New Philips study reveals seniors with common chronic conditions had an increased fall rate up to 54 percent

 Analysis of 145,000 Philips Lifeline users indicates that seniors with cognitive impairment, COPD and diabetes fell more often...Understanding the fall risk associated with seniors is the first step to prevention'

September 30, 2015/PRNewswire/ -- Royal Philips (NYSE: PHG; AEX: PHIA) today announced new study results demonstrating an insightful correlation between chronic conditions and falls risk. 

Philips' researchers retrospectively analyzed the records of 145,000 seniors equipped with a standard Philips Lifeline medical alert service or a medical alert service with AutoAlert (automatic fall detection) between January 2012 and June 2014. 

Data showed seniors with chronic conditions fell and required emergency transport up to 54 percent more often, compared to their peers with no chronic conditions. Additionally, the analysis revealed that seniors with physical conditions not typically tied to frailty, including COPD and diabetes, also were shown to fall more often.

In the United States, one in three seniors fall each year and about 75 percent of healthcare costs are spent on chronic diseases. 

Understanding the fall risk associated with seniors, especially those living with chronic conditions, is the first step to prevention, and by providing prompt care, outcomes can be improved and costs related to direct medical assistance better managed. 

Driving visibility to the need to take preventative steps can help this population prepare appropriately and help them get fast access to help when needed.

"While conditions like Parkinson's disease and osteoporosis are more obviously tied to falls, we're learning that other common chronic diseases, like diabetes and COPD, have a direct correlation to increased frailty and falls," 

said Kimberly O'Loughlin, Senior Vice President and General Manager of Home Monitoring, Philips. 

"As we use better, more personal information, we will be able to do an increasingly better job of keeping our loved ones safer and healthier in their homes."  

With 5.3 million Americans suffering from Alzheimer's³, 24 million from COPD⁴ and 29 million from diabetes⁵, chronic conditions are a growing concern in the U.S. In fact, 80 percent of the senior population has at least one chronic condition and 68 percent has two or more⁶. Among Philips Lifeline HomeSafe with AutoAlert users, seniors who self-reported suffering from three chronic conditions had 15 percent more falls that required hospital transport, and those with five or more conditions had 40 percent more falls than those with no chronic conditions. Within the study population, 72 percent reported having one or more chronic conditions, with 20 percent reporting five or more.

The data shows that seniors fell more often and needed hospital transport when reporting the following:

• Cognitive impairment by 54 percent;
• COPD by 42 percent;
• Diabetes by 30 percent; and
• Heart condition by 29 percent.

The complete findings⁷ are available at www.lifeline.philips.com/resources/fall-risk.

Philips is a leading provider of population health management solutions that improve outcomes and efficiency through coordinated care, real time analytics and patient engagement services. Through Philips Lifeline with AutoAlert, which can provide access to help if it detects falls that otherwise would not be reported, seniors can maintain their independence and avoid potential hospitalization resulting from complications of long lie times⁸. Additionally, in its continuing effort to support this population, Philips Home Monitoring recently launched CareSage in the U.S., a new predictive analytics engine that provides analysis of real-time and historical data from healthcare providers and Philips Lifeline AutoAlert technology. CareSage proactively identifies patients most likely to need to be transported to a hospital within the next 30 days so clinicians can provide timely intervention.

October is National Breast Cancer Awareness Month

Newswise, September 30, 2015– Roughly 230,000 women in the United States will develop breast cancer this year. Nearly 90% of women survive breast cancer five years, and beyond. The right treatment choices set the stage for life.

Often, a woman’s visceral response to a breast cancer diagnosis is, “I need to act fast. I want to be done with cancer - remove my breasts.” 

The truth is, women have time to evaluate thoughtful, personalized treatment decisions with their doctor.

Conversations with doctors about treatment options help women achieve the best outcome and maintain quality of life whether they are diagnosed with an early form of breast lesions called ductal carcinoma in situ (DCIS) or metastatic disease that has spread from the breast to other organs.

“A woman should carefully consider how treatment choices, from a breast-conserving lumpectomy to double mastectomy, systemic treatment options such as chemotherapy, anti-estrogen therapy, and breast radiation improve her chances of living cancer-free with the best quality of life based on her unique breast cancer,” says Charles L. Shapiro, MD, Co-Director of the Dubin Breast Center and Director of Translational Breast Cancer Research at the Tisch Cancer Institute at Mount Sinai.

“Mounting medical evidence shows more aggressive treatments may not yield better outcomes for all cancers.” 

“There’s no one-size-fits-all approach" to breast cancer, says Elisa Port, MD, Chief of Breast Surgery and Co-Director of the the Dubin Breast Cancer at The Mount Sinai Hospital. “You want a surgeon who focuses specifically on breast cancer, who is equipped to help you determine what’s best for you.” 

Understanding Risk & Options

Genes & Family History: Both are important in deciding your age for screening mammography and in weighing prophylactic treatment options.
Five to 10% of breast cancers are linked to gene mutations (commonly in BRCA1 & BRCA2) and 15% of women who get breast cancer have a family member with the disease .

