Sound Medicine -- March 8, 2003

Hosts Barbara Lewis and Dr. Ora Pescovitz talk to physicians & researchers about:

Promising research in Alzheimer disease

Malpractice insurance and the patient safety movement

The current state of nursing

Promising research in Alzheimer disease

Up until 25 years ago, the medical community knew very little about advanced dementia, now known as Alzheimer disease. But years of research are paying off, and today several approaches for preventing or slowing onset show promise. For an update, we meet again with Dr. Martin Farlow, professor of neurology, vice chair for research in the department of neurology, and director of the Alzheimer Disease Center at the Indiana University School of Medicine.

Dr. Farlow addresses a question many baby-boomers have about short-term memory lapses. He explains that early-onset Alzheimer disease is very rare, and that newfound forgetfulness might be attributed to "mild cognitive impairment," a condition which generally doesn't impair daily living. On the other hand, he says, for someone over 65, a sudden problem with short-term-memory could be significant. After 5 years, 50% of these individuals may develop dementia, usually Alzheimer disease. Dr. Farlow describes various diagnostic tests including the spinal tap and the PET scan, and why the appearance of amyloid placques in the brain is significant. The appearance of certain genes can confirm risks for the disease.

As for prevention, Farlow reports that studies on broad populations show that vascular risk factors -- the same risk factors for heart attack and stroke -- also play a role in Alzheimer disease. In fact, drugs to lower cholesterol seem to be protective, as is modest consumption of alcohol, according to Dutch and French studies. He details a current study looking at statin drugs for preventing or slowing onset of the disease and explains the role played by the amino acid, homosysteine, another vascular risk factor. He also talks about other protective measures, including vitamin E, which has also been shown to delay progression.

Resources:

Dr. Martin Farlow lectures on the topic of the aging brain at the next session of the IU School of Medicine's Mini Medical School, Tuesday, March 11.

The Alzheimer's Disease Education & Referral Center site includes a link to the statin drug trial Dr. Farlow mentions. Also, take a walking tour of the brain and read recent news about Alzheimer research.

Patients and caregivers can find excellent support at the Alzheimer's Association.

Still more information is available at MEDLINEplus.

Medical malpractice & the patient safety movement

In some states, the rising cost of malpractice insurance makes it too expensive to practice medicine. Doctors are striking, retiring early, or leaving the field altogether. An alternative to costly litigation may be the patient safety movement, an idea that, among other things, encourages healthcare workers, patients and families to work together to prevent patient injury. Professor Eleanor Kinney, JD, is the co-director of the Center for Law and Health at the IU School of Law in Indianapolis.

Ms. Kinney ties the current spike in malpractice insurance costs to an historical cycle in the insurance industry. Because investment income and policy underwriting are primary sources of revenue, when investment income is down as it is today, policy costs (underwriting) goes up. She describes how Indiana's cap on medical damages ($1,250,000) provides the stability insurance companies need and, surprisingly, provides the majority of plaintiffs with higher settlements. Limits bring concerns, but she warns against blaming insurance companies, who provide the only means we have to compensate victims.

Ms. Kinney talks about the patient safety movement, which emerged after a controversial Institute of Medicine report in 1999 stated that 44,000 (or more) deaths per year were caused by medical errors. The movement focuses on techniques for preventing accidents, not suing physicians, she says, so doctors aren't alienated from patients. Solutions to the compensation problem depend on how great a role the government plays. Should we have social insurance to protect us from medical injury, for example? Instead of worrying about the cyclical problem of insurance costs, Kinney recommends focusing on preventing healthcare injuries.

Resources:

Check the academic resources available at The Center for Law and Health at Indiana University, Indianapolis.

News stories abound concerning physicians and malpractice: doctors abandon expensive localities, worry about the reporting of errors, and stage walkouts.

Understand the tenets of patient the safety movement from the National Patient Safety Foundation. In 2000, the AMA endorsed the movement.

Read up on Indiana medical malpractice law at the McCullough, Campbell & Lane law firm Web site.

Read the instigating publication from the Institute of Medicine, To Err is Human: Building a Safer Healthcare System which initially addressed the problem of medical errors and patient safety. (National Academies Press, 2000)

The current state of nursing

In the year 2000, thirty states reported nursing shortages. As the number of registered nurses grows older and fewer students enroll in nursing school, it's estimated that by the year 2020, 44 states and the District of Columbia will have nursing shortages. This at a time when our aging population will have intensifying health care needs. Joining us to talk about the current state of nursing is Angela Barron McBride, MSN/PhD, distinguished professor and dean of the IU School of Nursing.

Dr. McBride believes the problem is not in the nursing profession per se, but is due to our aging society's intensified need for healthcare. We see the growing patient population reflected in nursing, she explains, because nurses comprise the majority of healthcare workers. She describes the working conditions that keep nurse morale high, such as room for advancement, education, and manageable patient-to-nurse ratios. Solutions to the problem, she says, are to treat hospital nurses well and to increase funding for nursing students and faculty.

Resources:

American Association of Colleges of Nursing has a wealth of information about the nursing shortage, including citations for recent studies and reports about the state of nursing.

The Indiana University School of Nursing Web site.

Is there a medical topic you'd like us to cover? Reach us by email: soundmed@iu.edu
or by phone:
(317) 274-4848.

The Indiana State Museum in White River State Park and Pfizer Inc. present a 5,000 square foot interactive exhibit exploring the brain and brain-based diseases.

With virtual reality, video games, optical illusions and interactive displays, visitors witness brain functions and disorders -- even try their hand at brain surgery with a simulated gamma knife - a laser-like tool used to deliver radiation to tumors.

The exhibit runs through May 4. For more information, check with the Indiana State Museum.

Aerobic exercise is associated with fighting off pounds and boosting cardiovascular health. But a recent study tried to determine if there is a relationship between exercise, aging and cognitive performance. What do you think they found?

A. That exercise makes people over 55 too tired to think;
B. that exercise improves brain function in aging people;
C. that there is no connection between aging, cognition and exercise.

Find out!

When conventional medical treatments fail, Mother Nature may have the answer. A certain insect has been shown to help treat wounds and ulcers that don't respond to antibiotics due to recurrent infection or underlying vascular problems. But it usually takes more than one of these slimy little creatures. It can take hundreds! What is this bug that leads to a cure?

Find out!

The largest national study involving cognitive training in the elderly found that training sessions improved memory, concentration and problem-solving skills of people over 65.

Called the Advanced Cognitive Training for Independent and Vital Elderly, or ACTIVE, the study included 2,802 elderly adults, 487 of them tested by researchers at the IU School of Medicine.

The clinical trial tested the effectiveness of memory, reasoning, and speed of processing training because these skills relate to daily tasks such as telephoning, shopping, housekeeping, transporting oneself, medication-use and personal finance management.

The memory-training group learned strategies for remembering word lists and sequences of items, text material, and main ideas and details of stories. The reasoning group focused on solving problems that follow patterns; and the speed of processing group concentrated on the ability to identify and locate visual information quickly.

The results? 26% of participants in memory training, 74% of participants in reasoning training, and 87% of participants in speed training demonstrated improvement on their respective cognitive ability.

"The improvement was still evident 2 years later," said Frederick W. Unverzagt, Ph.D., associate professor of psychiatry and co-leader of the study. "The results prove that certain thinking and reasoning skills can be improved in older adults."

The study was published in the November 13, 2002, issue of the Journal of the American Medical Association and was funded by the National Institute of Aging and the National Institute of Nursing Research.

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