UCSF researcher urges caution on use of certain diabetes drugs in dementia patients.

Kristine Yaffe, UC San Francisco

A new UC San Francisco-led study looks at the close link between diabetes and dementia, which can create a vicious cycle.

Diabetes-associated episodes of low blood sugar may increase the risk of developing dementia, while having dementia or even milder forms of cognitive impairment may increase the risk of experiencing low blood sugar, according to the study published online today (June 10)  in JAMA Internal Medicine.

Researchers analyzed data from 783 diabetic participants and found that hospitalization for severe hypoglycemia among the diabetic, elderly participants in the study was associated with a doubled risk of developing dementia later. Similarly, study participants with dementia were twice as likely to experience a severe hypoglycemic event.

The study results suggest some patients risk entering a downward spiral in which hypoglycemia and cognitive impairment fuel one another, leading to worse health, said Kristine Yaffe, M.D., senior author and principal investigator for the study, and a UCSF professor of psychiatry, neurology and epidemiology based at the San Francisco VA Medical Center.

“Older patients with diabetes may be especially vulnerable to a vicious cycle in which poor diabetes management may lead to cognitive decline and then to even worse diabetes management,” she said.

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U.S. News gives high marks to UC medical schools.

University of California Health ranked among the nation’s best graduate schools in a survey released today (March 12) by U.S. News & World Report.

Five UC medical schools placed in the top 50 nationally for research rankings and four placed in the top 40 nationally for primary care rankings.

In research, UC San Francisco was the top-ranked public school and tied for fourth among all U.S. schools, with UCLA 13th overall, UC San Diego 15th, and UC Davis and UC Irvine tied for 42nd. In primary care, UCSF ranked fourth, UCLA ranked 11th, UC Davis tied for 19th and UC San Diego tied for 39th, with UC Irvine tied for 66th. UCSF has the only medical school ranked in the top five of both categories.

UC medical schools also received high marks in a number of specialty programs. UCSF ranked first for its medical program in AIDS, second in both internal medicine and women’s health, tied for second in drug/alcohol abuse education, fourth in family medicine, sixth in geriatrics, and seventh in pediatrics. UCLA ranked third in geriatrics, seventh in drug/alcohol abuse education, tied for ninth in AIDS and 10th in women’s health. UC San Diego ranked ninth in drug/alcohol abuse education and 11th in AIDS.

U.S. News’ 2014 America’s Best Graduate Schools rankings were released online today (March 12) and can be viewed at www.usnews.com/grad.

The new rankings include previous assessments of a number of other health fields, which U.S. News also surveys but not each year. UCLA ranked first in clinical psychology, UCSF ranked first in pharmacy, UC Davis ranked second in veterinary medicine, UCSF ranked fourth for both its master’s of nursing program (tied) and its nursing-midwifery program, while in public health UC Berkeley tied for eighth and UCLA was 10th. The surveys do not rank dental or optometry schools.

UC Health runs five academic health centers and the nation’s largest health sciences education system with more than 14,000 students and 18 health professional schools and programs in medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine. UC’s sixth medical school, UC Riverside, will enroll its first class this fall.

Related links:

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• UC San Francisco

UCSF team devises checklist to help predict 10-year mortality.

Calculating medical risk can be an inexact science, especially for older adults, with many factors from the environment to chronic diseases helping determine how long a person lives. Now, a UC San Francisco team has developed a tool that can help determine – and perhaps influence – senior citizens’ 10-year survivability rates.

The simple checklist helps doctors assess health risks that influence the longevity of older adults, and according to the authors, could be an opportunity for seniors to really engage with their primary care provider in having informed discussions about their health care maintenance.

The UCSF team created a 12-item “mortality index” based on data of more than 20,000 adults over the age of 50 from 1998 until 2008, from the Health and Retirement Study (HRS), a nationally representative sample of independently living U.S. adults. The point system was based on their risk factors and survival rate at the end of 10 years.

Their findings will be published today (March 5) in the Journal of the American Medical Association (JAMA).

Calculating medical risk can be an inexact science, especially for older adults. Many factors from environmental to chronic diseases can help determine how long a person lives.

“The most important thing we found was the risk factors that go into estimating shorter intermediate survival are very similar to risk factors that go into estimating the likelihood of longer-term survival,” said first author Marisa Cruz, M.D., a clinical fellow with the UCSF School of Medicine. “We also found that building a tool that clinicians can use to estimate that likelihood of longer-term survival requires considering many different types of risk factors.

“Not one particular risk factor tells you whether or not you are likely to survive but a host of attributes about your life and your medical conditions will give you a clearer picture,” she said.

