Michele G. Sullivan

VIENNA – Diet and exercise appear to exert positive influences, even as people age, in terms of significant reductions in the risk of developing cognitive decline or dementia.

Researchers at the International Conference on Alzheimer's Disease presented several studies showing that a heart-healthy diet and moderate exercise are associated with lower dementia rates.

“Research continues to show us that there are lifestyle decisions we all can make to keep our brains healthier, and which may also lower our risk of memory decline as we age,” William Thies, Ph.D., chief medical and scientific officer of the Alzheimer's Association, which sponsored the meeting, said in a statement.

The diet study, led by Heidi J. Wengreen, Ph.D., of Utah State University, Logan, examined compliance with the Dietary Approaches to Stop Hypertension (DASH) eating plan and dementia rates among participants in the Cache County Study on Memory, Health, and Aging. The DASH plan encourages the consumption of fruits, vegetables, nuts and beans, whole grains, low-fat dairy, and lean animal proteins, and limits salt and sweets.

The study group included 3,831 subjects who were at least 65 years old at baseline, said Ronald Munger, Ph.D., the coinvestigator who presented the findings at the meeting.

On a DASH compliance scale of 0-45, the mean score was 27. “Not one of our participants was able to be fully compliant with the diet,” said Dr. Munger, also of the university. At baseline, all subjects took the Modified Mini-Mental State (3MS) examination, a global measure of cognition with a maximum score of 100. The test was repeated four times during 11 years of follow-up.

Compared with those in the lowest quintile of diet compliance, those in the highest quintile scored significantly better on the 3MS at baseline (91.38 vs. 90.41) and at 11 years (87.60 vs. 85.81).

The researchers identified four food groups that were independently associated with better 3MS scores: dairy, vegetables, whole grains, and nuts and beans. In a second model using just those four food groups, participants in the highest quintile for consumption of those foods scored significantly better than those in the lowest quintile at baseline (91.70 vs. 89.95) and 11 years (88.28 vs. 84.91)). Those in the highest quintile also had the lowest risk for developing dementia, but that finding was significant (hazard ratio, 0.40) only for ApoE4-negative subjects.

Dr. Munger said that the team is doing similar research on the Mediterranean diet, which has been linked to a similar reduction in dementia risk. “The goal is not to propose a single dietary pattern for the whole world, but to focus on finding the most effective food groups, which can be incorporated into any diet.”

One exercise study, by Deborah E. Barnes, Ph.D., and her colleagues, examined activity levels and brain aging in 3,075 subjects in the Health, Aging, and Body Composition Study. The mean age was 74 years at baseline; 52% were women, and their mean 3MS score was 90. Subjects self-reported the minutes they spent walking each week at baseline and at 2, 4, and 7 years. Activity levels were classified as sedentary (no weekly physical activity), low (less than 150 minutes of walking per week), or high (more than 150 minutes of walking per week).

Dr. Barnes, of the University of California, San Francisco, found that over 7 years of follow-up, 21% of the subjects were consistently sedentary, 12% maintained a steady level of activity, 26% had a declining level, 11% had an increase, and 30% had fluctuating levels.

After adjustment for age, sex, race, level of education, study site, alcohol and tobacco use, and the presence of diabetes and hypertension, those who reported consistent activity performed significantly better on the 3MS exam than those in the other groups. The mean rate of decline on the 3MS was 0.4 points/year in the consistent-activity group, 0.44 points/year in the increasing- or fluctuating-activity group, 0.54 points/year in the decreasing-activity group, and 0.62 points/in the sedentary group. The findings may speak to exercise's influence on neuronal health, she said. “Physical activity may lead to neurogenesis, synaptogenesis, and overall enhanced function.”

Findings from a second exercise study, presented by Dr. Thomas Obisesan in a poster session, suggest that exercise may be more beneficial among individuals who are free of the ApoE4 gene.

Dr. Obisesan, chief of geriatrics at Howard University, Washington, used data from the 1988-1994 National Health and Nutrition Survey to study 1,799 subjects aged 60 years and older who had full data on aerobic activity, shortened Mini-Mental State Examination (sMMSE) scores, and ApoE4 genotype. Among those aged 60-69 years, 60% reported engaging in physical activity during the previous month; in those aged 70 years or older, 54% reported such activity.

In a regression analysis, greater aerobic activity was associated with better cognitive function in subjects who did not carry the ApoE4 high-risk allele and those who carried only one copy: Among those aged 60-69, the mean sMMSE score was 16 in noncarriers and heterozygous carriers who exercised, and 15 in nonexercisers. Among those homozygous for the gene, the mean sMMSE score was 15 in both groups.

A separate analysis looked at subjects aged 70 years and older: In noncarriers, the mean sMMSE was 15.5 in exercisers and 14.5 in nonexercisers. Among heterozygous carriers, the score was 15 in exercisers and 14 in nonexercisers. Among homozygous carriers, the score was 13.5 in exercisers and 11.5 in nonexercisers.

“This study adds to growing evidence that increased levels of physical activity may offer an important primary intervention strategy to attenuate neurocognitive loss. If confirmed in experimental studies, this strategy may have significant public health benefits,” Dr. Obisesan said.

VIENNA – Diet and exercise appear to exert positive influences, even as people age, in terms of significant reductions in the risk of developing cognitive decline or dementia.

Researchers at the International Conference on Alzheimer's Disease presented several studies showing that a heart-healthy diet and moderate exercise are associated with lower dementia rates.

“Research continues to show us that there are lifestyle decisions we all can make to keep our brains healthier, and which may also lower our risk of memory decline as we age,” William Thies, Ph.D., chief medical and scientific officer of the Alzheimer's Association, which sponsored the meeting, said in a statement.

The diet study, led by Heidi J. Wengreen, Ph.D., of Utah State University, Logan, examined compliance with the Dietary Approaches to Stop Hypertension (DASH) eating plan and dementia rates among participants in the Cache County Study on Memory, Health, and Aging. The DASH plan encourages the consumption of fruits, vegetables, nuts and beans, whole grains, low-fat dairy, and lean animal proteins, and limits salt and sweets.

The study group included 3,831 subjects who were at least 65 years old at baseline, said Ronald Munger, Ph.D., the coinvestigator who presented the findings at the meeting.

On a DASH compliance scale of 0-45, the mean score was 27. “Not one of our participants was able to be fully compliant with the diet,” said Dr. Munger, also of the university. At baseline, all subjects took the Modified Mini-Mental State (3MS) examination, a global measure of cognition with a maximum score of 100. The test was repeated four times during 11 years of follow-up.

Compared with those in the lowest quintile of diet compliance, those in the highest quintile scored significantly better on the 3MS at baseline (91.38 vs. 90.41) and at 11 years (87.60 vs. 85.81).

The researchers identified four food groups that were independently associated with better 3MS scores: dairy, vegetables, whole grains, and nuts and beans. In a second model using just those four food groups, participants in the highest quintile for consumption of those foods scored significantly better than those in the lowest quintile at baseline (91.70 vs. 89.95) and 11 years (88.28 vs. 84.91)). Those in the highest quintile also had the lowest risk for developing dementia, but that finding was significant (hazard ratio, 0.40) only for ApoE4-negative subjects.

Dr. Munger said that the team is doing similar research on the Mediterranean diet, which has been linked to a similar reduction in dementia risk. “The goal is not to propose a single dietary pattern for the whole world, but to focus on finding the most effective food groups, which can be incorporated into any diet.”

One exercise study, by Deborah E. Barnes, Ph.D., and her colleagues, examined activity levels and brain aging in 3,075 subjects in the Health, Aging, and Body Composition Study. The mean age was 74 years at baseline; 52% were women, and their mean 3MS score was 90. Subjects self-reported the minutes they spent walking each week at baseline and at 2, 4, and 7 years. Activity levels were classified as sedentary (no weekly physical activity), low (less than 150 minutes of walking per week), or high (more than 150 minutes of walking per week).

Dr. Barnes, of the University of California, San Francisco, found that over 7 years of follow-up, 21% of the subjects were consistently sedentary, 12% maintained a steady level of activity, 26% had a declining level, 11% had an increase, and 30% had fluctuating levels.

After adjustment for age, sex, race, level of education, study site, alcohol and tobacco use, and the presence of diabetes and hypertension, those who reported consistent activity performed significantly better on the 3MS exam than those in the other groups. The mean rate of decline on the 3MS was 0.4 points/year in the consistent-activity group, 0.44 points/year in the increasing- or fluctuating-activity group, 0.54 points/year in the decreasing-activity group, and 0.62 points/in the sedentary group. The findings may speak to exercise's influence on neuronal health, she said. “Physical activity may lead to neurogenesis, synaptogenesis, and overall enhanced function.”

Findings from a second exercise study, presented by Dr. Thomas Obisesan in a poster session, suggest that exercise may be more beneficial among individuals who are free of the ApoE4 gene.

