WASHINGTON - A large new study found no sign that vitamin D lowers the overall risk of dying from cancer, injecting a note of caution to the latest vitamin craze. The exception: People with more vitamin D in their blood did have a significantly lower risk of death from colorectal cancer, supporting earlier findings.
Getting enough of the so-called sunshine vitamin — the skin makes it from ultraviolet rays — is vital for strong bones. But vitamin D has made headlines in recent years because of research saying it may be a powerful cancer fighter, sparking a push for people to get more than currently recommended amounts, either through diet or sun exposure.
The first-of-a-kind government study released Tuesday shows the issue is far from settled.
National Cancer Institute researchers analyzed vitamin D levels measured in almost 17,000 people as part of a national study that tracked their health. About a decade after enrolling, 536 of those people had died of cancer. Whether people had low or high vitamin D levels played no role in their risk of dying from cancer in general, they reported Tuesday in the Journal of the National Cancer Institute.
Then the researchers examined different types of cancer. There were just 66 deaths from colorectal cancer. Still, people with high levels of vitamin D appeared 72 percent less likely to die of colorectal cancer than people with the lowest vitamin D levels.
"While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not, in a rush to judgment, assume that vitamin D is a magic bullet and consume high amounts," Johanna Dwyer, a dietary supplement specialist at the National Institutes of Health, cautioned in an accompanying editorial.
Indeed, there are numerous risk factors for colorectal cancer, including obesity and low physical activity, and it's unclear if low vitamin D levels play an independent role or are just a marker for those other risks, she said.
Scientists have been interested in vitamin D's effects for decades, since noticing that cancer rates between similar groups of people were lower in sunny southern latitudes than in northern ones. A handful of studies since then have found people given vitamin D supplements have less risk of developing certain cancers, but much of the evidence is circumstantial.
Experts are cautious because other vitamins and nutrient supplements once widely thought to prevent cancer didn't pan out when put to rigorous testing.
The NCI's study is the first to compare blood levels of vitamin D to cancer mortality, and "it's the best research we have on this topic," said Dr. Len Lichtenfeld of the American Cancer Society.
But a big weakness: It measured vitamin D at just one point in participants' lives, when levels can vary widely with dietary changes and especially the seasons.
Overall, most research "seems to be pointing in the direction that there is a role of vitamin D," Lichtenfeld said. Tuesday's study "puts a note of caution in there that says with all the explosion of information and advocacy on behalf of vitamin D, we need to be cautious. ... We really need some further studies that are well done to answer the question."
Tuesday, October 30, 2007
Wednesday, October 24, 2007
FDA wants big warning on Glaxo diabetes drug: report
NEW YORK (Reuters) - Food and Drug Administration officials are pushing for a "black box" warning on GlaxoSmithKline Plc's hard-hit diabetes drug Avandia, the Wall Street Journal reported, citing sources.
The warning would be a further blow to the top-selling diabetes drug, which came under pressure last May when a U.S. analysis linked Avandia to a 43 percent higher risk of heart attack in patients.
Avandia already has strong warning advising of the risk of a different side effect, heart failure, the paper said. But a similar warning for the risks of heart attack would be more serious, it said.
The European Medicines Agency last week recommended a tighter label for Avandia, but said the benefits outweighed the risks of the drug and a similar one called Actos, made by Takeda Pharmaceutical Co..
Last July, an advisory panel to the FDA recommended that Avandia should stay on the market, but said it should have increased warnings.
Avandia posted global sales of $3.24 billion last year making it the company's second-biggest seller. But sales have plummeted since the May study linking it to increased risk.
The warning would be a further blow to the top-selling diabetes drug, which came under pressure last May when a U.S. analysis linked Avandia to a 43 percent higher risk of heart attack in patients.
Avandia already has strong warning advising of the risk of a different side effect, heart failure, the paper said. But a similar warning for the risks of heart attack would be more serious, it said.
The European Medicines Agency last week recommended a tighter label for Avandia, but said the benefits outweighed the risks of the drug and a similar one called Actos, made by Takeda Pharmaceutical Co..
Last July, an advisory panel to the FDA recommended that Avandia should stay on the market, but said it should have increased warnings.
Avandia posted global sales of $3.24 billion last year making it the company's second-biggest seller. But sales have plummeted since the May study linking it to increased risk.
Tuesday, October 23, 2007
Low testosterone in men linked to earlier death
NEW YORK (Reuters Health) - Older men with low levels of the hormone testosterone may die sooner than other men their age with normal testosterone levels, a study suggests.
