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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, December 19, 2006)
JAMA NEWS RELEASES
COGNITIVE TRAINING FOR OLDER ADULTS MAY HELP SLOW DECLINE OF DAILY FUNCTIONING ABILITIES
MORE PATIENTS BEING DIAGNOSED AT EARLIER STAGE OF COLON CANCER SINCE EXPANSION OF MEDICARE COVERAGE FOR SCREENING
KIDNEY TRANSPLANTATION LINKED WITH INCREASED RISK OF VARIOUS CANCERS
HIGHER LEVELS OF VITAMIN D IN THE BLOOD MAY LOWER RISK OF MULTIPLE SCLEROSIS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
COGNITIVE TRAINING IMPROVES MEMORY, OTHER MENTAL FUNCTIONS IN ELDERLY PEOPLE
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TV Note: This week's JAMA Report video is on the long-term effects of cognitive training on everyday functional outcomes in older adults. The report will be fed Tuesday, December 19, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 19, 2006
Media Advisory: To contact co-author Michael Marsiske, Ph.D., call Jill Pease at 352-273-5816. To contact editorial co-author Sally A. Shumaker, Ph.D., call Mark Wright at 336-716-3382.
COGNITIVE TRAINING FOR OLDER ADULTS MAY HELP SLOW DECLINE OF DAILY FUNCTIONING ABILITIES
CHICAGO—Older adults who received cognitive training reported improved cognitive function for up to 5 years afterwards and less decline in the ability to perform daily activities as compared to those who did not receive the training, according to a study in the December 20 issue of JAMA.
Decline in cognitive abilities has been shown to lead to an increased risk of difficulty in performing instrumental activities of daily living (IADL). However, whether interventions to maintain or enhance cognitive abilities in older adults will prevent or delay these functional difficulties has been unclear, according to background information in the article.
Sherry L. Willis, Ph.D., of Pennsylvania State University, State College, Pa., and colleagues conducted the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, the first multicenter, randomized controlled trial to examine the long-term outcomes of cognitive interventions on the daily functioning of older individuals living independently. The study was conducted between April 1998 and December 2004. Participants in the study included 2,832 persons (average age 73.6 years; 26 percent black), living independently in 6 U.S. cities, who were recruited from senior housing, community centers, and hospitals and clinics. Five-year follow-up was completed in 67 percent of the sample.
The study interventions included ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); and 4-session booster training at 11 and 35 months after training in a random sample of those who completed training.
At year 5, participants in all 3 intervention groups reported less difficulty compared with the control group in performing IADL. However, this effect was significant only for the reasoning group. Neither speed of processing training nor memory training had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing.
No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years. Booster training produced additional improvement with the reasoning intervention for reasoning performance and the speed of processing intervention for speed of processing performance.
“The ACTIVE study is the first large-scale, randomized trial to show that cognitive training improves cognitive function in well-functioning older adults and that this improvement lasts up to 5 years from the beginning of the intervention,” the researchers write.
“In conclusion, declines in cognitive abilities have been shown to lead to increased risk of functional disabilities that are primary risk factors for loss of independence. The 5-year results of the ACTIVE study provide limited evidence that cognitive interventions can reduce age-related decline in self-reported IADLs that are the precursors of dependence in basic ADLs associated with increased use of hospital, outpatient, home health, nursing home services, and health care expenditures. However, given the lag in the relationship between cognitive decline and functional deficits, the full extent of intervention effects on daily function would take longer than 5 years to observe in a population that was highly functioning at enrollment. We consider these results promising and support future research to examine if these and other cognitive interventions can prevent or delay functional disability in an aging population,” the authors write.
(JAMA. 2006;296:2805-2814. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: BEHAVIOR-BASED INTERVENTIONS TO ENHANCE COGNITIVE FUNCTIONING AND INDEPENDENCE IN OLDER ADULTS
In an accompanying editorial, Sally A. Shumaker, Ph.D., and colleagues from Wake Forest University Health Sciences, Winston-Salem, N.C., discuss the findings concerning cognitive training and functional outcomes.
“Results from the ACTIVE study have several clinical implications. If the results that cognitive training can protect cognitive and possibly functional performance were to be extended to individuals with Alzheimer disease, individuals who cannot tolerate existing pharmacological agents (such as the cholinesterase inhibitors or N-methyl-D-aspartate receptor antagonists) would have additional treatment options. Matching cognitive training with an individual’s risk factor profile is an intriguing possibility. For example, vascular cognitive impairment reveals itself predominantly in frontal lobe–mediated cognitive functioning (executive functions) and may respond best to training that targets executive functions, whereas memory training may be better for individuals at greater risk for Alzheimer disease–related cognitive impairment.
