Abuse of painkillers, anti-anxiety meds increasingly common in people 65 and over

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More than 20 years ago Patrick Gallagher began his long, troubled acquaintance with “a guy called pain,” as he wryly puts it.

AARP.org, April 20, 2009, by Katharine Greider — In the late ’80s, Gallagher, now 68 and living in southeast Florida, had surgery for his lower-back pain. But as the 1990s wore on, he also developed excruciating upper-back and neck pain, exacerbated by worsening compression of the spinal column. This time he opted for conservative treatment, including lots of physical therapy.

By his late 50s, though, disability had forced him to quit work as a publishing executive—the traveling was too difficult—and then to abandon a beloved job in academia. He began drinking more than usual. Finally he sought the help of a back pain specialist on Florida’s west coast, who doubled his dose of a powerful opioid painkiller called OxyContin. And boy, did he get relief. “Sipping my rum punch as the moon rose over the gulf, I felt like I’d died and gone to heaven,” Gallagher recalls.

But the pills and booze began to cause serious worry for his loved ones. In 2005 they confronted him. His 13-year-old granddaughter, the apple of his eye, let him know just how much it troubled her when he would fall asleep at family get-togethers. Gallagher took the family’s intervention to heart, and he went into treatment tailored to older patients at the Hanley Center in West Palm Beach, where he would learn a whole new way of managing his pain—and his addictions.

Gallagher’s experience represents the latest twist on a very old problem: Prescription medications are now playing a major role in drug abuse and addiction. Today, narcotic pain relievers, such as Vycodin, Darvan and Demerol, are second only to marijuana as the country’s most abused drug, according to a survey by the federal Substance Abuse and Mental Health Services Administration (SAMHSA). Tranquilizers are number four on the list. And an even more disturbing statistic: Fatal poisonings from street and prescription drugs rose 68 percent from 1999 to 2004, with the increase overwhelmingly due to prescription pain medicines.

The latest stats show the drugs are responsible for more accidental deaths than cocaine and heroin combined, a “dramatic” shift in the pattern of risk, according to Leonard J. Paulozzi, M.D., who analyzes these trends for the U.S. Centers for Disease Control and Prevention. The number of fatal overdoses seems to peak in middle age, among people 35 to 55 years old. A CDC study looking at people who died of a pharmaceutical overdose in West Virginia during 2006 found that most had consumed a highly potent cocktail of opioid analgesics mixed with tranquilizers, alcohol or illicit drugs.

Substance abuse problems in general continue to be least common among adults past middle age, but there’s some evidence that prescription drugs are playing a larger role in that age group, too. SAMHSA reports that from 1995 to 2005, among people 65 and older admitted for drug treatment, the percentage whose main problem was alcohol dipped from 84.7 percent to 75.9 percent, while the group primarily abusing an opiate grew from 6.6 percent to 10.6 percent.

The simplest explanation for this trend is that many more people are being exposed to the drugs. For example, per capita retail purchases in the United States of oxycodone—the active ingredient in the opioid Gallagher took—multiplied ninefold in the decade up to 2007, according to the CDC study on overdosing. Aggressive marketing played a role in the increase, but at least as important was the determination to offer more humane treatment for chronic pain, including, if necessary, narcotic medication.

Indeed, persistent pain, risk for substance abuse, depression and anxiety are frequently parts of one complex package that requires careful sorting out, says Peggy Compton, a registered nurse and an expert on pain and addiction at the University of California, Los Angeles. But sometimes doctors who are concerned patients might be addicted to their medications simply stop treating them, without addressing the problem. “The patient is very likely in pain,” says Compton. “But they’re being sent out without any pain management, without anybody treating their addiction.”

What’s the average person’s risk of getting hooked? “The answer is we don’t honestly know,” says David Oslin, M.D., a geriatric psychiatrist and addiction specialist at the University of Pennsylvania. “But the sense is that the vast majority take these drugs in a reasonable way.”

It’s important, he says, to understand that anyone who’s on opioid painkillers for more than a month or two may experience uncomfortable symptoms—cold sweats, cramping and the like—if the drug is abruptly withdrawn rather than tapered off. This physiological dependence doesn’t mean a patient is addicted (a term used to describe a problem that’s more psychosocial and often more chronic), so that a patient’s daily life comes to revolve around getting the drugs despite negative consequences.

Who’s the most likely to get into trouble with habit-forming medications? Those with a personal or family history of substance abuse or addiction, mood disorders and childhood sexual abuse.

