Topic: Research

Dementia and Acting Out Dreams

Tuesday, May 28th, 2013 by American Senior Fitness Association   View This Issue of Experience!

A recent Mayo Clinic study found a link between acting out dreams and the development of dementia. For details, see the following Mayo Clinic news release:

The strongest predictor of whether a man is developing dementia with Lewy bodies — the second most common form of dementia in the elderly — is whether he acts out his dreams while sleeping, Mayo Clinic researchers have discovered. Patients are five times more likely to have dementia with Lewy bodies if they experience a condition known as rapid eye movement (REM) sleep behavior disorder than if they have one of the risk factors now used to make a diagnosis, such as fluctuating cognition or hallucinations, the study found.

The findings were presented at the annual meeting of the American Academy of Neurology in San Diego. REM sleep behavior disorder is caused by loss of the normal muscle paralysis that occurs during REM sleep. It can appear three decades or more before a diagnosis of dementia with Lewy bodies is made in males, the researchers say. The link between dementia with Lewy bodies and the sleep disorder is not as strong in women, they add.

“While it is, of course, true that not everyone who has this sleep disorder develops dementia with Lewy bodies, as many as 75 to 80 percent of men with dementia with Lewy bodies in our Mayo database did experience REM sleep behavior disorder. So it is a very powerful marker for the disease," says lead investigator Melissa Murray, Ph.D., a neuroscientist at Mayo Clinic in Florida.

The study’s findings could improve diagnosis of this dementia, which can lead to beneficial treatment, Dr. Murray says.

“Screening for the sleep disorder in a patient with dementia could help clinicians diagnose either dementia with Lewy bodies or Alzheimer’s disease," she says. "It can sometimes be very difficult to tell the difference between these two dementias, especially in the early stages, but we have found that only 2 to 3 percent of patients with Alzheimer’s disease have a history of this sleep disorder.”

Once the diagnosis of dementia with Lewy bodies is made, patients can use drugs that can treat cognitive issues, Dr. Murray says. No cure is currently available.

Researchers at Mayo Clinic in Minnesota and Florida, led by Dr. Murray, examined magnetic resonance imaging, or MRI, scans of the brains of 75 patients diagnosed with probable dementia with Lewy bodies. A low-to-high likelihood of dementia was made upon an autopsy examination of the brain.

The researchers checked the patients’ histories to see if the sleep disorder had been diagnosed while under Mayo care. Using this data and the brain scans, they matched a definitive diagnosis of the sleep disorder with a definite diagnosis of dementia with Lewy bodies five times more often than they could match risk factors, such as loss of brain volume, now used to aid in the diagnosis. The researchers also showed that low-probability dementia with Lewy bodies patients who did not have the sleep disorder had findings characteristic of Alzheimer’s disease.

“When there is greater certainty in the diagnosis, we can treat patients accordingly. Dementia with Lewy bodies patients who lack Alzheimer’s-like atrophy on an MRI scan are more likely to respond to therapy — certain classes of drugs — than those who have some Alzheimer’s pathology," Dr. Murray says.

The study’s other key researchers at Mayo include neuroradiologist Kejal Kantarci, M.D., neuropsychologist Tanis J. Ferman, Ph.D., neurologist Bradley F. Boeve, M.D., and neuropathologist Dennis W. Dickson, M.D.

The study was supported by the National Institutes of Health/National Institute on Aging, the Harry T. Mangurian, Jr., Foundation, and the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer’s Disease Research Program of the Mayo Foundation.

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Diabetes, Health Literacy & Antidepressants

Tuesday, May 28th, 2013 by American Senior Fitness Association   View This Issue of Experience!

Adult patients with diabetes who don’t understand basic health information are significantly less likely to take newly prescribed antidepressant medication, according to a new Kaiser Permanente study published in the Journal of General Internal Medicine.

In this study conducted by the Kaiser Permanente Division of Research and the University of Washington School of Medicine, 72 percent of the 1,366 study participants had limited health literacy, and had significantly poorer adherence to newly prescribed antidepressants, compared to patients with no limitations.

“Research shows that those with health literacy limitations are more likely to have poor control of their chronic medical conditions such as diabetes, congestive heart failure and HIV,” said Andrew Karter, PhD, research scientist at Kaiser Permanente and senior author on the study. “However, this is the first study to examine the association between health literacy and antidepressant adherence among patients with diabetes. This type of research gives our health care systems important feedback because, as providers, we often remain unsure whether the critical health information we convey to our patients is fully understood.”

