Your arteries know your REAL age

1.11.09: CHD, here we come!
Image by Team Dalog via Flickr

Heart attacks, strokes and a long list of other artery-related afflictions top the list of health risks for the 50-and-over population — and a rising number of those even younger. So figuring how old you really are is an increasingly big deal. If your history includes cigarettes and fast food in abundance you might not want to know. But your arteries hold important information.

Wall Street Journal writer Ron Winslow reports on the intricate business of determining your vascular age — and why that’s an important determination to make.

Several tools are available that enable doctors and patients to calculate vascular age. These suggest there can be a substantial difference between how old you are and how old your blood vessels are. For instance, the vascular age of a 35-year-old man who smokes and has diabetes, high blood pressure and abnormal cholesterol could be as high as 76 years old—more than double his chronological age, according to a recent study. The arteries of a 30-year-old woman with similar risk factors could be equivalent to those of an average woman who is more than 80 years old.

Such a calculation “gives a sense that your risk-factor burden is making you age faster than you think you are,” says Donald Lloyd-Jones, a preventive cardiologist at Northwestern University, Chicago, who co-authored the recent study, which appeared in the journal Circulation last August. “The more you can make it concrete, the better you can impart information about risk.”

The good news, doctors say, is that by taking steps to reduce risk factors and the damage they inflict on arteries, it is possible to turn back the clock on vascular age.

Some of us — long-time smokers, members of a family with genetic problems that can’t be overcome — might not be able to access the good news. But many can, and for them, a few changes in lifestyle, or manageable medications, can make a lifetime of difference.

  • A 42-year-old man who smokes and has total cholesterol of 180, good cholesterol (HDL) of 45 and systolic blood pressure of 125, has a vascular age of a 54-year-old. If he quits smoking, his vascular age could drop to 42, the same as his chronological age.
  • A 52-year-old nonsmoking woman, who has total cholesterol of 220, HDL of 44 and systolic blood pressure of 135, has a vascular age of a 68-year-old. If the woman reduces her cholesterol below 200, her vascular age could drop to 59 years old.

If you’re feeling your age today, maybe your arteries are trying to tell you something.

Arteries Can Reveal Your Risk of Heart Disease – WSJ.com.

A once-a-month alcoholism shot? An anti-cigarette pill? Could happen

addiction
Image by alancleaver_2000 via Flickr

For those of us who got off addictions the old-fashioned way, reports from the recent American Psychiatric Association‘s annual meeting sound like good news, even if it’s a little late in coming. AP Medical writer Lauran Neergaard summed up the latest:

“This is the next frontier in substance abuse: Better understanding of how addiction overlaps with other brain diseases is sparking a hunt to see if a treatment for one might also help another.

We’re not talking about attempts just to temporarily block an addict’s high. Today’s goal is to change the underlying brain circuitry that leaves substance abusers prone to relapse.

It’s “a different way of looking at mental illnesses, including substance abuse disorders,” says National Institute on Drug Abuse Director Dr. Nora Volkow, who on Monday urged researchers at the American Psychiatric Association’s annual meeting to get more creative in the quest for brain-changing therapies for addiction.

Rather than a problem in a single brain region, scientists increasingly believe that psychiatric diseases are a result of dysfunctioning circuits spread over multiple regions, leaving them unable to properly communicate and work together. That disrupts, for example, the balance between impulsivity and self-control that plays a crucial role in addiction.

Addiction is a strange phenomenon, and we who know a lot about it (this writer kicked cigarettes in the 60s, alcohol in the 80s, crunching ice — you haven’t ever met an ice-crunching addict? Believe it. — five or six years ago) say it’s about time we got our own dysfunctional circuitry studies.

Think of it as if the brain were an orchestra, its circuits the violins and the piano and the brass section, all smoothly starting and stopping their parts on cue, Volkow told The Associated Press.

“That orchestration is disrupted in psychiatric illness,” she explains. “There’s not a psychiatric disease that owns one particular circuit.”

