- Created on 07 November 2012
Researchers have found some of the earliest signs of Alzheimer's disease, more than two decades before the first symptoms usually appear.
Treating the disease early is thought to be vital to prevent damage to memory and thinking.
A study, published in the Lancet Neurology, found differences in the brains of an extended Colombian family predisposed to develop an early form of Alzheimer's.
Experts said the US study may give doctors more time to treat people.
Alzheimer's disease starts long before anyone would notice; previous studies have shown an effect on the brain 10-15 years before symptoms.
It is only after enough brain cells have died that the signs of dementia begin to appear - some regions of the brain will have lost up to 20% of their brain cells before the disease becomes noticeable.
Continue reading the main story
However, doctors fear so much of the brain will have degenerated by this time that it will be too late to treat patients. The failure of recent trials to prevent further cognitive decline in patients with mild to moderate Alzheimer's disease has been partly put down to timing.
A team at the Banner Alzheimer's Institute in Arizona looked at a group of patients in Colombia who have familial Alzheimer's. A genetic mutation means they nearly always get the disease in their 40s. Alzheimer's normally becomes apparent after the age of 75.
Brain scans of 20 people with the mutation, aged between 18 and 26, already showed differences compared with those from 24 people who were not destined to develop early Alzheimer's.
The fluid which bathes the brain and spinal cord also had higher levels of a protein called beta-amyloid.
The researchers said differences could be detected "more than two decades before" symptoms would appear in these high-risk patients.
Dr Eric Reiman, one of the scientists involved, said: "These findings suggest that brain changes begin many years before the clinical onset of Alzheimer's disease.
"They raise new questions about the earliest brain changes involved in the predisposition to Alzheimer's and the extent to which they could be targeted by future prevention therapies."
Prof Nick Fox, from the Institute of Neurology at University College London, said some of his patients had lost a fifth of some parts of their brain by the time they arrived at the clinic.
He told the BBC: "I don't think this pushes us forwards in terms of early diagnosis, we already have markers of the disease.
"The key thing this does is open up the window of early intervention before people take a clinical and cognitive hit."
However, he said this raised the question of how early people would need to be treated - if drugs could be found.
Dr Simon Ridley, the head of research at Alzheimer's Research UK, said: "Although early-onset inherited Alzheimer's is rare and may not entirely represent the more common late-onset form, the findings highlight changes can take place in the brain decades before symptoms show.
"Mapping what changes happen early in the brain will help scientists to improve detection of the disease and allow potential new treatments to be tested at the right time.
"New drugs are being developed and tested to stop amyloid from taking hold, but studies like these show that timing could be crucial for whether these drugs are successful."
- Created on 06 November 2012
LOS ANGELES (AP) — Multivitamins might help lower the risk for cancer in healthy older men but do not affect their chances of developing heart disease, new research suggests.
Two other studies found fish oil didn't work for an irregular heartbeat condition called atrial fibrillation, even though it is thought to help certain people with heart disease or high levels of fats called triglycerides in their blood.
The bottom line: Dietary supplements have varied effects and whether one is right for you may depend on your personal health profile, diet and lifestyle.
"Many people take vitamin supplements as a crutch," said study leader Dr. Howard Sesso of Brigham and Women's Hospital in Boston. "They're no substitute for a heart-healthy diet, exercising, not smoking, keeping your weight down," especially for lowering heart risks.
The studies were presented Monday at an American Heart Association conference in Los Angeles.
A separate analysis released in connection with the meeting showed that at least 1 in 3 baby boomers who are in good shape will eventually develop heart problems or have a stroke. The upside is that that will happen about seven years later than for their less healthy peers.
The study is "a wake-up call that this disease is very prevalent in the United States and even if you're doing a good job, you're not immune," said Dr. Vincent Bufalino, a Chicago-area cardiologist and spokesman for the American Heart Association.
The findings came in an analysis of five major studies involving nearly 50,000 adults aged 45 and older who were followed for up to 50 years.
The research was published online by the Journal of the American Medical Association, along with the vitamin paper and one fish oil study.
Multivitamins are America's favorite dietary supplement. About one-third of adults take them. Yet no government agency recommends their routine use for preventing chronic diseases, and few studies have tested them to see if they can.
