By Genevra Pittman

NEW YORK |
Mon Feb 6, 2012 5:23pm EST

NEW YORK (Reuters Health) – The revised definition of a brain condition called mild cognitive impairment means that many people now considered to have mild or early Alzheimer’s disease could easily be given that diagnosis instead, suggests a new study.

Mild cognitive impairment is already seen by doctors as the first hint of a future Alzheimer’s diagnosis in many cases. And the new definition will blur those lines even more, the new report concludes — begging the question of whether it should be its own diagnosis at all.

“There’s been a lot of controversy… about the whole classification called mild cognitive impairment,” said Dr. Peter Whitehouse, a geriatric neurologist at the Case Western Reserve University School of Medicine in Cleveland, who wasn’t involved in the study.

“The major issue since the beginning (has been) defining its boundaries. Inventing a label like this,” he told Reuters Health, “creates confusion.”

Mild cognitive impairment was originally diagnosed in people with memory problems but no other difficulties in thinking and reasoning abilities or in completing daily activities.

But that definition has morphed over time to include more people, and in recent recommendations made for the National Institute on Aging and the Alzheimer’s Association, now covers people with some trouble doing household chores and hobbies, according to Dr. John Morris, from Washington University in St. Louis.

Those functional problems have traditionally been part of an early Alzheimer’s diagnosis.

Morris, the new study’s sole author, said he thinks there’s so much confusion because most cases of mild cognitive impairment really are the first signs of Alzheimer’s.

Other cognitive problems could be due to a stroke, certain medications or thyroid problems, he said — things that doctors could find explanations for if they kept looking and don’t require a separate diagnosis or label, he said.

Morris examined data on more than 17,000 people evaluated for Alzheimer’s disease at 33 different centers between 2005 and 2011, including about 6,000 who were originally diagnosed with full-on Alzheimer’s or mild dementia related to Alzheimer’s.

Those people were 75 years old when they were tested, on average, according to the report published in Archives of Neurology.

Morris determined that based on the new definition of mild cognitive impairment — including the criterion that someone can have some difficulty with everyday activities — almost every person with “very mild” Alzheimer’s disease dementia could be diagnosed with mild cognitive impairment instead.

That was also the case for more than 90 percent of people with “mild” Alzheimer’s disease.

The overlap could lead to a lot of subjective decisions on the part of doctors, according to Morris, when it comes to who has early Alzheimer’s and who has mild cognitive impairment — or to avoiding an Alzheimer’s diagnosis because it’s seen as “stigmatizing,” Morris told Reuters Health.

But that’s not usually a good thing for patients and their families, he added.

“If we think the cause of the cognitive impairment is underlying Alzheimer’s, by providing the diagnosis to the best of our accuracy, it does allow the patient and the family to start dealing with the reality of the disease at a stage when the patient still has plenty of cognitive ability to participate in those decisions,” Morris said.

According to the Alzheimer’s Association, 5.4 million people in the United States have the disease, including one in eight aged 65 and older.

Creighton Phelps, head of the Alzheimer’s Disease Centers Program at the National Institute on Aging, said that to a certain extent, the line between mild cognitive impairment and early Alzheimer’s is indeed “fuzzy” and depends on a doctor’s individual judgment. But he added that many researchers still think there’s a point in between normal thinking and functioning and Alzheimer’s dementia that deserves its own category.

“What other experts say is, you should not be calling it dementia too early, until you’re absolutely sure about it,” Phelps told Reuters Health.

“In (mild cognitive impairment), you pick up some very early changes. They don’t have to quit their job, it’s not interfering with their life, but it’s measureable,” he said. “It’s not enough to move them into the dementia category.”

Whitehouse said that all of the divisions between normal and mild cognitive impairment and Alzheimer’s miss the most important point: that everyone, as they age, should be taking steps to maintain their brain health. That includes keeping your mind and body active, eating a healthy, Mediterranean-style diet and keeping engaged socially, he added.

SOURCE: bit.ly/xHTMf8 Archives of Neurology, online February 6, 2012.

(This story was corrected to change the journal name in paragraph 11, the source line and study link)

By Frederik Joelving

NEW YORK |
Mon Feb 6, 2012 5:20pm EST

NEW YORK (Reuters Health) – Despite expert guidelines and scientific evidence to the contrary, a third of U.S. primary care physicians believe ovarian cancer screening is effective and many would offer it to patients, according to a new survey.

Although the results don’t necessarily translate into real practice, that means more than a million women might be offered the tests, which come with a hefty price tag and possible hazards, researchers say.

“Currently the evidence suggests that the harms of ovarian cancer screening exceed the benefits,” said Dr. Laura-Mae Baldwin of the University of Washington in Seattle.

“That’s why it is not being recommended.”

Baldwin and her colleagues surveyed more than 1,000 doctors across the country, asking them questions about a hypothetical case of a woman presenting for her annual exam.

The details varied, but the risk of ovarian cancer never went beyond medium. That covers about 95 percent of American women, for whom guidelines unanimously advise against screening.

