MEDICAL NEWS: New Pathways Between Memory Loss, Alzheimer's

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/22/2008

Mild cognitive impairment (MCI) is a stage between normal aging and Alzheimer's earliest stages. Understanding how it goes from mild thought problems to dementia could be key to figuring out how to prevent Alzheimer's. The following details of some of the latest research can give you an idea of the importance of aiming early.


Understanding Risk Factors

According to a Mayo Clinic report, the MCI rate increases with age and is higher in men, who are almost twice as likely to develop the condition than women. Although previous studies show women at higher risk of dementia and Alzheimer's, women generally outlive men, perhaps surviving long enough for their conditions to progress.

According to Dr. B. Brent Simmons, assistant professor and head of Temple University Hospital's Senior Care Specialists section of geriatrics, the higher rates of heart disease in men might also affect their chances of getting vascular dementia.

This study collected data from 1,786 people aged 70 to 89 and found that after a year, about 3.5 percent of 70- to 79-year-olds and 7.2 percent of 80- to 89-year-olds become afflicted with it. Overall, the growth rate of new MCI cases in the elderly population is at 5 percent per year - higher than anticipated.


Drug Development

In research by New York's Mt. Sinai School of Medicine, the brains of 124 diabetics taking medication (insulin and other glucose-lowering drugs) had up to 80 percent less beta-amyloid plaque compared to other diabetics and 124 non-diabetics. Beta-amyloid protein clumps in and around the brain, forming plaque that inhibits and destroys neurons necessary for daily functions and memory.

However, even if a combination of insulin and oral anti-diabetes medications may prevent Alzheimer's-related factors, they cannot be prescribed for non-diabetics. Hopefully, though, brain pathways such as insulin signaling could be used in developing new treatment methods.

Besides plaque, Alzheimer's indicators include unusual changes to a protein called tau. A yearlong trial at Duke University Medical Center tested a promising new drug - a nasal spray called AL-108 - on 144 patients with MCI, between ages 55 and 85, and saw a 62.4 percent improvement in memory ability.

Patients took several tests that measured memory ability before and after medication. The tests measured short-term visual, verbal and auditory working memory, functions that deteriorate throughout the progression of Alzheimer's.

Although this drug doesn't cure Alzheimer's, it showed that attacking the protein tangles does work, stabilizing some of the progress of dementia.


Getting It Before It Starts

Instead of just treating symptoms, researchers at the University of Pennsylvania School of Medicine are trying to stop it before it starts, by finding chemical and biological markers of these conditions.

Since Alzheimer's is a disease measured by analyzing symptoms, the goal of the first investigation was, according to its lead researcher, Dr. Leslie Shaw, "to determine if we could detect Alzheimer's disease pathology before a patient went on to have full blown dementia and memory disorders."

The research focused on measuring levels of cerebral spinal fluid (CSF) and establishing benchmark concentration levels of biological indicators for normal, mildly cognitively impaired, and Alzheimer's individuals.

The differences between the baseline levels of three Alzheimer's-associated proteins were significant enough to speed up drug development efforts of biological compounds that can fix these differences.

The second Penn study uses MRI scans to detect abnormal structural changes linked to MCI in the brains of healthy elderly. Radiology professor Christos Davatzikos, Ph.D. and his colleagues monitored these slight physical changes to the brain successfully might provide a way to alert patients and doctors to brain deterioration and memory decline early enough to prepare or begin treatment.

With around 18 percent of 400 patients converting to Alzheimer's a year, this study is ongoing, and doctors are able to "study the progression as it's happening ... at a rate large enough to make our tests reliable or not with sufficiently large number of study subjects," said Dr. Shaw, who is also the director of Penn's ADNI Biomarker Core Lab.

Collaboration is key for all involved, and as Dr. Shaw noted, "the earlier we can detect the disease reliably with confidence, the earlier we can institute and monitor treatment such as diet, exercise, adjusted sleep patterns and having a social life, along with doctor visits, to delay and stop the disease."

The MRI-based study used images from the Baltimore Longitudinal Study of Aging (BLSA) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) and was funded by the National Institute on Aging and the Institute for the Study of Aging.

Dr. Shaw's research was funded by the Alzheimer's Disease Neuroimaging Initiative via the National Institutes of Health.


Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH NEWS: Study: Breast Cancer Survivors Still At Risk

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/14/2008

New research from a 16-year study indicates that early-stage breast cancer patients who have completed five to 10 years of drug and/or chemotherapy treatment have a one in five - around 20 percent - chance of relapse.

Between 1985 and 2001, oncologists/researchers at the University of Texas' M.D. Anderson Cancer Center examined 2,838 patients with stage I to III breast cancers who had been treated at the center. All were cancer-free five years after initial treatment with surgery or surgery and radiation.

All of the women underwent up to five years of additional treatments with chemotherapy, the anti-estrogen drug tamoxifen or both. After a 28-month follow-up, 215 women developed recurrent cancer.

This incidence rate put the risk at 7 percent for women with stage I breast cancer, 11 percent for stage II, and 13 percent for women with stage III cancer. This relapse rate increased to 20 percent 15 years after first being diagnosed.

