JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 13, 2006)
SPECIAL ONLINE PUBLICATION — MEDICATIONS THAT LOWER BLOOD PRESSURE LINKED TO REDUCED RISK OF ALZHEIMER'S DISEASE
COGNITIVE IMPAIRMENT APPEARS TO BE COMMON IN ALS PATIENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, March 13, 2006)
TELEPHONE COUNSELING AND CARE MAY HELP SMOKERS QUIT
FAXED ALERTS TO PHYSICIANS MAY NOT IMPROVE PATIENT ANTIDEPRESSANT ADHERENCE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 13, 2006
Media Advisory: To contact corresponding author Peter P. Zandi, Ph.D., call Tim Parsons at 410-955-6878.
MEDICATIONS THAT LOWER BLOOD PRESSURE LINKED TO REDUCED RISK OF ALZHEIMER'S DISEASE
CHICAGO—Taking medications to lower blood pressure, particularly those known as diuretics, may be associated with a lower incidence of Alzheimer's disease, according to a study posted online today that will appear in the May 2006 print issue of the Archives of Neurology, one of the JAMA/Archives journals.
Hypertension (high blood pressure) may increase the risk of Alzheimer's disease (AD), according to background information in the article. Researchers have therefore begun to examine whether antihypertensive agents, medications prescribed to treat high blood pressure, could reduce the risk of AD. These drugs include diuretics, which cause the kidneys to excrete water and salt, and beta blockers, which results in slowing the heart rate, reducing the heart's pumping action and widening blood vessels.
Ara S. Khachaturian, Ph.D., of Khachaturian and Associates, Inc., Potomac, Md., and colleagues examined the association between antihypertensive medications and the incidence of AD in 3,297 elderly residents of Cache County, Utah. Between 1995 and 1997, participants age 65 years and older were given an initial interview and assessment that included screening for dementia and a detailed inventory of all prescription and over-the-counter medications. Residents who had AD at the first interview were not included in the study. Follow-up assessments were done three years later, beginning in 1998.
Of the participants, 1,507 (944 women and 563 men) used antihypertensive medications and 1,790 (975 women, 815 men) did not. At the second assessment, 104 participants had developed AD. Elderly individuals who were using antihypertensive medications at the beginning of the study were significantly less likely to have developed AD than those who were not. This relationship persisted when the researchers controlled for other factors, including gender, age, high cholesterol, diabetes and genetic risk. When antihypertensives were broken down by type, diuretics were most strongly associated with a lower incidence of AD. More specifically, potassium-sparing diuretics, which contain additional components to preserve levels of the mineral in the body, were related to a more than 70 percent reduction in the risk of AD. Beta blockers and antihypertensives known as dihydropyridine agents also were linked to a slightly protective effect against AD, while those called ACE inhibitors did not appear to be associated with the risk of developing the condition.
Although the exact reasons for the link between potassium-sparing diuretics and reduced risk of AD is unclear, the authors suggest that the increased blood potassium levels associated with the medications may be a factor. "As yet unpublished findings ...also suggest that increased potassium levels may be associated with a reduced risk of dementia," they write. "Consistent with this idea are observations that low potassium concentrations are associated with oxidative stress, inflammation, platelet aggregation and vasoconstriction, all of which are possible contributors to AD pathogenesis."
"We suggest these findings should prompt further epidemiologic and basic science studies into the possible neuroprotective effects of these drugs," they conclude.
(Arch Neurol. 2006;63:(doi: 10.1001/archneur.63.5.noc60013). Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by grants from the National Institutes of Health, Bethesda, Md. Dr. Skoog received an honorarium from AstraZeneca, London, England, as chair of the SCOPE trial, which was an antihypertensive trial using atacand. Dr. Skoog has also been on the speakers' bureau for AstraZeneca.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 13, 2006
Media Advisory: To contact corresponding author Yaakov Stern, Ph.D., call Craig LeMoult at 212-305-2820. To contact editorialist Michael J. Strong, M.D., F.R.C.P.C., call Kathy Wallis at 519-661-2111, ext. 81136.
COGNITIVE IMPAIRMENT APPEARS TO BE COMMON IN ALS PATIENTS
CHICAGO—In a study of 40 patients with amyotrophic lateral sclerosis (ALS), about one-third showed evidence of cognitive impairment, but these deficits did not appear to be related to survival, according to a study in the March issue of the Archives of Neurology, one of the JAMA/Archives journals.
