Brain Function May Drop Quickly Before Alzheimer’s

SOURCE: American Academy of Neurology, news release, March 22, 2010
3/22/2010

MONDAY, March 22 (HealthDay News) — Memory and thinking skills can deteriorate quickly in people with mild cognitive impairment, the stage before Alzheimer’s disease, says a new study.

“These results show that we need to pay attention to this time before Alzheimer’s disease is diagnosed, when people are just starting to have problems forgetting things,” study author Robert S. Wilson, of Rush University Medical Center in Chicago, said in a news release from the American Academy of Neurology.

The study involved 1,158 people, who averaged 79 years old. The group included 149 people with Alzheimer’s disease, 395 with mild cognitive impairment and 614 with no thinking or memory problems.

Each participant completed a memory and thinking skill test at the start of the study and again every three years. Participants took part in the study for an average of 5.5 years, and up to 11 years.

The scores of people with mild cognitive impairment declined twice as fast each year as did scores of those with no memory problems. The scores for people with Alzheimer’s declined four times as fast as those of participants with no cognitive problems, the study found.

The results are in the March 23 issue of Neurology.

“The changes in rate of decline occur as the brain atrophies due to the disease, first mainly in the hippocampus during the initial symptomatic stage, referred to as mild cognitive impairment, then in the temporal, parietal and frontal cortex during the dementing illness phase of Alzheimer’s disease,” said Dr. David S. Knopman, of the Mayo Clinic in Rochester, Minn., who wrote an editorial accompanying the study.

Presidential Proclamation–Older Americans Month

A PROCLAMATION

Older Americans have lived through momentous and trying times in our history, and they have strengthened our national character. Their experience and wisdom connect us to the past and help us meet the challenges of the present. During Older Americans Month, we show our support and appreciation for these treasured individuals who have contributed so much to our Nation.

This year’s theme for Older Americans Month, “Age Strong, Live Long,” recognizes the efforts of people of all ages to promote the well-being, community involvement, and independence of senior citizens. As Americans live longer, healthier, and more productive lives, many are starting second careers and continuing to be involved in their communities. Dedicated older Americans are also answering the call to serve through the Corporation for National and Community Service’s Senior Corps.

My Administration is committed to ensuring older Americans can age strong and live long. By strengthening Medicare and Medicaid, while protecting Social Security, we help ensure all Americans can age with dignity. The recently enacted Affordable Care Act strengthens Medicare by providing free preventive care starting next year, enhancing care coordination, and gradually closing the “donut hole” gap in prescription drug coverage. In addition, this law includes provisions to help prevent and eliminate elder abuse, neglect, and exploitation. Along with the Middle Class Task Force’s Caregiver Initiative, we are investing in wellness and prevention programs to help seniors remain healthy and close to their loved ones. The Administration on Aging’s network of State and local organizations provides services to older Americans that help prevent unnecessary hospitalization or institutionalization. We must also protect seniors by expanding efforts to fight fraud, waste, and abuse in Medicare and Medicaid through national and State efforts, as well as community-based programs that empower retirees to detect and defend against health care fraud.

Many of our Nation’s older men and women have worked tirelessly and sacrificed so their children could achieve something greater. Their passion and experience inspire us all and we are privileged to honor and care for the generations whose legacy continues to enrich our Nation and shape our future.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2010 as Older Americans Month. I call upon citizens of all ages to honor older Americans this month with appropriate ceremonies and activities.

IN WITNESS WHEREOF, I have hereunto set my hand this twenty-eighth day of April, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fourth.

BARACK OBAMA

Hospital Stays May Spur Brain Decline in Seniors

SOURCE: Journal of the American Medical Association, news release, Feb. 23, 2010
2/23/2010

TUESDAY, Feb. 23 (HealthDay News) — Elderly people who have been hospitalized have an increased risk of cognitive decline.

That’s the finding of U.S. researchers who analyzed data from 1994 through 2007 on 2,929 people, aged 65 and older, who did not have dementia at the start of the study. During an average follow-up of 6.1 years, 1,287 were hospitalized for a non-critical illness and 41 were hospitalized for a critical illness, while 1,601 of the participants were not hospitalized.