Dr. Obisesan, chief of geriatrics at Howard University, Washington, used data from the 1988-1994 National Health and Nutrition Survey to study 1,799 subjects aged 60 years and older who had full data on aerobic activity, shortened Mini-Mental State Examination (sMMSE) scores, and ApoE4 genotype. Among those aged 60-69 years, 60% reported engaging in physical activity during the previous month; in those aged 70 years or older, 54% reported such activity.

In a regression analysis, greater aerobic activity was associated with better cognitive function in subjects who did not carry the ApoE4 high-risk allele and those who carried only one copy: Among those aged 60-69, the mean sMMSE score was 16 in noncarriers and heterozygous carriers who exercised, and 15 in nonexercisers. Among those homozygous for the gene, the mean sMMSE score was 15 in both groups.

A separate analysis looked at subjects aged 70 years and older: In noncarriers, the mean sMMSE was 15.5 in exercisers and 14.5 in nonexercisers. Among heterozygous carriers, the score was 15 in exercisers and 14 in nonexercisers. Among homozygous carriers, the score was 13.5 in exercisers and 11.5 in nonexercisers.

“This study adds to growing evidence that increased levels of physical activity may offer an important primary intervention strategy to attenuate neurocognitive loss. If confirmed in experimental studies, this strategy may have significant public health benefits,” Dr. Obisesan said.

VIENNA – Diet and exercise appear to exert positive influences, even as people age, in terms of significant reductions in the risk of developing cognitive decline or dementia.

Researchers at the International Conference on Alzheimer's Disease presented several studies showing that a heart-healthy diet and moderate exercise are associated with lower dementia rates.

“Research continues to show us that there are lifestyle decisions we all can make to keep our brains healthier, and which may also lower our risk of memory decline as we age,” William Thies, Ph.D., chief medical and scientific officer of the Alzheimer's Association, which sponsored the meeting, said in a statement.

The diet study, led by Heidi J. Wengreen, Ph.D., of Utah State University, Logan, examined compliance with the Dietary Approaches to Stop Hypertension (DASH) eating plan and dementia rates among participants in the Cache County Study on Memory, Health, and Aging. The DASH plan encourages the consumption of fruits, vegetables, nuts and beans, whole grains, low-fat dairy, and lean animal proteins, and limits salt and sweets.

The study group included 3,831 subjects who were at least 65 years old at baseline, said Ronald Munger, Ph.D., the coinvestigator who presented the findings at the meeting.

On a DASH compliance scale of 0-45, the mean score was 27. “Not one of our participants was able to be fully compliant with the diet,” said Dr. Munger, also of the university. At baseline, all subjects took the Modified Mini-Mental State (3MS) examination, a global measure of cognition with a maximum score of 100. The test was repeated four times during 11 years of follow-up.

Compared with those in the lowest quintile of diet compliance, those in the highest quintile scored significantly better on the 3MS at baseline (91.38 vs. 90.41) and at 11 years (87.60 vs. 85.81).

The researchers identified four food groups that were independently associated with better 3MS scores: dairy, vegetables, whole grains, and nuts and beans. In a second model using just those four food groups, participants in the highest quintile for consumption of those foods scored significantly better than those in the lowest quintile at baseline (91.70 vs. 89.95) and 11 years (88.28 vs. 84.91)). Those in the highest quintile also had the lowest risk for developing dementia, but that finding was significant (hazard ratio, 0.40) only for ApoE4-negative subjects.

Dr. Munger said that the team is doing similar research on the Mediterranean diet, which has been linked to a similar reduction in dementia risk. “The goal is not to propose a single dietary pattern for the whole world, but to focus on finding the most effective food groups, which can be incorporated into any diet.”

One exercise study, by Deborah E. Barnes, Ph.D., and her colleagues, examined activity levels and brain aging in 3,075 subjects in the Health, Aging, and Body Composition Study. The mean age was 74 years at baseline; 52% were women, and their mean 3MS score was 90. Subjects self-reported the minutes they spent walking each week at baseline and at 2, 4, and 7 years. Activity levels were classified as sedentary (no weekly physical activity), low (less than 150 minutes of walking per week), or high (more than 150 minutes of walking per week).

Dr. Barnes, of the University of California, San Francisco, found that over 7 years of follow-up, 21% of the subjects were consistently sedentary, 12% maintained a steady level of activity, 26% had a declining level, 11% had an increase, and 30% had fluctuating levels.

After adjustment for age, sex, race, level of education, study site, alcohol and tobacco use, and the presence of diabetes and hypertension, those who reported consistent activity performed significantly better on the 3MS exam than those in the other groups. The mean rate of decline on the 3MS was 0.4 points/year in the consistent-activity group, 0.44 points/year in the increasing- or fluctuating-activity group, 0.54 points/year in the decreasing-activity group, and 0.62 points/in the sedentary group. The findings may speak to exercise's influence on neuronal health, she said. “Physical activity may lead to neurogenesis, synaptogenesis, and overall enhanced function.”

Findings from a second exercise study, presented by Dr. Thomas Obisesan in a poster session, suggest that exercise may be more beneficial among individuals who are free of the ApoE4 gene.

Dr. Obisesan, chief of geriatrics at Howard University, Washington, used data from the 1988-1994 National Health and Nutrition Survey to study 1,799 subjects aged 60 years and older who had full data on aerobic activity, shortened Mini-Mental State Examination (sMMSE) scores, and ApoE4 genotype. Among those aged 60-69 years, 60% reported engaging in physical activity during the previous month; in those aged 70 years or older, 54% reported such activity.

In a regression analysis, greater aerobic activity was associated with better cognitive function in subjects who did not carry the ApoE4 high-risk allele and those who carried only one copy: Among those aged 60-69, the mean sMMSE score was 16 in noncarriers and heterozygous carriers who exercised, and 15 in nonexercisers. Among those homozygous for the gene, the mean sMMSE score was 15 in both groups.

A separate analysis looked at subjects aged 70 years and older: In noncarriers, the mean sMMSE was 15.5 in exercisers and 14.5 in nonexercisers. Among heterozygous carriers, the score was 15 in exercisers and 14 in nonexercisers. Among homozygous carriers, the score was 13.5 in exercisers and 11.5 in nonexercisers.

“This study adds to growing evidence that increased levels of physical activity may offer an important primary intervention strategy to attenuate neurocognitive loss. If confirmed in experimental studies, this strategy may have significant public health benefits,” Dr. Obisesan said.

CHICAGO — Using a retrograde viewing device that looks behind haustral folds and flexures in the colon during colonoscopy was associated with the detection of significantly more polyps and adenomas than relying on a standard colonoscope alone, a prospective study has found.

Endoscopists who performed the procedures said that the Third Eye Retroscope found 11% more adenomas in the entire colon and 15% more in the right colon, where concerns are highest about missed lesions, Dr. Jerome D. Waye said at the annual Digestive Disease Week.

The scope, manufactured by Avantis Medical Systems, “provides a simultaneous backward and forward view of the colon,” said Dr. Waye of Mount Sinai Medical Center, New York. “The retroscope passes through the colonoscope channel and then automatically retroflexes 180 degrees. It carries its own light source and has a camera with a very wide angle lens. The camera looks backward while the colonoscope looks forward.”

Both images are simultaneously displayed on the video monitor, he said. When a lesion is detected, the retroscope has to be withdrawn so that the polyp can be snared; the scope is then reinserted and the procedure continues. Although this process can lengthen the overall time of the colonoscopy, the increased polyp yield is a worthy tradeoff, Dr. Waye said.

He presented the results of a prospective study of 249 patients who underwent screening or surveillance colonoscopy at any of eight U.S. sites.

The retroscope was used in conjunction with standard colonoscopy in all cases.

Whenever a polyp was identified, the endoscopist noted whether it was also seen on the colonoscope, or whether it appeared only on the retroscope.

Standard colonoscopy detected 257 polyps throughout the entire colon.

The retroscope detected 34 additional lesions that were not seen on the colonoscope, a significant 13% increase in yield.

The increase was even better when only the right colon was considered. Here, the colonoscope detected 133 lesions, while the retroscope identified an additional 22, a significant increase of 17%.

The average withdrawal time with the retroscope procedure was about 10 minutes, he said.

Standard colonoscopy detected 136 adenomas in the entire colon; the retroscope identified an additional 15, a significant 11% increase.

In the right colon, the standard scope identified 87 adenomas, and the retroscope identified an additional 13, a significant increase of 15%.

The average size of polyps detected by the retroscope was 4.6 mm, not significantly different from the average 4.2 mm size detected by the colonoscope.

The retroscope identified significantly larger adenomas than did the colonoscope (5.2 mm vs. 4.4 mm).

There were no technical failures during any of the procedures, he said.

Dr. Waye said he had no relevant financial disclosures and is not associated with Avantis Medical Systems.

The retroscope consists of a camera and light source on a flexible catheter.

Source Courtesy Dr. Douglas K. Rex and Avantis Medical Systems, Inc.

The screen splits to show both forward and backward views of the colon.

