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2010-02-13T15:13:00.000-08:00

For-Profit Hospitals Most Likely to Overtreat Dementia Patients

Tube-feeding patients with advanced dementia -- a practice whose effectiveness has been questioned by two widely cited literature reviews -- is most common in larger hospitals and those run for profit, researchers said.

The odds of a feeding-tube insertion in a hospitalized patient with advanced dementia were about 50% greater when the hospital was larger than 310 beds than in facilities with 100 beds or less, and it was 33% more common in for-profit versus government-owned facilities, reported Joan M. Teno, MD, of Brown University in Providence, R.I., and colleagues.

Click here for full story.

Alzheimer's series a learning tool for Shriver

2009-05-08T08:57:00.000-07:00

In "The Alzheimer's Project," executive producer Maria Shriver shares on camera that her father, Sargent Shriver, 93, no longer recognizes her.

"You want them to be that person you looked up to who knew the answer to everything," Shriver, 52, said during a conference call last week. She added that she takes cues from her children to deal with the pain and frustration.

"My children will always be like, 'Just talk to Grandpa, just go with whatever he is saying, don't try to correct him, don't get mad, it's not him. Just laugh with him or just accept him, or be patient with him.' "

Shriver, California's first lady, was promoting the HBO series that premieres this weekend. Her answers below are edited for length and clarity.

Q: In the last few years, there have been some advances in research toward Alzheimer's, including predictive genetic testing. Through your experience with your father, has it led you to take such a test?

A: No. I have not taken a test in particular to see if I have Alzheimer's or I'm predisposed to it. I try to follow some of the recommendations to keep myself mentally active. I think one of the things that comes out of this "Alzheimer's Project" is that your cardiovascular health is directly related to your brain health and if anything comes out of this, I hope it will also be to Baby Boomers to not just focus on keeping your body in shape, but you can keep your brain in shape by how you keep your body in shape. It's just not just about crossword puzzles.
But I think there is really nothing that is going to help us unless we find a cure. I think that's where I'm going to concentrate my efforts. My efforts have been in writing a book, being the executive producer of the special, testifying in front of the Congress, and trying to work with the Alzheimer's Study Group to perhaps bring attention and a sense of urgency to the research in funding Alzheimer's. I find that that might be a better use of my time than to go and get this test and find out if I might get Alzheimer's because that would really scare the daylights out of me. And I don't know what really productive, frankly, would come of it.

Q: How do you think this will impact Baby Boomers?

A: As Baby Boomers age they become more susceptible to getting Alzheimer's, and so many Baby Boomers I know are having to quit jobs, having to move home to care for their own parents. That's why I think that this is the Baby Boomer epidemic. This is an epidemic that Baby Boomers have to realize is their epidemic, to try to find a cure for. Otherwise it's going to ravage the Baby Boomer generation. Not only mentally but physically, spiritually, financially, and that's why I think that it used to be five or six years ago that people just looked at Alzheimer's and said that's an old person's disease, it's not about me, it's not going to happen to me.

Q: Can you talk about what you have learned from children with how they approach Alzheimer's? Their perspective?

A: I've learned from my own children to be much more in the moment, to accept the person for who they are, not for who they want them to be or who you remember them to be. My own children have taught me a lot about just trying to - let me just say also they obviously don't have all the emotional entanglements that a child has when it's a parent, so they can address it in a different way - but I think you can learn from them that to accept the person that's sitting in front of you as opposed to wanting that person to be the person they used to be. I think many children, and I say children whether you be 50, 40 or whatever, you are still a child of that person, you want that person to be the parent that they used to be.

Q: As a former journalist, how was it different for you to report on a topic that is so close to home and so personal for you?

A: Well, no different, believe it or not. In many of the stories that I covered, I felt I had some kind of understanding of the subject. Being an executive producer was a different role for me, from being the reporter and the writer and being involved in the editing and all that sort of stuff.
But I didn't feel like, oh, maybe I'm not objective - I didn't feel any of that. I was really interested because there was a lot of the science that I did not know. I didn't know the depth of the clinical trials, the breadth of the clinical trials. I didn't know all the doctors that have been working so tirelessly for so long. I knew a lot about what it's like to live with someone with Alzheimer's and I knew a lot about caretaking. One of the things I love so much about being a reporter is that even if you think you know something, you're constantly learning what you don't know. So for me the big difference here wasn't in the subject matter, it was in the role, actually.

San Francisco Chronicle

AAN: Diet Linked to Alzheimer's Risk

2009-05-05T19:41:00.000-07:00

SEATTLE, May 1 -- A diet that's high in vegetables, nuts, and fish but low in fatty dairy products may help protect against Alzheimer's disease, researchers said here.

Patients in the highest tertiles of such a diet had a 42% reduced risk of developing Alzheimer's, Yian Gu, Ph.D., of Columbia University, and colleagues said at the American Academy of Neurology Meeting.

"There was a significant relationship for the seven nutrients that are most consistently associated with Alzheimer's disease," Dr. Gu said.

Dr. Gu and her colleagues used the Reduced-Rank Regression model to analyze dietary patterns that might explain the variation of nutrients that is believed to be related to disease risk.

They evaluated the diet via those seven Alzheimer's disease-related nutrients: saturated fats, monounsaturated fats, omega-3 fatty acids, omega-6 fatty acids, vitamin E, vitamin B12, and folate.

The researchers prospectively assessed 2,136 healthy elderly patients in New York who
provided dietary information. Participants were evaluated with the same standardized neurological and neuropsychological measures every one-and-a-half years.

A total of 251 patients developed Alzheimer's disease over the four-year follow-up period.
In a multivariate analysis, the researchers found that a diet high in omega-3, omega-6, folate, and vitamin E, and low in saturated fat and B12, was strongly associated with lower risk of Alzheimer's disease.

Compared with the lowest scores for dietary pattern, the middle and highest tertiles had significantly reduced risks of developing Alzheimer's (HR 0.77, 95% CI 0.56 to 1.05 and HR 0.58, 95% CI 0.40 to 0.84, respectively, P<0.01).

Dr. Gu said the B12 finding was "surprising" since deficiency of the nutrient is associated with dementia. However, a major dietary source of B12 is meat, which is also a large source of saturated fat, she said.

The protective diet was characterized by higher intakes of cruciferous vegetables, green-leafy vegetables, fish, nuts, and tomatoes, and by a lower intake of high-fat dairy products.

Dr. Gu said that further study of Alzheimer's disease-related nutrients can better identify dietary patterns that relate to disease risk. .......report in MedPage Today

AACR: Designer T Cells Attack Prostate Cancer

2009-04-22T12:43:00.000-07:00

DENVER, April 21 -- Reprogrammed immune cells could become targeted "killing machines" against prostate cancer, a researcher said here.

In the early stages of a phase I study, these reprogrammed T cells sharply reduced the levels of prostate specific antigen (PSA) in two patients with metastatic prostate cancer, according to Richard Junghans, M.D., Ph.D., of the Roger Williams Medical Center in Providence, R.I.

Within a few weeks of the infusion of the engineered cells, one patient's PSA level had fallen by half and the other's by 75%, Dr. Junghans reported at the annual meeting of the American Association for Cancer Research. T cells, Dr. Junghans told reporters, are the "perfect killing machines" when faced with a cell infected with a virus. "We have to fool the T cells into thinking that the cancer has a virus infection," he said.

To do that, he and colleagues isolate a patient's T cells from a blood sample and use genetic engineering techniques to make them sensitive to a molecule that only occurs in prostate cancer -- prostate specific membrane antigen, or PSMA.

Over a period of weeks, the modified cells are amplified in culture. Meanwhile the patient undergoes chemotherapy to knock down his remaining lymphocytes, creating "hematopoietic space" for the engineered T cells.

Finally, he said, the cells are infused into the patient and begin attacking cells that express PSMA. A marker for that activity, Dr. Junghans said, is the level of prostate specific antigen.
The falling levels of PSA in the two patients treated so far were obtained despite the low dose of cells they were given -- about a billion each.

The researchers plan to test that dose in one more patient and then escalate the dose -- first to 10 billion in six patients and then to 100 billion in another six.

In the two patients treated so far, the falling PSA levels appeared to have bottomed without reaching zero -- possibly because the methods used to activate them caused them to enter a resting state without completely eradicating the cancer cells, Dr. Junghans said.

With the higher doses, he said, he hopes to see PSA levels fall all the way to zero.
"We are very hopeful that when we get to higher doses," he said, "all those activated (cells) may get us to 100% suppression before they go to the resting state."

Dr. Junghans said the redirected T cells are a "brave new world" for cancer treatment. "I predict the FDA will have approved one of these designer T-cell constructs -- if not this one, then another one -- as standard therapy in the next five or so years," he said.

Dr. Junghans' approach is a new twist on ideas that have been around for "two decades or more," said Louis Weiner, M.D., of Washington's Lombardi Cancer Center, who was not part of the research.

"What Dr. Junghans and colleagues have done is to really combine two critical elements" -- redirecting the T cells and creating space for them by chemotherapy, Dr. Weiner said.

He said while the idea is intriguing and the early results promising, "at the end of the day, we will need properly conducted efficacy trials."

But "the early returns are sufficiently encouraging that I certainly hope they continue doing the work," he said.
MedPage Today

Important Note from the MS News Channel re: The Latest in Mental Health: Working Out at the 'Brain Gym' (WSJ)

2009-03-28T13:30:00.000-07:00

We will attempt to gather more information from patients/consumers and will be reporting more about these 'Brain Gyms' in the next few days as information becomes available. Shirley Richardson, Editor, MS News Channel

The Latest in Mental Health: Working Out at the 'Brain Gym'

2009-03-28T13:07:00.000-07:00

Outfits Promise to Keep Older Minds Sharp With Computers, Walnuts and Green Tea

SAN FRANCISCO -- Linda Hale Bucklin, a 63-year-old writer, signed up on the spot when she saw a new "gym for the brain" in her neighborhood here. She now works out three times a week and credits a computer "visual processing" program for helping her find her car keys faster and sharpen her tennis skills.

On the court, "my game is just at a different level," says Ms. Bucklin. "I'm playing with 40-year-olds, and I'm holding my own really well."

Vibrant Brains, the business that drew her in, has attracted about 200 members since December 2007, according to its owners. Patrons pay $60 a month to work out on 20 computer stations loaded with "mental fitness" software, including a "neurobics circuit" that purports to stretch the brain. Ms. Bucklin says she's addicted to an art-auction game that displays a dozen Monets for purchase. "Then they'll intersperse them with other Monets, and you have to tell them apart," she says. "I minored in art history, and I still find it difficult."

Thousands of Americans are choosing to join a small, but growing, number of "brain gyms" springing up around the country. Similar brain-teaser programs are available on home computers, sometimes free of charge. The scientific jury is still out on the efficacy of such software.

The centerpiece of most outlets is a computer lab equipped with software from companies with names like Posit Science Corp., CogniFit Ltd., Lumos Labs Inc. and Happy Neuron Inc. Like gym rats who hit the weight machines or take Pilates classes, some users of the new technology say they prefer working with personal trainers. In this context, sessions are spent doing things like mental-fitness assessments and relaxation exercises in addition to basic cognitive training.

Sparks of Genius, in Boca Raton, is a Florida start-up drawing older adults with "scientific-based brain-fitness workouts." In southern California, a dozen "Nifty after Fifty" fitness clubs are combining traditional exercise with time in front of computer screens, claiming that mental calisthenics work best after physical exercise. Canyon Ranch, a Tucson, Ariz.-based spa operator, has added a series of "Memory & More" programs at its Lenox, Mass., resort, which include classes in brain nutrition, genetic workups, and cognitive training.

Brain exercise is spreading beyond gym walls, too. In Chicago, "Marbles: The Brain Store" offers classes on improving mental health. The New England Cognitive Center, a nonprofit group in Hartford, Conn., is teaching trainers to take its "Brain G.Y.M.M." program to community centers around the country. More than 700 retirement communities have added computerized brain-fitness centers in the past three years, according to Alvaro Fernandez, co-founder of SharpBrains Inc., a firm that surveys the brain-fitness software market.

The industry pins its claims for brain exercise on a relatively new scientific discovery: neuroplasticity, the brain's ability to rewire itself throughout life by creating neural connections in response to mental activity. In a study published in 2006 in the Journal of the American Medical Association, a clinical trial involving 2,832 older adults concluded that "cognitive training" -- such as identifying patterns in a series of letters or words -- helped improve memory and reasoning skills.

A more recent study, of 487 adults aged 65 and older, found that people who trained on brain-fitness software for 40 hours over eight weeks noted significant improvement with memory and attention skills. The study is scheduled to be published in the April edition of the Journal of the American Geriatrics Society.

Some neuroscientists say it's simply too early to tell whether a specific form of brain exercise will result in lasting benefits or a lower incidence of dementia.

"Cognitive activity is probably good, and it may make someone sharper. But there's very little evidence that shows that these things in a controlled trial reduce Alzheimer's disease or affect everyday function," says David Loewenstein, a psychiatry professor at the University of Miami's Miller School of Medicine.

But the "worried well" and people already in the early stages of dementia aren't waiting for research findings. More than 5.5 million copies of Nintendo Co.'s "Brain Age" games have been sold in the U.S. since 2006, the company says, jumpstarting awareness of the brain-exercise field.

While many brain-flexing centers are marketed primarily toward baby boomers, that generation's parents are signing up, as well. Last year, Eva Slane, an 80-year-old retired theatrical agent, joined Neurobics Club, a brain gym in Sarasota, Fla. "I would like to stay as sharp as I am," she says. Her favorite piece of equipment at the moment: the Dakim

BrainFitness System, a touch-screen computer that uses a game-show-like format with stories, voiceovers and pre-1950s film and music clips.

Lisa Schoonerman, the 41 year-old co-founder of Vibrant Brains LLC, says she first looked into cerebral gyms after her mother was diagnosed with frontotemporal dementia -- an often fast-progressing form of memory loss. Her partner, Jan Zivic, had used earlier versions of brain games after a car accident 11 years ago left her in a coma and compromised much of her memory. Both were struck by the idea of bulking up the brain, what brain scientists refer to as "cognitive reserve." The theory: People engaged in greater degrees of mental stimulation increase their brain mass and neural pathways, protecting them if a brain injury or dementia starts chipping away at brain connections.

The duo's first storefront, dubbed vibrantBrains, has a small retail area, computer lab and a lounge stocked with walnuts and green tea. (Some nutritionists say such snacks promote brain health.) A second location opened in January......full story in the Wall Street Journal

AAN: Nimble Activity Protects Against Mild Cognitive Impairment

2009-02-19T06:49:00.000-08:00

SEATTLE, Feb. 18 -- Middle-age and older adults who prefer a mental workout to passive activities, such as watching TV, may be less likely to develop memory loss as they age, researchers said.

Mentally stimulating social activity and reading in middle age reduced the likelihood of mild cognitive impairment in old age by more than 40%, found Yonas E. Geda, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues.

After age 65, reading, making crafts, using the computer, playing games, and watching less TV were associated with 30% to 50% lower risk of mild cognitive impairment, Dr. Geda's group reported in a case-control study to be presented at the American Academy of Neurology meeting here.

Dr. Geda said these findings provide concrete evidence for the "use it or lose it" axiom. "This means perhaps aging does not have to be a simple passive process."