The Institute of Medicine defines health literacy as the capacity for patients to “obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Because nearly 90 percent of Americans have some difficulty using routine health information, the U.S. surgeon general has identified the improvement of health literacy as a national priority.

Adequate adherence for antidepressants is particularly important for patients with diabetes and other chronic medical conditions. Depression occurs twice as frequently among adults with diabetes compared to adults without diabetes, and has been associated with an increased risk of the serious diabetic complications, dementia and mortality.

In the study, health literacy was based on a self-reported scale in which participants with type 2 diabetes responded to three questions:

1. How often do you have problems learning about your medical condition because of difficulty understanding written information?
2. How confident are you filling out medical forms by yourself?
3. How often do you have someone like a family member, friend, hospital or clinic worker or caregiver, help you read health plan materials?

The study examined medication nonadherence during the 12 months after the initial antidepressant prescription, and researchers found that many patients failed to adhere to their treatment. Although most patients filled the prescription at least once, 43 percent failed to fill the prescription a second time, and nearly two-thirds had discontinued the antidepressant by the end of the 12-month period.

Poor adherence to antidepressant medications has been described previously, but what was not known is that those with health-literacy limitations were significantly less likely to take their antidepressant medications. In fact, diabetes patients with limited health literacy were much less likely to refill their antidepressant medications in a timely fashion than patients with no limitations. These patterns were not explained by other factors known to be associated with medication nonadherence, including age, race/ethnicity, English proficiency and income, which were accounted for in the study.

Depression in adults with diabetes is frequently chronic, suggesting the need for long-term antidepressant therapy. “The high rates of early discontinuation that were observed among adults with diabetes who had any health literacy limitation suggest that few of these individuals received an adequate course of antidepressant therapy. Getting that sufficient treatment is critical in preventing relapse and recurrence of depression,” said lead author Amy Bauer, MD, of the University of Washington School of Medicine. “Physicians should be aware of this. For antidepressant treatment to succeed, patients with limited health literacy may require more intensive counseling and clearer explanations about use of antidepressant medications and closer follow-up.”

The researchers said the study findings underscore the importance of national efforts to address healthy literacy, simplify health communications regarding treatment options, improve public understanding of the importance of depression treatment, and monitor antidepressant adherence.

This research was supported by funding from the National Institutes of Health.

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More on Lung Disease

Monday, April 15th, 2013 by American Senior Fitness Association   View This Issue of Experience!

Not all lung disease is caused by cigarette smoking, but way too much is. And smoking can be very hard to give up. Still, there are benefits to quitting the habit at any stage of life — even after receiving a diagnosis of lung cancer or even after cancer surgery. A recent study conducted by the Moffit Cancer Center in Tampa, Florida, found that quitting prior to surgery is best.

Described by HealthDay, an affiliate of the National Institutes of Health, this study involved lung cancer patients as well as head and neck cancer patients who quit smoking either before or immediately following their surgery. The patients were followed-up for a year after surgery.

For patients who had quit smoking before surgery, the relapse rate was only 13 percent. By contrast, 60 percent of those who continued smoking during the week before surgery resumed smoking afterward. Most patients who took up smoking again did so shortly after their surgery. The researchers found that patients were more likely to relapse if they were at higher risk for depression, if they had a high amount of fear regarding cancer recurrence, and if they were less likely to trust in their ability to stop smoking.

Researchers noted that their findings underscore the importance of urging patients to quit smoking upon diagnosis and the value of offering stop-smoking programs to patients both pre- and post-surgery.

The study’s corresponding author Vani Nath Simmons stated: “Cancer patients need to know that it’s never to late to quit. Of course, it would be best if they quit smoking before getting cancer, but barring that, they should quit as soon as they get diagnosed. And with a little assistance, there is no reason that they can’t succeed.”

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Hard-to-Treat Breast Cancer

Monday, April 15th, 2013 by American Senior Fitness Association   View This Issue of Experience!

Can a diet high in fruits and vegetables reduce the risk of getting estrogen receptor-negative breast cancer?That is the question that a research team led by Seungyoun Jung, formerly of the Harvard School of Public Health, sought to answer by conducting a study recently published in the Journal of the National Cancer Institute.