Full-blown addiction with the associated behaviors—going from doctor to doctor to get more medication, “losing” prescriptions and repeatedly pleading for early refills—probably occurs in at most 5 percent of patients taking the opioid painkillers chronically, says Oslin. A larger group occupies a gray area, taking opiates as prescribed, not getting relief, but very much attached to continuing the drugs rather than trying a different tack. “Are they addicted? In some sense, yes,” says Oslin.

Benzos, after all these years

Another class of prescription drugs that’s proved problematic, especially for older people, is benzodiazepines. Sometimes called benzos or “minor tranquilizers,” these drugs include Valium, Xanax, Klonopin and Ativan and are prescribed for anxiety, panic attacks and sleep disorders. The trend in the use of these drugs is quite different from that of narcotic painkillers. After widespread use in the ’60s, ’70s and ’80s, concern about abuse and dependency drove doctors to push for limiting benzodiazepines to short-term prescriptions. Even so, these pills remain a medical mainstay, with 10 percent to as many as 20 percent of older people reporting taking a benzodiazepine.

In research published in the Journal of General Internal Medicine in 2007, psychologist Joan M. Cook conducted interviews with 50 older patients in Philadelphia primary care practices who were routinely taking benzodiazepines, in some cases daily and for many years. Now an assistant professor in the psychiatry department at Yale University, Cook found the patients felt reliant on the pills, and some expressed a deep reluctance to try going off of them. “I see no reason why I should put myself through hell,” one patient told Cook. “If it makes me feel better, I’m gonna do it … We don’t have that long to live, and we might as well enjoy ourselves while we’re here.”

Feeling better is precisely the point, of course, even though getting off the drugs can be tough at first as anxiety symptoms rebound. In fact, increased well-being is the likely outcome, says Cook. As people get older, the same dose of a benzodiazepine packs more power and can slow mental functioning, cause excessive sedation and lead to falls or other accidents. As one of Cook’s subjects told her: “My head always feels foggy.”

Getting help

Experts recommend several measures to help patients kick drug dependency or addiction:

* Don’t try to stop without medical supervision.  Withdrawal from opioids is unpleasant, and can be eased with drugs like methadone or buprenorphine. (Two formulations of the latter, Suboxone and Subutex, are the first narcotic drugs approved to treat opioid addiction that can be prescribed in a doctor’s office.) Regular benzo users must slowly taper their dosage, as sudden withdrawal can cause extreme psychological symptoms and, occasionally, seizures.

* Find the right help. Patients with an addiction typically need support well beyond the detox stage. Of those who made an unsuccessful effort to get drug treatment in 2007, the number one reason was they couldn’t afford it.

* How to pay for it. Private insurance coverage can be spotty, with higher copayments and limited coverage for drug treatment. Under original, fee-for-service Medicare, there is a 50 percent copayment for outpatient substance-abuse treatment, rather than the usual 20 percent—but beginning in 2010 the copayment will gradually be reduced. Many facilities charge on a sliding scale or offer some kind of assistance.

* Consider all your options. A rehab program isn’t the only game in town, says Frederic Blow, an expert on substance-abuse issues among older people at the University of Michigan. “Treatment programs work for older individuals,” he says, “but there are lots of ways to do this, like going to mutual self-help groups, a minister or rabbi, or your primary care doctor.”

* Deal with the underlying problem. Successfully kicking a destructive prescription drug habit may also mean finding other ways to deal with the condition the drug was meant to address. In the case of benzodiazepines, this could entail learning to manage anxiety through cognitive behavioral therapy, getting more exercise and adopting better sleep habits to ease insomnia.

During his weeks at the Hanley Center, Gallagher embarked on two recovery plans. “First is my 12-step program,” he says. “I know I can’t be a husband and a father if I don’t do that.” The other is a steady, disciplined program to ease his pain, which has included aquatherapy, massage, meditation, acupuncture, nonnarcotic painkillers and simply pacing his activities through the day. “It’s amazing,” he says. “All of the sudden your life takes on totally new meaning. I would say this is the happiest time in my life.”

STAYING SAFE WITH CAGE

Have you ever…

C—felt you should Cut down on your alcohol or drug use?

A—been Annoyed by someone criticizing your drinking or drug use?

G—felt Guilty about your drinking or drug use?

E—had a drink or used a drug in the morning as an “Eye opener”  to decrease hangover or steady your nerves?