Among those hospitalized for one or more non-critical illnesses, there were 228 cases of dementia, and among those hospitalized with one or more critical illnesses, there were five cases of dementia. There were 146 cases of dementia reported among the participants who weren’t hospitalized during the study period, the authors noted.

After adjusting for various factors, the researchers concluded that patients hospitalized for a non-critical illness were 40 percent more likely to develop dementia than those who weren’t hospitalized. Seniors hospitalized with a critical illness also had a higher risk of dementia, but the result wasn’t significant, possibly because of the small number of people in that group, the study authors explained.

“The mechanism of this association is uncertain,” wrote Dr. William J. Ehlenbach, of the University of Washington, Seattle, and colleagues. “These results also could suggest that factors associated with acute illness, and to a greater degree with critical illness, may be causally related to cognitive decline.”

There are a number of possible mechanisms through which critical illness could contribute to cognitive decline, including hypoxemia (decreased partial pressure of oxygen in blood), delirium, low blood pressure, glucose dysregulation, inflammation, and sedative and analgesic medications, the report indicated.

“Further studies are needed to better understand the factors associated with acute and critical illness that may contribute to cognitive impairment,” the researchers concluded.

The study findings are published in the Feb. 24 issue of the Journal of the American Medical Association.

Scans Might Monitor Success of Alzheimer’s Drugs

SOURCE: The Lancet, news release, Feb. 28, 2010
3/1/2010

MONDAY, March 1 (HealthDay News) — Noting that brain scans suggest that a new drug reduces plaque deposits in the brains of certain Alzheimer’s patients by 25 percent compared to a placebo, researchers say the scans could become a useful tool to study treatments for the disease.

Alzheimer’s disease appears to occur when plaques develop in the brain. But until recently, there was no way to view the plaques in people until they died.

The new PET scanning technology allows researchers to look for the plaques, known as amyloid-beta deposits, in the brains of living people.

In the study, Juha Rinne, from the University of Turku in Finland, and colleagues used the scanning technology to study a drug called bapineuzumab. Side effects were moderate, although two patients experienced an accumulation of water in the brain.

The findings represent “something of a breakthrough by demonstrating the feasibility of eventually testing the so-called amyloid hypothesis of sporadic Alzheimers disease in vivo,” said Sam Gandy, of the Mount Sinai School of Medicine in New York City in an accompanying commentary.

It’s too early to know if bapineuzumab is an effective drug to treat Alzheimer’s, he said, but the research will “move us closer to the goal of understanding, treating and, eventually, preventing major neurodegenerative diseases such as Alzheimers disease.”

The study appears online in advance of print publication in the April issue of The Lancet Neurology.

Get the Most Out of your Insurance Plan

Health care reform may be on its way. But there are ways you can make the most of your health insurance now.
By Jen Haley, producer
March 22, 2010

NEW YORK (CNN) — When you get your insurance, you probably get a stack of papers about your plan’s details, but going online can help you find benefits you may not even be aware of.

1. Go online

For example, you can find out where to get free screenings and when you can get immunizations says Carrie McLean of e-healthinsurance.com.

Many larger insurance groups, like Kaiser Permanente, Aetna and United Healthcare are starting up social networks so members can talk to each other and trade information about doctors or procedures.

And by setting up a profile you can get information on your benefits much more easily that paging through a book.

2. Get hotline information

Many larger carriers will have a hotline staffed by nurses that you can call for an infection that seems to be getting worse or advice on how to treat a sore throat. Of course, for major medical emergencies, head to the closest hospital, but for minor injuries or for advice, these hotlines can save you time, money and a long wait at the ER.

“Generally this is something that’s buried in the plan benefit information. It’s not something you’ll see on the first page,” says McLean. Keep in mind that while carriers may offer this hotline, it may not be available on every plan.