Estrogen receptor-negative breast cancer is rarer than other forms of breast cancer and has a lower survival rate. The study detected a lower incidence of the disease among women who consumed high amounts of fruits and vegetables — especially vegetables. However, it failed to prove a cause-and-effect relationship. Perhaps women who eat more fruits and vegetables tend to lead healthier lifestyles overall, which would help to reduce their risks. Notwithstanding, following a diet that is rich in fruits and vegetables is clearly worthwhile.

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Fighting Obesity

Monday, April 15th, 2013 by American Senior Fitness Association   View This Issue of Experience!

UF&Shands, the University of Florida Academic Health Center is the most comprehensive of its kind in the southeastern United States. Below is a UF&Shands news release about amazing research that may lead to surprising advances in the ongoing battle against obesity:

University of Florida researchers and colleagues have identified a protein that, when absent, helps the body burn fat and prevents insulin resistance and obesity. The findings from the National Institutes of Health-funded study were published Nature Medicine.

The discovery could aid development of drugs that not only prevent obesity, but also spur weight loss in people who are already overweight, said
Stephen Hsu, M.D., Ph.D., one of the study’s corresponding authors and a principal investigator with the UF Sid Martin Biotechnology Development Institute.

One-third of adults and about 17 percent of children in the United States are obese, according to the Centers for Disease Control and Prevention. Although unrelated studies have shown that lifestyle changes such as choosing healthy food over junk food and increasing exercise can help reduce obesity, people are often unable to maintain these changes over time, Hsu said.

“The problem is when these studies end and the people go off the protocols, they almost always return to old habits and end up eating the same processed foods they did before and gain back the weight they lost during the study,” he said. Developing drugs that target the protein, called TRIP-Br2, and mimic its absence may allow for the prevention of obesity without relying solely on lifestyle modifications, Hsu said.

First identified by Hsu, TRIP-Br2 helps regulate how fat is stored in and released from cells. To understand its role, the researchers compared mice that lacked the gene responsible for production of the protein, with normal mice that had the gene.

They quickly discovered that mice missing the TRIP-Br2 gene did not gain weight no matter what they ate — even when placed on a high-fat diet — and were otherwise normal and healthy. On the other hand, the mice that still made TRIP-Br2 gained weight and developed associated problems such as insulin resistance, type 2 diabetes and high cholesterol when placed on a high-fat diet. The normal and fat-resistant mice ate the same amount of food, ruling out differences in food intake as a reason why the mice lacking TRIP-Br2 were leaner.

“We had to explain why the animals eating so much fat were remaining lean and not getting high cholesterol. Where was this fat going” Hsu said. “It turns out this protein is a master regulator. It coordinates expression of a lot of genes and controls the release of the fuel form of fat and how it is metabolized.”

When functioning normally, TRIP-Br2 restricts the amount of fat that cells burn as energy. But when TRIP-Br2 is absent, a fat-burning fury seems to occur in fat cells. Although other proteins have been linked to the storage and release of fat in cells, TRIP-Br2 is unique in that it regulates how cells burn fat in a few different ways, Hsu said. When TRIP-Br2 is absent, fat cells dramatically increase the release of free fatty acids and also burn fat to produce the molecular fuel called ATP that powers mitochondria — the cell’s energy source. In addition, cells free from the influence of TRIP-Br2 start using free fatty acids to generate thermal energy, which protects the body from exposure to cold.

“TRIP-Br2 is important for the accumulation of fat,” said Rohit N. Kulkarni, M.D., Ph.D., also a senior author of the paper and an associate professor of medicine at Harvard Medical School and the Joslin Diabetes Center. “When an animal lacks TRIP-Br2, it can’t accumulate fat.”

Because the studies were done mostly in mice, additional studies are still needed to see if the findings translate to humans.

“We are very optimistic about the translational promise of our findings because we showed that only human subjects who had the kind of fat (visceral) that becomes insulin-resistant also had high protein levels of TRIP-Br2,” Hsu said.

“Imagine you are able to develop drugs that pharmacologically mimic the complete absence of TRIP-Br2,” Hsu said. “If a patient started off fat, he or she would burn the weight off. If people are at risk of obesity and its associated conditions, such as type 2 diabetes, it would help keep them lean regardless of how much fat they ate. That is the ideal anti-obesity drug, one that prevents obesity and helps people burn off excess weight.”