CAGE  is one of several questionnaires doctors frequently use to evaluate patients for possible substance abuse. Two or more positive responses might indicate a problem, and should be followed up with a more complete evaluation.

If you’re taking potentially habit-forming prescription drugs like opiate painkillers or tranquilizers, it’s also important to:

* Give the doctor a complete history, including other medicines you’re taking and any substance-abuse problems or mood disorders you may have experienced.

* Talk to your doctor if the prescribed dosage doesn’t seem to work and you find yourself needing or wanting more medication.

* Alert your physician if you experience side effects like sleepiness, unsteady gait or difficulties with concentration or short-term memory.

* Avoid mixing drugs like opioids with central nervous system depressants like tranquilizers and alcohol. It’s dangerous.

An ongoing debate among geneticists over the nature of common diseases.

MIT Technology Review, April 17, 2009, by Emily Singer — A trio of commentaries published online by the New England Journal of Medicine tackles an argument that has been heating up among geneticists. It looks at the usefulness of the genome-wide association studies (GWAS) that have become ubiquitous in genetics in the last few years. While such studies have identified more than 300 genetic variations linked to common diseases and other traits, taken together, they account for a relatively small proportion of the genetic risk of disease.

I explored what this might mean for personalized medicine in a feature in our January issue, “Interpreting the Genome.”

The latest data suggest that even the most common heritable illnesses, such as diabetes and heart disease, are linked to many different variants, each of them relatively rare. If that’s true, then practicing personalized medicine could become very complicated–and very expensive. “It would not be good to have a $5,000 genome and a $500,000 analysis,” says Francis Collins, the former director of the National Human Genome Research Institute and a leader of the Human Genome Project.

Thanks to relatively cheap microarrays that allow scientists to quickly scan the genome for specific variations linked to disease, researchers around the globe have been gathering data on tens of thousands of individuals with common genetic diseases, such as diabetes. With huge numbers of people in these studies, scientists can search for genetic variations that have subtler effects on disease.

Some scientists, including David Goldstein, who wrote one of the commentaries in the NEJM, argue that this approach has outlived its utility:

[It’s] hard to have any enthusiasm for conducting genome scans with the use of ever larger cohorts after a study of the first several thousand subjects has identified the strongest determinants among common variants. These initial studies for a given common disease are worth doing, since common variants do appear to explain a sizable fraction of the heritability of certain conditions–notably, exfoliation glaucoma, macular degeneration, and Alzheimer’s disease. Beyond studies of this size, however, we enter the flat or declining part of the effect-size distributions, where there are probably either no more common variants to discover or no more that are worth discovering.

Joel Hirschhorn, author of an opposing commentary, argues that a similar debate took place when GWAS were just getting started, and that the outcome of these studies was much better than naysayers predicted. He also counters arguments that the results of these studies will have little impact on personalized medicine:

The main goal of these studies is not prediction of individual risk but rather discovery of biologic pathways underlying polygenic diseases and traits . . .

Critically, genomewide association studies have also highlighted pathways whose relevance to a particular disease or trait was previously unsuspected. The genetic variants that are associated with age-related macular degeneration strongly implicate components of the complement system, the loci associated with Crohn’s disease point unambiguously to autophagy and interleukin-23-related pathways, and the height loci include genes encoding chromatin proteins and hedgehog signaling. This clustering into biologic pathways is highly nonrandom (as has been demonstrated by Raychaudhuri and Daly). Already, efforts are under way to translate the new recognition of the role of autophagy in Crohn’s disease into new therapeutic leads. As more pathways are highlighted and additional hypotheses emerge, new projects can be born.

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Shigenobu Shibata

Professor, Waseda University Faculty of Science and Engineering

Vice-Research Representative, Center for the Consolidated Research on Medical, Life Science and Engineering(*)

(*)Part of the Private University High-Tech Research Center Project funded by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)

Proving the existence of biological clock nervous centers

http://www.yomiuri.co.jp, April 20, 2009, by Shigenobu Shibata — My area of expertise is the discipline of pharmacology, which involves examining the system of the effects of pharmaceuticals. Pharmacology can be divided into two main categories. In the first category, clinical pharmacology, research is performed through the administration of pharmaceuticals to actual human patients. In the second category, fundamental pharmacology, examination of fundamental systems is performed while performing work such as animal experiments in a laboratory. I specialize in the latter, the field of fundamental pharmacology.

