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NEWS FROM THE CHAIRMAN OF THE U.S. SENATE SPECIAL COMMITTEE ON AGING

CRAIG CALLS FOR PASSAGE OF THE FLU PROTECTION ACT
Short term solution - import more vaccines
Long term solution - build more U.S. capacity

(Washington, DC) At a hearing today on the nation'™s flu vaccine situation, U.S. Sen. Larry Craig (R-Idaho) called for quick action from the Food and Drug Administration to ensure adequate supplies for next year'™s flu season, and for passage of the Flu Protection Act he is cosponsoring with Sen. Evan Bayh (D-Indiana).

'œWe have absolutely no time to waste in addressing this issue and making the necessary changes to assure an adequate supply of vaccine in the future,' Craig said.

'œFlu manufacturers are now making decisions in order to fill orders for next year. We can't wait until Congress is in full swing in February to address next year's supply challenges. By then it will be too late, especially if Chiron Corporation is unable to start production next year. Flu is a worldwide killer and the need for vaccine is clear - and yet, the market has dwindled to the point that the pullout of just one company can devastate our supply.'

In 1967 there were 26 makers of all types of vaccines. By 1980 that number had fallen to 17. By 1994 the number of influenza vaccine manufacturers was down to five: Wyeth, Evans (now part of Chiron), Connaught (now part of Aventis), Parke Davis and Lederle. By 1999 there were just four. Today there are just three flu vaccine makers involved in the U.S. market '“ Aventis, Chiron and MedImmune. Both the Chiron and MedImmune vaccines are manufactured in England.

'œThe simple truth is, the short-term solution is for the FDA to allow more importation of safe vaccines from other nations. But the long-term solution is to get more vaccine production within the U.S., and that is what the legislation I am sponsoring with Sen. Bayh seeks to achieve,' Craig said. 'œI remain hopeful that the Senate will pass our legislation before we close this session of Congress.'

Under the Flu Protection Act, vaccine makers would receive a tax credit for investing in the construction of new facilities in the United States, or renovation of production facilities.

The legislation would also allow the federal government to buy up a certain portion of any unused vaccines at the end of the season. Vaccines need to be changed each season to meet new strains of the flu virus and last year one flu vaccine maker had to discard 5 million of the 43 million doses it produced.

But even if the Flu Protection Act passes this week, getting flu vaccine production levels up quickly will not be easy. It presently takes manufacturers five years or more to bring a vaccine production facility on-line.

November 16, 2004
Contact: Jeff Schrade 202-224-8710

The British Medical Journal (BMJ) published several articles about using exercise programs to prevent falls in older people. One half of those aged 80 years and older will fall in any one year, often with serious health and social consequences, so fall prevention is a topic worth investigating. The BMJ research found that an exercise program delivered by a physiotherapist or trained nurses had some success in reducing falls and moderate injuries in elderly people, but were not always cost-effective.

Researchers at the University of Verona studied the relationship between body mass and lung function in older men and found a strong relationship between body composition, fat distribution, and lung function in elderly men. Researchers concluded that a small reduction in body mass might lead to significant improvement in lung function. The study was published in the April issue of the American Journal of Clinical Nutrition.

The National Academy on an Aging Society (NAAS) is studying the characteristics of people who retire early and those who continue to work past normal retirement ages in order to make predictions about the retirement of baby boomers. They are examining two groups of people, those who retire at ages 51 to 59, and those who continue to work past age 60. Staying healthy appears to be an extremely important factor in the timing and quality of retirement, and the ability of retirees to be financially independent.

They found that those who retire before age 60 are more likely to be:

• Women
• Less educated
• In poorer health
• Less well-off financially

Those who work past age 60 are most likely to be:

• Men
• More educated
• In better health
• Financially well-off

Health was a significant differentiator, with non-workers highly likely to be in fair to poor health.

Health Status

There was also a correlation between health and financial status. Those in good health were likely to be far better off financially than those in poor health.

Financial Status

Median Household Wealth

In another study, NAAS found that health was a significant factor in the decision to retire. People with chronic health conditions were much more likely to say that health was an important factor in their decision to retire. For example, 76% of those with heart disease said their health was an important factor in their decision to retire, as opposed to 39% of those without heart disease.

