Patients with High-Risk Macular Degeneration Show Improvement with High-Dose Statin Treatment

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Newswise, February 5, 2016-- Researchers at Massachusetts Eye and Ear/Harvard Medical School and the University of Crete have conducted a phase I/II clinical trial investigating the efficacy of statins (cholesterol-lowering medications) for the treatment of patients with the dry form of age-related macular degeneration (AMD) — the leading cause of blindness in the developed world.

Although effective treatments are available for the wet form of AMD, they are currently lacking for the more prevalent dry form. The researchers found evidence that treatment with high-dose atorvastatin (80mg) is associated with regression of lipid deposits and improvement in visual acuity, without progression to advanced disease, in high-risk AMD patients.

Their findings were published in EBioMedicine—a new online journal led by editors of the journals Cell andThe Lancet—and not only further the connection between lipids, AMD and atherosclerosis, but also present a potential therapy for some patients with dry AMD.

“We found that intensive doses of statins carry the potential for clearing up the lipid debris that can lead to vision impairment in a subset of patients with macular degeneration,” said Joan W. Miller, M.D., the Henry Willard Williams Professor and Chair of Ophthalmology at Harvard Medical School and Chief of Ophthalmology at Massachusetts Eye and Ear and Massachusetts General Hospital.

“We hope that this promising preliminary clinical trial will be the foundation for an effective treatment for millions of patients afflicted with AMD.”

Affecting more than 150 million patients worldwide, AMD is associated with an accumulation of drusen (deposits of lipid and fatty proteins) under the retina, and patients with AMD experience blurred vision or blindness in the center of the visual field.

There are two forms of AMD: “wet” and “dry.” The wet form accounts for approximately 15 percent of AMD cases and is treated using therapies previously developed at Mass. Eye and Ear/Harvard Medical School. The “dry” form is more common, accounting for approximately 85 percent of cases, and effective therapies are currently lacking.

Ophthalmologists and vision researchers have long suspected that there may be a connection between dry AMD and atherosclerosis. In dry AMD, physicians often see soft, lipid-rich drusen in the outer retina, similar to the build-up of lipid material in the inner walls of blood vessels in atherosclerosis.

Statin use is widespread in middle-aged and older individuals, who also have an increased risk of AMD; however, previous studies have shown very little correlation between regular statin use and improvements in AMD. The authors of the EBioMedicine paper hypothesized that, due to the heterogeneous nature of the disease, patients with soft, lipid-rich drusen may respond better to statins prescribed at higher dosages.

“Not all cases of dry AMD are the exactly the same, and our findings suggest that if statins are going to help, they will be most effective when prescribed at high dosages in patients with an accumulation of soft, lipid material” said Demetrios Vavvas, M.D., Ph.D., a clinician scientist at Mass. Eye and Ear and Co-Director of the Ocular Regenerative Medicine Institute at Harvard Medical School.

“These data suggest that it may be possible to eventually have a treatment that not only arrests the disease but also reverses its damage and improves the visual acuity in some patients.”

Twenty-three patients with dry AMD marked by soft lipid deposits in the outer retina were prescribed a high dose (80mg) of atorvastatin, the generic name of the statin marketed as Lipitor® and several generic equivalents. Of the 23 patients, 10 experienced an elimination of the deposits under the retina and mild improvement in visual acuity.

Other techniques that have attempted to eliminate the deposits have mostly failed with the disease continuing to progress to more advanced dry AMD or a conversion to the wet form of AMD.

As the next step for this line of research, the investigators plan to expand to a larger prospective multicenter trial to further investigate the efficacy of the treatment in a larger sample of patients with dry AMD.

“This is a very accessible, FDA-approved drug that we have tremendous experience with,” said Dr. Vavvas.

“Millions of patients take it for high cholesterol and heart disease, and based on our early results, we believe it offers the potential to halt progression of this disease, but possibly even to restore function in some patients with dry AMD.”