My work started in the pharmaceutical research of emotional nervous centers which control feelings, with a focus on mental symptoms such as depression and Alzheimer’s disease. I then proceeded to study in the laboratory of Professor Yutaka Omura (Professor Emeritus at Kyushu University), an expert in the field of cerebral physiology. While I was researching the relationship between the secretion of hormone and nervous centers for appetite/satiation, I learned that an area called the suprachiasmatic nucleus of the hypothalamus possessed the function of controlling the biological clock. This took place in the early 1980s.

In the laboratory, I performed an experiment in which I sliced the brain of a rat and then inserted electrodes in order to measure the action potential. I found that the suprachiasmatic nucleus was unique in that there were high levels of activity when sliced and measured in the morning, but low levels of activity when sliced and measured in the evening. However, subjects that were calm in the morning gradually became vital and active with the coming of morning and the afternoon. I realized that biological rhythms were the only explanation for this phenomenon. If, even when the transmission of information from other areas of the brain is cut off, the suprachiasmatic nucleus alone acts autonomously to fulfill a clock-like function, then the suprachiasmatic nucleus must be the brain center of the biological clock.

At that time, 3 different research groups from Germany, USA, and Japan had developed similar theory and were involved in experimentation. There was fierce competition to prove this theory. As the result of repeated experimentation, we were able to obtain good data and make a presentation that received global recognition.

At that time, I was still a graduate student working towards my doctoral degree. However, due to my involvement in this research, I encountered the new research field of examining the relationship between biological rhythms and pharmacology—a field which is recently attracting great attention under the name of “chronopharmacology”. Beginning from that encounter and continuing to this day, I have continued to work in this field.

New medicine created from chronopharmacology

There are many types of medicine for which effects are improved and side-effects are decreased when attention is based to the rhythm of ingestion. For example, people with hyperlipidemia are prescribed with medicine that reduces the formation of cholesterol, and this medicine is best taken in the evening. The enzymes which form cholesterol have a higher value in the evening but decrease in value in the afternoon. Therefore, it is best to conform to this body rhythm by taking more of the medicine in the evening.

Currently, I am involved in joint research with the University of Yamanashi Faculty of Medicine to examine the relationship between the biological clock and allergies such as asthma and hay fever. Itchiness, a symptom of allergies, tends to be more pronounced at night rather than in the afternoon. However, the mechanism behind this phenomenon is not yet understood. Another example is that asthma attacks occur more often at dawn. By examining the combination of the rhythm of asthma symptoms and the rhythms of medicinal effectiveness, I believe that we can understand the appropriate form of treatment to reduce the severity of symptoms.

In 2007, through joint research with the National Institute of Advanced Industrial Science and Technology and the University of Tsukuba, it was discovered that medicine (fibrate medicine) for the treatment of hyperlipidemia acts to alter the biological clock. When such medicine was administered to a laboratory mouse, the time that the mouse was active became earlier. Therefore, there is the possibility to link these findings to the development of medicine for “delayed sleep-phase syndrome (DSPS)”, a sleep disorder in which the biological clock becomes fixed to a pattern of late-night activity and late awakening in the morning. Until now, the only treatment available for sleeping disorders was symptomatic treatment such as sleeping medicine, so there are high expectations for the development of new types of medicine.

The above are just a few examples. In actuality, I believe that the effectiveness of many types of medicine can be improved through attention to the relationship with the biological clock. I also believe that new medicine and methods of treatment can be developed. There are great expectations for contributions to medicine from chronopharmacology.

circadian

Even healthy people experience respiratory stenosis at night (upper graph). / When the suprachiasmatic nucleus is destroyed in an experiment using mice, biological rhythms for day and night are lost and respiratory stenosis occurs (lower graph).

Approach towards “chrono-nutrition”

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Measurement of lifestyle rhythms using an actigraph

Recently, I am involved in research regarding nutritional intake and the biological clock, based on reasoning similar to chronopharmacology. This new field is known as “chrono-nutrition”. There is a high level of interest from the general public regarding this field, and we are involved in a variety of projects.

Through research aid given by JAXA (Japan Aerospace Exploratory Agency), our laboratory performed research to compare “morning people” and “night people” in terms of the relationship between the biological clock and lifestyle rhythm factors such as mealtime, exercise, and sleep. The Waseda University Women’s Lacrosse Team participated in the experiment as the “morning people” group, due to their habit of waking at the same time every morning to engage in morning practice. The difference between this “morning people” group and other types of people was then examined. All participants in the experiment wore an actigraph, a wristwatch-type measurement device that costs 100,000 per device, and activity amounts throughout the day were measured in detail.