“Cognitive training programs, once standardized and developed for mass market application, might be made available to seniors through nonhealth care facilities (e.g., senior centers, churches, schools) and health care facilities. Importantly, cognitive training programs may give individuals a greater sense of control over the disturbing prospect of cognitive decline and have a beneficial effect on their quality of life,” they write.
(JAMA. 2006;296:2852-2854. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The authors are supported by contracts from the National Institutes of Health. Financial disclosures: none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 19, 2006
Media Advisory: To contact Cary P. Gross, M.D., call Karen Peart at 203-432-1326. To contact editorial author Arden M. Morris, M.D., M.P.H., call Nicole Fawcett at 734-764-2220.
MORE PATIENTS BEING DIAGNOSED AT EARLIER STAGE OF COLON CANCER SINCE EXPANSION OF MEDICARE COVERAGE FOR SCREENING
CHICAGO—Since Medicare raised the amount it will reimburse for colon cancer screening in 1998, there has been an increase in use of colonoscopies by Medicare beneficiaries, and a rise in the proportion of patients being diagnosed with colon cancer at an early stage, according to a study in the December 20 issue of JAMA.
Although regular screening is the most effective way to detect colon cancer at an early, curable stage, widespread screening has been below optimal levels, according to background information in the article. The 2000 National Health Interview Survey found that 42.5 percent of respondents 50 years of age and older were up to date with colon cancer screening with any of the recommended methods; among persons 65 years of age and older, 48.7 percent were up to date. Several studies have suggested that lack of insurance coverage may be one of the most important barriers to colon cancer screening. Prior to 1998, Medicare did not routinely reimburse for colon cancer screening.
Cary P. Gross, M.D., and colleagues from the Yale University School of Medicine, New Haven, Conn., evaluated whether the implementation of the expanded Medicare reimbursement policies after 1998 was associated with changes in the use of colonoscopy among Medicare beneficiaries without cancer, as well as changes in the proportion of colon cancer patients who were diagnosed at an early stage. The researchers analyzed data from the Surveillance Epidemiology and End Results (SEER) -Medicare linked database of individuals who were 67 years of age and older and had a primary diagnosis of colon cancer during 1992-2002, as well as a group of Medicare beneficiaries who were not diagnosed with cancer. Among the patients with cancer, stage was classified as early (stage I) vs. all other (stages II-IV). Time was categorized as period 1 (no screening coverage, 1992-1997), period 2 (limited coverage, January 1998-June 2001), and period 3 (universal coverage, July 2001-December 2002).
The researchers found that among the sample of Medicare beneficiaries who did not have cancer, there was an increase in colonoscopy use during the study period. The average colonoscopy rate per 100,000 beneficiaries per quarter tripled from period 1 to 2, and went up 6.5 times, comparing period 1 to period 3.
The final sample of patients with colorectal cancer consisted of 44,924 patients (average age, 77.4 years; 56 percent were women and 8 percent were black). Time period was significantly related to stage at diagnosis. Approximately 22.5 percent of patients were diagnosed at an early stage in period 1 (1992-1997) compared with 25.5 percent in period 2 and 26.3 percent in period 3. In further analysis, patients diagnosed in periods 2 and 3 were significantly more likely to have early-stage illness than patients diagnosed in period 1.
“Our finding that new Medicare policies may have facilitated early diagnosis is encouraging and supports the institution and evaluation of other efforts to broaden the access to and use of screening tests in the older population. Given that there are approximately 60,000 cases of colorectal cancer diagnosed annually among patients 65 years of age and older in the United States, even a 4 percent increase in the percentage of patients whose cancer is diagnosed at an early stage can have a substantial impact at the population level,” the authors write. “Increasing the use of screening tests further has the potential to diagnose many more beneficiaries at an early stage.”
(JAMA. 2006;296:2815-2822. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: MEDICARE POLICY AND COLORECTAL CANCER SCREENING — WILL CHANGING ACCESS CHANGE OUTCOMES?
In an accompanying editorial, Arden M. Morris, M.D., M.P.H., of the University of Michigan, Ann Arbor comments on the study by Gross and colleagues.
“The findings of Gross et al demonstrate that the change in Medicare policy was effective: a target population received screening at a higher rate and this resulted in an increase in the detection of early stage and right-sided cancers. It remains to be seen if future screening will continue to increase the rates of early identification of colorectal cancer. Given the costs of universal screening, if rates of colonoscopy continue to increase without additional benefit in overall diagnosis of early stage disease, policy makers, health care organizations, and physicians may have to devise a feasible rationing plan for broader colon screening. While increasing access to care and improving compliance with recommended care is an undeniable good, providing screening colonoscopy to all is not realistic.