In the multivariate analysis adjusted for age, sex, and education, the researchers found the following activities done over the prior year late in life protective against mild cognitive impairment:

Reading books (odds ratio 0.67, 95% confidence interval 0.49 to 0.94)
Playing games (OR 0.65, 95% CI 0.47 to 0.90)
Crafting activities, such as quilting or pottery (OR 0.66, 95% CI 0.47 to 0.93)
Computer activities (OR 0.50, 95% CI 0.36 to 0.71)
Watching television less (OR 0.48 for fewer than seven hours per day versus more, 95% CI 0.27 to 0.86)

Dr. Geda cautioned that the findings were based on patients' memories of activities and need to be confirmed in prospective studies.

full story and video in MedPage Today

A Way Found to Judge Driving Safety of Alzheimer's Patients

2009-02-12T16:44:00.000-08:00

IOWA CITY, Iowa, Feb. 11 -- The difficult judgment call on whether Alzheimer's patients are safe to drive can be helped by a battery of cognitive tests, researchers here said.

"By measuring driver performance through off-road tests of memory, visual, and motor abilities, we may be able to develop a standardized assessment of a person's fitness to drive," Dr. Dawson said.

To determine whether performance on tests of cognition, visual perception, and motor function could predict the level of safety in licensed drivers with early Alzheimer's, the researchers conducted a controlled trial of 40 patients with mild disease and 115 patients without dementia.

"Given that driving puts demands on diverse cognitive functions, it is unlikely that a test of any single cognitive ability will be an accurate predictor of driving safety," the researchers said.

The study may have been limited by a lack of investigation of other environmental factors, such as having family members in the vehicle and time of day, as well as a possible lack of generalizability because only seven of the 40 patients in the experimental group were women.

Still, the researchers concluded that for predicting safety errors within the Alzheimer's disease group, "off-road neuropsychological tests of cognition, vision, and motor abilities gave additional information above and beyond diagnosis alone. Hence, performance on these tests can be helpful when predicting whether a patient with Alzheimer's disease can safely drive a vehicle."
full story in Medpage Today

VIDEO WEBCAST - Levodopa-Unresponsive Parkinson's Disease

2009-02-10T16:29:00.000-08:00

Kapil D. Sethi, MD, Professor of Neurology; Director, Movement Disorders Program, Medical College of Georgia, Augusta
Medscape Today

Stanford develops imaging technique to catch arthritis early in onset

2009-01-30T06:54:00.000-08:00

STANFORD, Calif. — You come into a doctor’s office with severe knee pain. The physician orders an MRI, which reveals substantial loss of cartilage — osteoarthritis, that is—in your knee joint. At this point, not much can be done beyond gulping down palliatives and trying to keep your weight off the joint. But the damage may have started building as much as 20 years earlier, possibly due to a traumatic injury to the affected joint.

Just ask Garry Gold, MD, an associate professor of radiology at the Stanford University School of Medicine. Now 45, Gold sustained a knee injury 20 years ago while playing in a pickup basketball game. These days, he’s starting to wish his house, currently being remodeled, didn’t have any stairs.

Gold, who has been diagnosed with osteoarthritis, is working with an imaging technology called sodium MRI to diagnose osteoarthritis as long as decades before the onset of physical symptoms. That may spawn new therapies that could possibly have blocked his disease before it put an end to his basketball days.

Using the new imaging technology, Gold and colleagues have been able to spot, soon after such an injury, telltale signs of cartilage deterioration consistent with the development of osteoarthritis.

Sodium MRI has been around for years, but until recently it couldn’t be used in clinical settings. For one thing, the magnets employed to excite sodium atoms were too puny, making crisp resolution possible only with tiny creatures such as mice. Gold and his colleague Brian Hargreaves, PhD, assistant professor of radiology, have designed improved magnets and software to scale up the technology for human application.

Gold and Hargreaves’ project is being conducted with funding from the National Institutes of Health and GlaxoSmithKline, an international pharmaceutical company. Neither researcher owns stock in, or receives consulting fees from, the company.

Catching osteoarthritis during its stealth phase may spur clinical trials that would be prohibitively time-consuming and costly if standard MRI were employed, because of the huge lag from the time of an ACL injury until the time cartilage deterioration can be detected by that old method.

With sodium MRI, cohorts of treated vs. untreated at-risk patients could be imaged over time to see if, within a few years of the injury, a drug or a lifestyle change is reducing or arresting the loss of glycosaminoglycan from the ligament. Once promising drugs or lifestyle changes are identified, they could then be administered to at-risk patients long before symptoms surface, Gold said.

As for Gold himself, he has yet to see what his own damaged knee looks like under sodium MRI. The 6-foot-6 once-avid amateur basketball center’s knee is too big for even his improved new experimental apparatus to fit. It’s probably too late for any kind of imaging to do Gold much good now, anyway. He already knows he’s got arthritis. “I don’t even want to look,” he said.

Full story & Video: Stanford School of Medicine

News & Video: Diets May Improve Memory

2009-01-28T06:04:00.000-08:00

Reducing Calorie Intake May Be Good for Memory

Click here for article and video: ABCNews

VIDEO - HERSTORY: Dear Abby Shares What Her Alzheimer's Mother's Life Is Like Today

2009-01-25T13:17:00.000-08:00

The original Dear Abby, now living with Alzheimer's disease, once positively impacted millions of lives. Her daughter, the current Dear Abby, shares what her life is like now.

http://www.empowher.com/community/herstory/video-herstory-dear-abby-shares-what-her-alzheimers-mothers-life-today

Personality and lifestyle in relation to dementia incidence

2009-01-19T16:18:00.000-08:00

High neuroticism has been associated with a greater risk of dementia, and an active/socially integrated lifestyle with a lower risk of dementia. The aim of the current study was to explore the separate and combined effects of neuroticism and extraversion on the risk of dementia, and to examine whether lifestyle factors may modify this association.
NEUROLOGY 2009;72:253-259

Testes stem cell can change into other body tissues, Stanford/UCSF study shows

2009-01-09T11:51:00.000-08:00

STANFORD, Calif. — Scientists at the Stanford University School of Medicine and at UC-San Francisco have succeeded in isolating stem cells from human testes. The cells bear a striking resemblance to embryonic stem cells — they can differentiate into each of the three main types of tissues of the body — but the researchers caution against viewing them as one and the same....full story in Stanford School of Medicine Medical News

Deep Brain Stimulation Bests Medical Therapy for Advanced Parkinson's Disease

2009-01-09T11:36:00.000-08:00

January 8, 2009 — Results of a randomized trial show that compared with best medical therapy, deep brain stimulation (DBS) increased "on" time without dyskinesias and improved motor function as well as quality of life at 6 months in patients with moderate to severe Parkinson's disease (PD), but at the cost of increased serious adverse events (SAEs)........full story
Medscape Today

Antipsychotics Lower Long-Term Survival in Alzheimer's Disease

2009-01-09T07:51:00.000-08:00

LONDON, Jan. 8 -- For patients with Alzheimer's disease, antipsychotic medications substantially increase one-year mortality risk, researchers found. Patients who continued on their antipsychotic regimen were 42% more likely to die over a one-year... full story

MedPage Today

Slide show: Exercises for osteoporosis

2009-01-07T15:57:00.000-08:00

Don't let osteoporosis rob your bones of their strength. Here are some exercises to prevent or treat this common bone disease.
The Mayo Clinic

Osteoporosis treatment puts brakes on bone loss

2009-01-07T15:56:00.000-08:00

Osteoporosis treatment may involve medication along with lifestyle change. A Mayo Clinic specialist answers some of the most common questions about osteoporosis treatment.
The Mayo Clinic

10 Techie Ways to Fight the Flu

2009-01-06T11:54:00.000-08:00

Technologies like a flu-tracking app and phone wipes could help you get through flu season unscathed.
PC Magazine

MRIs May Damage Cochlear Implants

2009-01-03T07:01:00.000-08:00

NEW YORK (Reuters Health) Dec 29 - Tests show that certain MRI machines may demagnetize magnets used in cochlear implants to couple external and implanted components, according to a report in the December issue of Otolaryngology--Head and Neck Surgery.
Medscape Today

Age-Related Memory Decline Linked to Increased Glucose Levels

2009-01-03T06:36:00.000-08:00

December 30, 2008 — Memory decline with age appears partly explained by increased blood glucose levels that cause decreased activity in the dentate gyrus, a new study published in the December issue of the Annals of Neurology suggests.

Since blood glucose levels tend to rise with age, this study suggests that improving blood glucose regulation may be a good way to ameliorate age-related memory decline, said Dr. Small.

"Whether through physical exercise, diet, or drugs, this research suggests that improving glucose metabolism could help some people avert the cognitive slide that occurs in many of us as we age," he said.

Their study suggests that moderating blood glucose levels, through physical exercise, diet, or medication, may aid in preventing cognitive decline, he added.

Nevertheless, "the results showed a clear difference in cognitive performance as a function of diet . . . [and] the data suggest that diet can affect more than just weight," Dr. Taylor said in a statement. "The brain needs glucose for energy, and diets low in carbohydrates can be detrimental to learning, memory and thinking."
Medscape Today

A drink only occasionally may reduce the risk of dementia, perhaps because long exposure to low alcohol levels help brain cells survive other stresses

2008-12-31T13:47:00.000-08:00

Judicious Drinking Associated with Reduced Risk of Dementia
MAYWOOD, Ill., Dec. 30 -- Having a drink only occasionally may reduce the risk of dementia, perhaps because long exposure to low alcohol levels help brain cells survive other stresses, researchers here said.
Medscape Today - Full story

Keeping Blood Sugar Low May Help Lessen Memory Loss

2008-12-31T13:41:00.000-08:00

NEW YORK, Dec. 30 -- Lowering blood glucose levels may help lessen the cognitive decline of normal aging, even in diabetes-free patients, researchers here said.
Medscape Today - Full story

FDA Requires Warnings about Risk of Suicidal Thoughts and Behavior for Antiepileptic Medications

2008-12-19T14:58:00.000-08:00

The U.S. Food and Drug Administration today announced it will require the manufacturers of antiepileptic drugs to add to these products' prescribing information, or labeling, a warning that their use increases risk of suicidal thoughts and behaviors (suicidality). The action includes all antiepileptic drugs including those used to treat psychiatric disorders, migraine headaches and other conditions, as well as epilepsy.

The FDA is also requiring the manufacturers to submit for each of these products a Risk Evaluation and Mitigation Strategy, including a Medication Guide for patients. Medication Guides are manufacturer-developed handouts that are given to patients, their families and caregivers when a medicine is dispensed. The guides will contain FDA-approved information about the risks of suicidal thoughts and behaviors associated with the class of antiepileptic medications.

"Patients being treated with antiepileptic drugs for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior,” said Russell Katz, M.D., director of the Division of Neurology Products in the FDA's Center for Drug Evaluation and Research. “ Patients who are currently taking an antiepileptic medicine should not make any treatment changes without talking to their health care professional.”

The FDA today also disseminated information to the public about the risks associated with antiepileptic medications by issuing a public health advisory and an information alert to health care professionals. Health care professionals should notify patients, their families, and caregivers of the potential for an increase in the risk of suicidal thoughts or behaviors so that patients may be closely observed.

The FDA's actions are based on the agency's review of 199 clinical trials of 11 antiepileptic drugs which showed that patients receiving antiepileptic drugs had almost twice the risk of suicidal behavior or thoughts (0.43 percent) compared to patients receiving a placebo (0.24 percent). This difference was about one additional case of suicidal thoughts or behaviors for every 500 patients treated with antiepileptic drugs instead of placebo.

Four of the patients who were randomized to receive one of the antiepileptic drugs committed suicide, whereas none of the patients in the placebo group did. Results were insufficient for any conclusion to be drawn about the drugs' effects on completed suicides. The biological reasons for the increase in the risk for suicidal thoughts and behavior observed in patients being treated with antiepileptic drugs are unknown.

The FDA alerted health care professionals in January 2008 that clinical trials of drugs to treat epilepsy showed increased risk of suicidal thoughts and actions. In July 2008, the FDA held a public meeting to discuss the data with a committee of independent advisors. At that meeting the committee agreed with the FDA's findings that there is an increased risk of suicidality with the analyzed antiepileptic drugs, and that appropriate warnings should extend to the whole class of medications. The panel also considered whether the drugs should be labeled with a boxed warning, the FDA's strongest warning. The advisers recommended against a boxed warning and instead recommended that a warning of a different type be added to the labeling and that a Medication Guide be developed.

Acting under the authorities of the Food and Drug Administration Amendments Act of 2007 (FDAAA), the FDA is requiring manufacturers of antiepileptic drugs to submit to the agency new labeling within 30 days, or provide a reason why they do not believe such labeling changes are necessary. In cases of non-compliance, FDAAA provides strict timelines for resolving the issue and allows the agency to initiate an enforcement action if necessary.

The following antiepileptic drugs are required to add warnings about the risk of suicidality:
Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
Clonazepam (marketed as Klonopin)
Clorazepate (marketed as Tranxene)
Divalproex sodium (marketed as Depakote, Depakote ER)
Ethosuximide (marketed as Zarontin)
Ethotoin (marketed as Peganone)
Felbamate (marketed as Felbatol)
Gabapentin (marketed as Neurontin)
Lamotrigine (marketed as Lamictal)
Lacosamide (marketed as Vimpat)
Levetiracetam (marketed as Keppra)
Mephenytoin (marketed as Mesantoin)
Methosuximide (marketed as Celontin)
Oxcarbazepine (marketed as Trileptal)
Phenytoin (marketed as Dilantin)
Pregabalin (marketed as Lyrica)
Primidone (marketed as Mysoline)
Rufinamide (marketed as Banzel)
Tiagabine (marketed as Gabitril)
Topiramate (marketed as Topamax)
Trimethadione (marketed as Tridione)
Valproic Acid (marketed as Depakene, Stavzor Extended Release Tablets)
Zonisamide (marketed as Zonegran)

Some of these medications are also available as generics.

Health care professionals and consumers may report serious adverse events or product quality problems with the use of this product to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail, fax or phone.

-- Online : http://www.fda.gov/MedWatch/report.htm

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U.S. Food and Drug Administration - FDA News

Radiotherapy Added to Hormone Therapy Boosts Survival in Prostate Cancer

2008-12-17T06:26:00.000-08:00

UMEA, Sweden, Dec. 16 -- Long-term mortality in locally advanced prostate cancer was improved by 50% when external-beam radiation was added to hormone therapy, found researchers here.

At 10 years, prostate specific mortality was 23.9% for those given only hormone therapy versus 11.9% for the combination therapy arm, wrote Anders Widmark, M.D., of Umea University, and colleagues in the Scandinavian Prostate Cancer Group.

The findings derived from evaluable results from 875 men, 439 who received three months of total androgen blockage followed by continuous hormone therapy using flutamide, and 436 who had the same hormone regimen combined with external beam radiation.

Yet Drs. Tan and Parker concluded that the findings represented a pivotal trial that should "change current practice, making long-term hormonal therapy plus radical radiotherapy the standard of care for men with locally advanced prostate cancer."

MedPage Today

Video Games May Improve Cognition in the Older Population

2008-12-12T06:08:00.000-08:00

URBANA, Ill., Dec. 11 -- Older individuals may be able to stem the age-related decline in cognitive function by playing video games, researchers here found.

Nearly two dozen hours of playing a strategic video game over several weeks led to increased performance on four out of six tests of executive function, Arthur Kramer, Ph.D., of the University of Illinois at Urbana-Champaign, and colleagues reported in the December issue of Psychology and Aging.

"Whether similar transfer effects would be observed with video-game-based training to everyday cognition in older adults is a both theoretically as well as practically important question, especially given the rapid expansion of commercial products and computer programs touted to improve the cognitive abilities of older adults," the researchers said.