Source Courtesy Avantis Medical Systems, Inc.

CHICAGO — Using a retrograde viewing device that looks behind haustral folds and flexures in the colon during colonoscopy was associated with the detection of significantly more polyps and adenomas than relying on a standard colonoscope alone, a prospective study has found.

Endoscopists who performed the procedures said that the Third Eye Retroscope found 11% more adenomas in the entire colon and 15% more in the right colon, where concerns are highest about missed lesions, Dr. Jerome D. Waye said at the annual Digestive Disease Week.

The scope, manufactured by Avantis Medical Systems, “provides a simultaneous backward and forward view of the colon,” said Dr. Waye of Mount Sinai Medical Center, New York. “The retroscope passes through the colonoscope channel and then automatically retroflexes 180 degrees. It carries its own light source and has a camera with a very wide angle lens. The camera looks backward while the colonoscope looks forward.”

Both images are simultaneously displayed on the video monitor, he said. When a lesion is detected, the retroscope has to be withdrawn so that the polyp can be snared; the scope is then reinserted and the procedure continues. Although this process can lengthen the overall time of the colonoscopy, the increased polyp yield is a worthy tradeoff, Dr. Waye said.

He presented the results of a prospective study of 249 patients who underwent screening or surveillance colonoscopy at any of eight U.S. sites.

The retroscope was used in conjunction with standard colonoscopy in all cases.

Whenever a polyp was identified, the endoscopist noted whether it was also seen on the colonoscope, or whether it appeared only on the retroscope.

Standard colonoscopy detected 257 polyps throughout the entire colon.

The retroscope detected 34 additional lesions that were not seen on the colonoscope, a significant 13% increase in yield.

The increase was even better when only the right colon was considered. Here, the colonoscope detected 133 lesions, while the retroscope identified an additional 22, a significant increase of 17%.

The average withdrawal time with the retroscope procedure was about 10 minutes, he said.

Standard colonoscopy detected 136 adenomas in the entire colon; the retroscope identified an additional 15, a significant 11% increase.

In the right colon, the standard scope identified 87 adenomas, and the retroscope identified an additional 13, a significant increase of 15%.

The average size of polyps detected by the retroscope was 4.6 mm, not significantly different from the average 4.2 mm size detected by the colonoscope.

The retroscope identified significantly larger adenomas than did the colonoscope (5.2 mm vs. 4.4 mm).

There were no technical failures during any of the procedures, he said.

Dr. Waye said he had no relevant financial disclosures and is not associated with Avantis Medical Systems.

The retroscope consists of a camera and light source on a flexible catheter.

Source Courtesy Dr. Douglas K. Rex and Avantis Medical Systems, Inc.

The screen splits to show both forward and backward views of the colon.

Source Courtesy Avantis Medical Systems, Inc.

CHICAGO — Using a retrograde viewing device that looks behind haustral folds and flexures in the colon during colonoscopy was associated with the detection of significantly more polyps and adenomas than relying on a standard colonoscope alone, a prospective study has found.

Endoscopists who performed the procedures said that the Third Eye Retroscope found 11% more adenomas in the entire colon and 15% more in the right colon, where concerns are highest about missed lesions, Dr. Jerome D. Waye said at the annual Digestive Disease Week.

The scope, manufactured by Avantis Medical Systems, “provides a simultaneous backward and forward view of the colon,” said Dr. Waye of Mount Sinai Medical Center, New York. “The retroscope passes through the colonoscope channel and then automatically retroflexes 180 degrees. It carries its own light source and has a camera with a very wide angle lens. The camera looks backward while the colonoscope looks forward.”

Both images are simultaneously displayed on the video monitor, he said. When a lesion is detected, the retroscope has to be withdrawn so that the polyp can be snared; the scope is then reinserted and the procedure continues. Although this process can lengthen the overall time of the colonoscopy, the increased polyp yield is a worthy tradeoff, Dr. Waye said.

He presented the results of a prospective study of 249 patients who underwent screening or surveillance colonoscopy at any of eight U.S. sites.

The retroscope was used in conjunction with standard colonoscopy in all cases.

Whenever a polyp was identified, the endoscopist noted whether it was also seen on the colonoscope, or whether it appeared only on the retroscope.

Standard colonoscopy detected 257 polyps throughout the entire colon.

The retroscope detected 34 additional lesions that were not seen on the colonoscope, a significant 13% increase in yield.

The increase was even better when only the right colon was considered. Here, the colonoscope detected 133 lesions, while the retroscope identified an additional 22, a significant increase of 17%.

The average withdrawal time with the retroscope procedure was about 10 minutes, he said.

Standard colonoscopy detected 136 adenomas in the entire colon; the retroscope identified an additional 15, a significant 11% increase.

In the right colon, the standard scope identified 87 adenomas, and the retroscope identified an additional 13, a significant increase of 15%.

The average size of polyps detected by the retroscope was 4.6 mm, not significantly different from the average 4.2 mm size detected by the colonoscope.

The retroscope identified significantly larger adenomas than did the colonoscope (5.2 mm vs. 4.4 mm).

There were no technical failures during any of the procedures, he said.

Dr. Waye said he had no relevant financial disclosures and is not associated with Avantis Medical Systems.

The retroscope consists of a camera and light source on a flexible catheter.

Source Courtesy Dr. Douglas K. Rex and Avantis Medical Systems, Inc.

The screen splits to show both forward and backward views of the colon.

Source Courtesy Avantis Medical Systems, Inc.

VIENNA — Post-traumatic stress disorder nearly doubled the risk of later dementia in large cohort of male veterans, a retrospective study has determined.

The finding points to the importance of close follow-up for veterans—or any patient—with symptoms of the stress-induced disorder, Dr. Kristine Yaffe said at the International Conference on Alzheimer's Disease. “It's critical to follow patients with PTSD and evaluate them early for dementia,” said Dr. Yaffe, director of the Memory Disorders Clinic at the San Francisco Veterans Administration Medical Center.

Dr. Yaffe studied the incidence of dementia in a retrospective cohort of 183,000 veterans in the Department of Veterans Affairs National Patient Care Database who did not have dementia at baseline enrollment (1997-2000). Most of the subjects (97%) were men; their mean age at baseline was 69 years. PTSD had been diagnosed in 53,155 of the subjects.

During a follow-up period from 2001 to 2007, the cumulative incidence of new-onset dementia was 11% for those veterans with PTSD and 7% for those without PTSD—a significant difference. The results did not change even when Dr. Yaffe excluded subjects with a history of traumatic brain injury, substance abuse, or depression.

“Even after adjusting for demographics and medical and psychiatric comorbidities, PTSD patients in this study were still nearly twice as likely to develop incident dementia—hazard ratio 1.8—than veterans without PTSD,” she said at the meeting, which was sponsored by the Alzheimer's Association.

PTSD was significantly associated with all four subtypes types of dementia that Dr. Yaffe examined, conferring a 70% increased risk of Alzheimer's disease, a doubled risk of senile dementia, a 70% increased risk of vascular dementia, and an 80% increased risk of nonspecific dementia.

She could not speculate on the nature of the connection between PTSD and dementia, saying that more research is necessary. “With that knowledge, we may be able to find ways to reduce the increased risk of dementia associated with PTSD.” However, she noted that other studies have confirmed that the disorder is associated with decreases in hippocampal volume, cognitive dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis.

Dr. Yaffe said she did not have any potential conflicts of interest with regard to the study.

VIENNA — Post-traumatic stress disorder nearly doubled the risk of later dementia in large cohort of male veterans, a retrospective study has determined.

The finding points to the importance of close follow-up for veterans—or any patient—with symptoms of the stress-induced disorder, Dr. Kristine Yaffe said at the International Conference on Alzheimer's Disease. “It's critical to follow patients with PTSD and evaluate them early for dementia,” said Dr. Yaffe, director of the Memory Disorders Clinic at the San Francisco Veterans Administration Medical Center.

Dr. Yaffe studied the incidence of dementia in a retrospective cohort of 183,000 veterans in the Department of Veterans Affairs National Patient Care Database who did not have dementia at baseline enrollment (1997-2000). Most of the subjects (97%) were men; their mean age at baseline was 69 years. PTSD had been diagnosed in 53,155 of the subjects.

During a follow-up period from 2001 to 2007, the cumulative incidence of new-onset dementia was 11% for those veterans with PTSD and 7% for those without PTSD—a significant difference. The results did not change even when Dr. Yaffe excluded subjects with a history of traumatic brain injury, substance abuse, or depression.

“Even after adjusting for demographics and medical and psychiatric comorbidities, PTSD patients in this study were still nearly twice as likely to develop incident dementia—hazard ratio 1.8—than veterans without PTSD,” she said at the meeting, which was sponsored by the Alzheimer's Association.

PTSD was significantly associated with all four subtypes types of dementia that Dr. Yaffe examined, conferring a 70% increased risk of Alzheimer's disease, a doubled risk of senile dementia, a 70% increased risk of vascular dementia, and an 80% increased risk of nonspecific dementia.