Wading Into the National Debate Over the Delivery of Primary Care: A Basis for Optimism

MD and NP applaud steps to define the concept of primary care in JAGS co-authored editorial; call for better data, measures to help achieve best outcomes for older adults with chronic illnesses

MD and NP applaud steps to define the concept of primary care in JAGS co-authored editorial; call for better data, measures to help achieve best outcomes for older adults with chronic illnesses.

Newswise, January 11, 2016 — There is an ongoing national debate, heated at times, amongst health professionals concerning nurse practitioners (NPs) taking on the role of primary care physicians (MDs).

An increasing number of states have been allowing NPs with advanced degrees to practice without the direct oversight of an MD, effectively allowing NPs to be the sole provider of primary care.

Such legislation has been the response to a general shortage of primary care physicians, especially in rural areas.

In a recent issue of the Journal of the American Geriatrics Society (JAGS) [Vol. 63, #10, October 2015], the lead article, “Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians,” by Yong-Fang Kuo, PhD, compares processes and cost of care among older diabetes patients cared for by NPs versus MDs in a retrospective cohort study.

Alongside the study, JAGS’ editors also chose to publish a commentary editorial entitled “The Eye of the Beholder,” authored by Dr. Robert Kane, MD, School of Public Health, University of Minnesota, and Eileen M. Sullivan-Marx, PhD, RN, College of Nursing, New York University.

Kuo and his colleagues, utilized data from patients with a diagnosis of diabetes in 2009 (n=64,354) who received all their primary care from NPs or MDs, selected from a national sample of Medicare beneficiaries.

They concluded that compared to MDs, NPs were either similar or slightly lower in their rates of diabetes guideline concordant care. NPs used specialist consultations more often but had similar overall costs of care to MDs.

“The basic message is that the original study found a very small difference that was statistically significant because of very large sample sizes from an administrative data base,” said Dr. Kane. “Pragmatically the results suggest no clinically important difference.”

“This is a case of cup perspective—an example of the phenomenon of point of view,” notes Sullivan-Marx. “Kuo and his team use these findings to suggest that the quality of care that NPs provide is less than that of physicians, but the performance seems similar.”

“At the very time when society faces a boom in chronic disease, there is a bust in primary care,” Sullivan-Marx adds. “NPs represent an important resource to help address this imbalance.”

Dr. Kane and Sullivan-Marx note that the Kuo study limits the definition of “primary care provider” by stipulating that care be provided by only one type of practitioner.

Such a definition marginalizes the idea that primary care can be a collaborative effort between practitioners, and “what we do know about diabetes care,” says Dr. Kane, “is that personal engagement, use of teams of caregivers, including nutritionists, leads to better overall patient outcomes.”

Dr. Kane and Sullivan-Marx stress that the concept of primary care remains elusive, but not unattainable.

“Efforts to use the best available administrative data to identify processes and outcomes of primary care have been frustrating, particularly so for older adults with complex chronic illnesses,” admitted Sullivan-Marx.

“The data are incomplete in these databases, and incomplete data can be misleading.”

“Sadly, the range of concerns underlying today’s concept of coordinated, continuous, comprehensive primary care gets lost on specialists, who too often are delivering the bulk of the care to many older people.” said Dr. Kane.

“At a time when it is a struggle to fill the primary care gap, NPs should be viewed as valued partners.”

“Kuo et al. have embraced the challenge to ascertain answers to these important questions using available, if incomplete data,” concludes Dr. Kane and Sullivan-Marx, “leaving us to recognize that better data and better measures are needed to understand how to achieve the best outcomes.”

Poor Air Quality Increases Heart Patients’ Risk of Suffering Most Serious Type of Heart Attack, New Study Finds

Newswise, November 9, 2015— People with heart disease face an increased risk of a serious heart attack during poor air quality days, according to a major new study presented today (Sunday, Nov. 8) at the American Heart Association Scientific Session in Orlando.

The study of more than 16,000 patients by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City examined patients who had suffered three types of heart attacks – STEMI, non-STEMI, and unstable angina – to identify which type of heart attack was more likely on days when the air was especially polluted.