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UC San Diego receives $3.4M grant.

Dilip Jeste, UC San Diego

The National Institute of Mental Health has awarded a $3.4 million grant to a team of researchers at the UC San Diego School of Medicine to study successful aging in HIV-infected adults. HIV is a serious, chronic, medical disease that affects the lives of more than 1 million Americans.

Since the advent of antiretroviral therapy (ART) to treat HIV, life expectancy of HIV+ adults has been increasing progressively. By 2015, nearly half of HIV+ individuals in the United States will be over age 50, and this number is expected to continue to rise. The newly funded study will be the first large-scale investigation of successful aging in HIV-infected individuals between the ages of 36 and 65 years.

The goals of the UC San Diego study are to examine the positive psychosocial factors such as resilience, hardiness, optimism, and social engagement that determine self-perceived successful aging, according to principal investigator Dilip Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego’s Stein Institute for Research on Aging. The study will also look at biomarkers of both physical and cognitive aging, comparing these factors in individuals who are HIV-infected with non-infected adults.

“Our hope is that understanding factors that promote successful aging at an individual level may lead to the development of new preventive and therapeutic interventions aimed at improving quality of life and well-being in adults living with HIV,” said co-principal investigator David J. Moore, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine.

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Later detection poses greater health risks.

One out of every four people living with HIV/AIDS is 50 or older, yet these older individuals are far more likely to be diagnosed when they are already in the later stages of infection. Such late diagnoses put their health, and the health of others, at greater risk than would have been the case with earlier detection.

According to the Centers for Disease Control and Prevention, 43 percent of HIV-positive people between the ages of 50 and 55, and 51 percent of those 65 or older, develop full-blown AIDS within a year of their diagnosis, and these older adults account for 35 percent of all AIDS-related deaths. And since many of them are not aware that they have HIV, they could be unknowingly infecting others.

Various psychological barriers may be keeping this older at-risk population from getting tested. Among them are a general mistrust of the government — for example, the belief that the government is run by a few big interests looking out for themselves — and AIDS-related conspiracy theories, including, for example, the belief that the virus is man-made and was created to kill certain groups of people.

Now, a team of UCLA-led researchers has demonstrated that government mistrust and conspiracy fears are deeply ingrained in this vulnerable group and that these concerns often — but in one surprising twist, not always — deter these individuals from getting tested for HIV. The findings are published today (Jan. 29) in the peer-reviewed journal The Gerontologist.

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Findings shed new light on some of the forgetfulness common to the elderly.

The connection between poor sleep, memory loss and brain deterioration as we grow older has been elusive.  But for the first time, scientists at the University of California, Berkeley, have found a link between these hallmark maladies of old age. Their discovery opens the door to boosting the quality of sleep in elderly people to improve memory.

UC Berkeley neuroscientists have found that the slow brain waves generated during the deep, restorative sleep we typically experience in youth play a key role in transporting memories from the hippocampus – which provides short-term storage for memories – to the prefrontal cortex’s longer term “hard drive.”

However, in older adults, memories may be getting stuck in the hippocampus due to the poor quality of deep ‘slow wave’ sleep, and are then overwritten by new memories, the findings suggest.

“What we have discovered is a dysfunctional pathway that helps explain the relationship between brain deterioration, sleep disruption and memory loss as we get older – and with that, a potentially new treatment avenue,” said UC Berkeley sleep researcher Matthew Walker, an associate professor of psychology and neuroscience at UC Berkeley and senior author of the study to be published today (Jan. 27) in the journal Nature Neuroscience.

The findings shed new light on some of the forgetfulness common to the elderly that includes difficulty remembering people’s names.

“When we are young, we have deep sleep that helps the brain store and retain new facts and information,” Walker said. “But as we get older, the quality of our sleep deteriorates and prevents those memories from being saved by the brain at night.”

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UC Irvine-Brookhaven study finds genetic tie to personality traits influencing healthy aging.

Robert Moyzis, UC Irvine

A variant of a gene associated with active personality traits in humans seems to also be involved with living a longer life, UC Irvine and other researchers have found.

This derivative of a dopamine-receptor gene – called the DRD4 7R allele – appears in significantly higher rates in people more than 90 years old and is linked to lifespan increases in mouse studies.

Robert Moyzis, professor of biological chemistry at UC Irvine, and Dr. Nora Volkow, a psychiatrist who conducts research at the Brookhaven National Laboratory and also directs the National Institute on Drug Abuse, led a research effort that included data from the UC Irvine-led 90+ Study in Laguna Woods. Results appear online in The Journal of Neuroscience.