More Treatment Isn’t Always Better: The average breast cancer patient who has bilateral mastectomy will have no better survival than the average patient who spares the healthy breast by choosing lumpectomy plus radiation.

Don’t over-estimate risk: When a woman has breast cancer on one side, breast cancer can spread to other parts of the body, but only very rarely does it spread to the other breast. More common is to develop a new primary breast cancer in the other breast, but that too is only 5-10% at 10 years without any treatment. For those women who have estrogen receptor positive cancer treated with anti-estrogens, such as tamoxifen or aromatase inhibitors, the rates are cut in half, about 2.5-5% at 10 years. 

About the Dubin Breast Center
Encompassing more than 15,000 square feet at 1176 Fifth Avenue, the Dubin Breast Center represents a bold new vision for breast cancer treatment and research—one that focuses on the emotional, as well as the physical health of individuals who have or are at risk of developing breast cancer, as well as survivors and their families, and breast cancer related research aimed at improving treatment choices and survival. 

The Center also includes an evaluation and treatment center for breast medical oncology and an infusion center for chemotherapy. Additional services include screening, genetic and nutritional counseling, access to research protocols and trials, breast reconstruction, psychosocial support and other complementary services, such as massage therapy, for the patient and his or her family. 

About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—.from community-based facilities to tertiary and quaternary care. 

The System includes approximately 6,100 primary and specialty care physicians; 12 minority-owned free-standing ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers.

 Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. Seven departments at The Mount Sinai Hospital and one at the New York Eye and Ear Infirmary (NYEE) ranked nationally in the top 25 in the 2015-2016 “Best Hospitals” issue of U.S. News & World Report.Mount Sinai’s Kravis Children’s Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report. 

For more information, visit http://www.mountsinaihealth.org/or find Mount Sinai on Facebook, Twitter and YouTube.

Blood Pressure Under Pressure

Newswise, September 28, 2015— Suddenly, people with high blood pressure and their health care providers have a bigger chance of protecting their health, but also a bigger challenge doing it.

A major study has found that lowering one type of blood pressure to well below the commonly recommended level also greatly lowered the number of cardiovascular events and deaths among people at least 50 years old with high blood pressure.

That’s very big news, considering that approximately one out of every three adults in the U.S. has high blood pressure (also known as hypertension) — which puts them at risk for heart disease, stroke, kidney failure and other health problems. Adults more than 54 years old and blacks have even greater incidence of high blood pressure.

The National Heart, Lung and Blood Institute, which sponsored the study, announced some preliminary results on Sept. 11. The findings of the Systolic Blood Pressure Intervention Trial, or SPRINT, were so definitive that it was stopped earlier than planned in order to share the results quickly.

“When the amount or type of blood pressure medication was adjusted to achieve a systolic blood pressure target of 120 mmHg compared to the higher target of 140 mmHg, cardiovascular events such as heart attack, stroke and heart failure were reduced by almost one-third, and the risk of death by almost one-fourth, observes Lynne T. Braun, PhD, CNP, a nurse practitioner in the Rush Heart Center for Women. 

“That’s important information, because more lives may be saved and more deaths may be prevented if we maintain lower blood pressure in our patients.”

“Another thing that was important to note in this study was that it examined a very diverse population. It seems to apply across the board,” adds Braun, who was not involved in the study.

Braun, who also is a professor in the Department of Adult Health and Gerontological Nursing in the Rush University College of Nursing, offered the following insights into the study and its implication for high blood pressure patients and their care.

When is blood pressure considered too high, and how low was the target before the study results were announced?

Braun: High blood pressure is defined as a systolic blood pressure of 140 mmHg or greater and/or a diastolic blood pressure of 90 mmHg or greater. (Systolic and diastolic blood pressure measure the pressure on heart vessels when the heart is pumping and at rest, respectively. The acronym mmHg represents a common unit of pressure.) For quite a long time, the medical community has debated how low blood pressure should be lowered. Our goal was a blood pressure of less than 140 over 90 for most people, although guidelines published in 2013 stated that the target for people age 60 and older was less than 150/90 mmHg.

What should the new blood pressure target be based on these study findings?

Although we have some information about the results, we don’t know exactly how much blood pressure reduction occurred in order to achieve fewer cardiovascular disease events and deaths. We’re all being very cautious about this, because we want to see the full data. It’s supposed to be published before the end of the year.

At least we know systolic blood pressure should be below 140 and perhaps even lower. How is that information affecting how you care for your patients?

I’ve talked about it with patients. For example, I might see a patient who has a borderline blood pressure just above 140. I’ve said that down the road, it may not be good enough to keep you safe from heart attacks and strokes, and I tell them about this study. I ask what can we do.

I have to explore. If they’re on medication, is medication adherence an issue, do they take it as they should? What is their lifestyle? Is weight management an issue? What about sodium intake? Do they exercise? We go through the whole gamut of things about how we can get blood pressure controlled.