FloridaHealthStat.com, a new website created by the Agency for Health Care Administration this year, has officially been designated by the Governor's Office as the state's health care electronic portal. All four major health care agencies (AHCA, Dept. of Health, Dept. of Children & Families, and Dept. of Elder Affairs) will all be linked together on the one website. Consumers will then be able to retrieve all types of health care information from this one site. Information will include physician profiles, hospital and nursing home evaluations and a host of other information.

In the current issue of Health Affairs, Allan Rock, Canada's minister of health, believes that Canadians want to see their revered health care system flourish once more. He discusses the problems the system is facing as funding shifts more and more to the provinces. He notes that, of the $90 annual spending on health care in Canada, the federal government contributes about 23 cents, the public contributes about 31 cents, and the remaining 45 cents is paid for by the provinces. So the federal government now contributes less to health care costs than the public.

Britain'™s National Health Service (NHS) has come under fire for alleged age discrimination over kidney care policies that sacrifice older patients in favor of saving younger victims of renal diseases. A confidential memorandum, leaked to the London Daily Mail, was signed by 12 senior clinicians at major hospitals in London. It indicates that a shortage of funds is forcing doctors to send kidney patients as young as 50 home to die so that the limited available funds can be channeled into treatment for the young.

This is the latest in a series of accusations that the National Health Service is actively promoting age discrimination in the delivery of health services. Age Concern's report Turning your Back on Us cites examples of ageism in the National Health Service. The report stated that old people are told that treatment is unavailable to them because of their age or are given a low priority. The Age Concern survey found that one in 20 people over the age of 65 in Britain had been refused treatment by the NHS, and that as many as one in 10 people said that they had noticed a difference in treatment since their 50th birthday. Areas of special concern are routine breast screening, cancer and coronary problems.

The following information was provided in a press release by the Alzheimer's Foundation of America:

MedicAlert ® and the Alzheimer's Foundation of America (AFA) have started marketing a new identification bracelet with a color-coded symbol specifically designed to symbolize Alzheimer's disease and related dementias in order to help individuals in emergency situations.

The new identification bracelet has a teal MedicAlert ® emblem to denote that an individual has Alzheimer's disease or a related dementia, marking the first time that MedicAlert ® is utilizing a colored emblem to symbolize a specific disease. In an emergency, the emblem alerts medical professionals or first responders to call MedicAlert ®'s 24-hour hotline to access electronic health records containing vital medical and contact information about each wearer.

Caregivers can easily obtain and update personal information in the system, including medication dosages, allergies, implanted devices, physician and family contacts, insurance information, organ donation specifications, and advance directives.

Membership in MedicAlert ®, which includes a bracelet with the teal emblem, a printed electronic health record summary, 24-hour emergency response service, patient identification, emergency contact and family notification service, and 24-hour customer service, costs $35 the first year and a $20 subscription each year thereafter. AFA and its member organizations will provide a special code that offers a $5 discount off the first year of membership.

PRESS RELEASE
New course will help people with dementia

The first nationally accredited training course aimed at improving the lives of people with dementia is being launched at the University of Sunderland.

The distance learning course for professionals will help further raise the level of care offered to thousands of people across the country living with dementia.

Sunderland has teamed up with the Alzheimer'™s society, BUPA care homes and the Joseph Rowntree Foundation to provide the new course, '˜an introduction to Dementia care'™.

Through open learning, the use of videos, group discussion and working with people with dementia, the course will encourage staff to view dementia care as a career choice and help in the understanding of the illness.

Vicki Lawson-Brown, senior lecturer in health studies at the university said: 'ÂœThis course recognises the attitude, expertise and knowledge needed to deliver successful dementia care.

'œIt'™s an exciting new development to provide a better quality of care for people who have dementia, treating them with the respect and dignity they deserve. We welcome the opportunity to recognise the work of care staff in this field.'

The new course is part of a range of Joseph Rowntree programmes awarded to the University of Sunderland by the trust two years ago.

Studies have shown that up to 75 per cent of people living in nursing and residential care homes have Alzheimer'™s or another form of dementia.

The Alzheimer'™s society hopes that all care providers will eventually use the course to help improve training for those working with people with dementia.

Daren Felgate, the Alzheimer'™s society'™s training and development manager, said: 'œWe hope this course will become the key introductory course for care workers helping people with dementia.

'œWorking with people with dementia is often seen as difficult and challenging, but with the right support many care staff will see it is the most rewarding work they have ever done.'