The variant gene is part of the dopamine system, which facilitates the transmission of signals among neurons and plays a major role in the brain network responsible for attention and reward-driven learning. The DRD4 7R allele blunts dopamine signaling, which enhances individuals’ reactivity to their environment.

People who carry this variant gene, Moyzis said, seem to be more motivated to pursue social, intellectual and physical activities. The variant is also linked to attention-deficit/hyperactivity disorder and addictive and risky behaviors.

“While the genetic variant may not directly influence longevity,” Moyzis said, “it is associated with personality traits that have been shown to be important for living a longer, healthier life. It’s been well documented that the more you’re involved with social and physical activities, the more likely you’ll live longer. It could be as simple as that.”

Numerous studies – including a number from the 90+ Study – have confirmed that being active is important for successful aging, and it may deter the advancement of neurodegenerative diseases, such as Alzheimer’s.

Prior molecular evolutionary research led by Moyzis and Chuansheng Chen, UC Irvine professor of psychology & social behavior, indicated that this “longevity allele” was selected for during the nomadic out-of-Africa human exodus more than 30,000 years ago.

In the new study, the UC Irvine team analyzed genetic samples from 310 participants in the 90+ Study. This “oldest-old” population had a 66 percent increase in individuals carrying the variant relative to a control group of 2,902 people between the ages of 7 and 45. The presence of the variant also was strongly correlated with higher levels of physical activity.

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UC Irvine, Institute on Aging collaborate on aid for law enforcement, emergency personnel.

368+ app co-created by UC Irvine

One in 10 older Americans experiences abuse or neglect each year, and the number of reported cases is growing at a time when resources necessary to properly respond are shrinking. To assist California law enforcement personnel in dealing with this problem, the UC Irvine Center of Excellence on Elder Abuse & Neglect has partnered with the Bay Area’s nonprofit Institute on Aging to develop a mobile app called 368+ Elder & Dependent Adult Abuse Guide for CA Law Enforcement.

“We want to provide law enforcement agencies and emergency first responders with a ‘cheat sheet’ about the signs of elder abuse and neglect, the penal code and other resources,” said Dr. Laura Mosqueda, chair of UC Irvine’s Department of Family Medicine and director of the university’s geriatrics program and Center of Excellence on Elder Abuse & Neglect.

The resultant app – achieved with input from colleagues in law enforcement, civil law and medicine – features:

• Warning signs of abuse, neglect and financial exploitation – what to look for in the home environment, caretaker behavior, senior or dependent adult with a disability;
• An easy-to-reference summary of California Penal Code 368 (concerning the abuse of elder and dependent adults) and other common crimes/charges that may accompany a PC 368 arrest;
• Quick tips on memory loss, people with dementia as witnesses, documenting the caretaker’s role, and assessing such injuries as bruises and pressure sores;
• Agency contacts for cross-reporting and victim assistance;
• Short training videos; and
• A way to sign up for bimonthly elder abuse news.

For a limited time, the app – designed to run on iPhones, iPads and Droid devices – is available at no cost, thanks to supporters including the Archstone Foundation, UniHealth Foundation, and the San Francisco Department on the Status of Women. It is also viewable on mobile Web browsers. To download a free app or learn more, visit www.centeronelderabuse.org/368ElderAbuseCA.asp.

Resilience and depression sway whether elders view aging in a positive light.

Dilip Jeste, UC San Diego

Presently, there are about 40 million Americans over the age of 65, with the fastest-growing segment of the population over 80 years old. Traditionally, aging has been viewed as a period of progressive decline in physical, cognitive and psychosocial functioning, and aging is viewed by many as the “No.1 public health problem” facing Americans today.

But this negative view of aging contrasts with results of a comprehensive study of 1,006 older adults in San Diego by researchers from the UC San Diego School of Medicine and Stanford University. Results of the Successful Aging Evaluation (SAGE) study — comprising a 25-minute phone interview, followed by a comprehensive mail-in survey — will be published in today’s (Dec. 7) online issue of the American Journal of Psychiatry.

“While there is a growing public health interest in understanding and promoting successful aging, until now little published research has combined measures of physical health with cognitive and psychological assessments, in a large and randomly selected sample,” said principal investigator Dilip V. Jeste, M.D., Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego’s Stein Institute for Research on Aging, and the current president of the American Psychiatric Association (which was not involved in this study).

