October 21, 2008
Spiriva doesn’t slow COPD decline, but it really helps a lot anyway
Tiotropium (Spiriva) did not achieve the main study objective of lowering the rate of decline in forced expiratory volume (FEV1) among COPD patients in the large multicenter UPLIFT trial.
However, the drug was responsible for significant improvements in
* lung function,
* quality of life, and
* time to first exacerbation
Patients in the study were allowed to use any respiratory medications they wanted, except for other inhaled anticholinergic agents.
Data from the same study just prompted the FDA to lift its earlier warning about tiotropium and the risk of stroke.
Like the TORCH study reported earlier this year, the UPLIFT study came close to (but did not succeed in) finding a significant effect on mortality.
The best way to slow the rate of FEV1 decline, of course, is to quit smoking. This helps even patients with severe COPD, according to a new review in the European Respiratory Journal.
Research/Reviews
In this category, you’ll find the latest research into the predictive value of the BODE index in COPD.
Related searches
Find reports from earlier trials of interventions to slow the respiratory decline in COPD:
EUROSCOP
ISOLDE
BRONCUS
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Cardiovascular, Family Medicine, Geriatrics, Internal Medicine, Respiratory_Infectious, Uncategorized | Tagged: stroke, COPD | 
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Posted by smnewsletters
August 12, 2008
Calories—not sugar, carbs, or fat—cause type 2 diabetes in those at risk
What people eat controls what they weigh, and that (setting aside genes and exercise) seems to determine the risk of type 2 diabetes—not the types of macronutrients themselves. That’s the upshot of two new studies in the Archives of Internal Medicine, according to a review in the same issue.
It’s not the sugar in soft drinks or juices but the poundage they so easily add that predisposes to type 2 diabetes, according to a study of young African-American women in the July 28 issue of Archives.
It was probably weight loss per se, not the low-fat or high-fiber diet, that reduced glycemia among postmenopausal women in the other study.
Which is best for weight loss: low carbs, low fat, or the Mediterranean diet? Depends on the patient’s underlying risk profile. The latter may be best for people at risk of diabetes, according to another new report, this one in the New England Journal of Medicine.
Related searches
Mediterranean diet diabetes
obesity children juice
menopause metabolic syndrome testosterone
Research/Reviews
How much exercise do patients need to maintain weight loss? Find more new reports in this article category.
Patient Education
Look in this category for trustworthy information for patients about physical activity and diabetes.
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Adolescent, Cardiovascular, Diabetes_Endocrine, Family Medicine, Gastrointestinal, Geriatrics, Internal Medicine, Pediatrics, Women | Tagged: calories, carbohydrates, Diabetes_Endocrine, fat, menopause, obesity, weight loss | 
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Posted by smnewsletters
August 5, 2008
College grads with MMSE below 27 need dementia testing, says Mayo team
The bar should be set higher in suspecting a diagnosis of early Alzheimer’s among highly educated patients, according to a new report in Archives of Neurology.
A study from the Mayo Clinic Alzheimer Research Center shows that, for college-educated individuals, an MMSE score below 27 is a much better predictor of dementia risk than the customary cutoff score of 24.
The difference is important because highly educated folks with Alzheimer’s decline faster and die sooner, according to the medical literature.
But there’s good news: Higher education also delays the steepest part of the cognitive decline, reports another recent study.
Well-educated people may want to know that physical exercise seems to diminish brain atrophy in Alzheimer’s, according to another new study. (Whether that translates to an effect on cognitive function is not yet determined.)
Other Alzheimer News
dimebon Alzheimer
etanercept Alzheimer speech
Clinical Trials
Scholarly people with memory loss may want to help researchers determine whether mental exercise can delay dementia, by enrolling in a clinical trial that’s testing the question.
Practical Articles/News
Read a review about medical treatment for early Alzheimer’s recently published in Consultant.
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Dementia, Family Medicine, Geriatrics, Psychiatry | Tagged: Alzheimer's disease, Dementia, education, memory | 
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Posted by smnewsletters
June 10, 2008
Any antipsychotic triples risk of serious events for elderly with dementia
Giving antipsychotics of any kind to an elderly person with dementia, even briefly, increases the risk of death or hospitalization by three or four times, according to a new longitudinal study in the Archives of Internal Medicine.
The study of over 40,000 elderly Canadians, equally divided between those living in nursing homes and those in the community, compared people who took antipsychotics with those who did not. The authors felt they have identified only the “tip of the iceberg” in terms of adverse events.
Research/Reviews
The risk of serious consequences in this study is considerably larger than in earlier studies that compared typical and atypical antipsychotics among the elderly.
Another recent study has found non-steroidal anti-inflammatory drugs (NSAIDs) of no value in preventing cognitive decline in Alzheimer dementia.
Clinical Trials
What’s happening in research using statins to treat Alzheimer disease?
No Comments » | Dementia, Geriatrics, Uncategorized | Tagged: antipsychotics, Dementia, elderly | Permalink
Posted by smnewsletters
April 1, 2008
Five million over age 70 have memory loss. One-fourth are chronically ill.
A groundbreaking nationwide longitudinal study has documented the dimensions of dementia. It estimates that 22% of Americans over age 70—more than five million people–have cognitive impairment without dementia.
On average, this progresses to dementia within about 18 months in about 12% of cases, according to the report in the Annals of Internal Medicine. (The rate of progression varies by subtype of cognitive impairment.)
In 24% of elderly patients, cognitive impairment without dementia is associated with a chronic comorbidity such as diabetes or heart disease. The report notes that doctors busy with the medical condition probably often overlook the cognitive issues (perhaps hindering the success of treatment).
The new national results echo earlier studies that associated early dementia with medical comorbidities.
A series of articles and letters in recent issues of the Journal of the American Medical Association pondered whether primary care doctors should begin screening for cognitive impairment in elderly patients.
Practice Guidelines
Look in this category for national guidelines on diagnosing mild cognitive impairment.
Cardiovascular
A recent study suggests best followup tests for cognitive impairment in stroke patients.
No Comments » | Dementia, Family Medicine, Geriatrics, Psychiatry | Tagged: cognitive impairment, Dementia, stroke | Permalink
Posted by smnewsletters
October 11, 2007
A new meta-analysis finds that stroke patients function better in daily activities after they have specific occupational therapy (training in dressing, self-feeding and the like). The researchers say that this should advance the discussion beyond merely whether occupational therapy helps outcomes in stroke, to what kind of OT is best for these patients.
Previous systematic reviews about occupational therapy, they say, have not focused specifically on stroke (although you’ll find a Cochrane review by the same authors on the topic of stroke also published this year).
Clinical Trials for Patients
A look at current clinical trials suggests that this topic is not yet high on the research agenda.
Patient Education Materials
Quickly find an article for patients about what to expect during stroke recovery.
No Comments » | Cardiovascular, Geriatrics | Tagged: occupational therapy, stroke | Permalink
Posted by Cranky Aged Mama
