The study, by scientists at the Rush Alzheimer’s Disease Center and Rush-Presbyterian-St. Luke’s Medical Center in Chicago, IL, appearing in the February 13, 2002, Journal of the American Medical Association, found that more frequent participation in cognitively stimulating activities is associated with a reduced risk of Alzheimer’s disease (AD). The research looked at everyday activities like reading books, newspapers or magazines, engaging in crosswords or card games, and going to museums among participants in the Religious Orders Study, an ongoing examination of aging among older Catholic nuns, priests, and brothers from several groups across the U.S. On a scale measuring cognitive activity -- with higher scores indicating more frequent activity -- a one-point increase in cognitive activity corresponded with a 33 percent reduction in the risk of AD.

The examination of cognitively stimulating activities and risk of AD was conducted by Robert S. Wilson, Ph.D., and colleagues at the Rush Alzheimer’s Disease Center, including David A. Bennett, M.D., principal investigator for the Religious Orders Study, and Denis A. Evans, M.D., director of the National Institute on Aging (NIA)-supported Rush Alzheimer’s Disease Center. The NIA is part of the National Institutes of Health, Department of Health and Human Services.

The findings are likely to strike a chord among middle-aged and older people interested in preserving cognitive health. “We are asked constantly about this use-it-or-lose-it approach to maintaining memory,” says Elisabeth Koss, Ph.D., Assistant Director of the NIA’s Alzheimer’s Disease Centers Program. “This study provides important new evidence that there may be something to the notion of increased cognitive activity and reduced risk of Alzheimer’s disease. Further research should help better sort out whether cognitive activities can be prescribed to reduce risk of AD and why that may be so.”

The study followed over 700 dementia-free participants age 65 and older for an average of 4.5 years from their initial assessments. At baseline and then yearly, some 21 cognitive tests were administered to assess various aspects of memory, language, attention, and spatial ability. At the initial evaluations, participants also were asked about time typically spent in seven common activities that significantly involve information processing – viewing television; listening to the radio; reading newspapers or magazines; reading books; playing games such as cards, checkers, crosswords, or other puzzles; and going to museums. The frequency of participating in each activity was rated on a five-point scale, with the highest point assigned to participating in an activity every day or about every day and the lowest point to engaging in an activity once a year or less.

During the follow-up period, 111 people in the study developed AD. In comparing the levels of cognitive activity with diagnosis of AD, the researchers found that the frequency of activity was related to the risk of developing AD. For each one point increase in the participants’ scores on the scale of cognitive activities, the risk of developing AD decreased by 33 percent. On average, compared with someone with the lowest activity level, the risk of disease was reduced by 47 percent among those whose frequency of activity was highest.

The researchers also looked at general cognitive decline among the participants. Over the period of the study, the group of older people showed modest age-related declines on several types of memory and information processing tests. There were lower rates of decline, however, in working memory, perceptual speed, and episodic memory among people who did more cognitively stimulating activities.

What accounts for the association between cognitively stimulating activities and reduced risk of cognitive decline and AD is unclear. It may be, some scientists theorize, that cognitive activities are protective in some way. Some speculate that repetition might improve the efficiency of certain cognitive skills and make them less vulnerable to the brain damage in AD. Or, some kind of compensatory mechanisms might be at work, strengthening information processing skills to help compensate for age-related declines in other cognitive areas. The study does not, however, eliminate the possibility that people who develop AD in future years may be less prone, years before, to engage in cognitively stimulating activities. Notes Wilson, “The associations among cognitive activity, Alzheimer’s disease, and cognitive function are extremely complex. Additional study, including testing some of these activities as cognitive interventions, will help to tell us whether such enjoyable and easy-to-do activities could be employed in some way to reduce the risk of memory decline and loss.” Because the participants in the study have agreed to brain donation, the investigators hope to be able to determine the mechanism underlying the association between cognitive activities and cognitive decline. More than 900 older Catholic clergy from 40 groups across the U.S. are participating in the Religious Orders Study. All participants have agreed to annual memory testing and brain donation at the time of death. “We are grateful for the remarkable dedication and altruism of this unique group of people,” says Bennett. “I expect we will learn a great deal more from them, as we look for insights into how the brain functions with age.”

The NIA leads the Federal effort to support and conduct research on aging and on AD. The Rush Alzheimer’s Disease Center is one of 29 NIA-supported Alzheimer’s Disease Centers across the U.S. which conduct basic, clinical, and social and behavioral research on dementia and AD. NIA also sponsors the Alzheimer’s Disease Education and Referral (ADEAR) Center, which provides information on AD research to the public, health professionals, and the media. ADEAR can be contacted toll free at 1-800-438-4380 weekdays during business hours or by visiting its website, www.alzheimers.org. Press releases, fact sheets, and other general information materials on aging and aging research can be viewed at the NIA’s home website, http://www.nia.nih.gov.

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By Merritt McKinney

NEW YORK (Reuters Health) - High levels of the amino acid homocysteine may increase the risk of developing Alzheimer's disease (news - web sites), researchers report.

In a new study, the risk of Alzheimer's was nearly doubled in people with high levels of the amino acid.