Researchers found that among 794 generally healthy older men, those with the lowest testosterone levels were 40 percent more likely to die within the 1985-2004 study period.
The findings do not mean, however, that older men should start taking testosterone supplements to achieve a longer life, the study authors are quick to point out.
The study shows only an association between low testosterone and earlier death -- not a cause-and-effect relationship, lead author Dr. Gail A. Laughlin told Reuters Health. What's more, there was no evidence that having above-average testosterone levels gave men any longevity advantage.
"We cannot recommend that any man take testosterone based on these results," Laughlin stressed.
She and her colleagues at the University of California, San Diego, report their findings in the Journal of Clinical Endocrinology & Metabolism.
In theory, low testosterone could affect older men's longevity through metabolic effects. Some past studies have found that low testosterone can precede the development of abdominal obesity and the metabolic syndrome -- a collection of risk factors for diabetes and heart disease that includes obesity, high blood pressure and unhealthy cholesterol levels.
In their study, Laughlin and her colleagues found that low testosterone was associated with abdominal obesity and aspects of the metabolic syndrome, but when these factors were excluded, low testosterone remained independently linked to earlier death.
The study included 794 men between 50 and 91 year old (average age 73.6 years) who were followed for an average of 11.6 years. Overall, the one quarter with the lowest testosterone levels at study entry were 40 percent more likely to die over the course of the study than men with higher levels of the hormone.
There is some disagreement among experts on how to define overt testosterone deficiency, with some saying it should be diagnosed when levels fall below 300 nanograms per deciliter (ng/dL) and others advocating lower cutoffs.
There was no evidence in this study that raising older men's testosterone above 300 ng/dL might boost survival, according to Laughlin's team.
This finding offers "no support for widespread testosterone therapy for aging men," the researchers write.
Indeed, it's unclear whether raising testosterone in men with a clear deficiency can safely prolong life. Only clinical trials that test hormonal supplementation against a placebo can answer this question, Laughlin said.
SOURCE: Journal of Clinical Endocrinology & Metabolism, October 2007.
Researchers found that among 794 generally healthy older men, those with the lowest testosterone levels were 40 percent more likely to die within the 1985-2004 study period.
The findings do not mean, however, that older men should start taking testosterone supplements to achieve a longer life, the study authors are quick to point out.
The study shows only an association between low testosterone and earlier death -- not a cause-and-effect relationship, lead author Dr. Gail A. Laughlin told Reuters Health. What's more, there was no evidence that having above-average testosterone levels gave men any longevity advantage.
"We cannot recommend that any man take testosterone based on these results," Laughlin stressed.
She and her colleagues at the University of California, San Diego, report their findings in the Journal of Clinical Endocrinology & Metabolism.
In theory, low testosterone could affect older men's longevity through metabolic effects. Some past studies have found that low testosterone can precede the development of abdominal obesity and the metabolic syndrome -- a collection of risk factors for diabetes and heart disease that includes obesity, high blood pressure and unhealthy cholesterol levels.
In their study, Laughlin and her colleagues found that low testosterone was associated with abdominal obesity and aspects of the metabolic syndrome, but when these factors were excluded, low testosterone remained independently linked to earlier death.
The study included 794 men between 50 and 91 year old (average age 73.6 years) who were followed for an average of 11.6 years. Overall, the one quarter with the lowest testosterone levels at study entry were 40 percent more likely to die over the course of the study than men with higher levels of the hormone.
There is some disagreement among experts on how to define overt testosterone deficiency, with some saying it should be diagnosed when levels fall below 300 nanograms per deciliter (ng/dL) and others advocating lower cutoffs.
There was no evidence in this study that raising older men's testosterone above 300 ng/dL might boost survival, according to Laughlin's team.
This finding offers "no support for widespread testosterone therapy for aging men," the researchers write.
Indeed, it's unclear whether raising testosterone in men with a clear deficiency can safely prolong life. Only clinical trials that test hormonal supplementation against a placebo can answer this question, Laughlin said.
SOURCE: Journal of Clinical Endocrinology & Metabolism, October 2007.
Thursday, October 18, 2007
DNA test betters Pap in detecting cervical cancer: study
WASHINGTON (AFP) - The human papillomavirus (HPV) screening test for cervical cancer is far more accurate than the traditional Pap test, according to a Canadian study published Wednesday in the United States.