Still, 65 percent of doctors said they “sometimes” or “almost always” offered or ordered ovarian cancer screening for women at medium risk. For women at low risk, the number dropped to 29 percent.

Screening is done either as an ultrasound scan or a blood test called CA-125.

Although these tests have never been shown to save lives, a third of doctors in the survey nonetheless believed they work.

“There are some critical knowledge gaps related to ovarian cancer screening among physicians,” said Baldwin, whose findings are published in the Annals of Internal Medicine. “I would suggest that women educate themselves about the risks and the benefits of the tests.”

HARM BUT NO BENEFIT

According to the largest clinical trial published so far — known as the Prostate, Lung, Colorectal and Ovarian, or PLCO, trial — women screened annually for ovarian cancer were just as likely to die from the disease as those who didn’t have regular screening.

Of some 34,000 women who got screened in that trial, 212 were diagnosed with ovarian cancer — and less than half of those cases were picked up by screening, according to Dr. Saundra Buys, who worked on the findings.

Meanwhile, the test had a false-positive rate of 8.4 percent, causing more than 3,000 false alarms — a third of which led to surgery.

“People get referred to tests they don’t need. A lot of women end up getting surgery,” said Buys, a cancer expert at the University of Utah School of Medicine in Salt Lake City.

“It’s concerning that doctors believe ovarian cancer screening is beneficial, because there is plenty of data to show that it isn’t,” she told Reuters Health.

But she also cautioned that based on data from the PLCO trial, which was published after the new survey was done, only a few percent of women say they’ve actually had a CA-125 screening test or an ultrasound.

“I don’t think there is a lot of ovarian cancer screening going on,” Buys said. “Despite what they are saying they are not ordering the tests.”

A woman’s lifetime risk of getting invasive ovarian cancer is just over one percent, with half of women diagnosed at age 60 or older, according to the American Cancer Society.

Baldwin and her colleagues estimate that about 1.2 million women might be offered one of the two screening tests for the disease. A CA-125 test costs about $80, while an ultrasound runs at $600.

EVIDENCE ‘CRUCIAL’

Even if the survey doesn’t reflect real practice, Baldwin told Reuters Health doctors often adopt new screening tests before evidence is available on whether or not they work.

Dr. Usha Menon, who runs the Gynaecological Cancer Research Centre at University College London, pointed out that physicians who listed the U.S. Preventive Services Task Force (USPSTF) as a major source of influence were more likely to stick to the guidelines.

The USPTF is a government-funded advisory agency that assesses the evidence for medical practices. It finds no evidence that routine ovarian cancer screening saves lives, but points to a “significant potential for harms.”

“By identifying critical knowledge gaps and the positive impact of the USPSTF guideline, the authors set out the first steps to promoting adherence to screening recommendations,” Menon told Reuters Health by email.

“The practice of evidence based medicine is crucial both for the wellbeing of our individual patients and for the appropriate use of available resources,” she added. “There is currently no evidence that ovarian cancer screening can save lives and it should not be offered outside clinical trials.”

Menon coordinates the massive UK Collaborative Trial of Ovarian Cancer Screening, which involves more than 200,000 women. She said results from that trial can be expected in 2014.

SOURCE: bit.ly/an7XRm Annals of Internal Medicine, February 6, 2012.

WASHINGTON |
Mon Feb 6, 2012 4:50pm EST

WASHINGTON (Reuters) – Healthy People Co is recalling 15 lots of seven different dietary supplements because they contain appetite suppressants or a drug for male erectile dysfunction, the Long Beach, California, company said.

The seven brands of supplements were sold at the company’s store at 13105 Ramona Boulevard, Irwindale, California, Healthy People said in a Friday statement carried on the Food and Drug Administration’s website.

Five of the supplements — Mince Belle, Everlax, Ever Slim, Ever Slim Shake Mix Dietary Supplement Strawberry, and Ever Slim Shake Mix Dietary Supplement Chocolate — contain sibutramine, an appetite suppressant.

Sibutramine can increase blood pressure or heart rate and has been withdrawn from the U.S. market, the statement said.

Two other supplements — Perfect Men Dietary Supplement and Herbal Drink Acai-man Mangosteen Dietary Supplement — contain tadalafil, used to treat male erectile dysfunction.

Tadalafil may interact with nitrates in prescription drugs such as nitroglycerin and may dangerously lower blood pressure, the statement said.

The statement did not say if any deaths or injuries had resulted from their use.

(Reporting by Ian Simpson; Editing by Tim Gaynor)

By Amy Norton

NEW YORK |
Mon Feb 6, 2012 4:19pm EST

NEW YORK (Reuters Health) – Losing fitness or packing on fat with age each can be bad for the heart — but avoiding either one of those fates may protect the ticker, a study published Monday suggests.

U.S. researchers found that of more than 3,100 healthy adults they followed, those who improved — or simply maintained — their fitness levels were less likely to develop high blood pressure, high cholesterol or other well-established heart disease risk factors.

Similarly, people who maintained their weight had fewer of those red flags than people who became heavier over time.

That may sound logical, but part of what’s new in the findings, researchers say, is that changes in fitness and “fatness” each appeared important on their own.

