geriatricsphilippines.org Blog

Authors: Silvina Levis, MD; Nancy Strickman-Stein, PhD; Parvin Ganjei-Azar, MD; Ping Xu, MPH; Daniel R. Doerge, PhD; Jeffrey Krischer, PhD

Journal: Arch Intern Med. 2011;171(15):1363-1369. doi:10.1001/archinternmed.2011.330

A 2- year randomized trial found no significant difference in bone loss or menopausal symptoms between women taking soy tablets or placebo.

Patients were women age 45-60 years, within 5 years of menopause and without osteoporosis.

Subjects were were randomly assigned, in equal proportions, to receive daily soy isoflavone tablets, 200 mg, or placebo.

Results
After 2 years, no significant differences were found between the participants receiving soy tablets (n = 122) and those receiving placebo (n = 126) regarding changes in bone mineral density in the spine (–2.0% and –2.3%, respectively), the total hip (–1.2% and –1.4%, respectively), or the femoral neck (–2.2% and –2.1%, respectively).

A significantly larger proportion of participants in the soy group experienced hot flashes and constipation compared with the control group. No significant differences were found between groups in other outcomes.

Authors’ Conclusions
In this population, the daily administration of tablets containing 200 mg of soy isoflavones for 2 years did not prevent bone loss or menopausal symptoms

The 32-year relationship between cholesterol and dementia from midlife to late life. Neurology. November 23, 2010 75:1862-1863
Authors: Mielke, Zandi, Shao, et al

Methods:
The Prospective Population Study of Women, consisting of 1,462 women without dementia aged 38–60 years, was initiated in 1968–1969 in Gothenburg, Sweden. Follow-ups were conducted in 1974–1975, 1980–1981, 1992–1993, and 2000–2001. All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria. Cox proportional hazards regression examined baseline, time-dependent, and change in cholesterol levels in relation to incident dementia and AD among all participants. Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000–2001 examination.

Results:
Higher cholesterol level in 1968 was not associated with an increased risk of AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence interval [CI] 0.94–8.43) among those who survived to and participated in the 2000–2001 examination. While there was no association between cholesterol level and dementia when considering all participants over 32 years, a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia (HR 2.35, 95% CI 1.22–4.58).

Conclusion:
These data suggest that midlife cholesterol level is not associated with an increased risk of AD. However, there may be a slight risk among those surviving to an age at risk for dementia. Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset. Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results.

They pointed to animal and cell culture studies suggesting a causal link with high cholesterol leading to amyloid-beta deposition characteristic of Alzheimer’s disease. However, cholesterol declines in older age, “perhaps as a function of underlying subclinical pathology, sarcopenia, or change in appetite,” Haan explained. The study was also limited by loss of participants due to death or refusal, possible undiagnosed dementia, lack of genotyping for high-risk alleles, and unknown generalizability to men and populations outside of Sweden, the researchers noted.

Calcium supplements are commonly prescribed to prevent and manage osteoporosis.

A few randomized trials on calcium supplements have shown an increased risk of cardiovascular adverse events in women taking calcium supplements. (Reid et al Am J Med 2006;119:777-85 and Bolland et al BMJ 2008;336:262-6)

[caption id=”attachment_523″ align=”aligncenter” width=”164″ caption=”osteoporotic hipfracture”][/caption]

A newly published meta analysis of clinical trials of calcium supplements (Bolland et al BMJ 2010 341 c3691) shows that calcium intake increases the risk of heart attacks (myocardial infarction) by 30%.

In this meta analysis, 15 trials were eligible for inclusion, five with
patient level data (8151 participants, median follow-up 3.6 years, interquartile range 2.7-4.3 years) and 11 with trial level data (11 921 participants, mean duration 4.0 years). The number of subjects in the analysis totalled 12,000 participants.

In the five studies contributing patient level data, 143 people allocated to calcium had a myocardial infarction compared with 111 allocated to placebo (hazard ratio 1.31, 95% confidence interval 1.02 to 1.67, P=0.035)

The authors conclude that calcium supplements (without co-administered vitamin D) are associated with an increased risk of myocardial infarction. As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population.

Studies on Vitamin D with or without calcium are also warranted.

The following study demonstrated that

Aspirin was not effective in the primary prevention of
cardiovascular events in patients with asymptomatic peripheral arterial disease and diabetes. Antioxidants showed no benefit on cardiovascular events in this population.

Study Title: The prevention of progression of arterial disease and
diabetes (POPADAD) trial: factorial randomised placebo
controlled trial of aspirin and antioxidants in patients with
diabetes and asymptomatic peripheral arterial disease

Authors:
Jill Belch, Angus MacCuish, Iain Campbell, et al.

Citation: BMJ 2008;337:a1840 doi:10.1136/bmj.a1840

Background:
Aspirin is effective in the secondary prevention of cardiovascular events in patients with symptomatic peripheral arterial disease and with or without diabetes. However, the role of aspirin and antioxidants in primary prevention is not clear.

The study’s main objective was to determine whether aspirin and antioxidant therapy, combined or alone, are more effective than
placebo in reducing the development of cardiovascular events in patients with diabetes mellitus and asymptomatic peripheral arterial disease.

Subjects: 1276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease. Baseline characteristics were equal in all groups. Average age was 60 years. Approximately 53% were women. Mean HBA1c level was 8%.

Method: Multicentre, randomised, double blind, 2×2 factorial, placebo controlled trial.