Previous studies have shown that training individuals in a particular cognitive task can enhance performance on that specific task, the researchers said.

But opinions are mixed on whether training can result in improvements in an array of cognitive skills, they said.

Commercially available computer products that claim to improve cognitive function, he said, tend to "take a more piecemeal approach."

The authors acknowledged that the study was limited by the fact that the control group did not play a video game.

Future studies should evaluate whether the improvements in laboratory-based measurements of cognitive function translate into everyday activities like driving a car or working in a busy office, they said.

MedPage Today

Treating Apnea May Improve Cognition in Alzheimer's Patients

2008-12-05T07:22:00.000-08:00

LA JOLLA, Calif., Dec. 4 -- Alzheimer's patients with coexisting obstructive sleep apnea may derive cognitive benefits from treatment with continuous positive airway pressure (CPAP), investigators here concluded.

CPAP led to significant improvement on a neuropsychological test battery compared to baseline, Sonia Ancoli-Israel, Ph.D., of the University of California San Diego, and colleagues reported in the November issue of the Journal of the American Geriatrics Society.

"Although it is unlikely that obstructive sleep apnea causes dementia, the lowered oxygen levels and sleep fragmentation associated with obstructive sleep apnea might worsen cognitive function," said Dr. Ancoli-Israel. "This study, which showed significant improvement in patients' neurological test scores after treatment with CPAP, suggests that clinicians who treat patients with Alzheimer's disease and sleep apnea should consider implementing CPAP treatment."

Alzheimer's patients have a high prevalence of obstructive sleep apnea. Estimates range from 70% to 80% of patients having at least five episodes of apnea or hypopnea per hour to 40% to 50% having 20 or more episodes per hour.

Some evidence has suggested that more severe dementia is associated with more severe obstructive sleep apnea, they continued.

Studies of CPAP treatment for sleep apnea in patients without dementia have demonstrated improvement in neuropsychological function. Whether CPAP would lead to similar improvement in patients with Alzheimer's disease had not been examined in a randomized, placebo-controlled trial.

After the first three weeks, the two groups did not differ in changes in neuropsychological scores. However, in a paired analysis at six weeks (at which time one group had received six weeks of therapeutic CPAP and the other three weeks), both groups had significant improvement that averaged 0.077 points (P=0.01).

The study was limited by the small sample size, which did not allow for analysis of specific cognitive tests, and by the short duration of the study.

"[Obstructive sleep apnea] may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with Alzheimer's Disease," the authors concluded. "OSA treatment seems to improve cognitive functioning."

Co-author Jody Corey-Bloom, M.D., Ph.D., also of UC San Diego, commented that "any intervention that improves cognition in patients with Alzheimer's disease is likely to result in greater independence and less burden on their caretakers."

A previous report from the same study showed that CPAP significantly reduced daytime sleepiness, a common complaint of Alzheimer's patients, Dr. Corey-Bloom added.

MedPage Today

City Pushes Cooling Therapy for Cardiac Arrest

2008-12-04T06:25:00.000-08:00

Starting on Jan. 1, New York City ambulances will take many cardiac arrest patients only to hospitals that use a delicate cooling therapy believed to reduce the chances of brain damage and increase the chances of survival, even if it means bypassing closer emergency rooms.

The move by the city’s Fire Department and Emergency Medical Service, after a year of preparation, indicates a shift away from the prevailing view among emergency workers and the public that how fast critically ill patients reach the hospital is more important than which hospital treats them.

It amounts to an endorsement by the Bloomberg administration of a labor-intensive, often expensive and still-developing therapy that smaller community hospitals say they lack the staffing and financial wherewithal to provide.

Some hospital officials fear that the policy could be unfair to these smaller hospitals, depriving them of income from emergency-room patients and hurting their reputations with the public.

Since the Fire Department sent letters to hospital chief executives this week informing them of the impending change, about 20 of the 59 hospitals with emergency rooms have said they will have cooling operations ready by the Jan. 1 deadline.

Dr. David J. Prezant, chief medical officer of the New York Fire Department, acknowledged the culture change and the possibility that some hospitals would feel slighted. But he argued that scientific data shows the survival rate of cardiac arrest patients treated with therapeutic hypothermia, as the cooling process is called, is so much better than with conventional treatment that it would be irresponsible not to provide it.

“Theoretically every closest 911-receiving hospital will be able to provide this service,” he noted. “Whether that will be a reality or not is not for me to say.”

New York joins a handful of other American cities, including Seattle, Boston and Miami, as well as Vienna and London, in requiring transport to hospitals with cooling systems. But given New York’s large population and concentration of hospitals, the policy may provide the largest test to date of therapeutic hypothermia.

Most patients who suffer total cardiac arrest outside hospitals die because their brains have been starved of oxygen. But studies show that if the pulse of patients can be restarted and the body temperature cooled to about 8 degrees Fahrenheit below normal, brain damage can be reduced or minimized.

Only those cardiac arrest patients revived enough to show a pulse and whose heart problems are not associated with some other trauma are eligible for the cooling treatment, Dr. Prezant said. In New York City, that represents 1,500 to 2,000 of the about 7,500 out-of-hospital cardiac arrest cases reported each year.

Dr. Prezant said that in deference to hospital finances, the city has set no requirements for the kind of cooling techniques hospitals must use — some may start with inexpensive saline solutions and plastic bags filled with ice, while others employ sophisticated equipment manufactured and aggressively promoted by companies like Alsius, Innercool Therapies and Medivance.

The American Heart Association endorsed cooling for some types of cardiac arrest patients after two studies on its effectiveness were published in The New England Journal of Medicine in 2002. One study found that 55 percent of the patients who received the cooling treatment ended up with moderate or no brain damage, compared with 39 percent who received standard treatment. About 41 percent of the cooled patients died within six months, compared with 55 percent of the others.

But hospitals have been slow to adopt the treatment because it requires a precision of temperature regulation that is difficult to achieve, constant vigilance and cooperation among nursing, emergency, cardiac and neurological units.

The research has shown that cooling is effective for cardiac arrest from ventricular fibrillation, in which the heart muscle wriggles ineffectively.

If a pulse can be restarted quickly enough — within a matter of minutes — with a defibrillator, such patients can walk away relatively unscathed. But if not, they become comatose and suffer a cascading series of cellular-level injuries to the brain, which frequently lead to permanent brain damage or death.

Inducing moderate cooling of the body within 6 hours, for 24 hours, followed by gradual warming, slows cerebral metabolism and seems to reduce such injuries, studies have shown. (The technique’s effectiveness on other medical problems, including traumatic brain injury, is more controversial.)

“It was a very slow process in terms of really getting it to take hold,” Dr. Mayer said of the cooling treatment. “One reason is that cardiac arrest patients have just been surrounded by this shroud of therapeutic nihilism. They come in after cardiac arrest, they’re intubated, in a coma, everybody’s reflex thought process in terms of caregivers is ‘Oh God, there’s nothing you can do for these people.’ ”

He said that his main motivation was not financial but experiential, and that he had been converted by seeing patients who were comatose and given up for dead recover full or near-full function after hypothermia.

The New York Times

Safeguarding your sight

2008-12-02T13:57:00.000-08:00

Although aging puts people at greater risk for serious eye disease and other eye problems, loss of sight need not go hand in hand with growing older. Practical, preventive measures can help protect against devastating impairment. An estimated 40% to 50% of all blindness can be avoided or treated, mainly through regular visits to a vision specialist.

Regular eye exams are the cornerstone of visual health as people age. Individuals who have a family history of eye disease or other risk factors should have more frequent exams. Don’t wait until your vision deteriorates to have an eye exam. One eye can often compensate for the other while an eye condition progresses. Frequently, only an exam can detect eye disease in its earliest stages.

You can take other steps on your own. First, if you smoke, stop. Smoking increases the risk of several eye disorders, including age-related macular degeneration. Next, take a look at your diet. Maintaining a nutritious diet, with lots of fruits and vegetables and minimal saturated fats and hydrogenated oils, promotes sound health and may boost your resistance to eye disease. Wearing sunglasses and hats is important for people of any age. Taking the time to learn about the aging eye and recognizing risks and symptoms can alert you to the warning signs of vision problems.

Although eyestrain, spending many hours in front of a television or computer screen, or working in poor light do not cause harmful medical conditions, they can tire the eyes and, ultimately, their owner (see below). The eyes are priceless and deserve to be treated with care and respect — and that is as true for the adult of 80 as it is for the teenager of 18.

5 common eye myths dispelled

Myth: Doing eye exercises will delay the need for glasses.

Fact: Eye exercises will not improve or preserve vision or reduce the need for glasses. Your vision depends on many factors, including the shape of your eye and the health of the eye tissues, none of which can be significantly altered with eye exercises.
Myth: Reading in dim light will worsen your vision.

Fact: Although dim lighting will not adversely affect your eyesight, it will tire your eyes out more quickly. The best way to position a reading light is to have it shine directly onto the page, not over your shoulder. A desk lamp with an opaque shade pointing directly at the reading material is the best possible arrangement. A light that shines over your shoulder will cause a glare, making it more difficult to see the reading material.
Myth: Eating carrots is good for the eyes.

Fact: There is some truth in this one. Carrots, which contain vitamin A, are one of several vegetables that are good for the eyes. But fresh fruits and dark green leafy vegetables, which contain more antioxidant vitamins such as C and E, are even better. Antioxidant vitamins may help protect the eyes against cataract and age-related macular degeneration. But eating any vegetables or supplements containing these vitamins or substances will not prevent or correct basic vision problems such as nearsightedness or farsightedness.
Myth: It’s best not to wear glasses all the time. Taking a break from glasses or contact lenses allows your eyes to rest.

Fact: If you need glasses for distance or reading, use them. Attempting to read without reading glasses will simply strain your eyes and tire them out. Using your glasses won’t worsen your vision or lead to any eye disease.
Myth: Staring at a computer screen all day is bad for the eyes.

Fact: Although using a computer will not harm your eyes, staring at a computer screen all day will contribute to eyestrain or tired eyes. Adjust lighting so that it does not create a glare or harsh reflection on the screen. Also, when you’re working on a computer or doing other close work such as reading or needlepoint, it’s a good idea to rest your eyes briefly every hour or so to lessen eye fatigue. Finally, people who stare at a computer screen for long periods tend not to blink as often as usual, which can cause the eyes to feel dry and uncomfortable. Make a conscious effort to blink regularly so that the eyes stay well lubricated and do not dry out.

FEATURED CONTENT:

How the eye works
The eye examination
Cataract
Glaucoma
Age-related macular
degeneration (AMD)

Diabetic retinopathy
Other common eye diseases of later life
Presbyopia: Ready for reading glasses?
Safeguarding your sight

Harvard Health Publications

Harvard Medical School

RSNA: Exercise May Prevent Loss of Small Blood Vessels in the Brain

2008-12-02T05:52:00.000-08:00

CHICAGO, Dec. 1 -- Older adults who exercise regularly may have increased cerebral blood flow and a greater number of small blood vessels in the brain, researchers here said.

This could be the mechanism by which exercise prevents cognitive decline in the elderly, Feraz Rahman, M.S., a medical student at Jefferson Medical College in Philadelphia, told attendees at the Radiological Society of North America meeting.

"Aerobic exercise improves cognitive function … and counteracts the effects of aging on the brain," Rahman said. "That may be due to blood flow and vasculature."

Previous research has shown that exercise reverses small vessel disease elsewhere in the body, and increases brain volume and cognitive function in the elderly.

Rahman concluded that the findings of this study show that "exercise is a vital part of healthy aging and might slow the loss of small vessels."

MedPage Today

More Men Take the Lead Role in Caring for Elderly Parents

2008-12-01T06:08:00.000-08:00

When Peter Nicholson’s mother suffered a series of strokes last winter, he did something women have done for generations: he quit his job and moved into her West Hollywood home to care for her full time.

Mr. Nicholson, 53, is part of a growing number of men who are providing primary care for their aging parents, usually their mothers.

The Alzheimer’s Association and the National Alliance for Caregiving estimate that men make up nearly 40 percent of family care providers now, up from 19 percent in a 1996 study by the Alzheimer’s Association. About 17 million men are caring for an adult.

“It used to be that when men said, ‘I’ll always take care of my mother,’ it meant, ‘My wife will always take care of my mother,’ ” said Carol Levine, director of the families and health care project at the United Hospital Fund. “But now, more and more men are doing it.”

Often they are overshadowed by their female counterparts and faced with employers, friends, support organizations and sometimes even parents who view caregiving as an essentially female role. Male caregivers are more likely to say they feel unprepared for the role and become socially isolated, and less likely to ask for help.

Women still provide the bulk of family care, especially intimate tasks like bathing and dressing. At support groups, which are predominantly made up of women, many women complain that their brothers are treated like heroes just for showing up.

But with smaller families and more women working full-time, many men have no choice but to take on roles that would have been alien to their fathers. Just as fatherhood became more hands-on in the baby boom generation, so has the role for many sons as their generation’s parents age.

And then there is the inevitable question: What happens when I have to bathe her?

“That’s where the rubber meets the road,” said Donna Wagner, the director of gerontology at Towson University and one of the few researchers who has studied sons as caregivers.

Though he is not squeamish about it, he said: “The weirdness permeates our relationship. She doesn’t know if I’m her husband or her boyfriend or her neighbor. She knows she trusts me. But there are times when it’s very difficult. I need to keep her from embarrassing herself. She’ll say things like, ‘I adore you.’ I don’t know who she’s loving, because she doesn’t know who I am. Maybe I’m embarrassed about it — it’s my mom, for Christ sakes. But it’s weird how the oldest son becomes the spouse.”

On a recent evening, Mr. Kassin visited his mother, Doris Golden, in her Manhattan apartment. Ms. Golden, 82, is in the early stages of Alzheimer’s and still lives independently, but relies on Mr. Kassin to arrange her schedule, pay her bills and make sure she remembers her daily tasks (his sister also helps).

In past generations, men might have answered this question by pointing to their accomplishments as breadwinners or fathers. Now, some men say they worry about the conflict between caring for their parents and these other roles.

In a 2003 study at three Fortune 500 companies, Dr. Wagner found that men were less likely to use employee-assistance programs for caregivers because they feared it would be held against them.

“Even though the company has endorsed the program, your supervisors may have a different opinion,” Dr. Wagner said. “I had a man who worked for a large company with very generous benefits, and he was told that if he took more time to go with his dad to chemotherapy, he was at risk of losing his job. He ended up not going with his father.”

Mr. Kassin said that although his employer had been understanding, he was reluctant to talk about his caregiving because “I think it would be looked at like, when they hire a male, they expect him to be 100-percent focused.”

“Nursing homes have a very difficult time dealing with male caregivers,” Ms. Torres said. “It’s unusual for them. The male caregiver is made to feel their interest in their relative is inappropriate. Our male callers say they’re made to feel what they’re doing is unusual, that it’s wrong.”

She gave the example of a son who was the health care agent for his mother and wanted to be in the room when the staff changed her diaper because he was concerned about her skin condition. “The staff refused to allow it,” Ms. Torres said. “They said the mother’s dignity was at risk.”

After two weeks of pressing, she said, he finally got his way. With a daughter, this would not have been an issue, Ms. Torres said.

And even when they are acknowledged, for many male caregivers, as for women, there is the lingering sense that whatever they do is not enough.

“I don’t know if this is just the musings of someone who’s on the verge of tossing everything and putting her in a home,” he said. “But this is a very revealing journey about who I am to me and my family, and what’s important to me.”

