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, October 9, 2006)
OMEGA-3 FATTY ACIDS MAY SLOW COGNITIVE DECLINE IN SOME PATIENTS WITH VERY MILD ALZHEIMER’S DISEASE
SPECIAL ONLINE PUBLICATION — MEDITERRANEAN DIET ASSOCIATED WITH REDUCED RISK OF ALZHEIMER’S DISEASE
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, October 9, 2006
TRANSMISSION OF ANTIBIOTIC-RESISTANT BACTERIA LINKED TO PREVIOUS INTENSIVE CARE UNIT ROOM OCCUPANTS
STROKE SYMPTOMS COMMON AMONG GENERAL POPULATION
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
Embargoed Until: 3 P.M. (CT), Monday, October 9, 2006
VISION AND HEARING LOSS OFTEN OCCUR TOGETHER IN OLD AGE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 9, 2006
Media Advisory: To contact corresponding author Jan Palmblad, M.D., Ph.D., e-mail: jan.palmblad{at}ki.se.
OMEGA-3 FATTY ACIDS MAY SLOW COGNITIVE DECLINE IN SOME PATIENTS WITH VERY MILD ALZHEIMER’S DISEASE
Supplements showed no effect in more advanced cases
CHICAGO—Omega-3 fatty acid supplements may slow cognitive decline in some patients with very mild Alzheimer’s disease, but do not appear to affect those with more advanced cases, according to results of a clinical trial published in the October issue of Archives of Neurology, one of the JAMA/Archives journals.
Alzheimer’s disease is a severely debilitating condition that affects thinking, learning and memory, beginning with declines in episodic memory (including memory about events in one’s own life), according to background information in the article. Medications are available to treat the symptoms, but these drugs do not affect the underlying cause and progression of the disease. Several studies have shown that eating fish, which is high in omega-3 fatty acids, may protect against Alzheimer’s disease, leading researchers to question whether supplements could have similar effects.
Yvonne Freund-Levi, M.D., Karolinska Institutet, Stockholm, Sweden, and colleagues compared the effects of supplements containing two omega-3 fatty acids with placebo in 204 patients with Alzheimer’s disease, 174 of whom completed the entire study. For six months, 89 patients (51 women and 38 men) took 1.7 grams of docosahexaenoic acid (DHA) and .6 grams of eicosapentaenoic acid (EPA), while 85 patients (39 women and 46 men) took placebo. For an additional six months, both groups took the omega-3 fatty acids. Patients had physical examinations, which included blood tests and blood pressure measurement, and took cognitive tests at the beginning of the study and at the six- and 12-month marks.
After six months, there was no difference in the rate of cognitive decline between the two groups. However, among a subgroup of 32 patients with very mild cognitive impairment at the beginning of the study, those who took the fatty acids experienced less decline in six months compared with those who took placebo. Among those who took placebo during the first six months, decline decreased during the second six months, when they also began taking the omega-3 supplements. The supplements appeared safe and well-tolerated, with no change in blood pressure or blood test results other than a higher ratio of fatty acids in the blood.
“The mechanisms by which omega-3 fatty acids could interfere in Alzheimer’s disease pathophysiologic features are not clear, but since anti-inflammatory effects are an important part of the profile of fish oils, they are conceivable also for Alzheimer’s disease,” the authors write. This could potentially explain why effects were seen only in those with very early-stage disease—recent evidence suggests that there is a critical period two or more years before patients develop dementia when levels of chemicals that signal the presence of inflammation are elevated. “It is possible that when the disease is clinically apparent, the neuropathologic involvement is too advanced to be substantially attenuated by anti-inflammatory treatment.”
The authors also point out that “these findings cannot serve as a basis for general recommendations for treatment of Alzheimer’s disease with dietary DHA-rich fish oil preparations. However, studies in larger cohorts with mild cognitive impairment, including those at risk for Alzheimer’s disease, are needed to further explore the possibility that omega-3 fatty acids might be beneficial in halting initial progression of the disease.”