The course has already been piloted through four BUPA care homes and the Joseph Rowntree Foundation in York. It will be launched at the Royal Society in London on April 22, where speakers from BUPA and the Alzheimer'™s Society will be highlighting the importance of effective dementia care training.

More info is at http://www.sunderland.ac.uk/

The Alzheimers Association recently released a research report showing that the cost to the US government's Medicare and Medicaid programs for Alzheimers was $50 billion -- $32 billion for Medicare and $18 billion for Medicaid. They predict that the cost to the Medicare program alone for Alzheimers would reach $50 billion by 2010, along with a $33 billion cost to the Medicaid program and another $50 billion cost to beneficiaries, for a total cost in the US of about $133 billion.

The report points out several factors behind these high costs. For instance, patients with dementia are more likely to have preventable medical crises caused by their impaired judgment and inability to manage their own care. Alzheimers is also a significant cause of the burgeoning cost of the Medicaid program. Half of all nursing home residents have dementia, often with lengthy stays that are paid for by Medicaid.

The report was done by the Lewin Group, and was presented in a Senate hearing this week. The association urged Congress to double spending on Alzheimers research to $1 billion a year to prevent a situation which has the potential to bankrupt the Medicare and Medicaid programs. They warned Congress that these costs will sky-rocket even further in the future as baby-boomers age and start becoming eligible for Medicare in 2010.

UK's National Institute for Clinical Excellence (NICE) has issued guidance to local councils on the use of drugs for the treatment of Alzheimers Disease. Three drugs, Aricept, Exelon and Reminyl, have been approved for treatment of mild to moderate Alzheimers. NICE estimates that there are about 400,000 people in the UK with Alzheimers, and that about 250,000 of them have mild to moderate levels of the disease.

NICE reports that Donepezil is marketed by Pfizer/Eisai as Aricept, rivastigmine by Novartis as Exelon and galantamine by Shire Pharmaceuticals and Janssen Cilag as Reminyl. The annual cost in the UK of donepezil is 891 (5 mg)/1,248 (10 mg), taken in a single daily dose, for rivastigmine is £821 (all doses), taken twice per day, and for galantamine is £876 (16 mg)/1049 (24 mg) (allowing for an initial starting dose of 8 mg daily), taken as 8 mg or 12 mg twice per day.

NICE points out that it is difficult to estimate the total aggregate cost of using these medications, but that the cost may be offset by later entry to a nursing home. For example, a delay of 12 weeks at £370 per week would yield a cost saving of about £4,500.

The NICE website includes full guidance for local councils and leaflets for patients.

Researchers developing a vaccine against Alzheimer's disease have shown that it seems to stop mice with the condition from losing their memory, which boosts hopes that such vaccines could delay or prevent similar symptoms in humans. The vaccine also reduces the build-up of protein deposits in mouse brains - the other major indicator of Alzheimer's disease. The pharmaceutical company Elan, based in Dublin, Ireland, is poised to begin large-scale human clinical trials of a potential treatment based on the vaccine. But what works in mice does not always work in people and the vaccine will still have to prove its worth in a battery of further tests.

Peter St George-Hyslop of the University of Toronto in Canada and his colleagues and a second team led by Dave Morgan of the University of South Florida at Tampa showed that the vaccine reduces learning and memory loss as the mice age. Each group gave Alzheimer's mice learning and memory tests, in which the animals had to swim to a submerged platform. In one trial the platform was moved each day, testing short-term memory. The second trial investigated 'spatial-reference' memory by leaving the platform in one place and testing the mice once a month. Mice given the test vaccine developed fewer and smaller protein deposits in their brains and performed markedly better than unvaccinated animals in both types of memory test.

Whether the protein deposits actually cause dementia in people is unclear. Some researchers believe that preventing the deposits from forming should relieve the distressing mental symptoms, although others disagree. This research supports the hypothesis that the two are related, but other factors could still be involved.

A collection of research reports on this subject are included in the current issue of Nature Magazine.