The study raises the possibility of staving off dementia by consuming more folic acid and vitamins B6 and B12, which can lower homocysteine levels.

But the study's first author emphasized that the research does not prove that lowering homocysteine levels will prevent Alzheimer's.

Still, Dr. Sudha Seshadri of Boston University School of Medicine in Massachusetts told Reuters Health that eating a low-fat, nutrient-rich diet is always a good idea.

"Our study is observational and cannot be used as a basis for treatment recommendations," she said. But the results should encourage future trials to study the effects of vitamin supplements and lowering homocysteine levels on the development of dementia, she said.

Prior research has shown that elevated levels of homocysteine may increase the risk of heart disease and stroke. Diet has a major effect on homocysteine levels. Folic acid and other B vitamins may lower homocysteine levels by breaking down the amino acid. The benefits of lowering homocysteine levels have not been proven, however.

The evidence linking homocysteine to dementia and Alzheimer's is mixed. Some studies have detected elevated homocysteine levels in people with Alzheimer's, but another study found that homocysteine levels did not affect the risk of developing dementia.

Now Seshadri and colleagues, under the leadership of Dr. Philip A. Wolf at Boston University, report that elderly men and women with high levels of homocysteine seem to have an increased risk of Alzheimer's.

The researchers followed 1,092 people who did not have dementia when they enrolled in the study between 1976 and 1978. Participants had their homocysteine levels measured between 1979 and 1982 and again between 1986 and 1990.

After an average of 8 years of follow-up, 111 participants developed dementia. Alzheimer's was thought to be the cause in 83 cases.

People with the highest level of homocysteine were nearly twice as likely to develop dementia or Alzheimer's disease as those with the lowest level, the authors report in the February 14th issue of The New England Journal of Medicine (news - web sites). The association between homocysteine levels and dementia was still present even after the researchers accounted for various factors that could have affected the results, including age, sex, blood levels of vitamins and the presence of an Alzheimer's-linked gene type.

Patients who had consistently high levels of homocysteine in their blood were most likely to develop dementia, according to the report.

The study provides "convincing evidence" that high homocysteine levels put the elderly at risk for Alzheimer's disease or other forms of dementia, according to Dr. Joseph Loscalzo of Boston University Medical Center.

Since certain B vitamins and other nutrients can reduce homocysteine levels, Loscalzo notes in an accompanying editorial, "It is intriguing to contemplate the possibility that consumption of these vitamins might prevent the development of Alzheimer's disease and other dementias."

This approach must be tested in clinical trials first, however, he notes.

In her comments to Reuters Health, Seshadri pointed out that the National Institute on Aging, which funded the current research, is already planning a study to see whether high doses of folic acid and vitamins B6 and B12 can prevent or slow the development of Alzheimer's.

SOURCE: The New England Journal of Medicine 2002;346:466-468,476-483.

Comment:  This is an important study.  However about one in five people have deficiencies of an enzyme that helps convert folic acid into a usable form.  For these people, high levels of folate, perhaps five-times the recommended dose would be necessary.  Fortunately, a new form of folate has just been developed that bypasses this enzymatic step.  Please contact me for more information.

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By Merritt McKinney

NEW YORK (Reuters Health) - For anyone who watches television or reads magazines, where ads for prescription drugs have become commonplace, the results of a new study will come as no surprise. Since the mid-1990s, pharmaceutical companies have tripled the amount of money they spend on advertising prescription drugs directly to consumers, researchers report.

  Despite the huge increase, drug companies continue to direct the overwhelming majority of their advertising spending toward physicians, not consumers. And most direct-to-consumer advertising is concentrated on a few medications.

Still, some physicians and health professionals are concerned that advertising drugs and medical tests directly to consumers interferes with the doctor-patient relationship and may raise medical costs by trumpeting expensive new medications.

Spending on prescription drugs is on the rise and is now the fastest growing portion of healthcare spending in the US. This increase is due no doubt in part to a rise in the number of effective medications, but "there is widespread concern" that part of the increase is due to advertising of drugs that do not provide better care, Dr. Meredith B. Rosenthal of Harvard School of Public Health in Boston, Massachusetts, and colleagues state in a report in the February 14th issue of The New England Journal of Medicine (news - web sites).

Though broadcast advertising of prescription drugs has been legal for years, guidelines released by the Food and Drug Administration (news - web sites) (FDA) in 1997 clarified the rules for advertising directly to consumers. According to these guidelines, drug companies can fulfill their obligations for informing consumers about prescription drugs by referring in advertisements to four sources of additional information: their doctor, a toll-free number, a magazine or newspaper ad and a Web site.

Rosenthal and her colleagues conducted the first study to measure patterns in direct-to-consumer advertising before and after the FDA guidelines were released.

From 1996 to 2000, spending on these ads more than tripled, rising from $791 million to nearly $2.5 billion, the researchers report.

"There has been a dramatic growth in advertising of prescription drugs," Rosenthal told Reuters Health. Most advertising dollars are spent on television ads, she said.

"It is important to put this in context, however," Rosenthal said. She noted that pharmaceutical companies still focus most of their attention on physicians. In fact, more than 80% of their promotional budgets target health professionals, she said.