As a result of this experiment, it became clear that the greatest influence on the biological clock was exerted by mealtime, rather than by exercise. This means that it is easier to maintain the biological clock by having meals at a set rhythm, rather than by adjusting the time and amount of exercise. Methods for maintenance of the biological clock are an important issue in an outer space environment. If the knowledge gained from our research can be skillfully applied, it will become easier to control the biological clocks of astronauts.

Although one day consists of 24 hours, people are active according to a biological clock with a 24.5 hour rhythm. In order to lead a well-regulated daily life, it is necessary for people themselves to adjust for this 0.5 hour discrepancy everyday. However, this is a difficult task. Even when viewing the data of students from the laboratory, the students are not able to skillfully adjust for this discrepancy.

Actually, my personal actigram (a graph of data for activity amount) shows a 24 hour cycle that is surprising in its accurateness. This is something that I can be proud of. I suppose this means that my personal lifestyle is an embodiment of the mealtime and sleep rhythms that I research. The MEXT (Ministry of Education, Culture, Sports, Science and Technology) is promoting a public campaign for “Early to Bed, Early to Rise, and a Good Breakfast”, and I am often asked to lend them my lifestyle data as an example!

tempBy using a high-capability actigraph (upper graph), rhythms for sleeping and awakening can be measured in detail from the time a person enters sleep until the person rises in the morning. Temperature of feet was also simultaneously examined (lower graph), and it can be seen that release of heat occurs together with going to sleep.

Construction of an evaluation library for herbal medicine

Chronopharmacology for herbal medicine is an area that I would like to enter in the future. As is widely known, herbal medicine consists of a combination of various medicines and has a fundamental philosophy of making prescriptions that match the constitution of the patient and that improve the patient’s constitution while performing treatment. This differs from Western medicine, which is based on symptomatic treatment. Prescription of herbal medicine has relied on the accumulation of experience throughout its long history, and a formal pharmacological evaluation has not been performed. Japanese manufacturers of herbal medicine conduct strict examinations regarding the safety of ingredients, but they do not have much excess resources to engage in pharmacological evaluation. Herbal medicine is attracting increased attention from Europe and USA, and has the possibility to spread on a global level if strict evaluations are established and standardization is performed.

I believe that the concept of chronopharmacology, which is based upon rhythms of the biological clock, is a good fit for evaluating the effectiveness of herbal medicine, which seeks to improve the user’s constitution while working in the body over a long period of continued use. It can be thought that, in terms of herbal medicine, a disrupted constitution is akin to a disruption in rhythm, and that improvement of the constitution is achieved through adjustment of rhythms.

Prescriptions of herbal medicine use delicate combinations of medicine. However, when conducting a pharmacological evaluation, it is necessary to delve one level deeper when evaluating, from the level of medicine to that of chemical compounds. It is also necessary to construct a library regarding these compounds. This library should contain profiling of combinations used in prescriptions for herbal medicine. I envision an evaluation database of herbal medicine constructed using the two pillars of a “compound library” and “profiling”.

Towards the next step of research through the fusion of medicine, science, and engineering

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Operation on a mouse and view of the laboratory

Another theme which I would like to become involved in is the development, through a fusion of medicine, science, and engineering, of research for biological rhythms at a cellular level. My laboratory is part of TWIns (Tokyo Women’s Medical University / Waseda University Joint Institution for Advanced Biomedical Sciences), and there are researchers from Tokyo Women’s Medical University who are working in advanced regenerative medicine engineering. I am currently planning joint research to bond cells into a variety of forms and to examine the functions of biological rhythms through the relationship with forms. This research will be performed through a partnership with the cell sheet engineering possessed by researchers of Tokyo Women’s Medical University. Form and function are in a deep relationship, and functions are often discovered by creating types of forms.

Among researchers from Waseda University at TWIns, there are several researchers, including myself, whose work relates to biological rhythm research. There has been discussion about creating a tangible summary of the knowledge gained by each of these researchers. As a result of these discussions, a new lecture course in “chronobiology” will be opened in 2010 for undergraduate and graduate schools. Researchers will cooperate to hold the lectures. I am looking forward to seeing what kinds of lectures are developed

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Mouse room

I enjoy myself the most when I am having discussions with students. We can freely develop theories on a variety of topics, such as the types of lifestyles that lead to obesity. Experiment work is very tedious and methodical. For this reason, it is important to hold discussions so that researchers can step back and review their objectives from a objective point of view, and so that excitement can be infused into the work.

