Health for life

Two points deserve emphasis:

1) Physician liability insurers (the companies that defend physicians against allegations of malpractice) are paying close attention and could use information like this in their underwriting.  It seems some are ready to conclude that bad EHRs can not only lead to patient injury, but may deserve increased premiums.

2) Nothing spurs action more than the threat of an outside or unfriendly regulator or government entity willing to independently collect this kind of information and act on it.  The DMCB wonders if that was one ingredient in the formation of this initiative.

The DMCB is looking forward to seeing the numbers in the coming months.  Stay tuned!

Baby boomers have long been spending millions to save their sagging skin, fix their crows feet, and plump their lips. Now, however, boomers are turning to brain boosters to fight an invisible effect of aging: memory loss.

While body parts sag and wrinkle, the brain actually shrinks with age, neural connections slow down, and fewer nerve cells are created, experts explain.
The process begins as early as your 30s and affects tens of millions of Americans, leaving them not only frustrated but also causing a loss of self-confidence, social impairment, and loss of enjoyment of life that can sometimes lead to self-neglect and serious health issues.

To thwart age-related memory loss, many people have turned to brain exercises and brain games such as chess, crossword puzzles, reading aloud, brushing teeth, and computer games like MindFit and Posit Science that promise mental sharpness if you practice enough.

But do those activities really work?


Brain Booster No.1: Exercise

Exercising is one of the most frequently cited activities to improve age-related memory.

"The one that has the most robust findings is physical exercise," says Molly Wagster, PhD, chief of the behavioral and systems neuroscience branch division of the National Institute on Aging.

And it helps if the exercise is aerobic, Wagster says. Studies have shown that older people who exercise -- and were talking fairly easy exercise of moderate walking a few times a week -- outperformed couch potatoes after six months.

Experts do not fully understand why exercise helps boost brainpower, but it could be for several reasons. First, exercise diminishes stress, a key drain of brain energy, and it also helps overall health. It also helps people sleep better, which improves memory and keeps the blood flowing to all parts of your body.

"In general, whats good for the heart is good for the brain," says Gary Small, MD, director of the UCLA Center for Aging and author of iBrain, which examines, among other things the effect of the Internet on our brains.
Brain Booster No. 2: Eating a Rainbow of Fruits and Vegetables

Experts stress that people must pay attention to their diets and eat a variety of fruits and vegetables, five to seven servings daily ranging from leafy greens to blueberries to tomatoes to sweet potatoes. While there is no one "brain food," antioxidants -- which are often found in fruits and vegetables -- help to curb free-radical damage to cells.

"Our brain kind of gets rusty with age," explains Small.

Also, experts say theres no magic brain vitamin or supplement that will protect against memory loss. P. Murali Doraiswamy, MD, chief of biological psychiatry at Duke University Medical Center and author of The Alzheimers Action Plan, says that B vitamins may help, as could the spice turmeric, but that studies are inconclusive.

Brain Booster No. 3: Mental Workouts

To keep your brain sharp, many experts say, you need to challenge it regularly.

"Its just like it is with muscles," says Randolph Schiffer, MD, director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

There is some evidence that mental gymnastics can help preserve memory, but some of the promises of computer games outstrip the reality of the benefits, researchers say.

"Nothing has met the gold standard," explains Doraiswamy. "If they had, theyd all be sold as prescription drugs."

Still, the games cant hurt, says Brenda Plassman, PhD, a professor in the department of psychiatry at Duke University Medical Center and the principal investigator of the Aging, Demographics and Memory Study. Plassman says she would simply caution older people not to spend money on something that hasnt been proved to work to help age-related memory loss.

"I would encourage people to look at various options for free," says Plassman.
Brain Booster No. 4: Sleep

Healthy sleep patterns are crucial for cognitive performance, especially memory, the experts say. That means at least seven hours of sleep each night.

Sleep is essential to lower levels of stress hormones, to relax and resh your entire body, and to literally turn off your brain. "There are parts of sleep where memory gets archived," says Doraiswamy.