In general, people who kept their fitness levels over time seemed to counter some of the ill effects of weight gain. And dips in fitness levels weren’t as bad if a person lost some excess body fat.

The results suggest that protecting heart health is not as hard as some people think, according to lead researcher Duck-chul Lee, of the University of South Carolina in Columbia.

That is, just maintaining your weight and fitness levels as you age may be enough to see benefits.

“If you’re overweight, losing weight and improving your fitness may be the best combination,” Lee told Reuters Health. “But that’s very challenging.”

For many people, “maintenance” may be more achievable, Lee said.

The study, published in the Journal of the American College of Cardiology, included 3,148 men and women in the Dallas area who were in their early 40s, on average, at the outset.

Over six years, they developed high blood pressure at a rate of four percent each year, high cholesterol at a rate of three percent per year and so-called metabolic syndrome at a rate of two percent per year. (Metabolic syndrome refers to a collection of risk factors for heart disease — including high blood pressure, unhealthy cholesterol levels, abdominal obesity and high blood sugar.)

But people who kept up or improved their fitness levels — as measured during treadmill tests — had lower odds of developing those heart risk factors.

Their risks of high blood pressure or high cholesterol were 26 percent to 30 percent lower, versus people whose fitness levels declined. And their risk of metabolic syndrome was 42 percent to 52 percent lower.

Similarly, when people increased their percentage of body fat over time, they were more likely to develop heart risk factors.

For each one percent increase in body fat, the odds of those risk factors climbed anywhere from three percent to eight percent.

But in general, people who gained weight stayed healthier if they kept up their fitness levels. And if overweight people shed some fat, they countered some of the negative effects of waning fitness.

The bottom line, according to Lee, is that people who are active should stay active. Even if you don’t see a benefit on your bathroom scale, you’ll stay fit.

“If you’re already exercising, keep it up, and maybe increase the intensity if you can,” Lee said.

If you’re sedentary but healthy, he said, you can safely take up moderate exercise like brisk walking. Lee added, though, that people who are obese or have chronic health conditions should talk to their doctors first.

“It’s the sedentary people who will get the most benefit from exercise in a short time,” Lee said.

He was, however, referring to the benefit of improved fitness. Overweight people often fail to see the pounds fly off when they first start exercising — possibly because they are hungrier and start eating more.

Don’t get discouraged by that, Lee said. You can improve your cardiovascular fitness even without shedding the extra body fat. One way to tell if your fitness is improving, Lee said, is to simply notice how you feel when you go about your normal exercise routine; if it’s getting easier, you’re getting fitter.

To actually lose weight, diet changes are needed as well.

“Most people will lose weight with exercise,” Lee said, “if they also pay attention to the calories they’re taking in.”

SOURCE: bit.ly/dIuKje Journal of the American College of Cardiology, online February 6, 2012.

By Kate Kelland

LONDON |
Mon Feb 6, 2012 4:15pm EST

LONDON (Reuters) – Men who smoke suffer a more rapid decline in brain function as they age than their non-smoking counterparts, with their cognitive decline as rapid as someone 10 years older but who shuns tobacco, scientists said on Monday.

In a large, long-term study, British researchers found that while there seems to be no link between cognitive decline and smoking in women, in men, the habit is linked to swifter decline, with early dementia-like cognitive difficulties showing up as early as the age of 45.

The research adds to an already large body of evidence about the long-term dangers of smoking — a habit the World Health Organisation refers to as “one of the biggest public health threats the world has ever faced.”

Smoking causes lung cancer, which is often fatal, and other chronic respiratory diseases. It is also a major risk factor for cardiovascular diseases, the world’s number one killers.

“While we were aware that smoking is a risk factor for respiratory disease, cancer, and cardiovascular disease, this study shows it also has a detrimental effect on cognitive ageing and this is evident as early as 45 years,” said Severine Sabia of University College London, who led the study and published it in the Archives of General Psychiatry journal.

In an interview she said one explanation for the gender difference found in this study might be the larger amount of tobacco smoked by men, or the fact that there was a significantly lower proportion of women than men among those involved in the research.

Sabia’s team looked for possible links between smoking history and cognitive decline in the transition from midlife to old age using data from 5,099 men and 2,137 women who are involved in a large research project called the Whitehall II study, which is based on employees of the British Civil Service.

The average age of those taking part was 56 when they had their first cognitive assessment.

The study used six assessments of smoking status over 25 years and three cognitive assessments over 10 years, and found that smokers showed a cognitive decline as fast as non-smokers 10 years older than them.

“A 50 year old male smoker shows a similar cognitive decline as a 60 year old male never smoker,” Sabia explained.

She also found that men who quit smoking in the 10 years before the first cognitive testing point were still at risk of greater cognitive decline, especially in executive function — which covers various complex cognitive processes involved in achieving a particular goal.

Long-term ex-smokers, however, did not show a faster decline in their brain functions or cognitive abilities.

Sabia said more research is now needed to find out why there was a difference between men and women in this study, and to look into possible mechanisms that might link declining brain function to smoking.

(Reporting by Kate Kelland, editing by Paul Casciato)