determine equivalent doses of resveratrol and Bordeaux, "the beneficial effects associated with having a glass of red wine with dinner could be explained by turning on the HO antioxidant system," says Sylvain Doré, Ph.D., an associate professor in anesthesiology, critical care medicine and neuroscience at Johns Hopkins. "There may be a scientific basis for the French Paradox after all," he says of the observation that frequent consumers of red wine seem more resistant to cardiovascular diseases

PharmaLive: Eisai, Pfizer: "Sad Day for Patients With Alzheimer’s Disease"

NICE Announce Plans to Stand by Their Perverse Decision to Restrict Alzheimer’s Disease Medicines

Eisai Limited, the licence holder of donepezil (Aricept®) and Pfizer Limited, its co-promotion partner, today (11 October) condemned the decision by the Appeal Panel of the National Institute for Health and Clinical Excellence (NICE) to dismiss all points of appeal heard by NICE on 13 and 14 July regarding the use of anti-dementia medicines in the treatment of Alzheimer’s disease.

Their decision supports the perverse recommendation by NICE to deny access to anti-dementia medicines on the NHS to all patients newly diagnosed with mild Alzheimer’s disease (AD).

Five separate appeals were heard; a joint appeal from the Alzheimer’s Society, Age Concern, Counsel and Care, Dementia Care Trust and The Royal College of Nursing; a second joint appeal from the Royal College of Psychiatrists and the British Geriatrics Society, and three separate appeals from manufacturers of anti-dementia medicines.

NICE has announced that it now plans to delay issuing its final guidance for a further five weeks to coincide with the publication of new guidelines on the management of dementia (including Alzheimer’s disease), developed by the Joint Social Care Institute for Excellence and NICE Guideline Development Group (GDG).

The GDG has been openly critical of NICE’s position on the treatment of Alzheimer’s disease, and it is not clear if NICE and the GDG will make similar recommendations – leading to the potential for further confusion on the best care doctors should be offering to patients suffering from this devastating condition.

Dr Paul Hooper, Managing Director of Eisai Limited, said: "This is a sad day for people with Alzheimer’s disease in that the rationing body is still proposing to take away the only medicines available for the early stages of Alzheimer’s, a most cruel disease, on grounds that are known only to itself."

Dr Hooper added: "In virtually every other disease doctors are trained to find and treat patients early. However with Alzheimer’s, NICE is saying wait until patients deteriorate before you treat them. It makes no sense medically, it makes no sense economically and it makes no sense to patients and their carers. NICE has failed to listen to the true experts when making this decision."

Page 1 of 2

Dr Olivier Brandicourt, Managing Director of Pfizer UK Ltd, said: "NICE has ignored the evidence of patients, charities, researchers and doctors that these drugs are of benefit in the mild as well as moderate stages of the illness. Alone in the world,...[CLICK BLUE LINK ABOVE FOR FULL ARTICLE]

Aricept (donepezil) Wins Indication for Severe Alzheimer's - CME Teaching Brief� - MedPage Today
Aricept (donepezil), a cholinesterase inhibitor on the market for mild to moderate Alzheimer's disease, today became the first of its class to win FDA approval for severe disease.

The FDA action made Aricept the only drug approved to treat all stages of Alzheimer's.

The FDA decision was based on efficacy demonstrated in two randomized, placebo-controlled 24-week trials in Sweden and Japan. The trials enrolled more than 500 patients with severe Alzheimer's dementia.

Both trials evaluated Aricept's efficacy with standard measures that assessed cognitive function including memory, language, orientations, and attention as well as overall functioning. The patients randomized to Aricept had better scores than patients in the placebo arms of both studies.

Steven Galson, M.D., director of the FDA's Center for Drug Evaluation and Research, said 4.5 million Americans are affected by Alzheimer's disease and the action by the FDA "makes available another treatment those with severe dementia."

The FDA has approved five drugs for treatment of Alzheimer's symptoms. In addition to Aricept, three others are cholinesterase inhibitors. They are Exelon (rivastigmine), Razadyne (galantamine) and Cognex (tacrine), all approved for mild to moderate disease.

The fifth drug, Nameda (memantine), is a N-methylD-aspartate (MNDA) antagonist, which was approved by the FDA three years ago for treatment of moderate to severe Alzheimer's.

Aricept is manufactured by Eisai Inc., Teaneck, N.J.

