Jury Still Out on Routine Dementia Screening for Seniors

By Steven Reinberg
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- There's not yet enough evidence to support screening all older adults for dementia or a less severe condition called "mild cognitive impairment," according to a statement released Monday by the influential U.S. Preventive Services Task Force.

Mild cognitive impairment is a type of mental decline that does not interfere with activities of daily life.

General screening tests for dementia typically involve health professionals asking patients to perform a series of tasks to assess memory, attention, language, and visual-spatial and executive function.

"We found there wasn't sufficient evidence to recommend for or against screening," said task force member Dr. Douglas Owens, a professor of medicine at Stanford University's Center for Health Policy.

"This recommendation applies to people who are completely free of symptoms," Owens said. "If someone has symptoms, they should be evaluated -- that's not screening in the sense we are talking about. We are talking about screening for people who have no symptoms whatsoever."

Screening all older adults for dementia or mild cognitive impairment would only be worthwhile if there were meaningful treatments, Owens said.

"There would need to be interventions that you can do where the benefits would outweigh the harms," he said.

Currently, the benefits of available treatments are "modest to small," Owens said, "and how important those are clinically is uncertain."

More research is needed on how early detection of mental decline could help older adults, their families and their doctors, Owens said.

The new statement, published online March 24 in the journal Annals of Internal Medicine, is the final recommendation, and updates the task force's draft recommendation released in November 2013.

One expert, however, suggested that the task force's recommendation is dodging a very important issue -- an epidemic of dementia.

"Apparently, the task force perceives a need to defend its statement that screening for cognitive impairment is not recommended," said Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City.

"Like Medicare's decision not to cover [a brain scan for Alzheimer's], the bottom line here is a cost-effectiveness analysis -- in other words, since we have no effective treatment, we should not spend money on proactive diagnosis of dementia," he said.

Many doctors avoid diagnosing dementia because, among other reasons, discussion of a dementia diagnosis with patients and family "is time consuming and the outlook is hopeless," Gandy said.

"The task force's advice that we look the other way can be interpreted as providing justification for this practice and misses an opportunity to elevate the conversation on dementia," he said.

Gandy said a recent report found that Alzheimer's may kill six times as many people as previously believed.

"This figure came as no surprise to dementia specialists," he said. "As long as primary-care physicians and other professionals fail to confront the epidemic status of dementia, the more time will be required before governments take seriously the economic threat of the dementia epidemic."

Heather Snyder, director of medical and scientific operations at the Alzheimer's Association, said there is value in detecting dementia early, despite the task force's stance.

"Their recommendation is that they can't make a recommendation," she said. "It's very important to separate insufficient evidence from no evidence."

The Alzheimer's Association supports early detection and diagnosis of Alzheimer's, Snyder said. "We know there is a better chance that an individual would be able to benefit from the current medications that are available," she said. "They would be able to take advantage of clinical trials and participate in conversations with their family about planning for their care and financial future."

According to the task force, dementia affects approximately 2.4 million to 5.5 million Americans. It results in trouble remembering, speaking, learning new things, concentrating and making decisions that affect daily life.

Alzheimer's disease is one type of dementia. Mental decline is not always as severe as Alzheimer's.

A recent study, published in the March/April edition of the journal Annals of Family Medicine, found that only about 20 percent of people who experience mild cognitive impairment will go on to develop serious brain-related disorders such as Alzheimer's.

Although some people will be stricken with Alzheimer's or other dementia, many will see their symptoms remain the same or disappear, the researchers said.

The U.S. Preventive Services Task Force is an independent, volunteer panel of experts in prevention- and evidence-based medicine. It makes recommendations about clinical preventive services such as screenings, counseling and medications.

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Douglas Owens, M.D., professor of medicine, Center for Health Policy, Stanford University, Palo Alto, Calif.; Sam Gandy, M.D., Ph.D., director, Center for Cognitive Health, Mount Sinai Hospital, New York City; Heather Snyder, Ph.D., director, medical and scientific operations, Alzheimer's Association; March 24, 2014, Annals of Internal Medicine

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Health Tip: Understanding Eye Allergies

(HealthDay News) -- Red, itchy, teary or burning eyes can signal allergies, a condition that affects millions.