(Arch Neurol. 2006;63:1402-1408. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by Pronova Biocare A/S and by grants from the Funds of Capio, Gamla Tjänarinnor, Swedish Alzheimer Foundation, Odd Fellow, Swedish Society of Physicians and Lion’s Sweden. Dr. Palmblad has received travel grants from Pronova Biocare A/S. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, October 9, 2006
Media Advisory: To contact Nikolaos Scarmeas, M.D., call Craig LeMoult at 212-305-0820.
MEDITERRANEAN DIET ASSOCIATED WITH REDUCED RISK OF ALZHEIMER’S DISEASE
CHICAGO—Eating a Mediterranean diet, which emphasizes fruits, vegetables and olive oil and includes little red meat, is associated with a lower risk for Alzheimer’s disease, according to an article posted online today that will appear in the December 2006 print issue of Archives of Neurology, one of the JAMA/Archives journals. This association persisted even when researchers considered whether individuals had vascular diseases—diseases of the blood vessels, such as stroke, heart disease and diabetes—suggesting that the diet may work through different pathways to reduce Alzheimer’s disease risk.
The Mediterranean diet consists of high amounts of fruits, vegetables, legumes, cereals and fish, mild to moderate amounts of alcohol and low amounts of red meat and dairy products, according to background information in the article. This diet has been associated with a lower risk for several diseases and risk factors, including cancer, obesity, high cholesterol, high blood pressure, problems with processing glucose that may lead to diabetes, coronary heart disease and overall death.
Nikolaos Scarmeas, M.D., and colleagues at Columbia University, New York, studied whether the Mediterranean diet could also help prevent Alzheimer’s disease—a debilitating neurodegenerative disease—in a group of 1,984 adults with an average age of 76.3. The participants, 194 of whom already had Alzheimer’s disease and 1,790 of whom did not, were given complete physical and neurological examinations and a series of tests of brain function. Their diet over the previous year was analyzed and scored based on how closely it adhered to the principles of the Mediterranean diet—scores ranged from zero to nine, with higher scores indicating eating patterns that aligned closely with the Mediterranean diet. The researchers obtained information about vascular disease diagnoses from the exams, participants’ or relatives’ reports and medical records.
Eating a diet that closely followed the Mediterranean model was associated with a significantly lower risk for Alzheimer’s disease. For each additional unit on the diet score, risk for Alzheimer’s disease decreased by 19 to 24 percent. After the researchers considered other factors that could influence Alzheimer’s disease risk, including age and body mass index, those who were in the top one-third of the diet scores had 68 percent lower odds of having Alzheimer’s disease than those in the bottom one-third, and those in the middle-one third had 53 percent lower odds.
Growing evidence links the Mediterranean diet to a reduced risk for vascular disease and suggests that vascular risk factors may contribute to the risk for Alzheimer’s disease, the authors write. “Thus, vascular variables are likely to be in the causal pathway between the Mediterranean diet and Alzheimer’s disease and should be considered as possible mediators,” they continue. “However, when we considered vascular risk factors in our models, the association between the Mediterranean diet and Alzheimer’s disease did not change. This was the case despite our attempt to capture vascular comorbidity in the most complete possible way by simultaneously considering both a long list and alternative definitions of vascular variables.”
“This could be the result of either other biological mechanisms (oxidative or inflammatory) being implicated or measurement error of the vascular variables,” the authors conclude.
(Arch Neurol. 2006;63:(doi:10.1001/archneur.63.12.noc60109). Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institute on Aging; the Charles S. Robertson Memorial Gift for Research in Alzheimer’s Disease; the Blanchette Hooker Rockefeller Foundation; the New York City Council Speaker’s Fund for Public Health Research; and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, October 9, 2006
Media Advisory: To contact Susan S. Huang, M.D., M.P.H., call Kevin Myron at 617-534-1605..
TRANSMISSION OF ANTIBIOTIC-RESISTANT BACTERIA LINKED TO PREVIOUS INTENSIVE CARE UNIT ROOM OCCUPANTS
CHICAGO—Staying in a room in the intensive care unit previously occupied by a patient with treatment-resistant bacteria may increase the odds of acquiring such bacteria, according to a report in the October 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Two particular microorganisms cause significant illness and death in hospitals: methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), according to background information in the article. Researchers previously found that 29 percent of patients who acquire these pathogens develop infections or other complications within 18 months. Floors, beds, gowns, faucets and other hospital room fixtures are persistently contaminated with these bacteria, but it is not known whether levels of the bacteria are high enough to infect additional patients or whether currently mandated cleaning practices are effective in reducing bacterial spread. “Although high-risk rooms may exist because of difficult-to-clean design or poor placement of hand hygiene equipment, transmission may be more directly linked to a prior occupant who harbors a resistant organism rather than to a particular room,” the authors write.