Facing reality: The cost of Alzheimer dementia--Who will pay?
[-- Jankowiak and Knopman 67 (6): E11 -- Neurology]

The Baby Boomers are "coming of age." They are living longer, on average, than any generation before. With this increased life span comes some real challenges. One is the expected increase in Alzheimer disease (AD) and other dementias (see About dementia predictions). As people live longer, the chances of developing AD increase markedly. At age 60, less than 0.1% of people have dementia. By age 85, 30 to 40% have the disease. Scientists are racing against the clock to find a cure or at least a way to slow the process. In the meantime, the costs for the person with AD, the family, and society are mounting.

The cost of AD cannot be measured in terms of the emotional impact on the victim and his or her family. The fear of losing one’s ability to think clearly is frightening. Many just hope "it won’t happen to me" and click to a "more pleasant" topic. However, this is a reality that our society must face if we are to avoid putting the United States into bankruptcy.

What exactly are the costs in dollars of having dementia? In the current issue of Neurology, Zhu and others discuss this important topic (Zhu CW, Scarmeas N, Torgan R, et al. Longitudinal study of the effects of patient characteristics on direct costs in Alzheimer disease. Neurology 2006; 67: 998–1005). The study looked at people with probable AD in the early stages. These people were seen in three different Alzheimer clinics: in New York, Baltimore, and Boston. About 200 people were followed for 2 to 7 years.

RESULTS:

At the beginning of the study, 95% were mildly demented. By the end of the study, 8% had died. Of the rest, 71% stayed mildly demented, 19% were moderately demented, and 10% were severely demented. Initially, 86% lived at home, 8% lived in a nursing home, and 6% in a retirement home or assisted living facility. Of interest, half the people had no other illness than mild dementia at the start of the study. About a third had one other illness, most often high blood pressure.

Everyone used some type of medical care each year, especially medications. The average number of medications increased from six at the beginning of the study to eight by the fourth year (a 25% increase). Medication cost rose from $2,870 to $4,300 (a 50% increase). Total medical care cost increased by almost 50%, from $7,000 to $10,600. On the other hand, non-medical care cost increased almost seven times, from $1,350 to $9,350.

Total direct cost of caring for a person with AD was $9,250 at the start of the study. By the fourth year, the cost had more than doubled, to $20,000 per year. It was noted that small declines in function led to large increases in medical care costs. In addition, developing one new illness increased the costs by 14%. Of interest, total direct cost was 21% lower for patients living at home.

Study Says Aspirin Has A Gender Gap, Drug May Help Women Prevent Strokes, Men Heart Attacks - CBS News:
"It is a medical mystery that doctors find more and more intriguing: how drugs can have different effects on men and women. And the latest evidence indicates that aspirin may be a startling example.

CBS News correspondent Elizabeth Kaledin reports that a new study shows aspirin does a better job of protecting women from strokes than from heart disease. And it works altogether differently for men.

The latest research tracked 95,000 healthy patients with no prior heart problems. For women, an aspirin a day reduced the risk of stroke by 17 percent, with no effect on heart attack.

But for men, the benefits were reversed. A daily dose of aspirin cut the risk of heart attack by 32 percent, but had no effect on strokes.

Dr. Nieca Goldberg specializes in cardiac care for women at Lenox Hill Hospital and hopes this data will trigger similar studies in the future.

'I think that this is clearly the time that we need to look at other medications for gender related differences,' said Goldberg.

Aspirin is not alone in this area. Several other drugs have shown signs of reacting differently in women, including some anti-depressants, painkillers and even anesthesia.

No one knows for sure why these differences exist because there have not been enough studies to pinpoint the causes. But doctors have theorized that women's smaller size and higher body fat could be factors. Also, women tend to take more drugs than men, such as birth control.

For patients, the news is more food for thought. Ruth Oakes has been taking an aspirin a day to prevent heart disease for the past six years and is contemplating this latest twist.

'I think it's interesting that we discover more and more men and women are different in our responses to medication,' said Oakes. 'It does not surprise me about aspirin.'

Goldberg agrees and says much remains to be explored in the area of gender specific medicine.

'We don't even know if maybe women should be on lower dosages of medicines compared to men,' she said."

FDA approves heart health claim for canola oil (click for more):
"The FDA has approved a qualified health claim on canola oil labels that states it supports heart health and reduces the risk of coronary heart disease due to its unsaturated fat content.