The New York Times

Helping the disabled or elderly walk with care

2008-11-25T17:54:00.000-08:00

A new Israeli device the ReWalk -- worn like an exoskeleton and maneuvered with crutches -- promises to give mobility to paraplegics. The company developing it, Argo Medical Technologies, has made news that has circled the globe.

Hot on its heels is Walk-Care. Inspired by the late Christopher Reeve's visit to Israel in 2003, Walk-Care's two founders, a gemologist and an aeronautics engineer, have paired up to revolutionize the "transportation" market for the disabled.

But really, their primary motive, says CEO Jacob Gabel is to change the lives of people with motor movement disabilities, and to do it at a cost most people can afford. "We spent two years talking to rehabilitation center specialists around Israel asking them for a wish-list -- what they would like in such a device for their patients," Gabel, the engineer, and a retired Israeli Air Force colonel tells ISRAEL21c. "

Without daily exercise, muscle mass withers away, circulation slows down and a whole set of new complications arise, such as osteoporosis and bedsores, which can lead to infection and death.

Walk with tears of joy

One success story is a woman who recently tried out the Walk-Care prototype, still heavily guarded until funding is secured to take the device from prototype stage to market. The 42-year-old woman hadn't used her legs for 30 years. "With Walk-Care, she was walking on her own feet again," says Gabel. There were lots of tears.

One of the big failures of other devices, he points out, is the embarrassment factor. With high rates of failure, it's far too common for a disabled person, especially the more severe ones, to topple over when using an assisted walking device.

Rehab doctors "go ballistic" over new device

Not ready to release images, Gabel says that top rehabilitation doctors in Israel have tried it out, exclaiming that it's a dream come true. "They went to the machine and used it on themselves and they went ballistic," says Gabel.

For the price of a small car -- about $15,000 -- the Walk-Care device comes highly customizable, meaning it can be operated with buttons, voice commands, or even with a blow straw, depending on the disability. It can even ride over uneven and bumpy surfaces such as grass.

The user literally walks on his own feet, and this is the whole point," says Gabel, emphasizing the importance of moving the legs for circulation and health. It's also essential, he tells ISRAEL21c, that the disabled get the opportunity to interact in this world on the same level as fully mobile people. Both for peace of mind and for building a life others take for granted.

ISRAEL 21c

Study Suggests Some Cancers May Go Away

2008-11-25T17:52:00.000-08:00

Cancer researchers have known for years that it was possible in rare cases for some cancers to go away on their own. There were occasional instances of melanomas and kidney cancers that just vanished. And neuroblastoma, a very rare childhood tumor, can go away without treatment.
The New York Times

Statins May Lower Odds of Pneumonia Death

2008-11-25T17:50:00.000-08:00

Danish researchers have found that statins, the drugs widely used to control cholesterol, may have another beneficial effect: lowering the risk of death from pneumonia.
The New York Times

Longevity Linked to Heart Disease Protection

2008-11-25T17:49:00.000-08:00

Older adults whose parents lived 100 years or longer are healthier than others their age and have dramatically lower risks of heart attack, stroke, diabetes or dying from any other cause, researchers at the Boston University School of Medicine report in a new study.
The New York Times

Diabetes Drug Linked to Higher Mortality in Medicare Patients

2008-11-25T17:47:00.000-08:00

Medicare patients started on a thiazolidinedione for diabetes had a higher mortality rate and were more likely to develop congestive heart failure if given rosiglitazone (Avandia) than pioglitazone (Actos), researchers here reported.
MedPage Today

Podcast: Tips for slowing the mental decline of Alzheimer's

2008-11-18T12:22:00.000-08:00

Medical expert: Glenn Smith, Ph.D.
Total time: 0:07:52 minutes

TheMayoClinic.com - Podcast

A Longer, Better Life

2008-11-16T13:07:00.000-08:00

Author Sara Davidson talks to two medical scientists about how the body ages and the research on trying to extend our healthy life span.
The New York Times - Magazine - Video interview

Four Signs of Early Alzheimer’s Disease

2008-11-14T07:34:00.000-08:00

This morning’s WSJ tells the story of Brian Kammerer who developed Alzheimer’s in his 40s, and the toll the illness takes on him and his family.

Early on, the CFO for a hedge fund forgets what a stapler is and calls his wife from the bathroom for help identifying it. He winds up unemployed. He stops driving.

Even now, at 51, his math skills remain sharp, but he has trouble recognizing neighbors he has known for two decades. Sometimes, he takes a cab to a nearby golf course without telling anyone and hitches a ride back from a stranger, says his wife, Kathy.

Some half a million Americans are living with early-onset Alzheimer’s, the WSJ says. An explainer from the federal Agency for Health Research and Quality gives some signs that go beyond basic loss of short-term memory:

Problems finding or saying the right word.
Inability to recognize objects.
Forgetting how to use simple, ordinary things, such as a pencil.
Forgetting to turn off the stove, close windows, or lock doors.

Now, just because you have occasional lapses — forgetting a name, leaving a window open — it doesn’t mean you have Alzheimer’s.

And, AHRQ reminds us, many cases of dementia aren’t Alzheimer’s. Often, they’re caused by factors that can be modified, such as depression, alcohol, or medication.

WSJ reporter Shirley Wang talks with Kathy Kammerer about the warning signs for her husband’s Alzheimer’s in this podcast.

The Wall Street Journal

When Alzheimer's Hits at 40

2008-11-14T07:15:00.000-08:00

Early-Onset Sufferers Juggle Children, Job and Dementia

Brian Kammerer, the 45-year-old chief financial officer of a small hedge fund, called his wife one day from a cellphone in the men's room of his Manhattan office building. A colleague had just asked him for something, he whispered, but he had no idea what it was.

"It clicks and it holds papers together," he said.

"A stapler?" Kathy Kammerer asked.

"I think that's what it's called," he replied.

Soon after that exchange in early 2003, the father of three was diagnosed with Alzheimer's disease, capping nearly five years of uncertainty and fear about his increasing forgetfulness and difficulty with language.

While most people who get Alzheimer's are over 65, Mr. Kammerer is one of about 500,000 Americans living with Alzheimer's or other dementias at an atypically young age. Alzheimer's takes a long time to develop -- usually, it isn't diagnosed until 10 years after the first symptoms appear -- but more Americans are identifying it early, thanks in part to aggressive screening programs pushed in recent years by groups including the Alzheimer's Foundation of America, a national alliance of caregivers.

The disease can be especially torturous when it creeps up on those in their 30s and 40s. As these patients move through Alzheimer's early stages, they are forced to cope with the dread of not knowing what is happening to them, often in the years when they're raising young children and building financial security. As the disease progresses, there are slip-ups to cover, appearances to keep up. When these "early onset" Alzheimer's sufferers are finally diagnosed, they face hard questions -- whom to tell and when, and what these divulgences mean for their jobs and health insurance.

There are no Alzheimer's cures now on the market. Current medications mitigate some symptoms but don't slow or halt the disease's progression. Pharmaceutical companies are working on new therapies that reduce or remove amyloid, a sticky substance in the brain thought to play a role in the disease. There are more medicines in development for Alzheimer's than any other neurologic disease except pain, according to Pharmaceutical Research and Manufacturers of America, the industry trade group. It will likely be years before a new generation of drugs makes it to market.

Now 51 years old, Mr. Kammerer, like many Alzheimer's patients, had no history of the disease in his family. He grew up on the north shore of Long Island, where he stood out at school for his talent with numbers. After attending college at the State University of New York-Albany, he got a job on Wall Street.

The Wall Street Journal

Zen and the Art of Coping With Alzheimer's

2008-11-13T11:27:00.000-08:00

In Brief:

The number of Alzheimer's patients is expected to increase dramatically in coming years, straining the health care system.

Scientists have not discovered the cause nor devised effective treatments. Even diagnosis is difficult.

In the absence of therapies, attention has turned to teaching the skills necessary to cope with demented patients.

Increasingly caregivers are encouraged to validate the feelings and perceptions of the person with Alzheimer's.

During the YouTube forum with the Democratic presidential candidates in July, the first question about health care came from two middle-age brothers in Iowa, who faced the camera with their elderly mother. Not everybody with Alzheimer’s disease has two loving sons to take care of them, they said, adding that a boom in dementia is expected in the next few decades.

“What are you prepared to do to fight this disease now?” they asked.

The politicians mouthed generalities about health care, larded with poignant anecdotes. None of them answered the question about Alzheimer’s.

Science hasn’t done much better. There is no cure for Alzheimer’s and no way to prevent it. Scientists haven’t even stopped arguing about whether the gunk that builds up in the Alzheimer’s brain is a cause or an effect of the disease. Alzheimer’s is roaring down — a train wreck to come — on societies all over the world.

People in this country spend more than a $1 billion a year on prescription drugs marketed to treat it, but for most patients the pills have only marginal effects, if any, on symptoms and do nothing to stop the underlying disease process that eats away at the brain. Pressed for answers, most researchers say no breakthrough is around the corner, and it could easily be a decade or more before anything comes along that makes a real difference for patients.

Drug companies are placing big bets on Alzheimer’s. Wyeth, for instance, has 23 separate projects aimed at developing new treatments. Hundreds of theories are under study at other companies large and small. Why not? People with Alzheimer’s and their families are so desperate that they will buy any drug that offers even a shred of hope, and many will keep using the drug even if the symptoms don’t get better, because they can easily be convinced that the patient would be even worse off without it.

The advice is painfully and ironically reminiscent of the 1960s and ’70s, the literal and figurative high point for many of the people who are now coping with demented parents. The theme is, essentially, go with the flow. People with Alzheimer’s aren’t being stubborn or nasty on purpose; they can’t help it. Arguing and correcting will not only not help, but they will ratchet up the hostility level and make things worse. The person with dementia has been transported into a strange, confusing new world and the best other people can do is to try to imagine the view from there and get with the program.

If a patient asks for her mother, for instance, instead of pointing out that her mother has been dead for 40 years, it is better to say something like, “I wish your mother were here, too,” and then maybe redirect the conversation to something else, like what’s for lunch.

If Dad wants to polish off the duck sauce in a Chinese restaurant like it’s a bowl of soup, why not? If Grandma wants to help out by washing the dishes but makes a mess of it, leave her to it and just rewash them later when she’s not looking. Pull out old family pictures to give the patient something to talk about. Learn the art of fragmented, irrational conversation and follow the patient’s lead instead of trying to control the dialogue.

Basically, just tango on. And hope somebody will do the same for you when your time comes. Unless the big breakthrough happens first.

The New York Times

Painkiller Risk Found for Heart Patients

2008-11-12T18:58:00.000-08:00

Heart attack and heart failure patients have a higher risk of a second heart attack or death if they take painkillers, including the generic drug ibuprofen and Celebrex, made by Pfizer, a Danish study has found.

Patients who had suffered a heart attack and were taking Vioxx, a painkiller that has been withdrawn from the market, had 2.7 times the risk of having another heart attack or dying compared with patients not taking painkillers, according to research presented Tuesday at the American Heart Association meeting in New Orleans. Patients taking Celebrex had double the risk; patients taking the generic diclofenac had 1.9 times the risk, and those taking ibuprofen had 1.3 times the risk, the study found.

Based on the findings, doctors should avoid prescribing nonsteroidal anti-inflammatory drugs for these patients, or give them at low doses, a researcher said.

Also Tuesday, researchers said that the risk of heart attacks and strokes for heart-stent patients taking the anti-clotting drug Plavix increased if they also took anti-ulcer medicines like Nexium.

Doctors implant about two million stents a year and often prescribe blood thinners like Plavix, made by Bristol-Myers Squibb and Sanofi-Aventis, to avoid clots. But the drugs raise the risk of stomach bleeding, so they also prescribe Nexium, made by AstraZeneca, or a rival drug in a group known as proton pump inhibitors. About a third of these patients suffered complications within a year, the study said.

The New York Times

Riken researchers make brain tissues from stem cells

2008-11-07T10:09:00.000-08:00

Japanese researchers said Thursday they had created functioning human brain tissues from stem cells, a world first that has raised new hopes for the treatment of disease. Stem cells taken from human embryos have been used to form tissues of the cerebral cortex, the supreme control tower of the brain, according to researchers at the government-backed research institute Riken.

The research was led by Yoshiki Sasai at Riken Center for Development Biology in Kobe.

The tissues self-organized into four distinct zones very similar to the structure seen in human fetuses, and conducted neuro-activity such as transmitting electrical signals, the institute said.

Research on stem cells is seen as having the potential to save lives by helping to find cures for diseases such as cancer and diabetes or to replace damaged cells, tissues and organs.

The team’s previous studies showed stem cells differentiated into distinct cells but until now they had never organized into functioning tissues.

“In regenerative therapy, only a limited number of diseases can be cured with simple cell transplants. Transplanting tissues could raise hopes for greater functional recovery,” the institute said in a statement.

“Cultivated tissues are still insufficient and too small to be used to treat stroke patients. But study of in-vitro cultivation of more mature cortex tissues, such as those with six zones like in the adult human brain, will be stepped up,” it said.

The tissues could also serve as “a mini organ” for use in studying the cause of the Alzheimer’s disease and developing vaccines, it said.

Embryonic stem cells are harvested by destroying a viable embryo, a process that some people find unacceptable.

Riken said cortex tissues were also obtained from “induced pluripotent stem cells,” which are similar to embryonic stem cells but artificially induced, typically from adult cells such as skin cells. The cultivated tissues look like miniature mushrooms two millimeters in diameter.

The team also succeeded in making cortex tissues from the embryonic stem cells of mice. Using mouse tissues, scientists confirmed they had formed a network of neurons that properly respond to stimulus.

The tissues can also be selectively induced to different cortex types controlling memories, visual sensation and other tasks.

The findings of the study were published in the Nov 6 online journal Cell Stem Cell in the United States.

Japan Today

Poor Night Vision Portends Progression of Age-Related Macular Degeneration

2008-11-05T08:39:00.000-08:00

PHILADELPHIA, Nov. 4 -- For patients with early age-related macular degeneration, impaired night vision is a risk factor for progression to advanced disease, researchers here found.

The worst scores on an assessment of night vision were significantly associated with a drop in visual acuity and development of choroidal neovascularization and geographic atrophy through follow-up of at least five years, Gui-shuang Ying, Ph.D., of the University of Pennsylvania here, and colleagues reported in the November issue of Ophthalmology.

The associations remained significant after adjusting for baseline participant and ocular characteristics and established risk factors.

"Because of the ease of ascertainment compared with testing dark adaptation or rod sensitivity," the researchers said, "assessing night vision symptoms may be useful in identifying patients with early or intermediate age-related macular degeneration who are at a relatively high risk of progression."

"These results are consistent with the biological and psychological findings that rod photoreceptor degeneration precedes cone degeneration in early age-related macular degeneration, and that rod dysfunction may contribute to the later degeneration of cones because of their interdependence," the researchers said.

The results also implied that different pathophysiological processes resulted in choroidal neovascularization and geographic atrophy because of differences in their associations with night vision symptoms, they said.

In addition to providing independent predictive information about the progression of disease, the researchers said, measuring night vision symptoms may help identify patients for use in clinical trials evaluating agents for the prevention of geographic atrophy.

"Including only patients with night vision symptoms, and therefore higher risk of progression and loss of vision," they said, "would be one way to decrease the risk-benefit ratio in these clinical trials and to decrease the total sample size or follow-up period required to attain a specific amount of statistical power."