Susan S. Huang, M.D., M.P.H., Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a 20-month study of 8,203 patients who had 11,528 stays in eight ICUs between 2003 and 2005. As part of the hospitals’ normal protocols, cultures were obtained from all ICU patients when they arrived and every week they stayed to determine the presence of MRSA and VRE.
Upon entering the ICU, 809 patients carried MRSA and 658 carried VRE, leaving 7,629 to screen for the acquisition of MRSA and 7,806 for acquisition of VRE. The average patient age was 61 years, and 58 percent were male. Fourteen percent of these ICU patients stayed in rooms in which the prior occupant had MRSA and 13 percent stayed in rooms in which the prior occupant had VRE. Those who stayed in rooms after patients with one of the types of bacteria were more likely to acquire that type of bacteria than those who stayed in rooms following patients who did not test positive for that bacteria (4.5 percent vs. 2.8 percent for VRE and 3.9 percent vs. 2.9 percent for MRSA). The excess risk associated with an infected prior occupant accounted for 5.1 percent of all new cases of MRSA and 6.8 percent of all new cases of VRE.
This additional risk occurred despite the fact that the room cleaning procedures of the hospital in the study exceed national guidelines, indicating that such guidelines do not prevent transmission of disease-causing bacteria. However, the low overall risk among patients exposed to the bacteria “suggests that levels of contamination do not pose a high risk for transmission or that current cleaning methods generally reduce contamination below levels required for transmission,” the authors write. “Based on our findings, the prevention of one case of acquisition due to room contamination could require more intensive cleaning of 94 rooms vacated by MRSA carriers and of 59 rooms vacated by VRE carriers.”
Though the number of cases attributed to previous room occupants was small, this type of transmission could become more common as the prevalence of treatment-resistant bacteria continues to rise. “Additional data are needed to determine whether more intensive cleaning practices can reduce the risk further and, if so, whether this is worthwhile in a resource-limited system,” the authors conclude.
(Arch Intern Med. 2006;166:1945-1951. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a Prevention Epicenters Program grant from the Centers for Disease Control and Prevention and by a grant from the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, October 9, 2006
Media Advisory: To contact Virginia J. Howard, M.S.P.H., call Jennifer Park Lollar at 205-934-3888.
STROKE SYMPTOMS COMMON AMONG GENERAL POPULATION
CHICAGO—As many as 18 percent of adults who have no history of stroke report having had at least one symptom of stroke, according to results of a large national study published in the October 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Using brain imaging to screen individuals without a history of stroke reveals that many have had an undiagnosed or silent stroke, according to background information in the article. One previous study found that 11 percent of individuals age 55 to 64, 22 percent of those ages 65 to 69 and 43 percent of those older than 85 years show evidence of stroke despite never having been diagnosed with the condition. Because awareness of stroke symptoms is low, it is possible that these individuals had symptoms but did not recognize them or that the symptoms did not reach the threshold necessary for a stroke diagnosis.
Virginia J. Howard, M.S.P.H., of the University of Alabama at Birmingham, and colleagues analyzed data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a random sample of 18,462 adults older than 45 years (average age 65.8) who had not been diagnosed with stroke. To ensure including many individuals at risk for stroke, the researchers included 7,567 African Americans (41 percent of the total sample, a higher ratio than in the general population) and 6,534 (35.4 percent of the sample) residents of the so-called “stroke belt,” which includes eight Southeastern states with increased rates of stroke. In telephone interviews, participants provided information about demographics, general quality of life and medical history, including whether a physician had ever told them they had a stroke and whether they had experienced the sudden onset of any of six stroke symptoms. Brief physical examinations were conducted three to four weeks later. A stroke risk score was calculated for each individual based on demographics, behaviors and other risk factors, with higher scores indicating a greater risk for stroke.