So NIDA, part of the National Institutes of Health, is calling for more research into treatments that could target circuits involved with cognitive control, better decision-making and resistance to impulses.

Addictive behavior has drawn attention from researchers and writers for years. A 1983 study done for the National Academy of Sciences by Alan R. Lang, Professor of Psychology at Florida State University reported that “some mental health experts find it useful to view addiction as including all self-destructive, compulsive behaviors”  and cited references to addictions as wide-ranging as caffeine (guilty), chocolate (definitely) and gambling (not on your life.)

Changing behaviors to conquer addictions, with a little help from therapies and therapists of all sorts, has been plugging along as a solution for decades. Takes a lot of work. Wouldn’t a magic pill be lovely?

Targeting brain circuits for addiction, relapse.

Alzheimer's: old music, new songs

Think nursery rhyme. Sing the words. How long is it since you learned that ditty?

Years ago a friend of mine named Alice suffered a stroke that left her with the ability to say only two words: “one, two.” Or she may have been saying “want to.” In the months ahead she developed a skill for packing more meaning into that phrase than most of us can manage in several paragraphs. “ONE two!,” she would fairly shout at her husband, expressing displeasure (something she did with regularity before the stroke.) “OnetwoONEtwo?” she would ask, in a “Do you really like it?” voice. Still, it was tough on friends and family, and had to have been more than frustrating for her.

Eventually Alice and her husband moved into an assisted living facility. Though she was a woman of limited education and resources, she was able to resume a minimal degree of activity within that community. I saw her about once a week there, for a period of months.

At Christmas time, a group of us went caroling in Alice’s building. Midway through one old, familiar song, as we stood facing an assembled group of residents, someone noticed that Alice was singing merrily along, word for word. There was a lot of nudging and head-nodding, and by the end of the last verse not a dry eye. As we left, Alice smiled and said, “One two, one two.”

Now comes another interesting word about music and the mind, from a Science Daily article posted on the PositScience blog. It cites results from research by the Boston University School of Medicine showing that people with Alzheimer’s retain verbal information better when it comes within the context of music. The findings appear online in Neuropsychologia, an international journal to which I admittedly do not subscribe.

To determine whether music can enhance new learning of information, AD (Alzheimer’s Disease) patients and healthy controls were presented with either the words spoken, or the lyrics sung with full musical accompaniment along with the printed lyrics on a computer screen. The participants were presented visually with the lyrics to 40 songs. Twenty of the song lyrics were accompanied by their corresponding sung recording and 20 were accompanied by their spoken recording.

After each presentation, participants were asked to indicate whether or not they were previously familiar with the song they had just heard. The BUSM researchers found accuracy was greater in the sung condition than in the spoken condition for AD patients but not for healthy older controls.

The blog elicited responses ranging roughly from “that’s very interesting” to “so what else is new?” I come down on the “that’s very interesting” side of the issue, because it is.

And the more we know about connections of this sort, the more we begin to understand about the workings of the mind and the broader the possibilities of unlocking its secrets. Those pesky memorizations of yore, set to music, still manage to survive all manner of afflictions.

I still can’t figure out where I put the keys… but I can sing you every line of “Itsy Bitsy Spider.”

Brain exercises oversold, study says

What? Brain exercises aren’t all they’re cracked up to be? Bah, humbug. But indeed, according to the Wall Street Journal‘s Gautam Naik in a recent article, “a large new study casts doubt on whether such programs can deliver what they promise.”

The hallmark of a good brain-training program isn’t whether it simply improves a person’s ability to do the specific mental tasks in the training, but whether it also boosts other cognitive skills. The latest study, published in the journal Nature, found no evidence for such cognitive transfers.

“Our brain-training groups got better at the tests they practiced, and the more they practiced, the better they got. But there was no translation to any improvements in general cognitive function,” said study co-author Jessica Grahn, a scientist at the Medical and Research Council’s Cognition and Brain Sciences Unit in Cambridge, England. The unit has close links to the University of Cambridge.