Researchers report in the November issue of Archives of Neurology that aspirin and other anti-inflammatory drugs may help prevent Alzheimer's Disease (AD). Previous research has suggested that anti-inflammatory drugs such as aspirin and ibuprofen may cut Alzheimer's risk, but researchers were not sure how high a dose was necessary to produce the desired effects. Dr. G. Anthony Broe led a group of researchers at the University of Sydney who studied more than 600 men and women age 75 and older and found that even low doses of the drugs seemed to ward off Alzheimer's. The researchers are uncertain why aspirin and similar drugs might protect against Alzheimer's. The study's authors speculate that the drugs' heart benefits may offer an explanation, noting that low doses of aspirin are already known to help prevent heart disease. Aspirin and similar drugs improve blood flow to the heart and may improve the function of cells lining blood vessels.

People who care for the 4 million Americans suffering from Alzheimer's disease consider quality of life just as important as efforts to prolong the patient's life when choosing treatment options, according to researchers in a study reported in the October 10th issue of Neurology. Lead author Dr. Jason H. T. Karlawish, of the University of Pennsylvania Health System in Philadelphia, and his team interviewed 40 primary caregivers of Alzheimer's disease patients, none currently living in a nursing home. The caregivers were asked how their choice of treatment was affected by the potential to lengthen their charge's overall survival, to slow the progression of the disease, or to delay the transfer of the patient to a nursing home. The investigators also measured the caregivers' willingness to risk the development of negative side effects from a treatment in order to affect the overall course of the disease's progression.

Over 50% of caregivers said that improving the patient's quality of life was a more important treatment benefit than either lengthening survival time or delaying a move to a nursing home. Other benefits similarly valued included preserving the patient's memory; ability to communicate and recognize the family; improving the patient's mood; and improving the ability to manage basic daily physical activities. Karlawish and his colleagues also found that the caregivers' ability to assess quality-of-life issues was influenced by his or her own level of depression and burden--so that their judgment when choosing treatment might be affected by a desire to alleviate their own related stresses.

Overall, most caretakers were willing to risk possible side effects in order to delay the disease progression by 1 year--with the goal of delaying a move to a nursing home playing a major role in the caregivers' assessment of quality of life.

The Ontario provincial government is providing $6.3 million to expand and enhance adult day programs and respite services for people with Alzheimer Disease, Health and Long-Term Care Minister Elizabeth Witmer announced. The funding will be provided to 80 agencies across Ontario and now serve over 4,000 people, including 2,300 new clients.

A collaborative effort between the Alzheimer Society of Canada, AstraZeneca Canada Inc., AstraZeneca US and the Canadian Institutes of Health Research (CIHR) through its partnership with Canada's Research-Based Pharmaceutical Companies (Rx&D) will help generate new research into Alzheimer Disease. The Alzheimer Disease Research Grants Program is designed to stimulate individual Canadian investigators to undertake innovative research into the cause and cure of Alzheimer Disease. The Program offers up to four biomedical research grants focussed on the causes, diagnosis and treatment of Alzheimer Disease for each of two years. Researchers are invited to submit proposals designed to yield new insights into the prevention and treatment of Alzheimer Disease. Applications for up to $100,000/annum for projects of up to two years will be considered.

Some of the most common prescription and over-the-counter medicines can produce side-effects with symptoms similar to those of dementia, glaucoma, and other diseases of old age, according to Dr. Jacobo Mintzer of the Medical University of South Carolina in the September Journal of the Royal Society of Medicine. Some of the side-effects he noted were dementia-like symptoms of confusion, memory loss, and disorientation, and glaucoma-like blurred vision, dry mouth, constipation, urinary problems, dizziness, likelihood of falling, anxiety, rapid shallow breathing, and irregular or rapid heartbeat.

He said that illnesses like angina, diabetes, glaucoma, and dementia appear to be worsened by drugs with "anticholinergic activity". This includes many of the prescription drugs used in the treatment of Parkinson's disease, depression, allergies, migraine, and irritable bowel syndrome, as well as some pain relieving drugs. Non-prescription drugs of this type are also becoming increasingly available, including cold and flu medicines, indigestion tablets, sleeping pills and anti-diarrhoea treatments. The risk of side-effects from a dose of one of these might be very small, but many elderly patients take several kinds of medications at once, increasing the likelihood of "anticholinergic load".

Dr. Mintzer warns that elderly patients in nursing homes are most at risk, since some reports suggest that 60% of nursing home residents will have received drugs from the anticholinergic group in the past year, compared with only 23% of elderly people in the community. Doctors may assume that any side-effects are an inevitable part of the ageing process rather than something which could be avoided by altering existing medication regimes. The elderly are also more likely to be at risk from anticholinergic load because their metabolism is often less efficient, allowing drugs to stay longer in their system.