The first round of the Canadian Cervical Cancer Screening Trial, led by Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, put the HPV test's accuracy in detecting pre-cancerous lesions at 94.6 percent, compared to 55.4 for the Pap test.
The study is published in the October 18 edition of The New England Journal of Medicine.
The trial, funded by a grant from the Canadian Institutes of Health Research, followed 10,154 women aged 30-69 in Montreal, Quebec and St. John's, Newfoundland from 2002-2005.
"We already knew before conducting this study that the sensitivity of Pap left a lot to be desired," said Franco.
The Papanicolaou (or Pap) test was invented by Georgios Papanicolaou in the 1940s and requires technicians to look under a microscope for abnormalities in cell samples collected from the patient's cervix. It has been the standard screening procedure for cervical cancer for almost 50 years.
The HPV test also requires the collection of cervical samples, but the analysis process is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
"Women currently vaccinated against cervical cancer will still need to be screened, because the vaccines that are available now only prevent about 70% of all cervical cancers, and they're primarily for young women," said Franco.
"The HPV test may be ideal for vaccinated women once they reach screening age, because it gives us an opportunity to monitor the protection that the vaccine is supposed to give them," he added.
Cervical cancer kills more than one quarter of a million women worldwide each year.
The first round of the Canadian Cervical Cancer Screening Trial, led by Eduardo Franco, Director of the Division of Cancer Epidemiology at McGill's Faculty of Medicine, put the HPV test's accuracy in detecting pre-cancerous lesions at 94.6 percent, compared to 55.4 for the Pap test.
The study is published in the October 18 edition of The New England Journal of Medicine.
The trial, funded by a grant from the Canadian Institutes of Health Research, followed 10,154 women aged 30-69 in Montreal, Quebec and St. John's, Newfoundland from 2002-2005.
"We already knew before conducting this study that the sensitivity of Pap left a lot to be desired," said Franco.
The Papanicolaou (or Pap) test was invented by Georgios Papanicolaou in the 1940s and requires technicians to look under a microscope for abnormalities in cell samples collected from the patient's cervix. It has been the standard screening procedure for cervical cancer for almost 50 years.
The HPV test also requires the collection of cervical samples, but the analysis process is automated and detects the DNA of high-risk HPV strains known to cause cervical cancer.
"Women currently vaccinated against cervical cancer will still need to be screened, because the vaccines that are available now only prevent about 70% of all cervical cancers, and they're primarily for young women," said Franco.
"The HPV test may be ideal for vaccinated women once they reach screening age, because it gives us an opportunity to monitor the protection that the vaccine is supposed to give them," he added.
Cervical cancer kills more than one quarter of a million women worldwide each year.
Monday, October 15, 2007
Blood Test Might Spot Alzheimer's Early
MONDAY, Oct. 15 (HealthDay News) -- An international team of scientists has developed a blood test that could reveal which patients with mild cognitive impairment will go on to develop Alzheimer's disease.
If replicated and validated -- and assuming the development of effective treatments against Alzheimer's in the future -- such a test could open the door to medicating at-risk patients earlier and slowing or limiting neurological damage, explained Dr. Allan Levey, chair of neurology at Emory University, Atlanta.
"If it can be replicated, then we will find out how important [the study] really is," said Levey, who was not involved in the research.
The findings were published in the Oct. 14 online issue of Nature Medicine.
According to the Alzheimer's Association, Alzheimer's is a progressive, fatal brain disease that affects almost one in eight individuals over the age of 65.
Yet there currently exists no early diagnostic screen for Alzheimer's disease. Diagnosis today is based not on blood chemistry, but on a combination of psychological and imaging tests. Many of those who present with mild cognitive impairment (MCI), will ultimately develop Alzheimer's disease, but others never do.
"Currently, it's very difficult to know who will progress to Alzheimer's and who will progress to other diseases, or which won't progress at all," said Levey. "Ideally, one wants to be able to know at the stage of mild cognitive impairment, or even earlier, if someone is destined to get Alzheimer's disease."
In the new study, a group led by Tony Wyss-Coray, an associate professor of neurology at the Stanford University School of Medicine, analyzed 259 blood samples obtained from individuals with and without Alzheimer's disease. They focused on 120 proteins involved in cellular signaling and communication.
The team identified 18 proteins in particular whose abundance could distinguish those with Alzheimer's disease from those without it, for an overall accuracy of about 90 percent -- that is, it correctly classified individuals who had been clinically diagnosed with Alzheimer's disease 95 percent of the time and classified as negative those without the disease 83 percent of the time.