But what causes allergies? The American College of Allergy, Asthma, & Immunology mentions these possible triggers:

Pet danderDust mitesMoldPollen, with common sources such as weeds, trees and grass.While not allergens themselves, things like cigarette smoke, diesel exhaust or perfumes can worsen existing symptoms.

-- Diana Kohnle
Copyright © 2014 HealthDay. All rights reserved.

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Toddlers Who Sleep Less May Eat More

TUESDAY, March 25, 2014 (HealthDay News) -- Toddlers who get too little sleep tend to eat more and are at increased risk for obesity, a new study indicates.

The study included children in over 1,300 British families who had their sleep measured when they were 16 months old and their diet checked when they were 21 months old.

Those who slept less than 10 hours a day consumed about 10 percent more calories than those who slept more than 13 hours, according to the study in the International Journal of Obesity.

This is the first study to link amount of sleep to calorie consumption in children younger than 3 years, the University College London (UCL) researchers said. They suggested that shorter sleep may disrupt the regulation of appetite hormones.

"We know that shorter sleep in early life increases the risk of obesity, so we wanted to understand whether shorter sleeping children consume more calories," Dr. Abi Fisher, of the Health Behavior Research Centre at UCL, said in a university news release.

"Previous studies in adults and older children have shown that sleep loss causes people to eat more, but in early life parents make most of the decisions about when and how much their children eat, so young children cannot be assumed to show the same patterns," she added.

Although the study found an association between toddler's sleeping less and eating more, it did not prove a cause-and-effect relationship.

The main message from the study "is that shorter-sleeping children may [be] prone to consume too many calories. Although more research is needed to understand why this might be, it is something parents should be made aware of," Fisher concluded.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCE: University College London, news release, March 24, 2014

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Blindness Rates Dropping Worldwide, Study Finds

MONDAY, March 24, 2014 (HealthDay News) -- Global rates of blindness and poor vision have fallen sharply over the past two decades, especially in rich nations, a new study reveals.

And providing eyeglasses for common vision-loss problems could improve the situation even more, according to the researchers.

The investigators analyzed 243 studies conducted in 190 countries and found that rates of blindness and poor vision fell by 37 percent and 27 percent, respectively, from 1990 to 2010.

In wealthy nations, the prevalence rate of blindness dropped by half, from 3.3 million people (0.2 percent of the population) to 2.7 million people (0.1 percent of the population), the findings showed.

In those countries, the rate of poor vision decreased 38 percent, from 25.4 million people (1.6 percent of the population) to 22.2 million people (1 percent of the population).

In high-income countries, women were more likely than men to be blind or to have poor vision throughout the study period.

The study was published online March 24 in the British Journal of Ophthalmology.

During the 20-year study timeframe, macular degeneration replaced cataracts as the most common cause of blindness, except in central and eastern European nations, according to a journal news release. The most common cause of poor vision remained uncorrected refractive errors such as long- and short-sightedness.

The findings show "that even for the highly developed countries one of the most effective, cheapest, and safest ways of improving vision loss by providing adequate spectacles for correcting refractive errors, is being overlooked," study author Rupert Bourne, a professor with the vision and eye research unit at Anglia Ruskin University, in Cambridge, England, and colleagues wrote.

They added that the growing number of people with diabetes will have a major effect on eye health worldwide, with as many as 100 million people expected to develop an eye disease called diabetic retinopathy. Of those, about one-third will be at risk of losing their vision.

"Strategies to screen for diabetic retinopathy and provide timely treatment access are critical to prevent this condition from having a greater impact on blindness prevalence in the future," the researchers concluded.

-- Robert Preidt
Copyright © 2014 HealthDay. All rights reserved. SOURCE: British Journal of Ophthalmology, news release, March 24, 2014

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Health Tip: Enjoying Warm Weather Fitness

(HealthDay News) -- When the snow finally begins to melt and the weather starts turning warmer, the improving forecast offers great motivation to get moving.