3. Check out your discounts

Many insurance carriers offer incentives to lose weight or stop smoking. So if you join a gym, take part in a weight loss program, or start a smoking cessation program, let your insurance company know. You may be eligible for discounts on those memberships.

Blood test can predict rheumatoid arthritis before symptoms arise

NewsRx.com
2/4/2010

Researchers from University Hospital in Umea, Sweden, have identified several cytokines, cytokine-related factors, and chemokines that increase significantly prior to rheumatoid arthritis (RA) disease onset. These findings confirm those of earlier studies which suggest that the risk of developing RA can be predicted and disease progression may be prevented. Complete findings of this study are published in the February issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology (see also Wiley-Blackwell).

Rheumatoid arthritis is a chronic autoimmune disease characterized by joint inflammation involving the synovial (lubricating fluid of the joints) tissue and eventually leading to destruction of cartilage and bone. The cause leading to disease development and progression is not completely understood, although various cells of the immune system and of synovial origin are suggested to be involved. Numerous cytokines are expressed and are functionally active in the synovial tissue once the disease has developed. Now a research team led by Solbritt Rantapaa-Dahlqvist, M.D. has found that several of these cytokine levels spike as much as several years prior to the development of arthritic symptoms.

An early and accurate diagnosis of RA is crucial. According to the American College of Rheumatology, RA can be difficult to diagnose because it may begin with only subtle symptoms, such as achy joints or early morning stiffness. Many diseases including lupus, osteoarthritis and fibromyalgia, especially early on, mimic the symptoms of RA making diagnosis more difficult. Studies have shown that people who receive early treatment for RA feel better sooner and more often, are more likely to lead an active life, and are less likely to experience the type of joint damage that leads to joint replacement.

To determine whether cytokines, cytokine-related factors, and chemokines are up-regulated prior to the development of RA, and which ones are involved, the team conducted a nested case-control study within the Medical Biobank of Northern Sweden. Blood samples were analyzed from 86 individuals before the appearance of symptoms of RA (pre-patients), from 69 of the pre-patients after the onset of RA, and from 256 matched control subjects (1:3 ratio). A consecutive time-dependent involvement of the immune system in disease development and progression was evaluated. The plasma levels of 30 cytokines, related factors, and chemokines were measured using a multiplex system. Individuals in whom RA subsequently developed were discriminated from control subjects mainly by the presence of Th1 cell-, Th2 cell-, and Treg cell-related cytokines, while chemokines, stromal cell-derived cytokines, and angiogenic-related markers separated patients after the development of RA from individuals before the onset of RA.

“We observed a clear relationship between cytokines related not only to Th1, Th2, and Treg cells but also to Th17 and the presence of anti-CCP antibodies, thereby supporting the concept that the immune system was already stimulated and disease was developing toward RA,” explains Dr. Rantapaa-Dahlqvist. Researchers found that blood samples obtained from individuals had elevated concentrations of proinflammatory cytokines, cytokine-related factors, and chemokines, indicating immune system activation prior to any symptoms of joint involvement. “Our findings present an opportunity for better predicting the risk of developing RA and possibly preventing disease progression,” concluded Dr. Rantapaa-Dahlqvist.

Keywords: Autoimmune Diseases, Autoimmune Disorder, Bone, Cytokines, Disease Progression, Immunology, Inflammation, Lupus, Osteoarthritis, Rheumatism, Rheumatoid Arthritis, Rheumatology, Wiley-Blackwell.

This article was prepared by Hospital Business Week editors from staff and other reports. Copyright 2010, Hospital Business Week via NewsRx.com.

More blood pressure worry: It’s linked to dementia

Associated Press
1/26/2010

WASHINGTON – If the cardiologist’s warnings don’t scare you, consider this: Controlling blood pressure just might be the best protection yet known against dementia.

In a flurry of new research, scientists scanned people’s brains to show hypertension fuels a kind of scarring linked to later development of Alzheimer’s disease and other dementias. Those scars can start building up in middle age, decades before memory problems will appear.