This panel of proteins was equally effective when applied to another, completely separate set of patient samples, the researchers noted.
But "the home run of the paper," said Levey, was the finding that, when applied to blood samples collected from patients who were diagnosed with mild cognitive impairment -- a condition that often, but not always, precedes Alzheimer's -- the panel could predict who would ultimately develop Alzheimer's with 81 percent accuracy, 30 months before clinical diagnosis, on average.
Calling the study "very interesting," Levey nevertheless noted two caveats. The first was its relatively small sample size. The other was its use of proteins that have no obvious relationship to Alzheimer's.
"The blood has thousands of proteins, and they started with 120 proteins that they could measure," he said. "I don't think if one were to try to make a biomarker for Alzheimer's that you would necessarily choose these 120 proteins."
Wyss-Coray agreed that the team's decision to focus specifically on signaling proteins might seem like "a bit of a crazy idea." But given the disease's target organ, it makes sense, he said.
"Cells receive input through hundreds of different receptors, and it responds with some output, usually a signaling protein," Wyss-Coray explained. "So, by thinking in terms of this output, we decided to look specifically at signaling proteins and see if there are changes between patients who are healthy versus those with Alzheimer's disease or other dementias."
Others have also made progress in the development of early diagnostic tests for Alzheimer's. At the Alzheimer's Association's International Conference on Prevention of Dementia, in June, for instance, one group described a candidate test based on gene expression levels in blood.
"It's exciting to see this sort of work progress," said Dr. Sam Gandy, chair of the Alzheimer's Association's Medical and Scientific Advisory Council. "The important next step is to be sure that the report can be independently replicated."
Should that happen, Gandy said, patients would not be the only beneficiaries; the drug-development industry could use this assay to help select patient populations for trials of drugs to prevent -- as opposed to treat -- Alzheimer's disease.
"Because we don't have a marker that predicts [Alzheimer's] right now, such a trial is almost prohibitively expensive," he said -- "easily 10 times" the estimated $50 million required for standard clinical trials.
More information
For more on Alzheimer's Disease, visit the Alzheimer's Association
If replicated and validated -- and assuming the development of effective treatments against Alzheimer's in the future -- such a test could open the door to medicating at-risk patients earlier and slowing or limiting neurological damage, explained Dr. Allan Levey, chair of neurology at Emory University, Atlanta.
"If it can be replicated, then we will find out how important [the study] really is," said Levey, who was not involved in the research.
The findings were published in the Oct. 14 online issue of Nature Medicine.
According to the Alzheimer's Association, Alzheimer's is a progressive, fatal brain disease that affects almost one in eight individuals over the age of 65.
Yet there currently exists no early diagnostic screen for Alzheimer's disease. Diagnosis today is based not on blood chemistry, but on a combination of psychological and imaging tests. Many of those who present with mild cognitive impairment (MCI), will ultimately develop Alzheimer's disease, but others never do.
"Currently, it's very difficult to know who will progress to Alzheimer's and who will progress to other diseases, or which won't progress at all," said Levey. "Ideally, one wants to be able to know at the stage of mild cognitive impairment, or even earlier, if someone is destined to get Alzheimer's disease."
In the new study, a group led by Tony Wyss-Coray, an associate professor of neurology at the Stanford University School of Medicine, analyzed 259 blood samples obtained from individuals with and without Alzheimer's disease. They focused on 120 proteins involved in cellular signaling and communication.
The team identified 18 proteins in particular whose abundance could distinguish those with Alzheimer's disease from those without it, for an overall accuracy of about 90 percent -- that is, it correctly classified individuals who had been clinically diagnosed with Alzheimer's disease 95 percent of the time and classified as negative those without the disease 83 percent of the time.
This panel of proteins was equally effective when applied to another, completely separate set of patient samples, the researchers noted.
But "the home run of the paper," said Levey, was the finding that, when applied to blood samples collected from patients who were diagnosed with mild cognitive impairment -- a condition that often, but not always, precedes Alzheimer's -- the panel could predict who would ultimately develop Alzheimer's with 81 percent accuracy, 30 months before clinical diagnosis, on average.
Calling the study "very interesting," Levey nevertheless noted two caveats. The first was its relatively small sample size. The other was its use of proteins that have no obvious relationship to Alzheimer's.
