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Weight Loss Found to Improve Incontinence

Urinary incontinence is a problem that plagues over 13 million American women today. Left untreated, incontinence usually worsens, and can be the first step in a debilitating withdrawal from life. Common treatments include bladder training, pelvic muscle exercises, medication, avoiding food irritants, and in some cases, surgery. Incontinence may be caused by weakening of the muscles which control bladder outflow, disorders of the nervous system or obstruction to the bladder. New studies show that being overweight also contributes to incontinence—and losing weight may help the problem.

Researchers from the University of California, San Francisco and University of Alabama at Birmingham worked with volunteer participants in the Program to Reduce Incontinence by Diet and Exercise (PRIDE). The study subjects were all overweight or obese, and experienced up to 10 episodes of incontinence per week. They went on a six-month program of diet, exercise and behavior modification. At the end of the six month period, participants had lost on average 17 pounds, and had cut their incontinence episodes in half.

Study author Dr. Leslee Subak said that weight loss should be a first-line treatment for incontinence when patients are significantly overweight. Co-author Dr. Frank Franklin said, “Earlier research has shown that behavioral weight loss programs have many benefits, including decreasing blood pressure and helping to fight off diabetes. Here we’ve shown that weight loss has measurable impact on reduced incontinence.”

Copyright © AgeWise, 2013 reporting on University of Alabama Birmingham news release

Sleep On It: How Snoozing Strengthens Memories

Information from National Institutes of Health studies shows that memories are formed and retained during sleep; poor sleep contributes to poor memory.

When you learn something new, the best way to remember it is to sleep on it. That’s because sleeping helps strengthen memories you’ve formed throughout the day. It also helps to link new memories to earlier ones. You might even come up with creative new ideas while you slumber.

What happens to memories in your brain while you sleep? And how does lack of sleep affect your ability to learn and remember? National Institutes of Health (NIH)-funded scientists have been gathering clues about the complex relationship between sleep and memory. Their findings might eventually lead to new approaches to help students learn or help older people hold onto memories as they age.

“We’ve learned that sleep before learning helps prepare your brain for initial formation of memories,” says Dr. Matthew Walker, a sleep scientist at the University of California, Berkeley. “And then, sleep after learning is essential to help save and cement that new information into the architecture of the brain, meaning that you’re less likely to forget it.”

While you snooze, your brain cycles through different phases of sleep, including light sleep, deep sleep, and rapid eye movement (REM) sleep, when dreaming often occurs. The cycles repeat about every 90 minutes.

The non-REM stages of sleep seem to prime the brain for good learning the next day. If you haven’t slept, your ability to learn new things could drop by up to 40%. “You can’t pull an all-nighter and still learn effectively,” Walker says. Lack of sleep affects a part of the brain called the hippocampus, which is key for making new memories.

You accumulate many memories, moment by moment, while you’re awake. Most will be forgotten during the day. “When we first form memories, they’re in a very raw and fragile form,” says sleep expert Dr. Robert Stickgold of Harvard Medical School.

But when you doze off, “sleep seems to be a privileged time when the brain goes back through recent memories and decides both what to keep and what not to keep,” Stickgold explains. “During a night of sleep, some memories are strengthened.” Research has shown that memories of certain procedures, like playing a melody on a piano, can actually improve while you sleep.

Memories seem to become more stable in the brain during the deep stages of sleep. After that, REM—the most active stage of sleep—seems to play a role in linking together related memories, sometimes in unexpected ways. That’s why a full night of sleep may help with problem-solving. REM sleep also helps you process emotional memories, which can reduce the intensity of emotions.

It’s well known that sleep patterns tend to change as we age. Unfortunately, the deep memory-strengthening stages of sleep start to decline in our late 30s. A study by Walker and colleagues found that adults older than 60 had a 70% loss of deep sleep compared to young adults ages 18 to 25. Older adults had a harder time remembering things the next day, and memory impairment was linked to reductions in deep sleep. The researchers are now exploring options for enhancing deep stages of sleep in this older age group.