About Shigenobu Shibata
Professor, Waseda University Faculty of Science and Engineering
Vice-Research Representative, Center for the Consolidated Research on Medical, Life Science and Engineering(*)
(*)Part of the Private University High-Tech Research Center Project funded by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)

Graduated from the Kyushu University School of Pharmaceutical Sciences, Department of Pharmaceutical Sciences in 1976. Completed his Doctorate Degree at the Kyushu University Graduate School of Pharmaceutical Sciences in 1981. Doctor of Pharmaceutical Science. Served as Research Associate and Associate Professor at Kyushu University and then as Research Fellow at the State University of New York. From 1995, served as Associate Professor and then Professor at the Waseda University School of Human Sciences. In 2003, assumed the position of Professor at the Department of Electrical Engineering and Bioscience in the School of Advanced Science and Engineering. Major research themes include pharmaceuticals which act upon the biological clock, as well as molecular biology research and pharmacological research regarding body rhythms. Received the PSJ Award from The Pharmaceutical Society of Japan in 1994. Has served various positions including Vice-Chairman of the World Federation of Societies for Chronobiology and Director of the Japanese Society for Chronobiology.

Shigenobu Shibata Laboratory

http://www.waseda.jp/sem-shibatas/

Embryonic stem cells used to regenerate hair on mice

 

GoogleNews.com, April 20, 2009, by Yomiuri Shimbun — A university lecturer has succeeded in regenerating hair on mice using embryonic stem cells, an achievement that could pave the way for the development of treatments for conditions including hair loss, it has been learned.

Details of the breakthrough, by Mariko Yamaki of Matsumoto Dental University, will be published in the May edition of The Japanese Society for Regenerative Medicine magazine.

The work involved taking skin cells and combining them with mesenchymal stem cells–multipotent stem cells that develop into various organs of the body–to regenerate hair. Yamaki said it would be difficult to regenerate hair using only embryonic stem cells.
Yamaki extracted mesenchymal stem cells taken from the teeth of mice embryos and mixed them with mice embryonic stem cells, which form the basis of skin cells. The clumps resulting from the mix were then nurtured.

It was later found that about 40 percent of the 48 clumps had one or two hairs growing from them. When protein, which quickens growth, is added, the hair growth rate increased to about 60 percent, Yamaki said.

Hair growth was observed on all 12 mice that had the clumps implanted on their back muscles.

Hair papilaries, which supply nourishment to the hair, also were found to have formed on the back muscle.

“If embryonic stem cells are combined with mesenchymal stem cells, which perform a number of other functions, a different organ can probably be created,” Yamaki said. “The first thing I want to try to do is regenerate hair using human embryonic stem cells.”

The New York Times, April 20, 2009, by Roni Caryn Rabin — People with Type 2 diabetes may be at increased risk for developing dementia as they age, several studies have suggested. Now researchers say the higher odds may be linked to life-threatening drops in blood sugar, or hypoglycemia, usually caused by excess insulin.

A long-term study of thousands of older patients with Type 2 diabetes in Northern California found that those who had experienced even one episode of hypoglycemia serious enough to send them to a hospital were at higher risk for developing dementia than diabetic patients who had not experienced such an episode. With each additional episode, the risk of developing dementia increased, the study found.

The findings, to be published on Wednesday in the Journal of the American Medical Association, are significant given the high rates of Type 2 diabetes around the world, and the expectation that dementia rates will increase as the population ages.

“We’ve known for some time that patients with Type 2 diabetes are at greater risk of dementia and cognitive problems,” said Rachel A. Whitmer of the Division of Research at Kaiser Permanente in Oakland, Calif., one of the authors. “This adds to the evidence that balance of glycemic control is important, and that trying to aim for a very low glycemic target might not be beneficial and might even be harmful.”

The study found that the risk of dementia among patients who had experienced a single episode of hypoglycemia that required hospitalization was 26 percent higher than the risk for patients who had never had an episode.

Patients who had experienced two episodes faced an increased risk of 80 percent, while those who had experienced three episodes or more had a 94 percent increase in risk, or almost double the odds of developing dementia.

“To see an effect after just one episode is remarkable,” said Dr. Alan M. Jacobson, a researcher at the Joslin Diabetes Center in Boston. An earlier study of Type 1 diabetes and dementia found no connection, Dr. Jacobson noted.