MEDPAGE TODAY

Older Patients Better Off When Choosing Their Own Care

2008-11-05T08:35:00.000-08:00

NEW HAVEN, Conn., Nov. 4 -- Patients 65 and older may fare better when they are brought into the decision-making of complex treatment trade-offs, researchers here said.

When patients with multiple medical conditions weighed outcomes of treatment options against one another, they typically preferred those that would achieve the outcome they most desired, Terri Fried, M.D., of Yale, and colleagues reported in the October issue of the Journal of the American Geriatrics Society.

"Prioritizing across all outcomes can help clarify what is most important to seniors who are faced with complex healthcare decisions," Dr. Fried said.

About 65% of older Medicare beneficiaries have at least two chronic conditions, and 24% have four or more, the researchers said. These patients often face complex care decisions when the treatment for one condition could worsen another -- which the researchers call "competing outcomes."

For example, if a patient with high blood pressure, heart disease, and osteoarthritis finds that the hypertension medication causes leg cramps that preclude the pool exercises needed to keep the arthritis symptoms in check, the patient may elect to stop taking it.

"I have high cholesterol," one participant said. "I took something but … I had such pain in my calf, so I was taken off whatever that was. I think [my cholesterol] is 241, and I'm willing to live with that."

Many participants initially thought of outcomes in terms of disease-specific goals, such as prevention of a stroke or heart attack. But during the discussions, they changed their focus to more global outcomes, such as quality of life, the researchers said.

For example, some participants, when debating taking a medication that would increase their risk of heart attack in order to treat pain, defined thresholds of decreased function at which they would become willing to take on a greater risk of cardiovascular mortality.

"When participants thought about outcomes in these global terms, they were able to weigh these more general outcomes against one another, in order to reflect on what was most important to them," the researchers wrote.

The researchers said that asking patients to prioritize their desired outcomes would enable physicians to subsequently determine a course of care that would most likely meet their priorities.

They said their study can only be used to "understand how older persons with coexisting conditions think about their illnesses and interventions and not to draw conclusions about their knowledge or perceptions."

However, they said, their findings suggest that asking older patients "to prioritize a set of global outcomes that can be applied across a spectrum of specific diseases may be one easily understood approach to eliciting values in a manner that can inform a range of healthcare decisions."

MEDPAGE TODAY

Medical decision-making capacity in mild cognitive impairment

2008-11-03T20:19:00.000-08:00

A 3-year longitudinal study

Objective: To investigate longitudinal change in the medical decision-making capacity (MDC) of patients with amnestic mild cognitive impairment (MCI) under different consent standards.

NEUROLOGY 2008;71:1474-1480

Survival in Alzheimer disease:

2008-11-03T20:13:00.000-08:00

A multiethnic, population-based study of incident cases

Objective: To describe factors associated with survival in Alzheimer disease (AD) in a multiethnic, population-based longitudinal study.

NEUROLOGY 2008;71:1489-1495

Geographical differences in the occurrence of Alzheimer's disease mortality: United States versus puerto rico.

2008-10-30T16:08:00.000-07:00

Here, the age-adjusted Alzheimer's disease mortality rate in Puerto Rico and United States from 1999 to 2004 was analyzed...

PubMed - Am J Alzheimers Dis Other Demen. 2008 Oct-Nov;23(5):462-9.

CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

Sex Hormone Binding Globulin and Aging.

2008-10-30T16:01:00.000-07:00

This review will discuss the possibility that sex hormone binding globulin (SHBG) plays an active role in the aging process.

PubMed - Horm Metab Res. 2008 Oct 27. [Epub ahead of print]
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

The usefulness of cube copying for evaluating treatment of Alzheimer's disease.

2008-10-30T15:59:00.000-07:00

Aims: Cube copying measures visuospatial ability, which is often impaired in Alzheimer's disease (AD). Cube copying was examined as an evaluation of cholinesterase inhibitor (ChEI) treatment in AD.

PubMed - Am J Alzheimers Dis Other Demen. 2008 Oct-Nov;23(5):439-46
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

Social compatibility as a consideration in caring for nursing home residents with dementia.

2008-10-30T15:57:00.000-07:00

This article describes a model of dementia care in which individual care needs are addressed and the social environment is valued as an essential element in care considerations.

PubMed - Am J Alzheimers Dis Other Demen. 2008 Oct-Nov;23(5):430-8.
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

Diagnosis and Treatment of Depression Comorbid with Neurologic Disorders.

2008-10-30T15:44:00.000-07:00

Depression is common in patients with neurologic disorders such as Alzheimer disease, stroke, Parkinson disease, and multiple sclerosis. Diagnosing depression in the context of neurologic disease is challenging, given the overlap between many signs and symptoms of depression with those of the neurologic disorders.

PubMed - Am J Med. 2008 Nov;121(11S2):S28-S37.
CLICK HERE TO READ THE FULL ABSTRACT & LINKS TO RELATED ARTICLES

10 Things to Know About Assisted Living

2008-10-28T05:39:00.000-07:00

Dr. Cheryl Woodson, you may recall from last week’s post, is a seasoned geriatrician in Chicago Heights, Ill., who has found that she can no longer afford to accept new Medicare patients.

Here’s some of Dr. Woodson’s advice on navigating the caregiving maze, which I culled both from her book, “To Survive Caregiving,” and from observing her during a recent day-long visit to her office.

1. Assisted living, a popular solution for elderly people who cannot live independently, is a “myth,” Dr. Woodson said, “a place for people who don’t exist.” Families often believe these facilities will meet all of their loved ones’ needs, enabling caregivers to focus on jobs and family, only to find this isn’t the case.

2. Squaring a family’s expectations with those legal limits would require a thorough, first-hand assessment of the elderly person’s physical and cognitive health before admission to an assisted living facility. That rarely happens. New residents are admitted based on a report from their current physicians, who may not be qualified to diagnose the early signs of dementia and impending immobility or may sugarcoat the situation in order to help a desperate family.

3. Instead, without verifying the physician’s report or the family’s representations, these facilities may admit residents who already need help with simple tasks like dressing or eating, or will in the very near future, and then charge extra for these services.

4. Coordinating all the services that the assisted living facility doesn’t provide generally falls to one sibling, Dr. Woodson noted, who then becomes overwhelmed, sacrificing more than should be expected. The solution is hiring a geriatric care manager — “They should be called rent-a-daughters,” Dr. Woodson said — adding further to the expense, until the resident and family can no longer afford this kind of accommodation and are forced to consider a nursing home.

5. Most families balk at the prospect of transferring an aging parent to a nursing home because they like the aesthetics of assisted living — the carpeted floors, overstuffed chairs and crystal chandeliers.

6. The doctors who see residents at assisted living facilities are essentially freelancers, not employees, since their fees are paid by Medicare and they also may maintain private practices. So rather than hang around the facility expecting them to answer your questions on the fly, Dr. Woodson suggested calling and arranging to see them “by appointment, not by ambush.”

7. If a parent lives in an assisted living facility, families should closely monitor the monthly pharmacy bill, less for cost than for content. Is Xanax being prescribed for anxiety? There are numerous other remedies available without the potentially dangerous side effects. What about muscle relaxants for arthritic pain? They increase confusion in the elderly and add to the risk of falls; instead, ask for pain medication and/or a heating pad. If the assisted living facility offers to have prescriptions filled and delivered by a local pharmacy — a huge convenience for family members — be sure it’s a pharmacy that insists upon periodic blood work or other tests for drugs that are supposed to be closely monitored.

8. The goal of medical care for the elderly, in Dr. Woodson’s view and the view of every geriatrician I’ve ever interviewed, is to make day-to-day life more comfortable, not to cure illness or extend longevity.

9. Apply similar standards to immunizations and vaccinations. If someone is so ill or disabled that death would be welcome, refuse the vaccine for pneumonia, long known as “the old person’s friend.” But never say no to the shingles vaccine, which can prevent an excruciating rash. “Even if someone was only going to live five more minutes, that’s the one thing I’d suggest,” Dr. Woodson says. “It’s a quality-of-life issue.”

10. Do not assume that the presenting symptom of Alzheimer’s disease will be forgetting words, losing things or other obvious examples of short-term memory loss. Often the first thing a family member will notice is an empty checking account, Dr. Woodson said, because a normally cautious and frugal person has been tricked by a get-rich-quick scheme or other scam. And like missing money, look out for pills missing from those seven-day dispensers that help people with multiple medications keep track of what they’re taking and when.

The New York Times
CLICK HERE TO READ THE FULL ARTICLE

Assisted Living Care: ‘Uneven and Often Problematic’

2008-10-28T05:32:00.000-07:00

Many of you take exception to the notion, expressed here last week by Dr. Cheryl Woodson, that assisted living is a “myth” that promises more than it can deliver to the frail elderly and their families. Interestingly, Dr. Woodson’s provocative observation is echoed in a study and an editorial in the current issue of the Journal of the American Medical Directors Association, both of which suggest that the medical needs of many current assisted-living residents exceed what these facilities can provide and that consumers are not adequately warned of these limitations.

Dr. Matthew K. McNabney, a geriatrician and assistant professor of medicine at Johns Hopkins University, and his fellow researchers reviewed the medical charts of 198 residents at 22 assisted living facilities in central Maryland, then interviewed those residents, their family members and the facility staff. They found that 46 percent of the residents had chronic conditions in three or more broad disease categories, such as those affecting the cardiovascular, pulmonary or endocrine systems. In addition, 25 percent had two or more specific diagnoses, such as congestive heart failure, osteoporosis or Parkinson’s disease, covered by clinical guidelines in use at long-term care facilities.

“As with nursing homes, many assisted living facilities perform admirably,” he wrote in the editorial. “However, overall performance across the country is uneven and often problematic. The public is still not getting a balanced picture of the variability, capabilities and limitations of assisted living. The AL propaganda machine often makes it difficult to engage in a meaningful discussion about reality. Instead, it often shouts down such discourse with the usual platitudes.”

“What almost certainly is needed in the long term,” Dr. McNabney added, “is not pretty decorations, but the capacity and commitment to care for people as their needs progress.”

There are two models of long-term care that experts say more realistically acknowledge the inevitability of decline and dependence among the elderly: CCRCs, or continuing care retirement communities, which require large up-front expenditures as well as high monthly fees; and PACE, an acronym for “program of all-inclusive care for the elderly,” a joint venture of Medicare and Medicaid that operates 42 programs in 22 states and serves low-income clients. We’ll be talking more about them in the future.

The New York Times

CLICK HERE TO READ THE FULL ARTICLE

Effect of cortisol levels on working memory performance in elderly subjects with Alzheimer's disease.

2008-10-26T15:10:00.000-07:00

BACKGROUND: Subjects with Alzheimer's disease (AD) have elevated cortisol levels as a result of hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Acute administration of hydrocortisone has been associated with working memory (WM) performance in young adults.

PubMed - Arq Neuropsiquiatr. 2008;66(3b):619-624.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Disclosure of the diagnosis of Alzheimer's disease: caregivers' opinions in a Brazilian sample.

2008-10-26T15:05:00.000-07:00

BACKGROUND: Disclosure of the diagnosis of Alzheimer's disease (AD) remains a contentious issue, and has been little studied in developing countries.

PubMed - Arq Neuropsiquiatr. 2008;66(3b):625-630.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Effectiveness of a psychoeducational intervention program in the reduction of caregiver burden in alzheimer's disease patients' caregivers.

2008-10-26T15:02:00.000-07:00

This study evaluated the benefits of a Psychoeducational Intervention Program (PIP) on caregiver burden in southern Europe.

PubMed - Int J Geriatr Psychiatry. 2008 Oct 23. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Relevance of transgenic mouse models to human Alzheimer disease.

2008-10-26T14:29:00.000-07:00

This review discusses the utility of transgenic mice as a research tool and their contributions to our understanding of Alzheimer disease.

PubMed - J Biol Chem. 2008 Oct 22. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

The Promise and Perils of an Alzheimer Disease Vaccine: A Video Debate.

2008-10-24T17:29:00.000-07:00

This video article takes the form of a debate between Dr. Morgan and Dr. Landreth on the merits and drawbacks of an Alzheimer's disease vaccine. Click on Supplemental Material to watch the streaming video.

PubMed - J Neuroimmune Pharmacol. 2008 Oct 23. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Patient Dependence and Longitudinal Changes in Costs of Care in Alzheimer's Disease.

2008-10-24T17:24:00.000-07:00

Background/Aims: To examine the incremental effect of patients' dependence on others, on cost of medical and nonmedical care, and on informal caregiving hours over time.

PubMed - Dement Geriatr Cogn Disord. 2008 Oct 22;26(5):416-423. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

[Alzheimer vaccine]

2008-10-24T17:21:00.000-07:00

Autopsy cases who had received Abeta vaccine showed clearance of senile plaques, and beneficial effect was shown in patients who had high antibody titers to amyloid plaques. Thus, vaccination is widely accepted as promising therapy for Alzheimer disease.

PubMed - Nippon Rinsho. 2008 Oct;66(10):2008-12.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Biomarker discovery in neurodegenerative diseases: A proteomic approach.

2008-10-24T17:18:00.000-07:00

In this review we have summarized current proteomics technologies involved in discovery of biomarkers for neurodegenerative diseases, practical considerations and limitations of several major aspects, as well as the current status of candidate biomarkers revealed by proteomics for Alzheimer and Parkinson disease.

PMID: 18938247 [PubMed - as supplied by publisher]
PubMed - Neurobiol Dis. 2008 Sep 26. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

White-coat effect among older patients with suspected cognitive impairment: prevalence and clinical implications.

2008-10-24T17:14:00.000-07:00

OBJECTIVES: To evaluate the prevalence of white-coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients evaluated for suspected cognitive impairment.

PMID: 18937278 [PubMed - as supplied by publisher]
PubMed - Int J Geriatr Psychiatry. 2008 Oct 20. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

The Influences of Gender and Religiousness on Alzheimer Disease Caregivers"" Use of Informal Support and Formal Services.

2008-10-24T17:11:00.000-07:00

OBJECTIVE: This study explored how male and female family caregivers of Alzheimer's disease (AD) patients differ in their use of formal services and informal support and how religiousness may affect such differences.

PMID: 18936242 [PubMed - as supplied by publisher]
PubMed - J Aging Health. 2008 Oct 20. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Lithium reduces Gsk3b mRNA levels: implications for Alzheimer Disease.

2008-10-24T17:07:00.000-07:00

BACKGROUND: There is evidence of increased systemic expression of active GSK3B in Alzheimer's disease patients, which apparently is associated with the formation of senile plaques and neurofibrillary tangles.

PMID: 18932008 [PubMed - as supplied by publisher]
PubMed - Eur Arch Psychiatry Clin Neurosci. 2008 Oct 17. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Cognitive Performance and Plasma Levels of Homocysteine, Vitamin B(12), Folate and Lipids in Patients with Alzheimer Disease.

2008-10-24T17:04:00.000-07:00

The objective of this study was to determine the relationship between cognitive performance and plasma levels of tHcy and its biological determinants folate and vitamin B(12), and lipids in clinically diagnosed AD patients.

PMID: 18931498 [PubMed - as supplied by publisher]
PubMed - Dement Geriatr Cogn Disord. 2008 Oct 16;26(4):384-390. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Improper Sexual Behaviors in Elders with Dementia Living in Residential Care.

2008-10-24T17:01:00.000-07:00

Objectives: There exists little information describing the spectrum and correlations of sexual behaviors manifested by elders with dementia living in residential care.

PMID: 18931496 [PubMed - as supplied by publisher]
PubMed - Dement Geriatr Cogn Disord. 2008 Oct 16;26(4):370-377. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Statins are associated with a reduced risk of Alzheimer disease regardless of lipophilicity. The Rotterdam Study.