Full disclosure: Posit Science CEO Steven Aldrich (quoted below) provided this geezer-driver writer with his company’s DriveSharp program at no charge. Whenever I can snatch some time (unfortunately that is seldom in 30-minute segments) I work on brain-training computer exercises designed to make me a safer driver.  This is anecdotal and unscientific, but I believe it has made a small improvement.

But back to the study.

The brain-training field has been boosted by studies suggesting that even adult brains are “plastic,” and cognitive ability can be improved with the right mental training. Another spur is an aging population, and the hope that cognitive exercises and lifestyle changes may help to forestall brain maladies such as Alzheimer’s disease.

The authors of the Nature study point out that some modest benefits to cognitive abilities have been reported in studies of older people, preschool children and videogame players who outperform nonplayers on some tests of visual attention. But wider empirical support has been lacking, they said.

The six-week online study involved 11,430 healthy participants, all viewers of a BBC television science program. They were first tested for their existing “benchmark” cognitive abilities, and then randomly assigned to one of three groups, each with a different set of tasks.

One group took part in online games aimed at improving skills linked to general intelligence, such as reasoning, problem-solving and planning. A second test group did exercises to boost short-term memory, attention and mathematical and visual-spatial skills—functions typically targeted by commercial brain-training programs. A third “control group” was asked to browse the Internet and seek out answers to general knowledge questions.

The conclusion: Those who did the brain-training exercises improved in the specific tasks that they practiced. However, their improvement was generally no greater than the gains made by the control group surfing the Internet. And none of the groups showed evidence of improvement in cognitive skills that weren’t specifically used in their tasks.

This study may be in, but the jury is still out. Proponents cite other sources and other studies in this still-new field, most aimed at helping the aging population keep up memory function and stave off general decline. And sites maintaining that it’s possible to build new brain cells continue to proliferate. Critics of the new study weighed in:

Some critics said the study’s design was flawed. For example, the participants were asked to do brain workouts for at least 10 minutes a day, three times a day, for six weeks. But that may not have been long enough.

“It’s not brain training,” said Alvaro Fernandez, chief executive officer of SharpBrains. Past studies, he said, indicate that proper cognition transfer “only happens after more than 15 hours of training and where each session lasts at least 30 minutes.”

Steven Aldrich, chief executive of Posit Science of San Francisco, which sells brain-training programs, said the “study overreaches in generalizing that since their methods did not work, all methods would not work.” Mr. Aldrich added that other randomized, peer-reviewed studies have shown that brain training improves some aspects of brain performance.

Given the growing aging population and its accompanying mental struggles, from Where did I leave the keys? to fears of Alzheimer’s, this space endorses all efforts to better the brain cells. I’m still working on my driving and in favor of giving a game a try.

Study Finds Mental Exercise Offers Brain Limited Benefits – WSJ.com.

Medical marijuana: a boon & a challenge

When my sister Mimi found that marijuana could relieve her severe gastrointestinal distress, years ago, one joint after dinner was all it took. Unfortunately we couldn’t keep up the supply. After one foray into the rather scary realm of pot-dealing in a state (Georgia) where we could have wound up in jail very quickly, we decided that not even such clear relief was worth the risk.

Today, at least in California and 14 other states — with the District of Columbia possibly to be added soon — the risk is minimal but the dosage is fuzzy. The conundrum was outlined by writer Lena K. Sun in the San Francisco Chronicle:

On Tuesday, District of Columbia officials gave final approval to a bill establishing a legal medical marijuana program. If Congress signs off, D.C. doctors – like their counterparts in 14 states – will be allowed to add pot to therapies they can recommend to certain patients, who will then eat it, smoke it or vaporize it until they decide they are, well, high enough.

The exact dosage and means of delivery – as well as the sometimes perplexing process of obtaining a drug that remains illegal under federal law – will be left largely up to the patient. Doctors say that upends the way they are used to dispensing medication, giving the straitlaced medical establishment a whiff of the freewheeling world of weed.