Researchers gathered their data from 16,667 Kaiser Permanente patients with Type 2 diabetes. They used hospital data to determine how many had experienced severe hypoglycemic episodes from 1980 to 2002 and how many had first received a diagnosis of dementia from 2003 to 2007, when their mean age was 74 to 78.

This article “Study Finds Risk of Dementia Increases After Hypoglycemia” originally appeared at The New York Times.

AARP.org, Ventura County Star, Apr. 20, 2009,by Tom Kisken — The number of Ventura County residents with Alzheimer’s disease will more than double over two decades, intensifying the pressure on families to provide care and ratcheting up needs for government assistance, according to a statewide report.

Like the tightening vise on Social Security and Medicare, the projected rise in dementia comes from the legions of aging baby boomers. Not only are there greater numbers of people growing old but more will reach their 80s and 90s, increasing their chances of Alzheimer’s.

Across California, the 588,208 people with Alzheimer’s in 2008 will accelerate into more than 1.1 million people with the disease in 2030, according to a study compiled for the California Council of the Alzheimer’s Association.

In Ventura County, the increase will be greater, based on projections of the numbers of residents 55 and older in 2030. There will be about 26,301 people with Alzheimer’s in the county, compared with 12,541 in 2008, according to the study released in February.

“It’s going to be devastating. We’re talking epidemic numbers,” said Rhonda Spiegel, executive director of the Alzheimer’s Association, Central Coast Chapter, referring to the nationwide increase. “If the government is smart, they’ll put more money into research so we don’t get there … research not just for a cure but for prevention of Alzheimer’s.”

Unless things change, the pressure of caring for people with varying levels of dementia will fall primarily on families. Some observers predict more people in what is known as the “sandwich generation” will be trying to take care of both their own children and their confused parents. Others predict more spouses in their 80s and 90s caring for a husband or wife with severe dementia.

“I think there are common misconceptions that there is a government program that is going to help,” said Christine Voth, grants and planning manager for the Ventura County Area Agency on Aging. “That is not the case. There is very limited funding.”

Medicare covers little Alzheimer’s care. Medi-Cal offers some long-term coverage but only for poor families and rarely for in-home Alzheimer’s care. Private long-term care insurance is often expensive.

Often it’s wives or daughters who end up providing the care, said Patrick Fox, co-director of the Institute for Health and Aging at UC San Francisco. About 75 percent of Alzheimer’s caregivers in California are women, according to the study.

But the recession is pushing them away from the unpaid work of watching out for a family member, Fox said.

Fox co-authored the statewide study and said it’s a wake-up call that should push lawmakers and families into planning for the future.

“If we only think of finding a cure and we don’t tend to these other things, like how we are going to cope as a family and as a society, we could really be in bad shape,” he said.

Dr. Jeffrey Allan, a Camarillo geriatrician, said the good news is that care for Alzheimer’s is getting better, particularly in terms of medication. He also said the projected surge in numbers doesn’t mean individuals have a dramatically greater chance of getting Alzheimer’s. Instead it shows there will be more seniors living longer.

Talk to baby boomers and some openly speculate about their chances of developing Alzheimer’s.

“The possibility it could happen to me — I’m not sure scary is the right word, but it concerns me,” said Gene Mancini, a 60-year-old environmental consultant from Camarillo.

Sue Hanlon, a 59-year-old special education teacher from Camarillo, said she’s not alarmed. “I have four children, so I figure they’ll get to worry about it, not me,” she said.

Beverly Genson, 76, takes care of her 77-year-old husband, who has dementia. She has no doubt the predicted increases will come true.

“You hear that cancer touches every family,” she said. “It’s equally true with Alzheimer’s.”

She, too, pushes for people to open their eyes and learn about the disease.

“I don’t know if you have to be frightened,” she said. “You have to be aware.”

chrysler

The automaker wanted U.S.-based manufacturing and a flexible battery design.

MIT Technology Review, April 17, 2009, by Kevin Bullis — This week, Chrysler announced that it will use batteries from A123 Systems in its planned electric vehicles and plug-in hybrids, the first of which will be available in small demonstration fleets by the end of the year. The automaker will use a modular battery system that the two companies developed together over the past three years.

Chrysler chose A123 in part because the company was looking for a supplier based in the United States, says Lou Rhodes, the vice president of advanced vehicle engineering at Chrysler. A123 is based in Watertown, MA, and is building factories in Michigan. The company’s battery cells–the basic components of a battery pack–met Chrysler’s performance and safety specifications, and the company was developing battery modules that could be easily adapted to fit different vehicles. This was important, Rhodes says, because the automaker plans to start selling several different electric vehicles at around the same time.