For the study, researchers compared air quality measurements to the number of patients treated for heart attacks at Intermountain Healthcare hospitals in the urban areas in and around Salt Lake City between Sept. 1993 and May 2014.

The Intermountain Medical Center Heart Institute research team identified a strong association between bad air quality days – those with a threshold above 25 micrograms of fine particulate matter per cubic meter of air – with a greater risk of STEMIs, the most dangerous type of heart attack.

Findings of the study were reported at the 2015 American Heart Association Scientific Session in Orlando on Sunday, November 8, 2015.

“Our research indicated that during poor air quality days, namely those with high levels of PM2.5, patients with heart disease are at a higher risk of suffering from a STEMI heart attack,” said Kent Meredith, MD, cardiologist and researcher at the Intermountain Medical Center Heart Institute.

A ST-segment elevation myocardial infarction, or STEMI, is a serious form of a heart attack in which a coronary artery is completely blocked and a large part of the heart muscle is unable to receive blood. 

If left untreated for too long, the lack of oxygen to the heart will damage the heart muscles and cause irreparable damage or death.

“By making this association, physicians can better counsel their heart patients to avoid exposure to poor air quality, and thus decrease their chances of suffering a heart attack on days that they are potentially at highest risk,” said Dr. Meredith.

“The study suggests that during many yellow air quality days, and all red quality air days, people with known coronary artery disease may be safer if they limit their exposure to particulate matter in the air by exercising indoors, limiting their time outdoors, avoiding stressful activities, and remaining compliant with medications,” said Dr. Meredith.

“These activities can reduce inflammation in the arteries, and therefore make patients less sensitive to the fine particulate matter present on poor air quality days.”

Other members of the study include C. Arden Pope; Joseph B. Muhlestein, MD; Jeffrey L. Anderson, MD; John B Cannon, Nicholas M. Hales; Viet Le; and Benjamin Horne.

Intermountain Medical Center is the flagship facility for the Intermountain Healthcare system, which is based in Salt Lake City.

Helping patients with movement disorders regain control of their lives

October 26, 2015 /PRNewswire-USNewswire/ -- Movement — even something as basic as picking up a piece of paper— appears to be simple to most people, but is actually a complex process.  It requires several different parts of the brain to work together with many muscle groups.

"There are continuous to and from communications between the brain, muscles and nerves," says Toby Yaltho, M.D., neurologist and movement disorders specialist with Methodist Sugar Land Neurology Associates. 

"These regulate the power, speed, coordination and balance necessary for smooth actions. A movement disorder results from the alteration of these communications and can sometimes lead to difficulty walking, involuntary movements, tremors or problems with posture and balance."

They are widely prevalent and some are genetic in nature.

The most common movement disorder is essential tremor. It affects one in 20 people over the age of 40, and the prevalence increases with advancing age. The disorder is typically characterized when a tremor or shaking occurs when attempting to perform a task.

Parkinson's disease is a movement disorder that affects more than one million people in the United States. Approximately 60,000 Americans are diagnosed with Parkinson's disease each year.

The incidence increases with age and is more common in people older than 65 years of age. Parkinson's is characterized by rigidity of muscles, tremor and slow movement. 

 "The proper treatment of movement disorders requires a great deal of coordination and communication between physician and patients," adds Yaltho who is board certified in both neurology and sleep medicine and fellowship trained in movement disorders and neurophysiology.

"Seeing an experienced specialist who understands available treatment options is important. I follow my patients very closely and make adjustments as necessary."

Yaltho can help alleviate a full range of movement disorders, including ataxia, dystonia, essential tremor,Huntington's disease, multiple system atrophy, myoclonus, Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, tardive dyskinesia, Tourette syndrome and Wilson's disease 

October 19, 2015--Oregon Health & Science University today released an iPhone app designed to advance melanoma research by giving users the ability to accurately measure and monitor moles, and contribute photos of how their potential trouble spots evolve over time. 