“While we have limited medical treatments for memory impairment in aging, sleep actually is a potentially treatable target,” Walker says. “By restoring sleep, it might be possible to improve memory in older people.”

Source: National Institutes of Health

May is Osteoporosis Awareness and Prevention Month

Osteoporosis is a loss of bone density that can occur as we age. It is responsible for over a million broken bones each year, and is a major cause of fractures, back pain, spinal problems and loss of independence. Ten million Americans are living with osteoporosis today, and the Centers for Disease Control and Prevention (CDC) estimates that by the year 2020 one in two Americans over age 50 will be at risk for fractures from osteoporosis. With the aging of the baby boomers, awareness of the disease becomes ever more important.

Yet many people, even seniors who are at high risk for osteoporosis, are unaware of the dangers of the disease and their own risk factors. Osteoporosis is sometimes called “the silent disease.” As it develops, it is often painless, with no obvious symptoms. In many cases, a fracture is the first symptom!

The American Academy of Orthopaedic Surgeons recently conducted a groundbreaking study showing that even though osteoporosis can lead to debilitating fractures, pain, spinal problems, loss of independence, and even death, many at-risk seniors have little knowledge about the disease. Even if they suffer an osteoporosis-related fracture, they may not realize they have the condition. “Many people who sustain a fracture don’t connect it to osteoporosis,” said study author Dr. Angela M. Cheung of the University Health Network/Mount Sinai Hospital Osteoporosis Program in Toronto, Ontario. Cheung points out in contrast, “A person who has a heart attack knows that there’s a problem with his or her heart, but a person who fractures thinks, ‘The floor was slippery’ or ‘I’m clumsy’ and doesn’t look at it as a symptom of a more serious medical condition.”

What you should know about osteoporosis

What causes osteoporosis?

To understand what causes osteoporosis, it’s important to know that our bones are actually a living tissue. All through our lives, bone is constantly being replaced by new bone. In young people, the bones become denser and stronger. But when we are around age 35, bone building no longer keeps up with bone loss. For persons who have a strong bone mass, this gradual loss of minerals from the bones may not cause problems. But when loss of bone density is so great that bones fracture easily, the person is said to have osteoporosis.

As it develops, osteoporosis is often painless, with no obvious symptoms. In most cases, the first sign is a fracture, most often of the hip, spine or wrist. The person with osteoporosis may develop a noticeably curved spine (sometimes called a “dowager’s hump”). Another sign is a decrease of height, which is caused by loss of bone in the spine. It is important that osteoporosis be diagnosed early, so that measures can be taken to slow the bone loss. A bone mineral density test—a painless test similar to having an x-ray—is the best way to measure bone health.

What are the risk factors?

Several risk factors increase the likelihood of osteoporosis:

  • aging
  • a family history of the condition
  • women past menopause (who have a lowered amount of estrogen, a hormone important in building bones)
  • inadequate intake of calcium and Vitamin D
  • an inactive lifestyle
  • small-boned and/or underweight body type
  • excess abdominal fat
  • use of certain medications
  • medical conditions such as liver or kidney disease, diabetes, or thyroid problems
  • smoking or alcohol abuse.

Can osteoporosis be prevented?

For the most part, once bone has been lost, it cannot be replaced. So the goal in treating osteoporosis is to maintain existing bone and to stop further loss. Here are some things you can do:

Get enough calcium. Some good sources of calcium are dairy products, dark leafy green vegetables, dried beans, canned sardines and salmon, sesame seeds, tofu, tortillas and soy flour. Some foods that are not rich in calcium may be fortified with calcium and vitamin D; check the label on breakfast cereals, breads and orange juice. Your health care provider may also recommend calcium and Vitamin D supplements.

Maintain a healthy weight. Being underweight raises the risk of osteoporosis. On the other hand, a recent study from Harvard Medical School shows that excess abdominal fat is also detrimental to bone health. Remember that prolonged weight loss diets are dangerous: the dieter may be losing bone right along with the weight.