"The blood has thousands of proteins, and they started with 120 proteins that they could measure," he said. "I don't think if one were to try to make a biomarker for Alzheimer's that you would necessarily choose these 120 proteins."
Wyss-Coray agreed that the team's decision to focus specifically on signaling proteins might seem like "a bit of a crazy idea." But given the disease's target organ, it makes sense, he said.
"Cells receive input through hundreds of different receptors, and it responds with some output, usually a signaling protein," Wyss-Coray explained. "So, by thinking in terms of this output, we decided to look specifically at signaling proteins and see if there are changes between patients who are healthy versus those with Alzheimer's disease or other dementias."
Others have also made progress in the development of early diagnostic tests for Alzheimer's. At the Alzheimer's Association's International Conference on Prevention of Dementia, in June, for instance, one group described a candidate test based on gene expression levels in blood.
"It's exciting to see this sort of work progress," said Dr. Sam Gandy, chair of the Alzheimer's Association's Medical and Scientific Advisory Council. "The important next step is to be sure that the report can be independently replicated."
Should that happen, Gandy said, patients would not be the only beneficiaries; the drug-development industry could use this assay to help select patient populations for trials of drugs to prevent -- as opposed to treat -- Alzheimer's disease.
"Because we don't have a marker that predicts [Alzheimer's] right now, such a trial is almost prohibitively expensive," he said -- "easily 10 times" the estimated $50 million required for standard clinical trials.
More information
For more on Alzheimer's Disease, visit the Alzheimer's Association
Sunday, October 14, 2007
What Open Enrollment means to you
For most insurance carriers, the months of October and November are “Open Enrollment”.
Open Enrollment is a time for you to make any changes to your current insurance policy. If you are happy with the coverage you currently have – GREAT! There is probably nothing for you to consider. However, if you are not happy, it is time to make a careful assessment of current coverage and the new coverage that is being offered.
Some things to take into consideration:
· Deductibles versus Premiums. Calculate how much you are spending each year on premiums. This can be calculated by multiplying your weekly deduction by 52, your bi-weekly deduction by 26, your bi-monthly deduction by 24 and your monthly deduction by 12. If your deductible far outweighs your premium, consider changing plans.
· What is covered under your plan? If your teenage son is going to need braces soon, make sure they are covered if your employer offers different options for dental coverage. Also see how much is covered as a yearly maximum.
· Were there any treatments you received over the last 12 months that weren’t covered or had limitations? For example, a routine woman exam is generally allowed once per year. Some plans have a capitation on what they will pay. If the capitation is low, consider choosing a plan with no dollar maximum. It could save you money in the long run. .
· Do you have coverage for dental or vision? If you do not currently have them, and they are available for 2008, you may want to consider paying the premiums. These are important coverages for you and your family.
· LIFE INSURANCE and Accidental Death and Dismemberment coverage. This coverage is most often overlooked. Are your current life insurance amounts acceptable for the size of your family, your standard of living, etc. While this is a topic no one wants to think about, it is something you must include in your analysis.
· Tiered Pharmacy Benefits. If your plan offers different copay amounts based on your pharmaceutical needs, and you or your family purchases more than one or two medications on a regular basis; this is definitely an area you will want to focus on.
Don’t let another year go by if you aren’t happy with the insurance coverage you currently have. Spend a couple of hours analyzing your needs and researching the coverage that is being offered.
Open Enrollment is a time for you to make any changes to your current insurance policy. If you are happy with the coverage you currently have – GREAT! There is probably nothing for you to consider. However, if you are not happy, it is time to make a careful assessment of current coverage and the new coverage that is being offered.
Some things to take into consideration:
· Deductibles versus Premiums. Calculate how much you are spending each year on premiums. This can be calculated by multiplying your weekly deduction by 52, your bi-weekly deduction by 26, your bi-monthly deduction by 24 and your monthly deduction by 12. If your deductible far outweighs your premium, consider changing plans.
· What is covered under your plan? If your teenage son is going to need braces soon, make sure they are covered if your employer offers different options for dental coverage. Also see how much is covered as a yearly maximum.
· Were there any treatments you received over the last 12 months that weren’t covered or had limitations? For example, a routine woman exam is generally allowed once per year. Some plans have a capitation on what they will pay. If the capitation is low, consider choosing a plan with no dollar maximum. It could save you money in the long run. .
· Do you have coverage for dental or vision? If you do not currently have them, and they are available for 2008, you may want to consider paying the premiums. These are important coverages for you and your family.