Called Mole Mapper, the app is free to download from the App Store and was developed using ResearchKit, an open source framework developed by Apple.

Equipping individuals en masse to use their iPhone cameras to chronicle subtle changes in spots on their skin, and share that photographic data with scientists, will accelerate an interactive, grassroots-style public health initiative underway at the OHSU Knight Cancer Institute to better understand the precursors for lethal melanomas and make headway in reducing deaths from the disease.

Mole Mapper allows individuals to photograph and measure mole sizes relative to a common reference object, like a coin, over time. In addition to providing a more accurate method for tracking, the app gives individuals the opportunity to contribute to a melanoma research initiative.

Dan Webster, a cancer biologist, created this app to help monitor his wife’s moles between visits to the dermatologist. He then teamed with OHSU’s Sancy Leachman, M.D., Ph.D., chair of the Department of Dermatology in the OHSU School of Medicine and director of the OHSU Knight Cancer Institute’s Melanoma Research Program. Sage Bionetworks, a nonprofit research institute whose efforts are aimed at leveraging the power of science to solve complex scientific problems, is a key partner and world leader in managing and analyzing big data.

“It’s amazing to think this app — something I created in my spare time — now has the capacity to involve so many people in the fight against melanoma,” said Webster. “Tracking your moles on your phone now gives you the opportunity to contribute to cancer research. It’s incredible.”

App users can maintain their images exclusively on their phones for later sharing with a dermatologist; or, after signing an electronic consent form, they can enroll in the OHSU Knight Cancer Institute Melanoma Community Registry to learn more about current research and educational opportunities focused on early detection, prevention and survivorship. Since Leachman launched the registry in 2014, more than 3,600 melanoma survivors, family members and friends have joined. Her hope is that the Mole Mapper app will expand that number into the tens of thousands.

“Our hypothesis is that digital images taken by members of the public on cell phones could one day be used to develop diagnostic algorithms for melanoma,” said Leachman. “To test this theory, we need a large number of images, and that’s where our partnership with Apple and Sage Bionetworks is key.”

“This is just the beginning of the War on Melanoma,” added Leachman. “We now have the unprecedented opportunity to bring in more data than ever to fuel research. This can be another tool to empower patients to take charge of their health monitoring. It also gives health care providers additional data to inform patient recommendations and diagnoses.”

The earlier melanoma is detected, the more likely it can be cured. The data collected with the Mole Mapper app will help inform research into the types of changes in skin that are the most meaningful in detecting lethal forms of the disease. This data will complement other efforts underway at the OHSU Knight Cancer Institute’s Melanoma Research Program and Department of Dermatology to better understand the biological drivers of melanoma so the disease can be more effectively detected and treated.

The OHSU Knight Cancer Institute recently raised $1 billion to fund, among other things, the launch of a large-scale program to advance the early detection of lethal cancers. The campaign was fueled by a $500 million pledge from Nike co-founder Phil Knight and his wife Penny.

About the Knight Cancer Institute



The Knight Cancer Institute at Oregon Health & Science University helped pioneer the field of precision cancer medicine. The institute's director, Brian Druker, M.D., proved it was possible to shut down just the cells that enable cancer to grow without harming healthy cells. This research breakthrough has made possible precision treatments that have transformed once-fatal forms of the disease into manageable conditions. The OHSU Knight Cancer Institute is the only National Cancer Institute-designated Cancer Center between Sacramento and Seattle – an honor earned only by the nation's top cancer centers. It offers the latest treatments and technologies as well as hundreds of research studies and clinical trials.

About OHSU



Oregon Health & Science University is a nationally prominent research university and Oregon’s only public academic health center. It serves patients throughout the region with a Level 1 trauma center and nationally recognized Doernbecher Children’s Hospital. OHSU operates dental, medical, nursing and pharmacy schools that rank high both in research funding and in meeting the university’s social mission. OHSU’s Knight Cancer Institute helped pioneer personalized medicine through a discovery that identified how to shut down cells that enable cancer to grow without harming healthy ones. OHSU Brain Institute scientists are nationally recognized for discoveries that have led to a better understanding of Alzheimer’s disease and new treatments for Parkinson’s disease, multiple sclerosis and stroke. OHSU’s Casey Eye Institute is a global leader in ophthalmic imaging, and in clinical trials related to eye disease.