A123 and Chrysler developed battery systems that use the same battery cell–one with a flat shape known as a prismatic cell–rather than tailoring the cells’ chemistries for each different vehicle. Rhodes expects that this will lead to larger volume production for the battery cell, which could drive down costs. The companies also developed battery modules–units that consist of a collection of cells with safety systems and electronic controls. The modules are designed so that the number of cells in each, as well as the voltage, can be varied according to the application. Finally, the companies developed battery packs for each vehicle. These comprise a varying number of modules arranged in different ways, depending on the configuration of the vehicle.

A123’s technology also lent itself to relatively simple battery packs, Rhodes says. The cells use a lithium iron phosphate electrode that is chemically much more stable than the lithium cobalt oxide used in most laptops and in some electric vehicles. Cobalt oxide batteries have been known, in very rare cases, to catch fire in laptops. To prevent this in the much larger and potentially more dangerous battery packs in electric vehicles, companies such as Tesla Motors have designed elaborate cooling systems that carry coolant past each of the thousands of cells in the pack. Because iron phosphate cells are less prone to overheating, the coolant system can be far simpler. The battery modules sit on a heat sink–flat metal sheet–which is cooled by a coolant loop.

A123’s battery chemistry does have a disadvantage compared with some other types of lithium ion batteries, including cobalt oxide. It stores less energy, which would limit the range of a car. But Chrysler is making up for this in part by taking advantage of the battery’s stability. Cobalt oxide deteriorates quickly if a battery is completely discharged and recharged; to make such batteries last longer and keep them more stable, they’re typically electronically limited to using only half of their energy. But A123 says that its iron phosphate batteries can be discharged almost completely without degrading; the result is that more of the energy in the battery can be used. In Chrysler’s electric vehicle, the battery pack can be discharged to 10 percent charge to provide a range of up to 200 miles–comparable to the range in similarly sized batteries with chemistries that store more energy.

At a press conference at the New York Auto Show earlier this week, Chrysler’s president, James Press, emphasized that the cars will be produced domestically. “In our tradition of being the quintessential American company,” he said, “we’re partnering with A123 Systems, which is Massachusetts based, and we’re going to build a factory in Michigan, and build all-American batteries for our cars.”

The decision could help promote an advanced battery industry in the United States, assuming the foundering automaker can stay afloat. A123 Systems is building factories in Michigan to manufacture battery cells and modules and assemble these together to make battery packs, and Chrysler hopes to provide a market for those batteries.

Right now, almost all advanced battery makers build their batteries overseas, including A123, although it has a pack assembly facility in Massachusetts. The company has started construction on the first factory, with help from the state of Michigan, but David Vieau, A123’s CEO, says that further help in the form of loans or grants from the federal government could help the company scale up its operations. A123 has applied for $1.8 billion under a loan program that was funded late last year. The company may also apply for grants made available under the stimulus package passed in February.

newfound

Newfound lichen species named for Obama  So named ‘for the president’s support of science and science education’

LiveScience.com, April 18, 2009 — A newly discovered species of lichen — a plant-like growth that looks like moss or a dry leaf — has been named after President Obama.

Kerry Knudsen, lichen curator of the University of California, Riverside Herbarium, discovered the species in 2007 while doing a survey for lichen diversity on Santa Rosa Island in California.

“I named it Caloplaca obamae to show my appreciation for the president’s support of science and science education,” he said. “I made the final collections of C. obamae during the suspenseful final weeks of President Obama’s campaign for the United States presidency.”

C. obamae, the first species of any organism to be named in honor of President Obama, grows on soil and almost became extinct during the days of cattle ranching that spanned nearly 100 on Santa Rosa Island.

“This species barely survived the intensive grazing of cattle, elk and deer on Santa Rosa Island,” Knudsen said. “But with cattle now removed, it has begun to recover. With future removal of elk and deer — both of which were introduced to the island — it is expected to fully recover.”

Lichens, which grow slowly and live for many years, result from fungi and algae living together.

There are about 17,000 species of lichen worldwide, with some 1,500 species reported from California. More than 300 lichens have been reported from Santa Rosa Island, almost as many species of native plants on the island.

“C. obamae teaches us that possibly other species of lichens and plants unique to Santa Rosa Island may have disappeared, without ever being known to science, since sheep ranching began there in the 1850s,” Knudsen said.

Knudsen published his discovery in the March issue of the journal Opuscula Philolichenum.

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