The SAGE study included adults between the ages of 50 and 99 years, with a mean age of just over 77 years. In addition to measures which assessed rates of chronic disease and disability, the survey looked at more subjective criteria such as social engagement and participants’ self-assessment of their overall health.

“Sometimes the most relevant outcomes are from the perspective of the subjects themselves,” said Jeste.

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Brain shows diminished response to untrustworthiness, UCLA scientists report.

Shelley Taylor, UCLA

Why are older people especially vulnerable to becoming victims of fraud? A new UCLA study indicates that an important clue may lie in a particular region of the brain that influences the ability to discern who is honest and who is trying to deceive us.

Older people, more than younger adults, may fail to interpret an untrustworthy face as potentially dishonest, the study shows. The reason for this, the UCLA life scientists found, seems to be that a brain region called the anterior insula, which is linked to disgust and is important for discerning untrustworthy faces, is less active in older adults.

“The consequences of misplaced trust for older adults are severe,” said Shelley E. Taylor, a distinguished professor of psychology at UCLA and senior author of the new research, which appears today (Dec. 3) in the journal Proceedings of the National Academy of Sciences (PNAS). “A recent study estimates that adults over age 60 lost at least $2.9 billion in 2010 to financial exploitation, ranging from home repair scams to complex financial swindles. This figure represents a 12 percent increase from 2008.

“Older adults seem to be particularly vulnerable to interpersonal solicitations, and their reduced sensitivity to cues related to trust may partially underlie this vulnerability.”

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Drugs commonly used off-label to treat dementia patients shown to have serious side effects.

Dilip Jeste, UC San Diego

In older adults, antipsychotic drugs are commonly prescribed off-label for a number of disorders outside of their Food and Drug Administration (FDA)-approved indications – schizophrenia and bipolar disorder. The largest number of antipsychotic prescriptions in older adults is for behavioral disturbances associated with dementia, some of which carry FDA warnings on prescription information for these drugs.

In a new study – led by researchers at the University of California, San Diego School of Medicine, Stanford University and the University of Iowa, and funded by the National Institute of Mental Health – four of the antipsychotics most commonly prescribed off label for use in patients over 40 were found to lack both safety and effectiveness. The results will be published today (Nov. 27) in The Journal of Clinical Psychiatry.

The study looked at four atypical antipsychotics (AAPs) – aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) – in 332 patients over the age of 40 diagnosed with psychosis associated with schizophrenia, mood disorders, PTSD or dementia.

“Our study suggests that off-label use of these drugs in older people should be short-term, and undertaken with caution,” said Dilip V. Jeste, M.D., Estelle and Edgar Levi Chair in Aging, Distinguished Professor of Psychiatry and Neurosciences, and director of the Stein Institute for Research on Aging at UC San Diego.

Results of the five-year study led by Jeste, who is also current president of the American Psychiatric Association (which was not involved in this research), showed that within one year of treatment, one-third of the patients enrolled in the study developed metabolic syndrome (medical disorders that can increase the risk of cardiovascular disease or diabetes). Within two years, nearly a quarter of the patients developed serious adverse effects and just over half developed non-serious adverse effects.

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Results apply to older adults with and without cognitive defects, UC Irvine scientists find.

Sabrina Segal, UC Irvine

A short burst of moderate exercise enhances the consolidation of memories in both healthy older adults and those with mild cognitive impairment, scientists with UC Irvine’s Center for the Neurobiology of Learning & Memory have discovered.

Most research has focused on the benefits of a long-term exercise program on overall health and cognitive function with age. But the UC Irvine work is the first to examine the immediate effects of a brief bout of exercise on memory.

In their study, postdoctoral scholar Sabrina Segal and neurobiologists Carl Cotman and Lawrence Cahill had people 50 to 85 years old with and without memory deficits view pleasant images — such as photos of nature and animals — and then exercise on a stationary bicycle for six minutes at 70 percent of their maximum capacity immediately afterward.

One hour later, the participants were given a surprise recall test on the previously viewed images. Results showed a striking enhancement of memory by exercise in both the healthy and cognitively impaired adults, compared with subjects who did not ride the bike.

“We found that a single, short instance of moderately intense exercise particularly improved memory in individuals with memory deficits,” Segal said. “Because of its implications and the need to better understand the mechanism by which exercise may enhance memory, we’re following up this study with an investigation of potential underlying biological factors.”

She believes the improved memory may be related to the exercise-induced release of norepinephrine, a chemical messenger in the brain known to play a strong role in memory modulation. This hypothesis is based on previous work demonstrating that increasing norepinephrine through pharmacological manipulation sharpens memory and that blocking norepinephrine impairs memory.

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