Will you try to get all your patients’ systolic blood pressure under 120?

It depends on the individual situation. If we have someone who is between 120 and 140, and if they’re on blood pressure medications or not, I would try to maximize lifestyle change at this point until I see all the data from the study.

But if somebody is between 140 and 150, I might think about increasing their dosage of the medication they’re taking. If they’re not doing much regarding lifestyle, and they’re willing to give it a good try, I would try that first.

It’s complicated, because it depends on what the risk factors are, whether they’ve already had a heart attack or stroke, if they’re overweight or obese. I would treat the person who is higher risk more aggressively sooner than somebody who only has high blood pressure and is at lower risk. Every person has to be evaluated as their own person, as an individual.

There’s some concern that it may take too much medication to get some patients’ blood pressure below 120, right?

It’s something we always have to keep in mind. We have to think about the number of medications we give people, whether or not there are drug interactions, whether or not there are side effects. There are other issues when you’re talking about multiple medications, such as cost, and adherence.

Realistically, we can’t get everybody down to 120. For an older person, it can be dangerous to keep them on so many medications that perhaps would cause unsafe side effects for them. diuretics (water pills), for example, can cause dehydration and dizziness in older people.

Sometimes we have to be happy having had some lowering of blood pressure with two or even three medications. Every patient needs to be treated individually.

You mentioned medication adherence. How do you handle it with patients?

I tell my patients it’s important that you take your medication every day as prescribed, and it’s important that you let me know if you think you’re having a side effect from the medicine, because we definitely will be able to provide an alternative. We have so many different blood pressure medications from different classes.

I also ask my patients to take their blood pressure at home. It helps my patients see the effect of their blood pressure treatments and helps me make better decisions about blood pressure management in the office.

What can you do besides medication to help patients reach this new target?

We always emphasize lifestyle changes in managing high blood pressure, because they do matter. If you walk 30 minutes a day, at least five times a week, you can reduce your blood pressure. If people who are overweight lose even five percent of their weight, their blood pressure will come down.

Across the board, we advise people to reduce their sodium intake, because Americans consume three to four times more salt than we need for adequate functioning of our bodies. Most people can cut back by doing things like not eating out as much, or requesting that their food is prepared with less salt, or not eating canned foods so much.

It’s important to maximize these lifestyle strategies anytime, because they’re healthy to begin with. They’re especially good for people who don’t have the blood pressure goal achieved that they should, and adding another drug might cause them side effects.

Good blood pressure control is important to prevent heart attacks, heart failure, strokes and kidney disease. Research like SPRINT helps us to know how far blood pressure should be lowered to prevent complications.

In Terminally Ill Patients, Some Types of Delirium Are a Sign of 'Imminent Death'

Newswise, September 24, 2015 - In cancer patients nearing the end of life, certain subtypes of delirium—specifically, hypoactive and "mixed" delirium—are a strong indicator that death will come soon, reports a study in Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of theAmerican Psychosomatic Society. The journal is published by Wolters Kluwer.

"Terminally ill patients with the hypoactive or mixed subtypes of delirium showed a higher probability of imminent death, with even earlier mortality among younger patients," according to the new research by Sung-Wan Kim, MD, and colleagues of Chonnam National University Medical School Gwangju, Republic of Korea. They believe their findings might help make more accurate predictions of survival in patients nearing the end of life.

Shorter Survival in Patients with Hypoactive/Mixed Delirium

The researchers looked at the relationship between delirium and survival time in 322 patients with terminal cancer entering palliative care. Delirium refers to confusion, altered awareness, or altered thoughts. It can result from many different illnesses, medications, and other causes.

Delirium was divided into subtypes according to standard DSM-5 criteria: hyperactive delirium, with increased motor activity, loss of control, and restlessness; hypoactive delirium, with decreased activity, decreased speech, and reduced awareness. 

Patients with normal psychomotor activity or fluctuating activity levels were classified as having "mixed" delirium.

About 30 percent of patients were diagnosed with delirium on entering palliative care. 

Of these, the delirium subtype was hyperactive in about 15 percent of patients, hypoactive in 34 percent, and mixed in 51 percent.

Survival time after entering palliative care was shorter for patients with delirium: median 17 days, compared to 28 days for those without delirium. However, the difference was significant only for patients with hypoactive or mixed delirium—with median survival times of 14 and 15 days, respectively.

These differences remained significant after adjustment for other factors. For patients with hyperactive delirium, survival was not different from that in patients without delirium.

While delirium was more common in older patients, the effects on time to death were actually stronger in younger patients. That was consistent with previous studies suggesting shorter survival times in younger patients diagnosed with delirium

Why are different delirium subtypes associated with differing survival times? It may have to do with differences in the underlying causes of and treatment responses. Hyperactive delirium is commonly related to reversible causes, such as medication side effects.

"In contrast, hypoactive delirium is generally related to hypoxia [decreased oxygen levels], metabolic disturbances, and multi-organ failure," Dr. Kim explains. "Therefore, hypoactive delirium could be associated with a higher mortality rate than hyperactive delirium."