Get enough exercise—and the right kind. Staying active encourages bone growth and strengthens muscles to protect the bones. Seniors who have osteoporosis should consult their healthcare provider before beginning an exercise program. Certain types of exercises are most beneficial; others may actually be dangerous. A physical therapist can train the patient to use good “body mechanics” during daily activities—even during sleep.

Limit alcohol and quit smoking. Alcohol and tobacco can both contribute to weakened bone in a variety of ways. Drinking too much alcohol also increases the risk of falling and fracturing a bone.

Take medications correctly. Some osteoporosis patients take medication to slow the loss of bone. Other drugs help control pain, or manage healthcare conditions that can make osteoporosis worse. Take these medications exactly as prescribed. Some prescription and over-the-counter drugs can increase fall risk or actually weaken the bones, so have medications reviewed regularly.

Make fall prevention a priority. Reduce the risk by having regular eye examinations, keeping the house free of clutter and other hazardous conditions, and talking to your healthcare provider about a balance training program. If you use a cane, walker or other assistive device, be sure it is properly fitted and you have been trained in its use.

While some of the risk factors for osteoporosis—such as body type, family history, and age—are beyond our control, others are lifestyle choices. People who follow the above suggestions lessen the likelihood of developing osteoporosis. And though in most cases lost bone mass cannot be replaced, the same preventative measures can also slow the loss.

Seniors Helping the Next Generation

The National Osteoporosis Foundation, sponsor of National Osteoporosis Month, recently rolled out the Generations of Strength campaign to encourage parents and grandparents to talk to their children and grandchildren about the importance of building strong bones. Foundation experts say, “Many people do not realize that osteoporosis is often considered a pediatric disease with geriatrics consequences—approximately 85 – 90 percent of adult bone mass is acquired by age 18 in girls and 20 in boys.” The NOF reminds grandparents, “It’s never too early or too late to take steps to improve bone health.” Young people are least likely to think about the importance of nutrition. A conversation with Grandma might be the best way to help grandchildren develop awareness of bone health. Learn more about the campaign at www.nof.org/connect.

Copyright © AgeWise, 2013

Many People Would Like to Know Their Risk of Developing Alzheimer’s Disease

Many People Would Like to Know Their Risk of Developing Alzheimer’s Disease

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Alzheimer’s disease can’t be prevented or cured, and it ranks second only to cancer among diseases that people fear. Still, a study last year found that about two-thirds of respondents would want to know if they were destined to get the disease.

Although there are no definitive tests that predict whether most people will get the disease, people sometimes want such information for legal and financial planning purposes or to help weigh the need for long-term-care insurance.

Current tests to identify the risk of developing Alzheimer’s disease when no symptoms are present provide only limited information, and health insurance generally doesn’t cover them. But that’s not stopping some people from trying to learn more.

Alzheimer’s disease, the most common form of dementia, gradually robs people of their memory and other intellectual capabilities. Most of the 5 million people who have Alzheimer’s developed it after age 60. In these cases, the disease is likely caused by a combination of genetic, lifestyle and environmental factors. About 5 percent of Alzheimer’s patients have inherited an early-onset form that is generally linked to a mutation on one of three chromosomes.

Research suggests that the brain may show signs of Alzheimer’s decades before obvious symptoms appear. Scans can identify the presence of beta-amyloid, a protein that is often deposited in the brains of people with the disease, for example. Changes in proteins in the blood or cerebrospinal fluid may also be associated with Alzheimer’s disease.

But tests to measure these changes are available only in a research setting, and insurance typically doesn’t cover them. James Cross, head of national medical policy and operations for Aetna, says his company “does not consider blood tests or brain scans medically necessary for diagnosing or assessing Alzheimer’s disease in symptomatic or asymptomatic people because the clinical value of these remains unproven.”

Genetic testing is somewhat easier to arrange, but insurers generally won’t pay for it, either.
In addition, genetic counselors caution that long-term-care insurers may use genetic testing results when evaluating whether to issue a policy. The Genetic Information Nondiscrimination Act prohibits health insurers and employers from discriminating against people based on their genetic information. However, life and long-term-care insurers are not covered by the law.