The Weight Control Information Network offers these suggestions for warm weather exercise:

Jump in the pool and swim some laps.Stroll through the zoo, a museum or an aquarium.Talk a walk through the nearest farmer's market and pick up fresh fruits and vegetables.Start a neighborhood garden.At least twice weekly, lift weights and do some push-ups.On hot days, work out indoors to a DVD. Remember to drink plenty of water.

-- Diana Kohnle
Copyright © 2014 HealthDay. All rights reserved.

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E-Cigarettes Won't Help You Quit, Study Finds

By Steven Reinberg
HealthDay Reporter

MONDAY, March 24, 2014 (HealthDay News) -- Contrary to some advertising claims, electronic cigarettes don't help people quit or cut down on smoking, a new study says.

Users of e-cigarettes inhale vaporized nicotine but not tobacco smoke. The unregulated devices have been marketed as smoking-cessation tools, but studies to date have been inconclusive on that score, the study noted.

"When used by a broad sample of smokers under 'real world' conditions, e-cigarette use did not significantly increase the chances of successfully quitting cigarette smoking," said lead researcher Dr. Pamela Ling, an associate professor at the Center for Tobacco Control Research and Education at University of California, San Francisco.

These findings -- based on nearly 1,000 smokers -- are consistent with other studies and contradict the claims frequently found in e-cigarette advertising, she said.

"Advertising suggesting that e-cigarettes are effective for smoking cessation should be prohibited until such claims are supported by scientific evidence," Ling said.

For the study, Ling's team analyzed data reported by 949 smokers, 88 of whom used e-cigarettes at the start of the study.

One year later, 14 percent of the smokers had quit overall, with similar rates in both groups.

"We found that there was no difference in the rate of quitting between smokers who used an e-cigarette and those who did not," Ling said.

There was no relationship between e-cigarette use and quitting, even after taking into account the number of cigarettes smoked per day, how early in the day a smoker had a first cigarette and intention to quit smoking, Ling added.

However, the researchers noted that the small number of e-cigarette users may have limited the ability to find an association between e-cigarette use and quitting.

The report, published online March 24 in JAMA Internal Medicine, also found that women, younger adults and people with less education were most likely to use e-cigarettes.

One expert said the study is flawed and shouldn't be taken seriously.

"It's an example of bogus or junk science," said Dr. Michael Siegel, a professor of community health sciences at Boston University School of Public Health.

"That's because the study does not examine the rate of successful smoking cessation among e-cigarette users who want to quit smoking or cut down substantially on the amount that they smoke, and who are using e-cigarettes in an attempt to accomplish this," Siegel said. "Instead, the study examines the percentage of quitting among all smokers who have ever tried e-cigarettes for any reason."

Many of the smokers who tried e-cigarettes may have done so out of curiosity, Siegel said.

"It is plausible, in fact, probable, that many of these 88 smokers were not actually interested in quitting or trying to quit with electronic cigarettes," he said. "These products have become very popular and have gained widespread media attention, and it is entirely possible that many of these smokers simply wanted to see what the big fuss is all about."

Calling that a "fatal flaw" in the research, Siegel said it "destroys the validity of the authors' conclusion."

It would be a tragedy, he said, if policy makers use the study to draw conclusions about the effectiveness of e-cigarettes for smoking cessation purposes.

Erika Ford, assistant vice president for national advocacy at the American Lung Association, said the study confirms what is already clear -- "e-cigarettes are not associated with quitting among smokers."

Ford noted that most e-cigarette companies no longer make claims that their products help smokers quit. "But there is a need for the FDA [U.S. Food and Drug Administration] to begin their oversight of these products. It's time for the FDA to find out which products are making no smoking claims and which ones might be in violation of current law," she said.

The FDA plans to introduce regulations for e-cigarettes, but hasn't yet. In the past, the agency has warned companies about making false claims and for poor manufacturing practices.