Dr. Kim adds, "Also, the earlier mortality in younger patients overturns a conventional assumption for survival prediction of delirium. Although delirium was more prevalent in older patients, as known, the irony is that delirium predicted shorter survival in younger patients."

Accurate predictions of survival time in terminally ill patients are important for many reasons—"in terms of ensuring good clinical decision making, developing care strategies, and preparing for the end of life in a dignified manner." The researchers conclude, "Thus, the present findings could facilitate more precise predictions of survival, allowing families to prepare for the patient’s death."

Click here to read “Differential Associations Between Delirium and Mortality According to Delirium Subtype and Age: A Prospective Cohort Study.”

Articles: “Differential Associations Between Delirium and Mortality According to Delirium Subtype and Age: A Prospective Cohort Study.” (doi: 10.1097/PSY.0000000000000239)

Everyday Activity More Beneficial Than Occasional Strenuous Exercise for Parkinson’s Disease

Newswise, September 23, 2015 — New University of Michigan research finds people with Parkinson’s disease may want to consider attempting to do the dishes, fold the laundry and take strolls around the neighborhood in their quest to control their symptoms.

Parkinson’s patients often become sedentary because of motor symptoms such as gait, balance problems or falls, said study principal investigator Nicolaas Bohnen, M.D., Ph.D., director of the U-M Functional Neuroimaging, Cognitive and Mobility Laboratory.

Once patients feel unstable on their feet, they may develop a fear of falling and then get scared to do any activity at all. Bohnen’s team investigated whether participation in exercise, like swimming or aerobics, could help alleviate the motor symptoms that made these patients want to stay sedentary in the first place.

“What we found was it’s not so much the exercise, but the routine activities from daily living that were protecting motor skills,” Bohnen said. “Sitting is bad for anybody, but it’s even worse for Parkinson’s patients.”

The imaging study, now available online in Parkinsonism and Related Disorders, was conducted by U-M faculty who hold appointments in both radiology and neurology.

Researchers investigated the relationship between the duration of both non-exercise and exercise physical activity and motor symptom severity for 48 Parkinson’s disease patients over a 4-week period.

They performed PET brain imaging to measure dopamine levels and used a questionnaire to learn about how physically active the patients were, including both exercise and non-exercise activity. They found that non-exercise physical activity was linked to less severe motor symptoms.

Although loss of dopamine is a key brain change for Parkinson’s patients, and has been thought to be the main reason why Parkinson’s patients become more sedentary, the researchers found non-exercise physical activity protected motor skills even among patients with differing levels of dopamine.

“This may have a big impact for Parkinson’s patients,” said co-author Jonathan Snider, M.D., clinical lecturer of neurology at the University of Michigan.

“Not only worsening Parkinsonism but also increasingly sedentary behavior may explain more severe motor symptoms in advanced Parkinson’s disease.”

“I tell my patients to stand up, sit less, and move more,” said Bohnen, also professor of radiology and neurology at the University of Michigan, VA Ann Arbor Healthcare System staff physician and investigator in U-M’s Udall Center for Excellence in Parkinson’s Disease Research.

Additional authors: Martijn L.T.M. Müller, Ph.D., Vikas Kotagal, M.D., Robert A. Koeppe, Ph.D., Peter J.H. Scott, Ph.D., Kirk A. Frey, M.D., Roger L. Albin, M.D., all of U-M.

Funding: This research was funded by the Department of Veterans Affairs (grant I01RX000317), the Michael J. Fox Foundation and the National Institutes of Health (grants P01 NS015655 and RO1 NS070856). Support was also provided by the University of Michigan Udall Center of Excellence for Parkinson’s Disease Research (P50 NS091856-01).

Disclosure: The authors declare no conflict of interest relevant to this work.

Reference: “Non-exercise physical activity attenuates motor symptoms in Parkinson disease independent from nigrostriatal degeneration,” Parkinsonism and Related Disorders (2015).

Death & Money in the ICU: Pneumonia Findings Surprise Researchers

More research needed to figure out which patients need ICU care most

Newswise, September 23, 2015—When an older person gets hospitalized for pneumonia, where’s the best place to care for them? New research findings about deaths and health care costs in such patients fly in the face of conventional wisdom – and could change where doctors decide to treat them.

Seniors with this common lung infection, the researchers show, had a better chance of surviving if they went to an intensive care unit rather than a general hospital bed.

And despite the ICU’s reputation as a high-cost place to care for patients, the costs to Medicare and hospitals were the same for both groups.

The research, published in the new issue of JAMA by a University of Michigan Medical School team, focuses on those patients on the “bubble” – those who doctors could send to either an ICU bed or a general bed depending on their judgment.

Since pneumonia sends hundreds of thousands of seniors to the hospital each year, costing taxpayers billions of dollars, even a small difference in mortality risk and cost for some of those patients could make a big difference.

The researchers looked at data from 1.1 million hospital stays at 2,988 hospitals between 2010 and 2012.