Even in states where marijuana is allowed for medical use, doctors cannot write prescriptions because of the drug’s status as an illegal substance. Physicians can only recommend it, and have no control over the quality of the drug their patients acquire.

Because there are no uniform standards for medical marijuana, doctors have to rely on the experience of other doctors and their own judgment. That, they say, can lead to abuse.

California’s “quick-in, quick-out mills” that readily hand out recommendations have proliferated, worrying advocates. The state, the first to legalize medical marijuana 14 years ago, allows for a wider range of conditions, including anxiety.

To guard against abuse, some doctors say they recommend marijuana only after patients exhaust other remedies. Some doctors perform drug tests as part of pre-screenings.

Mimi died over a year ago. Her last decades, like almost all of her adult life, were spent in the State of Georgia, where medical marijuana is still against the law. I know what her required dosage was; legalization and proper oversight would allow doctors to learn dosages that work for their patients. It seems worse than cruel that thousands of other sick and dying citizens continue to be denied the potential relief that legalized medical marijuana could bring.

Dispensing medical pot a challenge for doctors.

When Mom & Dad go wandering: dementia on a relentless rise

“MISSING,” the sign reads. “Distinguished-looking elderly man. 6′ 1” slightly stooped. Gray hair. Wearing dark blue sweater and gray slacks. Name: George; does not always respond. Suffering from mild dementia. Wandered away from the Laurel Village shopping center area. Please call 415-xxx-xxxx with any information.”

The sad, 8″ x 10″ flyer has appeared (once the words were slightly different, but it was clearly the same George) at the bus stop near my home twice in recent months. I kept the number in my wallet for a while, hoping I might spot him because I walk the city myself. But the difference is that I have on a warm jacket — it’s way too cold in San Francisco, especially after dark, for only a sweater — and I know how to get home.  I have wanted to call the number and learn whether George got home, but it seems intrusive.

Last year for the first time, as reporter Kirk Johnson writes in The New York Times, people like George and a 60-year-old Virginia woman named Freda Machett accounted for more missing-person alerts than children and adolescents. They are confused and lost, and often are not found in time.

Ms. Machett, 60, suffers from a form of dementia that attacks the brain like Alzheimer’s disease and imposes on many of its victims a restless urge to head out the door. Their journeys, shrouded in a fog of confusion and fragmented memory, are often dangerous and not infrequently fatal. About 6 in 10 dementia victims will wander at least once, health care statistics show, and the numbers are growing worldwide, fueled primarily by Alzheimer’s disease, which has no cure and affects about half of all people over 85.
It started with five words — ‘I want to go home’ — even though this is her home,” said Ms. Machett’s husband, John, a retired engineer who now cares for his wife full time near Richmond. She has gone off dozens of times in the four years since receiving her diagnosis, three times requiring a police search. “It’s a cruel disease,” he said.
“You have to stop thinking logically, because the people you’re looking for are no longer capable of logic,” said Robert B. Schaefer, a retired F.B.I. agent who cared for his wife, Sarah, for 15 years at home through her journey into Alzheimer’s. He now leads two-day training sessions for the Virginia Department of Criminal Justice Services.

How to deal with dementia is the most bewildering of end-of-life issues, whether for oneself or for a family member. Most of us would choose almost any other scenario for our last months or years, but the choice is often not ours to make. We can file advance directives (mine includes a “Dementia Provision“) and express our wishes and do brain exercises; still, one in seven Americans, according to most fairly recent reports, now suffers from dementia and the numbers are on the rise.

Here’s one interesting perspective. My greatly beloved brother-in-law, who recently relocated with my sister to a retirement community, has Parkinson’s. Though his mobility and function are diminished, the disease has yet to affect his mind. Several weeks ago he told me he no longer fears dementia. “I see people more and more with varying stages of dementia,” he said, “and I believe you can be happy.”

But you can also wander off.

More Wander Off in Fog of Age – NYTimes.com.