A study released by the National Academy on an Aging Society found that care for people with Alzheimers Disease can be very costly. The average cost for a person with Alzheimers who is still living at home is $12,572 a year, primarily for social services, like adult day care, homemaker services, and meal services. This cost is borne primarily by the patient or family, since most of these costs are not covered by Medicare, Medicaid, or insurance. The study also found that the lives of caregivers for Alzheimer's patients are more impacted by caregiving demands than those who care for people without dementia. Dementia caregivers were more likely to take time off of work (57% to 49%) and give up leisure activities (55% to 41%).

Researchers have found that people with a genetic high risk for Alzheimer's disease had to use more of their brains to perform memory tasks than those at normal risk. Thirty subjects aged 47 to 82 with normal age-appropriate memory performance were tested, and those with higher brain exertion demonstrated noticeable decline in their verbal recall abilities two years after initial testing. The results add to other evidence that physical changes to the brain begin years before dementia. The study was lead by Gary W. Small, director of the Center on Aging at the University of California at Los Angeles, and appears in the New England Journal of Medicine (NEJM).

The National Institutes of Health will increase funding for Alzheimers research by $50 million in the next five years. The National Alzheimers Association applauded the funding, but cautioned that it is still far short of the amount needed to significantly change Alzheimers treatment options. The association says $100 million should be allocated in the year 2001 alone.

PBS has posted on their web site streaming video and RealAudio files of their recent special on Alzheimers, along with a transcript of the program.

The current issue of the Journal of Clinical Oncology has a report from researchers who investigated complaints that breast cancer patients receiving chemotherapy have difficulty in their ability to remember, think, and concentrate. The research team was led by Dr. Ian F. Tannock of Princess Margaret Hospital in Toronto. Tannock's team found that, regardless of the women's mood, age and education, chemotherapy patients did show signs of mental impairment. They believe the cancer drugs may be acting on healthy brain cells, but that is still unclear. Tannock cautioned that this potential side effect should not scare away breast cancer patients, but that they should be fully aware of the possible adverse consequences of chemotherapy. He said, "As an oncologist, one thing that worries me is that some women might use this as an argument against a treatment that can help them."

The Journal of the American Medical Association (JAMA) has a report on a study into the potential benefits of estrogen replacement therapy on Alzheimers Disease. The researchers investigated whether this treatment was beneficial, in light of several reports from small clinical trials that indicated a potential benefit. They concluded that estrogen did not seem to be helpful in retarding the disease. They also said their study was inconclusive as to the benefit of estrogen in preventing or delaying Alzheimers, and recommended further study on that issue.

On March 13, the National Institute on Health Radio News Service will post an online audio clip from the National Institute on Aging. The clip will discuss a clinical trial being launched to determine whether treatment with certain non-steroidal anti-inflammatory drugs will slow cognitive and clinical decline in patients with Alzheimer's disease.

Ten key sessions at World Alzheimer Congress 2000, the largest international conference on Alzheimer's disease, will be broadcast over the Internet. Leaders in Alzheimer research, treatment and care from around the globe will gather in Washington D.C., from July 9 through July 18, to share the latest knowledge about research and care and identify strategies for eliminating Alzheimer's disease. Visit the congress web site at www.alzheimer200.org to get a schedule of viewable web casts.

Keeping active, either physically or mentally, in the midlife years may help prevent Alzheimer's disease, according to a study presented at the American Academy of Neurology's 52nd Annual Meeting. Robert Friedland, MD, a neurologist at Case Western Reserve University School of Medicine and University Hospitals of Cleveland, OH, was the primary author of the study.

This research found that participation in intellectual and physical activities had a significant impact on the likilhood of later development of Alzheimers Disease. Intellectual activities ranged from reading and painting to jigsaw puzzles, woodworking and knitting, whereas physical activity ran the gamut from gardening to racquet sports. The healthy participants had been more active between the ages of 40 and 60 than had the patients with Alzheimer's, even after the data was adjusted to take into account differences, such as age, income, gender and education.

The study's findings also suggest that it is never too late to get started - at least as far as intellectual activities are concerned. "A relative increase in the amount of time devoted to intellectual activities from early adulthood (ages 20 to 39) to mid-adulthood (ages 40 to 60) was associated with a significant decrease in the probability of having Alzheimer's disease later in life," said Friedland.