“With several recent studies suggesting that too many people are going to the ICU when their risk of death is low, we were surprised that there was a benefit to ICU admission for these patients,” says Colin Cooke, M.D., M.Sc., M.S., the study’s senior author and an intensive care specialist and health care researcher at U-M.

“Now, our challenge is to do further work to determine just which patients will get the greatest benefit, and to determine what about ICU care makes a difference.”

Surprises in the data

Cooke and his colleagues, including first author and pulmonary and critical care fellow Thomas Valley, M.D., used Medicare data to see how many hospitalized patients with pneumonia survived and what their care cost.

At first, their results suggested the expected: Patients with an ICU stay were more likely to die, and their care cost more than a general bed stay, even taking into account differences between patients’ backgrounds and underlying conditions.

But then they used statistical techniques to focus in on pneumonia hospital stays where the choice of bed type appeared to be truly “discretionary” – on the borderline of needing intensive care, and up to a doctor’s judgment.

In all, about 13 percent of the patients were placed in an ICU bed only because they lived closest to a hospital that happened to place a high percentage of its pneumonia patients in ICU beds.

It was among these patients that the researchers found a nearly 6 percent improvement in survival associated with ICU admission for pneumonia. In all, 14.8 percent of those who went to an ICU died within 30 days, compared with 20.5 percent of those placed in a general bed.

The cost of caring for these patients was about the same no matter which kind of bed they were in. Medicare paid hospitals an average of about $9,900 for the ICU patients and $11,200 for the non-ICU patients.

Hospitals routinely accept less from Medicare than what it actually costs to care for patients with that form of insurance – but even these costs were about the same, $14,100 for ICU patients and $11,300 for non-ICU.

For older pneumonia patients, and their loved ones, the results suggest that asking the medical team about the possibility of escalating to ICU-level care is completely acceptable, and may remind clinicians of the potential benefit of ICU care for patients with pneumonia, Cooke notes.

And for policymakers and hospital administrators, the new findings reiterate that instead of focusing on whether America needs more or fewer ICU beds, additional research should be done on how best to use the ones we have, perhaps by better identifying which patients most need an ICU bed.

More research needed

The findings don’t apply to patients who clearly need an ICU – those who can’t breathe on their own and need mechanical ventilation, for instance – nor to those who have low risk of developing complications from pneumonia in the hospital.

“It’s very clear that there are some pneumonia patients who absolutely need to be in an ICU, and some who may not even need a hospital stay at all,” says Cooke, an assistant professor of pulmonary and critical care medicine. “We need to understand more about whether ICUs are being overused, or perhaps underused, for patients in the middle of the spectrum of severity, where physicians could reasonably disagree on whether they should be in an ICU or a general bed.”

This is especially important given the risks that ICU care can present -- including drug-resistant infections and the potential harms associated with invasive monitoring and procedures that intensive care teams are more likely to perform.

The authors point out that their findings need to be tested with a randomized controlled trial, which their statistical techniques try to replicate but can’t match. And, they caution that they don’t have data on the bills that individual doctors sent Medicare, nor the costs that occurred after a patient was discharged, just the hospital side of payment.

The team is evaluating if the ICU is beneficial for other conditions, including chronic obstructive pulmonary disease, congestive heart failure and heart attack.

They hope to do more to determine what characteristics made pneumonia patients most likely to do well after an ICU stay, and what factors make hospitals more or less likely to put “discretionary” pneumonia patients in an ICU bed.

“It’s very rare in medicine that we find something that saves lives and doesn’t cost more,” says Cooke.

“But perhaps this is one of them.”

In addition to Cooke and Valley, the paper’s authors include fellow Medical School faculty Michael Sjoding, M.D., and Theodore Iwashyna, M.D., Ph.D., and Andrew Ryan, Ph.D. of the U-M School of Public Health. Cooke and several of his co-authors are members of the U-M Institute for Healthcare Policy and Innovation, the Michigan Center for Integrative Research in Critical Care and the Center for Health Outcomes and Policy.

The research was funded by the National Institutes of Health (HL007749), the Agency for Healthcare Research and Quality (HS020672) and the VA Health Services Research and Development Service.

Reference: JAMA Sept. 22/29, DOI 

Researchers Identify Possible Physiological Cause of Brain Deficits with Aging

Newswise, September 23, 2015 — Like scratchy-sounding old radio dials that interfere with reception, circuits in the brain that grow noisier over time may be responsible for ways in which we slow mentally as we grow old, according to the results of new studies from UC San Francisco on young and older adults.

The new intracranial and electroencephalogram (EEG) research, published online September 22, 2015, in The Journal of Neuroscience, supports the neural noise hypothesis, which proposes that the signal-to-noise ratio in nerve circuits diminishes with aging and leads to worse performance.

The studies were designed and conducted by Brad Voytek, PhD, when he was a postdoctoral research fellow working in the lab of Adam Gazzaley, MD, PhD, professor of neurology, physiology and psychiatry at UCSF.