A leading preventive medicine task force even recommends against beta-carotene supplements, alone or with other vitamins, to prevent cancer or heart disease because some studies have found them harmful. And vitamin K can affect bleeding and interfere with some commonly used heart drugs.
Sesso's study involved nearly 15,000 healthy male doctors given monthly packets of Centrum Silver or fake multivitamins. After about 11 years, there were no differences between the groups in heart attacks, strokes, chest pain, heart failure or heart-related deaths.
Side effects were fairly similar except for more rashes among vitamin users. The National Institutes of Health paid for most of the study. Pfizer Inc. supplied the pills and other companies supplied the packaging.
The same study a few weeks ago found that multivitamins cut the chance of developing cancer by 8 percent — a modest amount and less than what can be achieved from a good diet, exercise and not smoking.
Multivitamins also may have different results in women or people less healthy than those in this study — only 4 percent smoked, for example.
The fish-oil studies tested prescription-strength omega-3 capsules from several companies in two different groups of people for preventing atrial fibrillation, a fluttering, irregular heartbeat.
One study from South America aimed to prevent recurrent episodes in 600 participants who already had the condition. The other sought to prevent it from developing in 1,500 people from the U.S., Italy and Argentina having various types of heart surgery, such as valve replacement. About one third of heart-surgery patients develop atrial fibrillation as a complication.
Both studies found fish oil ineffective.
AP Medical Writer Lindsey Tanner in Chicago contributed to this report.
- Created on 02 November 2012
A new drug is the "most effective" treatment for relapsing-remitting multiple sclerosis, say UK researchers.
During MS the body's immune system turns on its own nerves causing debilitating muscle problems.
Researchers at the University of Cambridge say a cancer drug, which wipes out and resets the immune system, has better results than other options.
However, there is concern that a drugs company is about to increase the cost of the drug as a result.
Around 100,000 people in the UK have multiple sclerosis. When the condition is diagnosed most will have a form of the disease know as relapsing-remitting MS, in which the symptoms can almost disappear for a time, before suddenly returning.
Built from scratch
The researchers tested a leukaemia drug, alemtuzumab, which had shown benefits for MS in small studies.
In leukaemia, a blood cancer, it controls the excess production of white blood cells. In MS patients, the dose eliminates the immune cells entirely, forcing a new immune system to be built from scratch which should not attack the nerves.
Two trials, published in the Lancet medical journal, compared the effectiveness of alemtuzumab with a first-choice drug, interferon beta-1a.
One compared the effectiveness in patients given the drug after being diagnosed, the other looked at patients given the drug after other treatments had failed.
Both showed the drug was around 50% more effective at preventing relapses and patients had less disability at the end of the study than when they started.
Dr Alasdair Coles, from the University of Cambridge, said: "Although other MS drugs have emerged over the last year, which is certainly good news for patients, none has shown superior effects on disability when compared to interferon except alemtuzumab."
He told the BBC: "It is certainly the most effective MS drug, based on these clinical trials, but this is definitely not a cure."
However, he warned there were side-effects. These include developing other immune disorders.
He said he thought the drug would be most useful for patients for whom standard treatment had failed and in a "minority" of patients as a first-choice drug.
Eventually relapsing-remitting MS can become progressive MS as the good spells become shorter and less frequent. The drug will have no effect on this form of the disease.
The drug has been withdrawn from the market in Europe and the US as the manufacturer, Genzyme, intends to have it licensed as a treatment for MS.
A Lancet editorial warns: "There is concern that with a licence for multiple sclerosis, the cost of alemtuzumab could rise and might become too expensive for many patients and health systems.
"Finding promising treatments such as alemtuzumab is important. But so is keeping alemtuzumab accessible and affordable."
Dr Doug Brown, head of biomedical research at the MS Society, said: "These results are great news for people with relapsing-remitting multiple sclerosis.
"Alemtuzumab has been found to be an effective treatment for people with MS - but it's only useful to them if it's available on the NHS.
"We urge Genzyme to price the treatment responsibly so that if it's licensed, it's deemed cost-effective on the NHS."
The company said it would not come up with a price for the drug "until it is approved by regulatory authorities" and that it would "engage constructively" with the National Institute for Health and Clinical Excellence, which evaluates the cost-effectiveness of drugs for use in the NHS.
