Online Tool Can Help Seniors Quickly Determine Risk for Dementia

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Release Date: 01/12/2011
Assessment designed to educate, not diagnose, but could aid in early intervention

A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate herself about a disease that doctors now believe is best managed if caught early.

“As the population ages and dementia becomes more prevalent, it’s important to get people diagnosed early,” says Jason Brandt, Ph.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer’s & Dementia. “Alzheimer’s disease and other types of dementia don’t just creep up on you. They’re incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

Among the questions asked on the Dementia Risk Assessment are about whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment at www.alzcast.org. Those who scored lowest on the memory test were significantly older, and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss — a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

Brandt says the assessment may be helpful in weeding out those who have signs of dementia from those who are simply experiencing the memory loss that comes with aging or a busy lifestyle. Not being able to find your keys or remembering where you parked is rarely a failsafe sign that a person is suffering from dementia.

“Our goal is really to educate people about what some of the risk factors are and, often, to put people’s minds at ease,” he says. “We somehow expect our memories to be as good at 50 as they were at 30. We can’t run as fast as we could 20 years ago. Why should our memory be as good?”

Alzheimer’s disease still has no cure, but early interventions are being used to slow cognitive decline, Brandt says. Brandt says he hopes this assessment will get patients with several risk factors or symptoms to consult a physician.

Some forms of dementia, he says, may not be permanent, and getting to a doctor could help to restore brain function.

Sometimes, Brandt says, seniors are afraid to mention they are having memory or other cognitive issues. The new tool, he says, lets them learn more about themselves and their individualized risk factors in the privacy of their homes.

The aging population means that many more people will be diagnosed with dementia in the coming decades.

“Screening procedures that have demonstrated validity and predictive value and are noninvasive, brief and do not require any special expertise to administer may have the greatest potential to be accepted and actually used by the greatest number of people,” Brandt says. “This tool, which this study preliminarily validates, is the first step toward developing such a procedure.”

Brandt and colleagues are currently conducting research that compares a patient’s results from the online Dementia Risk Assessment with an in-person, comprehensive evaluation by a physician at one of two Johns Hopkins clinics.

This research was supported by a grant from the Geoffrey Beene Foundation’s GB Gives Back Alzheimer’s Initiative. Mark Rogerson, Ph.D., of Johns Hopkins also worked on this study.

For more information:

http://www.hopkinsmedicine.org/psychiatry/expert_team/faculty/B/Brandt.html

http://www.alzcast.org/

Media Contact: Stephanie Desmon
410-955-8665; sdesmon1@jhmi.edu

Exercise May Lower Risk of Death for Men With Prostate Cancer

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For immediate release: Wednesday, January 5, 2011

Boston, MA – A new study of men with prostate cancer finds that physical activity is associated with a lower risk of overall mortality and of death due to prostate cancer. The Harvard School of Public Health and University of California, San Francisco researchers also found that men who did more vigorous activity had the lowest risk of dying from the disease. It is the first study in men with prostate cancer to evaluate physical activity after diagnosis in relation to prostate cancer-specific mortality and overall mortality.

The study appears in an advance online edition of the Journal of Clinical Oncology.

“Our results suggest that men can reduce their risk of prostate cancer progression after a diagnosis of prostate cancer by adding physical activity to their daily routine,” said Stacey Kenfield, lead author of the study and a Harvard School of Public Health researcher. “This is good news for men living with prostate cancer who wonder what lifestyle practices to follow to improve cancer survival.”

Prostate cancer is the most frequently diagnosed form of cancer among men in the United States and affects one in six U.S. men during their lifetime. More than 2 million men in the U.S. and 16 million men worldwide are prostate cancer survivors.

The study was conducted in 2,705 men diagnosed with prostate cancer in the Health Professionals Follow-Up Study over an 18-year period. The participants reported the average time per week they spent doing physical activity, including walking, running, bicycling, swimming and other sports and outdoor work.

The results showed that both non-vigorous and vigorous activity were beneficial for overall survival. Compared with men who walked less than 90 minutes per week at an easy pace, those who walked 90 or more minutes per week at a normal to very brisk pace had a 46% lower risk of dying from any cause.

Only vigorous activity—defined as more than three hours per week—was associated with reduced prostate cancer mortality. Men who did vigorous activity had a 61% lower risk of prostate cancer-specific death compared with men who did less than one hour per week of vigorous activity.