Stem Cell Treatment Lessens Impairments Caused by Dementia with Lewy Bodies

Study finds significant improvements in both motor and cognitive function

Newswise, Oct. 16, 2015 — Neural stem cells transplanted into damaged brain sites in mice dramatically improved both motor and cognitive impairments associated with dementia with Lewy bodies, according to University of California, Irvine neurobiologists with the Sue & Bill Gross Stem Cell Research Center and the Institute for Memory Impairments and Neurological Disorders.

DLB is the second-most common type of age-related dementia after Alzheimer’s disease and is characterized by the accumulation of a protein called alpha-synuclein that collects into spherical masses called Lewy bodies – which also accumulate in related disorders, including Parkinson’s disease. 

This pathology, in turn, impairs the normal function of neurons, leading to alterations in critical brain chemicals and neuronal communication and, eventually, to cell death.

The UCI researchers, led by associate professor of neurobiology & behavior Mathew Blurton-Jones and doctoral student Natalie Goldberg, hope that one day transplantation of neural stem cells into human patients might help overcome the motor and cognitive impairments of DLB.

To test this idea, they transplanted mouse neural stem cells into genetically modified mice exhibiting many of the key features of DLB. 

One month later, the mice were retested on a variety of behavioral tasks, and significant gains in both motor and cognitive function were observed. For example, these mice could run on a rotating rod for much longer and recognize novel objects far better than untreated DLB mice.

To understand how stem cell transplantation alleviated impairments, Goldberg and colleagues examined the effects of the stem cells on brain pathology and circuitry connecting neurons. 

They found that functional improvements required the production of a specific growth factor – called brain-derived neurotrophic factor – by neural stem cells.

The team examined two of the key brain structures that become dysfunctional in DLB – dopamine- and glutamate-making neurons – to determine how BDNF might drive recovery. 

“Our experiments revealed that neural stem cells can enhance the function of both dopamine-and glutamate-producing neurons, coaxing the brain cells to connect and communicate more appropriately. This, in turn, facilitates the recovery of both motor and cognitive function,” Goldberg said.

To further confirm the importance of BDNF in these effects, the researchers modified the stem cells so that they could no longer produce the growth factor. When these modified cells were transplanted, they failed to improve behavioral function and no longer enhanced dopamine and glutamate signaling.

Testing the possibility that BDNF alone might be an effective treatment, Goldberg used a virus to deliver the growth factor to the brains of DLB mice.

She found that this treatment resulted in good recovery of motor skills in the test rodents but only limited recovery of cognitive function. 

This, Goldberg said, suggests that while BDNF is critical to stem cell-mediated motor and cognitive recovery, it does not achieve this outcome alone.

These results imply that transplantation of BDNF-producing neural stem cells may one day offer a new approach for treating DLB, and Blurton-Jones and Goldberg are cautiously optimistic.

“Many important questions remain before we could envision moving forward with early-stage trials,” Blurton-Jones said. “For example, we’ll need to identify and test human neural stem cells first.”

Nevertheless, if this approach holds up, BDNF-producing neural stem cells might also be beneficial for several other diseases. “BDNF, dopamine and glutamate are implicated in other neurodegenerative conditions, including Huntington’s and Alzheimer’s disease,” Goldberg noted.

Jacqueline Caesar, Ashley Park, Shawn Sedgh, Gilana Finogenov and Joy Davis of UCI as well as Eliezer Masliah of UC San Diego contributed to the study, which received support from the National Science Foundation.

Scarcity of Donor Organs Fuels R&D Activity in the Artificial Organs Space

Oct. 16, 2015 /PRNewswire/ -- The rapid increase in age-related disorders and the number of terminally ill patients awaiting organ transplants brings awareness to artificial organs. With the supply of donor organs stagnating in the past five years, the medical community's resistance to artificial organs is gradually decreasing.