The heart healthy claim -also found on oils such as phytosterols, omega-3s and olive oil -is popular among nutraceutical companies because consumers are spending more on healthier foods. The U.S. Canola Oil Association petitioned to be able to make the claim in January in order to promote the benefits of canola oil.

'The claim may ... encourage food manufacturers and food service providers to substitute canola oil for other oils with less favorable nutritional profiles,' said USCA president John Haas, who added that he expects the availability of the claim to promote consumer health by informing them of a simple, affordable and convenient strategy to reduce heart disease risk.

Studies suggest canola oil is high in healthy unsaturated fats, free of cholesterol and trans fats, and has the lowest saturated fat content of any common edible oil. Because canola oil is low in LDL (bad) cholesterol, the labels will be allowed to say:

'Limited and not conclusive scientific evidence suggests that eating about 1 1/2 tablespoons (19 grams) of canola oil daily may reduce the risk of coronary heart disease due to the unsaturated fat content in canola oil. To achieve this possible benefit, canola oil is to replace a similar amount of saturated fat and not increase the total number of calories you eat in a day. One serving of this product contains (x) grams of canola oil.'

'There is ample scientific evidence to demonstrate these benefits from the unsaturated fats in canola oil,' Haas said. 'By using it in place of other common edible oils, consumers can increase their compliance with the latest dietary recommendations.'

However, insiders are worried about what the move may mean for the industry as a whole. Since the health claims promote all canola oils, some companies have wondered why they would invest in claims that increase the sales of their competitors. Also, canola oil, along with olive oil, was granted it's heart health claim by the FDA because of it's low level of unsaturated fats, and experts say this may spur industry representatives for other oils to petition for the claim because of their oils' similar properties..."

Drugs to Curb Agitation Are Said to Be Ineffective for Alzheimes..../Click fror more at New York Times
....The drugs tested in the study — Zyprexa from Eli Lilly; Seroquel from AstraZeneca; and Risperdal from Janssen Pharmaceutical — belong to a class of medications known as atypical antipsychotics. The drugs are used to treat schizophrenia and other psychoses, and are commonly prescribed for elderly patients in long-term care facilities.

About a third of the estimated 2.5 million Medicare beneficiaries in nursing homes in the United States have taken the medications, researchers found. And the use of atypical antipsychotics in the elderly accounts for an estimated $2 billion in the annual sales of the drugs, much of the cost paid by Medicare and Medicaid......

News - Study Suggests Little Benefit from Antipsychotics in Alzheimer's.../click formore
LOS ANGELES, CA -- October 12, 2006 -- Most Alzheimer's patients prescribed antipsychotic drugs for delusions, agitation or aggression do no better than those who take a placebo because so many discontinue the drugs due to significant side effects, according to a major new nationwide study led by Lon Schneider, professor of psychiatry, neurology and gerontology at the Keck School of Medicine of the University of Southern California (USC).

The Phase I results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Alzheimer's Disease Study, funded by the National Institutes of Mental Health, appear in this week's New England Journal of Medicine. The study is highly anticipated, because it provides the first long-term comparative look at the three major antipsychotic drugs now used "off label" to treat difficult symptoms of Alzheimer's disease.

"We thought overall the drugs would show their effectiveness," explains Schneider. "The answer is yes, they are somewhat effective, but overall the efficacy is offset by adverse events that resulted in discontinuing the medication. It was a surprise, in that the expert opinion which drove this study was that these drugs are particularly useful in treating these difficult symptoms."

Almost 3⁄4 of all Alzheimer's patients suffer delusions or aggression, says Schneider, which makes their care particularly difficult. The study's 421 participants at 42 sites nationwide all had Alzheimer's disease and were experiencing delusions, hallucinations, aggression or agitation that disrupted their daily functioning.

"The findings here look at the time to discontinuation for the antipsychotics versus the placebo, and that time difference reflects the overall effectiveness of the medication. By that measure, the medications were not better than placebo," he explains. "Patients on the medications were more likely to discontinue because of the side effects, offsetting the efficacy.".....

Cognitive Benefits Continue in Patients with Mild to Moderate Alzheimer's Disease Treated With Memantine: Presented at ANA
Patients with mild to moderate Alzheimer's disease who are treated with memantine (Namenda) have measurably improved cognitive function that is maintained through 6 months of treatment, according to research presented here at the 131st Annual Meeting of the American Neurological Association (ANA).