The research suggests that the brain stimulation associated with intellectual and physical activities works against the neurodegeneration of diseases such as Alzheimer's. Although scientists cannot rule out the possibility that lower activity levels are themselves symptoms of the disease in its very early stages, Friedland believes that to be unlikely, because the study looked at levels of activity from at least five years before the onset of dementia.

The Alzheimer's Association reported that the number of people who will be afflicted by Alzheimer's will increase by 350% by the middle of this century, if the disease continues to grow at current rates. The only way to avoid the epidemic is to accelerate the search for a way to delay, prevent or cure the disease.

"Large scale trials are expensive - $15 million to $20 million each - and they take at least five years to get results," said Dr. Steven DeKosky, chairman of the Medical and Scientific Advisory Council of the Alzheimer's Association. "Scientists now know that brain cells begin to change 10 years or more before the symptoms of Alzheimer's appear. We do not have enough time left to do these five-year trials one at a time. Scientists have many more good ideas for effective treatments than they can test with current funding. An estimated 14 million baby boomers are living with a sentence of Alzheimer's disease today."

The Alzheimer's Association reports that without a research breakthrough the Alzheimer's epidemic alone will cost enough to bankrupt Medicare. At present, annual per capita expenditures for Medicare beneficiaries with Alzheimer's disease are $7,682, almost 70 percent more than the average of $4,524 for other beneficiaries. And that's true even though Medicare pays for almost no long-term care.

"The best scientific minds have been brought into the race for the answers to Alzheimer's disease," said Alzheimer's Association Vice President Stephen McConnell. "A solid research infrastructure is in place. The paths for further investigation are clear. The missing ingredient is the money needed to realize the scientific opportunities before us."

Danish scientists reported at the World Alzheimer Congress 2000 that failing memory may be a symptom of a treatable and reversible condition and not always a sign of Alzheimer?s disease. Gunhild Waldemar, M.D., and her colleagues examined 785 patients with memory problems, and found that only 43% were diagnosed with Alzheimer?s disease or some other form of dementia. 6% of those they examined had Alzheimers, but their memory problems were a result not of Alzheimers disease but of some treatable and reversable medical condition. Overall, they found that 35% of the patients they saw had a potentially treatable concomitant condition that could influence cognitive function, most commonly depression, high blood pressure and thyroid disease. Researchers concluded that it is important for patients with memory problems to have them properly assessed and treated, and not to assume that they indicate a diagnosis of Alzheimers.

Scientists working for the Human Genome Project at the National Human Genome Research Institute in Bethesda Maryland announced they have deciphered the genetic code for chromosome 21, which includes genes involved in cancer, hardening of the arteries, arthritis, Alzheimer's disease and other diseases associated with aging. This is the second of the 23 human chromosomes to be fully mapped and sequenced. This research is expected to help researchers studying Alzheimers and other diseases affected by the chromosome, and may shorten the time it will take to develop treatments for the diseases. 62 scientists in the USA, Japan, Germany, France, Switzerland, and England have been involved in this research.

Novartis Pharmaceuticals' Exelon, has received approval by the Food and Drug Administration (FDA). Exelon, whose approval was announced Friday, works in the brain the same way as the other two Alzheimer's drugs, Aricept and Cognex. They inhibit the breakdown of acetylcholine, a brain chemical vital for nerve cells to communicate with each other. The longer acetylcholine remains in the brain, the longer those cells can call up memories.

The drugs offer modest relief for mild to moderate Alzheimer's symptoms. While the products have not been compared directly, Exelon's effectiveness is believed to be "pretty much in the same league" as Aricept and Cognex, said FDA official Dr. Russell Katz.

The results of a recent study indicate that the lack of human contact may play a role in the development of Alzheimers Disease. The Lancet medical journal has published results of research done by Dr Laura Fratiglioni of the Stockholm Gerontology Research Center. In this study, researchers worked with 1,200 Stockholm residents, who were all over 75 years old and free of Alzheimers at the initiation of the study. After three years, 176 had developed Alzheimers, and researchers analyzed the information they had collected about the health and social networks of the study participants. These results showed that a poor social network increased the risk of dementia by 60%. Dr. Fratiglioni said that the study results indicate how important it is that older people are not left isolated in their homes as they age, and to ensure that they are given opportunities for contact and interaction.