“We observed benefits at very attainable levels of activity and our results suggest that men with prostate cancer should do some physical activity for their overall health, even if it is a small amount, such as 15 minutes of activity per day of walking, jogging, biking or gardening,” said Kenfield. “However, doing vigorous activity for three or more hours per week may be especially beneficial for prostate cancer, as well as overall health,” she said.

This study was funded by the National Institutes of Health, Charles A. King Trust and the Prostate Cancer Foundation.

“Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study,” Stacey A. Kenfield, Meir J. Stampfer, Edward Giovannucci, June M. Chan, Journal of Clinical Oncology, online January 4, 2011.

Visit the HSPH website for the latest news, press releases and multimedia offerings.

For more information:

Todd Datz
617.998.8819
tdatz@hsph.harvard.edu

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Harvard School of Public Health (http://www.hsph.harvard.edu ) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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Component in Common Dairy Foods May Cut Diabetes Risk

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For immediate release: Monday, December 20, 2010

Boston, MA – Scientists at the Harvard School of Public Health (HSPH) and collaborators from other institutions have identified a natural substance in dairy fat that may substantially reduce the risk of type 2 diabetes. The compound, trans-palmitoleic acid, is a fatty acid found in milk, cheese, yogurt, and butter. It is not produced by the body and so only comes from the diet.

Reporting in the December 21, 2010, issue of Annals of Internal Medicine, investigators led by Dariush Mozaffarian, associate professor in the Department of Epidemiology at HSPH and Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, and Gökhan S. Hotamisligil, J.S. Simmons Professor of Genetics and Metabolism and chair of the Department of Genetics and Complex Diseases at HSPH, explain that trans-palmitoleic acid may underlie epidemiological evidence in recent years that diets rich in dairy foods are linked to lower risk of type 2 diabetes and related metabolic abnormalities. Health experts generally advise reducing full-fat dairy products, but trans-palmitoleic acid is found in dairy fat.

The HSPH researchers examined 3,736 participants in the National Heart, Lung, and Blood Institute-funded Cardiovascular Health Study, who have been followed for 20 years in an observational study to evaluate risk factors for cardiovascular diseases in older adults. Metabolic risk factors such as blood glucose and insulin levels, and also levels of circulating blood fatty acids, including trans-palmitoleic acid, were measured using stored blood samples in 1992, and participants were followed for development of type 2 diabetes.

At baseline, higher circulating levels of trans-palmitoleic acid were associated with healthier levels of blood cholesterol, inflammatory markers, insulin levels, and insulin sensitivity, after adjustment for other risk factors. During follow-up, individuals with higher circulating levels of trans-palmitoleic acid had a much lower risk of developing diabetes, with about a 60% lower risk among participants in the highest quintile (fifth) of trans-palmitoleic acid levels, compared to individuals in the lowest quintile.

“This type of observational finding requires confirmation in additional observational studies and controlled trials, but the magnitude of this association is striking,” said Mozaffarian, lead author of the study. “This represents an almost three-fold difference in risk of developing diabetes among individuals with the highest blood levels of this fatty acid.”

In contrast to the types of industrially produced trans fats found in partially hydrogenated vegetable oils, which have been linked to higher risk of heart disease, trans-palmitoleic acid is almost exclusively found in naturally-occurring dairy and meat trans fats, which in prior studies have not been linked to higher heart disease risk.

“There has been no clear biologic explanation for the lower risk of diabetes seen with higher dairy consumption in prior studies. This is the first time that the relationship of trans-palmitoleic acid with diabetes risk has been evaluated,” said Mozaffarian. “We wonder whether this naturally occurring trans fatty acid in dairy fats may partly mimic the normal biologic role of its cis counterpart, cis-palmitoleic acid, a fatty acid that is produced in the body. In animal experiments, cis-palmitoleic acid protects against diabetes.”

“Unfortunately, with modern diets, synthesis of cis-palmitoleic acid is now driven by high amounts of carbohydrate and calories in the diet, which might limit its normal protective function. We wonder whether trans-palmitoleic acid may be stepping in as a “pinch hitter” for at least some of the functions of cis-palmitoleic acid,” said Mozaffarian.

Hotamisligil, the study’s senior author, also emphasized the magnitude of the risk reduction. “This is an extremely strong protective effect, stronger than other things we know can be beneficial against diabetes. The next step is to move forward with an intervention trial to see if there is therapeutic value in people.”

Because trans-palmitoleic acid, also known as trans-palmitoleate, is a natural compound, Hotamisligil said that conducting clinical trials should be possible. “This study represents the power of interdisciplinary work bridging basic science with population studies to realize exciting translational possibilities,” he said.