When the investigators measured patients' responses on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), "individual ADAS-cog items of commands, orientation, comprehension, and recall of test instructions showed improvement associated with memantine treatment," said Nunzio Pomara, MD, professor of psychiatry, Nathan S. Kline Institute, and director of geriatric psychiatry, New York University School of Medicine, Orangeburg, New York....

Cognitive Benefits Continue in Patients with Mild to Moderate Alzheimer's Disease Treated With Memantine: Presented at ANA
Patients with mild to moderate Alzheimer's disease who are treated with memantine (Namenda) have measurably improved cognitive function that is maintained through 6 months of treatment, according to research presented here at the 131st Annual Meeting of the American Neurological Association (ANA).

When the investigators measured patients' responses on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), "individual ADAS-cog items of commands, orientation, comprehension, and recall of test instructions showed improvement associated with memantine treatment," said Nunzio Pomara, MD, professor of psychiatry, Nathan S. Kline Institute, and director of geriatric psychiatry, New York University School of Medicine, Orangeburg, New York....

Activities of Daily Living Score Can Differentiate Mild Cognitive Impairment From Mild Alzheimer's Disease: Presented at ANA
An assessment of a patient's ability to perform certain activities of daily living can help differentiate mild cognitive impairment from Alzheimer's disease, according to investigators who presented their findings here at the American Neurological Association (ANA) 131st Annual Meeting.

The researchers evaluated the Functional Activities Questionnaire (FAQ), which is commonly administered to the patient's caregiver and assesses the patient's ability to participate in 10 categories of instrumental activities of daily living. These included:
1) writing checks and maintaining other financial records;
2) assembling tax or business records;
3) shopping alone;
4) playing a game of skill;
5) making coffee or tea;
6) preparing a balanced meal;
7) keeping track of current events;
8) attending to and understanding a television program, book or magazine;
9) remembering appointments, family occasions, and medications; and
10) traveling out of the neighborhood.

The study required the caregiver to give the patient a score of zero to 3 on each activity, with 0 equaling normal independent participation in the activity, 1 indicating the patient's ability to do the activity alone but with difficulty, 2 indicating that the patient requires assistance, and 3 indicating that the patient is dependent on others to conduct the activity.

"Our findings show that analyses of individual assessments of activities of daily living, such as the FAQ, may be useful for diagnosing mild cognitive impairment," said principal investigator Edmond Teng, MD, PhD, fellow, Alzheimer Disease Center, David Geffen School of Medicine, UCLA, Los Angeles, California.....

New drug may help Alzheimer patient : valproate:.../CLICK FOR LINK TO STUDY
Researchers are testing an old drug to delay the onset of aggression in people with Alzheimer’s disease. The drug, valproate, is already FDA-approved for epilepsy, migraine headaches and bipolar disorder. The study, led by researchers at the University of Rochester (National Institutes of Aging sponsored study), is looking at whether the drug delays the onset the agitation common with Alzheimer’s disease. Previous studies have shown valproate does provide a beneficial effect for agitation in some, though not all, patients.

PROMISING FINDINGS:

Researchers are excited by more than valproate’s effects on agitation. They say the drug may actually help protect the brain. Dr. Ismail explains, “[Valproate] can actually modify what is happening at the cellular level. We are hoping that it actually protects the cell from being stressed out or being damaged. If those cells could be preserved longer, that would translate into meaningful outcomes.”

The study is the first of its kind to study a drug that could block one of the hallmarks of AD -- “tangles.” Tangles are abnormal brain tissue structures formed by abnormal processing of a protein called tau. In healthy people, tau is critical for intracellular functioning and structure. In patients with Alzheimer’s disease, stringy clusters of tau and phosphate molecules form. This leads to an impairment of the cells' ability to transport material within the cell. When the cell does not function the way it should it cannot communicate efficiently with other cells. Eventually, this process leads to cell death. Dr. Ismail says, “This is just one aspect of what we think is valproate’s potential to work. More recently, there has been evidence that it works [another way].” He says the drug also probably works on the clearance and production of amyloid. Amyloid plaques are found outside the neurons, and neurofibrillary plaques are found inside the neurons. Neurons are the nerve cells within the brain. These plaques are found in large amounts in people with Alzheimer's disease.