These devices have the ability to serve as a bridge-to-transplant therapy for terminally ill patients until a donor organ becomes available. This service is creating opportunities for research and commercialization.

Analysis from Frost & Sullivan, Innovations in Artificial Organs (http://www.frost.com/d68f), finds there have been several breakthroughs in the use of human cell line to develop artificial organs as well as a variety of wearable and implantable solutions. The seven main categories of artificial organs covered in this study are cochlear implants, heart, liver, pancreas, eyes, lungs and  kidneys.

For complimentary access to more information on this research, please visit: http://bit.ly/1KJRzT9.

"Several companies have created novel systems capable of mimicking the function of a diseased native organ," saidTechnical Insights Research Analyst Karan Verma. "Artificial organs often leverage innovations across industries to better assist in managing diseased states."

However, given the nature of the research, the cost of R&D activities is extremely high. 

Poor reimbursement policies, material biocompatibility issues and general lack of physician interest towards newer devices are other serious challenges impeding technology developers' efforts to obtain funding for their projects. Additionally, the stringent regulatory approvals make it difficult to introduce devices to the market further alienate investors.

In short, the growth of artificial organs' R&D highly relies on private sector investment from angel and seed investors as well as venture capitalists (VCs) across North America, Europe, Middle East and Asia. Top tier firms need to be educated on the potential of artificial organs and the various technologies currently under development by a number of start-ups and VC-funded firms.

"Working closely with universities and research organizations will enable companies to earn funds to expand the capabilities of the technology," observed Verma. "Investor support not only boosts R&D but also accelerates commercialization."

Manufacturers can play their part in popularizing artificial organs by developing low-cost solutions. In addition, their pricing strategy needs to be sensitive to specific markets as the majority of the affected people are from low-income groups.

Innovations in Artificial Organs, a part of the TechVision (http://ww2.frost.com/research/technology/health-wellness) subscription, identifies and profiles 10 technologies expected to shape the medical device and imaging industry. 

The list includes technologies that are already in the market as well as recently commercialized technologies. This research throws light on technology capability, maturity, global research intensity, adoption over the short and medium terms, and funding activities.

Frost & Sullivan's global TechVision practice is focused on innovation, disruption and convergence that provides a variety of technology based alerts, newsletters and research services as well as growth consulting services. 

Its premier offering, the TechVision program, identifies and evaluates the most valuable emerging and disruptive technologies enabling products with near-term potential. 

A unique feature of the TechVision program is an annual selection of 50 technologies that can generate convergence scenarios, possibly disrupt the innovation landscape, and drive transformational growth. View a summary of our TechVision program by clicking on the following link:http://ifrost.frost.com/TechVision_Demo.

About Frost & Sullivan

Frost & Sullivan, the Growth Partnership Company, works in collaboration with clients to leverage visionary innovation that addresses the global challenges and related growth opportunities that will make or break today's market participants.

Our "Growth Partnership" supports clients by addressing these opportunities and incorporating two key elements driving visionary innovation: The Integrated Value Proposition and The Partnership Infrastructure.

• The Integrated Value Proposition provides support to our clients throughout all phases of their journey to visionary innovation including: research, analysis, strategy, vision, innovation and implementation.
• The Partnership Infrastructure is entirely unique as it constructs the foundation upon which visionary innovation becomes possible. This includes our 360 degree research, comprehensive industry coverage, career best practices as well as our global footprint of more than 40 offices.

For more than 50 years, we have been developing growth strategies for the global 1000, emerging businesses, the public sector and the investment community. Is your organization prepared for the next profound wave of industry convergence, disruptive technologies, increasing competitive intensity, Mega Trends, breakthrough best practices, changing customer dynamics and emerging economies?