Support for the study was provided by the National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health and the National Institutes of Health Office of Dietary Supplements and National Institute of Neurological Disorders and Stroke. A subset of additional fatty acid measurements were supported by a Searle Scholar Award.

“Trans-Palmitoleic Acid, Metabolic Risk Factors, and New-Onset Diabetes in U.S. Adults,” Dariush Mozaffarian, Haiming Cao, Irena B. King, Rozenn N. Lemaitre, Xiaoling Song, David S. Siscovick, and Gökhan S. Hotamisligil, Annals of Internal Medicine, December 21, 2010

Visit the HSPH website for the latest news, press releases and multimedia offerings.

For more information:

Todd Datz
617-998-8819
tdatz@hsph.harvard.edu

photo: iStockphoto/olgna

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Harvard School of Public Health (http://www.hsph.harvard.edu ) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter: http://twitter.com/HarvardHSPH
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Alzheimer’s Caregivers’ Top Three Concerns

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– National Survey Co-Sponsored by Alzheimer’s Foundation of America, Eisai and Pfizer Sheds Light on Difficulties Faced by America’s Alzheimer’s Disease Caregivers –

Woodcliff Lake, N.J., and New York, October 14, 2010 — Results announced today from a national survey of Alzheimer’s disease (AD) caregivers found that memory loss and confusion, which are cognitive symptoms, in addition to personal safety are the greatest concerns related to the progression of their loved one’s AD. In fact, 67 percent of AD caregivers surveyed said changes in cognitive symptoms were among their main concerns. The survey of 524 non-professional caregivers, which was conducted by Harris Interactive in September 2010 for Eisai Inc. and Pfizer Inc in partnership with the Alzheimer’s Foundation of America (AFA), provides insight into the current state of caring for a loved one with AD in the United States.

“These survey results reveal that changes in cognition as the disease progresses were an important concern among caregivers,” said Eric J. Hall, president and CEO of AFA. “We encourage caregivers and health care professionals to discuss these changes and any others during regular visits.”

As AD – a progressive brain disease typically characterized by three stages: mild, moderate and severe – changes over time, caregivers and their healthcare professionals may wish to regularly discuss modifications in lifestyle and treatment. According to the survey, the majority of AD caregivers are proactive participants in the dialogue and decision-making around their loved one’s disease, and 75 percent of those surveyed were either “satisfied” or “very satisfied” with the communication they have with their loved one’s health care professional. For the remaining 25 percent (who are either “somewhat” or “not at all satisfied”), there may be room for improvement in this dialogue.

“AD caregivers are typically the first to notice when their loved one’s symptoms are becoming worse and whether the disease may be progressing to the next stage, which is why caregivers are essential partners in disease management discussions,” said Barry W. Rovner, M.D., director of the Division of Geriatric Psychiatry and professor in the departments of Neurology and Psychiatry at Thomas Jefferson University, Philadelphia. “In the face of this devastating chronic and progressive disease, it is important for AD caregivers to know about the available educational resources, support networks and treatments in order to enhance these discussions at all stages of the disease.”

Key Survey Findings
Following are results illustrating the difficulties faced by caregivers, concerns about disease progression and discussions with health care professionals, highlighting differences between men and women. Of note, 173 males and 351 females were surveyed, which is reflective of the overall unpaid AD caregiver population, in which caregivers are more likely to be female.

Difficulties Faced by Caregivers
· 55 percent of AD caregivers surveyed said caring for their loved one has taken a toll on their own health
· Women surveyed were more likely to worry “all the time” compared to men [13 percent versus 3 percent]. Also, women were less likely than men to feel that they have enough support to take care of themselves and their own needs [60 percent versus 76 percent]
· 60 percent of AD caregivers surveyed said they feel overwhelmed
· Women surveyed were more likely to consider “maintaining relationships with family or friends” as a challenge compared to men [47 percent versus 31 percent]
· 84 percent of caregivers of loved ones with severe AD surveyed said caregiving frequently stops them from participating in activities that they enjoy, which is more than caregivers of loved ones with mild (67 percent) and moderate (68 percent) AD
Concerns About Disease Progression
· The three greatest caregiver concerns about the progression of their loved one’s AD were memory loss (41 percent), personal safety (33 percent) and confusion (27 percent)
· 67 percent of AD caregivers surveyed named at least one change in cognitive symptoms as a main concern about the progression of their loved one’s AD
· Men surveyed were more likely to be concerned about memory loss compared to women [50 percent versus 37 percent]
Discussions with Health Care Professionals
· Men surveyed were more likely to be satisfied with communication with their health care professional compared to women [84 percent versus 70 percent]. Also, men were more likely to regularly discuss options for information or support [26 percent versus 14 percent]
· 53 percent of AD caregivers surveyed who said they were not very involved (somewhat or not at all involved) in these interactions were dissatisfied with their loved one’s treatment, as compared with 31 percent who said they were engaged

Additional information about AD and caregiver resources can be found at www.alzfdn.org.