The "Nun Study" is a research project to determine the causes of Alzheimer disease, other brain diseases, and the mental and physical disability associated with old age. Researchers are from the University of Kentucky Sanders-Brown Center on Aging and participants are 678 American members of the School Sisters of Notre Dame religious congregation from 75 to 103 years of age. Each sister in the study agreed to participate in annual assessments of her cognitive and physical function, undergo a brief medical examination, have her blood drawn, allow investigators full access to her archival and medical records, and donate her brain at death for neuropathologic study.

Researchers just announced a finding from this study that low serum folate (folic acid) was strongly associated with atrophy of the cerebral cortex in women who had a significant number of Alzheimer lesions in the brain when they died a few years later. They postulate that folic acid may play an important role in maintaining the integrity of the brain in late life, although further research is necessary. Folic acid is present in leafy dark green vegetables, and in peas, beans, and legumes.

The Labor, Health and Human Services, and Education subcommittee of the Senate Appropriations committee held hearings on March 21 to discuss the need for $100 million in additional funding for Alzheimers research. The subcommittee is encouraging increased funding to the National Institutes of Health for such research, and held these hearings to identify issues to be considered. The witnesses included Maureen Reagan, daughter of ex-president and Alzheimers' victim Ronald Reagan.

The current issue of the Journal of the American Geriatrics Society reports there are significant delays between the first observation of symptoms and the final diagnosis of Alzheimers for many victims of the disease. The journal published results from a study done to determine how much time passes between the first observation of Alzheimer-like symptoms by caregivers and the time when a physician was consulted and a diagnosis was made. The study found that one to two or more years pass between the first time caregivers notice symptoms and the time they recognize there is a real problem. Caregivers then delayed another 10 months to a year or more before consulting a physician. There were further delays at that time, since caregivers reported that physicians correctly diagnosed the condition at the time of the initial consultation only 38% of the time.

A study published in the Journal of the American Medical Association found that there was a strong correlation between Alzheimers and levels of amyloid peptides Ax-40 and Ax-42. Levels of peptides were elevated early in dementia and were strongly correlated with cognitive decline. Of particular interest, peptide levels were elevated before the occurrence of significant tau pathology, which means they may be early indicators of the disease. Researchers concluded that these results support an important role for peptides in mediating initial pathogenic events in AD dementia and suggest that treatment strategies targeting the formation, accumulation, or cytotoxic effects of peptides should be further pursued.

Researchers have never been sure of the cause of arthritis pain, since cartilage that is affected has no nerve endings, but a new study points to one possible cause. Researchers led by Dr. David T. Felson of Boston University School of Medicine in Massachusetts studied 401 people with knee osteoarthritis, some who had knee pain, and some who did not, to see if they could find a common thread among those with pain.

Bone marrow lesions were found in 78% of those with painful knees compared with 30% of persons with no knee pain. Large lesions were present almost exclusively in persons with knee pain, and after adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. They concluded that bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.

The study was funded by Bayer Corporation, the Arthritis Foundation and the National Institutes of Health, and is published in the April 3 issue of Annuls of Internal Medicine.

British scientists have announced what they say is the first evidence of a cure for rheumatoid arthritis. A research team at University College in London led by Professor Jonathan Edwards says it has discovered what causes the body's defenses mistakenly to attack healthy joints and tissue. Its cure focuses on the role of B-cells, white blood cells that defend the body against viruses and bacteria by making antibodies that attack the hostile microbes. B-cells can accidentally make antibodies that attack healthy tissue. In the case of arthritis, the result is a self-sustaining attack on joints and tissue.

Researchers followed 20 patients who have had rheumatoid arthritis for an average of 20 years and who all failed to respond to any standard therapy, and put them through 18 months of treatment. Of the 20, five now have only some residual pain from the damage already done. Researchers said they have returned to leading a more or less normal life, with one going to the gym and one taking up gardening for the first time in ages.

Prof Edwards and his colleagues believe that they have found a way to break the circle, using drugs that seek out and destroy B-cells. He said: "Unlike with other cells in the immune system, most people can live without any B-cells for a while. By the time we reach adulthood we have already made most of the antibodies we need." After a single treatment to wipe out all the B-cells, the body responds by making fresh ones. The chances of these new B-cells making the same mistake as their predecessors, however, thereby triggering a return of rheumatoid arthritis, is small.