Women with Alzheimer’s-Related Gene Lose Weight More Sharply After Age 70

Finding May Aid in the Treatment of Dementia

Newswise, October 6, 2015 — Brooklyn, NY – Researchers led by Deborah Gustafson, PhD, MS, professor of neurology at SUNY Downstate Medical Center, have shown that women with a gene variant (APOEe4 allele) associated with Alzheimer’s disease experience a steeper decline in body mass index (BMI) after age 70 than those women without the version of the gene, whether they go on to develop dementia or not. 

The finding adds to a body of evidence suggesting that body weight change may aid in the diagnosis and management of Alzheimer's disease.

The results of the study are published online in the Journal of Alzheimer's Disease 48(4). The article is entitled, “37 Years of Body Mass Index and Dementia: Effect Modification by the APOE Genotype: Observations from the Prospective Population Study of Women in Gothenburg, Sweden.” Dr. Gustafson is also docent and affiliate researcher, University of Gothenburg, Sahlgrenska Academy, Neuropsychiatric Epidemiology Research Unit, in Sweden.

Dr. Gustafson notes that women tend to evidence a U-shaped relationship between age and body weight or body mass index (BMI), a common marker of overweight and obesity. From middle age to approximately 70 years of age, adults gain weight on average. 

After age 70, weight tends to decrease on average. This weight change over the life course may be due to aging, changes in body composition, energy metabolism, sensory changes, and changes in the brain related to regulation of basic body processes.

Among adults who develop dementia, however, the life course of BMI differs. Studies have shown that being more overweight or obese in mid-life may increase risk for dementia. 

Studies have also shown that after age 70 years, adults who develop dementia may lose weight more rapidly compared to those who do not develop dementia and that if one is a bit more overweight in later life, it is protective for both dementia and death.

Dr. Gustafson explains, “In this study, we followed Swedish women for almost 40 years from mid-life ages of 38-60 years. We tracked their BMI in relation to dementia onset, and considered the potential role of the APOEe4 allele, a known risk factor for late-onset dementia.” 

She adds, “In a previous publication, we showed that development of dementia is associated with specific pattern of BMI change over the life course. Women who developed dementia after age 65 tended to gain BMI at a slower rate during middle age.”

Dr. Gustafson concludes, “Now, we show that those with the APOEe4 allele experience greater or steeper decline in BMI after age 70 years, whether they develop dementia or not. Body weight change and BMI are easily measured, noninvasive potential prognostic indicators for dementia. Better understanding of a relatively common risk allele such as APOEe4 and how it modifies risk may aid in our understanding of how we can better intervene among those at highest risk for dementia.”

An abstract of the article,

Bäckman, EJ, Waern, M, Östling, S, Guo,X, Blennow, K, Skoog, I, Gustafson, DR, 37 Years of Body Mass Index and Dementia: Effect Modification by the APOE Genotype: Observations from the Prospective Population Study of Women in Gothenburg, Sweden, Journal of Alzheimer’s Disease (2015), doi: 10.3233/JAD-150326., is available here: http://content.iospress.com/articles/journal-of-alzheimers-disease/jad150326 .

More information about the APOE gene is available from Genetics Home Reference, a service of the U.S. National Library of Medicine, here: http://ghr.nlm.nih.gov/gene/APOE .

The research leading to the results published in the Journal of Alzheimer's Disease has received funding from the EU 7th framework LipiDiDiet project (FP7/2007-2015) under grant agreement no211696; Swedish Research Council for Health, Working Life and Welfare (AGECAP 2013-2300; 2013-2496); National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases(NIAID) U01 318345; Swedish Research Council (523-2005-8460; 2013-8717; 11267; 825-2012-5041) and the State University of New York Research Foundation. 