In two new experiments, Voytek, now an assistant professor of cognitive science and neuroscience at UC San Diego, found that background noise in key cortical regions of the brain responsible for higher functions was associated with poorer memorization of visual information, and that this noise also was associated with age.

He concluded that neural noise might be the mechanism behind aging-associated loss of cognitive ability, slowing of behavioral responses, uncertain memories and wavering concentration.

“Our measurement of noise seems to show up in aging, just as we thought it would,” Voytek said.

The noise measured in the studies was random signaling that did not fit the pattern of the brain’s natural oscillations. These oscillations are rhythmic patterns of electrical activity generated by nerve cells, or neurons, linked within the brain’s circuitry.

This activity occurs in addition to electrical signals generated by individual neurons.

In recent years brain oscillations have become an intense focus of research by Voytek and others seeking to discover any functional roles they might play. Emerging evidence suggests that oscillations might prime nerve circuits to respond more efficiently to stimuli.

“Imagine that individual neurons are like surfers,” Voytek said. “Nearby surfers experience the same waves, which are like the oscillations linking neurons in the brain. But like noise, additional interfering factors often disrupt the perfect wave at different times and different spots along the beach.”

In one experiment on 15 consenting subjects, Voytek collected and analyzed voltage measurements from electrodes placed directly in contact with cortical regions of the brain during surgery by neurosurgeons searching for the specific location that triggered each patient’s seizures.

The intracranial study design eliminated detection of confounding signals from muscle. The alert study subjects performed a listening task, which in one of Voytek’s earlier human studies resulted in a high degree of coordinated brain oscillations in these regions.

In the new experiment Voytek’s research team found that noise in the frontal cortex and in the temporal cortex was associated with age.

In the second experiment, the researchers collected data from EEG electrodes placed on the scalps of 11 healthy participants between the ages of 20 and 30 and 13 healthy participants between the ages of 60 and 70, while the research subjects performed a visual memorization test.

Researchers flashed one, two or three colored squares for less than one-fifth of a second, gave the subjects almost one second to memorize the colors, and then flashed a second display and asked the participants if the colors matched.

The researchers used mathematical algorithms to extract measures of noise in the oscillations from data collected during the interval when the subjects were trying to memorize the colors. 

On average, older subjects performed worse than younger subjects. The scientists determined that this poorer performance was due to additional noise in nerve circuits in the visual cortex; neurons did not appear to coordinate as well in generating lower-frequency oscillations.

When the researchers accounted for the noise, age was no longer an independent, significant factor in performance in this experiment.

Voytek suggested an analogy.

“A big group of friends can have a fairly normal conversation at home,” he said, “but in a crowded bar everyone keeps asking each other, ‘What did you say?’ Similarly, instead of having a normal conversation, the neurons that make up the memory networks in older adults seemed to be talking over one another, leading to a communication breakdown and degrading their memory performance.

“I think these types of experiments will allow neuroscientists to explore the neural underpinnings of cognitive changes across normal aging and in a variety of disease states, including autism, Parkinson’s and schizophrenia, each of which is associated with breakdowns in neural oscillations.”

The study was funded by the National Institutes of Health and by a University of California Presidential Postdoctoral Fellowship.

Additional authors include research specialists John Case and Zachari Tempesta from UCSF; Mark Kramer, PhD, assistant professor of mathematics, and Kyle Lepage, PhD, postdoctoral fellow, from Boston University; and Robert Knight, MD, professor of psychology, from UC Berkeley.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visitwww.ucsf.edu.

FTC Complaint Filed Against Maker of Memory Supplement Ad Watchdog Issues Warning to Consumers

September 22, 2015,  /PRNewswire/ -- With an aging baby-boomer population and an estimated 10 million Americans predicted to develop some form of brain disease, supplements claiming to help brain function are flooding the market. 

Wisconsin-based Quincy Bioscience, the self-proclaimed industry leader, has sold more than two million bottles of its jellyfish-based supplement Prevagen since its launch in 2007 on the premise that it is clinically proven to improve memory. But an investigation by ad watchdog TINA.org has found that the company does not have reliable scientific evidence to back up its claim and the organization has filed a deceptive advertising complaint with the Federal Trade Commission.

"Aging Americans should not be a target for unscrupulous marketers making empty promises that their miracle product can cure memory loss," said TINA.org Executive Director Bonnie Patten.

Prevagen is manufactured and marketed by Quincy Bioscience and sold at major retail stores such as CVS and Walgreens for between $40 and $60.

TINA.org's investigation found that the studies the company cites as evidence that Prevagen improves memory are riddled with deficiencies that render them unreliable.

In addition, according to Dr. David S. Seres, director of medical nutrition at Columbia University Medical Center, basic scientific principles do not support that the key ingredient in Prevagen – apoaequorin, a synthetic protein the company claims was originally found in bioluminescent jellyfish from Puget Sound — has any effect on memory.

"It is biologically inconceivable that taking a protein by mouth would have any effect on memory," Seres concluded.