Is your cell phone frying your brain?

OK, if you think it’s all just a lot of hysterical hooey about cell phones & radiation, you can click on to another page. But this op ed piece by public health expert Joel Moskowitz (with Diana McDonnell and Gene Kazinets) in the San Francisco Chronicle got my attention. Moskowitz is the Director of U.C. Berkeley’s Center for Family and Community Health.

A huge, 30-year study called COSMOS has been launched in Europe to determine whether cell phones cause cancer and other health problems. Meanwhile, policymakers in Sacramento are considering legislation to ensure people know how much radiation their cell phones emit. The wireless industry vigorously opposes such legislation. It argues that its phones comply with regulations, and there is no consensus about risks so people don’t need to know this. Our research review published in the Journal of Clinical Oncology found alarming results to the contrary.

We reviewed 23 case-control studies that examined tumor risk due to cell phone use. Although as a whole the data varied, among the 10 higher quality studies, we found a harmful association between phone use and tumor risk. The lower quality studies, which failed to meet scientific best practices, were primarily industry funded.

The 13 studies that investigated cell phone use for 10 or more years found a significant harmful association with tumor risk, especially for brain tumors, giving us ample reason for concern about long-term use.

Do federal regulations adequately protect the public? The 1996 Federal Communications Commission regulations are based upon the Specific Absorption Rate (SAR), a measure of heat generated by six minutes of cell phone exposure in an artificial model that represents a 200-pound man’s brain. Although every cell phone model has a SAR, the industry doesn’t make it easy to find it. Moreover, children, and adults who weigh less than 200 pounds, are exposed to more radiation than our government deems “safe.”

So just for fun, I got out the 107-page User Guide that came with my cell phone. Full disclosure: my cell phone is turned off unless I’m out walking or traveling; it takes pictures but it doesn’t do apps. Still, those 107 pages say it can do all the fancy Stuff.

On page 81 I found the SAR data. Even if I wanted to decipher the very small print, there is no way any of it would be meaningful to a lay reader. It does say that “Your wireless phone is a radio transmitter and receiver. It is designed and manufactured not to exceed limits for exposure to radio frequency (RF) energy set by the Federal Communications Commission (FCC) of the U.S. Government.”

I do try to trust the U.S. Government. But since they once sent my then-Marine husband double-timing out of a foxhole toward an A-bomb blast with a radiation tag hung around his neck in the ’50s, it would appear we have long been open to experimentation about radiation damage. (He survived. The animals positioned closer to the blast site did not. No one will ever be certain how much damage was sustained by those Marines wearing radiation tags… but then, who knew we’d keep right on storing bombs and fighting senseless wars anyway?)

Another what-can-you-believe? comes from CNN’s medical guru Sanjay Gupta in this line from a two-year-old commentary on potential cell phone radiation damage still up on his blog:

Over the last year, I have reviewed nearly a hundred studies on this topic, including the 19 large epidemiological studies. I urge you to do the same and read carefully to see what you think. Here is an example from a Swedish paper showing no increased risk of a brain tumor, known as acoustic neuroma. (see study) As you read the paper, you will find they defined a “regular” cell phone user as someone who uses a cell phone once per week during six months or more.

Once a week? Hello? Even in Sweden, even a decade ago, did anyone with a cell phone not use it at least once an hour? This very old study did have a timeless conclusion: “Our findings do not indicate an increased risk of acoustic neuroma related to short-term mobile phone use after a short latency period. However, our data suggest an increased risk of acoustic neuroma associated with mobile phone use of at least 10 years’ duration.”

Moskowitz argues that it’s time to revamp FCC regulations, pointing out that it is not just heat transfer but also variations in frequencies emitted that could cause damage.