Rosenthal also noted that drug companies market only a small group of drugs directly to the public. The study found that the top 20 most advertised drugs--including household names such as Viagra and Claritin--account for 60% of all direct-to-consumer dollars spent by the pharmaceutical industry. For the most part, pharmaceutical companies tend to concentrate their advertising budgets on newer drugs or ones that have no generic competition, Rosenthal and her colleagues note in the report.

"We can't say for sure what caused the renewed interest in marketing directly to consumers," according to Rosenthal. The trend had already started by the time the FDA released the guidelines in 1997. These guidelines might have been a response to the surge in consumer advertising, she said.

"The big question, of course, is whether advertising leads to improvements in health or unnecessary spending and inappropriate treatment," Rosenthal said.

Unfortunately, according to the Harvard researcher, there is no solid evidence "on the appropriateness of prescribing that results from consumers requesting an advertised drug."

"For now, the jury is still out on the public health effects of direct-to-consumer advertising of prescription drugs," she said.

Direct-to-consumer medical advertising is not limited to pharmaceutical industry, however, researchers point out in a second report in the same issue.

"Increasingly, entrepreneurs, including physicians, are offering to the general public high-technology screening tests that are not covered by most health insurance plans," according to Drs. Thomas H. Lee and Troyen A. Brennan at Harvard Medical School (news - web sites).

Two commonly advertised tests are electron-beam computed tomography (CT) to screen for undetected coronary artery disease and low-dose spiral CT to screen for lung cancer and other malignancies.

For people thinking about paying to have one of these screens, Lee told Reuters Health, "This is not a good way to spend your money."

These tests are perfectly legal, but their benefits for detecting these diseases in low-risk people who have no symptoms have not been proven, Lee and Brennan note in their report.

When and if these tests prove valuable, health insurance plans will start to cover them, Lee said.

"In the meantime, there is a pretty good chance that an abnormal test will be needlessly frightening to you and a negative test will be giving false reassurance," Lee said.

The Harvard researcher noted that doctors do not know what to do with the information these tests provide. This uncertainty is normal, he said, and will be resolved within a few years.

"In the meantime, there is no reason to throw away your money to enrich entrepreneurs," according to Lee.

What is even more troubling than the unconfirmed accuracy of these tests is that patients must undergo invasive diagnostic procedures to confirm the results, according to Dr. Jeffrey M. Drazen, the editor-in-chief of the journal. These tests have high false-positive rates, so the results have to be confirmed.

"I am sure that there will be anecdotes about people who believe that their lives were saved by the early discovery of such lesions," Drazen notes in an editorial.

"But these stories will be counterbalanced by untold stories about those who suffer from the inevitable complications of diagnostic procedures that are required in order to prove that an incidentally discovered lesion was benign," he writes.

Despite claims by the pharmaceutical industry that direct-to-consumer advertising is educational, the public is often misinformed about these ads, according to Dr. Sidney M. Wolfe, of the Public Citizen Health Research Group in Washington, DC.

He points out in an accompanying editorial that one study found that "a substantial proportion" of people mistakenly believe that the FDA reviews all ads before they are released and allows "only the safest and most effective drugs" to be promoted directly to the public.

Though a ban on direct-to-consumer advertising would be unconstitutional, Wolfe urges the FDA to increase its control over such ads. He points out that FDA actions to enforce advertising rules have decreased as direct-to-consumer pharmaceutical advertising has mushroomed.

"The education of patients--or physicians--is too important to be left to the pharmaceutical industry," whose primary aim is to promote drugs, according to Wolfe.

"Public Health Service agencies such as the National Institutes of Health (news - web sites) and the FDA, along with medical educators in schools and residency programs, must move much more forcefully to replace tainted drug company 'education' with scientifically based, useful information that will stimulate better conversations between doctors and patients and lead to true empowerment," he concludes.

But a representative of the drug industry asserts in another editorial that direct-to-consumer advertising can enhance the physician-patient relationship.

Alan F. Holmer, of the Pharmaceutical Research and Manufacturers of America in Washington, DC, a drug industry trade group, notes that drug ads may prompt patients to talk with a doctor about a previously undiscussed medical condition.

"Direct-to-consumer advertising does not replace the physician-patient relationship," according to Holmer. "Its purpose is rather to encourage an informed discussion between patient and physician."

Although advertising can inform the public, it is important for patients to remember that it is "simply advertising," according to Drazen, the journal editor.

"It should not be confused with medical advice given in the best interest of the patient by a learned intermediary," he concludes.

One of Rosenthal's co-authors has served as a consultant for several drug companies.

SOURCE: The New England Journal of Medicine 2002;346:498-505,524-531.

Comment:  I find direct to consumer advertising of drugs to be deplorable.  I also find it deplorable that physicians receive much of there information directly from drug company representative, are given perks for prescribing certain drugs, and will generally disdain any form of nutritional or other natural treatments that can help people avoid these powerful and often dangerous substances.  Please, please, please, read the fine print on these advertisements. Please be educated in their possible dangers and side effects.  Over 100,000 people die each year from the side effects of properly prescribed and properly dosed prescription medications.