She could not speculate on the nature of the connection between PTSD and dementia, saying that more research is necessary. “With that knowledge, we may be able to find ways to reduce the increased risk of dementia associated with PTSD.” However, she noted that other studies have confirmed that the disorder is associated with decreases in hippocampal volume, cognitive dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis.

Dr. Yaffe said she did not have any potential conflicts of interest with regard to the study.

VIENNA — Post-traumatic stress disorder nearly doubled the risk of later dementia in large cohort of male veterans, a retrospective study has determined.

The finding points to the importance of close follow-up for veterans—or any patient—with symptoms of the stress-induced disorder, Dr. Kristine Yaffe said at the International Conference on Alzheimer's Disease. “It's critical to follow patients with PTSD and evaluate them early for dementia,” said Dr. Yaffe, director of the Memory Disorders Clinic at the San Francisco Veterans Administration Medical Center.

Dr. Yaffe studied the incidence of dementia in a retrospective cohort of 183,000 veterans in the Department of Veterans Affairs National Patient Care Database who did not have dementia at baseline enrollment (1997-2000). Most of the subjects (97%) were men; their mean age at baseline was 69 years. PTSD had been diagnosed in 53,155 of the subjects.

During a follow-up period from 2001 to 2007, the cumulative incidence of new-onset dementia was 11% for those veterans with PTSD and 7% for those without PTSD—a significant difference. The results did not change even when Dr. Yaffe excluded subjects with a history of traumatic brain injury, substance abuse, or depression.

“Even after adjusting for demographics and medical and psychiatric comorbidities, PTSD patients in this study were still nearly twice as likely to develop incident dementia—hazard ratio 1.8—than veterans without PTSD,” she said at the meeting, which was sponsored by the Alzheimer's Association.

PTSD was significantly associated with all four subtypes types of dementia that Dr. Yaffe examined, conferring a 70% increased risk of Alzheimer's disease, a doubled risk of senile dementia, a 70% increased risk of vascular dementia, and an 80% increased risk of nonspecific dementia.

She could not speculate on the nature of the connection between PTSD and dementia, saying that more research is necessary. “With that knowledge, we may be able to find ways to reduce the increased risk of dementia associated with PTSD.” However, she noted that other studies have confirmed that the disorder is associated with decreases in hippocampal volume, cognitive dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis.

Dr. Yaffe said she did not have any potential conflicts of interest with regard to the study.

VIENNA — A drink or two a day seems to protect against the development of dementia in cognitively normal elderly adults, a study suggests.

But moderate alcohol consumption doesn't improve thinking processes in those who already have mild cognitive impairment (MCI), and heavy drinking can tip the scales from mild impairment to dementia, Dr. Kaycee M. Sink said at the International Conference on Alzheimer's Disease.

“Our findings support current recommendations for alcohol consumption [of one drink per day for women and two for men], at least for older adults with normal cognition,” Dr. Sink said in an interview.

However, she warned, alcohol's brain benefit can't be used as an excuse to take up drinking at an advanced age. “The results of our study apply only to older adults who reported drinking alcohol at the start of the study. They can't be extrapolated to those who do not currently drink—that is, we cannot recommend that someone in his 70s or 80s start drinking alcohol to try to prevent dementia,” said Dr. Sink of Wake Forest University, Winston-Salem, N.C.

Dr. Sink and her colleagues based their study on data extracted from the Ginkgo Evaluation of Memory (GEM) study, which enrolled 3,069 participants aged 75 or older with normal cognition or mild cognitive impairment. They were randomized to twice-daily doses of either placebo or 120 mg of ginkgo extract. Although the extract was safe, it was not associated with any significant cognitive improvement (JAMA 2008;300:2253-62).

At baseline, the subjects' average age was 78 years; 2,587 were cognitively normal, and 482 had MCI. MCI was present in 20% of the alcohol abstainers and 12% of the consumers.

Subjects self-reported daily alcohol consumption as abstinent, light (1-7 drinks/week), moderate (8-14 drinks), or heavy (more than 14 drinks). Abstinence was reported by 43%, light drinking by 38%, moderate drinking by 9%, and heavy drinking by 10%.

There were 523 new cases of dementia during the 6-year follow-up period. After adjusting for demographics, smoking, medical comorbidities, depression, social activity, and baseline cognition, moderate alcohol consumption conferred a 37% reduction in the risk of dementia in those who were cognitively normal at baseline. But moderate drinking did not reduce the dementia risk for those who already had MCI at baseline.

Heavy drinking conferred a nonsignificant 18% risk reduction for cognitively normal subjects. But in those who already had MCI, heavy drinking significantly increased by 92% the risk of progression to dementia. “Heavy alcohol use is associated long-term toxic effects in the brain. In addition to the almost twofold increase in risk of progression to dementia for participants with MCI who drank heavily, we saw that even lesser amounts of alcohol were associated with greater declines in a measure of overall cognition over the 6-year study,” she said.

The protective mechanism of mild drinking remains a mystery, she said. “We don't fully understand how alcohol may be protective against dementia. However, since for many people, MCI is a transition state between normal cognition and dementia, it may be that any protective benefits from moderate alcohol intake are too late once the process of cognitive impairment begins. Alternatively, the results could be consistent with the cognitive reserve hypothesis, in that those who are already declining aren't as resilient to neurotoxic effects of heavy alcohol use as cognitively normal older adults might be.”

Dr. Sink said she had no conflicts of interest with regard to the study.

Moderate drinking did not reduce the dementia risk for those who already had mild cognitive impairment at baseline.

Source DR. SINK

VIENNA — A drink or two a day seems to protect against the development of dementia in cognitively normal elderly adults, a study suggests.

But moderate alcohol consumption doesn't improve thinking processes in those who already have mild cognitive impairment (MCI), and heavy drinking can tip the scales from mild impairment to dementia, Dr. Kaycee M. Sink said at the International Conference on Alzheimer's Disease.

“Our findings support current recommendations for alcohol consumption [of one drink per day for women and two for men], at least for older adults with normal cognition,” Dr. Sink said in an interview.

However, she warned, alcohol's brain benefit can't be used as an excuse to take up drinking at an advanced age. “The results of our study apply only to older adults who reported drinking alcohol at the start of the study. They can't be extrapolated to those who do not currently drink—that is, we cannot recommend that someone in his 70s or 80s start drinking alcohol to try to prevent dementia,” said Dr. Sink of Wake Forest University, Winston-Salem, N.C.

Dr. Sink and her colleagues based their study on data extracted from the Ginkgo Evaluation of Memory (GEM) study, which enrolled 3,069 participants aged 75 or older with normal cognition or mild cognitive impairment. They were randomized to twice-daily doses of either placebo or 120 mg of ginkgo extract. Although the extract was safe, it was not associated with any significant cognitive improvement (JAMA 2008;300:2253-62).

At baseline, the subjects' average age was 78 years; 2,587 were cognitively normal, and 482 had MCI. MCI was present in 20% of the alcohol abstainers and 12% of the consumers.

Subjects self-reported daily alcohol consumption as abstinent, light (1-7 drinks/week), moderate (8-14 drinks), or heavy (more than 14 drinks). Abstinence was reported by 43%, light drinking by 38%, moderate drinking by 9%, and heavy drinking by 10%.

There were 523 new cases of dementia during the 6-year follow-up period. After adjusting for demographics, smoking, medical comorbidities, depression, social activity, and baseline cognition, moderate alcohol consumption conferred a 37% reduction in the risk of dementia in those who were cognitively normal at baseline. But moderate drinking did not reduce the dementia risk for those who already had MCI at baseline.

Heavy drinking conferred a nonsignificant 18% risk reduction for cognitively normal subjects. But in those who already had MCI, heavy drinking significantly increased by 92% the risk of progression to dementia. “Heavy alcohol use is associated long-term toxic effects in the brain. In addition to the almost twofold increase in risk of progression to dementia for participants with MCI who drank heavily, we saw that even lesser amounts of alcohol were associated with greater declines in a measure of overall cognition over the 6-year study,” she said.

The protective mechanism of mild drinking remains a mystery, she said. “We don't fully understand how alcohol may be protective against dementia. However, since for many people, MCI is a transition state between normal cognition and dementia, it may be that any protective benefits from moderate alcohol intake are too late once the process of cognitive impairment begins. Alternatively, the results could be consistent with the cognitive reserve hypothesis, in that those who are already declining aren't as resilient to neurotoxic effects of heavy alcohol use as cognitively normal older adults might be.”

Dr. Sink said she had no conflicts of interest with regard to the study.

Moderate drinking did not reduce the dementia risk for those who already had mild cognitive impairment at baseline.

Source DR. SINK

VIENNA — A drink or two a day seems to protect against the development of dementia in cognitively normal elderly adults, a study suggests.