“Before anyone has genetic testing, they should get life insurance and long-term-care insurance,” says Jill Goldman, a certified genetic counselor at the Taub Institute at Columbia University Medical Center.
Genetic testing for late-onset Alzheimer’s involves one gene, the apolipoprotein E (APOE) gene on the 19th chromosome. The gene comes in three different forms – E2, E3 and E4. Everyone inherits one form, or allele, from each parent. Having one or two of the E4 variants can increase a person’s risk of developing Alzheimer’s disease three to 15 times.

About half of those who develop late-onset Alzheimer’s, however, don’t have any E4 alleles at all. Genetic testing in asymptomatic people therefore isn’t definitive or even all that informative, say experts. For late-onset Alzheimer’s, “the predictive value of genetic testing is low,” says Mary Sano, director of the Mount Sinai Alzheimer’s Disease Research Center.

But sometimes people want information, even if it’s inconclusive. Brian Moore, whose father died of Alzheimer’s at age 89, wanted to know more about his genetic risk for the disease. Moore, 48, was better equipped than most to understand the testing: A neuropathologist who co-chairs the department of pathology at Southern Illinois University’s School of Medicine, he has performed hundreds of autopsies on the brains of people who died of Alzheimer’s disease.

Moore contacted 23andMe, a company that for $299 offers a genetic analysis of a person’s risk for more than 100 diseases and conditions, including Alzheimer’s, based on the APOE gene. The company sent him a specimen kit with a container for saliva collection that he then sent to a lab for analysis. About six weeks later, he logged on to the company’s Web site and learned that he has two E3 alleles, the most common variants, which means that his Alzheimer’s risk is average, at least as it relates to the APOE gene.

“It was reassuring,” he says. “I know it’s not determinant, and environment and lifestyle also play a role. But at least I have that base covered.”

The National Society of Genetic Counselors and the American College of Medical Genetics practice guidelines recommend against direct-to-consumer APOE testing for late-onset Alzheimer’s, in part because of difficulty interpreting the results.

Ashley Gould, 23andMe’s vice president of corporate development and chief legal officer, says that if people want help understanding their results, genetic counselors are available. The service is available by phone for a fee based on the level of service.

But in the case of the APOE gene, some experts say, the information isn’t all that helpful.
“The things we know that really impact the disease are related to lifestyle,” says George Perry, dean and professor of biology at the University of Texas at San Antonio, who is the editor-in-chief of the Journal of Alzheimer’s Disease. “Be mentally and physically active, eat a diet rich in fruit and vegetables. These reduce the risk of developing the disease by at least half.”


Reproduced by permission of Kaiser Health News (www.kaiserhealthnews.org), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Are You Taking Advantage of Medicare Health Screenings?

Are You Taking Advantage of Medicare Health Screenings?

If you or a loved one is on Medicare, it’s smart to learn about the free screenings that are now available under the Affordable Care Act (ACA).

According to Dr. Carolyn Clancy of the U.S. Agency for Healthcare Research and Quality (AHQR), these preventive and screening tests now include:

  • Bone mass measurement (also known as bone density test): Covered every 2 years.
  • Cholesterol and other cardiovascular screening: Tests for cholesterol, lipid, and triglyceride levels are covered every 5 years.
  • Colorectal cancer screening: Medicare covers colonoscopy tests once every 2 years for people at high risk; otherwise, once every 10 years.
  • Diabetes screening: Up to two fasting blood glucose tests are covered each year.
  • Flu shot: Medicare covers a shot once per flu season in the fall or winter.
  • Mammogram: Screening mammograms are covered once every 12 months. Diagnostic mammograms are covered when medically necessary.
  • Prostate cancer screening: Medicare covers a digital rectal exam once each year; prostate specific antigen (PSA) tests are covered once each year.

This is in addition to the new “Welcome to Medicare” wellness visit for people who are new to the program.

Read more about Medicare screening services on the Medicare.gov website (www.medicare.gov/coverage/preventive-and-screening-services.html)

Source: AgeWise reporting on Agency for Healthcare Research & Quality information.