ALS, commonly referred to as Lou Gehrig disease, is a progressive disorder characterized by the loss of muscle function and the atrophy (wasting away) of muscle tissue. ALS is primarily a disorder involving the motor neurons, which control muscles and movement in the body, but new evidence suggests it also may have an impact on cognition (thinking, learning and memory), according to background information in the article. Previous research has estimated that anywhere from 2 to 52 percent of patients with ALS also experience cognitive impairment.
Gregory A. Rippon, M.D., M.S., and colleagues at the Columbia University College of Physicians and Surgeons, New York, analyzed 40 consecutive patients with ALS who were evaluated at neurologists' offices between August 1991 and August 1992. Participants underwent examinations and testing to gauge their cognitive functioning and verify the diagnosis and history of their disease, including whether symptoms were first detected in muscles of the throat, jaw, tongue or face (bulbar onset) or those in the arms (limb onset). The researchers selected a control group of 80 individuals without ALS, matched to the ALS patients by age, gender and education, from a series of patients referred to a memory disorder clinic from 1992 to 2003.
Of the 40 patients with ALS, 12 (30 percent) showed evidence of cognitive impairment, including nine (23 percent) who met criteria for dementia. There were no significant differences between ALS patients who had dementia and those who did not in terms of age, sex, education, site of onset, memory loss, emotional stability, severity of the disease or family history. ALS patients and control participants had similar results on cognitive tests, although patients with more severe ALS showed a decline in verbal skills beyond what would be associated with motor difficulties affecting speech muscles. Survival data from public and medical records were available in January 2004 for 38 of 40 patients with ALS, who lived an average of 3.4 years after testing. Cognitive impairment and dementia did not appear to be associated with survival.
"In conclusion, using a conventional test battery, 30 percent of a consecutive series of patients with ALS demonstrated cognitive impairment, and nearly a quarter qualified for a neuropsychologic diagnosis of dementia," the authors write. "Free recall, executive function and naming were most impaired in ALS patients with dementia." Future studies using testing and diagnostic criteria specific to frontotemporal lobar dementia, the type believed to be associated with ALS and other motor neuron diseases, may find that the percentage of ALS patients with cognitive impairment or dementia is even higher, they conclude.
(Arch Neurol. 2006;63:345-352. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by Ruth L. Kirschstein National Research Service Award from the National Institutes of Health, Bethesda, Md.
EDITORIAL: A NEW UNDERSTANDING OF ALS
Even though ALS was previously thought to affect only the motor system, physicians are increasingly recognizing that the symptoms are much broader, writes Michael J. Strong, M.D., F.R.C.P.C., University Hospital, London, Ontario, Canada, in an accompanying editorial.
These revelations lead to questions about whether information about cognitive impairment is clinically relevant to patients with ALS and also raises controversy about the biological mechanisms involved in the disease, Dr. Strong writes. "It behooves us to understand the nature of this process in detail to truly understand the nature of this aspect of ALS, its influence not only on survival but also on the quality of life of patients with ALS and for their caregivers, and also to shed light on the biological nature of this process," he concludes.
(Arch Neurol. 2006;63:319-320. Available to the media pre-embargo at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 13, 2006
Media Advisory: To contact Lawrence C. An, M.D., call Sara Buss at 612-624-2449.
TELEPHONE COUNSELING AND CARE MAY HELP SMOKERS QUIT
CHICAGO—Smokers who receive telephone care and counseling for smoking cessation have higher rates of stopping smoking than those who receive routine care by health care providers, according to a study in the March 13 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous studies have shown that telephone counseling is an effective aid for helping smokers quit, according to background information in the article. One component of the U.S. national action plan for tobacco cessation is the recommendation for creation of a telephone quitline network, offering smokers access to counseling and medications. However, it is not clear that access to telephone care would provide additional benefits when added to the physician-patient dialogue that occurs in the course of routine health care. "For clinicians and administrators, this information identifies the potential value of adding telephone care to existing clinical programs," the authors write. "For public health and policy experts, this information helps define the role of telephone care as part of a comprehensive cessation program, such as the national action plan."