Dr. Ismail is hopeful that valproate will offer new hope. “It’s very exciting. Scientifically, it is novel. The theory behind it is very impressive, and the good thing about it is that the evidence is growing.”

Marijuana may stave off Alzheimer's: Reuters
"WASHINGTON (Reuters) - Good news for aging hippies: smoking pot may stave off Alzheimer's disease.

New research shows that the active ingredient in marijuana may prevent the formation of deposits in the brain associated with the degenerative disease.

Researchers at the Scripps Research Institute in California found that marijuana's active ingredient, delta-9-tetrahydrocannabinol, or THC, can prevent an enzyme called acetylcholinesterase from accelerating the formation of "Alzheimer plaques" in the brain more effectively than commercially marketed drugs.

The researchers said their discovery could lead to more effective drug treatment for Alzheimer's, the leading cause of dementia among the elderly.

Those afflicted with Alzheimer's suffer from memory loss, impaired decision-making, and diminished language and movement skills. The ultimate cause of the disease is unknown, though it is believed to be hereditary.

Marijuana is used to relieve glaucoma and can help reduce side effects from cancer and AIDS treatment....

Extended Release Niacin Reduces Cardiovascular Inflammatory Marker Lp-PLA2....Tufts-New England Medical Center
Niacin, in conjunction with statin therapy, reduces lipoprotein-associated phospholipase A2 (Lp-PLA2), an important new marker of inflammation associated with heart disease and stroke due to plaque rupture, according to a study published in the September 15, 2006, issue of The American Journal of Cardiology. The study, conducted at Tufts-New England Medical Center, evaluated 54 patients who were assigned either 1,000 mg daily extended release niacin or placebo, in addition to their existing drug regimen, primarily statins, ACE inhibitors, and aspirin.

The study shows that when extended release niacin was administered to stable heart disease patients for three months, Lp-PLA2 levels were reduced by 20 percent (p<0.05), while low-density lipoprotein (LDL) remained unchanged. Lp-PLA2 levels were measured by the PLAC test from diaDexus. The PLAC test is a simple blood test that measures the concentration of the enzyme Lp-PLA2, identifying people at high risk for heart disease and stroke associated with atherosclerosis, who may not be identified by traditional risk factors.

DISCOVERY OF NEW GENE ASSOCIATED WITH ALZHEIMER'S DISEASE: Johns Hopkins Medicine Press Release

FOR IMMEDIATE RELEASE

NEWS TIPS FROM JOHNS HOPKINS MEDICINE
2006 ANNUAL MEETING OF THE AMERICAN SOCIETY OF HUMAN GENETICS, OCT. 9-13, NEW ORLEANS, LOUISIANA

DISCOVERY OF NEW GENE ASSOCIATED WITH ALZHEIMER'S DISEASE
(Scheduled for presentation at 4:30 p.m. CDT, Tuesday, Oct. 10; poster presentation #2034, Hall D/E, Ernest N. Morial Convention Center.)

Researchers at Johns Hopkins have identified what might be a second gene that signals risk for late-onset Alzheimer's disease. As many as 4.5 million Americans are believed to have AD, a disabling and fatal disorder marked by memory loss, trouble with language and difficulty performing familiar tasks.

Late-onset AD occurs after age 65. While three genes are known to cause an early-onset form, only one other gene has been shown to be a risk factor for the late-onset form.

Hunting for genes that are turned on or off in AD patients, the Johns Hopkins researchers identified a gene on chromosome 10 that they call ASAH2L, which, interestingly, appears to exist only in humans and appears less active in AD patients. The gene also appears less active in women and with advancing age, which are risk factors for developing AD. According to the researchers, ASAH2L seems to have arisen from an accidental duplication of another nearby gene.

Although the exact role of the ASAH2L gene in AD is not yet clear, the investigators think it might be involved in keeping brain cells from dying. Says Dimitrios Avramopoulos, M.D., Ph.D., an assistant professor of psychiatry and behavioral sciences at Johns Hopkins, "Hopefully it will lead to developing more treatment options in the future."

"A daily glass of antioxidant-rich pomegranate juice could halve the build-up of harmful proteins linked to Alzheimer’s disease (CLICK FOR MORE):

“This study is the first to show beneficial effects (both behavioral and neuropathological) of pomegranate juice in an animal model of AD,” wrote lead researcher Richard Hartman from Loma Linda University in California.