- Created on 05 November 2012
Humana Inc. (HUM), the second-biggest private Medicare insurer, agreed to buy medical provider Metropolitan Health Networks Inc. (MDF) for about $500 million as the company expands beyond paying claims into delivering care.
Humana also reported third-quarter profit that fell less than analysts estimated, raised its earnings forecast for the year and said President Bruce Broussard, previously announced as the incoming chief executive officer, will take over Jan. 1. Humana will pay off $350 million of Metropolitan debt, valuing the deal at $850 million.
Stockholders of Boca Raton, Florida-based Metropolitan Health will receive $11.25 a share in cash, the companies said in a statement today. The price is 3.7 percent above Metropolitan Health's closing level Nov. 2. Louisville, Kentucky-based Humana also will buy a company that helps doctors share patient records and a stake in another medical provider.
The purchase of Metropolitan Health is Humana's latest foray into providing medical services, as the insurer seeks more levers to control rising costs in Medicare, the U.S.-backed program for the elderly. The company bought Concentra Inc. for $790 million in 2010, adding 300 health clinics in 40 states, and since then has also invested in urgent-care clinics, a home- care company and other providers.
The deal is "strategically the right move" and showcases Broussard's growth strategy, said Ana Gupte, a Sanford C. Bernstein & Co. analyst in New York, in an e-mail. "All the moves drive Humana's prowess further up in coordinated care management and delivery which in our view is critical for the success" of private insurers covering Medicare patients.
Shares of Metropolitan Health, already a contractor with Humana, had risen 45 percent this year through last week, and investors had likely "priced in" some type of acquisition, Gupte said. The stock gained 2.7 percent to $11.14 at 9:41 a.m. New York time.
Humana fell 1.4 percent to $74.18. The shares had lost 14 percent this year through yesterday.
Metropolitan Health had $323.5 million in long-term liabilities (MDF) and debt as of June 30, according to data compiled by Bloomberg.
The acquisition gives Humana a company with experience coordinating care for 87,500 customers mostly covered by Medicare and Medicaid, the joint state-federal program covering the poor. Both are expected to grow as the U.S. population ages and government services expand under the 2010 health-care law passed by Congress.
The three deals announced today "significantly advanced our strategy of aligning physician pay to quality," Broussard said in a statement. Combined with previous acquisitions, "Humana will soon employ or have strategic investments in medical practices that include nearly 2,300 physicians nationwide."
The purchase of Metropolitan Health is expected to close in next year's first quarter.
Humana also agreed to buy (HUM) San Jose, California-based Certify Data Systems, a health-information exchange company that helps doctors share electronic medical records, and purchased a non-controlling equity interest in MCCI Holdings LLC, another care provider that primarily serves Medicare and Medicaid members in Florida and Texas. Terms of those deals weren't disclosed. Humana said the acquisitions would increase earnings "modestly" in 2013.
Third-quarter profit fell 4 percent as Humana continued to grapple with higher-than-expected medical costs.
Net income (HUM) fell to $426 million, or $2.62 a share, from $444.8 million, or $2.67, a year earlier. The results beat the $2.05 average of 20 analyst estimates compiled by Bloomberg.
The company raised its 2012 profit forecast to $7.25 to $7.35 a share, after cutting its outlook in June due to rising costs. Analysts had estimated an average of $7.11.
Humana said last year that Broussard, 50, would succeed Michael McCallister, who is retiring after 12 years as CEO.
- Created on 31 October 2012
(CNN) -- For too many, the past few days have been some of the toughest in recent memory.
We gasped at the approach of a monster storm, no less formidable because of its casual moniker. In the days leading up to its arrival, our friends and family in the East prepared as best as they could. Then they hunkered down as Sandy wreaked havoc in a crazed rumpus.
Millions have begun to take the first steps on the road to recovery, daunting as it may be.
Stress and anxiety are a given in the aftermath of a natural disaster -- particularly for those living in shelters; those still lacking power; those attempting to return to work with no transit system; or those who must deal with insurance companies -- or worse.
Short-term emotional and behavioral reactions are both common and normal following a natural disaster, says Richard Heaps, a clinical psychologist and professor at Brigham Young University's counseling psychology department. Heaps has served as a disaster mental health volunteer with the American Red Cross since 1992.