Most of us know something about potential damage lurking in our Stuff. But we tend to be slow learners, and our regulatory agencies tend to be even slower. Having just lost a greatly loved sister, a long-time smoker, to pulmonary failure, Moskowitz’ concluding paragraphs hit home:

We should address this issue proactively even if we do not fully understand its magnitude. Our government has faced similar public health threats in the past. In 1965, although there was no scientific consensus about the harmful effects of cigarettes, Congress required a precautionary warning label on cigarette packages: “Cigarette Smoking May Be Hazardous to Your Health.” More specific warnings were not required until 1984: “Smoking Causes Lung Cancer, Heart Disease, Emphysema, And May Complicate Pregnancy.”

Should we have waited 19 years until absolutely certain before we informed the public about these risks?

Although more research on cell phone radiation is needed, we cannot afford to wait. There are 285 million cell phones in use in this country, and two-thirds of children over the age of seven use them. Manufacturers bury the SAR within their owner’s manuals, along with safety instructions to keep your phone up to an inch away from your body.

Nine nations have issued precautionary warnings. It is time for our government to require health warnings and publicize simple steps to reduce the health risks of cell phone use.

Why not?

Government must inform us of cell phone risk.

Cycling a relief for Parkinson’s?

That old saw about bike-riding as something one never forgets has taken on a new meaning. According to a report in the latest New England Journal of Medicine, cycling skills learned long ago can remain even when the ravages of Parkinson’s have destroyed most other abilities to get around… or even to stand without aid.

Dr. Bastiaan R. Bloem of the Radboud University Nijmegen Medical
Center in the Netherlands thought he had seen it all in his years of
caring for patients with Parkinson’s disease. But the 58-year-old
man who came to see him recently was a total surprise.

The New England Journal of Medicine

A video from the Netherlands of a 58-year-old man
with a 10-year history of Parkinson’s disease showed him freezing in his
movements after a few steps. Yet he was able to ride a bicycle.

The man had had Parkinson’s disease for 10 years, and it

had progressed until he was severely affected. Parkinson’s, a
neurological disorder in which some of the brain cells that control
movement die, had made him unable to walk. He trembled and could walk
only a few steps before falling. He froze in place, his feet feeling as
if they were bolted to the floor.

But the man told Dr. Bloem something amazing: he said he was a regular
exerciser — a cyclist, in fact — something that should not be possible
for patients at his stage of the disease, Dr. Bloem thought.

“He said, ‘Just yesterday I rode my bicycle for 10 kilometers’ — six
miles,” Dr. Bloem said. “He said he rides his bicycle for miles and
miles every day.”

“I said, ‘This cannot be,’ ” Dr. Bloem, a professor of neurology and
medical director of the hospital’s Parkinson’s Center, recalled in a
telephone interview. “This man has end-stage Parkinson’s disease. He is
unable to walk.”

But the man was eager to demonstrate, so Dr. Bloem took him outside
where a nurse’s bike was parked.

“We helped him mount the bike, gave him a little push, and he was gone,”
Dr. Bloem said. He rode, even making a U-turn, and was in perfect
control, all his Parkinson’s symptoms gone.

Yet the moment the man got off the bike, his symptoms returned. He froze
immediately, unable to take a step.

Parkinson’s has to be among the most bewildering of diseases, to the patient and caregiver alike. A very old friend of mine, former dean of a major theological school and author of a long list of acclaimed books, has had Parkinson’s for decades. He is fortunate also to have a wife with spine of steel and persistence of Job. More than a decade ago, when he was in a period of severe decline, she agitated for changes in his medications she felt needed to be made — and they subsequently left for an anniversary cruise to Scandinavia.  Some years later, after he had lost control of his mobility and most other functions it was determined that his Parkinson’s was not Parkinson’s after all, but “Parkinson’s-like symptoms,” and once again his treatment was dramatically changed. To dramatic effect. Having missed his sharp wit and ability to make conversation on earlier visits, the last time I was in their town the three of us enjoyed a long and hilarious lunch in a local restaurant.

If the old, familiar bicycle can be utilized to revive mobility and offer a new route to exercise and enjoyment, it will be very good news for Parkinson’s families.

For Some, Cycling Eases Parkinson’s Symptoms – NYTimes.com.