Lawrence C. An, M.D., University of Minnesota and Minneapolis Veterans Affairs Medical Center, and colleagues studied 837 daily smokers (751 men and 86 women) who received care at five Veterans Affairs medical centers in the upper Midwest in the year prior to the study. All the participants committed to setting a quit date within the next 30 days. The 420 smokers (average age 57.1) in the standard care group were mailed self-help materials and had continued access to smoking cessation services through their medical center. The 417 individuals in the telephone care group (average age 57.2) received counseling sessions using a telephone care protocol, which consisted of seven calls over a two-month period, with additional calls as needed at the discretion of the counselor. There were an average of 7.7 behavioral counseling sessions by telephone over the following year.
After three months in the study, 39.6 percent of the telephone care group had not smoked in the previous seven days, compared with 10.1 percent of the standard care group. At the one-year mark, 13 percent of the telephone care group and 4.1 percent of the control group had abstained from smoking for the previous six months. Compared with those in the standard care group, individuals receiving telephone care were more likely to use other techniques to help them stop smoking, including smoking cessation counseling programs (97.1 vs. 24 percent after one year) and medications (89.6 vs. 52.3 percent after one year). They also made more attempts to quit than those in the control group.
"At a minimum, telephone care for smoking cessation should be made available to veterans who are interested in stopping smoking," the authors conclude. "The findings of this study lend additional support to the recommendation for a national network of quitlines that would make these services available to all tobacco users in this country."
(Arch Intern Med. 2006;166:536-542. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by a Department of Veterans Affairs Health Services Research and Development Service grant.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, March 13, 2006
Media Advisory: To contact Kara Zivin Bambauer, Ph.D., call Leah Gourley at 617-432-0442.
FAXED ALERTS TO PHYSICIANS MAY NOT IMPROVE PATIENT ANTIDEPRESSANT ADHERENCE
CHICAGO—Faxing pharmacy information to alert physicians when their patients fail to refill their prescriptions for antidepressants may not increase the rates of patients taking their drugs as prescribed, according to an article in the March 13 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Antidepressants are most effective when taken for at least six months, according to background information in the article. However, rates of adherence (taking medications as prescribed) are low and methods that effectively increase them are often prohibitively expensive and complex. Managed care organizations have used a number of approaches to increase adherence at a lower cost, the authors write. These include providing print and Internet-based educational materials and developing comprehensive opt-in depression management programs.
Kara Zivin Bambauer, Ph.D., Harvard Pilgrim Health Care and Harvard Medical School, Boston, and colleagues assessed one such antidepressant compliance program, which began in May 2003 and alerted physicians by fax when patients were not adherent during the first six months of antidepressant therapy. Physicians were sent faxes when patients did not refill their prescription for at least 10 days beyond the date that their previous prescription ran out. The researchers studied 13,128 members of one health plan (9,079 women and 4,049 men) who received antidepressant prescriptions between May 15, 2002, and May 14, 2004.
Slightly less than half (6,387) of the patients began taking antidepressants before the fax alert program began and slightly more than half (6,741) began afterward. Over the two-year period of the study, there was no significant change in prescription adherence rates; 1,159 (18 percent) of patients were adherent before the fax alert program began and 1,171 (17 percent) were adherent afterward. The proportion of nonadherent patients remained relatively constant at about 75 percent.
There are several reasons why such a program might not be effective on its own, the authors suggest. "Patient nonadherence to drug therapy is a complex phenomenon, and reasons for nonadherence to recommended therapy may vary depending on where patients are in the treatment process," they write. Programs that involve personal contact with patients by pharmacists, nurses or depression care managers may be more effective. In addition, physicians could become densensitized if they receive too many faxes regarding patients who are actually adherent, which could happen if prescriptions are filled on day 11, if information from the pharmacy is delayed or if patients stop therapy because of adverse effects, they explain.
"Given the high rates of nonadherence to long-term drug therapy in general, and to the use of antidepressants in particular, inexpensive interventions to improve adherence are needed," the authors conclude. "However, based on the results of this study, managed care organizations should be cautious about using this form of faxed reminder system as a singular approach for physicians to improve patient medication adherence."
(Arch Intern Med. 2006;166:498-504. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was funded by a faculty grant from the HPHC Foundation. Dr. Soumerai is an investigator in the HMO Research Network Center for Education and Research in Therapeutics, supported by the Agency for Healthcare Research and Quality, Rockville, Md.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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