But moderate alcohol consumption doesn't improve thinking processes in those who already have mild cognitive impairment (MCI), and heavy drinking can tip the scales from mild impairment to dementia, Dr. Kaycee M. Sink said at the International Conference on Alzheimer's Disease.

“Our findings support current recommendations for alcohol consumption [of one drink per day for women and two for men], at least for older adults with normal cognition,” Dr. Sink said in an interview.

However, she warned, alcohol's brain benefit can't be used as an excuse to take up drinking at an advanced age. “The results of our study apply only to older adults who reported drinking alcohol at the start of the study. They can't be extrapolated to those who do not currently drink—that is, we cannot recommend that someone in his 70s or 80s start drinking alcohol to try to prevent dementia,” said Dr. Sink of Wake Forest University, Winston-Salem, N.C.

Dr. Sink and her colleagues based their study on data extracted from the Ginkgo Evaluation of Memory (GEM) study, which enrolled 3,069 participants aged 75 or older with normal cognition or mild cognitive impairment. They were randomized to twice-daily doses of either placebo or 120 mg of ginkgo extract. Although the extract was safe, it was not associated with any significant cognitive improvement (JAMA 2008;300:2253-62).

At baseline, the subjects' average age was 78 years; 2,587 were cognitively normal, and 482 had MCI. MCI was present in 20% of the alcohol abstainers and 12% of the consumers.

Subjects self-reported daily alcohol consumption as abstinent, light (1-7 drinks/week), moderate (8-14 drinks), or heavy (more than 14 drinks). Abstinence was reported by 43%, light drinking by 38%, moderate drinking by 9%, and heavy drinking by 10%.

There were 523 new cases of dementia during the 6-year follow-up period. After adjusting for demographics, smoking, medical comorbidities, depression, social activity, and baseline cognition, moderate alcohol consumption conferred a 37% reduction in the risk of dementia in those who were cognitively normal at baseline. But moderate drinking did not reduce the dementia risk for those who already had MCI at baseline.

Heavy drinking conferred a nonsignificant 18% risk reduction for cognitively normal subjects. But in those who already had MCI, heavy drinking significantly increased by 92% the risk of progression to dementia. “Heavy alcohol use is associated long-term toxic effects in the brain. In addition to the almost twofold increase in risk of progression to dementia for participants with MCI who drank heavily, we saw that even lesser amounts of alcohol were associated with greater declines in a measure of overall cognition over the 6-year study,” she said.

The protective mechanism of mild drinking remains a mystery, she said. “We don't fully understand how alcohol may be protective against dementia. However, since for many people, MCI is a transition state between normal cognition and dementia, it may be that any protective benefits from moderate alcohol intake are too late once the process of cognitive impairment begins. Alternatively, the results could be consistent with the cognitive reserve hypothesis, in that those who are already declining aren't as resilient to neurotoxic effects of heavy alcohol use as cognitively normal older adults might be.”

Dr. Sink said she had no conflicts of interest with regard to the study.

Moderate drinking did not reduce the dementia risk for those who already had mild cognitive impairment at baseline.

Source DR. SINK

Patients with uncontrolled hypertension are twice as likely to develop diabetes as are those whose blood pressure is well controlled, a prospective study has found.

The study followed 1,754 patients enrolled in a hypertension clinic network in Naples, Italy, for up to 3.5 years. At baseline, the patients' mean age was 52 years, and all had normal fasting glucose levels. Blood pressure was considered uncontrolled if it exceeded 140/90 mm Hg while the patient was taking antihypertensive medication.

Uncontrolled hypertension occurred in 712 (41%) of the patients. Those with uncontrolled hypertension were significantly younger (51 vs. 53 years), and had a significantly higher heart rate than did those with controlled hypertension, Dr. Raffaele Izzo of Federico II University Hospital in Naples, and his colleagues reported (Diabetes Care 2009;32:845-50).

During follow-up, 109 (6%) of the patients developed diabetes. These patients were older (56 vs. 52 years), and had significantly higher body mass index, fasting glucose levels, uric acid, and triglycerides. They were significantly more likely to have metabolic syndrome (61% vs 21%).

After the researchers controlled for age at the time of first visit, gender, baseline systolic blood pressure, family history, fasting glucose, BMI, and physical activity, the rate of diabetes was twice as high among those with uncontrolled blood pressure. The risk of diabetes tripled when the regression model replaced fasting glucose and BMI with the modified Adult Treatment Panel-III definition of metabolic syndrome.

The authors reported no conflicts of interest.

Patients with uncontrolled hypertension are twice as likely to develop diabetes as are those whose blood pressure is well controlled, a prospective study has found.

The study followed 1,754 patients enrolled in a hypertension clinic network in Naples, Italy, for up to 3.5 years. At baseline, the patients' mean age was 52 years, and all had normal fasting glucose levels. Blood pressure was considered uncontrolled if it exceeded 140/90 mm Hg while the patient was taking antihypertensive medication.

Uncontrolled hypertension occurred in 712 (41%) of the patients. Those with uncontrolled hypertension were significantly younger (51 vs. 53 years), and had a significantly higher heart rate than did those with controlled hypertension, Dr. Raffaele Izzo of Federico II University Hospital in Naples, and his colleagues reported (Diabetes Care 2009;32:845-50).

During follow-up, 109 (6%) of the patients developed diabetes. These patients were older (56 vs. 52 years), and had significantly higher body mass index, fasting glucose levels, uric acid, and triglycerides. They were significantly more likely to have metabolic syndrome (61% vs 21%).

After the researchers controlled for age at the time of first visit, gender, baseline systolic blood pressure, family history, fasting glucose, BMI, and physical activity, the rate of diabetes was twice as high among those with uncontrolled blood pressure. The risk of diabetes tripled when the regression model replaced fasting glucose and BMI with the modified Adult Treatment Panel-III definition of metabolic syndrome.

The authors reported no conflicts of interest.

Patients with uncontrolled hypertension are twice as likely to develop diabetes as are those whose blood pressure is well controlled, a prospective study has found.

The study followed 1,754 patients enrolled in a hypertension clinic network in Naples, Italy, for up to 3.5 years. At baseline, the patients' mean age was 52 years, and all had normal fasting glucose levels. Blood pressure was considered uncontrolled if it exceeded 140/90 mm Hg while the patient was taking antihypertensive medication.

Uncontrolled hypertension occurred in 712 (41%) of the patients. Those with uncontrolled hypertension were significantly younger (51 vs. 53 years), and had a significantly higher heart rate than did those with controlled hypertension, Dr. Raffaele Izzo of Federico II University Hospital in Naples, and his colleagues reported (Diabetes Care 2009;32:845-50).

During follow-up, 109 (6%) of the patients developed diabetes. These patients were older (56 vs. 52 years), and had significantly higher body mass index, fasting glucose levels, uric acid, and triglycerides. They were significantly more likely to have metabolic syndrome (61% vs 21%).

After the researchers controlled for age at the time of first visit, gender, baseline systolic blood pressure, family history, fasting glucose, BMI, and physical activity, the rate of diabetes was twice as high among those with uncontrolled blood pressure. The risk of diabetes tripled when the regression model replaced fasting glucose and BMI with the modified Adult Treatment Panel-III definition of metabolic syndrome.

The authors reported no conflicts of interest.

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

WASHINGTON — Three-fourths of patients hospitalized for a hip fracture do not receive an osteoporosis diagnosis before discharge, and the majority are not taking a bisphosphonate at discharge or 6 months after the injury, a small study has shown.

The findings are dismaying, said Dr. Pardeep Bansal, because 24% of patients older than 50 years who sustain an osteoporotic hip fracture die within a year. “The 1-year mortality rate is higher than it is in some cancers, and even higher than it is after a heart attack,” said Dr. Bansal, chief resident at the Scranton-Temple Residency Program, Scranton, Pa. “But if you have a heart attack, no physician is going to let you leave the hospital without aspirin, a beta- blocker, and a statin. If you have a hip fracture, you're likely to be discharged without even the underlying diagnosis, much less the appropriate treatment.”

The two-part study began with a chart review of 191 patients who were admitted to a hospital with a hip fracture. Most (80%) were white females older than 70 years. At the time of discharge, 25% had been assigned a diagnosis of osteoporosis. Only 30% were taking calcium; patients who had been diagnosed with osteoporosis were significantly more likely to be taking both calcium and vitamin D than were patients without a diagnosis.

Furthermore, only 15% were taking a bisphosphonate at discharge, Dr Bansal said. Clinical contraindications did not appear to play a significant role in the lack of treatment: Only 2% of patients had a glomerular filtration rate of less than 30 mL/min per 1.73 m

Dr. Bansal then performed a telephone survey of the 105 patients who could be contacted; 33% of the original cohort had died since their fractures, and another 12% could not be found. All of the patients interviewed reported having seen their primary care physicians within 6 months of the fracture. Yet still, only 50% had received a diagnosis of osteoporosis, 50% were taking calcium, 40% were taking vitamin D, and only 28% were taking a bisphosphonate.