While it may be tempting to take over-the-counter -- or even prescription -- sleeping medications, be aware that many may impair memory. Check with your doctor about side effects of sleep medications, as well as all drugs.

Also, limit your intake of alcohol if you experience sleeping problems, as it can disrupt sleeping patterns.
Brain Booster No. 5: Red Wine

Some studies indicate that red wine is good for the heart and thus the brain, the experts say. Not all the reasons are understood, but many researchers believe red wine may be good for you because it contains the antioxidant resveratrol.

There is a possibility, however, that the benefits associated with red wine could come from other factors, such as the social aspect of wine drinking or income level associated with those who drink wine.

A 2007 study of elderly Italians showed that drinking alcohol in moderation may slow the progression to dementia in elderly people who already have mild mental declines. Defined in the study as less than one drink a day, low to moderate drinking was associated with a significantly slower progression to dementia among people with mild age-related cognitive declines, compared with nondrinkers.
Brain Booster No. 6: No More Multitasking

One of the biggest causes of failing to remember something, explains Small, is that "people arent paying attention."

"As our brain ages, its more difficult to do several things at once," says Plassman.

Multitasking thus becomes an impediment to remembering names, a recipe, or something you just read. Thats because the brain first has to encode information before it can retrieve the information as memory. Unless the brain is paying attention and taking in the information it will later need, the brain cannot encode the information.

Brain Booster No 7: Learning New Memory Tricks

Small, who also authored the best-selling book The Memory Bible, says he teaches a technique called "look, snap, connect" in which participants are taught how to focus on someone or something and make a connection that will help them remember.

"These kinds of techniques can be learned very quickly," Small adds.

Long-practiced strategies such as linking a persons name to something else or another person are also helpful, or using sound associations, says Plassman. Check your local library, senior center, or hospital to see whether free classes might be offered.

While age-related memory loss is typically minor, be on the lookout for more serious memory loss in yourself or a loved one. "Forgetting where you parked your car is one thing," says Doraiswamy. "Forgetting that you have a car is another."

If memory loss is making an impact in your everyday life or getting worse, consult with a doctor.

Also, try to laugh a little about the age-related memory loss while doing what you can to curb it. While the loss is real, its not as if you are losing control of your brain. The loss is relatively subtle, and in most cases, your brain still works like the incredible organ that it is.

A large-scale National Eye Institute study has shown fish oil supplements containing omega-3 fatty acids do not alter the progression of age-related macular degeneration, says a national team of researchers including David M. Brown, M.D., an retina specialist at The Methodist Hospital who ran Houstons part of the study.

Another key finding of the Age-Related Eye Disease Study 2, or AREDS 2, is that lutein and zeaxanthin may be safer than beta-carotene in reducing risk of disease progression.

"If you look at all the analysis performed in the AREDS 2 study, it looks like lutein taken with zeaxanthin is at least as effective and may be better than beta-carotene," Brown said. "If you also consider that beta-carotene was associated with increased lung cancer rates in all former smokers, I no longer recommend any formulations containing beta-carotene."

Researchers saw a modest decrease in the development of age-related macular degeneration (AMD) among those who took high amounts of zinc, but that result was not statistically significant.

"Millions of older Americans take nutritional supplements to protect their sight without clear guidance regarding benefit and risk," said NEI director Paul A. Sieving, M.D., Ph.D. "This study clarifies the role of supplements in helping prevent advanced AMD, an incurable, common, and devastating disease that robs older people of their sight and independence."

Like beta-carotene, lutein and zeaxanthin can be converted to vitamin A in humans and can collect at the retina, where they probably limit chemical damage caused by light. Lutein is found in foods like egg yolk and animal fat deposits. Zeaxanthin is found in some berries, corn, and paprika.

AREDS 2s results agree with past studies that have shown an association between beta-carotene consumption and the development of lung cancer in current or former smokers. About half of AREDS 2 participants reported having been smokers at some point in their lives.