TINA.org called on Quincy Bioscience to correct its deceptive advertising. After the company failed to respond, the ad watchdog filed a complaint with the FTC urging it to take action.

The memory supplement industry has faced increased scrutiny in recent months - this summer, the heads of the Senate's Special Committee on Aging sent letters to the FDA and more than a dozen major retailers including Amazon, Target and Google, requesting information on how the agency and companies safeguard consumers from dubious products for the brain.

For more on TINA.org's complaint regarding Prevagen: www.truthinadvertising.org/prevagen-ftc-complaint

Beet Juice Boosts Muscle Power in Heart Patients​​​

Newswise, September 21, 2015 — Scientists have evidence that Popeye was right: Spinach makes you stronger. But it’s the high nitrate content in the leafy greens — not the iron — that creates the effect.

Building on a growing body of work that suggests dietary nitrate improves muscle performance in many elite athletes, researchers at Washington University School of Medicine in St. Louis found that drinking concentrated beet juice — also high in nitrates — increases muscle power in patients with heart failure.

“It’s a small study, but we see robust changes in muscle power about two hours after patients drink the beet juice,” said senior author Linda R. Peterson, MD, associate professor of medicine.

“A lot of the activities of daily living are power-based — getting out of a chair, lifting groceries, climbing stairs. And they have a major impact on quality of life. We want to help make people more powerful because power is such an important predictor of how well people do, whether they have heart failure, cancer or other conditions.

“In general, physically more powerful people live longer.”

Based on research in elite athletes, especially cyclists who use beet juice to boost performance, the study’s corresponding author, Andrew R. Coggan​, PhD, assistant professor of radiology, suggested trying the same strategy in patients with heart failure.​​​​​

In the September issue of the journal Circulation: Heart Failure, the scientists reported data from nine patients with heart failure.

Two hours after the treatment, patients demonstrated a 13 percent increase in power in muscles that extend the knee. The researchers observed the most substantial benefit when the muscles moved at the highest velocities.

The increase in muscle performance was significant in quick, power-based actions, but researchers saw no improvements in performance during longer tests that measure muscle fatigue.

Patients in the study served as their own controls, with each receiving the beet juice treatment and an identical beet juice placebo that had only the nitrate content removed.

There was a one- to two-week period between trial sessions to be sure any effects of the first treatment did not carry over to the second. Neither the trial participants nor the investigators knew the order in which patients received the treatment and placebo beet juice.

The researchers also pointed out that participants experienced no major side effects from the beet juice, including no increase in heart rates or drops in blood pressure, which is important in patients with heart failure.

Heart failure can have various triggers, from heart valve problems to viral infections, but the result is the heart’s gradual loss of pumping capacity.

“The heart can’t pump enough in these patients, but that’s just where the problems start,” said Peterson, a cardiologist and director of Cardiac Rehabilitation at Washington University and Barnes-Jewish Hospital​.

“Heart failure becomes a whole-body problem because of the metabolic changes that happen, increasing the risk of conditions such as insulin resistance and diabetes and generally leading to weaker muscles overall.”

While the trial was not designed to find out whether patients noticed an improved ability to function in daily life, the researchers estimated the size of the benefit by comparing the improvement in muscle power with what is seen from an exercise program.

“I have compared the beet-juice effect to Popeye eating his spinach,” said Coggan, who specializes in exercise physiology. 

“The magnitude of this improvement is comparable to that seen in heart failure patients who have done two to three months of resistance training.”

The nitrates in beet juice, spinach and other leafy green vegetables such as arugula and celery are processed by the body into nitric oxide, which is known to relax blood vessels and have other beneficial effects on metabolism.

With the growing evidence of a positive effect from dietary nitrates in healthy people, elite athletes and now heart failure patients, the researchers also are interested in studying dietary nitrates in elderly populations.

“One problem in aging is the muscles get weaker, slower and less powerful,” Coggan said.

“Beyond a certain age, people lose about 1 percent per year of their muscle function. If we can boost muscle power like we did in this study, that could provide a significant benefit to older individuals.”

This work was supported by The Foundation for Barnes-Jewish Hospital, the Washington University Mentors in Medicine and C-STAR programs, and Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH).

Coggan AR, Leibowitz JL, Spearie CA, Kadkhodayan A, Thomas DP, Ramamurthy S, Mahmood K, Park S, Waller S, Farmer M, Peterson LR. Acute dietary nitrate intake improves muscle contractile function in patients with heart failure: a double-blind, placebo-controlled, randomized trial. Circulation: Heart Failure. September 2015.

Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

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Researchers Find Some Evidence of Link Between Stress, Alzheimer’s Disease

Newswise, September 21, 2015 — University of Florida Health researchers have uncovered more evidence of a link between the brain’s stress response and a protein related to Alzheimer’s disease.

The research, conducted on a mouse model and in human cells, found that a stress-coping hormone released by the brain boosts the production of protein fragments. Those protein pieces, known as amyloid beta, clump together and trigger the brain degeneration that leads to Alzheimer’s disease.