Survey Methodology
The survey was conducted by Harris Interactive in September 2010 for Eisai Inc. and Pfizer Inc in partnership with AFA. A total of 524 non-professional adult AD caregivers, including those of mild, moderate and severe AD patients, were surveyed. Caregivers were asked to classify the stage of their loved one’s AD, as identified by their loved one’s health care professional. Respondents for this survey were selected from among those who have agreed to participate in Harris Interactive surveys. The data have been weighted to reflect the composition of the U.S. non-professional AD caregiver population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated. A full methodology is available. Funding was provided by Eisai Inc. and Pfizer Inc.

About AD
AD is a degenerative disease of the brain that gets worse over time and is the sixth leading cause of death in the United States. Right now, as many as 5.1 million Americans age 65 and older have AD, with 3.6 million of those having moderate-to-severe disease. As our population ages – including the first wave of baby boomers turning 65 in 2011 – the disease may impact a greater percentage of Americans. The number of people aged 65 and older may more than double between 2010 and 2050; likewise, those 85 and older may rise three-fold. As the number of people with AD increases, it is likely that the number of caregivers will increase as well.

Alzheimer’s Foundation of America
The Alzheimer’s Foundation of America, based in New York, is a non-profit organization that unites more than 1,400 member organizations nationwide with the goal of providing optimal care and services to individuals confronting dementia and to their caregivers and families. Its services include a toll-free hotline, educational materials, a free quarterly magazine for caregivers and professional training. For more information, call toll-free 866-AFA-8484 or visit www.alzfdn.org.

Eisai Inc.
Eisai Inc. was established in 1995 and is ranked among the top 20 U.S. pharmaceutical companies (based on retail sales). The company began marketing its first product in the United States in 1997 and has rapidly grown to become a fully integrated pharmaceutical business with fiscal year 2009 (year ended March 31, 2010) sales of approximately $3.9 billion. Eisai’s areas of commercial focus include neurology, gastrointestinal disorders and oncology/critical care. The company serves as the U.S. pharmaceutical operation of Eisai Co., Ltd.

Eisai has a global product creation organization that includes U.S.-based R&D facilities in Maryland, Massachusetts, New Jersey, North Carolina and Pennsylvania as well as manufacturing facilities in Maryland and North Carolina. The company’s areas of R&D focus include neuroscience; oncology; vascular, inflammatory and immunological reaction; and antibody-based programs. For more information about Eisai, please visit www.eisai.com.

Eisai Co., Ltd.
Eisai Co., Ltd. is a research-based human health care (hhc) company that discovers, develops and markets products throughout the world. Through a global network of research facilities, manufacturing sites and marketing subsidiaries, Eisai actively participates in all aspects of the worldwide healthcare system. Eisai employs approximately 11,000 employees worldwide.

Pfizer Inc: Working together for a healthier world™
At Pfizer, we apply science and our global resources to improve health and well-being at every stage of life. We strive to set the standard for quality, safety and value in the discovery, development and manufacturing of medicines for people and animals. Our diversified global health care portfolio includes human and animal biologic and small molecule medicines and vaccines, as well as nutritional products and many of the world’s best-known consumer products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as the world’s leading biopharmaceutical company, we also collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, Pfizer has worked to make a difference for all who rely on us. To learn more about our commitments, please visit us at www.pfizer.com.

Harris Interactive
Harris Interactive is one of the world’s leading custom market research firms, leveraging research, technology and business acumen to transform relevant insight into actionable foresight. Known widely for The Harris Poll and for pioneering innovative research methodologies, Harris offers expertise in a wide range of industries including healthcare, technology, public affairs, energy, telecommunications, financial services, insurance, media, retail, restaurant and consumer package goods. Serving clients in over 215 countries and territories through our North American, European and Asian offices and a network of independent market research firms, Harris specializes in delivering research solutions that help us – and our clients – stay ahead of what’s next. For more information, please visit www.harrisinteractive.com.