“Another painful finding was that 14% of the group had experienced a subsequent fragility fracture,” Dr. Bansal said.

To help improve the rate of osteoporosis diagnosis at his hospital, Dr. Bansal and his colleagues have instituted a standardized protocol. “It's very simple,” he said. “Any patient who comes in with a fracture suggestive of osteoporosis is started on calcium, vitamin D, and a bisphosphonate before discharge. If they have a contraindication to a bisphosphonate, such as an allergy or a low GFR, then we call the family physician and discuss an alternative treatment.”

Although a dual-energy x-ray absorptiometry scan is a helpful diagnostic tool, Dr. Bansal said treatment should not be delayed until a scan can be obtained. “You have to wait for the fracture to heal and then schedule that as an outpatient, and during that time the patient can be lost to follow-up. It's a good idea to get it, but don't delay the treatment while waiting for the scan.”

Dr. Bansal presented the study in a poster session at an international symposium sponsored by the National Osteoporosis Foundation. He had no conflicts of interest to declare.

Discharged hip fracture patients are unlikely to be diagnosed, much less get the appropriate treatment. DR. BANSAL

Pregnant women consumed just as much alcohol in 2005 as they did in 1991, with 12% drinking at least once during pregnancy and 2% reporting binge drinking.

The findings illustrate the small effect of national educational programs aimed at decreasing this dangerous behavior, according to primary author Clark Denny, Ph.D. (MMWR 2009;58:529-32).

In Healthy People 2010, the national health agenda published in 2000, Dr. David Satcher, the U.S. surgeon general at that time, set abstinence targets of 95% for alcohol and 100% for binge drinking among pregnant women.

“The prevalence of both types of drinking behavior among pregnant women remains higher than the Healthy People 2010 targets and greater progress will be needed to reach them,” Dr. Denny wrote.

The 15-year study found that women aged 35-44 years had the highest incidence of drinking during pregnancy (18%), wrote Dr. Denny, an epidemiologist from the Centers for Disease Control and Prevention. Rates were also higher in college-educated women, employed women, and unmarried women.

The study was based on data collected from 1991 to 2005 through the Behavioral Risk Factor Surveillance System surveys. These annual surveys randomly poll community-dwelling U.S. adults about behavioral health issues. The CDC study included data collected from women aged 18-44 years, who were asked about alcohol use (at least one drink in the last 30 days) and binge drinking (at least five drinks on any one occasion in the last 30 days).

During the 15-year period, 533,500 women were surveyed; 22,000 (4%) reported being pregnant at the time of the survey. The average annual percentage of any alcohol use among the pregnant women was 12%, and did not change from 1991 to 2005. The average annual percentage of pregnant women who said they binged was 2%; again, that percentage was stable over the survey period.

From 2001 to 2005, the study also examined the relationship between drinking during pregnancy and demographic factors. Age was associated with both any drinking and binge drinking. The oldest women (35-44 years) had the highest drinking rate (18%), while the youngest women (18-24 years) had the lowest rate (9%). Age was not highly associated with binge drinking.

Education, employment, and marital status were also associated with drinking during pregnancy. Any drinking was higher among employed women than unemployed (14% vs. 8%), and among unmarried women than married women (13% vs. 10%). Binge drinking was also more common among employed than unemployed women (2% vs. 1%), and unmarried women than married women (4% vs. 1%).

The reasons for these associations are unclear, wrote Dr. Denny. “Some possible reasons include that older women might be more likely to be alcohol dependent and have more difficulty abstaining while pregnant, more educated and employed women might have more discretionary money for the purchase of alcohol, and unmarried women might attend more social occasions where alcohol is served.”

Rates of drinking and binge drinking were higher among nonpregnant women (54% and 12%). Prepregnancy alcohol use is a strong predictor of use during pregnancy, and many women who drink continue to do so before realizing that they are pregnant, Dr. Denny noted. “Approximately 40% of women realize they are pregnant at 4 weeks of gestation, a critical period for fetal organ development.”

The findings confirm the need for alcohol use screening and counseling among all women, he wrote in a press statement. “By screening and advising women about the risks of drinking while pregnant, health care providers can play a key role in reducing rates of fetal alcohol syndrome. This study revealed that there is still a great need for health care professionals to routinely ask all women who are pregnant or at risk of being pregnant about their alcohol consumption.”

Pregnant women consumed just as much alcohol in 2005 as they did in 1991, with 12% drinking at least once during pregnancy and 2% reporting binge drinking.

The findings illustrate the small effect of national educational programs aimed at decreasing this dangerous behavior, according to primary author Clark Denny, Ph.D. (MMWR 2009;58:529-32).

In Healthy People 2010, the national health agenda published in 2000, Dr. David Satcher, the U.S. surgeon general at that time, set abstinence targets of 95% for alcohol and 100% for binge drinking among pregnant women.

“The prevalence of both types of drinking behavior among pregnant women remains higher than the Healthy People 2010 targets and greater progress will be needed to reach them,” Dr. Denny wrote.

The 15-year study found that women aged 35-44 years had the highest incidence of drinking during pregnancy (18%), wrote Dr. Denny, an epidemiologist from the Centers for Disease Control and Prevention. Rates were also higher in college-educated women, employed women, and unmarried women.

The study was based on data collected from 1991 to 2005 through the Behavioral Risk Factor Surveillance System surveys. These annual surveys randomly poll community-dwelling U.S. adults about behavioral health issues. The CDC study included data collected from women aged 18-44 years, who were asked about alcohol use (at least one drink in the last 30 days) and binge drinking (at least five drinks on any one occasion in the last 30 days).

During the 15-year period, 533,500 women were surveyed; 22,000 (4%) reported being pregnant at the time of the survey. The average annual percentage of any alcohol use among the pregnant women was 12%, and did not change from 1991 to 2005. The average annual percentage of pregnant women who said they binged was 2%; again, that percentage was stable over the survey period.

From 2001 to 2005, the study also examined the relationship between drinking during pregnancy and demographic factors. Age was associated with both any drinking and binge drinking. The oldest women (35-44 years) had the highest drinking rate (18%), while the youngest women (18-24 years) had the lowest rate (9%). Age was not highly associated with binge drinking.

Education, employment, and marital status were also associated with drinking during pregnancy. Any drinking was higher among employed women than unemployed (14% vs. 8%), and among unmarried women than married women (13% vs. 10%). Binge drinking was also more common among employed than unemployed women (2% vs. 1%), and unmarried women than married women (4% vs. 1%).

The reasons for these associations are unclear, wrote Dr. Denny. “Some possible reasons include that older women might be more likely to be alcohol dependent and have more difficulty abstaining while pregnant, more educated and employed women might have more discretionary money for the purchase of alcohol, and unmarried women might attend more social occasions where alcohol is served.”

Rates of drinking and binge drinking were higher among nonpregnant women (54% and 12%). Prepregnancy alcohol use is a strong predictor of use during pregnancy, and many women who drink continue to do so before realizing that they are pregnant, Dr. Denny noted. “Approximately 40% of women realize they are pregnant at 4 weeks of gestation, a critical period for fetal organ development.”

The findings confirm the need for alcohol use screening and counseling among all women, he wrote in a press statement. “By screening and advising women about the risks of drinking while pregnant, health care providers can play a key role in reducing rates of fetal alcohol syndrome. This study revealed that there is still a great need for health care professionals to routinely ask all women who are pregnant or at risk of being pregnant about their alcohol consumption.”

Pregnant women consumed just as much alcohol in 2005 as they did in 1991, with 12% drinking at least once during pregnancy and 2% reporting binge drinking.

The findings illustrate the small effect of national educational programs aimed at decreasing this dangerous behavior, according to primary author Clark Denny, Ph.D. (MMWR 2009;58:529-32).

In Healthy People 2010, the national health agenda published in 2000, Dr. David Satcher, the U.S. surgeon general at that time, set abstinence targets of 95% for alcohol and 100% for binge drinking among pregnant women.

“The prevalence of both types of drinking behavior among pregnant women remains higher than the Healthy People 2010 targets and greater progress will be needed to reach them,” Dr. Denny wrote.

The 15-year study found that women aged 35-44 years had the highest incidence of drinking during pregnancy (18%), wrote Dr. Denny, an epidemiologist from the Centers for Disease Control and Prevention. Rates were also higher in college-educated women, employed women, and unmarried women.

The study was based on data collected from 1991 to 2005 through the Behavioral Risk Factor Surveillance System surveys. These annual surveys randomly poll community-dwelling U.S. adults about behavioral health issues. The CDC study included data collected from women aged 18-44 years, who were asked about alcohol use (at least one drink in the last 30 days) and binge drinking (at least five drinks on any one occasion in the last 30 days).

During the 15-year period, 533,500 women were surveyed; 22,000 (4%) reported being pregnant at the time of the survey. The average annual percentage of any alcohol use among the pregnant women was 12%, and did not change from 1991 to 2005. The average annual percentage of pregnant women who said they binged was 2%; again, that percentage was stable over the survey period.