A total of 3,292 (17.8 percent) of the participants reported having had one or more stroke symptoms. Eight and one-half percent reported sudden numbness on one side of the body; 5.8 percent sudden weakness on one side of the body; 4.6 percent sudden vision loss in one or both eyes; 2.7 percent sudden loss of the ability to understand what others were saying; and 3.8 percent suddenly could not express themselves in speech or writing.
African Americans and those with lower incomes, less education, poorer health status and higher stroke risk scores were more likely to have had stroke symptoms. “The last finding suggests that at least some of these symptoms may represent stroke events that did not reach the threshold required for clinical diagnosis,” the authors write. “These undiagnosed or unrecognized events could have a substantial impact on cognitive functioning or personality and could also be powerful harbingers of subsequent major strokes.”
It is not known whether these individuals visited a physician for their symptoms, but previous studies have shown that many people do not seek medical care for stroke symptoms and if they do, they do not seek it immediately. “Targeted education on the warning signs of stroke and risk factor reduction efforts for individuals who report stroke symptoms may be helpful in improving early recognition and in the prevention of stroke,” the authors conclude.
(Arch Intern Med. 2006;166:1952-1958. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research project was supported by a cooperative agreement from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, October 9, 2006
Media Advisory: To contact corresponding author Paul Mitchell, M.D., Ph.D., e-mail: paul_mitchell{at}wmi.usyd.edu.au.
VISION AND HEARING LOSS OFTEN OCCUR TOGETHER IN OLDER AGE
CHICAGO—Older adults with vision loss may be more likely to also have hearing loss, and the opposite appears true as well, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
In 1994, 18 percent of U.S. adults older than 70 reported impaired vision, 33 percent reported hearing problems and 9 percent reported both, according to background information in the article. Because more adults are living longer and the number of older adults is increasing, the burden associated with such age-related sensory impairments may be increasing.
Ee-Munn Chia, M.B.B.S., University of Sydney, Australia, and colleagues examined the association between age-related hearing and vision loss in 1,911 adults who were part of the Blue Mountains Eye Study, which enrolled older adults from the Blue Mountains region west of Sydney. Five years after the original study, between 1997 and 1999, participants (then age 55 to 98, average age 69.8) underwent a medical interview along with vision and hearing examinations.
Among the participants, 178 (9.3 percent) had visual impairment (worse than 20/40 vision) without contacts or glasses and 56 (2.9 percent) had best-corrected visual impairment, meaning that their best vision while wearing glasses or contacts was worse than 20/40. In addition, 766 (40 percent) had hearing impairment, including 599 with mild impairment, 141 with moderate impairment and 26 with marked impairment. Hearing loss occurred in 116 patients (65.2 percent) of those who were visually impaired. For each additional line on the eye chart that an individual could not read, his or her odds of having hearing impairment increased by 18 percent if the reduction was in best-corrected vision or 13 percent in uncorrected vision. When the researchers looked specifically at the two most common causes of age-related vision impairment, cataracts and age-related macular degeneration, they found that both were independently associated with hearing loss.
It is possible that both vision and hearing loss are regular consequences of aging, which could explain why they often occur in the same individual. In addition, common risk factors could predispose older adults to both conditions. “Each condition has been postulated to result from somewhat similar genetic, environmental and lifestyle factors,” the authors write. “Exposure to oxidative stress [when cells receive too much oxygen], cigarette smoking and atherosclerosis [hardening of the arteries] and its risk factors have been linked respectively to age-related macular degeneration, cataract and hearing loss. Another common risk factor for cataract and visual and hearing impairments is diabetes.”
“Irrespective of the cause of sensory impairment, these two impairments were found to have a cumulative effect on function and well-being, significantly affecting both physical and mental domains,” they conclude. “Further studies are needed to understand the relationship between visual and hearing impairments in older persons and to determine whether intervention to improve these impairments could delay biologic aging.”
(Arch Ophthalmol. 2006;124:1465-1470. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the Australian National Health and Medical Research Council and the Westmead Millennium Institute, University of Sydney. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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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