"It's OK to mourn losses," says Heaps. "It's not an abnormal reaction, but healthy and appropriate."
Heaps and Melissa Brymer, director of Terrorism and Disaster Programs at the UCLA/Duke University National Center for Child Traumatic Stress, offer advice and strategies for stress management following natural disasters:
1. Keep in touch
Connection and communication are both critical right now, says Brymer.
People experiencing strong emotional reactions may sometimes withdraw and pull inside themselves, Heaps says. This gets in the way of managing and dealing with the stress of traumatic incidents. "These people may avoid threat, but they also avoid healing," he says.
Do not withdraw from important relationships, recommends Heaps. Keep in touch with the people you are worried about, so that you know what is happening instead of continuing to worry.
If necessary, find ways of connecting that require less energy, suggests Brymer. Send a text message. Use social media. There may be ways that work better for you than picking up a phone.
What's key, she says, is the connection, whatever form it may take.
Brymer also emphasizes the importance of connecting with your local community. "If you are relying too much on national networks, it will be difficult to find out what's happening in your area," she says. Connecting on a local level can help ease worries by providing important updates that are relevant to you.
2. Take care of yourself and get back to routines
As we strive for a return to normalcy, there may be a tendency toward over-work, particularly for those involved in some way in cleanup and recovery efforts.
Important though your job may be, Brymer suggests taking the time to care for yourself. "Think about what you're eating. Do your best to sleep enough. Consider whether there are any major decisions that you can put off right now."
We often do not recognize that the additional nuisances we have to deal with following a natural disaster can wear on us, says Brymer. "It's important to actively take care of yourself."
According to Heaps, reestablishing routines and returning to old patterns is important because they can serve as a signal that we are moving past the trauma.
Heaps also advises returning to normal eating and activity patterns -- and especially sleep patterns -- to the best of your ability.
"Some people find it difficult to do these things when they are stressed, but the more you return to these patterns, the more you return to normal," he says. "These routines will help your body and mind to function better."
3. Process through storytelling
Storytelling -- orally, in writing, or whatever other form it may take -- can be healing. Make an effort to talk to friends or family about what you experienced or write down your thoughts and ideas in a journal or diary.
"Communicating their thoughts and feelings helps people understand the reality of what they have experienced. It also opens the door to the possibility of moving forward past the trauma," says Heaps.
4. Honor other ways of coping
Brymer emphasizes that there is no one way of coping. "One thing we have learned is that individuals, even members of the same family who went through the same disaster together, have different ways of expressing themselves about the event," she says.
Don't assume that others will feel or react the same way you will. Each one of us has been impacted in a different way and we must accept that others may have their own way of expressing themselves.
If someone needs a longer period of time before they can talk about what has happened, be OK with that, says Brymer. Be willing to listen when they are ready. You can check in with them frequently by asking, "How are you doing right now?"
5. Limit exposure
Many of us have been glued to our various media screens for updated images and news about the disaster and rescue efforts. Brymer suggests curbing that inclination because "ongoing exposure can make some people even more anxious and worried."
6. Practice calming and relaxation methods
What can you do to help alleviate anxiety in the moment?
Both Heaps and Brymer suggested finding ways to calm yourself during anxious moments. This can take many forms, including deep breathing or meditation. Some people like music or singing. Others prefer praying. Whatever works best for you is the one you should be doing.
When we are distressed, we take rapid and shallow breaths. Brymer suggests taking time out throughout the day to breathe in and out slowly. Pay particular attention to breathing out, she says.
Or try this exercise: Tense your muscles and then relax them. This helps people identify where the tension may lie in their bodies and tightening the muscles may help people relax them more effectively, says Heaps.
"You may also distract yourself," advises Brymer. "Remind yourself that you are OK right now, that you are safe. And keep repeating it, if you need to. Because more than likely, you are safe. Self-talk can be very helpful."
7. Lend a hand in any way you can
"Service is a therapeutic activity," says Heaps. "Some people find it difficult to accept help. It's important to accept help, but it is equally important to help others."
Both Heaps and Brymer suggest seeking support from mental health professionals if stress reactions to the disaster feel overwhelming or continue long-term.
For more information, visit the American Psychological Association's help center or the National Child Traumatic Stress Network.