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Pamela Ling, M.D., M.P.H., associate professor, Center for Tobacco Control Research and Education, University of California, San Francisco; Michael Siegel, M.D., M.P.H., professor, Department of Community Health Sciences, Boston University School of Public Health; Erika Ford, assistant vice president for national advocacy, American Lung Association; March 24, 2014, JAMA Internal Medicine, online

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Spanking Triggers Vicious Cycle, Study Finds

By Dennis Thompson
HealthDay Reporter

TUESDAY, March 25, 2014 (HealthDay News) -- Parents who spank unruly children may not know it, but they are participating in a vicious cycle that will lead to both more spankings and more misbehavior in coming years, a new study suggests.

Researchers wanted to resolve the age-old "chicken-and-egg" question that surrounds the issue of physical discipline in childhood -- do spankings promote aggression in children, or do naturally aggressive children simply receive more spankings as parents try to control their behavior?

The answer is yes to both, said study author Michael MacKenzie, an associate professor at the Columbia University School of Social Work in New York City.

Across a child's first decade of life, current spankings will lead to future misbehavior -- but current misbehavior also will lead to future spankings, the investigators found.

"You can think of it as an escalating arms race, where the parent gets more coercive and the child gets more aggressive, and they get locked into this cycle," MacKenzie said. "These processes can get started really early, and when they do there's a lot of continuity over time."

The findings are based on almost 1,900 families from the Fragile Families and Child Wellbeing Study. That's a decade-old research project conducted by researchers at Columbia and Princeton universities involving children born in 20 large American cities between 1998 and 2000.

Families in the study took part in assessments shortly after giving birth and when the children were approximately 1, 3, 5 and 9 years old. These assessments included questions about whether the children received spankings and the extent to which the children behaved aggressively, broke rules or acted surly or antagonistic.

About 28 percent of mothers reported spanking their children during their first year of life, increasing to 57 percent at age 3 and then hovering around 53 percent at age 5 and 49 percent at age 9.

But researchers also found that at each age, children who exhibited more behavioral problems went on to experience more spanking at a later age, indicating that the more difficult children might prompt increasing levels of punishment from their parents.

"Some children are eliciting higher levels of physical discipline, and high levels of physical discipline are in turn associated with later higher levels of parental aggression," MacKenzie said.

Even though the study shows that spanking and misbehavior tend to feed each other, the investigators also found strong evidence that spanking a child within the first year of life likely is the catalyst that starts the cycle.

These findings put an end to the "chicken or the egg" debate over which comes first, the spanking or the childhood misbehavior, said Dr. Andrew Adesman, chief of developmental & behavioral pediatrics at Steven & Alexandra Cohen Children's Medical Center of New York in New Hyde Park, N.Y.

"I see it starting with the egg, with the egg being the spanking, and then the spanking then leads to more aggressive behavior, and the aggressive behavior then leads to more spanking," Adesman said.

The findings are published in the March 25 online issue of the Journal of Youth and Adolescence.

If parents can stick to non-physical forms of punishment when a toddler acts out, they are more likely to have a well-behaved child at ages 3, 5 and 9, he said.

"During the early toddler years, parents probably need to get more counseling or advice on strategies for managing children's behavior without resorting to spanking," Adesman said.

Unfortunately, MacKenzie said, it can be tough to avoid the urge to spank, given how stressed and overwhelmed many young parents can become.

"Spanking gives very immediate feedback, because children will stop doing what they were doing, but it's not giving children the ability to regulate themselves over time," he noted.

"But parenting is not an easy thing, and challenging kids make the job even tougher," MacKenzie explained. "We need to give these parents the support they need to do as well as they'd like by their children."

Copyright © 2014 HealthDay. All rights reserved. SOURCES: Michael MacKenzie, associate professor, Columbia University School of Social Work, New York City; Andrew Adesman, M.D., chief, developmental & behavioral pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, New Hyde Park, N.Y.; March 25, 2014, Journal of Youth and Adolescence, online

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