· LIFE INSURANCE and Accidental Death and Dismemberment coverage. This coverage is most often overlooked. Are your current life insurance amounts acceptable for the size of your family, your standard of living, etc. While this is a topic no one wants to think about, it is something you must include in your analysis.
· Tiered Pharmacy Benefits. If your plan offers different copay amounts based on your pharmaceutical needs, and you or your family purchases more than one or two medications on a regular basis; this is definitely an area you will want to focus on.
Don’t let another year go by if you aren’t happy with the insurance coverage you currently have. Spend a couple of hours analyzing your needs and researching the coverage that is being offered.
Friday, October 5, 2007
Mechanism Of Addiction Of SMOKING
There is little doubt that many habitual smokers find it difficult to quit the habit because they have become addicted to the nicotine present in the smoke. This paper addresses some of the pharmacological mechanisms underlying this addiction and discusses how an understanding of these mechanisms may contribute to the more effective use of nicotine replacement therapy during smoking cessation. It considers critically the evidence that the "rewarding" properties of nicotine, which serve to reinforce drug-seeking behaviour, are related to stimulation of the mesolimbic dopamine system of the brain. The critique focuses specifically on the evidence that many central nicotinic receptors, including those which mediate the effects of the drug on dopamine secretion, are readily desensitized by chronic exposure to agonist and that hypotheses which assume that nicotine inhaled from tobacco smoke invariably results in stimulation of the receptors must be treated with caution. Nicotinic receptors in the brain are, however, heterogeneous in nature with different molecular structures and pharmacologies. It is concluded that the reinforcing properties of nicotine sought by smokers may reflect both stimulation and desensitization of the different nicotinic receptor populations, and that smokers may adjust their smoking habits to achieve the balance of receptor stimulation and desensitization which they find most reinforcing. It seems likely that the efficacy of the different nicotine formulations during the treatment of smoking cessation may also reflect their ability to stimulate or desensitize brain nicotinic receptors.
Wednesday, October 3, 2007
Parkinson's and Alzheimer's dementia very different
NEW YORK (Reuters Health) - Dementia associated with Parkinson's disease is distinctively different from that seen in Alzheimer's disease, Norwegian researchers report in the Journal of Neurology, Neurosurgery and Psychiatry.
Dr. Kolbjorn Bronnick at Stavanger University Hospital, Norway, and colleagues conducted a neurological assessment of 488 patients with Parkinson's disease dementia and another 488 patients with Alzheimer's disease, using the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-Cognitive Subscale.
The objective of the study by was to assess whether or not a diagnosis could be made based on the results of the cognitive profiles.
"Both groups showed memory impairment, Alzheimer's disease patients performing worse than Parkinson's disease dementia patients," the investigators report. "On the verbal memory tasks in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, however, both groups were clearly impaired relative to a normal control group, with very large effect sizes."
"Poor performance of the Alzheimer's disease patients on the orientation test in Alzheimer's Disease Assessment Scale-Cognitive Subscale best discriminated between the groups, followed by poor performance of the Parkinson's disease dementia patients on the attentional task in Mini-Mental State Examination," Bronnick's team found.
"Diagnosis was predicted from the cognitive profile, with an overall accuracy of 74.7 percent," they report.
"In conclusion," the researchers write, "we found differential cognitive profiles in patients with Parkinson's disease dementia and Alzheimer's disease."
This strongly supports the hypothesis that Parkinson's disease dementia occurs through a mechanism that is quite different than the one associated with Alzheimer's disease, and that there exist pathological and physiological mechanisms specifically related to Parkinson's disease dementia.
SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, October 2007.
Dr. Kolbjorn Bronnick at Stavanger University Hospital, Norway, and colleagues conducted a neurological assessment of 488 patients with Parkinson's disease dementia and another 488 patients with Alzheimer's disease, using the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-Cognitive Subscale.
The objective of the study by was to assess whether or not a diagnosis could be made based on the results of the cognitive profiles.
"Both groups showed memory impairment, Alzheimer's disease patients performing worse than Parkinson's disease dementia patients," the investigators report. "On the verbal memory tasks in the Alzheimer's Disease Assessment Scale-Cognitive Subscale, however, both groups were clearly impaired relative to a normal control group, with very large effect sizes."