From 2001 to 2005, the study also examined the relationship between drinking during pregnancy and demographic factors. Age was associated with both any drinking and binge drinking. The oldest women (35-44 years) had the highest drinking rate (18%), while the youngest women (18-24 years) had the lowest rate (9%). Age was not highly associated with binge drinking.

Education, employment, and marital status were also associated with drinking during pregnancy. Any drinking was higher among employed women than unemployed (14% vs. 8%), and among unmarried women than married women (13% vs. 10%). Binge drinking was also more common among employed than unemployed women (2% vs. 1%), and unmarried women than married women (4% vs. 1%).

The reasons for these associations are unclear, wrote Dr. Denny. “Some possible reasons include that older women might be more likely to be alcohol dependent and have more difficulty abstaining while pregnant, more educated and employed women might have more discretionary money for the purchase of alcohol, and unmarried women might attend more social occasions where alcohol is served.”

Rates of drinking and binge drinking were higher among nonpregnant women (54% and 12%). Prepregnancy alcohol use is a strong predictor of use during pregnancy, and many women who drink continue to do so before realizing that they are pregnant, Dr. Denny noted. “Approximately 40% of women realize they are pregnant at 4 weeks of gestation, a critical period for fetal organ development.”

The findings confirm the need for alcohol use screening and counseling among all women, he wrote in a press statement. “By screening and advising women about the risks of drinking while pregnant, health care providers can play a key role in reducing rates of fetal alcohol syndrome. This study revealed that there is still a great need for health care professionals to routinely ask all women who are pregnant or at risk of being pregnant about their alcohol consumption.”

Patients who receive the Gardasil vaccine should sit or lie down in the office for at least 15 minutes after vaccination to prevent possible injury from falling during syncope, while being observed for paleness, sweating, dizziness, or other signs of a possible vasovagal reaction, the Food and Drug Administration recommended.

Because of continued reports of syncope and related traumatic injury, the FDA requested that Merck & Co., manufacturer of the human papillomavirus vaccine, add this information to the warnings and precautions section of the label.

“The addition of syncope to the [label] emphasizes that health care providers and consumers should be alert that fainting may occur following vaccination with Gardasil, sometimes resulting in falling and injuries,” the FDA said in a public information statement.

“These are preventable by having Gardasil recipients remain seated or lying down for 15 minutes following vaccination and closely watching them for the following warning signs and symptoms: paleness, sweating, dizziness, ringing in ears or vision changes, which generally occur before fainting.”

Up to 40% of adolescent syncope associated with Gardasil is also accompanied by tonic-clonic seizurelike activity, the FDA said. “If an individual faints and especially if seizurelike activity occurs, the individual should be placed in a position, such as lying down, to help restore blood flow to the brain.”

Syncope has been listed on the label as a possible adverse event since October 2007, the statement said. However, the FDA's Vaccine Adverse Event Reporting System (VAERS) continues to receive reports of traumatic injuries related to fainting and falling after vaccination. In light of this, the agency decided to strengthen the label warning.

Fainting doesn't appear to be unique to Gardasil, the statement added. “Syncope has been reported after administration of other adolescent and adult vaccines. … It can also occur with certain medications, after blood donation, or in response to pain.”

The fact sheet did not give details of the injuries associated with all these events. However, 70 episodes of syncope in U.S. patients were reported that occurred from January 2005 to July 2007 (MMWR 2008;57;457-60). The reports noted that about 5% of the spells were considered serious; 38 occurred on the same day as vaccination and 37 required hospitalization.

As of May 1, 2009, there were 13,758 VAERS reports of adverse events following more than 24 million Gardasil vaccinations in the United States. Of these reports, 93% were considered nonserious and 7% serious. Nonserious adverse events include fainting, pain and swelling at the injection site, headache, nausea, and fever.

However, the vaccine is still considered a safe and effective one, the FDA said in the public information statement. “Based on all of the information we have today, the Centers for Disease Control and Prevention continues to recommend Gardasil vaccination for the prevention of four types of human papillomavirus. As with all approved vaccines, the CDC and the FDA will continue to closely monitor the safety of Gardasil.”

Patients who receive the Gardasil vaccine should sit or lie down in the office for at least 15 minutes after vaccination to prevent possible injury from falling during syncope, while being observed for paleness, sweating, dizziness, or other signs of a possible vasovagal reaction, the Food and Drug Administration recommended.

Because of continued reports of syncope and related traumatic injury, the FDA requested that Merck & Co., manufacturer of the human papillomavirus vaccine, add this information to the warnings and precautions section of the label.

“The addition of syncope to the [label] emphasizes that health care providers and consumers should be alert that fainting may occur following vaccination with Gardasil, sometimes resulting in falling and injuries,” the FDA said in a public information statement.

“These are preventable by having Gardasil recipients remain seated or lying down for 15 minutes following vaccination and closely watching them for the following warning signs and symptoms: paleness, sweating, dizziness, ringing in ears or vision changes, which generally occur before fainting.”

Up to 40% of adolescent syncope associated with Gardasil is also accompanied by tonic-clonic seizurelike activity, the FDA said. “If an individual faints and especially if seizurelike activity occurs, the individual should be placed in a position, such as lying down, to help restore blood flow to the brain.”

Syncope has been listed on the label as a possible adverse event since October 2007, the statement said. However, the FDA's Vaccine Adverse Event Reporting System (VAERS) continues to receive reports of traumatic injuries related to fainting and falling after vaccination. In light of this, the agency decided to strengthen the label warning.

Fainting doesn't appear to be unique to Gardasil, the statement added. “Syncope has been reported after administration of other adolescent and adult vaccines. … It can also occur with certain medications, after blood donation, or in response to pain.”

The fact sheet did not give details of the injuries associated with all these events. However, 70 episodes of syncope in U.S. patients were reported that occurred from January 2005 to July 2007 (MMWR 2008;57;457-60). The reports noted that about 5% of the spells were considered serious; 38 occurred on the same day as vaccination and 37 required hospitalization.

As of May 1, 2009, there were 13,758 VAERS reports of adverse events following more than 24 million Gardasil vaccinations in the United States. Of these reports, 93% were considered nonserious and 7% serious. Nonserious adverse events include fainting, pain and swelling at the injection site, headache, nausea, and fever.

However, the vaccine is still considered a safe and effective one, the FDA said in the public information statement. “Based on all of the information we have today, the Centers for Disease Control and Prevention continues to recommend Gardasil vaccination for the prevention of four types of human papillomavirus. As with all approved vaccines, the CDC and the FDA will continue to closely monitor the safety of Gardasil.”

Patients who receive the Gardasil vaccine should sit or lie down in the office for at least 15 minutes after vaccination to prevent possible injury from falling during syncope, while being observed for paleness, sweating, dizziness, or other signs of a possible vasovagal reaction, the Food and Drug Administration recommended.

Because of continued reports of syncope and related traumatic injury, the FDA requested that Merck & Co., manufacturer of the human papillomavirus vaccine, add this information to the warnings and precautions section of the label.

“The addition of syncope to the [label] emphasizes that health care providers and consumers should be alert that fainting may occur following vaccination with Gardasil, sometimes resulting in falling and injuries,” the FDA said in a public information statement.

“These are preventable by having Gardasil recipients remain seated or lying down for 15 minutes following vaccination and closely watching them for the following warning signs and symptoms: paleness, sweating, dizziness, ringing in ears or vision changes, which generally occur before fainting.”

Up to 40% of adolescent syncope associated with Gardasil is also accompanied by tonic-clonic seizurelike activity, the FDA said. “If an individual faints and especially if seizurelike activity occurs, the individual should be placed in a position, such as lying down, to help restore blood flow to the brain.”

Syncope has been listed on the label as a possible adverse event since October 2007, the statement said. However, the FDA's Vaccine Adverse Event Reporting System (VAERS) continues to receive reports of traumatic injuries related to fainting and falling after vaccination. In light of this, the agency decided to strengthen the label warning.

Fainting doesn't appear to be unique to Gardasil, the statement added. “Syncope has been reported after administration of other adolescent and adult vaccines. … It can also occur with certain medications, after blood donation, or in response to pain.”

The fact sheet did not give details of the injuries associated with all these events. However, 70 episodes of syncope in U.S. patients were reported that occurred from January 2005 to July 2007 (MMWR 2008;57;457-60). The reports noted that about 5% of the spells were considered serious; 38 occurred on the same day as vaccination and 37 required hospitalization.

As of May 1, 2009, there were 13,758 VAERS reports of adverse events following more than 24 million Gardasil vaccinations in the United States. Of these reports, 93% were considered nonserious and 7% serious. Nonserious adverse events include fainting, pain and swelling at the injection site, headache, nausea, and fever.

However, the vaccine is still considered a safe and effective one, the FDA said in the public information statement. “Based on all of the information we have today, the Centers for Disease Control and Prevention continues to recommend Gardasil vaccination for the prevention of four types of human papillomavirus. As with all approved vaccines, the CDC and the FDA will continue to closely monitor the safety of Gardasil.”