Edwards said the B-cell based therapy might also offer hope to patients with other auto-immune diseases, such as Crohn's disease, lupus and even multiple sclerosis.

The team will announce the results of its research Monday at the annual scientific meeting of the American College of Rheumatology in Philadelphia. The findings will be also published in the leading journal Rheumatology.

Scientists working for the Human Genome Project at the National Human Genome Research Institute in Bethesda Maryland announced they have deciphered the genetic code for chromosome 21, which includes genes involved in cancer, hardening of the arteries, arthritis, Alzheimer's disease and other diseases associated with aging. This is the second of the 23 human chromosomes to be fully mapped and sequenced. This research is expected to help researchers studying Alzheimers and other diseases affected by the chromosome, and may shorten the time it will take to develop treatments for the diseases. 62 scientists in the USA, Japan, Germany, France, Switzerland, and England have been involved in this research.

Myths about arthritis keep people from seeking a doctor's help against the number one cause of disability in the United States, according to the national Centers for Disease Control and Prevention (CDC). Arthritis disables more Americans than heart disease and stroke, and the CDC says it's what Americans don't know about the disease that can hurt them. They have published a list of myths and facts about arthritis, including tested treatments, unproven remedies, and prevention measures.

A recent Gallup survey found that 90% of Americans age 18 and older experienced pain at least once a month, and 55% of people age 65 and over experienced daily pain. 15% of those who experienced pain said their pain was "severe", and over half felt they did not have any effective method of controlling their pain. 64% of pain sufferers will see a doctor only when they cannot stand the pain any longer, and only 42% of those who visit their doctor for pain believe that their doctor completely understands how their pain makes them feel.

As a result of this survey, the Arthritis Foundation, along with the American Society on Aging, Business and Professional Women/USA, General Federation of Women?s Clubs, MANA, A National Latina Organization and the National Council of Negro Women has launched "Speaking of Pain", an educational program to empower people to help gain control of their pain by better communicating with health care professionals about it.

Middle-class and upper-middle-class US and Canadian residents have similar odds of surviving cancer, but America's poorer residents do not fare as well as those in Canada, according to new study findings. The study was led by Dr. Kevin M. Gorey, of University of Windsor in Ontario, and reported on in the Journal of Public Health Medicine.

Among people on the bottom one third of the socioeconomic ladder, Canadians were about 35% more likely to survive cancer than similar US residents. The researchers attribute the results to the differences in the Canadian and US healthcare systems. Gorey noted that several previous studies have failed to detect a difference in cancer survival between the two countries, but the research did not break down the statistics by socioeconomic status. The disparity between the US and Canada was even greater when the analysis only included people who were diagnosed with cancer before age 65. In the US, most of these people would not be eligible for Medicare, the federal health insurance program for the elderly.

The Food and Drug Administration (FDA) has created a new cancer web site. The site provides both professionals and consumers with information about drugs approved for cancer treatment, disease summarys, and regulatory tools. The site is the first effort of the FDA to subdivide the drug information on their site by disease category. The site includes detailed data on approved oncology drugs, including uses, product labels, and transcripts of pertinent advisory committee discussions; a flow chart to help select the starting dosage for cytotoxic drugs in oncology; general advice on how to obtain access to experimental drugs; information about reporting adverse events; assessment tools for conducting clinical investigations, such as a staging manual for different types of cancers; and information about filing an application for an investigational new drug and about investigational review boards.

A study in the latest issue of The Journal of the American Geriatrics Society found that poverty, lack of education and a lack of health insurance prevent many elderly black Americans from getting screened for cervical, breast and colon cancer. Dr. Verona Hegarty from the Veterans Affairs Medical Center in Durham, North Carolina, and colleagues conducted the research, and concluded that this lack of screening at least partly explains why blacks in the US are more likely to die of cancer than whites.

Previous studies have uncovered racial differences in cancer screening. To investigate why these differences occur, researchers interviewed more than 4,000 elderly Americans in 1986-1987 and followed up with nearly 3,000 people in 1992-1993. The follow-up survey included 1,246 blacks and 966 whites older than 70 years. Investigators asked patients about their use of the Pap smear; clinical breast examination and mammography; and rectal examination and fecal occult blood testing to diagnose colorectal cancer. Researchers concluded that black women were less likely than white women to be screened for cervical and breast cancer, and that elderly blacks were less likely to be screened for colon cancer.