Macular degeneration is a disease in which retina damage causes a loss of visual acuity in the center of the eye, called the macula. AMD is a major cause of blindness in the elderly, and currently affects about 11 million Americans. National Eye Institute experts believe that number will double by 2050.

About 12 years ago, the National Eye Institute began funding studies to look at how diet and dietary supplements affect the progression of the disease. AREDS showed a 25 percent decreased risk of AMD when study participants took vitamin C, beta-carotene (a precursor to vitamin A), vitamin E, zinc, and copper (called the AREDS Formulation).

The five-year AREDS 2, which began in 2006, was a national study of more than 4,200 people. It suggests fish oil supplements probably do not need to be added to the formulation, and that lutein with zeaxanthin might replace beta-carotene in the AREDS Formulation, since lutein is not associated with increased risk for lung cancer.

"The first AREDS study showed us that vitamins really make a difference in decreasing the complications of AMD," Brown said. "Now with the AREDS 2, we have solid data on what to recommend to our patients. Based on the AREDS 2 data, I now recommend that my patients no longer take beta-carotene but look for a vitamin with 10 mg Lutein, 2 mg zeaxanthin, 80mg zinc, 2mg copper, 500mg vitamin C, and 400 IU vitamin E."

A new study has found that drinking-related hypertension has a higher risk in flushers than in non-flushers, and the risk of hypertension was significantly increased when flushers consumed more than four drinks per week.

Excessive drinking is a known risk factor for hypertension. Drinking that results in facial flushing indicates high sensitivity or even intolerance to alcohol. A study of the relationship between drinking and these two conditions has found that drinking-related hypertension has a lower threshold value and higher risk in flushers than in non-flushers.

Results will be published in the April 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Facial flushing after drinking is always considered as a symptom of high alcohol sensitivity or even intolerance to alcohol, unless a patient is taking special medicine," said Jong Sung Kim, head of the department of family medicine at Chungnam National University School of Medicine. "The facial flushing response to drinking usually occurs in a person who cannot genetically break down acetaldehyde, the first metabolite of alcohol."

"Facial flushing after alcohol drinking differs across gender, age, and ethnic groups," added Kyung Hwan Cho, president of the Korean Academy of Family Medicine. "In general, it is more common in women, the elderly, and East Asians versus Westerners."

Cho noted that it is well known that excessive alcohol consumption is associated with elevated blood pressure and the likely development of hypertension. "This association persists regardless of beverage type and shows a dose-response relationship, which means excess drinking for weeks or months can increase blood pressure," he said. "However, the relationship may vary by gender, race/ethnicity, or presence of other risk factors for cardiovascular disease. Conversely, many studies have reported that meaningful blood pressure reductions occur after reductions in alcohol drinking."

"To my knowledge," noted Kim, "there has been no detailed research that has analyzed the relationship between drinking and hypertension while considering individual responses to alcohol."

Kim and his colleagues collected data from the medical records of 1,763 men (288 non-drinkers, 527 flushing drinkers, 948 non-flushing drinkers) who had received a health check-up. The risk of hypertension related to the weekly drinking amount by non-flushers and flushers was analyzed and compared with the risk of hypertension among non-drinkers.

"Our results indicate that hypertension associated with drinking has a lower threshold value and higher risk in flushers than in non-flushers," said Kim. "After adjusting for age, body mass index, exercise status, and smoking status, the risk of hypertension was significantly increased when flushers consumed more than four drinks per week. In contrast, in non-flushers, the risk increased with consuming more than eight drinks per week".

Kim added that these results indicate that facial flushing after drinking may potentially serve as a marker of risk for hypertension associated with drinking. "Our research findings suggest that clinicians and researchers should, respectively, consider evaluating their patients flushing response to alcohol as well as drinking amount in a daily routine care, and researching hazard by drinking."

"Thus, if you or your patient have facial flushing, the risk of hypertension can increase even if you drink less than those who do not have facial flushing," said Cho. "[Under these circumstances, I would] recommend limiting your or their drinking amount even more to prevent the development of hypertension."