The findings were published recently in The EMBO Journalby a group that includes Todd Golde, M.D., Ph.D., director of the UF Center for Translational Research in Neurodegenerative Disease and a professor in the UF College of Medicine’s department of neuroscience.

The research contributes to further understanding the potential relationship between stress and Alzheimer’s disease, a disorder believed to stem from a mix of genetic, lifestyle and environmental factors.

The findings strengthen the idea of a link between stress and Alzheimer’s disease, Golde said.

“It adds detailed insight into the stress mechanisms that might promote at least one of the Alzheimer’s pathologies,” Golde said.

Figuring out the non-genetic factors that heighten the risk of Alzheimer’s disease is especially challenging, and the recent study is one step in a long process of looking at the effects of stress and other environmental factors, according to Golde. It could also point the way to a novel treatment approach in the future, he said.

Here is what researchers found: Stress causes the release of a hormone called corticotrophin releasing factor, or CRF, in the brain.

That, in turn, increases production of amyloid beta. As amyloid beta collects in the brain, it initiates a complex degenerative cascade that leads to Alzheimer’s disease.

During laboratory testing, mouse models that were exposed to acute stress had more of the Alzheimer’s-related protein in their brains than those in a control group, researchers found.

The stressed mice also had more of a specific form of amyloid beta, one that has a particularly pernicious role in the development of Alzheimer’s disease.

To better understand how CRF increases the amount of Alzheimer’s-related proteins, researchers then treated human neurons with CRF.

That caused a significant increase in the amyloid proteins involved in Alzheimer’s disease.

Those and other complex experiments reveal more about the mechanics of a likely relationship between stress and Alzheimer’s disease.

The stress hormone, CRF, causes an enzyme known as gamma secretase to increase its activity. That, in turn, causes more of the Alzheimer’s-related protein to be produced, Golde said.

Modifying environmental factors such as stress is yet another approach to warding off Alzheimer’s disease, and one that is easier than modifying the genes that cause the disorder, Golde said. One possible solution — blocking the CRF receptor that initiates the stress-induced process that generates Alzheimer’s-related proteins — didn’t work. Researchers are now looking at an antibody that could be used to block the stress hormone directly, Golde said.

“These softer, non-genetic factors that may confer risk of Alzheimer’s disease are much harder to address,” Golde said. “But we need more novel approaches in the pipeline than we have now.”

The idea of looking more closely at the mechanism linking stress and Alzheimer’s disease came from Seong-Hun Kim, M.D., Ph.D., a former assistant professor in the College of Medicine’s department of pharmacology and therapeutics and now a psychiatrist in Seattle.

Much of the project’s experiments were done by Hyo-Jin Park, Ph.D., who was a postdoctoral associate during the project and is now an assistant scientist in the College of Medicine’s department of aging and geriatric research. Kevin Felsenstein, Ph.D., an associate professor of neuroscience in UF’s College of Medicine, also made major contributions to the work.

The research was supported by multiple grants from the National Institutes of Health and the U.S. Department of Veterans Affairs.

Identifying Typical Patterns in the Progression Towards Alzheimer's Disease

Newswise, September 21, 2015 — How the brain progresses from mild cognitive impairment (MCI) to Alzheimer's-type dementia has been an enigma for the scientific community.

However, a recent study by the team of Dr. Sylvie Belleville, PhD, Director of the Research Centre at the Institut universitaire de gériatrie de Montréal (Montreal Geriatric Institute) and Professor of Psychology at Université de Montréal, has shed light on this progression by showing the typical patterns of the brain's progression to dementia.

For the study, the team compared changes that occurred over many years in people with stable MCI with changes in people for whom MCI progressed to a diagnosis of Alzheimer's.

Dr. Belleville worked with doctoral student Simon Cloutier and a team of clinician researchers from Montreal. This study was funded by the Canadian Institutes of Health Research (CIHR) and was published in theJournal of Alzheimer’s Disease.

The study showed that different cognitive areas (language, inhibition, visuo-spatial processing, working memory, executive functions, etc.) do not change in a uniform way.

Cognitive decline does not occur in a linear fashion; instead, the path to dementia is complex and may sometimes be characterized by periods of stability followed by accelerated decline one or two years before diagnosis.

“We've identified a profile of changes that characterizes people who progress towards dementia. In reality, a quick decline in episodic and working memory associated with language problems appears to be the typical profile of people who have a high risk of developing dementia within a short amount of time,” the researcher explained.

Instead of seeing this as bad news, Dr. Belleville views these results as hope for seniors who are worried about their memories.

“Many people complain about their memories. However, the presence of a change is what determines the risk of progression.”

This study has let us characterize the parameters of decline in people who will eventually develop Alzheimer's, which means we can better identify both benign symptoms and those that warrant particular attention.

Rapid memory decline suggests that the onset of symptoms is probably due to a loss of the brain's compensatory mechanisms.”
Alzheimer's disease is diagnosed late in its progression and sometimes up to fifteen years after its first effects on the brain. It is important to identify the early indicators so that patients can receive treatment as soon as possible.