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Sleep and Memory

Monday, March 4th, 2013 by American Senior Fitness Association   View This Issue of Experience!

Recent research published in the journal Nature Neuroscience looked at the effects of lighter sleep — which often accompanies aging — on memory skills. The small study involved 18 young people (average age 20) and 15 older adults (average age 72).

Given a memory test after sleeping, the older persons scored 55 percent lower than the young persons. The researchers think that the older adults remembered less than their younger counterparts during the memory task because the older persons’ sleep was not as deep.

With age, sleep may become lighter due to sleep interruptions caused by aches, pains and/or the need to urinate. However, sleep quality can be improved which might, in turn, lead to better everyday memory function.

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Hearing, Aging and Mental Function

Monday, March 4th, 2013 by American Senior Fitness Association   View This Issue of Experience!

New findings published in the journal JAMA Internal Medicine suggest that older adults who are hard of hearing may experience a more rapid decline in thinking skills, compared to older adults without hearing problems.

Researchers from Johns Hopkins School of Medicine in Baltimore studied 1,984 men and women in their seventies and eighties. At the beginning of the study, most of the participants (1,162) did have some hearing loss, but none exhibited signs of impaired memory or thinking ability.

During a six-year follow-up period, the participants underwent periodic testing to assess their memory, concentration and language skills. During that interim, 609 of them showed new signs of mental decline. Interestingly, the risk was 24 percent higher in those who had hearing deficits.

This study, which was funded by the U.S. National Institutes of Health, did not prove a cause and effect relationship between hearing loss and dementia. However, it did underscore the importance of having one’s hearing checked regularly by a qualified health professional as one ages.

Hearing problems might contribute to declines in cognitive function by promoting social isolation. When it is difficult to hear what others are saying, some elders tend to avoid interaction. Previous research has connected social withdrawal to an elevated risk for dementia.

Also, it is possible that hearing loss might cause one’s brain to expend extra energy trying to process the "garbled" input that it is receiving through the ears. This could mean taking resources away from other brain functions such as memory.

Hearing loss impacts approximately two-thirds of persons over age seventy. Hearing aids and other assistive devices, for example, telephone amplifiers may be helpful. Whether successfully treating hearing impairment can slow down declines in cognitive function is a question soon to be tackled by the research team that conducted this investigation.

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Decision-Making and White Matter

Thursday, September 27th, 2012 by American Senior Fitness Association   View This Issue of Experience!

A recent imaging study indicated that there is a decline with aging in an individual’s ability to make decisions in situations that are new to him or her. This appears to be due to changes in the white matter of the brain, according to research conducted at Vanderbilt University in Nashville, Tennessee, and published in the Journal of Neuroscience.

To better understand this research, note the following brief descriptions of certain parts of the brain:

  • Medial prefrontal cortex (located within the cerebral cortex): it plays an important role in decision-making;
  • Ventral striatum (located more deeply in the brain): it is involved in motivational and emotional behaviors; and
  • Thalamus (also located deeper in the brain): it is a complex, sophisticated relay center.
  • Researchers found that age-related losses in decision-making capability are connected with a weakening of two white-matter pathways linking the medial prefrontal cortex with the ventral striatum and the thalamus.

    The 25 adult subjects of the study (ages 21 to 85) undertook a cognitive task that involved money and also underwent MRI brain scans. The study’s lead author Gregory Samanez-Larkin stated in a Vanderbilt University news release: "The evidence that this decline in decision-making is associated with white-matter integrity suggests that there may be effective ways to intervene. Several studies have shown that white-matter connections can be strengthened by specific forms of cognitive training."

    Editor’s note: For an in depth exploration of cognitive health in seniors, enroll in the American Senior Fitness Association (SFA) distance-learning program "Brain Fitness for Older Adults: How to Incorporate Cognitive Fitness into Physical Activity Programming."

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    More About the Brain

    Thursday, September 27th, 2012 by American Senior Fitness Association   View This Issue of Experience!

    Recent research undertaken at NYC’s State University of New York Downstate Medical Center, and published in the journal Frontiers in Evolutionary Neuroscience, indicated that worrying may have evolved in conjunction with intelligence as a critical survival mechanism in human beings.