2008-10-24T16:58:00.000-07:00

BACKGROUND: Cross-sectional reports suggest that statin-users are less likely to have Alzheimer disease (AD). Prospective studies have provided inconsistent evidence.

PubMed - J Neurol Neurosurg Psychiatry. 2008 Oct 17. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Drug therapy in Alzheimer disease: an update for the oral health care provider.

2008-10-24T16:55:00.000-07:00

This article provides an update of the available drug therapies for AD and discusses their implications on the oral and dental health of patients.

PubMed - Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Oct;106(4):467-76
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Acetylcholinesterase inhibitors as disease-modifying therapies for Alzheimer's disease.

2008-10-24T16:49:00.000-07:00

This review will focus also on particular classes of AChEIs, namely dual binding site AChEIs, which are being purposely designed to target Abeta aggregation and / or other biological targets that contribute to AD pathogenesis, thus constituting very promising disease-modifying anti-Alzheimer drug candidates.

PubMed - Curr Med Chem. 2008;15(24):2433-55.
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Alzheimer’s disease awareness stamp now available

2008-10-22T16:04:00.000-07:00

According to the Alzheimer’s Association’s 2008 Alzheimer’s Disease Facts and Figures, an estimated 5.2 million Americans are living with Alzheimer’s and this number is expected to grow to 16 million by midcentury. With an aging baby boomer population, this degenerative brain disease will continue to touch more lives. More funding for research and more supportive services for those living with Alzheimer’s disease begins with greater overall public awareness. The Alzheimer’s Association commends the U.S. Postal Service because this new stamp is a tremendous step in that education effort.

Alzheimer’s doesn’t just impact the individual; it impacts entire families. Today, there are nearly 10 million people providing 8.4 billion hours of unpaid care to someone with Alzheimer’s or another dementia valued at $89 billion. By including Alzheimer’s disease in its long tradition of highlighting health and social issues through its awareness stamp program, the Postal Service continues to illuminate the challenges of those with the disease and their caregivers as well.

The Alzheimer’s Association list 10 warning signs of Alzheimer’s disease:

• Memory loss

• Problems with language

• Poor decreased judgment

• Misplacing things

• Changes in personality

• Difficulty performing familiar tasks

• Disorientation to time and place

• Problems with abstract thinking

• Changes in mood or behavior

• Loss of initiative

For more information or to buy the Alzheimer Awareness 42-cent commemorative stamp:
visit http://shop.usps.com/
click on "Stamps"
click on "42-Cent First-Class"

Alzheimer's Association (http://www.alz.org/)

CLICK HERE TO READ THE FULL ARTICLE & LINKS TO RELATED INFORMATION

More Alzheimer’s Risk for Hispanics, Studies Find

2008-10-21T10:55:00.000-07:00

PHILADELPHIA — Antonio Vasquez was just 60 when Alzheimer’s disease derailed him.

He lost his job at a Queens bakery because he kept burning chocolate chip cookies, forgetting he had put them in the oven. Then he got lost going to job interviews, walking his neighborhood in circles.

Teresa Mojica of Philadelphia was 59 when she got Alzheimer’s, making her so argumentative and delusional that she sometimes hits her husband. And Ida J. Lawrence was 57 when she started misplacing things and making mistakes in her Boston dental school job.

Slide Show

Besides being young Alzheimer’s patients — most Americans who develop it are at least 65, and it becomes more common among people in their 70s or 80s — the three are Hispanic, a group that Alzheimer’s doctors are increasingly concerned about, and not just because it is the country’s largest, fastest-growing minority.

Studies suggest that many Hispanics may have more risk factors for developing dementia than other groups, and a significant number appear to be getting Alzheimer’s earlier. And surveys indicate that Latinos, less likely to see doctors because of financial and language barriers, more often mistake dementia symptoms for normal aging, delaying diagnosis.

“This is the tip of the iceberg of a huge public health challenge,” said Yanira L. Cruz, president of the National Hispanic Council on Aging. “We really need to do more research in this population to really understand why is it that we’re developing these conditions much earlier.”

It is not that Hispanics are more genetically predisposed to Alzheimer’s, say experts, who say the diversity of ethnicities that make up Hispanics or Latinos make a genetic explanation unlikely.

Rather, experts say several factors, many linked to low income or cultural dislocation, may put Hispanics at greater risk for dementia, including higher rates of diabetes, obesity, cardiovascular disease, stroke and possibly hypertension.

The New York Times
CLICK HERE TO READ THE FULL ARTICLE

Education and Employment May Offer Alzheimer's Protection

2008-10-21T06:49:00.000-07:00

MedPage TodayMILAN, Oct. 20 -- More education and mentally challenging employment appear to protect against the cognitive impairment of Alzheimer's disease, researchers here said.

The findings appear to confirm the so-called "brain reserve hypothesis," which suggests that high intelligence, education, and an active lifestyle are associated with a reserve capacity that protects the brain against the effects of aging and disease, according to Valentina Garibotto, M.D., of the Italian National Institute of Neuroscience, and colleagues.

But it remains unclear whether the reserve is a genetic endowment that also leads to higher education and employment or whether such mental challenges create the reserve, Dr. Garibotto and colleagues said in the Oct. 21 issue of Neurology.

"The theory is that education and demanding jobs create a buffer against the effects of dementia on the brain, or a cognitive reserve," Dr. Garibotto said.

For people with such a history, "their brains are able to compensate for the damage and allow them to maintain functioning in spite of damage," she said.

Indeed, in the study, people with more education and more demanding jobs tended to have more brain damage for a given level of impairment -- indicating, the researchers said, that they cope better with the disease than their less educated counterparts.

On the other hand, among the probable Alzheimer's patients, higher educational level was associated -- for the same level of clinical impairment -- with lower blood glucose in the right temporo-parietal association cortex and the precuneus. The association was significant at P<0.01.>

There are two possible explanations of the findings, Dr. Garibotto said.

"The brain could be made stronger through education and occupational challenges," she said, "or genetic factors that enabled people to achieve higher education and occupational achievement might determine the amount of brain reserve."

But, she added, it isn't possible yet to say which explanation holds true.

MedPage Today

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Heterogeneity of white matter hyperintensities in Alzheimer's disease: post-mortem quantitative MRI and neuropathology.

2008-10-19T16:02:00.000-07:00

White matter hyperintensities (WMH) are frequently seen on T(2)-weighted MRI scans of elderly subjects with and without Alzheimer's disease.

Brain. 2008 Oct 16. [Epub ahead of print]
CLICK HERE TO READ FULL ABSTRACT & LINKS TO RELATED INFORMATION

Hyperphosphorylation of microtubule-associated protein tau: a promising therapeutic target for Alzheimer disease.

2008-10-19T15:58:00.000-07:00

Acetylcholinesterase inhibitors as disease-modifying therapies for Alzheimer's disease.

2008-10-19T15:54:00.000-07:00

Laboratori de Química Farmacèutica (Unitat Associada al CSIC), Facultat de Farmàcia, Universitat de Barcelona, Av.

The therapeutic arsenal for the treatment of Alzheimer's disease (AD) remains confined to a group of four inhibitors of AChE and one NMDA receptor antagonist, which are used to provide a relief of the very late symptoms of the dementia, i.e. the cognitive and functional decline.....

This review will focus also on particular classes of AChEIs, namely dual binding site AChEIs, which are being purposely designed to target Abeta aggregation and / or other biological targets that contribute to AD pathogenesis, thus constituting very promising disease-modifying anti-Alzheimer drug candidates.

PMID: 18855672 [PubMed - in process]
Curr Med Chem. 2008;15(24):2433-55
CLICK HERE TO READ THE FULL ABSTRACT & RELATED INFORMATION

Neuropsychiatric symptoms in dementia: Importance and treatment considerations.

2008-10-19T15:50:00.000-07:00

Wolfson Centre for Age-Related Diseases, Guy's Campus, King's College London.

Neuropsychiatric symptoms are frequent in people with dementia, result in distress for the people experiencing them and their caregivers, and are a common precipitant of institutional care. The safe and effective treatment of these symptoms is a key clinical priority, but is a long way from being achieved. Psychological interventions are recommended as the first line treatment strategy in most good practice guidelines, and there is emerging evidence of efficacy for agitation and depression.

PMID: 18925489 [PubMed - in process]
Int Rev Psychiatry. 2008 Aug;20(4):396-404.
CLICK HERE TO READ THE FULL ABSTRACT & RELATED INFORMATION

Alzheimer's Disease Not Susceptible to B Vitamins

2008-10-18T20:28:00.000-07:00

SAN DIEGO, Oct. 14 -- High-dose vitamin B supplements reduced homocysteine levels but did not slow Alzheimer's disease progression, researchers here found in a large placebo-controlled trial.

After 18 months of treatment, patients taking high doses of vitamins B6 and B12 as well as folic acid showed the same degree of cognitive decline compared with baseline as those assigned to placebo, reported Paul Aisen, M.D., of the University of California San Diego, and colleagues in the Oct. 15 issue of the Journal of the American Medical Association.

Participants in the vitamin group also showed a significantly higher frequency of depressive symptoms, seen in 27.9% compared with 17.8% of the placebo group (P=0.02). Blurred vision and hyperhidrosis also appeared more common with vitamin supplements, but the differences missed statistical significance (P=0.7 and 0.53, respectively).

"Our study does not support the treatment of individuals with mild to moderate Alzheimer's disease and normal vitamin levels with B vitamin supplements," Dr. Aisen and colleagues concluded.

The study was prompted by earlier findings that blood homocysteine levels are elevated in patients with Alzheimer's disease and that B vitamin supplements can lower homocysteine levels.

But there was not even a hint that vitamin supplements slowed participants' cognitive decline by any measure used in the study:

--Alzheimer Disease Assessment Scale cognition scores increased 6.54 points (SD 8.17) in the placebo group after 18 months, compared with 7.38 points (SD 9.72) in the vitamin supplement group.

--Mini-Mental State Exam scores decreased 3.08 points (SD 4.46) in the placebo group versus 2.65 points (SD 4.56) with supplements.

--Clinical Dementia Rating scores increased 2.51 points (SD 2.57) with placebo compared with 2.58 points (SD 2.45) in the supplement group.

--Activities of daily living scores on the Alzheimer Disease Cooperative Study index decreased 10.00 points (SD 11.09) with placebo versus 10.96 points (SD 12.36) with supplements.

Dr. Aisen and colleagues stopped short of ruling out any benefit from vitamin B supplements for anyone.

"Randomized studies in individuals without dementia have yielded conflicting results; supplementation may be useful in older individuals with relatively high homocysteine levels," they wrote. "The identification of groups that may benefit from such treatment remains an important goal."

They said it was possible that supplements might be more effective if begun while cognition is still intact. "Individuals with established cognitive impairment may be refractory to treatment," Drs. Clarke and Bennett suggested.

But until future research identifies populations or circumstances in which supplements are beneficial, "there is insufficient evidence to justify routine use of homocysteine-lowering vitamin supplements for the prevention of Alzheimer disease and cognitive decline among individuals with normal vitamin status," they said.

MedPage Today
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Acetylcholinesterase inhibitors as disease-modifying therapies for Alzheimer's disease.

2008-10-16T20:38:00.000-07:00

Laboratori de Química Farmacèutica (Unitat Associada al CSIC), Facultat de Farmàcia, and Institut de Biomedicina (IBUB), Universitat de Barcelona, Av. Diagonal 643, E-08028-Barcelona, Spain.

The therapeutic arsenal for the treatment of Alzheimer's disease (AD) remains confined to a group of four inhibitors of AChE and one NMDA receptor antagonist, which are used to provide a relief of the very late symptoms of the dementia, i.e. the cognitive and functional decline.

This review will focus also on particular classes of AChEIs, namely dual binding site AChEIs, which are being purposely designed to target Abeta aggregation and / or other biological targets that contribute to AD pathogenesis, thus constituting very promising disease-modifying anti-Alzheimer drug candidates.

PMID: 18855672 [PubMed - in process]
PubMed
Curr Med Chem. 2008;15(24):2433-55.
CLICK HERE TO READ FULL ABSTRACT

Hyperphosphorylation of microtubule-associated protein tau: a promising therapeutic target for Alzheimer disease.

2008-10-16T20:35:00.000-07:00

Department of Neurochemistry, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, New York, USA.

Alzheimer disease (AD) is the most common cause of dementia in adults. The current therapy for AD has only moderate efficacy in controlling symptoms, and it does not cure the disease. Recent studies have suggested that abnormal hyperphosphorylation of tau in the brain plays a vital role in the molecular pathogenesis of AD and in neurodegeneration. This article reviews the current advances in understanding of tau protein, regulation of tau phosphorylation, and the role of its abnormal hyperphosphorylation in neurofibrillary degeneration. Furthermore, several therapeutic strategies for treating AD on the basis of the important role of tau hyperphosphorylation in the pathogenesis of the disease are described. These strategies include (1) inhibition of glycogen synthase kinase-3beta (GSK-3beta), cyclin-dependent kinase 5 (cdk5), and other tau kinases; (2) restoration of PP2A activity; and (3) targeting tau O-GlcNAcylation. Development of drugs on the basis of these strategies is likely to lead to disease-modifying therapies for AD.

PMID: 18855662 [PubMed - in process]
PubMed
Curr Med Chem. 2008;15(23):2321-8.
CLICK HERE TO READ FULL ABSTRACT

[Dementive patients' caregivers--psychological aspect of their needs]

2008-10-16T20:31:00.000-07:00

Przychodnia Chorób Zawodowych Wsi, Instytut Medycyny Wsi, 20-950 Lublin, ul. Jaczewskiego 2.

Patients with dementia, especially with dementia in the course of Alzheimer's disease require long-time care. The aim of the research was to assess how caregivers deal with everyday care problems, especially the psychical and social ones. The study was conducted in 1999 by the method of anonymous inquiry in the group of 42 caregivers, mostly members of Lublin's Alzheimer Association. The caregivers are children (53.6%) or spouses of patients (39.8%). In 61% of cases patient lives with the carer's family. 72% of our respondents consider their work as very hard. The care takes them seven days a week, 77% of carers have no possibility of rest. Almost half of respondents (47%) constantly feel depressed and tired. 15% claim that they hardly cope with nursing. 39% of caregivers have the feeling of deep, internal exhaustion.

PMID: 18853662 [PubMed - in process]
PubMed
Przegl Lek. 2008;65(6):304-7
CLICK HERE TO READ FULL ABSTRACT

Prevalence of vitamin d insufficiency in patients with Parkinson disease and Alzheimer disease.

2008-10-16T20:27:00.000-07:00

Department of Neurology, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329, USA. mevatt@emory.edu

BACKGROUND: A role for vitamin D deficiency in Parkinson disease (PD) has recently been proposed.

CONCLUSIONS: This report of 25(OH)D concentrations in a predominantly white PD cohort demonstrates a significantly higher prevalence of hypovitaminosis in PD vs both healthy controls and patients with AD. These data support a possible role of vitamin D insufficiency in PD. Further studies are needed to determine the factors contributing to these differences and elucidate the potential role of vitamin D in pathogenesis and clinical course of PD.

PMID: 18852350 [PubMed - in process]
Arch Neurol. 2008 Oct;65(10):1348-52.
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High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial.