“The onus is on physicians and other primary care clinicians to capitalize on the momentum associated with screening colonoscopy to encourage other effective but less expensive forms of screening, such as fecal occult blood tests with sigmoidoscopy. Screening colonoscopy could be made more effective by targeting subgroups with higher incidence and mortality from colorectal cancer, and those at greatest risk of right-sided or proximal neoplasms that would not be identified by sigmoidoscopy. Such a strategy, while difficult, would provide the best opportunity to judiciously maximize access to care without sacrificing outcomes,” Dr. Morris writes.
(JAMA. 2006;296:2855-2856. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Morris is supported by a Mentored Research Scholar Grant from the American Cancer Society. Financial disclosures: none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 19, 2006
Media Advisory: To contact Claire M. Vajdic, Ph.D., email: cvajdic{at}nchecr.unsw.edu.au.
KIDNEY TRANSPLANTATION LINKED WITH INCREASED RISK OF VARIOUS CANCERS
CHICAGO—Following kidney transplantation, some recipients may face a 3-fold increased risk of certain cancer types, according to a study in the December 20 issue of JAMA.
Immune suppression after organ transplantation is associated with a markedly increased risk of nonmelanoma skin cancer, non-Hodgkin lymphoma, and Kaposi sarcoma. Whether other cancers occur at increased rates is uncertain, because there have been few long-term population-based studies, according to background information in the article.
Claire M. Vajdic, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues compared the incidence of cancer in 28,855 patients with end-stage kidney disease (ESKD) who received renal (kidney) replacement therapy (RRT). Data were collected for three separate time periods: the 5 years before RRT, during dialysis, and after transplantation. New cancers (1982-2003) were determined by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House.
The researchers found that the overall incidence of cancer, excluding nonmelanoma skin cancer and those cancers known to frequently cause end-stage kidney disease, was markedly increased (3.27 times) after transplantation. In contrast, cancer incidence was only slightly increased (1.35 times) during dialysis and before RRT (1.16 times). After transplantation, cancer occurred at significantly increased incidence at 25 sites, and risk exceeded 3-fold at 18 of these sites.
“Although the incidence of some cancers was increased during dialysis, and the incidence of a few was increased before RRT, the magnitude and breadth of the increased risk after transplantation suggests that immune suppression causes a substantial and broad-ranging increase in cancer risk,” the authors write.
“After kidney transplantation, a wide variety of cancers across a number of organ systems occur with substantially increased incidence. Most, but not all, of these cancers are those with known or suspected viral causes. In contrast, cancer incidence was only slightly increased before kidney transplantation. Our findings point to an important role of the interaction between common viral infections and the immune system in the etiology [cause] of cancers at a broad range of sites,” the researchers conclude.
(JAMA. 2006;296:2823-2831. Available to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 19, 2006
Media Advisory: To contact corresponding author Alberto Ascherio, M.D., Dr.P.H., call Todd Datz at 617-432-3952.
HIGHER LEVELS OF VITAMIN D IN THE BLOOD MAY LOWER RISK OF MULTIPLE SCLEROSIS
CHICAGO—New research suggests that having higher circulating levels of vitamin D is associated with a reduced risk for multiple sclerosis, although this relationship was not seen for black and Hispanic individuals, according to a study in the December 20 issue of JAMA.
Multiple sclerosis (MS) is among the most common neurological diseases in young adults, affecting 350,000 individuals in the United States and 2 million worldwide, according to background information in the article. Previous research has indicated that vitamin D may provide a protective effect, but evidence has been inconclusive.
Kassandra L. Munger, M.Sc., of the Harvard School of Public Health, Boston, and colleagues examined whether high blood levels of 25-hydroxyvitamin D is linked with a lower risk of MS. The study included more than 7 million U.S. military personnel who have serum samples stored in the Department of Defense Serum Repository. Multiple sclerosis cases were identified through Army and Navy physical disability databases and diagnoses were confirmed by medical record review. Each case (n = 257) was matched to two controls by age, sex, race/ethnicity, and dates of blood collection.
The researchers found that among whites, there was a 41 percent decrease in MS risk for every 50-nmol/L (nanomoles per liter) increase in 25-hydroxyvitamin D. In analysis by quintiles, MS risk was highest among individuals in the bottom quintile and lowest among those in the top quintile of 25-hydroxyvitamin D levels. Those in the top quintile had a 62 percent lower risk of MS compared to those in the bottom quintile. The inverse relation with multiple sclerosis risk was particularly strong for 25-hydroxyvitamin D levels measured before age 20 years. Among blacks and Hispanics, who had lower 25-hydroxyvitamin D levels than whites, no significant associations between vitamin D and multiple sclerosis risk were found.