Alzheimers disease is the most common form of dementia and currently affects over 13 million people worldwide. The direct and indirect cost of Alzheimer care is over $100bn (€ 81bn) in the US alone. The direct cost of Alzheimer care in the UK was estimated at �15bn (€ 22bn).

Although the mechanism of Alzheimer's is not clear, more support is gathering for the build-up of plaque from beta-amyloid deposits. The deposits are associated with an increase in brain cell damage and death from oxidative stress.

It is against the oxidative stress that the polyphenols appear to offer protection..."

Red Wine May Help Prevent Alzheimer's (CLICK FOR MORE):

"Drinking Cabernet Sauvignon may help prevent Alzheimer's disease, according to new animal research.

Reporting in the November issue of the FASEB Journal, researchers observed the effects of feeding the red wine to mice with Alzheimer's disease-type brain changes.

Compared to mice that received ethanol or water, the mice that were given Cabernet Sauvignon experienced significantly reduced Alzheimer's disease-type brain deterioration of memory function.

The researchers, from Mount Sinai School of Medicine in New York City, found Cabernet Sauvignon's benefits were due to its ability to prevent the generation of proteins that cause plaque build-up in the brain, which is the main characteristic of Alzheimer's disease..."

Water in the Brain Hints at Early Cognitive Decline (CLICK FOR MORE):

"Early signs of Alzheimer's disease may show up in subtle changes in the diffusion of water in key brain structures, as revealed by MRI, researchers here suggested.

In a small study, patients with mild cognitive impairment were found to have elevations in apparent diffusion coefficient in brain areas governing memory when compared with control patients, and reported Min-Ying Su, Ph.D., of the University of California at Irvine, and colleagues, in the October issue of Radiology.

These elevations correlated with worse memory performance scores, the investigators added.

'Our methods may enable earlier diagnosis of Alzheimer's disease, allowing earlier intervention to slow down disease progression,' they said.

Apparent diffusion coefficient is a measure of the diffusion of water in the brain, which is normally hindered by local tissues such as cell membranes, intracellular organelles, axons and myelin sheaths. MRI evidence of elevated apparent diffusion coefficient is therefore believed to signal tissue atrophy.

Dr. Su and colleagues conducted a prospective study of alteration in the apparent diffusion coefficient of cortical gray and white matter and subcortical structures known to be involved in mild cognitive impairment..."

Marijuana may stave off Alzheimer's..../Click for full press release from The Scripps Research Institute
"Discovery Could Lead to More Effective Treatments"

"Scientists at The Scripps Research Institute have found that the active ingredient in marijuana, tetrahydrocannabinol or THC, inhibits the formation of amyloid plaque, the primary pathological marker for Alzheimer's disease. In fact, the study said, THC is "a considerably superior inhibitor of [amyloid plaque] aggregation" to several currently approved drugs for treating the disease.

According to the new Scripps Research study, which used both computer modeling and biochemical assays, THC inhibits the enzyme acetylcholinesterase (AChE), which acts as a "molecular chaperone" to accelerate the formation of amyloid plaque in the brains of Alzheimer victims. Although experts disagree on whether the presence of beta-amyloid plaques in those areas critical to memory and cognition is a symptom or cause, it remains a significant hallmark of the disease. With its strong inhibitory abilities, the study said, THC "may provide an improved therapeutic for Alzheimer's disease" that would treat "both the symptoms and progression" of the disease.

"While we are certainly not advocating the use of illegal drugs, these findings offer convincing evidence that THC possesses remarkable inhibitory qualities, especially when compared to AChE inhibitors currently available to patients," said Kim Janda, Ph.D., who is Ely R. Callaway, Jr. Professor of Chemistry at Scripps Research, a member of The Skaggs Institute for Chemical Biology, and director of the Worm Institute of Research and Medicine. "In a test against propidium, one of the most effective inhibitors reported to date, THC blocked AChE-induced aggregation completely, while the propidium did not. Although our study is far from final, it does show that there is a previously unrecognized molecular mechanism through which THC may directly affect the progression of Alzheimer's disease."....

As the new study points out, any new treatment that could halt or even slow the progression of Alzheimer's disease would have a major impact on the quality of life for patients, as well as reducing the staggering health care costs associated with the disease....."

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