TAG: "Geriatrics"

Women suffer higher rates of decline in aging, Alzheimer’s disease


UC San Diego study finds women experience greater regional brain loss over time than men.

The rates of regional brain loss and cognitive decline caused by aging and the early stages of Alzheimer’s disease (AD) are higher for women and for people with a key genetic risk factor for AD, say researchers at the UC San Diego School of Medicine in a study published online July 4 in the American Journal of Neuroradiology.

The linkage between APOE ε4 – which codes for a protein involved in binding lipids or fats in the lymphatic and circulatory systems – was already documented as the strongest known genetic risk factor for sporadic AD, the most common form of the disease. But the connection between the sex of a person and AD has been less-well recognized, according to the UC San Diego scientists.

“APOE ε4 has been known to lower the age of onset and increase the risk of getting the disease,” said the study’s first author Dominic Holland, Ph.D., a researcher in the Department of Neurosciences at UC San Diego School of Medicine. “Previously we showed that the lower the age, the higher the rates of decline in AD. So it was important to examine the differential effects of age and APOE ε4 on rates of decline, and to do this across the diagnostic spectrum for multiple clinical measures and brain regions, which had not been done before.”

The scientists evaluated 688 men and women over the age of 65 participating in the Alzheimer’s Disease Neuroimaging Initiative, a longitudinal, multi-institution study to track the progression of AD and its effects upon the structures and functions of the brain. They found that women with mild cognitive impairment (a condition precursory to AD diagnosis) experienced higher rates of cognitive decline than men; and that all women, regardless of whether or not they showed signs of dementia, experienced greater regional brain loss over time than did men. The magnitude of the sex effect was as large as that of the APOE ε4 allele.

“Assuming larger population-based samples reflect the higher rates of decline for women than men, the question becomes what is so different about women,” said Holland. Hormonal differences or change seems an obvious place to start, but Holland said this is largely unknown territory – at least regarding AD.

“Another important finding of this study is that men and women did not differ in the level of biomarkers of Alzheimer’s disease pathology,” said co-author Linda McEvoy, Ph.D., an associate professor in the UCSD Department of Radiology. “This suggests that brain volume loss in women may also be caused by factors other than Alzheimer’s disease, or that in women, these pathologies are more toxic. We clearly need more research on how an individual’s sex affects AD pathogenesis.”

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Guidelines help doctors answer question: ‘How long do I have to live?’


Clinicians can use framework in communicating uncertain prognoses.

“How long do I have to live?” is a question senior citizens and those battling terminal illness often ask their doctors.

Now, a UC San Francisco-led team of physicians publishing in today’s (June 26) New England Journal of Medicine have created a set of guidelines for doctors and other clinicians to use for communicating uncertain prognoses to patients.

Prognosis – the science of predicting how long a patient will live – can be a complex undertaking because uncertainty is an inherent part of predicting medical outcomes.

Alexander Smith, UC San Francisco

“It used to be that making a prognosis was a fundamental part of what we did, and that’s waned over time as we’ve focused more on diagnosis and treatment,” said senior author Alexander K. Smith, M.D., M.P.H., assistant professor of medicine in the UCSF Division of Geriatrics. “But providing a prognosis is still an essential part of what we do. Patients ask about it. It is important for nearly every medical decision in older adults.” (See an earlier video with Smith about assessing life expectancy of older patients.)

Smith and his colleagues at University of Pittsburgh assessed what clinicians’ responsibility should be for providing a prognosis. “On the one hand,” he said, “they should not use uncertainty as an excuse to avoid the conversation entirely.  On the other hand, how should they help patients deal with uncertain information, given that uncertainty tends to produce so much anxiety in patients?”

The co-authors developed several guidelines for clinicians to use in addressing the issue with patients.

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Nurse practitioners can help boost quality of primary care for older patients


Study highlights key role nurse practitioners can play in treating chronic geriatric conditions.

David Reuben, UCLA

U.S. residents today are living longer than previous generations, thanks to improved public health and medical treatment. But they’re also living longer with chronic geriatric health conditions like dementia, urinary incontinence, depression and debilitating falls, which often require complex medical care.

Doctors spend significant time and resources treating individuals with chronic conditions, and the average family physician can become severely overtaxed managing care for such patients. The picture becomes even worse with chronic geriatric conditions.

Several heath care treatment models have been designed over the years to improve medical care for chronic geriatric ailments. One model, for instance, helped improve patient care by teaming geriatricians in an academic medical center setting with nurse practitioners to co-manage care. But can the same model work in community-based primary care settings?

The answer is yes, according to a UCLA-led study published in the June issue of the Journal of the American Geriatrics Society. The study’s findings highlight the crucial role nurse practitioners can play in treating chronic geriatric conditions.

“It is becoming increasingly clear that care of chronic geriatric conditions is better when it’s done in teams,” said the study’s lead author, Dr. David Reuben, chief of the geriatrics division in the department of medicine at the David Geffen School of Medicine at UCLA. “There are some things that nurse practitioners do better than doctors and some things that doctors do better than nurse practitioners.”

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Memory improves for older adults using computerized brain-fitness program


Study is one of first to assess cognitive effects of a computerized memory-training program.

Prabha Siddarth, UCLA

FINDING:
UCLA researchers have found that older adults who regularly used a brain-fitness program on a computer demonstrated significantly improved memory and language skills.

The UCLA team studied 69 dementia-free participants, with an average age of 82, who were recruited from retirement communities in Southern California. The participants played a computerized brain-fitness program called Dakim BrainFitness, which trains individuals through more than 400 exercises in the areas of short- and long-term memory, language, visual-spatial processing, reasoning and problem-solving, and calculation skills.

The researchers found that of the 69 participants, the 52 individuals who over a six-month period completed at least 40 sessions (of 20–25 minutes each) on the program showed improvement in both immediate and delayed memory skills, as well as language skills.

The findings suggest that older adults who participate in computerized brain training can improve their cognitive skills.

IMPACT:
The study’s findings add to a body of research exploring whether brain fitness tools may help improve language and memory and ultimately help protect individuals from the cognitive decline associated with aging and Alzheimer’s disease.

Age-related memory decline affects approximately 40 percent of older adults. And while previous studies have shown that engaging in stimulating mental activities can help older adults improve their memory, little research had been done to determine whether the numerous computerized brain-fitness games and memory training programs on the market are effective in improving memory. This is one of the first studies to assess the cognitive effects of a computerized memory-training program.

AUTHORS:
Authors of the study were Karen Miller, Ph.D., an associate clinical professor at the Semel Institute for Neuroscience and Human Behavior at UCLA, and Prabha Siddarth, Ph.D., a research statistician in psychiatry and biobehavioral sciences at the Semel Institute. Both are available for interviews.

FUNDING:
The study was funded in part by Dakim, manufacturer of Dakim BrainFitness, the computerized program used in the study. Miller and Siddarth have served as consultants on the development of the software included in the program.

JOURNAL:
The study is published in the July issue of the American Journal of Geriatric Psychiatry. A copy of the full study is also available.

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Alzheimer’s and low blood sugar in diabetes may trigger a vicious cycle


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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UC Health ranks among best in nation


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.

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New clinical tool assesses health risks for older adults


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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NIMH awards funding to study successful aging in adults with HIV


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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Mistrust of government deters older adults from HIV testing


Later detection poses greater health risks.

Older woman talks with doctorOne 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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Poor sleep in old age prevents the brain from storing memories


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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Gene variant linked to human longevity


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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Mobile app with elder abuse resources launched


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

368+ Elder Abuse app

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.

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