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Medical News Tips From The Duke Aging Center

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Duke Health News 919-660-1306

What Did I Need at the Grocery Store?

Can't recall what items
were on your grocery list? Forget who cuts your grass every Saturday?
The ability to store new memories and retrieve old ones declines with
age, even in the absence of brain-altering conditions like stroke and
Alzheimer's disease. And while researchers are spending millions to
understand diseases that rob elderly people of memory and cognition,
they are just beginning to understand the natural decline of brain
function with age.

The answers are more than just academic, said David Madden, professor of medical psychology in the department of psychiatry.

"Learning
how the healthy, aging brain functions can help us distinguish between
normal memory decline versus abnormal brain events, like stroke,
depression or disease-related dementia," Madden said. "Without a
baseline to compare it against, how can we know by looking at a brain
scan that something abnormal has occurred?"

In a series of
imaging studies aimed at defining what is "normal" in the aging brain,
Madden found that older adults store and retrieve information at a
slower rate than young adults. In addition, older adults require more
"brain power" than younger folks, meaning that they engage more brain
regions to accomplish the same level of memory and recall as a younger
person.

While young adults used their right prefrontal cortex to
memorize a list of words and then distinguish these words from a group
of newly presented ones, older adults used prefrontal regions in both
hemispheres. Madden measured these effects using positron emission
topography, a brain imaging technique that illuminates regions of
increased blood flow in the brain and hence tells researchers what
regions are being used during particular brain tasks.

"Essentially,
what we have shown is a form of functional compensation, in which
age-related increases in some brain regions compensate for the
decreases occurring in other regions," said Madden.

While the
speed and accuracy of memory processes had slowed in older adults, the
fact that older adults can recruit other brain regions to assist them
in memory suggests that the brain is still adaptive late in life,
Madden said.

Madden can be reached at (919) 660-7537.

Best Medicine For Families Doesn't Come from the Doctor

"I
swore with every fiber of my being that I would never put my husband in
a nursing home. I had made him give me the same promise. I took care of
him at home for 12 years. My doctor finally said to me, 'You must put
Jack in a nursing home or you'll die, and then we'll put him in a
nursing home.'

"In my heart of hearts, I knew he was right. But
now I have so many concerns about the care he's getting. There are
nights I can't sleep. I feel I have abandoned him, though I visit him
almost every day. I am not sure this is a better answer."

For
this distraught spouse of a man with Alzheimer's disease, the best
medicine she can give and receive comes in the form of love, support
and understanding. Without a cure, a remedy or even a certain
diagnosis, Alzheimer's support programs fill in the gap where medicine
has yet to provide relief.

Lisa Gwyther knows this all too well.
As director of the Duke Family Support Program, Gwyther has ministered
to hundreds of spouses, children, sisters and brothers of patients with
this devastating illness. While medicine has fallen short of offering
the remedies that stave off the memory and behavioral decline so
typical of this disease, support programs can teach families how to
cope with the loss of their loved one's former abilities.

With a
staff of two, Gwyther serves families members throughout the state of
North Carolina, but with far more than the usual counseling and
support. Gwyther has written manuals that cover everything from
financial considerations to cutting-edge research and has developed
specialized education and training programs for families and health
care professionals alike.

Her extensive outreach efforts have
earned her program the 1999 Agency of the Year award from the North
Carolina chapter of the National Association of Social Workers, (NASW)
and her only social worker was named social worker of the year by the
NASW and social worker of the year by Duke in 1995.

"We've
developed a national reputation for excellence as a technical
assistance and training center, and we've done that with no increase in
state funding in 15 years," Gwyther said. "We provide support for
family members, but we do much more - we train health professionals, we
organize a regional Alzheimer's conference for families and health care
professionals, and we staff a hotline."

From tips on dealing with
behavior changes to translating the research findings discovered by
scientists in the Joseph and Kathleen Bryan Alzheimer's Disease
Research Center of Duke, Gwyther and colleagues Edna Ballard and Claire
McDonnell have built a model program used as a template by their
colleagues around the nation, said Kathy Boyd, executive director of
North Carolina chapter of the National Association of Social Workers.

Gwyther can be reached at (919) 660-7510.

New Treatments for Alzheimer's

Can
a herb or a drug that reduces inflammation help stave off Alzheimer's
disease -- or even prevent it? Researchers at Duke don't know, but they
think it's worth testing.

Alzheimer's disease is still a
devastating, mysterious malady, but it seems to have turned a bit of a
corner, according to Dr. Murali Doraiswamy, director of clinical trials
in Duke's psychiatry department.

Clinicians have been heartened
that symptoms of the disorder have become more treatable due to the
two-year-old drug Aricept, which aids memory, thinking and general
functioning in some AD patients. The disorder affects the ability of
brain cells to pass signals, and Aricept helps boost that signal
transmission. Now Doraiswamy and other researchers at Duke are looking
at ways of giving Aricept a one-two punch by combining it with other
medications. One ongoing clinical trial pairs Aricept with the common
anti-oxidant vitamin E; another links it with a powerful new type of
anti-inflammatory drug called a cox-2 inhibitor.

Based on a line
of research that suggests brain inflammation is central to the
Alzheimer's disease process, Duke researchers are also studying the
ability of a cox-2 inhibitor to help prevent, or at least slow, the
onset of the disease. They are also looking at the effects of gingko
biloba, a herb said to enhance memory function, in preventing
forgetfulness in patients who have a family history of Alzheimer's
disease.

Doraiswamy can be reached at (919) 684-5933.

Move Over Viagra; Some Men Need More than a Pill

Viagra
is touted as the wonder drug for aging men who've lost their sexual
prowess. But a much more insidious condition may be at work in men who
have the symptoms of low sex drive or inability to perform. The dreaded
disorder is hypogonadism or testosterone deficiency, and it affects up
to half a million men in the United States alone. Although men over 60
are at greater risk, it can affect men of all ages, causing a multitude
of social and physical concerns.

Men who have it frequently
experience unexplained fatigue, loss of sexual interest or function,
sparse facial hair, osteoporosis or spinal fractures, and increased
body fat. And while good treatments do exist, they have traditionally
been cumbersome or carry a number of unpleasant side effects.

Now,
doctors at Duke are testing a testosterone derivative in gel form that
may hold the same benefits of traditional testosterone replacement
therapy but without the side effects. Because the gel contains a
derivative of testosterone, called dihydrotestosterone, it doesn't pose
the same risks to the prostate as could a recently approved
testosterone gel, used for younger men with the same condition.

If
the new gel proves more successful in clinical trials at Duke and
elsewhere, it could replace existing therapies, which Duke doctors say
are impractical: intra-muscular injections, skin patches and pills.
Injections require biweekly visits to the doctor and cause serious
fluctuations in hormone levels; skin patches can cause allergic
reactions to the skin and often don't adhere well due to perspiration;
and pills must be taken three times daily and held under the tongue
until they dissolve to prevent liver toxicity. The new gel need only be
applied once a day to the forearm or chest. Its alcohol base allows the
gel to evaporate quickly, leaving the testosterone derivative to be
absorbed throughout the day. Dr. Thomas Weber of Duke said the clinical
trial should confirm its safety and effectiveness in older men.

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