"Poor performance of the Alzheimer's disease patients on the orientation test in Alzheimer's Disease Assessment Scale-Cognitive Subscale best discriminated between the groups, followed by poor performance of the Parkinson's disease dementia patients on the attentional task in Mini-Mental State Examination," Bronnick's team found.
"Diagnosis was predicted from the cognitive profile, with an overall accuracy of 74.7 percent," they report.
"In conclusion," the researchers write, "we found differential cognitive profiles in patients with Parkinson's disease dementia and Alzheimer's disease."
This strongly supports the hypothesis that Parkinson's disease dementia occurs through a mechanism that is quite different than the one associated with Alzheimer's disease, and that there exist pathological and physiological mechanisms specifically related to Parkinson's disease dementia.
SOURCE: Journal of Neurology, Neurosurgery and Psychiatry, October 2007.
Tuesday, October 2, 2007
Special teams fight diabetic amputations
WASHINGTON - A stubbed toe can lead to having your foot amputated? It can if you're a longtime diabetic. And it can happen fast.
"Tuesday in the office, they're fine. Friday, they're in the emergency room with gangrene in a toe," says Dr. Peter Sheehan, diabetes chief at New York's Cabrini Medical Center.
It's a little-known statistic: Foot problems — wounds that won't heal, infections, warping bones — are the most common reason diabetics are hospitalized.
And many of the 80,000-plus amputations of toes, feet and lower legs that Americans diabetics undergo each year are preventable, say specialists who brought more than 900 health providers to a meeting last week to figure out how to do just that.
One recommendation: For hospitals to create diabetes limb-salvage teams.
It sounds simple. But it involves pairing specialists who seldom work side-by-side — like podiatrists and vascular surgeons — to shave weeks off the time it can take to get proper care for a festering foot.
"It gets them everything they need right away, without months of waiting (between doctor appointments) while the wound is going downhill," says Dr. John Steinberg, a podiatrist with Georgetown University Hospital's limb-salvage team.
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels seriously damage blood vessels and nerves, eventually leading to kidney failure, heart disease and other complications.
Among them is a vicious trio: Foot ulcers that strike about 600,000 diabetics annually; loss of sensation in the feet called neuropathy that makes sufferers slow to notice they have a wound; and poor blood flow in the lower legs that makes the ulcers slow to heal.
Amputation may end the grueling cycle of unhealing wounds and infection on one limb. But those patients still face grim odds. About half will develop ulcers and infections in the remaining foot, and undergo more amputations. And within five years, more than 40 percent are dead.
Infection is the chief reason for amputating. But there are no firm guidelines on when a limb is beyond salvaging — and a 2001 study of Medicare-covered diabetics found large differences in amputation rates in different parts of the country.
Until recently, most research into diabetic wounds has focused on methods to clean them out and spur new skin growth.
The newer message: Check blood pressure in a diabetic's ankle before rushing to foot surgery. One in three diabetics over age 50 has a condition called peripheral arterial disease or PAD, where leg arteries become too clogged to get enough blood to the feet.
That's one reason that last week's meeting urged a team approach to saving diabetics' limbs: Whatever foot surgeons apply to heal a nasty ulcer won't work unless a vascular surgeon has first cleared clogged leg arteries.
"We are hostage to the blood flow," is how Dr. David G. Armstrong, a podiatrist at Chicago's Rosalind Franklin University of Medicine and Science, puts it.
Minimally invasive leg-clearing therapy — propping open clogged arteries with balloons and stents, or rooting out the sludge with tiny razors and lasers — is on the rise. But Dr. Richard Neville, Georgetown's vascular surgery chief, says many diabetics have such severe blockages that they need blood rerouted, using one of their own clog-free veins or artificial blood vessels.
Then can come what Armstrong calls the variety of "goops and gadgets" to apply straight to the ulcer.
What works best? Studies are under way to try to determine that, but Armstrong and Steinberg recommend old-fashioned debridement — scraping away dead tissue every few days — and a vacuum-sealing device that helps keep the wound moist. Certain dressings can provide a scaffolding for healthy cell growth from the inside-out.
Between those vascular and ulcer-patching surgeries, patients see a lot of other doctors. Endocrinologists get blood sugar controlled enough to allow surgery. Infectious disease specialists find the right antibiotic cocktail. Orthotists design casts and special shoes to keep pressure off the foot's weak spots.
Treating a simple diabetic foot ulcer can cost $8,000; an infected one, $17,000.