“Although this association was not seen among blacks, their smaller sample size and substantially lower 25-hydroxyvitamin D levels may have reduced the power to detect an association in this group,” the authors write.
“A broad recommendation for a several fold increase in vitamin D intake among adolescents and young adults requires stronger evidence than that provided by observational studies alone. First-degree relatives of individuals with MS are at a higher risk of developing MS, and a prevention trial among this population would be possible and timely. Meanwhile, use of vitamin D supplements for MS prevention should not be undertaken until efficacy is proven,” the researchers conclude.
(JAMA. 2006;296:2832-2838. Available to the media at www.jamamedia.org)
Editor's Note: This work was supported by grants from the National Institute of Neurological Diseases and Stroke and by a pilot grant from the National Multiple Sclerosis Society. Co-author Dr. Bruce Hollis is a consultant for Diasorin. No other disclosures were reported. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
COGNITIVE TRAINING IMPROVES MEMORY, OTHER MENTAL FUNCTIONS IN ELDERLY PEOPLE
VIDEO:
NAT SOT UP FULL FOR :07
C/u Trainer talking to elderly women
AUDIO:
“The next word is elephant, because the elephant is on the moon, not a man in the moon.”
VIDEO:
B-ROLL
Wide of trainer talking to elderly women
Cutaways to women writing, listening
AUDIO:
THIS TRAINER IS TEACHING THESE WOMEN STRATEGIES TO HELP THEM REMEMBER THINGS LIKE LISTS BETTER. THE GOAL IS TO HELP ELDERLY PEOPLE MAINTAIN COGNITIVE, OR MENTAL, SKILLS.
VIDEO:
SOT/FULL
@ :16
Super: Sherry Willis, Ph.D.
Pennsylvania State University
Runs : 06
AUDIO:
“We focused on three abilities: memory, reasoning and speed of processing.”
VIDEO:
B-ROLL
Dr. Willis and colleagues
Exterior Penn State
Women taking touch screen computer test
Trainer with man counting change
AUDIO:
DR. SHERRY WILLIS AND HER COLLEAGUES AT PENNSYLVANIA STATE UNIVERSITY, AND AT FIVE OTHER SITES IN THE U.S., STUDIED NEARLY THREE-THOUSAND ELDERLY PEOPLE WHO LIVED INDEPENDENTLY AND DID NOT HAVE DEMENTIA. THE PEOPLE GOT TEN, ONE-HOUR TRAINING SESSIONS OVER SIX WEEKS OR THEY GOT NO TRAINING AT ALL.
VIDEO:
SOT/FULL
Sherry Willis, Ph.D.
Pennsylvania State University
Runs : 12
AUDIO:
“Immediately after training, individuals who were trained on memory or individuals who were trained on reasoning or speed showed significantly higher performance than those who received no training.”
VIDEO:
B-ROLL
Women and trainer using strategy board
Cutaways women
GFX/JAMA Cover
AUDIO:
BUT EVEN BETTER, MUCH OF THAT BENEFIT HELD UP FOR FIVE YEARS AFTER THE TRAINING. AND PEOPLE WHO GOT THE TRAINING ALSO FELT BETTER ABOUT HOW WELL THEY FUNCTIONED IN THEIR DAILY ACTIVITIES. THE FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Sherry Willis, Ph.D.
Pennsylvania State University
Runs : 14
AUDIO:
Older adults really can continue to exercise mentally and to improve their cognitive abilities. But it does take work. It’s just like physical exercise, you have to do it consistently and diligently.”
VIDEO:
B-ROLL
Man loading pills into pill reminder
Cutaways filling pill reminder
Pauline doing memory training
Pan down to her writing
AUDIO:
STRONG MENTAL ABILITIES MEAN PEOPLE CAN TAKE BETTER CARE OF THEMSELVES, BY REMEMBERING THEIR MEDICATIONS, FOR EXAMPLE. EIGHTY-YEAR OLD PAULINE LOPEZ HAD TROUBLE REMEMBERING PHONE NUMBERS, UNTIL SHE WAS IN THE STUDY AND HAD THE MEMORY TRAINING.
VIDEO:
SOT/FULL
@ 1:29
Super: Pauline Lopez
Received cognitive training
Runs : 13
AUDIO:
“I do remember phone numbers much more readily right now. I don’t know what’s happened but I see them one time, then I remember them, and I remember directions better than I had before.”
VIDEO:
B-ROLL
Pauline dialing phone number
AUDIO:
SHE GOT THAT MEMORY TRAINING IN 1999, AND SHE SAYS IT CONTINUES TO HELP HER. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
