Other Degenerative Diseases
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Antioxidants May Decrease Risk of Alzheimer's Disease
Alzheimer’s disease (AD) is a complex disease that spreads through
the brain. It affects some 4 million Americans, causing memory loss,
impaired thinking, and changes in personality. Scientists have suspected
that substances called antioxidants — vitamin C, vitamin E, and
beta carotene, for example — may guard against AD. However, studies
testing the relationship between antioxidant supplements and the risk
of AD have not found consistent evidence of a benefit. But now two studies
published in the Journal of the American Medical Association have
found that high intakes of antioxidants from food may reduce the risk
of developing AD.
In the first study, researchers recruited 5,395 participants with an
average age of 67.7 years, who lived independently. All participants
reported their eating habits and went through two mental state examinations
to ensure that they were free of dementia at the start of the study.
During six years of follow-up, the researchers re-screened the participants
for Alzheimer’s disease. They found that high dietary intake of
vitamin C significantly reduced the risk of developing Alzheimer’s
disease and that the reduced risk of AD from high dietary intake of vitamin
E was also borderline significant. These antioxidants were most effective
at preventing AD in current smokers, compared with current non-smokers.
Use of dietary supplements was controlled in this study, so the beneficial
effects of vitamins C and E were only from food. Vitamin C is found in
large amounts in citrus fruits, kiwi, and broccoli, and good sources
of vitamin E include nuts, milk, and egg yolk.
In the second study, participants were also free of Alzheimer’s
disease at the beginning and completed a food frequency questionnaire.
The questionnaire helped researchers keep track of the intake of certain
foods and supplements. The 815 subjects were 65 years and older, and
were followed for four years.
After adjusting for age, education, sex, race, and presence of APOE
e4 (a genetic characteristic that makes a person more likely to develop
AD), the researchers found that those with the highest dietary intake
of vitamin E were 70% less likely to develop AD than those with the lowest
dietary intake of vitamin E. However, the highest Vitamin E intake for
the study was 363.6 International Units (IU) per day, well above the
Recommended Dietary Allowance of 22 IU.
The other dietary antioxidants tested in this study, vitamin C and beta
carotene, did not reduce the risk of AD. More research will need to be
performed to find out why vitamin C proved effective in one study but
not in the other. While dietary antioxidants are proving more effective
in reducing Alzheimer's risk than antioxidant supplements, these weren't
randomized, clinical trials, so these studies won't translate into dietary
August 2002 Update
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Sertraline Effectively Treats Depression in
A large portion of the 4 million Americans with Alzheimer's disease
a progressive degenerative disease of the brain that results in
memory loss, impaired thinking, and personality change also suffer
from major depression. This can make the already devastating condition
even more difficult, not only for patients, but also for their caregivers.
Until recently, the efficacy of antidepressants in such patients was
uncertain. Now, a study from The American Journal of Psychiatry shows
that sertraline (Zoloft) a type of antidepressant known as a selective
serotonin reuptake inhibitor (SSRI) is more effective than placebo in
reducing depression in patients with AD. This study is the first to show
both the efficacy and safety of an SSRI in treating depression in patients
A team of researchers from the Johns Hopkins University School of Medicine
and the Copper Ridge Institute in Maryland selected 22 patients with
Alzheimer's disease who also met the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV) criteria for having had a major depressive
episode. Over the course of the 120week double-blind trial, the scientists
gave the patients, whose average age was 77, either a placebo or up to
150 milligrams of sertraline per day. All patients and caregivers received
illness education, encouragement, and emotional support every three weeks
over the course of treatment.
The scientists found that AD patients who had been given sertraline experienced
significantly greater improvements in mood than patients who received
a placebo. In addition, the sertraline patients experienced less decline
than placebo patients in participation indaily activities.
Side effects of the drug included tremor, restlessness, and gastrointestinal
complaints. But all were mild, and there was no significant difference
in side effects between the sertraline group and the placebo group.
April 2001 Update
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Pallidotomy for Parkinson's
Parkinson's disease results from the mysterious and progressive death
of nerve cells that produce the neurotransmitter dopamine. The death
of these cells causes cells elsewhere in the brain to become hyperactive.
During a pallidotomy a type of brain surgery the surgeon
uses electrodes to destroy the hyperactive cells. This often helps minimize
the involuntary movements that are the hallmark of Parkinson's. Late
last year, Dutch researchers reported that unilateral pallidotomy is
an effective treatment for people with Parkinson's disease. In a study
of 37 patients who were randomly assigned to undergo surgery either within
a month or six months later, the researchers noted pallidotomy patients
improved substantially over the controls. Specifically, mobility scores
of the pallidotomy group improved, while such scores deteriorated for
the control group. Shaking and disability decreased for the treatment
group, but remained constant for the controls.
Another emerging surgical treatment for Parkinson's is deep brain stimulation,
which also relies on electrodes. Rather than killing the cells, however,
the electrodes stimulate them. Similar to a pacemaker, the electrodes
remain in the brain and are controlled by a magnet the patient can keep
on his or her person. Scientists are also testing fetal tissue implants
to produce the absent dopamine, but there are obvious ethical issues
shadowing this procedure.
For more information about Parkinson's disease, including symptoms and
treatment options, see page 371 of the Family Health Guide.
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Side Effect Warnings for New Arthritis
Individuals taking Enbrel, a new rheumatoid arthritis medication,
should be advised of the following. Among patients taking Enbrel, there
have been 10 cases of low blood-cell counts, including reductions in
red and white blood cells and platelets which leave patients vulnerable
to infection. Five of the individuals who developed this serious side
effect died. Patients taking Enbrel are advised to seek medical care
if they experience any of the following symptoms: persistent fever, bruising,
bleeding, or paleness. If blood tests show significant abnormalities,
they should consider discontinuing the drug. It should be noted that
the Food and Drug Administration has stated that there is no proof that
Enbrel causes dangerous anemia.
In patients with multiple sclerosis (MS) who also take Enbrel for their
rheumatoid arthritis, the drug may increase MS symptoms. Among people
who do not have MS, but have been taking Enbrel, there have been
11 cases of patients acquiring certain demyelinating diseases, a specific
type of nerve disorder that includes MS. New cases of MS in Enbrel users
are rare, however, and, in fact, there is no evidence that MS strikes
Enbrel users more often than it strikes the general population. However,
since Enbrel might increase MS symptoms in users who already have this
condition, individuals with MS should consider these reports when evaluating
treatment options rheumatoid arthritis.
October 2000 Update
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