The evidence is strong enough that the National Institutes of Health soon will begin enrolling thousands of hypertension sufferers in a major study to see if aggressive treatment – pushing blood pressure lower than currently recommended – better protects not just their hearts but their brains.

“If you look … for things that we can prevent that lead to cognitive decline in the elderly, hypertension is at the top of the list,” Dr. Walter Koroshetz, deputy director of NIH’s National Institute of Neurological Disorders and Stroke, told The Associated Press.

Age is the biggest risk factor for Alzheimer’s disease and other forms of dementia that affect about one in eight people 65 or older.

Scientists have long noticed that some of the same triggers for heart disease – high blood pressure, obesity, diabetes – seem to increase the risk of dementia, too. But for years, they thought that link was with “vascular dementia,” memory problems usually linked to small strokes, and not the scarier classic Alzheimer’s disease.

Now those lines are blurring as specialists realize that many if not most patients have a mix of the two dementias. Somehow, factors like hypertension – blood pressure readings of 140 over 90 or higher – that weaken arteries also seem to spur Alzheimer’s disease-like processes.

One suspect: Scarring known as white matter lesions. White matter acts as the brain’s telephone network, a system of axons, or nerve fibers, that allow brain cells to communicate with each other. Even slightly elevated blood pressure can damage the tiny blood vessels that nourish white matter, interrupting those signals.

Among the strongest new studies:

-MRI scans showed women 65 and older with high blood pressure had significantly more white matter lesions in their brains eight years later. The study included 1,403 women who were enrolled in a memory subset of the landmark Women’s Health Initiative that tracked postmenopausal health. The worse their blood pressure, the higher volume of white matter damage, says the study published online last month in the Journal of Clinical Hypertension.

“This is a silent disease in the brain,” says lead researcher Dr. Lewis Kuller of the University of Pittsburgh. “It’s evolving over time and it leads to very bad outcomes.”

-The journal Stroke just published similar evidence from a Johns Hopkins University-led study that tracked 983 people for more than 15 years, starting in middle age. The longer people spent with uncontrolled high blood pressure, the more white matter damage they accumulated. The researchers could see a change with each 20-point jump in too-high systolic pressure, the top number in a blood-pressure reading.

Clearly, hypertension alone doesn’t doom someone to later dementia. Far more people, nearly one in three U.S. adults, have hypertension.

And there are plenty of other reasons to lower blood pressure: Hypertension is a leading cause of heart attacks, strokes and kidney failure.

But while some studies have found hypertension treatment lowered the dementia risk, others haven’t.

Enter the NIH’s SPRINT study, which in a few months is to begin enrolling 7,500 hypertension patients age 55 and older around the country. The test: Whether aggressive treatment to lower systolic blood pressure below 120 – what’s considered normal – will prove healthier than today’s guidelines that urge getting it below 140, or 130 for diabetics.

The main focus is on heart and kidney health. But all participants will be screened for dementia, and a subset will undergo repeated cognitive testing and MRI scans to tell if lowering blood pressure also protects against a slide toward dementia. Another question: If older patients can tolerate bigger than usual blood pressure drops without side effects, such as falls.

With dementia rising fast as the population grays, even a small effect from better blood pressure control could have a big public health impact, says Dr. William Thies of the Alzheimer’s Association.

Other dementia-preventing efforts, such as targeting the sticky amyloid plaques in Alzheimer’s patients brains, haven’t panned out so far – while hypertension control has little downside, notes Pittsburgh’s Kuller.

“Until I can tell you how to get rid of amyloid in your brain, take care of the blood pressure.”

—

EDITOR’s NOTE – Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

UCLA researchers image earliest signs of Alzheimer’s, before symptoms appear

NewsRx.com
2/11/2010

Estimates are that some 10 percent of people over the age of 65 will develop Alzheimer’s disease, the scourge that robs people of their memories and, ultimately, their lives (see also University of California – Los Angeles).

While researchers race to find both the cause and the cure, others are moving just as fast to find the earliest signs that will predict an eventual onset of the disease, well before any outward symptoms. The reason is simple: The earlier the diagnosis, the earlier treatments can be applied.