Intervention:
The interventions were daily aspirin 100 mg or placebo tablet, plus antioxidant or placebo capsule. The antioxidant capsule contained α-tocopherol 200 mg, ascorbic acid 100 mg, pyridoxine hydrochloride
25 mg, zinc sulphate 10 mg, nicotinamide 10 mg, lecithin 9.4 mg, and sodium selenite 0.8 mg

Conclusions: This trial does not provide evidence to support
the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied.

Lifestyle Diseases (Sakit sa Puso)

Sinulat ni JD Agapito

Sa dami ng sakit sa ating lipunan

Sakit ng katawan ay kayang pigilan

Lalo na’t sa puso ang pag-uusapan.

Disiplina ang siyang tanging kailangan

Bakit ko nasabi ang huli kong linya?

Dahil ang sakit ay tayo ang may gawa.

Alam na masamang kumain ng taba.

Hanap nitong dila’y karneng mamantika.

Kung may pera nama’y panay rin ang punta

Sa mga food chains na prito ang siyang tinda.

Sa order na chicken, balat ang inuuna.

Mataas na kolesterol siyang ‘di iniinda.

Bukod pa nga rito’y ang hindi paggalaw.

Panay ang pag-upo’t di man lang sumayaw.

Kahit na minsan lang sa buong isang araw.

Maglakad lakad ng taba ay matunaw.

Maging sa inumi’y di displinado.

Kung uminom ng softdrinks sadyang bigay todo.

Dapat ay minsan lang sa buong ‘sang linggo.

Mas maraming tubig ang dapat sa iyo.

Kaya’t mas marami ang may hypertension.

Dahil sa kinai’y mayr’ong alta presyon.

Dagdagan pa natin ng lahat ng tensyon.

Dala na rin mismo ng mga sitwasyon.

Kaya kung ikaw ay hindi magbabago.

Lalo pa kung ika’y naninigarilyo.

Tiyak ang buhay mo ay mamimiligro.

Sakit sa puso ang tatapos sa iyo.

Dito sa aking tula ‘y may hihilingin.

Pwede bang pagkain ay sadyang isipin

Para makontrol ang taba maging asin.

Mga simpleng bagay ‘wag ng problemahin.

Kaya’t sana ay hindi pa mahuli.

Itong aking payong hangad ay mabuti.

Upang maiwasan itong maatake.

At di na mangyari itong pagsisisi.

Dahil may dalanging kasama ang tula.

Itaas sa Diyos ang nais na sadya.

Sa kanyang patnubay lahat magagawa.

Kung buhay ay maayos, siya’y matutuwa.

Contributed by COMADD NIH Member
Prof JD
June 28, 2010 5:00

Part 2: Cognitive Engagement and Physical Activity

1. Cognitive Engagement.

Cognitive Training - modest benefits on cognitive functioning and a small but statistically significant effect on reducing the extent of age-related decline in cognitive function at a 5-year follow-up. Very small but statistically significant benefit on instrumental activities of daily living—for example, managing finances, managing medications, keeping house, and, in a subgroup analysis, benefit on driving performance in the elderly.

However, these results from a single trial must be replicated to confirm the benefits of cognitive engagement on preventing
cognitive decline over a longer time period and in study subjects with varying levels of baseline cognitive abilities before a firm recommendation can be made.

2. Physical Activity. Increased physical activity, including walking, may help maintain or improve cognitive function in normal adults.

Although encouraging, these data should be viewed as preliminary. Work is ongoing to further investigate the benefits of
physical activity.

Factors associated with decreased risk of Alzheimer’s disease and cognitive decline were cognitive engagement (as indicated by literacy and social enrichment), physical activities in later life, and a diet low in saturated fat and high in vegetable intake. Light to moderate alcohol intake
is reported to be associated with reduced risk of Alzheimer’s disease, but results are inconsistent for cognitive decline

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

AFP - Thursday, October 16

WASHINGTON (AFP) - - Googling is good for you. No, really.

A team of US researchers has found that searching the Internet stimulates brain activity in the elderly and middle-aged and may help keep their minds sharp.

The study was carried out by scientists at the University of California at Los Angeles (UCLA) and published in the latest edition of the American Journal of Geriatric Psychiatry.

The UCLA scientists found that searching the web triggers key centers in the brain that control decision-making and complex reasoning and may help stimulate and possibly improve brain function.

“The study results are encouraging, that emerging computerized technologies may have physiological effects and potential benefits for middle-aged and older adults,” said Dr. Gary Small, the principal investigator of the study.

“Internet searching engages complicated brain activity, which may help exercise and improve brain function,” said Small, a professor at UCLA’s Semel Institute for Neuroscience and Human Behavior.

The study’s authors noted that their findings are the latest to suggest that complex activity that keeps the mind engaged, such as crossword puzzles, may help keep the brain healthy.

The UCLA researchers said they tested 24 neurologically normal research volunteers between the ages of 55 and 76, half with experience searching the Internet and half with no experience.

The study participants performed Web searches and book-reading tasks while undergoing functional magnetic resonance imaging (fMRI) scans, which record brain-circuitry changes.

They all showed significant brain activity during book reading and web searching, but the Internet-savvy group registered a twofold increase in brain activation during web use when compared with those with little Internet experience.

They said the web-savvy group also registered greater activity in the frontal, temporal and cingulate areas of the brain, which control decision-making and complex reasoning.

“Our most striking finding was that Internet searching appears to engage a greater extent of neural circuitry that is not activated during reading — but only in those with prior Internet experience,” said Small.

“A simple, everyday task like searching the web appears to enhance brain circuitry in older adults, demonstrating that our brains are sensitive and can continue to learn as we grow older,” he added.