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Brain and Nervous System
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Other Degenerative Diseases

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Dietary 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 recommendations.

August 2002 Update

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Sertraline Effectively Treats Depression in Alzheimer's Patients

A large portion of the 4 million Americans with Alzheimer's disease (AD) — 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 with AD.

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 Drug Enbrel

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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