Now, through the use of sophisticated brain-imaging techniques, researchers at UCLA have been able to predict a brain’s progression to Alzheimer’s by measuring subtle changes in brain structure over time, changes that occur long before symptoms can be seen. The research appears in two separate papers currently available online and scheduled for future print publication.

In the first study, which appears in the online edition of the journal Human Brain Mapping, UCLA assistant clinical professor of neurology Liana Apostolova and colleagues tracked 169 people over three years who had been diagnosed with mild cognitive impairment (MCI), a condition that causes memory problems greater than those expected for an individual’s age – but not the personality or cognitive changes that define Alzheimer’s. They found that after three years, those who went on to be diagnosed with Alzheimer’s disease showed a 10 to 30 percent greater atrophy in two specific locations within the brain’s hippocampus, a part of the brain known to be critical for long-term memory.

In the second study, which appears in the online edition of the journal Neurobiology of Aging, the researchers looked at 10 cognitively normal elderly people and compared their brain scans with those of seven other elderly people who were later diagnosed with MCI and then Alzheimer’s. Again, they found that the group that went on to be diagnosed with Alzheimer’s showed the same pattern of atrophy in the same regions of the hippocampus.

This shows, Apostolova said, that excess atrophy is present in cognitively normal individuals who are predestined to develop MCI. Further, that atrophy ultimately cascades across the entire hippocampus of the brain, leading to Alzheimer’s disease.

“We feel this is an important finding because it is in living humans,” said Apostolova, senior author of both papers and a member of the UCLA Laboratory of Neuro Imaging. “Now we have a sensitive technique that shows the ‘invisible’ – that is, the progression of a disease before symptoms appear.”

In the first study, the researchers wanted to track disease progression in the hippocampus. In earlier work, Apostolova’s lab had shown that greater atrophy can be documented in the living brain and that it can predict conversion from MCI to Alzheimer’s. The researchers looked at two areas within the hippocampus: the CA1 (cornu ammonis) and the subiculum. In this study, they tracked atrophy from the CA1 as it spread to the subiculum, which matched disease progression from the MCI state to a diagnosis of Alzheimer’s.

They split the MCI subjects into those who had no noticeable hippocampal atrophy other then what is expected from normal aging alone, and those who had atrophy greater than expected for normal aging. Three years later, the researchers followed up and compared the MCI group with no visual change to the one with premature change. They found 10 to 30 percent greater atrophy in the CA1 and subiculum of those MCI patients with premature atrophy who were later diagnosed with Alzheimer’s.

“In looking at the longitudinal changes, we could see there was definitive evidence of a progression from the CA1 to the subiculum region, and on to the other regions of the hippocampus,” Apostolova said.

The second, much smaller study of 17 individuals confirmed the findings of the larger study, but this time in people who were cognitively healthy. Here, the researchers looked at 10 cognitively normal elderly subjects who remained normal at three-year and six-year follow-ups, and at seven cognitively normal elderly subjects who were diagnosed with MCI between two and three years after their initial brain scan and with Alzheimer’s approximately seven years after the initial scan.

Again, excessive atrophy in the CA1 and subicular regions was present in cognitively normal individuals who went on to be diagnosed with MCI, and a slow progression of atrophy beyond the CA1 and subiculum to other regions was evident in those ultimately diagnosed with Alzheimer’s.

Apostolova noted that the degree of atrophy is not easily visible in the brain scans and that very sensitive techniques are required to show its progression.

“We can’t see the pathologic changes, but we clearly see the neurodegenerative atrophy associated with MCI and AD, and how it spreads through the hippocampus,” she said. “This is exactly what a biomarker, being an indirect measure of disease progression, is supposed to do.”

Keywords: Age and Aging, Alzheimer Disease, Atrophy, Neurobiology, Neurology, University of California – Los Angeles.

This article was prepared by Pain & Central Nervous System Week editors from staff and other reports. Copyright 2010, Pain & Central Nervous System Week via NewsRx.com.