    Scientists compared research subjects who had generalized anxiety disorder with subjects who did not have the disorder. They discovered that worry as well as high intelligence were connected with specific brain activity, measurable by changes in the brain’s white matter. The results suggest that anxiety (worry) may have evolved right alongside intelligence as an important means of survival.

    In a medical center news release, Professor Jeremy Coplan said: "While excessive worry is generally seen as a negative trait and high intelligence as a positive one, worry may cause our species to avoid dangerous situations, regardless of how remote a possibility they may be… In essence, worry may make people ‘take no chances,’ and such people may have higher survival rates. Thus, like intelligence, worry may confer a benefit upon the species."

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    Myth Bustin’

    Thursday, September 27th, 2012 by American Senior Fitness Association   View This Issue of Experience!

    An interesting investigation conducted recently by a University of Florida physician and his colleagues found that, contrary to popular belief, patients at teaching hospitals don’t fare worse when trainee doctors come on board. For details, see the following news release from UF&Shands Newsnet:

    A University of Florida physician and colleagues have “mythbusted” a notion long held in medical circles: patients at teaching hospitals fare worse in July when new medical graduates start their residency training and older residents take on more responsibilities. A large national study revealed no such “July phenomenon” or “July effect” — at least not in the field of neurosurgery.

    The findings were published recently in the journal Neurosurgery.

    “If anything goes wrong in July, then everyone’s quick to say ‘Do you see? It’s because of the July effect’ — but we saw no evidence for that,’ said senior author Dr. Brian Hoh, the William Merz associate professor of neurological surgery at the UF College of Medicine. “This study will raise thoughts and ideas about how we can improve training for residents and improve safety for patients.”

    The July phenomenon is infamous both among physicians and patients. Conventional wisdom has it that if you are going to be a patient at a teaching hospital, try not to go in July.

    The graduate medical year starts on July 1, at which time recent medical school graduates start bearing responsibility for patients for the first time, and previous interns and residents move up a level, taking on new and unfamiliar tasks.

    Previous studies of the July phenomenon in fields such as general surgery, obstetrics, gynecology and internal medicine have yielded inconsistent results, some finding an effect and others finding none. Hoh, a member of UF’s McKnight Brain Institute, wanted to see what happens in neurosurgery, where doctors train for many years to gain proficiency in complex and delicate brain surgeries. One earlier study of pediatric neurosurgery found no effect, whereas another study found a small effect.

    Seeking a clearer view, Hoh and colleagues at UF and Harvard’s Massachusetts General Hospital analyzed more than 850,000 teaching hospital admission and patient-outcome records from a database called the National Inpatient Sample. They assessed the rates of patient deaths and surgical complications in July compared with all other months, from 1998 to 2008.

    The researchers evaluated four brain conditions that were representative of diseases commonly treated at teaching hospitals: nontraumatic hemorrhage, central nervous system trauma, central nervous system tumor and hydrocephalus.

    After taking variations in patient demographics and hospital characteristics into account, the researchers found that the risk of death or complications at teaching hospitals was the same in July as in other months. The results reflected those at nonteaching hospitals used for comparison.

    “If you’ve got new physicians on the job and you’ve got physicians that have just been promoted to a new level, it’s sort of the perfect storm for medical errors — it makes intuitive sense, but for a variety of peculiar reasons it’s just not the case,” said Dr. Hunt Batjer, the Lois C.A. and Darwin E. Smith Distinguished Chair in Neurological Surgery at the University of Texas Southwestern Medical Center and chair of the Residency Review Committee for neurological surgery of the
    Accreditation Council for Graduate Medical Education, the body that certifies post-medical school training for the entire U.S. Batjer was not involved in the study.

    The authors say multiple layers of supervision seem to more than compensate for the inexperience of young physicians, providing a safety net for patients.

    “Maybe in July, that oversight is heightened because supervising physicians pay more attention to what new residents and interns are doing,” said Hoh, who practices at Shands at UF medical center.

    Still, the researchers point out, there might have been near misses in which errors or complications were averted, but there was no way to identify from the database whether such occurrences increased in July compared with other months.

    “In some ways, I hope people continue to talk about the July effect or the August effect,” Batjer said. “It will force us to remain vigilant.”

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