Other funders include the National Institutes of Health/National Institutes on Aging; Swedish Council for Working Life and Social Research, The Alzheimer's Association Stephanie B. Overstreet Scholars (IIRG-00-2159), Sahlgrenska University Hospital (ALF),Swedish Alzheimer Association, Stiftelsen Söderström-Königska Sjukhemmet, Stiftelsen för Gamla Tjänarinnor, Hjalmar Svenssons Foundation, The Swedish Society of Medicine, The Gothenburg Medical Society, the Lions Foundation, the Dr. Felix Neubergh Foundation, the Wilhelm and Martina Lundgren Foundation, the Elsa and Eivind Kison Sylvan Foundation, the Alzheimer’s Association Zenith Award, and State University of New York Research Foundation. All researchers are independent of funders.

The content of the published article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, NIAID, or other funders.

Exchanging Physical Activity for Sitting Time Associated with Lower Risk of Death for Less-Active Older Adults

Newswise, October 1, 2015 — In this study, investigators measured the amount of time older adults spent sitting and in different physical activities.

 They next used statistical models to estimate risk of death associated with replacing one hour of sitting time with an equal amount of physical activity.

The investigators found that for less active older adults, replacing sitting time with exercise or other activities, like household chores or walking, resulted in lower risk of death.

In contrast, highly active older adults had to replace an hour of sitting with purposeful exercise to reduce risk of death.

Although the researchers cautioned that their results were from statistical models, not from actual changes in behavior, replacing sitting time with physical activity appears to provide important mortality benefits, particularly for less-active adults.

Find the Silver Linings in Life Bestselling author, nurse and breast cancer survivor shares advice for healthy living

October 1, 2015, (Family Features)-- Every year, approximately 250,000 people are diagnosed with breast cancer. As a vegan-eating, marathon-running, mother in her 30s with no family history of breast cancer, Hollye Jacobs was unexpectedly diagnosed with the disease.

Now, the nurse turned New York Times bestselling author of “The Silver Lining: A Supportive and Insightful Guide to Breast Cancer” has partnered with Allstate to help everyone impacted by cancer receive a free guide with practical tips, important information and inspiration to inform and support people from diagnosis, through treatment and recovery, and into life after cancer.

“I am honored to partner with Allstate to empower women with knowledge to take control of their health and encourage each other along the way,” said Jacobs. “I hope we can all be there for each other and find the silver linings in life.”

As a follow-up to her successful book, Jacobs offers this inspiring advice on how to find the silver lining and feel your best in any situation:

·        Dress the part: Dress to feel your best no matter where your day takes you, from school to work to chemotherapy. Invest in pieces that make you feel comfortable and confident. During her chemotherapy experience, Jacobs found that cotton scarves were the easiest to tie and most effective at staying comfortably on her head when out and about.

·        Exercise: Pace yourself and set reasonable goals to take control of a healthy lifestyle. Begin slowly but consistently to establish a positive habit on which you can build; even a slow stroll can be transformative for your health.

·        Healthy eating: Like exercise, good nutrition helps offset exhaustion that comes with the weight of daily stresses and fatigue. A balanced and healthy diet doesn’t have to be expensive. Incorporate nutrient-dense foods like avocados and nuts, and drink plenty of water. Whenever possible, avoid alcohol, sugar and processed foods.

·        Encourage each other: Jacobs’ biggest life lesson from her experience with cancer was that asking for help is a sign of strength, not weakness. If you think that you could benefit from professional or spiritual support, pursue it. Celebrate positive thinking and remember that everyone reacts to life’s unexpected struggles and pain differently. Be kind and patient with others and, most importantly, yourself.

·        Express yourself: For Jacobs, writing was cathartic. Her book evolved from her blog, www.TheSilverPen.com, which unexpectedly reached audiences far beyond her circle of friends and family. She encourages people to write down at least three silver linings each day, from noticing the color of a flower to petting an animal.

·        Educate yourself: Be an active participant in your health by learning from trusted sources and resisting the urge to blindly search online for information. When learning anything new, be patient, open, flexible and assertive to find what works best and most comfortably for your routine.

The free Silver Lining Companion Guide is available for download or for pick up at participating distribution centers and select Allstate agencies nationwide. Download or find the nearest participating distribution center at www.Allstate.com/SilverLining.

Photo courtesy of Getty Images

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.

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