To see more of the NewsRx.com, or to subscribe, go to http://www.newsrx.com .

Albany Senior Resource Fair

Come meet and get to know the Care Managers of Home Care Assistance of Danville!

Home Care Assistance will be tabling at the annual Senior Resource Fair on Thursday, March 25th from 10 am-1 pm at the Albany Senior Center. Our Care Managers will be available to answer all your questions about home care and senior resources in the area.

A variety of organizations will be on hand to provide information on services such as: transportation, housing, health care, estate planning and much, much more! Bring yourself, bring a grandparent, bring a neighbor!

Free memory screenings & blood pressure checks!

Free giveaways & free lunch!

Albany Senior Center
846 Masonic Avenue
Albany, CA 94706

Untreated Poor Vision In Elderly Linked To Dementia, University Of Michigan Study Shows

Untreated Poor Vision In Elderly Linked To Dementia, University Of Michigan Study Shows
February 22, 2010

Elderly people with visual disorders that are left untreated are significantly more likely to develop Alzheimer’s disease — the most common form of dementia, according to a University of Michigan Health System study.

The study used Medicare data and shows that those with poor vision who visited an ophthalmologist at least once for an examination were 64 percent less likely to develop dementia.

The study appears online ahead of print in the American Journal of Epidemiology and may draw a new picture of poor vision as predictor of dementia rather than as a symptom after the diagnosis.

“Visual problems can have serious consequences and are very common among the elderly, but many of them are not seeking treatment,” says lead author Mary A.M. Rogers, Ph.D, research assistant professor of internal medicine at the U-M Medical School and research director of the Patient Safety Enhancement Program at the U-M Health System and the Ann Arbor VA Medical Center.

For the study, Rogers and her colleague Kenneth M. Langa, M.D., Ph.D., professor of internal medicine at U-M Medical School, analyzed data from the nationally representative Healthand Retirement Study and records from Centers for Medicare and Medicaid Services.

“Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated,” Rogers says.

The types of vision treatment that were helpful in lowering the risk of dementia were surgery to correct cataracts and treatments for glaucoma, retinal disorders and other eye-related problems.

Proper vision is a requirement for many of the activities that previously have been found to lower the risk of Alzheimer’s disease. These include reading, playing board games, other mentally stimulating activities, social networking, as well as physical activity such as walking and routine exercising. A visual disorder may interfere with normal mobility and may also hinder a person’s ability to participate in such activities.

“Many elderly Americans do not have adequate health coverage for vision, and Medicare does not cover preventative vision screenings for most beneficiaries,” Rogers says. “So it’s not unusual that the elderly receive vision treatment only after a problem is severe enough to warrant a visit to the doctor when the problem is more advanced.”

According to a survey conducted by the National Eye Health Education Program, less than 11 percent of respondents understood that there are no early warning signs for eye problems such as glaucoma and diabetic retinopathy.

However, vision problems and blindness are among the top 10 disabilities among adults and can result in a greater tendency to experience other health conditions or even to die prematurely.

“While heart disease and cancer death rates are continuing to decline, mortality rates for Alzheimer’s disease are on the rise,” says Rogers. “So if we can delay the onset of dementia, we can save individuals and their families from the stress, cost and burden that are associated with Alzheimer’s disease.”

The study was based on the surveys and medical information from 625 people compiled from 1992-2005. Only 10 percent of Medicare beneficiaries who developed dementia had excellent vision at the beginning of the study, while 30 percent of those who maintained normal cognition had excellent vision at the onset of the study.

One in five Americans who are over age 50 report experiencing a visual impairment, according to the U.S. Centers for Disease Control and Prevention. Approximately 5 million Americans have Alzheimer’s disease and the number has doubled since 1980. It is expected to be as high as 13 million by 2050.

Additional author: Kenneth M. Langa, M.D., Ph.D., is also a researcher at the Veterans Affairs Center for Practice Management and Outcomes Research and Institute for Social Research

Reference: American Journal of Epidemiology, 2010 Feb. 11; doi:10.1093

SOURCE: University of Michigan