"The risk of relapse was still small, but certainly not insignificant," Abenaa M. Brewster, M.D., an oncologist and researcher with M.D. Anderson Cancer Center told WebMD. "I think these numbers are somewhat reassuring, but they also highlight the need for new [therapeutic] options for women who have completed five years of treatment."

Factors associated with the risk of recurrence were tumor grade, hormone receptor status and endocrine therapy.

Forms of treatment available to newly diagnosed patients usually include surgery and radiation therapy (chemotherapy) or surgery and drug therapy.

Up until the year 2000, drug treatment consisted of tamoxifen for both premenopausal and postmenopausal women with estrogen-receptor positive tumors (they respond to hormone treatments). Today, a newer class of drugs called aromatase inhibitors are used.

In the study, 34 ER-negative women had a relapse and 149 ER-positive women did. The study and results were published Tuesday in the online edition of the Journal of the National Cancer Institute.

Estrogen-receptor (ER) negative tumors are considered more deadly than ER-positive ones. However, "women who had ER-positive cancer were more likely to have late recurrences than those with ER-negative," according to Len Lichtenfeld, M.D., the American Cancer Society deputy chief medical officer in healthday.com.

However, what to do about this continued risk is up in the air, Dr. Lichtenfeld said.

A possible treatment alternative is in the works by British and Finnish researchers, who are testing a combination of two inexpensive, commonly used and easily available drugs on killing cancer-cells in tumors.

The first drug is doxorubicin, a common chemotherapy-regimen drug, followed 24 hours later by the osteoporosis medication zoledronic acid. When tested on mice, the drug combo was 99.99 percent effective in killing such cells. Human trials are currently underway with results expected later this year.

This announcement was also made in the Journal of the National Cancer Institute.

Each year in the U.S., around 180,000 women are diagnosed with breast cancer. In the U.K., almost 46,000 new cases are diagnosed every year.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH: Psychiatrists Are Prescribing More Pills, Less Therapy

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/07/2008

With Sigmund Freud and HBO's popular series "In Treatment" featuring a psychiatrist and his patients, it seems a safe bet that paying someone to analyze your life is still a strong option.

However, a new report published in the Archives of General Psychiatry this Monday reveals that fewer psychiatrists are providing psychotherapy to patients during office visits, instead prescribing drug therapy - medication - at increasing rates.

According to the researchers, the trend appears to be linked to there being fewer trained psychiatrists, the marketing of improved psychiatric drugs and pressure from managed care companies that offer incentives for prescribing drugs over giving the more expensive psychotherapy.

"Psychiatrists get [paid] more for three 15-minute medication management visits than for one 45-minute psychotherapy visit," said Dr. Ramin Mojtabal, who co-led the research at Beth Israel Medical Center in New York, and who now works at Johns Hopkins Bloomberg School of Public Health in Baltimore.

"I was trained almost 30 years ago and received a lot of training in psychotherapy," said Dr. Christopher C. Colenda, a psychiatrist and Dean of Medicine at Texas A&M Health Science Center College of Medicine. "Thanks to the advances of managed care, psychotherapy was basically devalued from the perspective of psychiatry. ... A lot of the incentives for wanting to be in psychiatry were essentially removed by managed care."

The study examined data from the National Ambulatory Care Survey on visits to psychiatrists' offices for a 10-year period between 1996 and 2005, finding that the proportion of visits over 30 minutes long dropped from 44 percent in 1996-1997 to 28.9 percent in 2004-2005. Overall, out of 14,108 visits, only 34 percent provided psychotherapy to patients.

The number of psychiatrists who provided psychotherapy to all patients also fell, from 19.1 percent to 10.8 percent during the same 10-year period. Those who chose to continue psychotherapy had more patients who paid out-of-pocket for treatment than other doctors who gave less talk therapy.

For patients who require a combination of talk therapy and drug therapy, the trend towards medication-only can result in spotty treatment, in which the patient receives psychotherapy from a psychologist and drugs from a psychiatrist or general practitioner.

Physicians differ in their opinions over whether this is a problem.

"Whether it has any impact on the outcome of the disorder, we don't really know," said Dr. Mojtabal to Reuters. "I don't think necessarily that it is harmful. It might not be as efficient."

However, Dr. Eric Plakun, who leads an American Psychiatric Association committee working to restore interest in psychotherapy by psychiatrists, told Reuters that a shift away from psychotherapy began about 10 years ago when medical schools began to focus more on the biology of mental illness than on its psychology and behavior. "Either way, I'm worried about our patients [who] need the best help we can give them."

So is this the end of psychotherapy? Perhaps not, as it is effective and less expensive, and if you look deeper, there are signs that the use of talk therapy will continue and is, in fact, on the rise.

Since its benefits are well documented via behavior changes, emotional and mental habits, as well as through brain imaging studies, whether alone or combined with drug therapy, "the couch is far from dead," Dr. Plakun said. "The couch turns out to be an effective 21st century treatment."

Accreditation requirements for psychiatric residency programs are also putting more emphasis on talk therapy, so future medical professionals have the appropriate background to keep it alive.

Various forms are the recommended form of treatment for depression, post-traumatic stress disorder, bipolar disorder and other psychiatric illnesses.

In addition, visits to psychologists, social workers and other mental health counselors, who also provide talk therapy but are not medical doctors - and thus cannot prescribe drugs - were not included in this research.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008