2008-10-16T20:25:00.000-07:00

Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr, M/C 0949, La Jolla, CA 92093, USA. paisen@ucsd.edu

CONTEXT: Blood levels of homocysteine may be increased in Alzheimer disease (AD) and hyperhomocysteinemia may contribute to disease pathophysiology by vascular and direct neurotoxic mechanisms. Even in the absence of vitamin deficiency, homocysteine levels can be reduced by administration of high-dose supplements of folic acid and vitamins B(6) and B(12). Prior studies of B vitamins to reduce homocysteine in AD have not had sufficient size or duration to assess their effect on cognitive decline.

CONCLUSION: This regimen of high-dose B vitamin supplements does not slow cognitive decline in individuals with mild to moderate AD.

PubMed
JAMA. 2008 Oct 15;300(15):1774-83.
CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Single brain cell can reactivate paralysed limbs: study

2008-10-15T13:47:00.001-07:00

One tiny brain cell is all it takes to restore voluntary movement of paralysed muscles, scientists in the United States reported Wednesday.

In experiments pointing to new treatments for paralysis caused by spinal cord injury or stroke, monkeys learned within minutes to harness the power of a single neuron to activate muscles immobilised by drugs.

There are some 100 billion neurons in the human brain, and the study suggests an unsuspected degree of flexibility in the kinds of tasks they can perform.

"Nearly every neuron we tested could be used to control this type of stimulation," Chet Moritz, lead author and a researcher at the University of Washington, told journalists in a conference call.

If a monkey can do it, a human should be able to do it even better, he said.

Clinical trials, however, are at least several years away, perhaps longer, Moritz added.

Spinal cord injuries cripple hundreds of thousands of people worldwide every year, rendering the simplest of actions -- opening a door, scratching an itch, drinking a glass of water -- frustratingly difficult, or simply impossible.

Those afflicted with the most severe form of paralysis, known as lock-in syndrome, are fully conscious prisoners inside a body that no longer responds to commands.

While the brain activity that would normally result in a voluntary movement is still present, the instructions simply don't reach the muscles.

Moritz and two colleagues at the University of Washington found a way to bypass the kind of nerve damage that can result in such paralysis.

They first connected electrodes to individual neurons inside the motor cortex of monkey's brain and recorded the electrical activity.

These signals were then routed in real-time to a computer, and from there through a stimulator to another set of electrodes attached directly to wrist muscles that had been artificially blocked further up the arm along the normal neural pathway.

Because little processing power is needed, the computer is the size of a cell phone, and can be attached to the animal's body.

Future versions will be wireless and small enough to implant directly in the body, the researchers said.

The monkey had already mastered a simple video game, grasping targets shown on a video screen with a control device manipulated by a single hand.

"But once he was paralysed, the only way to move his wrist was to change the activity of individual neurons in his brain," Moritz explained.

On average it took about 10 minutes for the monkeys to "train" the neuron well enough to play the video game again.

"The brain can very rapidly learn to control new cells and use them to generate movements," said co-author Eberhard Fetz.

Earlier experiments enabling monkeys to manipulate prosthetic devices or computer cursors using only electrical impulses coming from the brain were based on a fundamentally different premise, according to the new study.

"They tried to read the mind of the money and figure out what he was planning to do," a technique that required massive computing power, said Moritz.

"Our approach is to recreate the raw connectivity between single neurons in the brain and muscles, and let the monkey's nervous system learn how to use that connectivity."

This is also the first study to show that a one neuron can control a muscle -- and possibly a whole group of muscles.

Electrodes connected to a single location in the spinal cord below an injury may be able to activate 10 or 15 muscles that are already precisely balanced for, say, grasping a coffee mug or walking, the researchers said.

And if a stroke has damaged the motor cortex, patients might be able to commandeer other brain cells that do not usually play a role in controlling muscles.

Several obstacles remain, however, before this new technique can be tested in humans, he said.

To avoid infections, the system would have to become fully implantable so that no wires passed through the skin. And electrodes would need to be made more stable so that they could record the activity of neurons over a period of years, rather than weeks.

Breitbart.com

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EEG functional connectivity and ApoE genotype in Alzheimer's disease and controls.

2008-10-14T20:58:00.000-07:00

Department of Neurology, Alzheimer Centre, VU University Medical Center, PO Box 7057, De Boelelaan 1118, 1007 MB Amsterdam, Noord Holland, The Netherlands; Department of Clinical Neurophysiology, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.

OBJECTIVE: We examined the relation between Apolipoprotein E epsilon4 allele (ApoE epsilon4) genotype and functional connectivity measured by Electroencephalography (EEG) in patients with Alzheimer's disease (AD) and patients with subjective complaints (SC).

SIGNIFICANCE: The observed increase in SL in both AD and patients with SC carrying ApoE epsilon4 suggests a strong genetic impact of ApoE epsilon4 on brain function.

PMID: 18848805 [PubMed - as supplied by publisher]
Clin Neurophysiol. 2008 Oct 9. [Epub ahead of print]

CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Intelligent Assistive Technology Applications to Dementia Care: Current Capabilities, Limitations, and Future Challenges.

2008-10-14T20:50:00.000-07:00

From the Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic (AJB, MAD, CFR); and Carnegie Mellon University (VA, JF, SS, HW), Pittsburgh, PA.

The number of older Americans afflicted by Alzheimer disease and related dementias will triple to 13 million persons by 2050, thus greatly increasing healthcare needs. An approach to this emerging crisis is the development and deployment of intelligent assistive technologies that compensate for the specific physical and cognitive deficits of older adults with dementia, and thereby also reduce caregiver burden.

PMID: 18849532 [PubMed - as supplied by publisher]
Am J Geriatr Psychiatry. 2008 Oct 10. [Epub ahead of print]

CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Chronic Psychosocial Stress Exacerbates Impairment of Cognition and Long-Term Potentiation in beta-Amyloid Rat Model of Alzheimer's Disease.

2008-10-14T20:45:00.000-07:00

Department of Pharmacological and Pharmaceutical SciencesCollege of Pharmacy, University of Houston, Houston, Texas.

BACKGROUND: Alzheimer's disease (AD) is a degenerative disorder that leads to progressive cognitive decline. Alzheimer's disease develops as a result of over-production and aggregation of beta-amyloid (Abeta) peptides in the brain. The reason for variation in the gravity of symptoms among AD patients is unknown and might result from patient-related factors including lifestyle. Individuals suffering from chronic stress are at an increased risk for developing AD. This study investigated the effect of chronic psychosocial stress in Abeta rat model of AD.

CONCLUSIONS: Chronic stress significantly intensified Abeta-induced deficits of short-term memory and E-LTP by a mechanism involving decreased CaMKII activation along with increased calcineurin levels.

PMID: 18849021 [PubMed - as supplied by publisher]
Biol Psychiatry. 2008 Oct 10. [Epub ahead of print]

CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Aluminum bioavailability from tea infusion.

2008-10-14T20:35:00.000-07:00

Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky Academic Medical Center, 511C Pharmacy Building, 725 Rose Street, Lexington, KY 40536-0082, USA; Graduate Center for Toxicology, University of Kentucky Academic Medical Center, Lexington, KY 40536-0305, USA.

The objective was to estimate oral Al bioavailability from tea infusion in the rat, using the tracer (26)Al. (26)Al citrate was injected into tea leaves.

Further testing of the hypothesis that Al contributes to Alzheimer's disease may be more warranted with studies focusing on total average daily food intake, including tea and other foods containing appreciable Al, than drinking water.

PMID: 18848597 [PubMed - as supplied by publisher]
Food Chem Toxicol. 2008 Sep 21. [Epub ahead of print]

CLICK HERE TO READ FULL ABSTRACT & RELATED INFORMATION

Is the glass half empty or half full?: Genetically determined disease in frontotemporal dementia

2008-10-14T13:52:00.000-07:00

Genetic studies are a critical source of knowledge about neurodegenerative diseases. The identification of families with an autosomal dominant pattern of inheritance has proven crucial in improving our care of patients with conditions such as Alzheimer disease (AD) and Parkinson disease. This work has led to improvements in diagnostic accuracy, a better understanding of the biologic mechanisms underlying disease, and most importantly, the identification of targets for therapeutic intervention. Recently, genetic studies of patients with frontotemporal dementia (FTD) have proven to be very fruitful. Two distinct, genetically determined causes have been defined in the last decade. These include the locus of the gene coding for the microtubule-associated protein tau (MAPT) on chromosome 17,1 and within the last 2 years, the gene coding for progranulin (GRN), also on chromosome 17.2,3

Despite these remarkable advances, the glass remains half empty. Why? There is substantial reason to be optimistic about our ability to identify the cause of FTD in up to 27% of patients with an autosomal dominant family history. However, the cause of disease remains a mystery in 73% of patients with FTD. Many pieces of the puzzle remain to be found. Very few studies have pursued interacting genetic factors, for example, and even fewer studies have examined environmental risk factors for FTD and more complex interactions between genetics and the environment. Much biomarker work is needed to identify the histopathologic abnormalities during life of patients with sporadic FTD who show accumulations of the same aberrant proteins at autopsy. This would allow treatments developed for familial FTD to be administered safely and confidently to patients with similar sporadic diseases.

The report of Seelaar et al. provides us with an important yardstick indicating our remarkable success in identifying the cause of FTD in an impressively large percentage of these patients. They also point us in informative directions for future work that can identify the cause of disease in some additional familial patients with FTD. Before breaking out the champagne, however, we should consider the large amount of work that remains before we can improve the care of all patients with FTD.

Neurology-Volume 71(16), 14 October 2008, pp 1216-1217
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Alzheimer's treatments: What's on the horizon?

2008-10-14T13:38:00.000-07:00

Despite many promising leads, new treatments for Alzheimer's are slow to emerge. Future treatments will likely focus on stopping the disease in people at risk.

Alzheimer's treatments consist mainly of medications that stabilize cognitive function, if only for a short period of time. These drugs stage a holding action, primarily postponing further cognitive declines.

But the Alzheimer's treatments of the future will focus more on preventing the disease or halting its progress in its earliest stages. The following treatment options are among the strategies currently being studied.

Alzheimer's vaccine

Immunization can reduce the number of amyloid plaques — clusters of abnormal cells associated with Alzheimer's disease — in the brain. But a human trial of an Alzheimer's vaccine was halted when several participants developed brain inflammation.

Secretase modulators

Secretase-modifying drugs might block the action of the clumping enzymes, or activate the nonclumping enzyme.

Certain anti-inflammatory drugs — including ibuprofen (Advil, Motrin, others), naproxen sodium (Aleve) and indomethacin (Indocin) — appear to modify how one of these enzymes works, so that it doesn't produce fragments that clump. One of the most promising drugs being studied in this group is tarenflurbil (Flurizan).

Antibiotics

A three-month course of antibiotics, specifically doxycycline and rifampin, reduced the rate at which cognitive problems worsened in a group of people who had mild to moderate Alzheimer's disease. The antibiotics appear to interfere with the development of amyloid plaques in the brain.

Hormones

Early studies indicated that hormone replacement therapy, typically prescribed to ease menopausal symptoms, might protect women over the age of 65 against Alzheimer's. But more recent studies not only refute these findings but also suggest that this hormone therapy might even increase the risk of dementia.

In men, low testosterone levels have been linked to increased risk of Alzheimer's disease. Researchers are investigating whether testosterone supplements might help men who have Alzheimer's or are at risk of the disease, but the results have been mixed.

Timeline for answers

New Alzheimer's treatments take time to develop, and then even more studies are needed to establish a treatment's safety and effectiveness. But all this time and effort will eventually pay off. Most researchers expect to see major progress in the treatment and prevention of Alzheimer's in the next few decades.

MayoClinic.com
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Alzheimer’s offspring confront their own risk

2008-10-13T08:38:00.000-07:00

Heredity, genetics make disease more likely, but how much isn't clear

For adult children of patients with Alzheimer’s disease, the diagnosis can be devastating — and not just because of what it means for their parents.

Along with concerns about caregiving and grief over the loss of the mother or father they knew, there’s another, more private fear: What if I get it, too?

“I think about it all the time,” said Julie Winokur, 44, a videographer from Montclair, N.J., who chronicled her father’s decline into dementia and its effects on her family. “It’s a terrifying thing to me.”

But even as scientists say they may be getting closer to predicting who may develop the mind-robbing disorder, thanks to new research into biomarkers, heredity and genetics, many children of people who suffer or died from the disease say they wouldn’t want to know.

“My feeling is I’d only want to know if there’s something I can do about it,” said Winokur.

Right now, that’s not the case, Alzheimer’s experts concede. There’s virtually no known cause, no cure and no prevention for the disease that causes memory loss and mental deterioration and affects some 5.2 million people in the U.S. and some 27 million people worldwide.

“I don’t know of anything that has been documented to prevent the onset of this disease,” said Dr. Thomas Bird, a neurologist and Alzheimer's disease researcher at the University of Washington in Seattle. “The advice you get is the advice you’d give to anybody to live a good, healthy lifestyle: Watch your weight, watch your blood pressure, eat a balanced diet.”

Recommendations for ways to predict the disease are even more vague. Perhaps 5 percent of Alzheimer’s cases are caused by a rare genetic mutation responsible for early onset of the disorder that usually strikes after 65. For the rest, scientists have proposed analyzing everything from blood, saliva, skin cells, urine and brain scans to detect early signs of the disorder, with no irrefutable results.

Even the most reliable marker of risk, the apolipoprotein E-e4 gene, known as ApoE4, doesn’t determine for sure whether a person will develop Alzheimer’s. Many people with the gene do get the disease, but many don’t, prompting most experts to advise against screening, Bird said.

That leaves offspring of one or both parents with dementia in limbo, focusing on doing anything they can to stave off Alzheimer’s, even when there’s no clear agreement on what that might be. That can range from working crossword puzzles and gulping antioxidants to engaging in new forms of physical exercise, techniques suggested — but not proven — to prevent the disease.

“We’re being much more vigilant about our exercise,” said Karen Moldt, 54, of the oldest of five siblings in Cary, N.C., who were “shell-shocked” when their father was diagnosed with Alzheimer’s four years ago. “One of my brothers who is right-handed started doing things with his left hand.”

Genetics, heredity boost risk

Still, recent research into genetics and heredity suggests that children like Winokur and Moldt have reason to worry.

Just this summer, Dr. Piero Antuono and a team of scientists at the Medical College of Wisconsin reported that healthy offspring of Alzheimer’s patients who carry the ApoE4 gene show declines in brain function that are detectable long before any clinical symptoms appear.

And last spring, Bird and a team of researchers at the University of Washington revealed that children with two parents who have Alzheimer’s disease are far more likely to get the disease themselves.

In the study of 111 families in which two parents were diagnosed with Alzheimer’s, more than 22 percent of the adult children also developed the disease. That compares to about 13 percent expected in the general population, according to the national Alzheimer's Association. The risk rose with age, affecting 30 percent of children older than 60 and nearly 42 percent of those older than 70.

“I pretty much though that my odds of getting it had to be higher than anybody walking down the street,” said Gayle Dorman, 63, of Tacoma, Wash., a study participant who lost both parents to Alzheimer’s a decade ago.

Increasingly, families like Dorman’s are confronting what neurologist Dr. Daniel I. Kaufer calls the “double-parent dementia dilemma.”

“The way I convey this to children is that it’s a double whammy,” said Kaufer, who directs the Memory and Cognitive Disorders program at the University of North Carolina School of Medicine. “They have the burden of care and the burden of risk.”

‘Oh my god, I hope this doesn't happen to me’
Coping with that burden isn’t easy for family members confronting their own future, said Dr. Zoe Lewis, a palliative care specialist and author of a new book, “I Hope They Know: The Essential Handbook on Alzheimer’s Disease and Care.”