A modified-release formulation of prednisone reduced morning stiffness duration in patients with rheumatoid arthritis, according to data presented at the annual European Congress of Rheumatology.

The new formulation is designed to be taken at bedtime. The medication is released about 4 hours after ingestion, with the goal of adapting glucocorticoid drug release to the circadian rhythms of endogenous cortisol and symptoms of the disease, both of which have their peaks during the early morning hours. It has been theorized that morning glucocorticoid dosing only inadequately controls the circadian rhythm of RA symptoms in these patients, Prof. Frank Buttgereit of Charité Medical University of Berlin, said in an interview.

“It's well known that symptoms of rheumatoid arthritis follow circadian rhythms and are typically most prominent in the early morning hours,” he said. “Therefore, the timing of systemic glucocorticoid therapy may be important with respect to the natural secretion of endogenous glucocorticoids as well as the control of symptoms.”

Findings from research conducted by Prof. Buttgereit and his associates involved a 3-month randomized, controlled trial of 288 patients with long-standing active rheumatoid arthritis that was published last year in The Lancet (2008;371: 205-14).

The data he presented at EULAR concerned 219 patients who completed a new 9-month follow-on open-label trial of the same group, during which all patients took the modified-release formulation.

At baseline, patients' mean age was 55 years; their mean duration of disease was 10 years. Patients who were randomized to the active group took a placebo tablet in the morning and the study drug in the evening. The comparator group took immediate-release prednisone in the morning and placebo in the evening. The prednisone dose was individually titrated (range, 3-10 mg/day).

The mean relative reduction of morning stiffness duration was significantly higher in the modified-release group than in the immediate-release group (23% vs. 0.4%). Patients taking the modified-release drug experienced a significantly greater decrease in the duration of morning joint stiffness than did those taking the immediate-release tablet (44 fewer minutes vs. 23 fewer minutes of morning stiffness). Median levels of interleukin-6 were also reduced in the modified-release group compared with the immediate-release group (29% vs. 0%).

Adverse events led to premature discontinuation of the drugs in 8% of the modified-release group and 7% of those in the immediate-release group. The frequency of serious adverse events was low and similar in both groups (3% vs. 2%).

Prof. Buttgereit reported that the combined results of the randomized and open-label trials. In both groups, morning stiffness duration remained similarly low over the entire study duration. At 12 months, the reduction was somewhat greater in the group that had taken the modified-release formulation during both trials (55%) than among those who took the immediate release during the first trial and the modified-release during the follow-on study (45%). The incidence of adverse events remained low throughout the open-label study, he said.

Among his expected conclusions is that “bedtime administration of prednisone via the new modified-release tablet provides significantly greater efficacy for at least 12 months over conventional immediate-release prednisone, due to prednisone release which occurs prior to the circadian flare-up of IL-6 synthesis and inflammatory activity.”

The study was sponsored by Merck Pharma GmbH and Nitec Pharma AG. Prof. Buttgereit and some of the coauthors said they had received consulting and grant funding from the companies.

A modified-release formulation of prednisone reduced morning stiffness duration in patients with rheumatoid arthritis, according to data presented at the annual European Congress of Rheumatology.

The new formulation is designed to be taken at bedtime. The medication is released about 4 hours after ingestion, with the goal of adapting glucocorticoid drug release to the circadian rhythms of endogenous cortisol and symptoms of the disease, both of which have their peaks during the early morning hours. It has been theorized that morning glucocorticoid dosing only inadequately controls the circadian rhythm of RA symptoms in these patients, Prof. Frank Buttgereit of Charité Medical University of Berlin, said in an interview.

“It's well known that symptoms of rheumatoid arthritis follow circadian rhythms and are typically most prominent in the early morning hours,” he said. “Therefore, the timing of systemic glucocorticoid therapy may be important with respect to the natural secretion of endogenous glucocorticoids as well as the control of symptoms.”

Findings from research conducted by Prof. Buttgereit and his associates involved a 3-month randomized, controlled trial of 288 patients with long-standing active rheumatoid arthritis that was published last year in The Lancet (2008;371: 205-14).

The data he presented at EULAR concerned 219 patients who completed a new 9-month follow-on open-label trial of the same group, during which all patients took the modified-release formulation.

At baseline, patients' mean age was 55 years; their mean duration of disease was 10 years. Patients who were randomized to the active group took a placebo tablet in the morning and the study drug in the evening. The comparator group took immediate-release prednisone in the morning and placebo in the evening. The prednisone dose was individually titrated (range, 3-10 mg/day).

The mean relative reduction of morning stiffness duration was significantly higher in the modified-release group than in the immediate-release group (23% vs. 0.4%). Patients taking the modified-release drug experienced a significantly greater decrease in the duration of morning joint stiffness than did those taking the immediate-release tablet (44 fewer minutes vs. 23 fewer minutes of morning stiffness). Median levels of interleukin-6 were also reduced in the modified-release group compared with the immediate-release group (29% vs. 0%).

Adverse events led to premature discontinuation of the drugs in 8% of the modified-release group and 7% of those in the immediate-release group. The frequency of serious adverse events was low and similar in both groups (3% vs. 2%).

Prof. Buttgereit reported that the combined results of the randomized and open-label trials. In both groups, morning stiffness duration remained similarly low over the entire study duration. At 12 months, the reduction was somewhat greater in the group that had taken the modified-release formulation during both trials (55%) than among those who took the immediate release during the first trial and the modified-release during the follow-on study (45%). The incidence of adverse events remained low throughout the open-label study, he said.

Among his expected conclusions is that “bedtime administration of prednisone via the new modified-release tablet provides significantly greater efficacy for at least 12 months over conventional immediate-release prednisone, due to prednisone release which occurs prior to the circadian flare-up of IL-6 synthesis and inflammatory activity.”

The study was sponsored by Merck Pharma GmbH and Nitec Pharma AG. Prof. Buttgereit and some of the coauthors said they had received consulting and grant funding from the companies.

A modified-release formulation of prednisone reduced morning stiffness duration in patients with rheumatoid arthritis, according to data presented at the annual European Congress of Rheumatology.

The new formulation is designed to be taken at bedtime. The medication is released about 4 hours after ingestion, with the goal of adapting glucocorticoid drug release to the circadian rhythms of endogenous cortisol and symptoms of the disease, both of which have their peaks during the early morning hours. It has been theorized that morning glucocorticoid dosing only inadequately controls the circadian rhythm of RA symptoms in these patients, Prof. Frank Buttgereit of Charité Medical University of Berlin, said in an interview.

“It's well known that symptoms of rheumatoid arthritis follow circadian rhythms and are typically most prominent in the early morning hours,” he said. “Therefore, the timing of systemic glucocorticoid therapy may be important with respect to the natural secretion of endogenous glucocorticoids as well as the control of symptoms.”

Findings from research conducted by Prof. Buttgereit and his associates involved a 3-month randomized, controlled trial of 288 patients with long-standing active rheumatoid arthritis that was published last year in The Lancet (2008;371: 205-14).

The data he presented at EULAR concerned 219 patients who completed a new 9-month follow-on open-label trial of the same group, during which all patients took the modified-release formulation.

At baseline, patients' mean age was 55 years; their mean duration of disease was 10 years. Patients who were randomized to the active group took a placebo tablet in the morning and the study drug in the evening. The comparator group took immediate-release prednisone in the morning and placebo in the evening. The prednisone dose was individually titrated (range, 3-10 mg/day).

The mean relative reduction of morning stiffness duration was significantly higher in the modified-release group than in the immediate-release group (23% vs. 0.4%). Patients taking the modified-release drug experienced a significantly greater decrease in the duration of morning joint stiffness than did those taking the immediate-release tablet (44 fewer minutes vs. 23 fewer minutes of morning stiffness). Median levels of interleukin-6 were also reduced in the modified-release group compared with the immediate-release group (29% vs. 0%).

Adverse events led to premature discontinuation of the drugs in 8% of the modified-release group and 7% of those in the immediate-release group. The frequency of serious adverse events was low and similar in both groups (3% vs. 2%).

Prof. Buttgereit reported that the combined results of the randomized and open-label trials. In both groups, morning stiffness duration remained similarly low over the entire study duration. At 12 months, the reduction was somewhat greater in the group that had taken the modified-release formulation during both trials (55%) than among those who took the immediate release during the first trial and the modified-release during the follow-on study (45%). The incidence of adverse events remained low throughout the open-label study, he said.

Among his expected conclusions is that “bedtime administration of prednisone via the new modified-release tablet provides significantly greater efficacy for at least 12 months over conventional immediate-release prednisone, due to prednisone release which occurs prior to the circadian flare-up of IL-6 synthesis and inflammatory activity.”

The study was sponsored by Merck Pharma GmbH and Nitec Pharma AG. Prof. Buttgereit and some of the coauthors said they had received consulting and grant funding from the companies.

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.