The main message for the average diabetic: Take off your socks and shoes at every visit to the doctor and ask that he or she examine your feet. Many doctors follow this government guideline, but almost half of diabetics don't get a simple foot check that could spot brewing problems in time to avoid a limb-threatening ulcer.
And ask about the ankle blood pressure test, called an ankle brachial index. New York's Sheehan says the simple test is a leading predictor of which diabetics will be hospitalized for foot ulcers, and the American Diabetes Association recommends that every diabetic over 50 get checked.
"Tuesday in the office, they're fine. Friday, they're in the emergency room with gangrene in a toe," says Dr. Peter Sheehan, diabetes chief at New York's Cabrini Medical Center.
It's a little-known statistic: Foot problems — wounds that won't heal, infections, warping bones — are the most common reason diabetics are hospitalized.
And many of the 80,000-plus amputations of toes, feet and lower legs that Americans diabetics undergo each year are preventable, say specialists who brought more than 900 health providers to a meeting last week to figure out how to do just that.
One recommendation: For hospitals to create diabetes limb-salvage teams.
It sounds simple. But it involves pairing specialists who seldom work side-by-side — like podiatrists and vascular surgeons — to shave weeks off the time it can take to get proper care for a festering foot.
"It gets them everything they need right away, without months of waiting (between doctor appointments) while the wound is going downhill," says Dr. John Steinberg, a podiatrist with Georgetown University Hospital's limb-salvage team.
Some 21 million Americans have diabetes, meaning their bodies cannot properly regulate blood sugar, or glucose. Over years, high glucose levels seriously damage blood vessels and nerves, eventually leading to kidney failure, heart disease and other complications.
Among them is a vicious trio: Foot ulcers that strike about 600,000 diabetics annually; loss of sensation in the feet called neuropathy that makes sufferers slow to notice they have a wound; and poor blood flow in the lower legs that makes the ulcers slow to heal.
Amputation may end the grueling cycle of unhealing wounds and infection on one limb. But those patients still face grim odds. About half will develop ulcers and infections in the remaining foot, and undergo more amputations. And within five years, more than 40 percent are dead.
Infection is the chief reason for amputating. But there are no firm guidelines on when a limb is beyond salvaging — and a 2001 study of Medicare-covered diabetics found large differences in amputation rates in different parts of the country.
Until recently, most research into diabetic wounds has focused on methods to clean them out and spur new skin growth.
The newer message: Check blood pressure in a diabetic's ankle before rushing to foot surgery. One in three diabetics over age 50 has a condition called peripheral arterial disease or PAD, where leg arteries become too clogged to get enough blood to the feet.
That's one reason that last week's meeting urged a team approach to saving diabetics' limbs: Whatever foot surgeons apply to heal a nasty ulcer won't work unless a vascular surgeon has first cleared clogged leg arteries.
"We are hostage to the blood flow," is how Dr. David G. Armstrong, a podiatrist at Chicago's Rosalind Franklin University of Medicine and Science, puts it.
Minimally invasive leg-clearing therapy — propping open clogged arteries with balloons and stents, or rooting out the sludge with tiny razors and lasers — is on the rise. But Dr. Richard Neville, Georgetown's vascular surgery chief, says many diabetics have such severe blockages that they need blood rerouted, using one of their own clog-free veins or artificial blood vessels.
Then can come what Armstrong calls the variety of "goops and gadgets" to apply straight to the ulcer.
What works best? Studies are under way to try to determine that, but Armstrong and Steinberg recommend old-fashioned debridement — scraping away dead tissue every few days — and a vacuum-sealing device that helps keep the wound moist. Certain dressings can provide a scaffolding for healthy cell growth from the inside-out.
Between those vascular and ulcer-patching surgeries, patients see a lot of other doctors. Endocrinologists get blood sugar controlled enough to allow surgery. Infectious disease specialists find the right antibiotic cocktail. Orthotists design casts and special shoes to keep pressure off the foot's weak spots.
Treating a simple diabetic foot ulcer can cost $8,000; an infected one, $17,000.
The main message for the average diabetic: Take off your socks and shoes at every visit to the doctor and ask that he or she examine your feet. Many doctors follow this government guideline, but almost half of diabetics don't get a simple foot check that could spot brewing problems in time to avoid a limb-threatening ulcer.
And ask about the ankle blood pressure test, called an ankle brachial index. New York's Sheehan says the simple test is a leading predictor of which diabetics will be hospitalized for foot ulcers, and the American Diabetes Association recommends that every diabetic over 50 get checked.
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