“It is literally the collective fear of anyone, anywhere: Oh my god, I hope this doesn’t happen to me,” Lewis said.

As patients watch their parents spiral downward, often over several years or even decades, they can't help but wonder whether that's the fate they face.

"The fear is that you'll lose your mind and you won't be treated well," Lewis explained.

That fear permeates daily life, making children vigilant for signs of dementia, said Dorman. “For me, it’s pretty scary when I forget where I parked my car. I think, ‘Here it is, here I go.’”

Winokur said she quizzes herself constantly, testing to see whether she remembers people’s names and what they were wearing.

Many children of parents with dementia say they’ve considered confirming their risk by being screened for the ApoE4 gene — and then rejected the idea. “Right now, I don’t know if I’d want to know,” Dorman said.

Others, however, think the information could be valuable. “You could just plan better. If you have a ticking time bomb, you’d want to know, wouldn’t you?” said Mike Sanchez, 37, of Santa Ana, Calif. His 82-year-old father has had Alzheimer’s disease for more than a decade.

Most children of dementia patients are able to put their fear in perspective, said Bird, the University of Washington researcher whose own mother died of Alzheimer's disease.

"I know that I'm at risk for it. Everybody who gets older is at risk. My risk is higher than average," he said. "But I don't feel there's anything more than I could do than I do to prevent it. I don't worry about a disease that I can't prevent."

But at least one son of an Alzheimer’s patient had his worry confirmed in the worst way: By developing signs of the disease himself.

“Within the last nine months, when I try to think of a word, I draw a blank. I’ll know I’m looking for a word and can’t find it,” said Francis, a 59-year-old mechanical engineer from South Carolina who watched his mother succumb to the disease.

He asked to be identified only by his middle name because he hasn’t told his children or his employer that he likely has early-onset Alzheimer’s disease. He has begun taking donepezil, popularly known as Aracept, one of a handful of drugs aimed at slowing cognitive decline.

Francis is clear that he does not want his wife and grown children burdened by his disease. He said he wouldn’t think of asking them to care for him at home if the disease gets worse.

“If it happens to me, I will probably divorce my wife, become indigent and let the government take care of me,” he said.

That’s a stark contrast to Winokur, who said the care she provided keeping her father at home should serve as a model for her children.

“I would really pray that by example, that’s just something you can expect,” she said. “I would definitely want to stay at home. I fulfilled what I would want.”

Researchers like Antuono, who also lost his mother to Alzheimer's, expect to have a reliable treatment for Alzheimer's within a decade.

"In 10 years we'll have an intervention that willl compress the first symptoms of the disease all the way to end," he said, noting that it likely will make the disease a chronic condition, but will not cure the disorder. "A cure to get rid of this altogether? That might be left to the next generation."

NAMS: Estrogen Cream Eases Vaginitis with No Endometrial Safety Signals

2008-09-30T06:39:00.000-07:00

ORLANDO, Sept. 27 -- Moderate to severe atrophic vaginitis can be eased for postmenopausal women by either of two low doses of estrogen cream, with no endometrial safety signals, investigators reported here.

Both low-dose regimens of the conjugated estrogen cream led to significant improvement in vaginal maturation index, vaginal pH, and most bothersome symptoms compared with placebo, Gloria Bachmann, M.D., of Robert Wood Johnson Medical School in New Brunswick, N.J., said at the North American Menopause Society meeting.

The improvement was statistically significant at 12 weeks and persisted during follow-up for a year.

In a subgroup of patients who had endometrial biopsies, no cases of endometrial hyperplasia or carcinoma occurred with either estrogen cream regimen.

"Low-dose [vaginal estrogen cream] represents an important therapy for treating atrophic vaginitis without endometrial safety concerns over a one-year study period," Dr. Bachmann and colleagues concluded.

As many as 40% of postmenopausal women are affected by atrophic vaginitis. Vaginal application of topical low-dose estrogens is thought to reduce systemic exposure to estrogen and limit its stimulatory effects on the endometrium, the investigators said.

Both daily and twice-weekly vaginal administration of low-dose vaginal estrogen cream have demonstrated efficacy for reducing symptoms of atrophic vaginitis. Dr. Bachmann reported findings from a randomized clinical trial comparing the two regimens.

Both active-therapy regimens led to significantly greater improvement in all outcome measures at 12 weeks compared with placebo.

A total of 155 patients treated with either regimen of vaginal estrogen cream had evaluable endometrial biopsies. In the patients assigned to daily therapy, six of 85 had evidence of proliferative endometrium. Among 72 assigned to twice-weekly treatment, six had proliferative endometrium.

In general, adverse events were similar in the active-treatment and placebo groups, Dr. Bachmann reported, and treatment-emergent adverse events were uncommon. Treatment-emergent vaginal bleeding occurred in no more than two patients in any randomized group during the double-blind and open-label phases of the study.

MedPage Today

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Adherence to Mediterranean Diet Reduces Risk of Major Chronic Diseases

2008-09-22T18:26:00.000-07:00

September 15, 2008 — Sticking with any diet is difficult, but the incentives of adhering to the traditional Mediterranean diet are particularly beneficial, a new meta-analysis has shown [1]. Strictly following the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease, and investigators say that greater adherence can be a relatively simple tool to reduce the risk of premature death in the general population.

"The practical implication is that we are able to talk to our patients and show them that sticking to this diet, the specific characteristics of the diet, improves their overall health and quality of life," lead investigator Dr Francesco Sofi (University of Florence, Italy) told heartwire. "This is good information to give, especially if we're able to tell them something as simple as eating more fruits and vegetables."

The meta-analysis, published online September 12, 2008 in BMJ, included primary-prevention studies that assessed how well individuals stuck to the traditional Mediterranean diet and whether this translated into health benefits. In each of the 12 trials included in the meta-analysis, which included more than 1.5 million patients followed from three to 18 years, a numerical score, known as the adherence score, was used to assess how closely individuals were following the diet. A score of zero indicated low adherence to the diet, while a score of 7 to 9 points indicated high adherence to the Mediterranean diet.

Individuals who stuck strictly to a Mediterranean diet—defined as a two-point increase in the adherence score—had significant improvements in their overall health, including a 9% reduction in all-cause mortality, a 9% reduction in mortality from cardiovascular disease, and 6% reduction in cancer mortality. Although only three trials examined the association between adhering to the diet and the risk of Parkinson's and Alzheimer's disease, there was a reduced risk of these diseases when individuals closely followed the Mediterranean diet.

"The results overall showed that increasing two points on the adherence score results in a significant protective effect in terms of chronic diseases," said Sofi. "The study supports the current guidelines and recommendations of all the current scientific organizations that encourage the Mediterranean diet. It does say more, however, in terms of adherence, meaning it is important to actually stick with the diet."

In terms of applying the findings to the real world, Sofi said creating an adherence score based on "a theoretically defined Mediterranean diet" could be used as preventive tool for reducing the risk of mortality and morbidity in the general population. However, he added, it is important to define the diet properly.

"The problem with the literature is that a lot of papers suggest eating in a Mediterranean way, but what is the Mediterranean way? That's the problem. If you ask two subjects, you're going to get two different answers. We need to attempt to develop the characteristics of the Mediterranean diet and create the adherence score based on that."

CLICK HERE FOR FULL STORY ON Medscape Today & RELATED INFO

Long-Term Osteoporosis Risk in Men Rises with Weight Loss

2008-09-22T18:15:00.000-07:00

OSLO, Sept. 19 -- Thinner men in middle age, or those who lose substantial weight as they grow older, may have brittle bones in their 70s, researchers here said.

Some 15.1% of men who lost 10% or more of their body weight after their late 40s had osteoporosis when they reached 75, compared with 0.6% of those who had weight gains of at least 10%, reported Haakon E. Meyer, M.D., Ph.D., of the University of Oslo, and colleagues in the Aug. 15 issue of the American Journal of Epidemiology.

The researchers, who studied nearly 1,500 men over a 30-year period, found that combination of low initial weight and subsequent weight loss was an even stronger risk factor for osteoporosis.

"Low BMI in middle-age men was related to the risk of osteoporosis three decades later and ... this risk was modulated considerably by later weight change," Dr. Meyer and colleagues wrote. They said a clinical implication of their findings is that weight loss, while generally beneficial, is not risk-free. "When considering weight-loss interventions, the effect on osteoporosis and fracture should also be included and, if possible, counteracted," they suggested.

Slimness and short-term weight loss are already recognized as a risk factor for osteoporosis for men as well as women, the researchers said, but their effects had not previously been studied for such a long period.

The new findings emerged from studies of 1,476 Norwegian men in the cities of Oslo and Tromsø who underwent general health exams from 1972 to 1975 and again from 2000 to 2001. The follow-up screening also included bone mineral density testing of the hip.

They also estimated that men in the lowest quartile of BMI who lost at least 5% of body weight would be 2.79 times as likely to suffer a future hip fracture relative to those in the highest quartile and with stable weight.

"Weight change might act on the skeleton through changes in mechanical loading, changes in mechanical muscle stress, changes in hormone regulation of bone metabolism, and changes in intake of nutrients," the researchers wrote in addressing possible mechanisms.

Altered smoking habits or physical activity can affect weight as well as osteoporosis risk, they said.

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Adherence to Mediterranean Diet Reduces Risk of Major Chronic Diseases

2008-09-20T09:09:00.000-07:00

September 15, 2008 — Sticking with any diet is difficult, but the incentives of adhering to the traditional Mediterranean diet are particularly beneficial, a new meta-analysis has shown [1]. Strictly following the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease, and investigators say that greater adherence can be a relatively simple tool to reduce the risk of premature death in the general population.

"The practical implication is that we are able to talk to our patients and show them that sticking to this diet, the specific characteristics of the diet, improves their overall health and quality of life," lead investigator Dr Francesco Sofi (University of Florence, Italy) told heartwire. "This is good information to give, especially if we're able to tell them something as simple as eating more fruits and vegetables."

The meta-analysis, published online September 12, 2008 in BMJ, included primary-prevention studies that assessed how well individuals stuck to the traditional Mediterranean diet and whether this translated into health benefits. In each of the 12 trials included in the meta-analysis, which included more than 1.5 million patients followed from three to 18 years, a numerical score, known as the adherence score, was used to assess how closely individuals were following the diet. A score of zero indicated low adherence to the diet, while a score of 7 to 9 points indicated high adherence to the Mediterranean diet.

Individuals who stuck strictly to a Mediterranean diet—defined as a two-point increase in the adherence score—had significant improvements in their overall health, including a 9% reduction in all-cause mortality, a 9% reduction in mortality from cardiovascular disease, and 6% reduction in cancer mortality. Although only three trials examined the association between adhering to the diet and the risk of Parkinson's and Alzheimer's disease, there was a reduced risk of these diseases when individuals closely followed the Mediterranean diet.

"The results overall showed that increasing two points on the adherence score results in a significant protective effect in terms of chronic diseases," said Sofi. "The study supports the current guidelines and recommendations of all the current scientific organizations that encourage the Mediterranean diet. It does say more, however, in terms of adherence, meaning it is important to actually stick with the diet."

In terms of applying the findings to the real world, Sofi said creating an adherence score based on "a theoretically defined Mediterranean diet" could be used as preventive tool for reducing the risk of mortality and morbidity in the general population. However, he added, it is important to define the diet properly.

"The problem with the literature is that a lot of papers suggest eating in a Mediterranean way, but what is the Mediterranean way? That's the problem. If you ask two subjects, you're going to get two different answers. We need to attempt to develop the characteristics of the Mediterranean diet and create the adherence score based on that."

Medscape Today Medical News
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Aging: Study Links Falls to Lack of Sleep

2008-09-16T11:05:00.000-07:00

Women over 70 who get five hours of sleep a night or less may be more likely to fall than those who sleep seven to eight hours, according to a new study.

After controlling for age, body mass, alcohol use, sleep medications and many other variables, they found that women who slept less than five hours a night were about 47 percent more likely to have fallen twice or more in the course of the study.

Analysis showed that while a variety of factors associated with poor sleep might increase the risk of falls — depression, balance or gait problems — these things explained some, but not all, of the relationship. The association with shorter nighttime sleep remained an independent risk factor.

“People think getting less sleep is just a normal aspect of aging,” said Katie L. Stone, the lead author and a scientist at the California Pacific Medical Center Research Institute. “But you should bring it to the attention of your physician. There are options available for treatment.”

The New York Times

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Vitamin B12 status and rate of brain volume loss in community-dwelling elderly

2008-09-09T12:58:00.000-07:00

Objectives: To investigate the relationship between markersof vitamin B₁₂ status and brain volume loss per year over a5-year period in an elderly population.

Conclusion: Low vitamin B₁₂ status should be further investigatedas a modifiable cause of brain atrophy and of likely subsequentcognitive impairment in the elderly.

NEUROLOGY 2008;71:826-832

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Decline in Mental Skills Begins Years Before Death

2008-09-06T04:39:00.000-07:00

August 29, 2008 — As people grow older, they experience a substantial acceleration in cognitive decline — even if they don't have dementia, a new study suggests.

"Based on previous studies, we expected to see an acceleration in the decline in cognitive abilities before death," lead author Valgeir Thorvaldsson, from the department of psychology at Göteborg University, in Sweden, told Medscape Neurology & Neurosurgery. "However, the onset of this acceleration was much earlier than we expected."

Mr. Thorvaldsson said this was especially the case for perceptual speed, where the average onset of terminal decline was almost 15 years before death.

"The findings imply that the brain changes that influence cognitive abilities in old age occur over a relatively long period of time," he noted.

Their findings were published online August 27 in Neurology.

Medscape Today

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Omega-3 Fatty Acids, but Not Statin Therapy, Cuts Mortality and Hospitalizations in Heart Failure

2008-09-06T04:37:00.000-07:00

September 3, 2008 — Omega-3 fatty-acid supplementation improves morbidity and mortality in symptomatic heart-failure patients, while statins failed to have any beneficial effect in the same group of patients, two new studies have shown [1,2]. The long-term administration of omega-3 fatty acids reduced all-cause mortality and admission to the hospital for cardiovascular (CV) reasons, while there was no effect on these end points with 10-mg rosuvastatin (Crestor, AstraZeneca)....

Medscape Today

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No Neuroprotective Effect of Dipyridamole, Aspirin, or Telmisartan in Recurrent Stroke

2008-09-06T04:35:00.000-07:00

September 3, 2008 — Results of a randomized trial show no evidence that extended-release dipyridamole (Aggrenox, Boehringer Ingelheim), aspirin, or telmisartan (Micardis, Boehringer Ingelheim) have neuroprotective effects on either disability due to a recurrent stroke or cognitive decline over time.

The results of this third factorial analysis of the Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) trial are published online August 29 in Lancet Neurology. Results of the other 2 main analyses, 1 comparing aspirin plus extended-release dipyridamole with clopidogrel for the prevention of recurrent stroke and another comparing telmisartan vs placebo in these same patients, were published online August 27 in the New England Journal of Medicine.

"PROFESS is the largest trial so far to investigate in a prespecified manner whether treatment with antiplatelet drugs or angiotensin II receptor agonists (such as telmisartan) are neuroprotective in patients who have had a recurrent stroke," the researchers, with first author Hans-Christoph Diener, MD, from the University of Duisberg/Essen, in Essen, Germany, conclude. "The degree of functional impairment at 3 months poststroke was similar across treatment arms."

The findings from all 3 analyses were previously presented at the 17th European Stroke Conference in Nice and reported by Medscape Neurology & Neurosurgery at that time.

Medscape Today

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